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Filling rotten baby teeth may be an unnecessary trial for children to endure, experts say. Some 40% of five-year-olds in the UK have tooth decay and at least one in 10 of these is treated with fillings. But anecdotal evidence from 50 dentists gathered by Manchester University researchers suggests filling baby teeth may not offer significant benefits. Advisers to the NHS are now beginning a study on treatment options to provide dentists with clear guidelines. Experts already know there is wide variation in care which means that a young child with signs of tooth decay could have no treatment, a filling or the tooth pulled out depending on which dentist they attend.
Without any clear guidelines, dentists currently have to rely on their experience and judgement to decide whether or not to intervene. If the child is in severe pain and having sleepless nights, and the parent is confident that their child will cope with and benefit from the treatment, then the choice may be clear. But when the decay is not causing symptoms, it can be difficult to decide what is in the child's best interests given that their tooth will ultimately fall out by the time they are 11 anyway. Indeed, anecdotal evidence gathered from the case notes of 50 dentists suggests filling baby teeth may achieve nothing but expose children to the discomfort of an injection and the sound of the drill. Dental phobia Professor Martin Tickle, of the University of Manchester, found no difference in the numbers of extractions for pain or infection whether baby teeth had been filled or not. And when he surveyed the parents of all five-year-olds living in Ellesmere Port and Chester in 2003, he found only 6% would want their child to have a filling if they had symptomless decay in a baby tooth.
In comparison, a third would want the dentist to monitor the tooth but provide no treatment. Experts working for the Health Technology Assessment Programme plan to recruit over 1,000 children from across the UK to take part a study that will compare the outcomes of three treatment options. They are conventional drilling and filling, no fillings or a painless paint-on tooth treatment that merely seals and contains the decay. Lead investigator Dr Gail Topping, of the University of Dundee, said: "This is a really big question to answer. "At the moment there is no clear winner and we do not know which is best to recommend. There is no guidance or mandate. "At the moment, dentists are doing what they believe is the right option for the child on a case by case basis." She said dentists would welcome evidence-based guidelines because the treatment decision can be a difficult one to make. Softly, softly Kamini Shah, dentist and honorary secretary of the British Association for the Study of Community Dentistry, said: "There are two schools of thought, one being that baby teeth can cause pain and sleepless nights and so dentists should fill. "The other is that actually the evidence around filling baby teeth is questionable. "Sometimes you need to adopt a pragmatic approach rather than go in with all guns blazing. "If a child is very uncooperative but has a mouthful of non-symptomatic holes you might decide to apply a fluoride varnish to stabilise the disease rather than to do conventional fillings." Painted on with a small brush, the banana-flavoured varnish is totally painless and can slow or even stop the decay if applied often enough.
Dr Shah said: "That way you gain the child's confidence and can work on prevention. You do not want to upset the child and make them phobic of future treatments. "The problem arises when children come in aged three or four and it is their first experience of the dentist and it is because they are in pain. "In that scenario you can well imagine that they might not be most cooperative." She said in extreme cases, and when the decay was so bad it necessitated treatment, a child might be referred for anxiety management or have the teeth removed under general anaesthetic. Recently, an eight-year-old girl starved to death because of an apparently severe dental phobia. Sophie Waller, from St Dennis in Cornwall, is thought to have been so traumatised by her phobia that she refused to open her mouth after having eight teeth removed under general anaesthetic. The full trial will run for four years from 2011 across England, Scotland and Wales, with a feasibility study starting in the coming months. | |||||||
No proof' for filling baby teeth
No rush to lose extra baby pounds
No rush to lose extra baby pounds
 Victoria Beckham was back in shape shortly after giving birth to her boys |
Trying to copy celebrities who are back in skinny jeans weeks after giving birth is unrealistic and dangerous, new mothers are being warned.
It can take women six months or even a year, not weeks, to shed the weight they put on in pregnancy, say experts.
Crash diets and intensive exercise programmes are not only likely to fail but can harm mother and baby.
The advice comes from Germany's Institute for Quality and Efficiency in Health Care.
According to the Institute, women are under too much pressure to lose weight quickly after giving birth, when many need some of that extra weight to provide nourishment for the baby.
 |  For about half of all women, the weight will not go away as quickly  The Institute's director Professor Peter Sawicki |
And celebrities who snap back to their normal weight within weeks of having a baby are not a true reflection of real life.
