Many Parents Share Genetic Test Findings With Kids

(HealthDay News) -- As genetic testing for diseases becomes more commonplace, the impact of those findings on family members may be underestimated, researchers say.

For instance, some women who discover they have the BRCA gene mutation, which puts them at higher risk for breast cancer, choose to tell their children about it before the children are old enough to understand the significance or deal with it, a new study found.

"Parents with the BRCA mutation are discussing their genetic test results with their offspring often many years before the offspring would need to do anything," said study author Dr. Angela Bradbury, director of the Fox Chase Cancer Center's Family Risk Assessment Program, in Philadelphia.

According to Bradbury, more than half of parents she surveyed told their children about genetic test results. Some parents reported that their children didn't seem to understand the significance of the information, and some had initial negative reactions to the news.

"A lot of genetic information is being shared within families and there hasn't been a lot of guidance from health-care professionals," Bradbury said. "While this genetic risk may be shared accurately, there is risk of inaccurate sharing."

In the study, Bradbury's team interviewed 42 women who had the BRCA mutation. The researchers found that 55 percent of parents discussed the finding and the risk of breast cancer with at least one of their children who was under 25.

Also, most of the women didn't avail themselves of the services of a doctor or genetic counselor in helping to tell their children, Bradbury's group found.

Bradbury is concerned that sharing genetic information with young children can create anxiety. "The children could be overly concerned about their own risk at a time when there is nothing that they need to do," she said.

But, she added, "it may be possible that sharing may be good for children in adapting to this information."

The findings are published in the Aug. 20 issue of the Journal of Clinical Oncology.
The lack of definitive data on when -- or if -- to discuss genetic test results with children is a real problem, Bradbury said.

"As we move genetic testing forward for cancer or other illnesses, we have to consider the context of the whole family and focus our counseling to the whole family, and not just the person who comes in for testing," Bradbury said. "We should learn more about how and when we should talk to children about this, so that we can promote healthy behaviors without causing too much anxiety for the offspring."

Barbara Brenner, executive director of Breast Cancer Action, agreed that the psychological component of genetic testing needs more attention.

"This is the tip of a very scary iceberg," Brenner said. "We don't know the psychological consequences [of BRCA testing], not only to the person who has the test, but to her family members."

Brenner thinks guidelines to help parents deal with this information are needed. So is help from doctors and genetic counselors in counseling family members, especially children, she added.

More information
For more on genetic testing, visit the U.S. National Library of Medicine.

Childhood Brain Tumor Survivors Often Struggle in School

(HealthDay News) -- Children who've had brain tumors tend to do worse in school than other children, a Finnish study finds.

Foreign language classes, especially, prove most difficult for young brain tumor survivors, the researchers found.

This is the first study to examine how having a brain tumor affects school childrens' grades, the team said.

"These results will help us identify brain tumor survivors who are at greatest risk for school failure and may need remedial help as early as possible," study author Dr. Paivi Lahteenmaki of Turku University Hospital said in a prepared statement.

He and his colleagues compared the 9th-grade report cards of 300 students who'd had brain tumors treated with surgery or radiation to the report cards of almost 1,500 healthy students.

Brain tumor survivors had significantly lower grades in all subjects, particularly in foreign language classes. This was especially true for girls. The study found that more than 58 percent of female brain tumor survivors had grades lower than eight (4 = fail, 10 = excellent) in foreign language classes, compared to 38 percent of healthy students.

"It appears verbal performance is the area most seriously affected for brain tumor survivors. This may be a reflection of a diminished ability to learn new information," said Lahteenmaki, who noted that girls may be more sensitive than boys to radiation therapy-related cognitive decline.

The study is published in the July 17 issue of the journal Neurology.

More information
The U.S. National Cancer Institute has more about childhood brain tumors.

New Cholesterol Check Gauges Kids' Heart Risk

(HealthDay News) -- Whether America's fast-food-and-video-game culture, or some other confluence of factors is to blame, there's no denying that adolescents' health is at risk.

Little wonder, then, that one group of researchers has begun to take a serious look at the long-term health consequences of kids' inactivity. And they are using cholesterol levels as a window into these youngsters' futures.

