Not Just One Reason Kids Don’t Drink Enough Water

By Jennifer Clopton

July 29, 2019 — Kids need to drink plenty of water all year long — and especially in the summer — to stay healthy, hydrated, and active. But a recent study finds that on any given day, a staggering 20% of the children in the U.S. don’t drink a drop of water from tap or bottled sources.

“That doesn’t mean they don’t drink water on other days. But I think 1 in 5 kids not drinking any water on any given day is a bit surprising,” says the study’s author, Asher Rosinger, PhD, director of the Water, Health and Nutrition Laboratory at Pennsylvania State University in State College.

“Kids should be drinking water every day because water is the healthiest,” he says.

But for many parents, getting their children to drink water is not only a challenge, it is an almost impossible task. This lack of water can have deep impacts on children. It contributes to obesity, affects their performance in school, and can lead to other unhealthy habits.

“Our 6-year-old daughter drinks water, but with our son, who will be 2 in August, he won’t even drink a cup a day,” says Sarah Ford. “He drinks milk and half-water, half-juice, and that’s it. I’m at a loss as to how to get more water in him.”
She’s not alone, and this isn’t a problem parents can shrug away or ignore. The CDC says water consumption is a key part of keeping healthy, staying hydrated, and managing a healthy weight, and doctors say there are many health risks when children don’t get enough.
“Mild dehydration leads to symptoms like fatigue, headache, and poor endurance. Longer term, chronic lack of fluids affects the kidneys, the liver, the brain, and can lead to constipation, which can be very problematic,” explains Linda Friehling, MD, a pediatrician and assistant professor of general pediatrics at West Virginia University in Morgantown.

Julie A., who asked that we not use her last name, has seen her daughter negatively affected from not drinking enough water. “My daughter would get off the bus in kindergarten with her head hung, exhausted, saying she had a headache, and then she would usually vomit,” the mom says. “I would give her a bottle of water or Gatorade, and she would fall asleep on the couch, wake up an hour later, and be fine. No fever or other symptoms. It took me a while to realize she was simply dehydrated.”

The latest research indicates this is a real challenge for many. Rosinger’s study, published in JAMA Pediatrics in April 2019, analyzed 8,400 children and young adults in the U.S., showing everything they ate and drank in a 24-hour period. That data not only found that 20% of kids aren’t drinking water in a given day. It also showed that when kids didn’t drink water, they were more likely to drink sugar-sweetened beverages.

“Those kids that did not drink any plain water consumed almost twice as many calories as kids that consumed water. That is when they would drink more than 10% of their daily calories from sugary drinks,” Rosinger says.

The Penn State research team found that when children did that, they added 100 calories a day to their diet — increasing their risk of becoming overweight or obese.

“The association indicates that when kids drink water on a given day, their caloric intake from sugary drinks is half that of kids who don’t drink water,” Rosinger says. “So the recommendation that is very important for parents and pediatricians is that water should be the first beverage offered. If kids are consuming water, they get hydration from that instead of less healthy sources.”

What’s a parent to do if their children struggle or downright refuse to drink water? WebMD takes a closer look at the problem — and solutions.

Why Don’t Kids Drink Water?
There isn’t just one reason that kids don’t drink water.

“It is definitely a more complex issue than you might think,” says Erica L. Kenney, ScD, an assistant professor at the Harvard T. H. Chan School of Public Health.

Some don’t like how it tastes, and others don’t know how much their bodies need it. The problem is made worse in some places by water distrust. “It should be easy to go get a drink of water when you want one because tap water should be readily available and clean, but that’s not always the case,” she says.

A study published by Kenney’s research partners in 2019 that looked at statewide initiatives between 2016 and 2018 in 24 states and the District of Columbia found that many students attend public schools in states where not all taps are tested for lead. Kenney was also lead author of a 2017 study that found that racial, ethnic, and socioeconomic disparities in water consumption are related to differences in tap water. Kenney pointed to a 2014 study that found black and Hispanic adults were more likely to say their tap water was not safe to drink, leading them to drink less of it.

“I think something similar might be going on with children,” she says. “Kids who drank more tap water had a lower risk of being poorly hydrated, and it makes sense. If you do live in a place where your tap water is safe, abundant, and cheap, it’s the quickest and easiest route to hydration.”
Melissa Mays understands the effect of water distrust on children’s drinking habits. The mother of three and activist from Flint, MI, filed a Safe Drinking Water Act lawsuit against her state government, forcing it to replace water service lines polluted by lead as a result of the city’s water crisis.

