Study nails secret of child sleep

He may not have had enough exercise today. Researchers have confirmed what parents have long believed - running around in the day means your child may well fall asleep faster at night. But the study of 500 children provides a figure: for every hour they sit, they need three minutes longer to nod off. Interestingly, it was not relevant what the child did while they sat. TV was no more detrimental than quietly reading. And the Archives of Disease in Childhood found those who took longer to get to sleep were no worse behaved. Experts from Monash University in Melbourne and the University of Auckland looked at 519 seven-year-olds. The majority fell asleep within 45 minutes, and the average "sleep latency" - the time it took - was 26 minutes. Sleepyhead Children who were very physically active during the day tended to take less time to fall asleep, but the more prominent association was between being sedentary and taking longer to drift off. Those who fell asleep faster also tended to sleep for longer. There has been much discussion about the impact of reduced sleep duration on children. "As short sleep duration is associated with obesity and lower cognitive performance, community emphasis on the importance of promoting healthy sleep in children is vitally important," the researchers wrote. Activity is not the be all and end all, and shouldn't be encouraged right before bedtime Mandy Gurney Sleep specialist "This study emphasises the importance of physical activity for children, not only for fitness, cardiovascular health and weight control, but also for sleep." They did not however find any evidence of bad behaviour, as measured by professional charts, among those who took longer to fall asleep. Nor did they find any significantly different sleep latencies for children who went to bed after 9pm. Mandy Gurney, founder of children's sleep clinic Millpond, said the research was useful confirmation of the benefits of exercise for sleep as well as fitness and weight. "But activity is not the be all and end all, and shouldn't be encouraged right before bedtime. What's essential is a routine wind-down hour, a quiet time before bed. A warm bath, but no longer than 10 minutes, and then straight into a darkened bedroom. "That way you make the most of the the natural sleep trigger of the warm water, and you can cap it all off with a bedtime story."

Unraveling how children become bilingual so easily

The best time to learn a foreign language: Between birth and age 7. Missed that window?

New research is showing just how children's brains can become bilingual so easily, findings that scientists hope eventually could help the rest of us learn a new language a bit easier.

"We think the magic that kids apply to this learning situation, some of the principles, can be imported into learning programs for adults," says Dr. Patricia Kuhl of the University of Washington, who is part of an international team now trying to turn those lessons into more teachable technology.

Each language uses a unique set of sounds. Scientists now know babies are born with the ability to distinguish all of them, but that ability starts weakening even before they start talking, by the first birthday.

Kuhl offers an example: Japanese doesn't distinguish between the "L" and "R" sounds of English — "rake" and "lake" would sound the same. Her team proved that a 7-month-old in Tokyo and a 7-month-old in Seattle respond equally well to those different sounds. But by 11 months, the Japanese infant had lost a lot of that ability.

Time out — how do you test a baby? By tracking eye gaze. Make a fun toy appear on one side or the other whenever there's a particular sound. The baby quickly learns to look on that side whenever he or she hears a brand-new but similar sound. Noninvasive brain scans document how the brain is processing and imprinting language.

Mastering your dominant language gets in the way of learning a second, less familiar one, Kuhl's research suggests. The brain tunes out sounds that don't fit.

"You're building a brain architecture that's a perfect fit for Japanese or English or French," whatever is native, Kuhl explains — or, if you're a lucky baby, a brain with two sets of neural circuits dedicated to two languages.

It's remarkable that babies being raised bilingual — by simply speaking to them in two languages — can learn both in the time it takes most babies to learn one. On average, monolingual and bilingual babies start talking around age 1 and can say about 50 words by 18 months.

Italian researchers wondered why there wasn't a delay, and reported this month in the journal Science that being bilingual seems to make the brain more flexible.

The researchers tested 44 12-month-olds to see how they recognized three-syllable patterns — nonsense words, just to test sound learning. Sure enough, gaze-tracking showed the bilingual babies learned two kinds of patterns at the same time — like lo-ba-lo or lo-lo-ba — while the one-language babies learned only one, concluded Agnes Melinda Kovacs of Italy's International School for Advanced Studies.

While new language learning is easiest by age 7, the ability markedly declines after puberty.

