Social Ladder Forms Early in Life

Lori Holden, 46, of Denver, Colo., remembered fourth-grade as the year she was forever labeled a "nerd, or a dork, or pick the pejorative of your choice." It was a label that stuck until college.

At 46, now with a successful life, Holden said she is perfectly fine with her nerdy identity. But after watching her two young children play with others, she took pause.

"It is doing things like telling another child, 'Don't play with that yet, you can't play with that,' and then turning to another child and saying, 'Just you and I will play together,'" Holden said.

"I watch my children with their peers and wonder if I am seeing the early stages of their social-ladder construction," she said.

"I can see this happening at age 4 and 5."

Holden has it right, according to Maurice Elias, professor of psychology at Rutgers University in New Jersey and the author of "Emotionally Intelligent Parenting."

"It is true that it's a natural tendency in kids to form groups and have in-groups and out-groups, and you can see that in very young children," Elias said.

A small group of children in preschool might isolate one child. By fourth-grade, Elias said, children become more sophisticated at creating lasting labels for entire groups.

"But age 4 to 5 is when you really want to start to think about this, in my opinion," he said.

Long-term studies show once children get labeled in a group, clique or ladder on the social rung, that status tends to stick all the way through the high school years, Elias said.

"It may be an impulse, but there's no reason why all children, including children that are a little different, can't play together," he said. "The reason we were given frontal lobes is so that we would modify these sorts of instinctual tendencies."

Elias said researchers have learned the drive to exclude can be molded and controlled by teachers so that no strict mini-caste system or pervasive pecking order rules the school.

Reading, and Writing and ... Social Utopia?

Elias is part of a burgeoning movement to teach empathy and "emotional learning" in schools across the United States. In 2003, Illinois passed the Illinois Children's Mental Health Act to require emotional learning in schools. Similar legislation was passed in New York State in 2006. Some groups estimate that 10 percent of all U.S. schools now use some kind of evidence-based, emotional learning program.

By 2007, governments in Spain and Malaysia adopted programs for emotional learning.

Stemming Social Ladders Internationally

"In Singapore, it's now been standardized as part of the curriculum there," said Mary Utne O'Brien, vice president of strategic initiatives for the non-profit Collaborative for Academic Social and Emotional Learning (CASEL).

"The international community in Singapore said 'our students are technically brilliant here, they always win national science awards, but they aren't creatively solving problems'," said O'Brien, who is also a professor of education and psychology at the University of Illinois at Chicago.

With slipping international rankings in math and science test scores, the United States seems to have the opposite problem.

O'Brien said educators on American soil dealing with behavioral problems were moved to try the emotional learning program.

"It was a bunch of teachers saying these problems get too big for us to handle by the time kids get older," O'Brien said. "We'd be much smarter to give children the emotional tools to start out in school in the first place.

"We don't think of these things as an intelligence, we think of them as skills that can be taught."

As Holden guessed, the social hierarchy does start at a very young age and, as she hoped, there might be something she and the children's teachers can do about it.

"As a parent, you want to work on both ends of it," Holden said. "You don' want them to be a mean person, but you don't want them to be a victim of a mean person."

What Parents and Teachers Can Do About Social Ladders

Elias said some researchers have shown that children do have a natural temperament that might lead them to exclude or be excluded. But these temperaments are like a "factory preset"

"Kids will try on different behavior, their temperament can lead them to start somewhere," Elias said. "Some kids can start out by being shy, some kids can start out by being very directive and bossy."

Teachers Impact the Cliques in a School

Depending on how on how far the behavior gets them, the child might adjust the degree of their natural temperament, Elias said.

"The most powerful factor in that is the environment," said Elias.

Parents and teachers needn't make children play with everyone, but social learning experts say that not tolerating emotionally aggressive behavior in the same way of enforcing a rule of "no hitting" can go a long way. So, too, can encouraging children to recognize similarities in their classmates.

"Even when we see these longitudinal studies that kids retain these attributes over time, but we don't know what the adults did during that time," Elias said.

Since the mid-1990s, groups like CASEL and others have done intensive studies about which social interventions work. Even something in kindergarten as simple as the seminal book "You Can't Say You Can't Play," by Vivian Gussin Paley, can have a lasting effect in students.