Obesity, inactivity and cholesterol are closely linked, and data from the latest U.S. National Health and Nutrition Examination Survey (NHANES) finds that 17 percent of U.S. teens are overweight. Just one in four high school students packs enough physical activity into their day, and 12 percent get little or no daily exercise, reports the U.S. Centers for Disease Control and Prevention.

So, measuring kids' cholesterol in a really detailed way may make sense.
"There is growing scientific evidence indicating that cholesterol levels in childhood and adolescence have an effect on the development of plaque in the arteries, which is a clear indication of cardiovascular disease risk," explained study leader Ian Janssen, an assistant professor in the School of Kinesiology and Health Studies at Queens University in Ontario, Canada.

"There is also strong evidence indicating that children and youth with high cholesterol will continue to have high cholesterol in adulthood," he added. "Thus, it is important to start treatment and prevention efforts early."

Using data from the NHANES on more than 6,000 kids aged 12 to 20, Janssen and his colleagues developed age- and gender-specific reference points for total cholesterol, LDL ("bad") cholesterol, HDL ("good) cholesterol and triglyceride fat levels. The new tables, published last year in the journal Circulation, take into account fluctuations in cholesterol and fat that occur as a child matures.

The new reference data are meant to improve upon current guidelines, published by the U.S. National Cholesterol Education Program, which do not account for age-related fluctuations.
Still, Janssen admits that the guidelines have not yet been routinely adapted into clinical care settings in the United States. "These sorts of changes to clinical practice typically take years to manifest," he said.

Dr. Marc S. Jacobson, director of the Center for AtherosclerosisAtherosclerosis Prevention at Schneider Children's Hospital in New Hyde Park, N.Y., said it's unclear how the new tables will be received in the United States.

"It complicates lives of people like me who treat adolescents with lipid problems because instead of just having one number, you have to have four graphs and plot them out by age," he said.
"Instead of having one cut point," he continued, "you have a graph that you have to plot out a percentile. With each lipid profile, you have to decide which percentile this is for that individual's age. And when it goes up and when it goes down, did it go down because of treatment? Or did it go down because of advancing puberty?"

The challenge, then, is to make sense of that information, he explained. "It argues that you almost have to take it into account because you could say if the LDL changes, is it the treatment or is it a change in puberty?"

Currently, the federal government recommends cholesterol screening for children and teens with at least one parent with high cholesterol or a family history of early heart disease.
"Typically high-risk adolescents should be screened, and probably every year or two," Janssen said. "A high-risk adolescent would be one who's had a parent or grandparent with premature cardiovascular disease or high cholesterol, or a teen with other risk factors, such as obesity and high blood pressure."

Other risk factors, such as high blood pressure, obesity, diabetes or smoking, also would trigger cholesterol testing in doctors' offices, "and that covers a lot of kids now," Jacobson noted.
The issue is destined to garner greater attention when a U.S. National Heart, Lung, and Blood Institute (NHLBI) panel updates guidelines on cholesterol screening in children and teens. The new guidance is scheduled for release in April 2008, said Dr. Rae-Ellen Kavey, senior medical officer with the Pediatric Cardiovascular Risk Reduction Program in NHLBI's Office of Prevention, Education, and Control.

"Stay tuned," Kavey said, "because there really is going to be new information."

More information
Find out more about cholesterol at the U.S. National Heart, Lung, and Blood Institute.

Dads' Parenting Style Influences Childhood Obesity

(HealthDay News) -- Fathers' parenting styles have a major influence on children's weight, says an Australian study that looked at almost 5,000 children, ages 4-5, and their parents.

The researchers found that fathers with permissive (no limits on their children) or disengaged parenting styles were more likely to have overweight or obese children, while fathers with a consistent (clear limits, following through with instructions, etc.) style were less likely to have children with a higher body mass index (BMI).

There was no association between the mothers' parenting styles and children's weight, said the study authors from the Centre for Community Child Health (CCCH) at the Royal Children's Hospital, Melbourne, and the Murdoch Children's Research Institute.

The findings were to be presented this weekend at the annual meeting of the Pediatric Academic Societies, in Toronto.

"This study of a large cross section of Australian preschoolers has, for the first time, suggested that fathers could be at the frontline in preventing early childhood obesity. Mothers are often blamed for their children's obesity, but this study suggests that for more effective prevention, perhaps we should focus on the whole family," Melissa Wake, an associate professor at CCCH, said in a prepared statement.

