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cars in traffic

Sleep science: Decoding drowsy driving

cars in traffic

A study published in The Journal of Pediatrics finds an association between a teen’s preference for evening or morning activities, coupled with nightly sleep duration, influences how awake they feel behind the wheel.

Each year, around Daylight Saving Time, we set our clocks forward and reprogram our bodies to adjust to spring. While most people welcome warmer days and lingering daylight, the time transition – and losing an hour of sleep – may leave some feeling jet lag.

For teens, the time transition is even more pronounced. Due to an adolescent’s developing body and a release of hormones to support growth and development, their biological clock is naturally set for late-evening bedtimes. Getting enough sleep is tough, especially with packed activity schedules and early-morning school start times.

A new study in The Journal of Pediatrics finds the impact of student sleep deprivation extends past feeling alert in class. Almost half of teen drivers surveyed – 205 out of 431 – from Fairfax County Public Schools reported driving drowsy at least once during the 2015 school year, the study period. Out of the 431-person sample, 63.1 percent of respondents reported driving several times a week. One-third of participants drove every day.

Helping teens feel alert behind the wheel is two-fold: Healthy school start times, those starting at 8:30 a.m. or later, help. Getting enough sleep is critical. The researchers also found that a student’s chronotype, or their preference for morning or evening activities, based on the Morningness-Eveningness Scale for Children, factor into drowsy driving:

  • Students with an evening chronotype, or preference for evening activities, coupled with shorter school-night sleep duration, were more likely to experience sleep-impaired driving.
  • Students with a morning chronotype, and who got at least eight hours of sleep, had the lowest prevalence of drowsy driving.
  • Compared with students who slept for at least eight hours on school nights, those who slept for less than seven hours had a 13.9 percent higher prevalence of drowsy driving.
  • The mean age of students surveyed was 16.9 years. The mean range of school-night sleep was seven hours.

Daniel Lewin, Ph.D., associate director of sleep medicine at Children’s National Health System, encourages schools to adopt later school start times, which Fairfax County Public Schools did, and he encourages students and families to assess their sleep patterns – focusing not just on sleep quantity but on sleep quality. His advice for families or students hesitant to change is to start small.

Try a seven-day challenge: Sleep on a regular schedule, sleep for recommended amounts of time, based on age-appropriate guidelines, cut out naps and eliminate late-afternoon caffeine intake.

Most children and families will start to notice the immediate benefits of getting a good night’s sleep, especially throughout the week: less daytime sleepiness, happier moods, improved eating habits and feeling more alert behind the wheel, which impacts driver safety – and not just for teen drivers but for parents, teachers and everyone on the road.

toddler nursing

Newborns with suspected food allergies breastfed significantly longer

toddler nursing

Mothers whose newborns had suspected food allergies reported breastfeeding them significantly longer than women whose infants had no adverse reactions after food exposure, according to preliminary research led by Karen A. Robbins, M.D., and presented during the American Academy of Allergy, Asthma & Immunology 2019 Annual Meeting.

According to the Centers for Disease Control and Prevention (CDC), food allergies affect 4 to 6 percent of U.S. children, making such allergies a growing public health concern. Researchers are attempting to learn more about the interplay between food allergies and what, when and how children eat to inform allergy-prevention efforts. Little is known about the association between perceived food allergies, intolerance or hypersensitivity among babies eating their first bites of solid food and how long they’re breastfed.

Dr. Robbins and colleagues analyzed data gathered through a longitudinal study led by the Food and Drug Administration (FDA) and the CDC from 2005 to 2007. The Infant Feeding Practices Study II tracked diet and feeding practices of about 2,000 women late in their pregnancies and followed their babies’ diets through the first year of life.

Some 2,586 breastfeeding mothers in the study completed surveys when their infants were 4, 9 and 12 months old. The women were asked whether there were problems caused by food, such as an allergic reaction, sensitivity or intolerance. The majority of these infants (84.6 percent) had no suspected allergic reaction to either food they ate on their own or to food they were exposed to via breastmilk. The mothers reported that nearly 11 percent of infants reacted to something they ate; 2.4 percent reacted to food products they were exposed to via breastmilk; and 2.4 percent reacted to both food they consumed directly or were exposed to via breastfeeding. They also found:

  • Infants with suspected food allergies after exposure to food their mothers ate were breastfed a mean of 45.8 weeks.
  • Infants with food intolerance after both exposure to food their mother consumed and food they ate themselves were breastfed a mean of 40.2 weeks.