But despite the reports of classrooms with happier, more congenial children, researchers like Elias and people at CASEL weren't universally sought after by schools.

Why Care About the Social Ladder Anyway?

"We had parents say, 'In our neighborhood, if you teach my kids this, they're going to be sliced and diced on the street.' This is not the way we live," O'Brien said.

"It is a question as to whether the little lambs from these schools are brought to slaughter later," O'Brien added. "But more it's administrators fearing that this was not the role of the school."

Even in more touchy-feely districts, O'Brien said, many administrators balked at trying to spend money on programs for empathy and emotional learning when the district needed to compete in academic arenas.

That is, until more studies showed a link between the emotional learning programs and higher performance in academics.

O'Brien and her colleagues met Friday with representatives of the U.S. Department of Education in talks about incorporating standards in the federal levels for emotional learning programs.

"They have a profound impact on their behaviors, it affects academic achievement and standardized test scores," O'Brien said. "Once the academic link was established, it really became a point of entree."
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'Vid Kids' Likely to Suffer Delayed Language Development

The more time your infant or toddler spends listening to the television, the less likely he is to hear your voice, or to speak himself, a new study asserts.

The findings strengthen a suspected link between infant TV exposure and delayed language development, according to a report in the journal Archives of Pediatric and Adolescent Medicine.

This sets up an interesting paradox. While some researchers think audible TV is linked to decreased communication in young children, an entire market of educational DVDs geared toward babies has sprouted under the opposite theory that TV programs can help promote interaction between parent and child.

Whatever the connection, infants are spending an increased amount of time in front of the TV, according to a team led by Dr. Dimitri A. Christakis of the Center for Child Health, Behavior and Development at the University of Washington.

A 2003 report from the Henry J. Kaiser Family Foundation found that each day, 68 percent of American infants viewed some type of electronic medium: TV programming, DVDs or video tapes, computers or video games.

To determine the impact of infant TV watching, the Christakis group recruited parents who agreed to equip their 2- to 24-month-old kids with a wire for one day a month in order to record every sound for a 12- to 16-hour period.

Using noise-detection software that analyzed at least one recorded session from each of the 329 youngsters, files were sorted into sounds the kids heard and sounds the kids made.

The researchers used a statistical model to determine the association between audible television and the number of words spoken by each adult and each child. They also examined how many meaningful vocal interactions were shared by the child and adult while the TV was on.

They found that each hour spent with a TV was associated a significant reduction in a child's own attempts to talk.

Likewise, for each hour in front of the tube, the child heard 770 fewer words from an adult. That's 7 percent fewer than the average number of words a child hears in a household when the television is off.

TV May Present Toddlers With Distractions

"Some of these reductions are likely due to children being left in front of the television screen, but others likely reflect situations in which adults, though present, are distracted by the screen and not interacting with their infant in a discernible manner," the researchers concluded.

The authors said 30 percent of households have a TV on at all times, which brings up the question, How many opportunities for child-parent communication are being missed?

Previous research has shown that when adults are watching their own programs -- even a show like Jeopardy, which would be mere background noise to an infant -- the grownups communicate less with their children, and the kids make less noise themselves, said Deborah Linebarger, a researcher at the University of Pennsylvania who has studied the effects of media on young children.

Linebarger was not affiliated with the study.

The authors of the latest report acknowledged that their findings seem obvious: More TV time equals less human interaction. But they say it might also debunk the claims of companies that market DVDs for infants suggesting that their products promote child-parent interaction.

Those claims are not backed by evidence, the authors said, adding that communicating with a child while the TV is on may be more important than the type of program to which the child is exposed.

Linebarger said her biggest criticism of the Christakis study is that it did not take into account what effect various types of programs have on parent-child communication.

She said her research indicates that television shows designed for young kids that mimic the storytelling approaches of books are best at promoting language development.

The battle is likely to go on, with plenty of ammunition on both sides.

Since 1999, the American Academy of Pediatrics has discouraged the watching of TV or other screen media by children younger than 2.

In addition to its adverse effects on body weight, attention and sleep, watching TV before age 2 may restrict a child's cognitive development and the uptake of language, a variety of studies have found.

