Recent and Fascinating Reserach on Parenting

Neuroscience Meets Parenting:

A Fascinating Look at the Latest Findings on Parenting

On May 27, 2015, the Charlie Rose show on PBS aired a fantastic review of the latest neuroscience of parenting.

http://www.bloomberg.com/news/videos/2015-05-27/charlie-rose-brain-series-3-episode-2-05-27-

This episode is part of an ongoing set of panel discussions covering some of the most interesting work on the mind over the last few years.   It is on the Charlie Rose show, but the entire set of panel discussions is co-hosted by Nobel Laureate Dr. Eric Kandel, one of the world's leading neuroscientists and a classical psychoanalyst.   

I am a very big fan of Dr. Kandel.  He is truly a genius, but very humanistic and caring.  I can also highly recommend two books of his I have read.  In Search of Memory is a magnificent tour of the neuroscience of memory and his ground-breaking discoveries on how memory physically occurs.   And, the Age of Insight is one of my favorites, a truly incredible review of turn-of-century Vienna where the most fascinating topics were all about medical discoveries, and how that helped define the birth of modern art.

On this panel discussion, Dr. Kandel hosts a team of superstar researchers from Harvard, Columbia, and such schools.  There is also a pediatrician who talks about his own personal experience of paternal post-partum depression.   

The findings presented, research discussed, and experiences shared touch on many of the central concerns and experiences all parents share or have concerns about.

The big themes of the discussion include the following:

1. How does attachment work?  How does the brain lead parents to connect to their baby?
2. What happens when attachment does not work?  What goes wrong inside the baby's brain and outside in the baby's life?
3. Can troubles with attachment be reversed later in life?
4. What is post-partum depression?  How often does it happen?  How often does it happen to fathers?  What can be done about it?
5. Is there a point at which improvements in parenting offer no further benefit to the child, or are we all in the position of feeling we should have done more?

Attachment

Attachment is the core of all parenting, and it is just what the word means in plain English, the extent to which a parent feels connected to their baby, and the baby feels connected to the parent.   In this program, we find just how dramatically attachment makes a difference.  Without it, a baby's brain will actually have dramatically less electrical activity and will grow to be physically much smaller.

The key attachment that makes the baby's mind grow and fire away is emotional, not cognitive.   That means playing and touching and laughing together makes all the difference in the world.  It is loving and playing that literally turns the baby's mind on to grow and develop.   

Strictly speaking, if one could present purely factual material to a newborn and infant it appears it would have little impact on stimulating the brain to develop.   Of course, in the normal course of presenting cognitive materials, we almost always connect it to emotion.  Who can read their baby Goodnight Moon without being tender and cuddly?

But the point here is that play trumps teaching.  It is truly the playful loving way we all have with our children that their minds require in order to grow and function.

What Happens if Attachment does not Happen?

Let me preface their findings by making clear that attachment almost always happens in a family.  It takes a true catastrophe to keep it from taking place.   The research done to answer this question required finding orphanages in ravished lands where infants got little or no attention.

With that in mind, the research finds that when a baby has no emotional input from a loving adult, their brain's electricity literally nearly stops firing.   Further, the number of nerve cells in their brain fails to increase and the number of connections between nerve cells in their brains fail to grow at anywhere the normal rate.

This is very striking.  Love and play are required to make the human (and animal) brain actually fire electrical signals and grow.   For humans left to complete neglect, IQ's can drop to the level of 50, or barely half of normal intelligence, a level of serious mental impairment.

Can Troubles with Attachment be Reversed Later in Life?

Yes, the researchers found that if a child impaired by no attachment in infancy receives loving care and playfulness even later in childhood, their brains regain normal electrical activity and intelligence zooms upward.

Post-Partum Depression

Somewhere on the order of 9-16% of all women who deliver experience the difficult experience of post-partum depression.   The research presented on this phenomenon were also deeply compelling.  There appears to be a direct link between the extremely dramatic shifts in hormone levels and mood.   This should provide some comfort as it proves that the profound sadness of post-partum depression is purely a physical event and has nothing to do with how the mother (or father) truly feels about their beloved baby.