“There is a serious distrust here of water,” she says. “It is hard, especially for younger kids. This is all they know — that water is bad. You try not to teach them water is bad, but you have to teach them to be safe.”

Mays says when water distrust is an issue, finances sometimes rule your decisions. “A lot of parents will get a 2-liter of soda because it’s easier to come by and cheaper than a case of water,” she explains. “I understand that for many families, it is a hard choice. There are a lot of hard decisions.”

Access to water at schools, camps, daycares, and preschools is another big challenge. The CDC stresses the need for students to drink water at school and has materials aimed at increasing access to it. But research published in 2016 in the Journal of Adolescent Health looked at access in 59 middle and high schools in Massachusetts. It found many schools weren’t meeting state or federal policies for minimum drinking water access for students, and in some cases, school staff may not have been accurately reporting water access.

“This is something that I think adults forget about,” Kenney says. “When you become an adult and you want a drink of water, you can generally get it. As a kid though, you are in a captive school environment, and it really depends on whether or not the school makes it easy to get the water. In some cases, there are a lot of hoops kids can have to jump through, and you can easily have a scenario where kids are going through the day and can’t get enough water to satisfy their thirst.”

Parents report many problems in school settings. Some say there are logistical and time challenges for students when it comes to getting to the bathroom. Others say water isn’t offered or encouraged in the hopes of limiting diaper changes in preschool and bathroom trips, or other distractions in older grades.

“I send my kids to school with water bottles, but they aren’t allowed to just leave them on their desk or go grab whenever. Super frustrating,” Jenn Pullen says.

“When my kids started full-time preschool last year, they did not know how to use the water fountain. They just could not get the knack of it and didn’t know how to request water from a teacher. Refillable water bottles were not allowed due to possible contamination with kids swapping bottles. My kids were coming back with stomachaches and constipation,” Rosy Estrada says.

Estrada says she’s since worked with the administration at her child’s school to raise awareness of the importance of drinking water, especially on hot days, and there are now systems in place to ensure children drink enough water throughout the day.

Understanding the Problem
So how much water should kids drink? An old adage says we should all be drinking 8 glasses a day, but in reality, guidelines vary. Some scientific publications say thirst can be your guide, but the Academy of Nutrition & Dietetics says that’s not a good idea with children.
“Children that complain often of thirst may not be drinking enough, because if you experience thirst, you may already be dehydrated,” says Kristi King, a registered dietitian nutritionist and a senior dietitian at Texas Children’s Hospital in Houston. “A great indicator is making sure their urine is pale yellow and not dark yellow. You may also be able to tell by their mood. A well-hydrated child typically is energized, where if they are dehydrated, they may be sleepy, fussy, or more moody than normal.”

CHOC Children’s, a California hospital, recommends kids drink one 8-ounce cup of water a day for every year of age. For example, 2-year-olds should drink 2 cups; 8-year-olds should have 8. Kids ages 9 and older should also have 8 cups.

The Academy of Nutrition & Dietetics says parents also need to pay close attention to how much water their children drink before, during, and after physical activity, especially in hot weather. The nutrition group recommends half a cup to 2 cups of water every 15 to 20 minutes during exercise.

Keeping children properly hydrated has long been a challenge. Kenney has been doing research in this area for several years. When she and her team looked at the hydration status of children and teens in the U.S. from 2009 to 2012 for research published in the American Journal of Public Health in 2015, about half (54.5%) of more than 4,000 participants between the ages of 6 and 19 weren’t hydrated enough.

Solutions
When it comes to solutions, advocates say you have to approach a complex problem like this in many different ways. There are organizations and advocates like the National Drinking Water Alliance working to make sure all children have access to clean and safe drinking water.

“I don’t think we have enough concrete solutions,” Kenney says. “I think there needs to be more investment in improving infrastructure for kids and families. There are a lot of homes that have outdated plumbing. We need to improve access. There also needs to be an effort to help kids trust tap water and think of it as something they drink with meals.”

Friehling says there is a role for the nation’s pediatricians to play in solving this problem, too. “From a pediatric standpoint, there is much that can be done to encourage children to drink water. I start discussing it at a very early age, between 4 and 6 months — at the same time that I discuss starting solid foods,” she explains. “I recommend that parents offer plain water, in a bottle or cup, with every meal, and drink water themselves to provide a model. Babies that have been drinking water since before they can remember are less likely to reject it later on.Experts say parents can also help boost how much water their children drink. Here are several ways to try to get ahead of the problem.