Stars like Nicole Kidman and Victoria Beckham were back in their skinny jeans weeks after giving birth, while model Heidi Klum was on the catwalk in her underwear weeks after having her baby.
No rush
The Institute's director Professor Peter Sawicki said: "Often, the extra effort women have to make to look after a new baby and breastfeed after giving birth means the kilos just melt away without effort.
"But for about half of all women, the weight will not go away as quickly."
Those new mothers still in their maternity wear weeks later should not rush to do punishing exercise classes, says the guidance, but should instead follow a sensible diet and build up slowly to more strenuous exercise.
| We would discourage a rush to lose weight after pregnancy Louise Silverton of the Royal College of Midwives |
"Even though many magazines have 'get your bikini body back quickly' diets on their covers, promising women they can achieve their ideal weight in time for summer, it is not getting quick results that counts the most.
"This is particularly true after pregnancy. It is normal for it to take three to six months for women to lose the weight they gained in pregnancy," it says.
Professor Sawicki said women could avoid weight problems after birth by eating sensibly during pregnancy.
"It is not a good idea to 'eat for two' in pregnancy and forget about your weight until after the baby is born if you are at all overweight - or prone to overweight - already."
Louise Silverton of the Royal College of Midwives agreed with the advice.
"We would discourage a rush to lose weight after pregnancy, it places undue strain on the mother's body when she needs her strength to look after her baby, and the evidence suggests that slow and sustained weight loss, if needed, is the sensible option.
"Also, following the birth and to breastfeed well, women need a good diet with adequate energy intake, so restricting the amount of food they eat simply to lose weight should be avoided."
UK guidance on weight management for mothers after childbirth is due to be published by the National Institute for Health and Clinical Excellence next year.
Can a toddler have an eating disorder?
Any parent of a toddler knows that mealtimes can be a minefield.
But in this week's Scrubbing Up health column, child health specialist Su Laurent says some are attributing their offspring's dietary foibles to an eating disorder, rather than bad behaviour.
I spend a significant amount of time seeing healthy young children whose parents are convinced that their child has an eating disorder.
Some parents think that their baby has an inability to swallow solids, others think that their child will fade away unless they are offered the few foods which they like and some parents say that their child eats nothing at all, despite the fact that they are consuming a packet of "Wotsits" in front of me!
| It's often easier for a doting parent to believe that a child has a medical problem rather than a behavioural one |
All three scenarios can be helped by a good health visitor, but sadly there are no longer enough health visitors to spend the time needed with first-time parents.
The difficulty I face is that parents often have a fixed idea that their child has a disorder and it can be very hard to convince them that, on the contrary, their child is very powerful and is getting away with eating exactly what they want!
It's often easier for a doting parent to believe that a child has a medical problem than a behavioural one.
Chips - or chips
| FROM BBC WORLD SERVICE  |
Some parents surprise their toddlers by popping out from behind the sofa in an attempt to stuff a spoon full of food into their mouths.
Others accept that their child will only eat chips, chicken nuggets and chocolate cereal.
| Some parents surprise their toddlers by popping out from behind the sofa in an attempt to stuff a spoon full of food into their mouths |
One mother told me with pride that since the last time I saw her seven-year-old in clinic he'd tried a new food: he was now happy to eat KFC chips in addition to McDonald's chips.
You can imagine the expression on my face!
These children are often overweight, and yet their parents live in fear of starving their child unless they are given exactly what they want to eat.
In these families food dominates, the parents have got themselves into a rut and can't see a way out.
'Don't give in?'
So how should these issues be tackled?
The basic principles are:
- Make eating fun
- Eat with your child whenever possible
- Stop any force-feeding
- Let him follow your example and feed himself, however messy he becomes
- Remember that a normal child will not allow himself to starve
| This sort of article makes my blood boil! My daughter had a genuine medical problem but I was fobbed off by several GPs. Jenny, Notts, England |
A baby who feels he's being force-fed has an amazing ability to clamp his jaw shut, turn his head away and even gag on food and refuse to swallow.
Offer your child a small amount of healthy food and clear the plate away after 15 minutes even if he's eaten nothing.