A pediatrician described in moving and articulate terms his experience of paternal post-partum depression.

Also encouraging was the benefit of treatment and the good chance of reversing this experience with therapy and treatment.

Here is a very useful link for further information about post-partum depression:  http://www.apa.org/pi/women/programs/depression/postpartum.aspx

The key insight on this subject was that the parent struck by this physical event must face the challenge of feeling badly about feeling badly, otherwise the help that makes such a difference will not be within reach.

Is there a Ceiling to Attachment, to Love from Parents?

This was one of the most fascinating findings discussed.

It turns out the answer is yes.   That is, after engaging with your newborn, infant, child with loving playfulness, and the ability to attend to their emotions and respond in a way that suggests to them that your are indeed aware and caring of their emotions, there is no benefit to doing this at greater and greater levels.

Basics of love, play, and being responsive turn out to do all that can be done to promote our children's well-being.

Once a parent is loving, caring and responsive to even basic degrees, no parent should worry about feeling that their infant or child is on the edge of not getting enough love, or that if only the parent did more, their child's brain would be that much better.  This has been measured and it turns out extra, extra love and attention does nothing more than the basics.

I found this a powerful finding because it supports the whole concept that a healthy, thriving, happy child deserves parents taking pleasure in their child, rather than parents worried that the good things they do are not enough, or that their child is at risk.

BOTTOM LINES

1.  This link will bring you to a truly outstanding show reviewing some of the latest research on the neuroscience of parenting.  http://www.bloomberg.com/news/videos/2015-05-27/charlie-rose-brain-series-3-episode-2-05-27-

2.  The host of this discussion is one of the world's leading and most thoughtful neuroscientists, Nobel Laureate Dr. Eric Kandel.

3.   Attachment is necessary for a newborn and infant's brain literally to work and to grow.   

4.  Successful attachment simply requires an adult (doesn't even have to be the parent) to love the child, to love being with them, to play with them, and to be responsive to their emotions over time.   Once a basic level of loving, responsive play is achieved, there is not much further gained from more of it.  

5.  Post-partum depression affects about one in 6-10 women who deliver, but also some new fathers.  It is a physical event that turns emotions towards profound sadness and distance.   As physical changes can cause the depression, physical treatments can reverse it.   The key to the terrible experience of post-partum depression is for the person experiencing moving beyond the guilt of bad feeling towards the hope of recovery and treatment.

6.  Overall, the program offers a fascinating discussion of just how good parenting helps a child's mind function and grow.  And, very importantly, that once good parenting is happening, parents can relax with the knowledge that neuroscience finds that is all that is needed, there are not benefits to every increasing levels of play and responsiveness.

I hope you enjoy this program as much as I did.

To your health,

Dr. Lavin 

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

A Routine Immunization Turns out to Prevent Childhood Leukemia!

A Routine Immunization Turns Out

to Prevent Childhood Leukemia!

Most surprises about medical treatments are bad, so when a good surprise emerges, it is cause for real celebration.

It turns out the children who get the Hib immunization reduce their chances of developing the most common form of childhood leukemia by 20%!

http://well.blogs.nytimes.com/2015/05/20/scientists-unravel-how-a-vaccine-reduces-risk-of-a-cancer/?ref=health&_r=0

http://www.nature.com/ni/journal/vaop/ncurrent/full/ni.3160.html

Hib is an abbreviation for a very nasty germ- Hemophilus influenza type b.  Hib once caused many cases of deadly meningitis (bacterial infection of the brain and spinal cord) in young children, as well as bacterial pneumonia, very serious deep skin infections, and the dreaded epiglottitis (a serious bacterial infection of the valve between your esophagus and airway- the epiglottis).