"We're seeing the brain as more plastic and ready to create new circuits before than after puberty," Kuhl says. As an adult, "it's a totally different process. You won't learn it in the same way. You won't become (as good as) a native speaker."

Yet a soon-to-be-released survey from the Center for Applied Linguistics, a nonprofit organization that researches language issues, shows U.S. elementary schools cut back on foreign language instruction over the last decade. About a quarter of public elementary schools were teaching foreign languages in 1997, but just 15 percent last year, say preliminary results posted on the center's Web site.

What might help people who missed their childhood window? Baby brains need personal interaction to soak in a new language — TV or CDs alone don't work. So researchers are improving the technology that adults tend to use for language learning, to make it more social and possibly tap brain circuitry that tots would use.

Recall that Japanese "L" and "R" difficulty? Kuhl and scientists at Tokyo Denki University and the University of Minnesota helped develop a computer language program that pictures people speaking in "motherese," the slow exaggeration of sounds that parents use with babies.

Japanese college students who'd had little exposure to spoken English underwent 12 sessions listening to exaggerated "Ls" and "Rs" while watching the computerized instructor's face pronounce English words. Brain scans — a hair dryer-looking device called MEG, for magnetoencephalography — that measure millisecond-by-millisecond activity showed the students could better distinguish between those alien English sounds. And they pronounced them better, too, the team reported in the journal NeuroImage.

"It's our very first, preliminary crude attempt but the gains were phenomenal," says Kuhl.

But she'd rather see parents follow biology and expose youngsters early. If you speak a second language, speak it at home. Or find a play group or caregiver where your child can hear another language regularly.

"You'll be surprised," Kuhl says. "They do seem to pick it up like sponges."

Nursery Equipment Safety for Newborn Babies

What to look for when buying things for baby

Some parents buy just a few essential pieces of nursery equipment for their newborn baby, such as a crib and a stroller. Others purchase the whole kit and caboodle: carrier seat, bassinet, change table, playpen, and more. Here are a few safety considerations when choosing nursery equipment for your newborn baby.

Cribs

Your newborn baby’s crib is one of the most important purchases you will make in terms of nursery equipment. As with most nursery equipment, if you buy a new crib labelled with the initials of your national safety association, you can be quite confident that it meets national safety requirements. However, you need to be especially diligent about safety concerns if your baby will be using a “previously enjoyed” crib. In Canada, crib safety standards changed in September 1986, so you should only use a crib that was manufactured after that date. When choosing a crib, make sure it meets the following safety requirements:

• slats spaced no more than 6 cm apart, so your baby’s head cannot squeeze through
• no missing or cracked slats
• a snugly fitting mattress with less than two finger widths between the edge of the mattress and the side of the crib
• corner posts that are no higher than 1.5 mm, to prevent your baby’s clothing from getting entangled on the posts
• head- and footboards that do not have cutouts where your baby’s head can become entrapped
• drop-side latches that stay securely in the raised position and are not easily released
• screws and bolts that are secure and tightly fastened

Never leave your baby in a crib with the drop side down. Place the crib away from blinds or curtains where your baby can become entangled in the cords. When your child reaches 90 cm or about three feet in height, or can climb over the sides of the crib, she should be moved to a bed.

Bassinets and cradles

A bassinet or cradle should have a sturdy bottom, a wide base, and no protruding staples or other hardware that can harm your newborn baby. The mattress should be firm and fit snugly. The legs of the bassinet or cradle should be sturdy and strong. If the legs can fold, they should have locks to prevent folding while in use. Follow the manufacturer’s instructions and make sure not to use the bassinet or cradle if your baby is above the height or weight requirement of the device.

Carrier seats

A carrier seat should have a wide, sturdy base and a non-skid bottom to prevent slipping. The seat should come with an easy to use buckle or strap that secures your newborn baby’s crotch and waist. Carrier seats should not be used as car seats.

Change tables

Change tables need to have safety straps to prevent falls. Choose a table that has easily accessible drawers and shelves. Always strap your newborn baby into the change table and never leave her on the table unattended.

Playpens

A wooden playpen should have slats spaced no more than 6 cm apart. If there are staples, they should not be missing or loose.