TV Exposure May Not Increase Baby's Intelligence

But research published in Pediatrics as recently as March found that the amount of time spent watching TV before age 2 was not associated with cognitive development at age 3.
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Vaccine Refusal Puts Kids at Risk for Whooping Cough

Children of parents who refuse to have their children vaccinated against whooping cough are 23 times more likely to develop the disease than children who get the shots, according to a new study. The U.S. Centers for Disease Control and Prevention says whooping cough now infects more 5,000 children a year.

Authors of the study, which was conducted at Kaiser Permante Colorado's Institute for Health Research in Denver, say the results show a continued need to "to further understand why parents refuse immunizations and to develop strategies for conveying the risks and benefits of immunizations to parents more effectively."

Whooping cough or pertussis -- the medical name for the disease, causes a respiratory infection with an uncontrolled cough with a characteristic whoop or yelp -- said Dr. Jason Glanz, the lead author of the study.

Parents may shun the vaccines over the fear of rare but serious side effects associated with the use of some vaccines in certain individuals.

Many parents who refuse whooping cough vaccine make the argument that their children don't need to be vaccinated because peers -- friends and classmates -- have been vaccinated so all children in the group would be protected by a phenomenon known as herd immunity.

But Glanz said his study suggests that the herd immunity theory doesn't hold for pertussis.

"One of the misperceptions among parents is that the pertussis vaccine doesn't work and that their children are at low risk for infection, and our study showed that both were not true," Glanz said.

Glanz and his colleagues based that estimate on a case control study that compared children whose parents had refused vaccination to children who received vaccinations. The findings were published in the June issue of Pediatrics.

The researchers determined that 11 percent of whooping cough cases in the overall population were linked to vaccine refusal.

Dr. Gregory Poland, director of Mayo Clinic Vaccine Research Group in Rochester, Minn., said this study's results were consistent with others.

"Parents need to know they place their children at a documented and real risk, as well as others, when they refuse vaccines based on inaccurate information," he said.

He added, "This study shows that there is plenty of pertussis out there and it is highly contagious."

Vaccine Refusal Leaves Door Open to Whooping Cough Infection

The CDC said the incidence of pertussis has increased steadily each year since the 1980s and in 2007 the incidence was 3.6 cases per 100,000 population.

The World Health Organization reported more than 200,000 whooping cough deaths in 2000 world-wide.

Initially the symptoms mimic the common cold -- upper respiratory congestion and a cough. But the cough rapidly progressed to the characteristic whoop or yelp in rapids succession or paroxysms. In infants complications included pneumonia, seizures, brain swelling, and death. Adults are also at risk for pneumonia and rib fractures caused by coughing.

The rate of vaccine refusal in the United States remains low, typically measured by counting non-medical exemptions from required school immunizations. But it has increased over the past two decades.

This could be the result of parents' attention shifting from the dangers of vaccine-preventable illnesses to issues of vaccine safety as the diseases become rarer, Glanz and colleagues said.

In a herd effect, some parents believe the diseases are not much of a threat to their children, or that vaccinated children will protect the unvaccinated, they say.

But Dr. Ari Brown, a pediatrician in Austin, Tex., and co-author of Baby 411, said this study "is proof that their kids cannot hide in the herd."

Accompanying the rise in vaccine refusal are increasing rates of some vaccine-preventable illnesses, such as pertussis and measles. In 2007, there were more than 10,000 cases of pertussis in the U.S. In 2008, there were 131 cases of measles, the most in 12 years.

And, because like-minded families "live in the same communities and send their children to the same schools," Brown said, "it leaves clusters or hot pockets that are ground zero for an outbreak."

For example, Colorado had a disproportionate number of the pertussis cases in 2007, making it a good place to study vaccine refusal and rates of infection, Glanz said.

To quantify the increased risk of pertussis with vaccine refusal using patient data, the researchers examined Kaiser Permanente's electronic health records for patients ages 2 months to 18 years over a 12-year period.

Infection Risk Soars 20-Fold in Unvaccinated Children

They looked for children who had laboratory-confirmed cases of pertussis, and for those whose parents had refused at least one of the initial series of diphtheria, pertussis, and tetanus (DTaP) immunization for their children.