That contrasts with infants with no concern for food reactions, who were breastfed a mean of 32 weeks.

“Breastfeeding a newborn for the first few months of life helps their developing immune system become more robust, may affect the microbiome, and could influence or prevent development of allergy later in life,” says Dr. Robbins, an allergist at Children’s National Health System and lead author of the research. “However, mothers’ perceptions of their newborns’ adverse reactions to food appears to factor into how long they breastfeed.”

One potential concern is that extended breastfeeding can impact solid food introduction practices.

“Gradually transitioning to solid food gives infants an opportunity to sample an array of foods, nibble by nibble, including food allergens like peanut and eggs. We know from previously published research that introducing high-risk babies to a food allergen like peanuts early in life appropriately primes their immune system and dramatically decreases how often these children actually develop peanut allergies,” Dr. Robbins adds. “The relationship between breastfeeding and allergy development is complex, so understanding mothers’ practices is important. We also do not know how often these early reactions result in true food allergy, compared with transient food intolerance.”

American Academy of Allergy, Asthma & Immunology 2019 Annual Meeting presentation

  • “Perceived food allergy, sensitivity or intolerance and its impact on breastfeeding practices.”

Monday, Feb. 25, 2019, 9:45-10:45 a.m. (PST)

Karen A. Robbins M.D., lead author; Marni Jacobs, Ph.D., co-author; Ashley Ramos Ph.D., co-author; Daniel V. DiGiacomo, M.D., co-author; Katherine M. Balas BS, co-author; and Linda Herbert, Ph.D., director of Children’s Division of Allergy and Immunology’s psychosocial clinical program and senior author.

little boy looking at gun

A ‘compelling call’ for pediatricians to discuss firearm safety

little boy looking at gun

The Children’s commentators point to the “extremely dangerous” combination of “the small curious hands of a young child” and “the easily accessible and operable, loaded handgun” and suggest that pediatricians who counsel families about safely storing weapons tailor messaging to the weapon type and the family’s reason for owning a firearm.

Paradoxically, as overall firearm ownership decreased in U.S. households with young children from 1976 to 2016, the proportion of these families who owned handguns increased. This shift in firearm preferences over decades from mostly rifles to mostly handguns coincided with increasing firearm-mortality rates in young children, researchers report Jan. 28, 2019, in Pediatrics.

“Almost 5 million children live in homes where at least one firearm is stored loaded and unlocked,” Kavita Parikh, M.D., a pediatric hospitalist at Children’s National Health System, and co-authors write in an invited commentary. “This study is a loud and compelling call to action for all pediatricians to start open discussions around firearm ownership with all families and share data on the significant risks associated with unsafe storage. It is an even louder call to firearm manufacturers to step up and innovate, test and design smart handguns, inoperable by young children, to prevent unintentional injury,” Dr. Parikh and colleagues continue.

The Children’s commentators point to the “extremely dangerous” combination of “the small curious hands of a young child” and “the easily accessible and operable, loaded handgun” and suggest that pediatricians who counsel families about safely storing weapons tailor messaging to the weapon type and the family’s reason for owning a firearm.

They also advocate for childproofing firearms stored in the home – through free or discounted locks, storing weapons separately from ammunition, and using personalized technology that limits the firearm’s potential to be used by children accidentally. According to a retrospective, cross-sectional study led by Children’s researchers, younger children are more likely to be shot by accident.

“The development of effective safety controls on firearms is not only attainable but could be the next big step towards reducing mortality, especially among our youngest. We as a society should be advocating for continued research to ‘childproof’ firearms so that if families choose to have firearms in the home, the safety of their children is not compromised,” Dr. Parikh and co-authors write.

In addition to Dr. Parikh, the senior author, the Pediatrics commentary co-authors include Lead Author Shilpa J. Patel M.D., MPH, emergency medicine specialist; and co-author Monika K. Goyal M.D., MSCE, assistant division chief and director of research in Children’s Division of Emergency Medicine.

general school supplies

Studying the impact of later school start times

general school supplies

Teens have a biological preference to fall asleep later than younger children and adults, and wake up later, due to a delayed release of hormones that promote sleep. This timing coincides with puberty and makes it harder for middle and high school students to fall asleep early – regardless of 5 a.m. alarms and 7:17 a.m. school start times.

