Princesses aside, many young girls worry they are fat

Parents who worry their young daughters may be overexposed to princess images on television and in movies and videos can take a small measure of satisfaction from a new study showing girls age 3 to 6 don't suffer body-image problems from observing these characters. However, the study still found that even little girls worry they are fat.

The role of media in shaping girls' perceptions of their appearances has been a concern for many years. Several studies suggest that grade-school-age girls and teens compare themselves with fashion models and television and movie stars and may become dissatisfied with their own appearance as a result. But the new study, which surveyed 121 U.S. girls, found they were not affected by watching "Cinderella" or Belle in "Beauty and the Beast." Half of the girls watched videos of pretty, thin heroines and half watched videos that did not contain appearance-related messages. After observing the girls' behavior during play, the researchers concluded that young girls were more likely to adopt the persona of the princess instead of focusing on her appearance.

Despite this positive finding, 31% of the girls said they always worried about being fat and another 18% said they sometimes worried about being fat, according to the study, conducted by the researchers from the University of Central Florida.

The new Disney movie "The Princess and the Frog" opens this week in Los Angeles, providing a good opportunity for parents to talk to their daughters about perceptions of beauty. For example, parents can point out how the princess' waist is unrealistically tiny and that no one has perfect skin.

"We need to help our children challenge the images of beauty, particularly thinness, that they see and idolize and encourage them to question how much appearance should be part of their self-worth," said the lead author of the study, psychology professor Stacey Tantleff-Dunn, in a news release. "We should help them build a positive self-image with an appreciation for many different types of body attributes."

The study is published online this week in the British Journal of Developmental Psychology.

-- Shari Roan

Photo credit: Actress Anika Noni Rose arrives at the premiere of Walt Disney Pictures' "The Princess and the Frog" at the Disney Studios in Burbank. Credit: Kevin Winter  /  Getty Images.

Children in home-based day care watch more TV

Several studies have been conducted to determine how much television young children are watching. The topic is important because research shows planting a kid in front of the TV for several hours a day does much more harm than good. A new study, published online today in the journal Pediatrics, has found that children in day care are watching twice the amount of television than previously thought.

Previous studies on kids' viewing habits did not include data from hours of television watched in child care settings, according to researchers. The new study examined both home-based and child-care settings and found that, with the exception of infants, children in home-based day care programs were exposed to much more TV per day than children in child-care centers: for toddlers, 1.6 hours compared with .1 hour and, for preschool-age children, 2.4 hours versus .4 hour.

The average time of daily TV use for preschool-age children in which television was used at all was 3.4 hours for home-based programs and 1.2 hours in center-based programs. Overall, children watched TV daily in 70% of home-based programs and 36% of center-based programs. The study was conducted among 168 day-care settings, of which 94 were home-based.

These figures reflect little change from surveys conducted in previous years, noted the authors, from the University of Washington. "This lack of change is disconcerting, given the intervening publication of the American Academy of Pediatrics guidelines regarding television use for young children," the authors wrote in the paper. They note that infant and toddler TV viewing is linked to increased risks of obesity, language delay, inactivity, aggression and decreased attention spans. The AAP recommends no TV viewing in children ages 2 and younger and, for older children, no more than one to two hours a day of "quality programming."

"Our findings highlight just how pervasive screen time is for very young U.S. children," they wrote.

The AAP policy on children and television viewing can be found here.

— Shari Roan

Photo credit: Alan Marler  /  Associated Press

Parent training boosts medication effect for autism [Updated]

Life with a child who has a pervasive developmental disorder such as autism or Asperger's syndrome is often a storm of tantrums, irritability, impulsive behavior and obstinacy — a challenge that has child psychiatrists casting about for ways to help the stressed-out families of their patients, as well as the patients themselves. 

The antipsychotic medication risperidone is approved for those with autism to reduce irritability, and many other medications are widely used to rein in the defiance and explosive behavior that often come with a PDD diagnosis. But a group of researchers, spurred by the National Institute of Mental Health, set out to see if parent training could help children already on medication to further temper their negative behaviors, and bring an added measure of peace to their families.

Compared with kids on medication alone, the behavior of children whose parents got a battery of training sessions improved more and by several measures. The success of the program prompted the authors of the study — researchers from Ohio State University, Indiana University, Yale University and the University of Pittsburgh as well as with NIMH — to declare they will make the parent-training manual, homework assignments and therapist scripts broadly available. Their study is published in the Journal of the American Academy of Child & Adolescent Psychiatry. [Updated 5:45 p.m. Nov. 24] (An earlier version of this article included an incorrect name for this publication. It now has the correct name.)