"Given the importance of the family unit in a child's preschool years, and its influence on their nutrition and physical activity levels, it is timely to look at the parenting roles of both parents and the impact they have on a child's tendency to be overweight or obese," Wake said.
She noted that more than 60 percent of the fathers and more than 40 percent of the mothers in the study were overweight or obese.

More information
The U.S. National Institute of Diabetes and Digestive and Kidney Diseases offers advice for parents on healthy eating and physical activity for children.

Taping Doctors' Conversations Helps Parents of Newborns in Intensive Care

(HealthDay News) -- Parents of infants hospitalized in intensive-care units are often upset and stressed and don't always fully understand what the doctors are telling them.

But by taping the doctors' conversations, parents can review the talks later and understand exactly what they were being told and the advice being offered, according to a report by Australian researchers.

"Patients, especially when stressed or in a state of shock, find it difficult to recall information given by senior doctors," said lead researcher Dr. Tieh Hee Koh, a neonatologist and clinical director at the Women's and Children's Health Institute of James Cook University Medical School, in Douglas, Queensland. "Even if we doctors discuss at length with the patients about their conditions, they may still not recall anything," he added.

For the study, the researchers recruited 200 mothers with babies in neonatal intensive care. The women were put into two groups: One group had their consultations with doctors recorded and were given a copy of the recording. The second group did not receive a recording.

After 10 days, and then again at four months, the mothers were asked to recall the diagnosis, tests, treatment and outcome of their babies, as explained by their neonatologist.

Koh's team found that women who received a tape recalled significantly more about diagnosis, treatment and outcome, than mothers in the control group. "Six of the 100 mothers not given the tapes did not recall any of the conversations," he said.

The study is published in the Dec. 2 edition of the British Medical Journal.
Although the tapes did not affect the mothers' levels of anxiety or depression, 96 percent listened to the tapes and found them helpful. Moreover, among babies with poor outcomes, the mothers who got tapes were significantly more satisfied with the conversations with the doctors than those who didn't get tapes, the researchers found.

The study authors believe that this method of improving communication between doctors and family members and patients can be extended to other areas of medical care.
Koh, who has been using this method for 12 years, advises "buying a tape recorder for anybody going into hospital or for any doctor friends."

One expert thinks the taping method isn't necessarily the best way for patients and family members to get the medical information they need.

"Patients never hear what doctors tell them," said Dr. Charles Safran, an associate clinical professor of medicine at Harvard Medical School and an expert in patient-doctor communication. "It's not surprising in neonates, where parents need a Ph.D. in intensive care to even remotely understand what's happening to their kid, [that they] don't remember what their doctors tell them."

Safran thinks there's a need for better communication, and the answer may rest with the Internet. Using Web-based, interactive communication allows people to access the information they need as they need it and helps improves communication between doctors and patients and patients' families.

"Web-based intervention, where there is persistence of information, where information, rather than just being given in one large taped session, is made available where and when a parent needs it, has a huge value," Safran said. "When you do that, you can improve parent satisfaction dramatically."

More information
For more on doctor-patient communication, visit the American Academy of Family Physicians.

Schools Should Boost Kids' Daily Exercise

(HealthDay News) -- Citing "alarming health trends" on kids' obesity, the Top of Form

American Heart Association (AHA) is calling on schools to aggressively promote physical education throughout the academic day.
The organization is proposing nine practical steps that elementary schools, high schools, child development centers, colleges, universities, school districts and states can all take to provide opportunities for elementary and high school kids to exercise.

"Kids spend a lot of time in the schools for a lot of years, and in order for them to be as physically active as they need in order to be healthy, schools are going to have to take the initiative," said Russell Pate, chairman of the group that drafted the recommendations, and a profFueling the concern, the AHA said, is the dramatically rising obesity rates among American children over the past two decades: About 16 percent of kids aged 6 to 19 are now considered overweight.
And a 2003 survey showed that more than one third of the students spend no more than 20 minutes a day on vigorous activity, while their time in front of the TV is up to three hours daily, the AHA added.