Make it a habit. The best way to get your kids drinking more water is to make it a family practice, from as early an age as possible. “I think that good habits can start in infancy,” Friehling says. “Parents can make water drinking a fun part of mealtime and break time, certainly a part of family activities and an important part of physical conditioning.”

Build it into the entire day. Have a cup of water by their bed so children can drink it before they fall asleep and when they wake up. Have a cup waiting for them in the morning when they come into the kitchen and at every meal, and make sure everyone has a cup or bottle all day around the house and when you head out.

Make water the only option. If water is the only drink available, chances are greater that kids will drink it, so remove sugary drinks from your home and see if it makes a difference.
Get water from food. King says it is important to remember that some hydration can come from fruits and vegetables. “Cucumbers, watermelon, celery, lettuce, tomatoes, and strawberries are good examples,” she says.

Get creative. Play around with how you serve water, and see if that makes a difference. Try adding fruit or fruit slices like strawberries and mint, cucumbers or berries. Add a splash of fruit juice, or make slushies with water, ice, and fruit, which can make it more fun, especially for younger children.

Laura Fuentes, a mother of three who owns a health and wellness company, has written numerous blog posts on how to get kids to drink more water. She recommends serving water really cold, in a stainless steel cup if possible and with a straw, which she says children and teens enjoy. She also likes to use frozen fruit instead of ice cubes for extra flavor. She says you can buy fresh fruit and freeze it or buy it frozen for an easier, more economical option.

“I have an easy-to-open Tupperware in the freezer with chunks of pineapple and peaches, apples, berries. Not a big frozen block of fruit, but small bites the kids can reach and grab and put in. Everyone takes what they want, and instead of an ice cube, they use that,” Fuentes says.

Start small. If your child will drink only juice, cut it down by mixing it with water. Fuentes says you can also make ice cubes out of juice and drop those in a cup of water instead of serving a whole cup of juice.

Let technology help. There are apps designed to help you remember to drink throughout the day. Smartwatches and personal activity trackers can help by offering reminders to drink. You can set reminders to go off on phones or voice-based virtual assistants like Amazon’s Alexa throughout the day, too.

Look at your own habits. Last but not least, parents and caregivers should pay attention to what they’re drinking, especially in front of the kids.

“I typically tell parents, you set the example,” Fuentes says. “If you are buying flavors for your drinks or always drinking sports drinks, you may have a problem with water too, and your child is modeling that. My kids see me walk everywhere with a cup of water, so for them, drinking water throughout the day is the norm. Children will pick up the behaviors we parents set, so modeling what we wish them to do is best.”

A common skin bacterium put children with severe eczema at higher risk of food allergy

In a new study published today in the Journal of Allergy and Clinical Immunology, scientists from King’s College London have found that young children with severe eczema infected with Staphylococcus aureus (SA) bacterium, are at a higher risk of developing a food allergy.

Staphylococcus aureus (SA) is a bacterium that can be found in the nose and the skin of healthy individuals.

However, SA is more common in sufferers of eczema, especially severe eczema.

When someone has an allergy, their immune system mistakes a harmless substance (such as eggs or peanuts) as an intruder and overreacts in response. Their body produces a molecule or else antibody known as Immunoglobin E (IgE).

When IgE encounters the intruder on the skin or within the body it releases chemicals, such as histamine that cause the allergic reaction.

The team of scientists found that young children with severe eczema who are infected with SA produce more IgE against peanut, egg and milk indicating they have a food allergy to each of these.

These children were also more likely to have their egg allergy persist at the age of 5 or 6 years in comparison to children that did not have SA present.

Lead author Dr Olympia Tsilochristou from King’s College London said: “This is significant as most children with egg allergy usually outgrow this at an earlier age.

“We do not know yet the exact mechanisms that lead from eczema to food allergy however our results suggest that the bacteria Staphylococcus aureus could be an important factor contributing to this outcome.”

These results build on the earlier ones from the Learning Early About Peanut Allergy (LEAP) study which demonstrated that infants who were at a high-risk of developing peanut allergy but consumed a peanut?containing snack throughout the study were prevented from later developing a peanut allergy.

In this current study, scientists found that children with SA on their skin and/or nose were more likely to develop peanut allergy despite them being fed with peanut from early ages as part of the LEAP study protocol.

