Kids

Researchers from Northwestern Medicine discovered that a novel medicine was extremely successful in lowering the signs and symptoms of moderate-to-severe eczema in a new multi-site international phase III research. This is the first trial to use a biologic therapy (monoclonal antibody) instead of immune-suppressing drugs to treat moderate-to-severe eczema in babies and children aged 6 months to 5 years.

After a 16-week treatment of dupilumab, a medicine that targets a critical immune mechanism in allergens, more than half of the children saw at least a 75% decrease in eczema symptoms, substantial reductions in itching, and better sleep. This is the first large-scale, randomised, placebo-controlled trial of a monoclonal antibody in children as young as six months old for any skin disease, including eczema. The study, which included 31 sites in Europe and North America, will be published in The Lancet on September 15.

According to the lead study author Dr Amy Paller, chair of dermatology at Northwestern University Feinberg School of Medicine and an attending physician at Northwestern Memorial Hospital, “preschoolers who are constantly scratching, awake multiple times a night with their parents, irritable and markedly limited in their ability to do what other children their age can do improved to the extent that they sleep through the night, change their personalities, and have a normal life — as babies and children should.”

Eczema, also known as atopic dermatitis, is a chronic inflammatory skin condition that causes itching, red, dry skin, and frequent weeping. It can have a significant impact on the life of both the patient and their family.

More than one-fifth of all children under the age of six are thought to have eczema and 85 to 90 per cent of those who have the condition as a whole experience its commencement in the first five years of life.

The crippling itch of the kids causes sleep disruption, poor neurocognitive growth, and, on average, a full night of lost sleep every week.

Infants and young children who suffer greatly from this disease will live far better lives if they can take this medication, according to Paller. “There is a lot more to atopic dermatitis or eczema than just scratchy skin. It is a fatal condition. Severe eczema has a quality of life that rivals many illnesses that are potentially fatal, not just for the child who has it but also for the parents.”

This study led to the availability of this drug for infants and preschoolers as young as 6 months. According to Paller, it has “an amazing safety profile” and doesn’t even need any laboratory tests before the prescription is started.

The remaining one-third or more of young children with eczema have the moderate-to-severe illness and require more active therapy, even if half to two-thirds of them have mild symptoms that can be managed with steroid ointment and moisturisers.

“Up to now, all we have had to treat more severe eczema is immune-suppressing medications, such as oral steroids, which we try to avoid in children because they are associated with so many side effects and thus are not a preferred treatment for a chronic skin disease,” Paller said. “The potential long-term impact on the development of the immune system in young children is also of concern with these immunosuppressants.”

The first “biologic” treatment to treat eczema in a targeted manner or a focused attack on only what researchers have discovered is causing the disease’s skin symptoms, has recently been accessible and is called dupilumab. This medication was determined to be efficient and secure in tests involving adults, adolescents, and other school-aged children.

However, Paller noted that children under 5 were not assessed for safety and could not receive this drug.

The child receives a monthly shot of the drug from a parent or medical professional.

“The effect for most of these younger children is dramatic and at least as good as we’ve seen with the risky immunosuppressant medications,” Paller said.

Potential added benefit by treating associated allergies

Although it has been proven to be helpful in treating asthma, gastrointestinal allergy symptoms, and other allergy-related issues, this medicine is not currently licenced for use in newborns and young children.

In fact, more than 80% of children in this experiment had already developed at least one allergic disease, such as asthma or a food allergy, by the time the dupilumab was started. 66% of children in this trial had eczema during the first six months of life.

“By treating more aggressively to calm the immune system activation in these young children with early, severe eczema, we may also reduce the risk of their developing a range of allergic problems, changing their life beyond improving eczema,” Paller said. “These associated allergic issues most often begin after eczema starts.”

Every four weeks for 16 weeks, children were randomly assigned to receive either a placebo injection or the weight-based dose of dupilumab. The only kids who could enrol were those whose topical treatments weren’t working well on them, and even then, their severity level had to be high.

Paller noted that as a result of the study, researchers and medical experts would be able to better understand the links between eczema and a variety of allergy issues, as well as decide whether to utilise this treatment for other disorders that afflict these very young children.

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Researchers at the Del Monte Institute for Neuroscience discovered that children who have a traumatic brain injury (TBI), even if it is minor, have more emotional and behavioural issues than children who do not.

“These hits to the head are hard to study because much of it depends on recall of an injury since the impacts do not all require a visit to a doctor,” said Daniel Lopez, a PhD candidate in the Epidemiology program and first author of the study published in NeuroImage. Daniel added, “But being able to analyze longitudinal data from a large cohort and ask important questions as this gives us valuable information into how a TBI, even a mild one, impacts a developing brain.”

Researchers analysed MRI and behavioural data from hundreds of youngsters in the Adolescent Brain Cognitive Development (ABCD) Study. They discovered that children with a moderate TBI had a 15% greater chance of developing an emotional or behavioural issue.

The danger was greatest in youngsters under the age of 10. Researchers discovered that children who had a major blow to the head but did not fulfil diagnostic criteria for a moderate TBI were at a higher risk of developing these behavioural and emotional issues.