The AHA statement, published this week in Circulation, calls for:
Schools to establish a daily minimum of 30 minutes of moderate-to-vigorous activity during school hours, and set up health education programs that encourage exercise and discourage sedentary behavior;

Schools to establish optional exercise programs outside school hours, provide extracurricular sports clubs, and promote safe walking and biking routes to school;

States to ensure that physical education (PE) programs are taught by certified and highly qualified teachers, and to hold schools accountable for the adequacy of such programs and for ensuring they are part of a core curriculum;

Child development centers and elementary schools to ensure at least 30 minutes of daily recess for exercise;

Higher education groups to establish programs that produce highly qualified PE and health education teachers.

The AHA statement cites a host of statistics that suggest that school exercise is sorely lacking.
Between 1991 and 2003, the percentage of high school students taking PE classes dropped from more than 41 percent to little more than 28 percent.

Between 6 percent and 8 percent of schools at all grade levels offer PE at the recommended levels of between 150 and 225 minutes a week, depending on student age.

Fewer than 33 percent of those kids who live within a mile of their school get there by walking or biking. That figure drops to just 3 percent for kids residing within two miles of their school.
With exercise getting such failing grades, one expert applauds the effort to prioritize PE.

However, Dr. David L. Katz, director of the Prevention Research Center at the Yale University School of Medicine, cautions that schools are currently caught between a rock and a hard place.
"I support the statement, and I think every parent and school should support it," he said. "But while it's well and good for the AHA to say that schools should promote physical activity, we can't just leave it at that, because they will ask us to help make it possible at a time when we've actually been making it more and more difficult for them to do so."

In that regard, Katz highlighted the impact that the 2002 passage of the federal "No Child Left Behind Act" (NCLB) has had on school curricula.

Emphasizing "core" subjects such as math and reading, the law has dramatically increased pressure to allocate more time for standardized test preparation, he noted.

As a result, Katz suggested that PE programs and even recess breaks are being pushed to the national backburner, where cutbacks and even elimination have become the trend.

"I've said that NCLB is leaving far too many children on their behinds," said Katz, a father of five. "So while I agree that schools have an obligation to cultivate the physical, as well as mental, well-being of children, we can't impose an additional burden without offering empowering and creative strategies."

To that end, Katz suggests that educators take a fresh and practical look at how PE could perhaps be integrated directly into classroom studies -- so that mental and physical activities aren't forced to compete for time and money.

On that point, Pate agreed.

"He's right about that, and our view is that it doesn't have to be an either-or situation," he said. "We think the schools can deliver both excellent academic programs and the physical activity students need during the school day."

More information
For more on exercise and children, visit the American Heart Association.
By Alan MozesHealthDay Reporteressor of exercise science at the University of South Carolina, in Columbia.

Pediatric Use of Complementary Therapies: Ethical and Policy Choices

"Pediatric Use of Complementary Therapies: Ethical and Policy Choices" by Cohen et al. appeared in the October issue of Pediatrics electronic pages.

Pediatric Use of Complementary Therapies: Ethical and Policy Choices"
Michael H. Cohen, JD, MBA*,{ddagger},§, Kathi J. Kemper, MD, MPH, Laura Stevens, BA, Dean Hashimoto, JD, MD and Joan Gilmour, LLB, JSD

* Division for Research and Education in Complementary and Integrative Medical Therapies, Harvard Medical School, Boston, Massachusetts{ddagger} LLB Program, College of the Bahamas, Nassau, Bahamas§ Institute for Integrative and Energy Medicine, Cambridge, Massachusetts Department of Pediatrics, Brenner Children’s Hospital, Wake Forest University School of Medicine, Winston-Salem, North Carolina Boston College School of Law, Boston, Massachusetts# Osgoode Hall Law School, York University, Toronto, Ontario, Canada
Objective. Many pediatricians and parents are beginning to integrate use of complementary and alternative medical (CAM) therapies with conventional care. This article addresses ethical and policy issues involving parental choices of CAM therapies for their children.

Methods. We conducted a literature search to assess existing law involving parental choice of CAM therapies for their children. We also selected a convenience sample of 18 states of varying sizes and geographic locations. In each state, we inquired within the Department of Health and Human Services whether staff were aware of (1) any internal policies concerning these issues or (2) any cases in the previous 5 years in which either (a) the state initiated proceedings against parents for using CAM therapies for their children or (b) the department received telephone calls or other information reporting abuse and neglect in this domain. We asked the American Academy of Pediatrics and the leading CAM professional organizations concerning any relevant, reported cases.

[for full text see Pediatrics online at http://pediatrics.aappublications.org/.]

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