Co-author Professor du Toit said: “These findings indicate that SA may have reduced the chance of young infants gaining tolerance to peanut, even if peanut was eaten in early childhood.”

Professor Lack, who conceived and led the LEAP study, said that “SA could be considered as an additional risk factor for the development of food allergy.”

Diet Sodas May Not Help Kids Cut Calories

By Amy Norton
HealthDay Reporter

THURSDAY, May 2, 2019 (HealthDay News) — Kids who favor diet sodas over sugary ones don’t consume fewer calories over the course of a day, a new study finds.

And they average 200 more calories daily than their peers who choose water, according to the results of a survey of over 7,000 U.S. children and teens.

Experts said the findings support what’s already recommended by groups like the American Heart Association: Ideally, kids should be drinking water instead of sugar-laden beverages — or artificially sweetened ones.

“Water is best, and we should be promoting it over low-calorie sweetened beverages,” said lead researcher Allison Sylvetsky, an assistant professor at George Washington University’s School of Public Health, in Washington, D.C.

Unfortunately, a survey published just last week suggests this could be an uphill battle. On any given day, one in five American youngsters don’t drink any water at all, the Penn State researchers found.

That said, the latest results — published May 2 in the journal Pediatric Obesity — do not prove that reduced-calorie drinks are bad.

The findings come from a one-time survey, Sylvetsky said, so there are unanswered questions. For example, kids drinking low-cal beverages might have switched from sugary varieties, and were actually consuming fewer calories than they used to. In that case, the beverages would be a positive influence.

Julie Stefanski, a registered dietitian who was not involved in the study, made another point.

“It’s possible that the children who are drinking low-calorie beverages are already individuals who prefer a larger quantity of food, and parents were trying to make changes to reduce their overall calorie intake,” said Stefanski, who is a spokesperson for the Academy of Nutrition and Dietetics.

However, she noted, there is evidence that beverages can sway food choices.

“In some studies in adults, it’s been found that artificial sweeteners caused a craving for more sweet foods,” Stefanski said. “This isn’t an automatic association, but if your taste buds are wired to always expect a sweet sensation, plain water might help to decrease that craving for sweets.”

In the survey, the teens were asked to recall what they’d eaten and had to drink the previous day.

Kids who’d had at least 4 ounces of water, and little to no sugary or artificially sweetened drinks, were considered water consumers.

On average, those kids had the lowest calorie intake for the day, and consumed the least amount of sugar and added sugar. In comparison, their peers who had low-calorie sweet drinks — at least 4 ounces for the day — consumed 200 more calories, on average.

That put them on par with kids who’d had sugar-sweetened drinks. (Any beverage dubbed sugar-free, diet, light, low-calorie or no-calorie was categorized as a low-calorie sweetened drink.)

On the other hand, kids who drank diet beverages were doing better in some ways, the study found. They consumed less daily sugar for the day — including added sugars — than those who drank sugar-sweetened beverages.

So the fact that their calorie intake was the same is not necessarily a bad thing, according to Sylvetsky — if those calories came from nutritious foods.

“We weren’t able to look at overall diet quality,” she said. “We’d like to do that in a future study.”

The Calorie Control Council, which represents the low-calorie food industry, said the study has too many unknowns to draw conclusions.

“These results do not challenge the existing evidence that [low-calorie sweetened beverages] are one of many helpful tools in weight management and overall calorie reduction,” the group said in a statement.

The study did not prove a cause-and-effect link, other diet and lifestyle factors weren’t measured, and self-reported results can be biased, the council explained.

Stefanski said it’s always important to consider a child’s overall diet when deciding whether beverage “swaps” are needed.

But, she stressed, “parents should definitely steer clear of foods or drinks with a lot of added sugar.”

If your child turns her nose up at water, Stefanski said, there are ways to “jazz it up” — like adding lemon, or slices of strawberry or cucumber.

“Younger kids can help to cut up the fruit or vegetables and create their own fancy color combos,” she suggested.

Inactive Lifestyle Begins as Early as Age 7: Study

By Robert Preidt

HealthDay Reporter

MONDAY, April 15, 2019 (HealthDay News) — Kids can start becoming couch potatoes as early as age 7, a new study reveals.

A review of 27 studies published between 2004 and 2018 in different countries found high rates of decreasing physical activity among children and teens.