After studying this trend among nearly 1,000 seventh and eighth-grade students in 11 middle schools within a Mid-Atlantic school district, Daniel Lewin, Ph.D., a sleep medicine specialist, pediatric psychologist and associate director of the sleep medicine program at Children’s National Health System, coauthored and published research entitled “Later Start, Longer Sleep: Implications of Middle School Start Times” in the Journal of School Health, which outlines the benefits of delaying school start times.

The research team divided students into two groups: Close to 650 students attended eight late-starting middle schools, where school started at 8 a.m., while nearly 350 students attended early-starting middle schools, where school started at 7:23 a.m.

Students starting school 37 minutes later, despite going to bed 15 minutes later than peers attending an earlier-starting school, got 17 minutes more sleep each night and were more likely to report feeling wide awake during class. The researchers predicted this later-starting school model would translate to students getting an extra 75 minutes of sleep a week – roughly 51 hours of extra sleep each school year. These researchers find that every two minutes in delayed school start times results in one minute of additional sleep each night for children and teens.

Sleep Chart

Middle and high school students should get 8.5 to 10.5 hours of sleep each night, ideally between 9 p.m. and 8:30 a.m. for 12- to 15-year-olds and 10:30 p.m. and 9 a.m. for 16- to 18-year-olds.

The American Academy of Pediatrics (AAP) published similar research in their journal, Pediatrics, about the benefits of letting teens catch up on sleep, citing a reduced risk of students being overweight, getting into car accidents or suffering from depression as well as a greater likelihood of having better grades, higher test scores and a better quality of life. AAP recommends schools start at 8:30 a.m. or later to allow students to get 8.5 to 9.5 hours of sleep each night and issued a statement in 2014, entitled “School Start Times for Adolescents.”

Dr. Lewin continues to track these benefits and works with schools to implement the changes. He recently wrote an editorial, entitled “All the Clocks Are Ticking: Sleep Health and Metabolism,” for the Journal of Adolescent Health about the correlation between improved sleep health, mental and physical health and academic performance, explaining how circadian clocks, present on a cellular level, influence behavior and metabolism.

While pushing school start times back requires an immediate investment of rearranging travel routes, bell schedules and after-school activities, several school districts near Washington, D.C., from Virginia Beach to Fairfax County, are adopting this public health model.

An economic analysis conducted by the RAND Corporation finds that after two years, the benefits of reorganizing school start times outweigh the costs.

Craig Sable

Can a vaccine prevent the earliest forms of rheumatic heart disease?

Craig Sable

Craig Sable, M.D., associate chief of the division of cardiology and director of echocardiography at Children’s National Health System, earned a lifetime achievement award, formally known as the 2018 Cardiovascular Disease in the Young (CVDY) Meritorious Achievement Award, on Nov. 10 at the American Heart Association’s Scientific Sessions 2018.

The CVDY Council bestows the prestigious award to individuals making a significant impact in the field of cardiovascular disease in the young. The CVDY Council supports the mission to improve the health of children and adults with congenital heart disease and acquired heart disease during childhood through research, education, prevention and advocacy.

Dr. Sable is recognized for his entire body of research, education and advocacy focused on congenital and acquired heart disease, but especially for his rheumatic heart disease (RHD) research in Uganda.

Over the past 15 years, Dr. Sable has brought more than 100 doctors and medical staff to Kampala, the capital and largest city in Uganda, partnering with more than 100 local doctors and clinicians to develop a template for a sustainable infrastructure to diagnose, treat and prevent both RHD and congenital heart disease.

RHD is a result of damage to the heart valves after acute rheumatic fever (ARF). The process starts with a sore throat from streptococcal infection, which many children in the United States treat with antibiotics.

“For patients who develop strep throat, their body’s reaction to the strep throat, in addition to resolving its primary symptoms, can result in attacking the heart,” says Dr. Sable. “The initial damage is called acute rheumatic fever. In many cases this disease is self-limited, but if undetected, over years, it can lead to long-term heart valve damage called rheumatic heart disease. Unfortunately, once severe RHD develops the only treatment is open-heart surgery.”

In 2017, Sable and the researchers published a study in the New England Journal of Medicine about the global burden of RHD, which is often referred to as a disease of poverty.

RHD is observed more frequently in low- and middle-income countries as well as in marginalized communities in high-income countries. RHD has declined on a global scale, but it remains the most significant cause of morbidity and mortality from heart disease in children and young adults throughout the world.