During the study, there were 156 confirmed cases of pertussis infection. These cases were matched with up to four healthy controls each.

During the study period, the overall rate of vaccine refusal at Kaiser Permanente was less than 1 percent.

Infected children were significantly more likely to have parents who refused vaccinations than the controls (11.5 percent versus 0.5 percent). The difference equated to a 22.8-fold increased risk of infection in the unvaccinated children.

In a secondary analysis limited to children who were continuously enrolled at Kaiser Permanente from 2 to 20 months of age (the period during which the initial immunization series would be completed), there was a similarly high risk.

Glanz said that when clinicians encounter parents who refuse vaccines for their children, "it's important to not be defensive, not be condescending. Just acknowledge their fears and help them weigh the risks and benefits the best way you can."

Doctors Should Confront Misconceptions About Pertussis Vaccine

Glanz also said it might be helpful for physicians to familiarize themselves with the vaccine-refusal literature so they can directly refute misconceptions -- although he acknowledged that time constraints make this difficult.

The authors acknowledged that the study was limited by the use of data from a single health plan in one state.

The study was supported by a grant from the National Institute of Allergy and Infectious Diseases.

The authors reported that they had no relevant financial relationships to disclose.
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Cancer chemicals: Pool herbicides put kids at risk

It seems a lot of Australian homeowners are turning to carcinogenic herbicides to keep their pools the right shade of blue.

Authorities are considering placing a ban on the use of herbicides which have a key ingredient called simazine which is of particular risk to children.

There are almost 1 million swimming pools in Australia. In a sun-soaked land they provide fun for children and relief from the heat.

Dr Alison Bleaney is a GP in Tasmania and for a long time has had concerns about the use of chemicals in swimming pools.

"The concern is that children are more susceptible to the effects of chemicals in their bodies than adults are, just by the fact that they're smaller, their systems are not capable of detoxifying nasty chemicals the way an adult is," she said.

"We know that the trizines, atrazines, simazines, are immune modifiers, they modify our immune systems, they affect our hormone systems in extremely small levels.

"In swimming pools they can be taken in through the skin surface ... as well as children of course just gulping it down."

Her concerns have been ignored for a long time despite moves on the other side of the world to ban the use of simazine as a cleaning agent.

"They've been withdrawn in the United States in the early 1990s, aren't used at all in Europe, and the fact that they're allowed to be used in our swimming pools, where our young children are swimming, can only be described as disgraceful," she said.

The Australian Pesticides and Veterinary Medicines Authority is independent of government and says it is prepared to review the evidence presented to it.

The regulator's spokesman is Doctor Simon Cubit.

"We undertake reviews when we have information that suggests that there might be concerns about a particular chemical," he said.

"We're at the scoping stage of that review. So what that means is that we'll get together and determine what we know now about the chemical, information that raises uncertainty about its continued use.

"The current advice that we have from our advisors, which are other commonwealth government departments, has not suggested that there are any causes of concern."

A spokeswoman for Federal Agriculture Minister Tony Burke says the Government welcomes the review.

She says the Minister believes the community needs to remain vigilant on the use of chemicals with the potential to have an impact on human health.
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Study Adds to Evidence of Vaccine Safety

A new study from Italy adds to a mountain of evidence that a mercury-based preservative once used in many vaccines doesn't hurt children, offering more reassurance to parents.

In the early 1990s, thousands of healthy Italian babies in a study of whooping cough vaccines got two different amounts of the preservative thimerosal (pronounced thih-MEHR'-uh-sawl) from all their routine shots.

Ten years later, 1,403 of those children took a battery of brain function tests. Researchers found small differences in only two of 24 measurements and those "might be attributable to chance," they wrote in the February issue of the journal Pediatrics, which was released Monday.

Only one case of autism was found, and that was in the group that got the lower level of thimerosal.

Autism is a complex disorder featuring repetitive behaviors and poor social interaction and communication skills. Scientists generally believe genetics plays a role in causing the disorder; a theory that thimerosal is to blame has been repeatedly discounted in scientific studies.

"Put together with the evidence of all the other studies, this tells us there is no reason to worry about the effect of thimerosal in vaccines," said the new study's lead author, Dr. Alberto Tozzi of Bambino Gesu Hospital in Rome.