While many teens quit playing sports, overall activity starts to decline during early school years among kids who were once active, said study author Irinja Lounassalo. She’s a doctoral student in sport and health sciences at the University of Jyvaskyla in Finland.

So, “being physically active in childhood and adolescence may be of high importance since it can postpone the time of becoming inactive later on,” Lounassalo said.

While the percentage of inactive people increases with age, certain groups actually increase their activity levels in adulthood and old age.

“In the future, special attention should be paid to these individuals who increase their physical activity, because it is important to understand how potential lifelong inactivity could be turned into activity,” Lounassalo said.

Among children and teens, parental support for an active lifestyle helped increase activity. For teens, less time in front of the television was associated with regular activity.

For adults, quitting smoking brought increased activity. And among older adults, regular activity was associated with a lack of chronic illnesses, a lower death rate and good physical functioning.

“Since physical activity behavior stabilizes with age and inactivity is more persistent behavior than activity, interventions should be targeted at children early in life before their habits become stable,” Lounassalo said.

Parents can help by supporting physical activity in the schools and extracurricular sports clubs for kids, she said.

“Building publicly available sport facilities and safe bicycling and walkways might help in increasing opportunities for being active regardless of age, nationality, gender or educational level,” Lounassalo said.

The study was recently published in the journal BMC Public Health.

After-School Programs Can Ease Kids’ ADHD

By Sonya Collins

Kids with ADHD often struggle just to stay on task or behave in school. So the idea of taking on more activities after school might feel like you’re asking for trouble. But new research shows that after-school programs could relieve some troubles for kids with this condition.

“These activities have potential benefits for kids with ADHD and should be part of the holistic strategies that we offer,” says Nicole Brown, MD, a pediatrician at Children’s Hospital at Montefiore in New York City. Brown co-led a study on this subject with Yonit Lax, MD, a pediatrician at Maimonides Medical Center in New York City.

Brown and Lax pulled data from the 2016 National Survey on Children’s Health, a questionnaire for parents of children ages 5 to 17. Parents of 4,185 children reported that their child had ADHD and answered questions about how severe it was. Kids who did after-school activities were more likely to have only mild — versus moderate to severe — ADHD symptoms. These children were less likely than others who have ADHD to have missed more than 7 days of school in the last 12 months.

The researchers can’t say for sure whether after-school programs ease symptoms or whether kids with already mild symptoms are more likely to enroll in such programs. But they see clear benefits to enrollment. “When children are in after-school activities,” says Lax, “they’re less likely to be sitting and watching TV for several hours a day and more likely to be engaging both their mind and their body.” That results in better mental and physical health for everyone.

After-school programs can also build friendships and confidence. These perks could ease the school-related anxiety and stress that often come with ADHD, “which is very strongly linked with refusal to go to school,” says Brown.

Treating ADHD isn’t just about prescription medications and behavioral therapy. “We need to think about multimodal strategies that can also help with symptoms, and after-school programs are pretty low-cost and associated with great outcomes,” she says.
Four Tips

After-school activities are just one lifestyle change that could help improve symptoms for a child with ADHD. Brown and Lax offer more tips:

  • Limit screen time: Keep the use of tablets, computers, phones, and TVs to less than 2 hours per day.
  • Go outside: Don’t let your child spend all their downtime in the same indoor space. “Get them out into different settings, such as parks or the backyard, to avoid stagnant time in the same environment for extended periods,” says Lax.
  • Get fit: Help your child get as close to national physical activity guidelines as possible. The CDC recommends 60 minutes of mostly aerobic activity per day.
  • Stick to a schedule: “Structure is very important, no matter what the activity, so try to have your child do the same things at the same time every day,” says Brown.

More Sleepless Nights for Toddlers With Autism

by Elizabeth Hlavinka, Staff Writer, MedPage Today

Children with autism spectrum disorder (ASD) were more than twice as likely to have problems sleeping than those without neurodevelopmental disorders, according to a community-based case-control study.

In a sample of nearly 2,000 children ages 2 to 5 years, those with ASD had significantly higher odds of sleep troubles — such as night waking and bedtime resistance — than kids in the general population (adjusted OR 2.37, 95% CI 1.75-3.22), reported Ann Reynolds, MD, of the University of Colorado School of Medicine, and colleagues.

Children with ASD were also more than twice as likely as children with other developmental delays and disorders to have problems sleeping (adjusted OR 2.12, 95% CI 1.57-2.87), they wrote in Pediatrics.