Don't make a big thing about it and resist all temptations to give him a snack before the next meal even if he's grumpy.
| Your child won't fade away if he eats nothing for a day or two |
Limit milk to a pint a day, many poor eaters get most of their calories from milk. Encourage your child to drink water or very dilute fruit juice.
Reward your child for trying something new and don't punish him for refusing to try.
A very stubborn child may refuse to eat for two or three meals but eventually will have to give in unless he's being offered snacks between meals.
Of course, as a mother of three I confess that all of this can be easier said than done.
Remember the basic principles that food is a powerful weapon and your child won't fade away if he eats nothing for a day or two.
Is TV delaying child development?
New research suggests having the TV on may impair young children's development by reducing the amount of conversation between infant and adult. So how bad is the box for young minds?
A US team recorded more than 300 children aged between two months and four years on several days every month over two years.
They found that when the TV was audible - either on in the background or being watched - the number of words spoken and sounds made by either adult or child reduced considerably.
It is the latest study to imply that delays in language development may be the fault of TV, a medium blamed for a host of other modern ills, from bullying to obesity.
But while it is not without its problems, experts warn that to expunge it from our children's lives completely may be as undesirable as it is unrealistic.
Mixed picture
Certainly there is a body of research building up that finds a correlation between heavy TV viewing at an early age and linguistic problems.
| This study is the first to demonstrate that when the television is on, there is reduced speech in the home Dimitri Christakis Lead researcher |
The exact nature of the relationship is unclear, and the role that family circumstances and other social influences play has not been established. However lack of interaction at a personal level is thought to be a key culprit.
But there is equally evidence that, for those over two at least, monitored levels of age-appropriate programmes can in fact foster language skills and indeed improve attention.
Watching with an adult and discussing the contents after a shared experienced has been found to be particularly beneficial, but not always necessary providing children are watching high-quality, tailored programmes which contain familiar words and scenarios.
Indeed some psychologists argue that given young children cannot read their own books or surf the internet, watching may be an empowering experience that gives them access to other worlds which present useful information in a way their parents may not be able to.
But there are some serious caveats: what appears to be particularly undesirable is the viewing of general audience or adult programmes both alone or in the company of a carer.
| National Literacy Trust's TV tips Limit TV time to one hour for 3-5 year olds Where possible, watch together Switch off when finished Encourage imaginative play based on what was watched Videos/dvds may be better due to repetition of words Avoid TV in the bedroom |
In addition while some TV may be beneficial for the over twos, the evidence for those younger is more shaky. First words, it is argued, are learnt far more effectively from real people than voices on the TV.
In the US, the American Academy of Paediatrics recommends no exposure to TV and computer screens for those under two, but lack of evidence for such a measure means there is no such policy in the UK.
Constant hum
This latest study into TV's effect on children comes from the University of Washington's Dimitri Christakis, the researcher who made headlines after reporting that infants who watched the Baby Einstein series - a set of programmes billed as educational - learnt fewer new words than those who did not.
His new study did not differentiate between TV being watched or background TV, nor did it examine the kind of programmes that were on. But it did find that overall, adults barely spoke to children when the TV was audible.
Research published last year also in the US also found problems with background TV, concluding that it affected both the quality and quantity of play in young children.
Liz Attenborough, director of Talk to Your Baby at the UK's National Literacy Trust, agrees that the permanent presence of the TV in the background is something parents should try to reduce.
"Even if you think you're not paying attention to it, you probably are - and this may well interfere with how much you speak to your child. The TV shouldn't be on all the time.
"But we are lucky to have some high-quality children's programmes in the UK. They are usually well thought-out, often featuring a clear, single voice, and incite children to make responses," she said.
"Of course we need to be aware of the problems TV can pose, but equally we don't want to throw the baby out with the bathwater."
Not an only child anymore: Helping your child adjust to a new sibling
Being an only child
rocks. You're the centre of your parents' universe, you get to name the
pets, you have the backseat of the car to yourself, and chances are,
you're the apple of Grandma and Grandpa's eyes. But suddenly, the bump
in Mommy's belly turns into a real live brother or sister… and
your world's never the same again.
While most kids will bond
with their new siblings – involving them in the pregnancy by
having them come along on doctor's appointments, and helping you
prepare baby's layette will help – the adjustment from Only Child
to First Child can sometimes take time. Here are some tips for helping
your firstborn cope.