The University of Rochester Medical Center is one of 21 study sites for the National Institutes of Health ABCD Study.

Since 2017, 340 children from the greater Rochester area have been part of the 10-year study that is following 11,750 children through early adulthood. It looks at how biological development, behaviours, and experiences impact brain maturation and other aspects of their lives, including academic achievement, social development, and overall health.

Researchers hope future ABCD Study data will better reveal the impact these head hits have on mental health and psychiatric problems.

“We know some of the brain regions associated with increased risk of mental health problems are impacted during a TBI,” said Ed Freedman, Ph.D., associate professor of Neuroscience and co-principal investigator of the ABCD Study at the University of Rochester. Freedman also led this study. “With more time and data, we hope to gain a better understanding of the long-term impact of even a mild TBI.”

A international research team led by UCL has created an artificial intelligence (AI) algorithm capable of detecting minute brain irregularities that cause epileptic seizures.

The Multicentre Epilepsy Lesion Detection project (MELD) algorithm was created utilising over 1,000 patient MRI images from 22 international epilepsy centres to report the locations of abnormalities in cases with drug-resistant focal cortical dysplasia (FCD), a primary cause of epilepsy. FCDs are brain areas that have developed incorrectly and commonly result in drug-resistant epilepsy. Surgery is commonly used to treat it, but doctors have a hard time locating the lesions on an MRI since MRI scans for FCDs might seem normal.

The scientists employed about 300,000 places throughout the brain to quantify cortical properties from the MRI scans, such as how thick or folded the cortex/brain surface was.

The system was then trained on cases that experienced radiologists had classified as either having FCD or being a healthy brain based on their patterns and attributes.

In general, the algorithm was successful in identifying the FCD in 67% of instances in the cohort, according to the results, which were published in Brain (538 participants).

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Radiologists had previously been unable to uncover the abnormalities in 178 of the patients based on their MRI results; however, the MELD algorithm was able to detect the FCD in 63% of these cases.

This is crucial because, if doctors can identify the anomaly in the brain scan, surgery to remove it could result in a recovery.
Mathilde Ripart, a co-first author from the UCL Great Ormond Street Institute of Child Health, stated: “We focused on developing an AI system that was interpretable and could assist physicians in making decisions. A crucial step in that process was demonstrating to the doctors how the MELD algorithm generated its forecasts.

Dr Konrad Wagstyl, a co-senior author from the UCL Queen Square Institute of Neurology, added: “This algorithm might make it easier to identify these concealed lesions in epileptic children and adults, which would increase the number of patients who could potentially benefit from brain surgery to treat their condition and enhance cognitive function. In England, epilepsy surgery could help about 440 kids a year.”

Epilepsy is a severe neurological illness that affects 1% of the world’s population and is marked by recurrent seizures.
About 600,000 people in the UK are impacted. The majority of epilepsy patients can be treated with pharmaceuticals, although 20-30% of them do not benefit from them.

FCD is the most frequent cause in children who have had surgery to treat their epilepsy, and it is the third most frequent cause in adults.

Furthermore, FCD is the most frequent reason for epilepsy in people who have a brain anomaly that cannot be seen on an MRI scan.
Dr Hannah Spitzer, a co-first author from Helmholtz Munich, stated: “Our system automatically learns to detect lesions from thousands of patient MRI scans. It is capable of accurately identifying lesions of various sorts, forms, and sizes, including several that radiologists had previously overlooked.

Dr Sophie Adler, a co-senior author from the University College London’s Great Ormond Street Institute of Child Health, added: “We believe that this technology may assist to discover abnormalities that are now being missed that cause epilepsy.

In the long run, it might make it possible for more epilepsy patients to undergo possibly curative brain surgery.

This FCD detection study makes use of the biggest MRI cohort of FCDs to date, making it capable of identifying all FCD subtypes.

The 22 hospitals participated in the study employed varied MRI scanners from across the world, which increased the algorithm’s robustness but may have impacted its sensitivity and specificity.

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Anterior cruciate ligament (ACL) damage, a type of knee injury that most frequently happens during sports, is becoming increasingly common in kids and teens, claims a research. Surgery should be carried out as soon as feasible for adolescents and young adults with ACL injuries when it is recommended. However, there is a twofold increase in the likelihood of delayed surgery for kids and teens whose parents don’t understand English.

The journal Clinical Orthopaedics and Related Research published the study’s results. ACL rips hurt and may become permanently disabled if left untreated.

Most surgeons agree that surgery should be carried out within a month or two of the accident if it is necessary, which is typically the case with young athletes. Longer delays might cause more serious, permanent knee injury.

Sports medicine expert Neeraj M. Patel, MD, MPH, MBS, and colleagues examined 543 young patients who underwent ACL surgery at the Ann and Robert H. Lurie Children’s Hospital in Chicago. 16 was the average patient age, and both boys and girls were evenly represented. The authors analysed the timing of surgical procedures between 113 patients whose preferred language was not English and 430 patients whose families spoke Spanish at home (more than 90% of these patients’ families spoke Spanish at home).

