Bimanual strategies for object retrieval in infants and young children

Age differences in goal-directed bimanual coordination were studied in typically developing infants aged 9–29 months, compared to a group of children aged 4–6 years and a group of adults, using an object retrieval task. This task required one hand to open and hold the lid of a transparent box, while the second hand retrieved a small toy from inside the box. Well-coordinated retrieval strategies with differentiated use of the two hands were not established in the majority of infants until 18 months of age. Temporal analysis of the hand actions revealed that, unlike adults who perform the task with close synchronization of the hands at the start, the infants performed the task sequentially and did not activate the second hand until the first hand had started to lift the lid. The children’s hand preferences for the two-hand actions also contrasted with those of adults. In children aged 27–29 months and 4–6 years, there was a preference for using the right-hand to lift the lid while in right-handed adults, the reverse pattern was observed. The results suggest that although bimanual coordination starts to develop in the second year of life, the adult pattern of performance on this task is not observed before 6 years of age. It is likely that further maturation of the brain networks involved in bimanual coordination, and in particular functional interhemispheric transfer via the corpus callosum, is required before automatization of bimanual hand actions is achieved.     

Vaccination strategies for mucosal immune responses

Mucosal administration of vaccines is an important approach to the induction of appropriate immune responses to microbial and other environmental antigens in systemic sites and peripheral blood as well as in most external mucosal surfaces. The development of specific antibody- or T-cell-mediated immunologic responses and the induction of mucosally induced systemic immunologic hyporesponsiveness (oral or mucosal tolerance) depend on complex sets of immunologic events, including the nature of the antigenic stimulation of specialized lymphoid structures in the host, antigen-induced activation of different populations of regulatory T cells (Th1 versus Th2), and the expression of proinflammatory and immunoregulatory cytokines. Availability of mucosal vaccines will provide a painless approach to deliver large numbers of vaccine antigens for human immunization. Currently, an average infant will receive 20 to 25 percutaneous injections for vaccination against different childhood infections by 18 months of age. It should be possible to develop for human use effective, nonliving, recombinant, replicating, transgenic, and microbial vector- or plant-based mucosal vaccines to prevent infections. Based on the experience with many dietary antigens, it is also possible to manipulate the mucosal immune system to induce systemic tolerance against environmental, dietary, and possibly other autoantigens associated with allergic and autoimmune disorders. Mucosal immunity offers new strategies to induce protective immune responses against a variety of infectious agents. Such immunization may also provide new prophylactic or therapeutic avenues in the control of autoimmune diseases in humans.     

Effect of maternal diet during lactation on development of bovine insulin-binding antibodies in children at risk for allergy

BACKGROUND: The role of exposure to dietary antigens through maternal milk is intriguing, because it may result either in immunization or in tolerance. Exposure to cow's milk proteins results in antibody formation against bovine insulin in infants at risk for type 1 diabetes. OBJECTIVE: To study the appearance of IgG antibodies to bovine and human insulin in infants with an atopic family history whose mothers followed a cow's milk-free diet during the first 3 months of lactation. METHODS: In a prospective cohort study on prevention of food allergies, 123 infants were exclusively breast-fed or received supplementation with a hydrolyzed casein-based formula (Nutramigen) until the age of 6 months. The mothers either avoided cow's milk during the first 3 months of lactation (diet group) or had an unrestricted diet (nondiet group). The levels of IgG antibodies to bovine and human insulin were determined by enzyme immunoassay at 3, 6, 12, and 18 months and at 4 years. In addition, cord blood was obtained at birth and a maternal sample at delivery. RESULTS: At 3 months, IgG antibodies to bovine insulin were low in both dietary groups (median levels 0.150 and 0. 114 optical density units in the diet and nondiet groups). After exposure to dietary insulin, IgG antibodies to bovine insulin increased in both groups, reaching a peak at 12 months in the nondiet group and at 18 months in the diet group. At 18 months, IgG antibodies to bovine insulin were lower in infants in the nondiet group than in infants in the diet group (0.287 vs 0.500, P<.0001). At 4 years, the antibodies no longer differed between the groups. CONCLUSION: The exposure to cow's milk proteins through breast milk during the first 3 months of life resulted in decreased levels of antibodies to dietary bovine insulin at 18 months of age, suggesting a role for breast milk antigens in early tolerance induction.     