The Hib immunization has essentially eliminated the chance of an immunized child getting these dangerous infections from the Hib germ.   The Hib immunization provides protection as young as 6-8 weeks of age if the immunization is given then.   The recommended schedule is to have it at 2, 4, 6, and 15 or 18 months of age.   That leaves a child fully protected starting at 2 months of age and throughout the vulnerable period of early childhood.   Once you are over 4 years of age, the risk of these infections from Hib becomes quite remote.

At Advanced Pediatrics, we combine the Hib immunization with the polio and DTaP immunization in an immunization called Pentacel at 2, 4, and 6 months of age.  The 15 or 18 month old dose is given with the DTaP.

Now, how does a shot for meningitis prevent leukemia?

The evidence is now established that if a child develops a serious Hib infection during infancy or early childhood, it activates two genes leading to an increased chance of developing leukemia.

The Hib immunization prevents activation of these two genes, and then really does reduce the chance of a child developing leukemia.

Bottom Line

1.  Hib is a bacteria that causes deadly infections.

2.  The Hib immunization prevents infection from these infections.

3.  Children who get their Hib vaccine in early childhood reduce their chance of developing leukemia by 20%!

4.  In the ongoing discussion of immunizations, this news it truly extraordinary.  It is a tremendous gift that we have a very simple intervention that can actually reduce the chances of developing something as serious as leukemia.

To your health,

Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

When Being Right Can Still be Wrong- The Curious Impact of Overdiagnosis

When Being Right Can Still be Wrong- 
The Curious Impact of Overdiagnosis

There is a very curious aspect to the process of diagnosis.  It's called overdiagnosis, but it should be called causing more harm than good.   Overdiagnosis is defined as correctly identifying a problem or disease is present, but finding this out provides no benefit to the person, and may cause harm.

This is not misdiagnosis where one is told they have a condition when in fact they do not have that condition.   And, it is not the same as overtreatment where excess medication is prescribed or excess procedures are done whether the diagnosis is correct or not.  (Coon, et al, Overdiagnosis: How Our Compulsion for Diagnosis May be Harming Our Children, Pediatrics, Nov. 2014, pp. 1013-1023)

The problem of overdiagnosis is mostly discussed when it comes to some very prominent illnesses seen in adults, in particular three common cancers, prostrate, breast, and thyroid; but, is seen in a variety of pediatric conditions, some rare, but some common, as noted in the Pediatrics reference above.

An Example from the Adult World
A lot of adults will develop a lump in their thyroid gland sometime in their life.  The advent of imaging has allowed us to detect many more such lumps and so the rate of them being removed has gone up dramatically.  Often these lumps will contain a few cells that fit the definition of cancer.  Some call these micro-cancers.  They almost never spread, and it appears if they were not detect, no harm would happen.  But because of the advent of imaging and biopsing, the incidence of thyroid cancer in the US has tripled.  In South Korea, every adult is screened with a thyroid ultrasound, so there the incidence of thyroid cancer has gone up 15-fold, and there thyroid cancer is now the #1 most common cancer.  But, both in the US and South Korea, the chance of dying from thyroid cancer has not dropped, at all.  

Think about that for a moment.   In two nations, millions of people have been screened for thyroid cancer, and many, many more people than before have had their thyroid cancer long before it has spread anywhere.   And yet, despite early detection, and early intervention, no benefit materialized.

Even worse, the fact that no lives were saved means that those thousands and thousands of people told they had cancer would have been fine not finding out.  The incidence of permanent complications from thyroid surgery in South Korea has gone up dramatically.

So, not only was no benefit delivered, but great harm has been done.

This is the essence of overdiagnosis.

A great summary of this example, and of this subject overall is found in the May 11,2015 essay by the great Dr. Atul Gawande, originally from Youngstown, but now a major leader in re-thinking medical care at Harvard Medical School:  http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande

How Overdiagnosis shows up in Children
The review cited above in Pediatrics lists 11 illnesses that children can experience in which significant overdiagnosis may be happening.   The conditions range from gallstones in adolescents (which often are seen on a scan but turn out to be harmless 95% of the time), to jaundice in the newborn period (very, very common, but typically harmless), to hypercholestrolemia (new screening guidelines for 9-11 year olds could commit 200,000 children to drug therapy for no clear proof that it will help them).