"Because parents are the agents of change, parent training is less expensive than many other forms of psychosocial intervention," the researchers concluded. The growing population of kids with PDD, they added, makes the availability of "effective behavioral interventions" an urgent need.

Over 24 weeks, the parents of children with pervasive developmental disorder attended as many as 17 sessions, 60 to 90 minutes long, aimed at teaching them to help the child acquire and consolidate self-management and communication skills and to be more flexible and compliant. Parents learned to use visual schedules to ease transitions, to use positive reinforcement effectively, to teach their kids how to communicate their needs and be more flexible. A behavior therapist came to the home twice and made two telephone calls to answer questions and give support. 

— Melissa Healy

Study points to increasing food allergies among children

Almost 4% of American children have food allergies, according to a sweeping analysis of the problem published today in the journal Pediatrics.

The study is the first to make a broad estimate of the prevalence of food allergies among U.S. children and supports previous, smaller studies suggesting that food allergy rates are rising rapidly for reasons that are unclear.

Researchers from the Centers for Disease Control and Prevention found that self-reported food allergies increased 18% from 1997 to 2007.

The estimates were drawn from surveys of the children's parents and from medical records. Using data from medical records taken in 2005-06, researchers found 9% of all children tested positive for immunoglobulin E antibodies to peanuts. IgE tests are not considered reliable indicators of an allergy, but they do suggest an increased risk or past history of an allergy. The antibody tests were positive for egg allergies in 7% of children, for milk allergies in 12% and for shrimp allergies in 5%.

Finally, the analysis showed that healthcare visits for food allergies in children nearly tripled between the two time periods studied: 1992 through 1997 and 2003 through 2006. In the later period, U.S. children had an average of 317,000 visits to healthcare settings per year for food allergies.

The study also suggests potential racial differences among children with food allergies. While Latino children had the lowest prevalence of food allergies in 2007 compared with other racial groups, they had the greatest increase in reported food allergies over the time period studied.

"We used four different surveys, and to see an increase in food allergies in all of those surveys is very telling," said the lead author of the study, Amy M. Branum of the National Center for Health Statistics. "This is not just limited to one demographic or age group."

-- Shari Roan

Photo credit: Al Schaben / Los Angeles Times

Food-borne infections endanger long-term health, especially for kids

Fair warning: Put down that salad or medium-rare cheeseburger you're eating, pitch the brie cheese you enjoy with a glass of wine, and clear the chicken and leafy greens from the plate in front of Junior. Because you're not going to want eat or serve any of them after you read what a pair of reports released Thursday by the Center for Foodborne Illness Research & Prevention, have to say:

Long after the painful stomach cramps and bloody diarrhea of a brush with tainted food is over, many of us suffer long-term health effects, mostly unrecognized, that are the result of food-borne pathogens. These lingering effects can be very bad -- as bad as premature death, paralysis, kidney failure and a lifetime of seizures or mental disability. Many researchers believe these persistent health consequences cause more disability, lost productivity, doctor-office visits and hospitalizations than the acute illnesses that follow exposure to a food-borne toxin.

And while high-profile cases of food-borne illness have been caught, publicized and probably brought to an early end in recent years (think spinach, alfalfa sprouts, ground beef, peanut butter and tomatoes), the incidence of poisoning by tainted food is probably vastly understated.

As if all that isn't bad enough, food-borne pathogens cut their widest swath of destruction among the youngest of us. Children under 4 are disproportionately the victims of poisoning by the food-borne pathogens Campylobacter, E coli O157:H7, Listeria monocytogenes and Salmonella. And roughly half of all reported cases of food-borne illness affect kids younger than 15. Because younger kids are smaller, it takes a smaller dose of harmful bacteria to sicken them, and their less-experienced immune systems don't combat food-borne pathogens as effectively as do those of adults. They're more vulnerable, too, because their stomachs don't produce the volume of acids that adult digestive systems do.

In addition to urging public health officials, physicians and researchers to do a better job of understanding and stopping outbreaks of food poisoning, the American Academy of Pediatrics, in a campaign called Make our Food Safe for the Holidays, urges the following steps for consumers:

• Cook meat thoroughly.
• Clean work surfaces, cutting boards and bowls thoroughly after using them on uncooked meats or eggs to prevent contamination of other foods.
• Wash produce before consuming it.
• When buying milk and juice, make sure they're pasteurized, and make sure that products made from milk are made with pasteurized milk.
• Report any food-borne illness to a local health department.