The patients with parents who spoke a language other than English were twice as likely to have surgery more than 90 days after the accident, the researchers discovered. Even if the researchers took into consideration the patients’ insurance status, this disparity was still seen.

Orthopedic surgery departments are urged by Dr. Patel and his colleagues to offer more equal care to kids and teens whose parents speak a language other than English. Some of the tactics they advise are:

* Increasing the number of multilingual medical professionals,

* Making arrangements for improved interpreter availability,

* By making health information readily available in the local community’s native tongues,

* Collaborating with primary care physicians, community groups, and schools to promote awareness of ACL injuries, speed up diagnosis, and

* Teaching medical staff members how to make sure that families are aware of the suggestions for managing an ACL injury and are actively involved in the choice of whether to have surgery.

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The authors state that “institutions should build a culture of care that is attentive to and ready for persons whose preferred language is not English.” This should entail asking questions to and interacting with such families to learn more about their particular healthcare requirements, prejudices they deal with, and hurdles to care.

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Poor eating habits and weight increase are associated with emotional eating, which is the act of utilising food as a coping mechanism for unpleasant, elevating, or stressful sensations. An investigation into teen vulnerability to emotional eating was released by Elsevier in the Journal of Nutrition Education and Behavior. The article also covers how various feeding techniques, such as child engagement, food as a reward, and limitation, impact eating behaviour.

“It has previously been discovered that emotional eating is more learned than inherited. This study looked at how parents interact when feeding their kids as well as what kids learn from seeing their parents eat “said the study’s primary author, Joanna Klosowska, MSc, of the Ghent University’s Department of Public Health and Primary Care in Ghent, Belgium. With 218 families, the pilot study was done in 2017. Longitudinal data gathered in 2013 were furthermore accessible. The Child Feeding Questionnaire, the Child Feeding Practices Questionnaire, and the Dutch Eating Behavior Questionnaire were each completed by one parent from each home. With the help of the child-reported FEEL-KJ questionnaire, emotion control was evaluated. The researchers measured the adolescent’s height and body weight.

During the four years from 2013 to 2017, which spanned late childhood to middle adolescence, several parenting techniques evolved. Parents reported enhanced monitoring and good feeding habits modelling, despite the stated levels of food restriction and the healthy atmosphere remaining the same. During the same time period, teenagers reported a considerable increase in emotional eating, from below average in 2013 to above average in 2017, according to norms for the Dutch population. Additionally, the inappropriate method in which they handled their emotions was connected to emotional eating.

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Emotional eating was made worse by food as a reward and food monitoring, especially when teenagers utilised unhealthy coping techniques to handle their emotions. Child involvement in meals had the opposite effect because it was associated with higher levels of emotion regulation and lower levels of emotional eating. It’s noteworthy to observe that adolescents consumed less food out of emotion when their parents practised restrained eating.

This study shows that parental influence on children’s eating behaviours persists far into adolescence, according to Klosowska. More study is needed to completely comprehend how a parent’s regulated eating influences a child’s emotional eating.

A study found that youngsters with Down syndrome prefer crispy, oily meals while avoiding fragile or sticky foods. These choices, however, may result in a less healthful diet.

The study’s findings were published in the Journal of Texture Studies. “Children with Down syndrome appreciate meals like Pirate’s Booty and puffed corn,” said Carolyn Ross, a food science professor at WSU. “Those foods aren’t particularly nutritious, but they’re easily digestible, which is a huge plus for these kids. The challenge now is to create nutritious foods with those characteristics.”

“This was a major gap in research,” Ross added. “There are numerous anecdotal instances, and you may uncover information by going down an internet rabbit hole. However, research like this one can assist parents and physicians predict what these children will consume and therefore prevent choking incidents. If we can improve the nutritional value of those foods, we will be able to help a lot of people.”

Choking is one of the top causes of mortality in persons with Down syndrome because they may not chew their food sufficiently or “pack” it, overfilling their mouths and cheeks without swallowing.

Youngsters with Down syndrome have more health problems than typically developing children, such as eating and swallowing difficulties and food texture sensitivity.

Ross hopes to provide more nutritious food alternatives for children with Down syndrome and to help them grow more comfortable with complex textures.

“We want to assist people understand what food textures children with Down syndrome enjoy and how to transition them from pureed foods to texturally complex foods that have higher nutritional value,” Ross said.

Ross and her team distributed boxes containing 16 commercially available types of food to 218 youngsters aged 11 to 18 across 30 states. One hundred and eleven of those boxes were given to children with Down syndrome, with the remainder going to a control group of generally developing youngsters.

To ensure that flavour was not the basis for a texture preference, the boxes contained four items in each of four distinct texture groups.

Before sending the boxes, the study team contacted parents about their hated flavours in order to avoid such goods. To ensure that enjoyment was not attributable to novelty, all youngsters in the research ate one of each item every day for a week.

The parents then videotaped their children interacting with and consuming each food, which they subsequently sent to the research team.

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“We coded a lot of data; it’s the largest home-use test we’ve ever heard of involving children with Down syndrome,” Ross said. “There was also a significant variation in texture preferences between children with and without Down syndrome.”

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