If you choose a mesh playpen, make sure that the openings in the mesh are no more than 7 mm wide and that there are no tears, holes, or loose threads. The mesh should be securely attached to the floor plate and top rail.

Never leave your baby in a drop-side playpen with the drop side down. Your baby might roll into the area between the mattress and the dropped mesh side and suffocate. Even newborn babies can roll unexpectedly and become hurt in this way.

Playpens are not designed for sleeping. Do not leave your baby sleeping in a playpen.

Strollers

Make sure that your baby’s stroller has a wide base to prevent tipping. The brakes should securely lock the wheels. The seat belt should be securely attached to the frame and the buckle should be easy to use. Always use the seat belt when you take your newborn baby out in the stroller.

If your stroller has a shopping basket, make sure it hangs low in the back, directly over the rear wheels for stability. If your stroller does not have a shopping basket, do not hang items on the stroller, as this could cause tipping.

Pacifiers

When choosing a pacifier, make sure that its shield is large and firm so it will not fit in your baby’s mouth. The shield should contain ventilation holes so your baby can breathe if it does get into her mouth. Make sure that the pacifier nipple does not have any holes or tears and that the nipple cannot easily break off in your baby’s mouth. Do not attach strings or cords to the pacifier, and never hang a pacifier around your baby’s neck.

Toys

Rattles, squeeze toys, and other toys should be removed from your newborn baby’s crib while she sleeps, to prevent suffocation. If you do wish to use a toy in the crib, make sure it has no small parts that could be considered a choking hazard and no strings longer than 18 cm. If the label on the toy has a warning that it should be removed from the crib by a certain age, make sure to do so when your baby reaches that age. Remove crib gyms when your baby is able to pull or push up on her hands and knees.

When using toys and rattles outside the crib, make sure they are made of sturdy construction and will not break apart easily. Avoid toys and rattles that have small parts that can detach and become lodged in your baby’s throat.

Safety considerations for older babies

If your newborn baby is less than one month of age, she is still too young for back carriers and high chairs, and she probably will not need gates or a toy chest yet. Safety considerations for these items will become important as your baby gets older.

• Back carriers: A back carrier should not be used until your baby is four or five months old, when her neck is strong enough to withstand jolts. When choosing a back carrier, make sure it contains a restraining strap for your baby, and that the frame is covered with padding, especially near baby’s face. Also check that the leg openings are small enough to prevent your baby from slipping out, but large enough to prevent chafing.
• Gates: Make sure that the slats are spaced closely enough that your baby’s head cannot become stuck between them. Accordion-style gates are especially prone to causing head entrapment. Also make sure that the gate is strong enough and secured tightly enough to resist the strength of a child.
• High chairs: The chair should have a wide, stable base and a tray that locks securely. If this is a folding chair, it needs to have an effective locking device so that the chair will not collapse when in use. Ensure that the chair has an easy-to-use child restraining strap, and that any such straps are separate from the tray itself. When using the chair, always buckle in your baby, to prevent her from sliding under the tray and falling or strangling.
• Toy boxes: Toy boxes without lids are preferable. If you choose a toy box with a lid, make sure it does not have a latch, which could trap a child inside. A spring-loaded lid is safer than a free-falling lid, to avoid head injuries. Make sure that the toy box has ventilation holes in case your baby gets trapped inside.

Nursery equipment to avoid

Baby bath rings or seats and baby walkers are not recommended for use due to safety concerns. Baby walkers are banned in Canada; it is illegal to import or sell them, even second-hand. If you have one, Health Canada recommends that you destroy it and throw it away so it cannot be used again.

Modern signs of childhood obesity

 

Times have changed.

“When we started the clinic 15 years ago, we primarily saw kids who had congenital heart problems; problems they had inherited,” says Brian McCrindle, chief of the paediatric cholesterol and cardiac clinics and a cardiologist at Toronto’s SickKids Hospital. “Today we’re seeing obesity as the cause of these problems. And it’s not just my clinic. Across the board, gastroenterologists are seeing an increase in fatty livers; endocrinologists are seeing a boom in diabetes.”