The debate over thimerosal and autism has been much stronger in the United States than in Italy, Tozzi said. But the researchers recognized a chance to examine the issue by going back to the children who had taken part in the 1990s whooping cough research.

Randomization sets the new study apart. The random assignment of children rules out the chance that factors other than thimerosal, such as education or poverty, caused the results.

Thimerosal, used in some vaccines to prevent the growth of bacteria and fungus, hasn't been in U.S. childhood vaccines since 2001, except for certain flu shots. Italy and other European nations began removing it in 1999. U.S. health officials recommended the removal of thimerosal as a precaution and to reduce the overall exposure of children to mercury.

Safety regulations still require multi-dose vials of vaccines to contain some type of preservative to prevent the spread of infection from contaminated vials.

The study, funded by the U.S. Centers for Disease Control and Prevention, drew praise from outside experts.

"It's yet another well done, peer-reviewed research study that has demonstrated there is no risk of any neurodevelopmental outcomes associated with thimerosal in vaccines," said epidemiologist Jennifer Pinto-Martin of the University of Pennsylvania.

"This becomes the fourth study to look for subtle signs of mercury toxicity and show the answer was 'no,'" said Dr. Paul Offit, chief of infectious diseases at the Children's Hospital of Philadelphia, the author of a book on autism research and the co-inventor of a rotavirus vaccine.

Tozzi said comparing children with no exposure to thimerosal could have improved the study. "However, if thimerosal were a cause of harm, it is likely that this effect would increase with the administered dose," he said.

The children received either 62.5 micrograms or 137.5 micrograms of ethyl mercury from all their shots during their first year of life. Thimerosal breaks down as ethyl mercury in the body. Before the reduction of thimerosal in the United States, the maximum exposure for infants was 187.5 micrograms of ethyl mercury.

The researchers found the children in both groups scored, on average, in the normal range on 11 tests of memory, attention, motor skills and other brain functions.

Those 11 tests included 24 measured outcomes. Small, but statistical differences were found for only two of those areas, and only for girls. The girls with higher exposure scored worse on a finger-tapping test with their dominant hands, and on a vocabulary test in which they were asked to name common objects.

There was no difference in boys on those outcomes or others. Researchers also found no difference in tic disorders. And the one autism case found in the lower-intake group was likely a chance finding, Tozzi said.


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U.S. School Children Need Less Work, More Play: Study

Researchers reported on Monday that a growing trend of curbing free time at school may lead to unruly classrooms and rob youngsters of needed exercise and an important chance to socialize.

A look at more than 10,000 children aged 8 and 9 found better classroom behavior among those who had at least a 15-minute break during the school day compared to those who did not, Dr. Romina Barros and colleagues at the Albert Einstein College of Medicine in New York reported.

The behavior assessments were general in nature and not made at any particular time of the school day, their report said.

"The available research suggests that recess may play an important role in the learning, social development, and health of children in elementary school," the research team said in a study published in Pediatrics, the journal of the American Academy of Pediatrics.

But today many children get less free time and fewer physical outlets at school "because many school districts responded to the No Child Left Behind Act of 2001 by reducing time committed to recess, the creative arts, and even physical education in an effort to focus on reading and mathematics," they added.

The researchers also found that children not getting recess were more likely to be black, from poor families and attending public schools in large cities.

"This raises concern in light of evidence that many children from disadvantaged backgrounds are not free to roam their neighborhoods or even their own yards unless they are accompanied by adults," the team said. "For many of these children, recess periods may be the only opportunity for them to practice their social skills with other children."
Barros told Reuters that previously published research indicates that poor children often are deprived of recess because "those schools are located in very violent neighborhoods, and there is the concern that children may get exposed to fights or gun shooting while in recess."

In addition, she said, such schools are often overcrowded, with space designated for recess or physical activity turned into classrooms.

The study also said the growing problem of childhood obesity needs to be addressed by more activity, especially at school where children spend so much of their day.