Risk-taking and coping strategies of adolescents and young adults with food allergy

BACKGROUND: Fatal food-allergic reactions are most common among adolescents and young adults. OBJECTIVE: To gain insight toward devising interventions, we queried risk-taking behaviors and coping strategies of persons age 13 to 21 years with food allergy. METHODS: We used an Internet-based anonymous questionnaire devised on the basis of data from focus groups. RESULTS: Participants (174 subjects; 49% male; mean age, 16 years) reported the following: 75% had peanut allergy, 75% had 2 or more food allergies, and 87% had been prescribed self-injectable epinephrine. Regarding risk taking, 61% reported that they "always" carry self-injectable epinephrine, but frequencies varied according to activities: traveling (94%), restaurants (81%), friends' homes (67%), school dance (61%), wearing tight clothes (53%), and sports (43%). Fifty-four percent indicated purposefully ingesting a potentially unsafe food. Willingness to eat a food labeled "may contain" an allergen was reported by 42%. Twenty-nine participants were designated at high risk because they did not always carry epinephrine and ate foods that "may contain" allergens. The high-risk group, compared with the rest of the participants (P < .05), felt less "concern" about and "different" because of their allergy and had more recent reactions. The high-risk group was not distinguishable (P = not significant) by age, sex, or number or severity of reactions. Participants variably (60%) tell their friends about their allergy, but 68% believe education of their friends would make living with food allergy easier. CONCLUSIONS: A significant number of teens with food allergy admit to risk taking that varies by social circumstances and perceived risks. The results imply that education of teenagers and, importantly, those around them during social activities might reduce risk taking and its consequences. CLINICAL IMPLICATIONS: Our survey of adolescents and young adults with food allergy revealed risk-taking behaviors that vary by social circumstances and perceived risks, indicating that education of teenagers and their peers might reduce risk taking and its consequences.     

EpiPen Jr versus EpiPen in young children weighing 15 to 30 kg at risk for anaphylaxis.

BACKGROUND: The EpiPen Jr (0.15 mg) and EpiPen (0.3 mg) auto-injectors, widely prescribed for the out-of-hospital treatment of anaphylaxis, have not been compared prospectively in young children. OBJECTIVE: The purpose of this investigation was to study the rate and extent of epinephrine absorption after use of the EpiPen Jr and the EpiPen in children weighing 15 to 30 kg. METHODS: In a randomized, double-blinded, parallel-group pilot study, children at risk for anaphylaxis self-injected epinephrine using either an EpiPen Jr or an EpiPen with the aid of a physician. Plasma epinephrine concentrations, blood glucose, blood pressure, heart rate, and adverse effects were monitored before and for 180 minutes after the injection. RESULTS: Children (age [mean +/- SEM], 5.4 +/- 0.4 years; weight [mean +/- SEM], 18.0 +/- 0.6 kg) who injected epinephrine with an EpiPen Jr achieved a maximum plasma concentration (mean +/- SEM) of 2037 +/- 541 pg/mL at 16 +/- 3 minutes. Children (6.6 +/- 0.5 years; 25.4 +/- 1.5 kg) who injected epinephrine with an EpiPen achieved a maximum plasma concentration of 2289 +/- 405 pg/mL at 15 +/- 3 minutes. Mean systolic blood pressure 30 minutes after epinephrine injection was significantly higher with the EpiPen than with the EpiPen Jr. After injection with the EpiPen Jr, every child experienced transient pallor; some also experienced tremor and anxiety. After injection with the EpiPen, every child developed transient pallor, tremor, anxiety, and palpitations or other cardiovascular effects; some also developed headache and nausea. CONCLUSION: Epinephrine injection with the EpiPen rather than the EpiPen Jr raised the systolic blood pressure significantly but also caused more adverse effects. The beneficial pharmacologic effects and the adverse pharmacologic effects of epinephrine cannot be dissociated. For the out-of-hospital treatment of anaphylaxis, additional premeasured, fixed doses of epinephrine would facilitate more precise dosing in young children.     

Sleep disturbance and injury risk in young children

The objective of this study was to investigate the relationship between sleep disturbance and both injury rates and injury-prone behaviors in preschool-age and early school-age children, using cross-sectional surveys of sleep disturbance (Children's Sleep Habits Questionnaire) and injury-related behaviors (Injury Behavior Checklist), and chart review of injuries. Participants were 71 patients enrolled in a pediatric clinic in a children's teaching hospital, ages 3 through 7 years, coming either for well-child care in a pediatric primary care clinic or for pediatric emergency room treatment of minor injuries. Results suggest that children with more frequent injuries had significantly more sleep problems overall, particularly anxiety around sleep, than did children with low injury rates. Children with more parent-reported injury-prone behaviors also had significantly more sleep disturbance. Daytime sleepiness-related items did not differ between injury history or injury behavior groups. Results of this study support an increased prevalence of sleep disturbances in young children with higher injury rates and more injury-prone behavior. Sleep disturbance may be a potential risk factor for increased injuries in this age group.     

