How to improve your Children’s Health?

A fundamental goal of NICHD's research is to improve children's health and development. This year, NICHD research provided clinicians and health professionals with several new practical tools to help keep children healthy and well: Doctors have better guidance on the use of pain medication for infants; they have new warning signs for later cognitive problems; and they can identify early markers of future disease among the growing number of overweight children and adolescents.

Using morphine to control pain in premature newborns on mechanical ventilation should be limited. A large clinical trial found that continuous morphine infusions to relieve pain in premature newborns on mechanical ventilation did not reduce the frequencies of severe neurological (brain) injuries or deaths in these infants, contrary to results of an earlier pilot study. Rates of the adverse events were even higher in infants who received additional "bolus" doses of morphine to control pain. These results have important implications for clinical practice because routinely starting continuous infusion of morphine for pain associated with mechanical ventilation is a common practice in neonatal intensive care units. The severity of adverse events associated with this practice prompted the researchers to recommend that continuous morphine infusion be used sparingly, to reduce severe or repetitive pain in these infants. The research, however, also highlighted urgent needs to develop both less hazardous pain medications for the infants and better, standardized methods for assessing their pain.

Prolonged crying in infants may signal late cognitive problems. Infants who cry a lot after the first three months of life, without any obvious cause, may later experience cognitive problems, according to new study. The researchers distinguished between colic - extended, unexplained crying that typically stops after the first 12 weeks of life - and the "prolonged" crying of older infants. Prolonged crying is generally considered to be crying more than three hours a day. The research affirmed earlier findings that colic does not affect cognitive development. By contrast, the researchers found that approximately 5 percent of children experiencing prolonged crying as infants had lower IQ scores, poorer fine motor abilities, hyperactivity, and discipline problems at age five. The implications for clinical practice are that children with a history of prolonged, unexplained crying after the age of three months should be followed more intensively to detect emerging developmental problems that might respond to early intervention.

Heavy alcohol drinking during pregnancy causes persistent nerve damage in infants that escape fetal alcohol syndrome. A small, observational study by scientists at the NICHD and the University of Chile found significant damage in the peripheral nervous system of infants whose mothers drank large amounts of alcohol during pregnancy, even though the infants did not show symptoms of fetal alcohol syndrome. This is the first study to find peripheral neuropathy - a condition well-recognized in alcoholic adults - in children exposed to alcohol in utero. Neurological evaluations of these infants at ages six and twelve months showed damage both to the part of the nerve that carries signals to muscles and other tissue and to the part that insulates the nerve. The persistence of the damage at one year suggests that the alcohol exposure interfered with neural development. As the researchers continue to follow the children, they will look for emerging clinical symptoms that could not be measured in infancy. For instance, in adults, alcoholic peripheral neuropathy is associated with muscle weakness, impaired fine motor functioning, and other symptoms.

Overweight, obesity and the metabolic syndrome in children and adolescents. At a time when more U.S. teens are overweight than those in most other industrialized nations, researchers are also reporting high rates of a cluster of metabolic disorders (metabolic syndrome) in obese adolescents as well as in children as young as four years old. Metabolic syndrome - which includes high blood pressure, high insulin levels, abnormal cholesterol levels, and overweight or obesity - the likelihood of developing diabetes, heart disease, or stroke. The researchers studying the syndrome in children and adolescents found that the prevalence of the syndrome increased with the severity of obesity, reaching 50 percent in severely obese youngsters. They also found that the more obese the children and adolescents were, the more severe were each of the disorders that make up the syndrome. And, in a relatively short period (a year) between the initial testing and follow up, the researchers found a dramatic increase in the development of type 2 diabetes in the research subjects diagnosed with metabolic syndrome. They warned this increase could precede an epidemic of advanced cardiovascular disease as obese adolescents become obese adults.