A striking example involves the diagnosis of low oxygen levels in babies with bad respiratory infections.   Since the invention of oxygen monitoring devices, the chance a baby with a bad cold will get admitted to the hospital and placed on oxygen pending the level returning to normal, has jumped dramatically.  But despite all the extra oxygen and hospital care, the chance of a bad outcome with a bad cold in infancy has not changed at all over the last decade or two.  Here is a case where getting the diagnosis (in this case, your oxygen level is low) is correct, but not helpful.

A common example includes food allergies.    There are three tests for food allergies- a skin test, a blood test, and a what-happens-if-you-eat-it test.  The only one that really matters is seeing what happens if you eat the food.  It turns out that blood testing finds antibodies in the blood that might lead to allergic reaction, but it turns out that antibodies to a food are found about 7 times more often than actual reactions occur.  So a blood test can give you a diagnosis of food allergy, and does in about 17% of children, but a true allergic reaction only occurs in 2.5% of children.


BOTTOM LINES

1. Diagnosis is all about getting it right.  
2. But errors lurk in so many directions- one can say you have an illness or condition when you do not, or one can have the illness but still not need any intervention.
3. Overdiagnosis is the error of being correct that someone has a problem, but finding that out offers them no benefit, and may cause serious problems from the unnecessary intervention.
4. The best protection against overdiagnosis, misdiagnosis, and overtreatment, is accuracy in the diagnostic process.  That requires tremendous vigilance to details on how medical care is given, to avoid both overdoing and underdoing a level of investigation.

At Advanced Pediatrics, we are committed to thinking very carefully about how to not only be accurate in making diagnoses, but making sure doing so will actually translate into real benefit.

To your health,

Dr. Arthur Lavin

One more reference is a great book on this subject by H. Gilbert Welch and his team at Dartmouth:

Over-Diagnosed, Making People Sick in the Pursuit of Health (2011, Beacon Press)

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Lice- Not a Disease

Lice Update:

They are Not a Disease

The American Academy of Pediatrics and the National Association of School Nurses both have recently come out with major policy statements on lice.   The issues involved were nicely summarized on this article in Slate:

http://www.slate.com/articles/life/family/2014/03/lice_in_school_let_em_stay.1.html

Here are the main points:

1.  Lice have been around a long time, longer than we humans.   They come in a variety of species, and many have caused terrible diseases, but not the species we are talking about, the head louse.

2.  The lice we are talking about are a particular species called head lice which are only found on human heads that have hair.

3.  Human head lice are harmless.  They carry no disease and pose no danger at all.  They simply feed on shed skin flakes off the scalp.   They can cause itch, that's it.

4.  Human head lice are not that contagious.  They do not spread easily, but after hours of being together and having many contacts, they can spread.

5.  Once discovered in a classroom, there are probably many children with them in their hair, and have been for weeks.   

There are a number of important conclusions to be drawn from these facts:

1. Since lice are harmless, the treatment better be harmless, too.   Strong pesticides have no role to play in treating lice.  They can cause harm to the brain, and treat a situation that presents no danger.
2. Since lice are harmless, do not spread easily, but usually are present for months in any one classroom, it makes no sense to keep a child out of school if found to have head lice.
3. The no-nits policy, that is keeping a child with head lice out of school until all lice eggs are removed from the hair, makes no sense, and flies in the face of all the biology we know about lice.

And yet, common practice leads many families to soak their children's heads in strong pesticides many schools to block school attendance if any eggs are found.  This is a curious situation given that all of science argues very strongly against these practices, and has for many decades.

BOTTOM LINES:
1.  Lice are harmless.

2.  They do not spread all that easily.

3.   Since lice are harmless, any treatment or response to them should be too.

4.  No pesticides should be used to treat lice, rather products like Lice MD which simply form a silicone shell around the hair can be used.

5.  Children should not be blocked from attending school for having lice.

6.  Lice come and go, it does our children no good to panic.

To your health,
Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.