Toddlers
Child No. 1
may soon never even recall a time when she was an only child. Cool.
(But the challenge for parents is dealing with diapers and dependence
times two!)
• Give him a baby doll he can take care of, just as you take care of your new baby.
• If he's moving out of the nursery, start the process a few months before your second child arrives so you have the energy to help him adjust, and so he doesn't "blame" baby for the move.
• If you have the energy, stagger their naptimes so you have some one-on-one time with him while baby sleeps.
Preschoolers
Some
experts believe kids between 18 months and 3 years of age have the
hardest time adjusting to this life change. Be patient, involve him,
and get him psyched about his role introducing baby to world and vice
versa.
• Don't share the news too early. It
can be hard to be patient for nine months. (Also, miscarriages can
happen even if your first pregnancy was complication-free, and
explaining what happened won’t be easy.) Later in your pregnancy,
feel free to take him along for your ultrasound appointments.
• Sign him up for a sibling orientation session at the hospital.
• Enlist that preschooler desire to help. Ask him to fetch diapers, to entertain baby at "the other end" while you change diapers, to help you feed baby, and so on.
Grade school kids
Give her the opportunity to prove
what a big girl she is. But don't forget what a little kid she remains
at heart, and be sure to pay extra attention to her.
• Double up on your shopping. Take her for her back-to-school-gear, holiday formal wear, summer-camp gear and so on, and let her pick some of her little sibling's stuff, too.
• Appoint her your enforcer.
It can be awkward to ask guests to wash their hands as soon as they
walk in the door. Luckily, your bossy little seven-year-old can be
trusted with getting them to the sink or assailing them with hand
sanitizer.
• Decorate the nursery with her artwork. Frame it and hang it low so she can see it.
Tweens & teens
While
overt rivalry is less of an issue, too-cool-for-school big kids can act
like having a new sib's nothing to get excited about. Get them
interested and on-board by engaging their maturity.
• Bond through humour.
Joking about diaper changes and sleepless nights can diffuse tension
(and maybe even segue into another discussion about birth control!).
• Resist the urge to use him as a free babysitting service. It's not fair to saddle him with "parenting" responsibilities unless he expresses interest and aptitude.
• Engage him in reading to the baby. This is a low-pressure activity that allows him to help out, bond with baby and build his own reading skills at the same time.
All ages
• Spend some quality time alone with your firstborn. Hit the playground, see a movie, go out for a meal together. Make it a regular habit.
• Get them books about adjusting to a sibling. Ginger by
Charlotte Voake is a charming board book about a pampered cat who must
adjust to life with a new kitten; it's perfect for toddlers through to
seven-year-olds, as is Kevin Henkes' funny Julius, Baby of the World. Some Dog! By Mary Casanova is great for first and second graders. The ages six to 10 set will probably like the zany world of Ruby Lu, Empress of Everything by Lenore Look.
• Don't forget the gifts!
Take your firstborn on a shopping date before Baby No. 2 arrives. Catch
a movie, have lunch, and let her choose a gift for her new sibling.
Have it wrapped and put it aside, so she can "present" it to her new
baby sib when he arrives home. Don't forget to have a gift from baby
waiting for her, too! Remind those close to you that a small gift for
your older kid would be appreciated if they are visiting with gifts for
the newborn, but it can be a smart idea to have some inexpensive
wrapped items set aside in a closet for when guests forget.
Jealousy is a normal response with the arrival of a new baby.
Chemical cocktail 'risk to boys'
 Chemicals may disrupt male development in the womb |
Chemicals found in many food, cosmetic and cleaning products pose a real threat to male fertility, a leading scientist has warned.
Professor Richard Sharpe, of the Medical Research Council, warned these hormone-disrupting chemicals were "feminising" boys in the womb.
He linked them to raising rates of birth defects and testicular cancer and falling sperm counts.
Campaigners called for action to address the problem.
They warned that while exposure to a single chemical may cause no harm, the cumulative effect could be profound.
| HORMONE DISRUPTORS Chemicals in consumer products and food that have been reported to disrupt the sex hormones include: Phthalates: Found in vinyl flooring, plastics, soaps, toothpaste Bisphenol: Found in babies' bottles, food can linings. mobile phones, computers Pesticides: Including pyrethroids, linuron, vinclozolin and fenitrothion |
Professor Sharpe's report was commissioned by the CHEM Trust, a charity which works to protect humans and wildlife from harmful chemicals.