The Food & Drug Administration and the U.S. Department of Agriculture, which have shared responsibility for preventing, detecting, tracking and responding to food-borne illness, are exploring ways to improve their performance in tracking the sources of outbreaks. Meanwhile, here's a list of the chief culprits, the foods in which they're most commonly found and some of the possible long-term consequences of infection, all from the Center for Foodborne Illness Research & Prevention report:

Salmonella. The leading cause of food-borne illness in the United States, salmonella is harbored by foods with animal origins, including beef, poultry, milk and eggs. It causes 16,000 illnesses and 556 deaths per year. It can cause reactive arthritis -- painful and swollen joints mainly in the lower limbs -- from which patients generally recover in two to six months. Eye irritation and painful urination can also be long-term effects.

Campylobacter: Food-borne sources are raw and undercooked poultry, unpasteurized milk and contaminated water. It causes an estimated 2 million acute human illnesses (the vast majority in children under 4) and 124 deaths yearly. Long-term effects can include Guillain-Barre Syndrome, an acquired and sometimes permanent paralysis, reactive arthritis (like Guillain-Barre, an autoimmune reaction) and chronic arthritis.

E. Coli O157:H7: Disproportionately affecting children under 19, E. Coli can taint ground beef and other meats, green leafy vegetables, unpasteurized (or raw) milk and cheeses made from such milk. About 15% of children infected with E. coli O157:H7 develop hemolytic uremic syndrome, which can lead to kidney failure, chronic kidney problems, diabetes, high blood pressure, gallstones, irritable bowel syndrome, narrowed gastro-intestinal passages and neurological problems -- including seizures -- that can take as long four years to resolve.

Listeria monocytogenes: An estimated 2,500 in the U.S. are infected with Listeria each year, and roughly 500 of them die. Listeria monocytogenes taints vegetables grown in contaminated soil or fertilizer, contaminated meat or poultry products. Cold cuts, hot dogs, smoked seafood, raw milk and soft cheeses made from such milk are common sources. In pregnant women -- roughly one-third of those victims --  listeriosis can cause miscarriage, premature death or stillbirth. Surviving fetuses may have mental retardation, hearing loss or brain damage. Adults infected with listeriosis can suffer neurological effects, including seizures and impaired consciousness. About a third experience cardiorespiratory failure.

--Melissa Healy

Get rid of your glass mercury thermometers

Years ago, when my children were young, I remember walking into the bathroom to find a shattered thermometer on the counter, bits of glass and little beads of mercury scattered about. I was horrified that one of my kids had been exposed to the mercury or cut by the glass, and it took a fair bit of questioning on my part (and finger-pointing on theirs) to resolve the issue and conclude that everyone would live.

This week, researchers at Children's Hospital Boston remind us that glass mercury thermometers are a relic of the past and a needless risk in most homes. Some states, including California, have banned the sale of mercury thermometers. But many still remain in use. Mercury exposure isn't the only danger from the thermometers, according to the new study, published in the October issue of Pediatric Emergency Care. Researchers found 33 children were admitted to the Children's Hospital Boston emergency room from October 1995 to October 2007 with thermometer-related injuries, and 84% had broken-glass injuries to the mouth or rectum. Some of the injuries required surgical excision of the glass.

Glass mercury thermometers are favored by some people because of their accuracy. But pinpoint accuracy is not necessary for most home uses, the authors said. Some thermometers are still marketed that are made of glass but contain a chemical other than mercury. Those, too, should be avoided, they said. Parents of young children should use non-glass, non-mercury thermometers.

Information on how to properly dispose of a glass mercury thermometer can be found on the Web page for California's Mercury Reduction Act.

-- Shari Roan

Photo credit: Brian Vander Brug / Los Angeles Times

Lack of health insurance played a role in thousands of child deaths, researchers say

An analysis of 23 million hospital records from 37 states shows that a lack of health insurance likely played a role in the deaths of nearly 17,000 U.S. children over a 17-year period.

Researchers at Johns Hopkins Children's Center examined records from 1988 to 2005. They compared the risk of death in hospitalized children who were covered by health insurance with those who did not, and found that uninsured kids were 60% more likely to die, regardless of their medical condition. This does not mean that the children received less aggressive care at the hospital but that they were probably in poorer health before the arrived, researchers said. Insurance status did not affect how long a child spent in the hospital, according to the study.

The study did not count children who died outside the hospital or after leaving the hospital, which means that deaths among uninsured children are probably even higher. The report will be published Friday in the Journal of Public Health.

"Can we say with absolute certainty that 17,000 children would have been saved if they had health insurance? Of course not," a co-author of the study report, David Chang, said in a news release. "The point here is that a substantial number of children may be saved by health coverage. From a scientific perspective, we are confident in our findings that thousands of children likely did die because they lacked insurance or because of factors directly related to lack of insurance."