In 2017 there were 39.4 million causes of RHD, which resulted in 285,000 deaths and 9.4 million disability-adjusted life-years.

In 2018 the World Health Organization issued a referendum recognizing rheumatic heart disease as an important disease that member states and ministries of health need to prioritize in their public health efforts.

The common denominator that drives Dr. Sable and the global researchers, many of whom have received grants from the American Heart Association to study RHD, is the impact that creating a scalable solution, such as widespread adoption of vaccines, can have on entire communities.

“The cost of an open-heart surgery in Uganda is $5,000 to $10,000, while treatment for a child with penicillin for one year costs less than $1,” says Dr. Sable. “Investment in prevention strategies holds the best promise on a large scale to eradicate rheumatic heart disease.”

Sable and the team have screened more than 100,000 children and are conducting the first randomized controlled RHD trial, enrolling nearly 1,000 children, to examine the effectiveness of using penicillin to prevent progression of latent or subclinical heart disease, the earliest form of RHD.

During the Thanksgiving holiday weekend, Dr. Sable and a team of surgeons will fly back to Uganda to operate on children affected by RHD, while also advancing their research efforts to produce a scalable solution, exported on a global scale, to prevent RHD in its earliest stages.

Dr. Sable and colleagues from around the world partner on several grant-funded research projects. Over the next few years, the team hopes to answer several important questions, including: Does penicillin prevent the earliest form of RHD and can we develop a vaccine to prevent RHD?

To view the team’s previously-published research, visit Sable’s PubMed profile.

To learn about global health initiatives led by researchers at Children’s National, visit www.GHICN.org.

Desiree de la Torre

Desiree de la Torre named to The Daily Record’s 2018 VIP List

Desiree de la Torre

Desiree de la Torre, MPH, MBA, director of Community Affairs and Population Health Improvement at Children’s National, has been named one of The Daily Record’s 2018 VIP List — Very Important Professionals Successful by 40 awards.

The VIP List recognizes professionals 40 years of age and younger who have been successful in Maryland. Winners, chosen by a panel of previous VIP List honorees and business leaders, were selected on the basis of professional accomplishments, community service and commitment to inspiring change.

“I’m so happy to be selected as a 2018 Very Important Professionals (VIP) Successful by 40 winner,” says Desiree. “My parents instilled in me the importance of hard work, giving back to my community and a commitment to inspiring change – exactly what this award is about! When I first received the news, I called my parents because I owe my success to them.”

As director of Community Affairs and Population Health Improvement at Children’s National, Desiree leads the organization’s community health improvement strategic planning process, including support for community organizations, health equity and compliance with federal and local community benefit regulations. She is responsible for the development of new models of care that improve the health of populations and impact the social determinants of health. This includes multi-sector collaborations with community organizations, schools, government agencies and payers.

Desiree is a member of several local and national councils and associations. She holds a master’s degree in Public Health from Boston University, a master’s degree in Business Administration from Johns Hopkins University and a bachelor’s degree in Psychobiology from the University of California, Los Angeles.

Desiree will be honored along with other awardees at a reception in September, hosted by The Daily Record.

Tonya Kinlow

Children’s National Health System hosts School Health Symposium

Tonya Kinlow

The Child Health Advocacy Institute at Children’s National Health System held its first School Health Symposium, designed to strengthen relationships between the education and health care sectors. Led by Tonya Vidal Kinlow, M.P.A., vice president of Community Engagement, Advocacy and Community, Children’s National welcomed more than 150 regional health and education partners, community members and Children’s National staff to support the mission of helping kids grow up stronger.

In a day of panel discussions and breakout sessions, education, government and health professionals tackled the many societal challenges children face. The panel discussions at this year’s symposium focused on the following topics:

  • Caring for the whole child using a trauma-informed approach
  • Children’s National regional school-based programs
  • Local government role in school health
  • How a health system advocates for school health
  • How organizations are working with schools to address the social determinants of health

Participants also had the option to attend one of the following breakout sessions:

  • Mental wellness & self-care for school and health care professionals
  • School-based research: engaging families, empowering students
  • How an anchor institution is addressing the social determinants of health
  • School health legislation update

Outreach programs focused on strong community partnerships were recognized for serving diverse communities including infants and their caregivers, primary care clinicians, high school students, child care providers and teachers. Three programs were chosen as recipients for the Community Health Improvement Award through an application process where a panel of judges with expertise in public health and policy evaluated against an established criteria set.