Sustained attention in young people at high risk for schizophrenia

BACKGROUND: Sustained attention has been found to be impaired in individuals suffering from schizophrenia and their close relatives. This has led to the hypothesis that impaired sustained attention is an indicator of vulnerability to schizophrenia. METHODS: The Edinburgh High Risk Study used the Continuous Performance Test-Identical Pairs version (CPT-IP) to assess sustained attention in 127 high risk participants, 30 controls and 15 first-episode schizophrenic patients. A second assessment was completed by 59 high risk and 18 control participants 18 months to 2 years after the first. RESULTS: No differences in attentional capacity were found between the high risk and control groups and there was no association between genetic liability to schizophrenia and poor performance on the CPT-IP. Additionally, no association between occurrence of psychotic symptoms in the high risk group and impaired attentional capacity was found. CONCLUSIONS: The results suggest that deficits in sustained attention are not indicative of a genetic vulnerability to schizophrenia, and are not associated with the occurrence of psychotic symptoms.     

Mealtime behavior among parents and their young children with food allergy

Background

Food allergies are increasingly prevalent in the pediatric population. Balancing allergen avoidance with the promotion of healthy eating behaviors can be challenging for families.

Cytomegalovirus mononucleosis: risk for fathers of young children.

A case of pyrexia of unknown origin in a 35-year-old man, who had become a father nine months earlier, is presented. A diagnosis of cytomegalovirus mononucleosis was achieved only after extensive investigations. It is suggested that cytomegalovirus mononucleosis should be added to the differential diagnosis when investigating pyrexia of unknown origin in fathers of young children.     

Socioeconomic status is a risk factor for allergy in parents but not in their children

BACKGROUND: Allergic diseases are more prevalent in affluent countries, which has been attributed to life-style factors. Life-style habits may also differ between socioeconomic (SES) classes. The objective of this paper therefore was to evaluate if SES had an impact on the development of atopic disorders. METHODS: A total of 1314 German children were followed-up in an observational birth cohort study to 6 years of age. Parents filled in questionnaires, and had multi-allergen screening tests for sensitization. Indoor allergen concentrations were determined by ELISA. Children were examined regularly up to 6 years, specific serum IgE values were determined by CAP-Rast-Feia. RESULTS: The risk of aeroallergen sensitization (odds ratio 1.76; 95% CI 1.30-2.37), and the lifetime prevalence of hay fever (2.36; 1.76-3.17), and asthma (1.74; 1.08-2.80), but not of atopic dermatitis (AD: 0.90; 0. 54-1.51) was elevated in parents of high compared to low SES. With high SES the risk of smoking in pregnancy (0.35; 0.23-0.51), in the home (0.31; 0.21-0.46), pet ownership (0.37; 0.26-0.55), high mite (0.42; 0.25-0.74), and high cat (0.38; 0.18-0.82) allergen concentration in house dust was reduced, but elevated for breastfeeding over more than 6 months (4.67; 2.9-7.48). In children, even after controlling for other risk factors, only the risk of AD from 3 to 6 years (2.42; 1.42-4.14) was elevated in families with high SES, but not of AD in infancy or of any other atopic disorder. CONCLUSIONS: While parents of high SES have a higher prevalence of inhalative allergies, their favourable life-style prevents the development of atopic disorders in their children, except for AD beyond infancy.     

Vaccination strategies for the global eradication of poliomyelitis

The world-wide initiative to eradicate poliomyelitis has been remarkably successful since its launch in 1988. According to the WHO, the last wild virus should be isolated in 2005, thus paving the way for the certification of a world free of poliomyelitis in 2008. Discontinuation of poliomyelitis vaccination which constituted the ultimate objective of this campaign has been jeopardised by two recent developments: the characterisation of vaccine-derived polioviruses (VDPV), either circulating or excreted by immunodepressed patients, and renewed concern about the risk of bioterrorism. The threats posed by VDPV have led WHO to recommend that OPV usage be discontinued as soon as possible after eradication certification. This article examines the consequences of these developments and describes possible vaccination strategies to counter these new circumstances.     

The prevalence of allergy to egg: a population-based study in young children

BACKGROUND: The aim of the present study was to estimate the prevalence of adverse reactions to egg, as population-based prevalence estimates based on objective diagnostic procedures are lacking. METHODS: The parents of 2721 children in a population-based birth cohort completed questionnaires on the occurrence of any reaction to food at 12, 18, and 24 months of age. Children with parentally reported reactions to eggs at the age of 2 years were selected for further examination. A stepwise diagnostic procedure was developed that included diet trials at home, skin prick tests, and open and double-blind, placebo-controlled food challenges. The mean age of the children at the time of the examination was 2.5 years (CI 2.5-2.6). A sample of children without perceived reactions to egg was also selected for assessment of unrecognized reactions. RESULTS: The estimated point prevalence of allergy to egg in children aged 2(1/2) years was 1.6% (CI 1.3-2.0%), with an upper estimate of the cumulative incidence by this age calculated roughly at 2.6% (CI 1.6-3.6). Almost all reactions were IgE mediated. In general, two-thirds of the parentally perceived reactions were verified. However, the positive predictive value of a parentally perceived reaction depended on the number of times it had been reported, and increased from 50% to 100%, for reactions reported one and three times, respectively. Unrecognized reactions were infrequent. CONCLUSION: This study confirms that allergy to egg is frequent in a child population.