As the healthcare reform debate reaches a critical stage in Washington, the study is a reminder of the human cost of healthcare inequality. About 7 million American children are uninsured.

"In a country as wealthy as ours, the need to provide health insurance to the millions of children who lack it is a moral, not an economic issue," Dr. Peter Pronovost, a co-author of the study, said in a news release.

-- Shari Roan

Photo: Healthcare reform advocates protest outside the offices of Cigna Insurance in Los Angeles. Credit: Mark Ralston / AFP/Getty Images

Lengthy pacifier use can lead to speech problems

Questions on whether a baby should be given a pacifier or allowed to thumb-suck have existed for generations. The concerns center on whether sucking habits will impact tooth alignment and speech development. The latest evidence, published today, suggests that long-term pacifier use, thumb-sucking and even early bottle use increases the risk of speech disorders in children.

The study looked at the association between sucking behaviors and speech disorders in 128 children, ages three to five, in Chile. Delaying bottle use until at least 9 months old reduced the risk of developing a speech disorder, researchers found. But children who sucked their thumb, fingers or used a pacifier for more than three years were three times as likely to develop speech impediments. Breastfeeding did not have a detrimental effect on speech development.

The authors of the study noted that other research suggests that use of a pacifier or thumb-sucking for less than three years also increases the risk of a speech problem. The sucking motion may change the normal shape of the dental arch and bite. Breastfeeding, however, seems to promote positive oral development.

"The development of coordinated breathing, chewing, swallowing and speech articulation has been shown to be associated with breastfeeding. It is believed that breastfeeding promotes mobility, strength and posture of the speech organs," the authors wrote.

The study is published in the open access journal BMC Pediatrics.

- Shari Roan

Photo credit: Los Angeles Times

Reality or imagination from mouths of babes? Balloon boy is but latest case

The saga of the Heene family continues as authorities prepare to possibly file charges next week regarding the boy-supposedly-in-the-balloon event that riveted the country. While bizarre stories continue to surface about father Richard Heene's past behavior, much of the focus has been on his 6-year-old son,+ Falcon, originally believed to have been in the balloon that floated away.

When Falcon uttered the words, "You said we did this for a show" to his father during a television interview, scrutiny intensified about the parents' actions and motives. Law enforcement, forensics experts and the public tried to figure out if the child was telling the truth or mixing in a little fantasy. The Heenes have denied that any hoax took place.

How a young child perceives fantasy and reality is discussed in the story "Out of the mouths of babes..." that appears on the Nation page today. Psychologists and psychiatrists weigh in whether or not a 6-year-old is capable of distinguishing real from pretend, saying that a number of different factors figure in, such as developmental levels, relationships with parents, and stress.

Kids may also have difficulty keeping track and making sense of information, especially in cases where an adult authority figure is coaching them, or asking them to stick to a story. "Depending on the situation, if you convince a child that certain facts are true," says James Hord, a Florida-based clinical psychologist, "he'll believe that. If later on he hears something different that doesn't meld with what he was told before, that presents a conflict for the child and it's going to result in mental gymnastics to try to make them fit. The child could pay a big cost."

-- Jeannine Stein

Photo: Falcon Heene. Phto credit: David Zalubowski / AP

Recommendations for new school meal nutrition standards

The nutrition standards behind the National School Lunch Program and the School Breakfast Program have not been updated since 1995. Today, the federal Institute of Medicine is issuing a report recommending new standards, calling for more produce, more whole grains. And for the first time, a limit to calories.

Thirty million children eat school lunch, and 10 million eat school breakfast -- and the IOM panel says it hopes new standards will help those children develop good habits that they carry into adulthood. That, the panel says, should help curb obesity and other health problems associated with diet.

The panel's recommendations go to the U.S. Department of Agriculture for possible implementation. It was the USDA which requested the report.

The panel says new standards would cost money -- for food as well as for training and capital improvements. But it says food costs would go up by less than 10% for breakfast and 25% or less for lunches. The government now spends $8.7 billion a year in reimbursements for school meals to school districts.

The recommendations are meant to bring school food in line with the dietary guidelines the government issues for Americans. It seeks to have the amount of sodium in school meals reduced by more than half over the next decade.

Among its recommendations: that calories be limited, based on age level, for breakfast and lunch, and that the sodium level for a typical lunch be eventually reduced to 740 milligrams. It also sets out targets for weekly servings of fruits and vegetables, and it calls for more whole grains.

"It's about time," says Matthew Sharp of the California Food Policy Advocates and one of the people who testified before the panel. Meals, he says, should be nutritious and affordable and they also should "teach kids healthy habits" and expose them to a variety of foods.

-- Mary MacVean