“Our Community Health Improvement Awards recognize all efforts to conduct community outreach programs and shape public policies that benefit children and families in the Washington D.C.  area,” says Kurt Newman, M.D., president and CEO of Children’s National. “The award also recognizes the physicians and clinicians here at Children’s who go above and beyond to provide quality care to kids and their families.”

This year’s recipients actively play a role in contributing to school health:

The School Health Symposium was followed by a networking reception to allow participants an opportunity to connect with colleagues and discuss the sessions.

Monika Goyal

Monika Goyal M.D., M.S.C.E., consultant on $5M NIH grant to reduce pediatric firearm injuries

Monika Goyal

Monika Goyal M.D., M.S.C.E., director of research in Children’s Division of Emergency Medicine and Trauma Services, has been named a consultant on a new $5 million National Institutes of Health research grant that represents the agency’s largest funding commitment in more than two decades to reduce pediatric firearm injuries.

“I am honored that Children’s National Health System is among the 12 universities and health systems around the nation selected to work collaboratively to identify solutions to lower pediatric deaths and injuries due to firearms,” Dr. Goyal says. “This grant will expand the nation’s research capacity on this important subject area and will power the next wave of research to inform policy at the state and national level.”

Dr. Goyal is a member of Children’s firearms research work group which has published or presented at academic meetings on topics that include efforts to reduce pediatric firearm-related injuries and the pivotal role pediatricians can play in reducing the burden of firearm-related injuries among children.

Faculty from Ann & Robert H. Lurie Children’s Hospital of Chicago/Northwestern University, Arizona State University, Brown University, Children’s National Health System, Columbia University, Harvard University, Medical College of Wisconsin, Michigan State University, University of Colorado, University of Michigan, University of Pennsylvania and University of Washington make up the Firearm-Safety Among Children & Teens Consortium (FACTS). The initiative is co-led by Rebecca Cunningham, M.D., and Marc Zimmerman, Ph.D., of the University of Michigan.

In addition to tapping the expertise of scientists and researchers who specialize in criminal justice, emergency medicine, pediatrics, psychology, public health and trauma surgery, FACTS will include a stakeholder group that includes teachers, parent groups, gun owners, firearm safety trainers and law enforcement partners.

The five-year grant will produce a number of deliverables, including:

  • A research agenda for the field of pediatric firearm injury
  • Generating preliminary data through five small pilot projects that focus on topics such as the epidemiology of pediatric firearm injuries and prevention of firearm injuries
  • A data archive on childhood firearm injury
  • Training for the next generation of researchers, including postdoctoral trainees and graduate students

Financial support for this research was provided by the National Institute of Child Health & Human Development under award number R24HD087149.

At AAP: addressing the needs of children living in poverty

Lanre Omojokun Falusi, M.D., F.A.A.P., a pediatrician at Children’s National Health System and Associate Medical Director for Municipal and Regional Affairs at Child Health Advocacy Institute (CHAI), will tell attendees of the American Academy of Pediatrics 2016 National Conference that “poverty really is a public health issue.”

For any child, and particularly children living in poverty, adverse experiences during childhood are linked to health conditions that can linger for much of their adult lives.

While pediatricians are challenged by high case loads, Dr. Falusi believes that there is a place within the doctor visit for a discussion about such social determinants of health. Team-based care provides an opening for such conversations.

In some cases, pediatricians may feel out of their element. “It’s a very natural feeling: The best interventions to alleviate poverty are not the issues that doctors are used to working on,” she says. On the other side of the continuum are clinicians who try to take a lion’s share of the load.  “Many pediatricians trained in hospitals that are very work-focused, and even I still fight the urge of saying ‘I myself need to fix this. It’s my job to make their health better.’ ”

But social workers, who are trained in identifying such resources, and nurses are also integral members of the healthcare team. It would be equally natural for a referral to a food pantry or an application for the Supplemental Nutrition Assistance Program to come from these team members.

It’s a shift in mentality, refocusing on the patient’s broader needs that may impact health, rather than the narrow symptoms caused by those health concerns.

AAP 2016 presentation:
Saturday, October 22, 2016

  • I1161- Place Matters: Addressing the Needs of Children in Poverty in Rural and Urban Settings4 p.m. to 5:30 p.m.