There is evidence that male reproductive health is deteriorating, with malformations of the penis becoming more common, rates of testicular cancer rising, and sperm counts falling.
It is thought that all these conditions - collectively called Testicular Dysgenesis Syndrome (TDS) - are linked to disruption of the male sex hormone testosterone.
Professor Sharpe concludes that exposure to a cocktail of hormone-disrupting chemicals in the environment is likely to be at least partly to blame by blocking the action of testosterone in the womb.
His latest report highlights animal studies showing that testosterone disrupting chemicals can cause TDS-like disorders.
In addition, de-masculinisation effects due to chemical pollutants in the environment has been reported in many species of wildlife.
The direct evidence of an effect in humans is so far less compelling - but is beginning to mount.
Minimise exposure
Professor Sharpe said: "Because it is the summation of effect of hormone disrupting chemicals that is critical, and the number of such chemicals that humans are exposed to is considerable, this provides the strongest possible incentive to minimise human exposure to all relevant hormone disruptors, especially women planning pregnancy, as it is obvious that the higher the exposure the greater the risk."
New EU chemicals legislation, called REACH (Registration, evaluation, authorisation and restriction of chemicals) puts the onus on the chemical industry to prove that its products are safe.
Campaigners say it could be used to reduce exposure to hormone disrupting chemicals.
Elizabeth Salter Green, CHEM Trust director, said; "Chemicals that have been shown to act together to affect male reproductive health should have their risks assessed together.
"Currently that is not the case, and unfortunately chemicals are looked at on an individual basis.
"Therefore, government assurances that exposures are too low to have any effect just do not hold water because regulators do not take into account the additive actions of hormone disrupting chemicals.
"It is high time that public health policy is based on good science and that regulatory authorities have health protection, rather than industry protection, uppermost in mind."
Ms Green advised pregnant women to keep cosmetic use to a minimum and avoid DIY.
BBC.
Folic acid protects baby hearts
 Flour can be fortified with folic acid |
Mandatory fortification of bread with folic acid would slash the risk of babies being born with a heart problem, experience from Canada shows.
Rates of severe congenital heart defects among newborns in Quebec fell significantly after the move to fortify flour and pasta began in 1998.
The British Medical Journal online study lends support to calls for introducing fortification to Europe.
But others argue against this, saying it would inevitably harm some people.
The fear is that adding folic acid to products like bread could harm some elderly people if they are deficient in other B vitamins.
| Personally, I do not think mandatory fortification is the way forward. It is like using a sledge hammer to crack a nut Dr Sian Astley, a scientist for the Institute of Food Research |
In extreme cases, this can cause irreversible damage to the nervous system.
There is also concern that it may also increase the risk of certain cancers, including bowel cancer, in some people.
In 2007 the UK's watchdog, the Food Standards Agency, agreed with expert recommendations to fortify bread or flour with folic acid.
Since then, at the request of the Chief Medical Officer, an expert working group on folate has been considering the results of recent trials looking at the effect of folic acid on the risk of some types of cancer.
The group is expected to report back to Sir Liam Donaldson this summer.
Risk reduction
Folic acid is a synthetic form of folate, a B vitamin found in a wide variety of foods including liver and green leafy vegetables.
Pregnant women and those trying to conceive are already advised to take folic acid supplements to reduce the risk that their baby will have a "neural tube" birth defect like spina bifida.
But uptake is not ideal, particularly because some pregnancies are unplanned and can go unnoticed for some weeks.
The latest work suggests folic acid also cuts the risk of baby heart defects.
In the seven years after fortification was introduced there was a 6% drop per year in the birth prevalence of severe heart defects.
This compares with a 9% drop in neural tube defects.
Writing in the BMJ, lead author Professor Louise Pilote of McGill University in Montreal, said: "Given that severe congenital heart defects require complex surgical interventions in infancy and are associated with high infant mortality rates, even a small reduction in the overall risk will significantly reduce the costs associated with the medical care of these patients and the psychological burden on patients and their families."
Weighing the risks
The British Heart Foundation said the risks and benefits of fortification must be carefully weighed.