“For all children, lack of sleep can cause increased hyperactivity, inattention, and irritability, but for kids with ASD, poor sleep has been associated with more repetitive behaviors and self injury and so that has an impact on the quality of life for the child,” Reynolds told MedPage Today in an interview in which a media relations representative was present.

Although this study did not examine the cause of this increased risk for sleep disturbances, it’s possible that multiple contributing factors could predispose children with ASD to sleep problems, including obstructive sleep apnea, attention-deficit hyperactivity disorder (ADHD), or behavioral disturbances that interfere with sleep, Reynolds and colleagues noted.

Catherine Lord, PhD, of the David Geffen School of Medicine at UCLA, who wrote an accompanying commentary, said that although the same strategies and medications that improve childhood sleep are typically helpful in children with ASD, certain treatments like sleep training can take longer to change autistic children’s sleep patterns.

“Although medication used for sleep have been shown to be safe and have similar effects in kids with autism, there’s always variation and there will be more variation in kids with autism than in other populations,” Lord told MedPage Today.

Lord stressed the importance of pediatricians and healthcare providers working with parents of children with ASD to develop plans for improving sleep disturbances, particularly because a lack of sleep could further exacerbate their condition.

Reynolds and her team examined data from the Study to Explore Early Development (SEED) study, noting that all children included in this analysis were born from September 2003 to August 2006, completed a developmental evaluation, and had a caregiver interview and a completed Children’s Sleep Habits Questionnaire. Three groups of children were included in the study — those with a research classification of ASD, children with other developmental delays and disorders, and children from the general population.

Notably, a higher score on the 33-item Children’s Sleep Habits Questionnaire indicates more sleep issues, but researchers used two cut-offs for this study. While a total score of 41 differentiates a clinical sample of children with sleep problems, the authors said, they also used a total score cutoff of 48 for a more conservative estimate.

Data was adjusted for mothers’ education, race or ethnicity, and family income, as well as children’s sex, enrollment age, cognitive scores, and prior genetic or neurological diagnoses.

Of the 1,987 children included, those with ASD were more likely to be boys and have lower cognitive scores, and were less likely to have high-income families and non-Hispanic white mothers with a college degree.

Using the standard total score cutoff of 41, the results were “attenuated, but similar” as the more conservative total score cutoff. There were higher odds of sleep problems among children with ASD versus the children in the general population (adjusted OR 1.75, 95% CI 1.27-2.42) and versus children with other developmental delays and disorders (adjusted OR 1.45, 95% CI 1.05-2.00).

There was no difference in sleep patterns observed between children with ASD and children with other developmental delays and disorders in addition to ASD at either cutoff, Reynolds and colleagues noted.

Using the more conservative sleep score cut-off, 47% of parents reported sleep problems in their children with ASD compared to 29% of children with other developmental delays and disorders, and 25% of children in the general population, the authors noted.

Limitations to the data mainly involve limits to the Children’s Sleep Habits Questionnaire. Because it is a parent-completed questionnaire, there is no objective measure of sleep and no clinical assessment of sleep problems, the authors said, meaning “determining the exact prevalence of sleep problems” on the basis of the questionnaire “may be problematic.” In addition, the questionnaire was not designed to make a sleep order diagnosis or address the severity of sleep problems, nor has it been validated for use in young children (ages <4 ) or children with ASD as well, they noted.

Pediatric leukemia ‘super drug’ could be developed in the coming years

Northwestern Medicine scientists have discovered two successful therapies that slowed the progression of pediatric leukemia in mice, according to three studies published over the last two years in the journal Cell, and the final paper published Dec. 20 in Genes & Development.

When a key protein responsible for leukemia, MLL, is stabilized, it slows the progression of the leukemia, the most recent study found. The next step will be to combine the treatments from the past two years of research into a pediatric leukemia “super drug” to test on humans in a clinical trial.

The survival rate is only 30 percent for children diagnosed with MLL-translocation leukemia, a cancer that affects the blood and bone marrow. Patients with leukemia have a very low percentage of red blood cells, making them anemic, and have approximately 80 times more white blood cells than people without cancer.

“These white blood cells infiltrate many of the tissues and organs of the affected individuals and is a major cause of death in leukemia patients,” said senior author Ali Shilatifard, the Robert Francis Furchgott Professor of Biochemistry and Molecular Genetics and Pediatrics, the chairman of biochemistry and molecular genetics and the director of Northwestern’s Simpson Querrey Center for Epigenetics. “This is a monster cancer that we’ve been dealing with for many years in children.”