One earlier study found that free time has shrunk for U.S. children in and out of school since the 1970s, the report said. At the same time most elementary schools in Asia provide a 10-minute break after every 40 to 50 minutes of instruction, it added.
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ADHD Drugs Can Cause Hallucinations in Some Kids

Drugs Like Ritalin, Adderall Have Psychiatric Side Effects in Some Children

CHICAGO (Reuters) - Drugs for attention deficit hyperactivity disorder can cause children to have hallucinations even when taken as directed, U.S. government researchers said on Monday.

U.S. Food and Drug Administration researchers analyzed data from 49 clinical studies conducted by makers of the drugs and found they can cause psychosis and mania in some patients, including some with no obvious risk factors. In some cases, children hallucinated that worms, bugs or snakes were crawling on them.

"Patients and physicians should be aware of the possibility that psychiatric symptoms consistent with psychosis or mania" might arise in the course of treatment, Dr. Andrew Mosholder and colleagues wrote in the journal Pediatrics.

Their analysis provides fresh detail about known risks of the drugs, which include Novartis AG's Ritalin and Focalin XR, Shire Plc's Adderall XR and Daytrana patch, Johnson & Johnson's Concerta, Eli Lilly and Co's Strattera and Celltech Pharmaceuticals Inc's Metadate CD.

It also includes data on Cephalon Inc's modafinil, sold as Provigil, a narcolepsy drug that was rejected as an ADHD treatment in children.

FDA spokeswoman Sandy Walsh said the data formed the basis for recent warnings about psychiatric side effects that have been added to product labels in recent years.

Millions of children use drugs to treat symptoms of ADHD, which affects about three to seven percent of U.S. children.

ADHD is marked by restlessness, impulsiveness, inattention and distractibility that can interfere with a child's ability to pay attention in school and maintain social relationships.

"The numbers of cases of psychosis or mania in pediatric clinical trials were small," Mosholder and colleagues wrote. "However, we noted a complete absence of such events with placebo treatments."

In one account, they described a 7-year-old girl who took an 18 mg dose of Strattera or atomoxetine who started talking nonstop within hours of taking her first dose.

"Two hours after taking her second dose of atomoxetine, the patient started running very fast, stopped suddenly, and fell to the ground. The patient said she had 'run into a wall' (there was no wall there)," they wrote.

"These adverse side effects are rare," said Dr. Harold Koplewicz of New York University Child Study Center, who was not involved in the study, adding that they are reversible,

"Once you stop the medicine, the side effects go away," he said in a telephone interview.

He said children under age 10 are susceptible to negative drug side effects in the same way that older adults are.

"We know that medications that affect neurochemicals in your brain to increase your attention and make you less impulsive also can have an effect on other neurochemicals in your brain that affect mood," he said.

Both Koplewicz and FDA researchers urged doctors to discuss the potential side effects with parents and children to help ease their anxiety if such symptoms should occur.
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Report Sheds Light on Infant Suffocation

Margaret D'Arrigo-Martin knows firsthand the pain of losing an infant.

In 2003, her baby Alexis Claire was a very healthy 6½-week-old. D'Arrigo-Martin said she would often nurse Alexis and place her in a crib next to her own bed.

On the night Alexis died, however, the infant was more fussy than usual, and D'Arrigo-Martin placed her next to her in the bed in order to comfort her. When she awoke two hours later, she was horrified to find her baby not breathing.

"If I knew I was putting her in an unsafe situation by letting her sleep next to me, I never would have done it," she said.

She performed CPR and called 911, but unfortunately, nothing could be done to bring Alexis back.

D'Arrigo-Martin knew how important it was to keep her baby on her back and keep blankets and pillows away. But she did not know that it could also be dangerous to have her baby sleeping in the bed next to her.

"If I were to do it again, I would definitely [have put her] in a bassinet next to the bed, knowing what I know now," she said.
Unfortunately, stories like D'Arrigo-Martin's are not uncommon. Infant deaths related to suffocation and strangulation in bed have quadrupled in the last two decades, researchers at the U.S. Centers for Disease Control and Prevention reported in a study published Monday in the journal Pediatrics.

However, lead study author Dr. Carrie Shapiro-Mendoza said the reported increase does not necessarily mean that more infants overall are dying. Rather, she said, medical examiners now have more information available to better classify deaths in which suffocation or strangulation has occurred.