A spokeswoman said: "This Canadian study shows that when folic acid was added to flour and pasta the number of babies born with certain severe heart conditions was reduced.
"While the decrease in babies born with heart conditions during this time is statistically significant, many children were still born with congenital heart disease.
"This must be taken into account when considering the benefits of routinely introducing folic acid to flour and pasta in the UK.
"Especially because routine introduction could pose a risk to some elderly people as potentially dangerous vitamin B12 deficiency can be masked by high intake of folic acid."
Alternative suggested
Dr Sian Astley, a scientist for the Institute of Food Research, said: "Personally, I do not think mandatory fortification is the way forward. It is like using a sledge hammer to crack a nut.
"It would reduce ill health in children but there are cautionary issues.
"An alternative would be to fortify only certain foods and clearly label them so consumers can make the choice. Co-fortification with other B vitamins would be another sensible option."
She said the IFR believes there is still insufficient evidence to make a decision about whether the benefits of fortification would outweigh the risks.
Child behaviour 'linked to sleep'
 The study looked at children aged seven or eight |
A good night's sleep could reduce hyperactivity and bad behaviour among children, a Finnish study reports.
It has been suggested that some children who lack sleep do not appear tired, but instead behave badly.
Of the 280 examined in the Pediatrics study, those who slept for fewer than eight hours were the most hyperactive.
Experts said adequate sleep could improve behaviour in healthy children and reduce symptoms of attention deficit hyperactivity disorder (ADHD).
It is recognised that chronic sleep deprivation is a problem for many adults in Western countries and that it can have consequences for their health and daily life.
The team behind this research said not enough was understood about the role of sleep in children's lives but it has been estimated that a third of US children do not get enough sleep.
Monitoring
In this research, the team from the University of Helsinki and Finland's National Institute of Health and Welfare studied 280 healthy children aged seven or eight.
They wanted to see if those healthy children who slept the least were the most likely to display the kind of symptoms associated with ADHD.
None of the children studied had the attention disorder.
| There is a lot of commonality between the symptoms of a tired child and the symptoms of a child with ADHD Neil Stanley, Sleep expert |
Parents filled in questionnaires about their children's usual sleeping habits and then noted how long their children slept for over seven nights.
The children also wore devices called actigraphs, which measure movement, to monitor how long they actually rested for.
Parents' estimates of sleep duration were longer than the actigraph measurements, which the researchers say could be because they measured from bedtime or because they assumed their children were asleep when they were simply lying awake in bed or reading.
The parents were also asked about their children's behaviour, using measures normally used to diagnose ADHD.
The children whose average sleep duration as measured by actigraphs was shorter than 7.7 hours had a higher hyperactivity and impulsive behaviour score.
They also had a higher ADHD symptom score overall.
'Sleep needs differ'
Dr Juulia Paavonen, who led the study, said: "We were able to show that short sleep duration and sleeping difficulties are related to behavioural symptoms of ADHD.
"The findings suggest that maintaining adequate sleep schedules among children is likely to be important in preventing behavioural symptoms.
| Even 30 minutes per night has been shown to give a major improvement Dr Juulia Paavonen, Finnish National Institute of Health and Welfare |
"It may well be that inadequate sleep is increasing some of the behavioural problems that have been seen in children with attention deficit disorders."
Dr Paavonen said further studies were needed to confirm the link.
And she advised parents that, even though the study suggested fewer than eight hours sleep could be problematic, it was not a figure everyone should aim for.
"Sleep needs differ between individuals. The only way is to take care that a particular child has enough sleep is to see if they seem to have a problem with short sleep.
"But even [an extra] 30 minutes per night has been shown to give a major improvement in objective cognitive tests, improving reaction times, impulsivity and attention spans."
Sleep expert Neil Stanley, of the University of East Anglia, said: "It has been acknowledged for a while now that there is a lot of commonality between the symptoms of a tired child and the symptoms of a child with ADHD."
He said parents needed to recognise that sleep was important for children.
"These things have been lost at a time when ADHD is increasing.
"How much of what is diagnosed as ADHD is something that can be modified or improved, or even totally cured by a more rigid sleep pattern?
"Maybe parents should try and get sleep sorted out if the child is still showing symptoms, then that's probably the time to look at pharmacological interventions."
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