There are several types of leukemia. This research focused on the two most common found in infants through teenagers: acute myeloid leukemia (AML) and acute lymphocytic leukemia (ALL).

For the past 25 years, Shilatifard’s laboratory has been studying the molecular function of MLL within its complex known as COMPASS (Complex Proteins Associated with Set1). Most recently, it was demonstrated that COMPASS components are one of the most frequently identified mutations in cancer. The next step of this work will be to bring the drug to a clinical trial setting, which Shilatifard said he hopes will happen in the next three to five years.

“I’ve been working on this translocation for more than two decades, and we’re finally at the point where in five to 10 years, we can get a drug in kids that can be effective,” Shilatifard said. “If we can bring that survival rate up to 85 percent, that’s a major accomplishment.”

Earlier work from Shilatifard’s laboratory published in Cell in 2018 identified compounds that could slow cancer growth by interrupting a gene transcription process known as “Super Elongation Complex” (SEC). It was the first compound in its class to do this.

This MLL stabilization process discovered in the most recent paper could potentially work in cancers with solid tumors, such as breast or prostate cancer, said first author Zibo Zhao, a postdoctoral research fellow in Shilatifard’s lab.

“This opens up a new therapeutic approach not only for leukemia, which is so important for the many children who are diagnosed with this terrible cancer, but also for other types of cancers that plague the population,” Zhao said.

“The publication of these four papers and the possibility of a future human clinical trial could not have happened if it weren’t for the cross-disciplinary collaboration at Northwestern,” Shilatifard said.

Longer breastfeeding tied to lower risk of liver disease

(Reuters Health) – – Mothers who breastfeed for six months or more may have less fat in their livers and a lower risk of liver disease, a U.S. study suggests.

Breastfeeding has long been tied to health benefits for women, including lower risks for heart disease, diabetes and certain cancers. The current study focused on whether nursing might also be tied to a reduced risk of non-alcoholic fatty liver disease (NAFDL), which is usually linked with obesity and certain eating habits.

Researchers followed 844 women for 25 years after they gave birth. Overall, 32 percent reported nursing for up to a month, 25 percent said they breastfed for one to six months and 43 percent reported nursing for longer.

By the end of the study, the women were 49 years old on average. Fifty-four, or about 6 percent, had developed NAFLD. Women who breastfed babies for at least six months were 52 percent less likely to develop liver disease than mothers who nursed for less than one month, researchers report in the Journal of Hepatology.

“This new analysis contributes to the growing body of evidence showing that breastfeeding a child also offers significant health benefits to the mother,” said study leader Dr. Veeral Ajmera of the University of California, San Diego.

“Future studies will be needed to assess if breastfeeding can decrease the severity in NAFLD in women at high risk,” Ajmera said by email.

The women in the analysis were part of the larger Coronary Artery Risk Development in Young Adults study. They were assessed when they joined the study in 1985 and 1986, surveyed about breastfeeding with any subsequent births, and then examined for fat in their liver at the end of the study using computed tomography.

The study can’t prove whether or how breastfeeding might stave off NAFLD. It’s possible that women who breastfed for longer periods had healthier lifestyles that contributed to their lower risk of liver disease, the study authors note.

In particular, women who got more exercise appeared to nurse for longer periods, said Yukiko Washio of RTI International and the University of Delaware, College of Health Sciences.

“Recent evidence shows that physical activity helps improve fatty liver disease,” Washio, who wasn’t involved in the study, said by email.

Women are advised to breastfeed babies exclusively for at least six months, and it’s also unclear how much protection women might get if they achieved a total of six months of nursing after breastfeeding multiple children for shorter periods, said Dr. Lori Feldman-Winter of the Cooper Medical School of Rowan University in Camden, New Jersey.

“Maintaining lactation through at least the first six months is physiologically how the mother’s body reprograms metabolism and prevents chronic diseases,” Feldman-Winter, who wasn’t involved in the study, said by email. “While obesity and diet also modify this risk, the effect of lactation seems to be greatest and offers the best potential to decrease the prevalence of fatty liver disease.”

More research is needed to confirm the potential for breastfeeding to help prevent liver disease, said Jennifer Yourkavitch of the University of North Carolina, Greensboro.