"This provides support for child death review teams and better death scene investigations," Shapiro-Mendoza said. She added that the research suggests there needs to be more education of parents about safe sleep environments.

"Hopefully, it will reinvigorate the method of safe sleeping," she said.

Searching for an Explanation

The study looked at infant death rates between the years of 1984 and 2004 and found that deaths classified as accidental suffocation and strangulation in bed (ASSB) increased four-fold over this time period. But over the same time period, infant deaths classified as sudden infant death syndrome (SIDS) have declined. The total rate of unexplained death among infants has not changed significantly.

In the paper, ASSB includes suffocation by various means, such as when the baby's airway is blocked by soft bedding or a pillow, or if an adult rolls on top of the child. The classification of SIDS, on the other hand, indicates that there is no known cause of death after a thorough investigation.

So, why is it so important to further define the circumstances of death in these situations? Shapiro-Mendoza said that knowing what risk factors lead to ASSB and SIDS can help doctors tell new parents how to prevent these deaths from happening.

Dr. Sessions Cole, chief medical officer of St. Louis Children's Hospital, agreed.

"This will be a stimulus to get everyone to adhere to CDC recommendations for death scene investigations for children," Cole said.

But even as more information comes to light, there are still unanswered questions.

Currently, Shapiro-Mendoza said, the jury is still out on the exact risk factors for suffocation and strangulation in babies. These deaths occurred on beds, but they also occurred on cribs and sofas.

The study also finds that black male infants less than 4 months of age are most affected by ASSB, for reasons Shapiro-Mendoza said are still unclear.

Creating a Safer Sleep Space

But what is known is that parents can take steps to reduce the chance that their baby will die from suffocation or strangulation.

"We recommend room sharing instead of bed sharing," said Laura Reno, vice president of public affairs for First Candle, an organization devoted to parental education. "[Parents need to] learn how to create a safe sleep zone, making sure babies sleep in a separate space on their back, on a firm mattress, free from any soft bedding."

She added that if parents do not want to sleep too far away from their baby, they can place that safe sleep space right next to their bed.

"It will protect [the baby] and promote breastfeeding," Reno said.

Dr. Suresh Kotogal, a professor of neurology and a pediatric sleep specialist at Mayo Clinic, agreed.

"[This study] will fuel interest in this area again," Kotogal said. "[Safe] sleeping environments need to be emphasized by all primary care physicians and at the time babies [are] going home from the hospital."
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Poor Mothers and Children Most Vulnerable in Global Recession, World Health Organization Says

GENEVA (Reuters) - Global recession may lead many governments to reduce investment in basic healthcare, putting at risk the lives of vulnerable mothers and babies, the World Health Organization (WHO) said on Monday.

WHO Director-General Margaret Chan said the world's economic woes could set back huge public health campaigns meant to eliminate diseases, tackle the root causes of poverty and save the lives of mothers and babies.

The crisis will also make more people use public health services instead of private ones, adding to the demands on stretched public services.

"The crisis comes at a fragile time for public health ... Women and young children are among the first to be affected by a deterioration in financial circumstances and food availability," Chan told a meeting at the WHO's Geneva headquarters on the effects on health of the global financial turmoil.

The director-general raised concerns that "already vastly overstretched and underfunded" public health systems will fail to detect and treat conditions such as cancer and heart disease that are increasingly common in developing countries.

"In times of economic crisis, people tend to forego private care and make more use of publicly financed services," Chan said, warning that many people will neglect their health if they cannot access the basic services they need.

"Less preventive care is particularly disturbing at a time when demographic aging and a rise in chronic diseases are global trends," she added.

Efforts to safeguard healthcare funding in the crisis are expected to dominate the WHO's annual World Health Assembly in May, where health ministers may also reassess the United Nations agency's programs in the light of the financial malaise.

At a preparatory session for the assembly, the WHO's 34 member executive board also agreed on Monday to discuss the health situation in Gaza, where Israel damaged hospitals and killed 1,300 Palestinians during its three-week offensive.

The WHO executive board will consider that question on Tuesday afternoon and may add the issue for consideration by the WHO's full roster of 193 member states -- including Israel -- in May. The board's preparatory session runs until January 27.
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