Dr. McCrindle could well have added juvenile heart attack, high blood pressure, insulin resistance, unsafe cholesterol levels, and stroke to this inventory, all on the rise and caused in large measure by unhealthy weight gain in children. “The implications of what happens when kids become overweight is like putting the pedal to the floor in accelerating atherosclerosis,” he says, adding yet another obesity-related condition to the list.

Childhood obesity has become so bad that a new populist label has been coined to describe what happens when kids suffer with three or more symptoms. “This cluster of risks is loosely defined as ‘metabolic syndrome’,” Dr. McCrindle says, explaining that these risks together make children more susceptible to further problems.

Lifestyle changes for long-term health

Dr. McCrindle blames the epidemic on calorie-dense, sugary foods marketed directly to kids. This, he says, comes at a time when physical activity is being programmed out of school and an explosion of media-based pursuits is replacing outdoor activity. “It takes two minutes to eat a chocolate bar, and 40 minutes of running to use up those calories.” He says schools must teach children fitness routines for life, otherwise heart conditions and other “diseases of the old" will more and more become diseases of the young. “We need a coordinated action plan.”

Dr. McCrindle advises parents to make sure their children are snacking on fruits and vegetables. He says the only thing children over the age of two should be drinking is low-fat milk or water with their meals. He also says there should be limits set on computer and other passive activities. “If possible, being active with your children is the best example you can set,” he says.

The alternative to being active and eating right

Bariatric surgery, where the stomach is surgically reduced up to a tenth of its size, is now performed routinely in the U.S. on children. A smaller stomach means less food can go in it at any one time. The surgery is a last-ditch attempt at weight loss and like any operation, should not be taken lightly.

Botox for babies

Toxin's uses more than just skin deep

The temporary paralysis induced by Botox injections, making them effective at reducing wrinkles on the face, has other, less superficial uses. In addition to righting crossed eyes, reducing excessive drooling, and relieving chronic headache pain, Botox is now commonly used to control involuntary muscle spasms and contractions in children with cerebral palsy (CP) and other disorders.

"I've seen two-year-olds trying to stand up, legs crossed, bent at the knees and on their tippy-toes wanting to walk," says Dr. Ellen Wood, paediatric neurologist at IWK Health Centre in Halifax, describing some of her pre-Botoxed CP patients. "Over a couple of months with therapy, some of those children are walking on their own."

Botulinum toxin

Botox is a commercial name and the popular short form for a protein molecule called Clostridium botulinum toxin, of which there are several types. When injected into a muscle, type A binds to specific presynaptic nerve terminals, essentially shutting them down, causing paralysis and muscle relaxation. Over time, neurotransmission resumes after new nerve endings sprout and reform contacts with muscle fibres. This takes from three to six months.  

"It's the brain's job to tell the muscles to relax. In CP, the brain isn't doing that so you get the constant contraction," says Wood. This effect can be mild or severe, and can take place on different parts of the body, although contracted leg muscles are common. "They may just walk on their tip-toes, or their legs may cross over in scissoring pose to the point their hips come out of the joint."

The process starts with a needle

"Just the calf muscle of one leg is four Botox injections," says Wood, adding the number of needles goes up from there. "These are intra-muscular injections, which are normally painful, and they need to be in the right place." For most kids, especially the younger ones, this means a general anaesthetic and sleeping thourhg the procedure. "If you don't, you might get the first one in the right place but the rest, no. Not with a screaming child."

Although the kids wake up feeling the same, within a few days changes are noticed. Botox's maximum effect comes in a couple of weeks. The relaxation Botox provides creates a window in which the muscles can grow and other therapies can be used to help stretch out muscles, making them more mobile.

"We might put the child's leg in a cast to help with muscle stretching and the Botox may mean just one surgery, or perhaps surgery avoided, rather than multiple operations," says Wood, adding the ongoing process is ultimately dependent on brain function. "In the long term, we don't know what will happen. We are building them up physically and giving them opportunities. If they have the ability in the brain, we can deal with the legs. Sometimes the brain can't coordinate movement and this is why the treatment doesn't always work."

But often it does, which is a special experience for Wood. "As child neurologists we don't ever make anyone better. We are dealing with injured brains. We are not used to dramatic change," she says. "But when the first child I did came back a month later walking with help, that was pretty neat."

Not bad for the most toxic protein known to humanity.