“But there is a mountain of evidence supporting breastfeeding as beneficial to women’s and children’s health and it should be promoted and supported,” Yourkavitch, who wasn’t involved in the study, said by email. “These findings give us another reason to do that.”

Adolescent brain development impacts mental health, substance use

Advances in understanding adolescent brain development may aid future treatments of mental illness and alcohol and substance use disorders. The findings were presented at Neuroscience 2018, the annual meeting of the Society for Neuroscience and the world’s largest source of emerging news about brain science and health.

Adolescence is a developmental period characterized by outsized risk-taking and reward-seeking behavior, including first alcohol and drug exposures, as well as the first emergence of symptoms such as depression and anxiety. And yet, much of the research on brain functions related to these conditions is performed on adults. As we gain a better understanding of adolescence-specific neurological causes of these conditions and behaviors, we increase the potential for early treatments and for interventions even before serious symptoms emerge.

Today’s new findings show that:

A variant in an opioid receptor gene in the brain reduces the natural reward response in young adolescents before they have started using alcohol or other substances, indicating carriers of this genetic variant may be more susceptible to addiction (John W. VanMeter, abstract 281.06).
Childhood trauma impacts the development of critical brain networks during adolescence, elevating the risk for alcohol abuse (Sarita Silveira, PhD, abstract 645.04).
The strength of connections between the brain’s reward and anti-reward systems corresponds to the severity of several important psychiatric symptoms in adolescents, including anxiety and depression (Benjamin Ely, abstract 320.11).
“The neuroscience advances presented today help expand our understanding of the connections between adolescent brain development and mental health issues, including alcohol and substance use,” said press conference moderator Jay Giedd, MD, of the University of California, San Diego, who conducts research on the biological basis of cognition, emotion, and behavior with an emphasis on the teen years. “These advances provide potential new methods to identify young people who have biological susceptibility to addiction and mental illnesses, so we can implement intervention strategies even before problems emerge.”

This research was supported by national funding agencies including the National Institute of Mental Health, the National Institute on Alcohol Abuse and Alcoholism, and several U.S. universities. Find out more about adolescent brain development on BrainFacts.org.

Type 1 Diabetes in Children and Adolescents: A Position Statement by the American Diabetes Association

Introduction

Since the American Diabetes Association (ADA) published the Position Statement “Care of Children and Adolescents With Type 1 Diabetes” (1) in 2005, innovations have transformed the landscape and management of type 1 diabetes: novel autoantibodies, sophisticated devices for delivering insulin and measuring glucose, and diabetes registries. However, strategies to prevent or delay type 1 diabetes in youth remain elusive, and meanwhile the number of affected children continues to grow. The SEARCH for Diabetes in Youth (SEARCH) study found a 21.1% rise in the prevalence of type 1 diabetes from 2001 to 2009 in youth aged 0 through 19 years, with increases observed in all sex, age, and race/ethnic subgroups except those with the lowest prevalence (0–4 years old and American Indians) (2). Incidence has also increased; the adjusted risk for developing type 1 diabetes increased 1.4% annually between 2002 and 2012, with significant increases in all age-groups except those 0–4 years old (3).

One theme of this Position Statement is that “children are not little adults”—pediatric-onset diabetes is different from adult diabetes because of its distinct epidemiology, pathophysiology, developmental considerations, and response to therapy (4,5). Diabetes management for children must not be extrapolated from adult diabetes care. In caring for children and adolescents, clinicians need to be mindful of the child’s evolving developmental stages and must adapt care to the child’s needs and circumstances. Timely anticipatory guidance and care coordination will enable a seamless child/adolescent/young adult transition for both the developing patient and his or her family.

Although the ADA stopped developing new position statements in 2018 (6), this Position Statement was developed under the 2017 criteria (7) and provides recommendations for current standards of care for youth (children and adolescents) with type 1 diabetes. It is not intended to be an exhaustive compendium on all aspects of disease management, nor does it discuss type 2 diabetes in youth, which is the subject of an ADA Position Statement currently under review. While adult clinical trials produce robust evidence that has advanced care and improved outcomes (8), pediatric clinical trials remain scarce. Therefore, the majority of pediatric recommendations are not based on large, randomized clinical trials (evidence level A) but rely on supportive evidence from cohort/registry studies (B or C) or expert consensus/clinical experience (E) (Table 1). Please refer to the ADA’s “Standards of Medical Care in Diabetes” for updates to these recommendations (professional.diabetes.org/SOC).

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