Commonly used household disinfectants could increase the risk of young children becoming overweight by altering the makeup of their gut bacteria during the first few months of life, a study suggests.
The study, published Monday in the Canadian Medical Association Journal, analyzed the gut flora of 757 infants at age three to four months and their body mass index, or BMI, at one and three years old, looking at exposure to disinfectants, detergents and eco-friendly products used in the home.
Anita Kozyrskyj, professor of pediatrics at the University of Alberta, is shown in a handout photo. The high use of household disinfectant cleaners is changing the gut flora in babies, leading to them becoming overweight as three-year-olds.
“We found that infants living in households with disinfectants being used at least weekly were twice as likely to have higher levels of the gut microbes Lachnospiraceae at age three to four months,” said principal investigator Anita Kozyrskyj, a professor of pediatrics at the University of Alberta.
Lachnospiraceae is one of many non-pathogenic bacteria that naturally inhabit the human gut.
“When they were three years old, their body mass index was higher than children not exposed to heavy home use of disinfectants as an infant,” she added.
Researchers from across Canada looked at data on microbes in infant fecal matter among children enrolled in the Canadian Healthy Infant Longitudinal Development (CHILD) birth cohort. They used World Health Organization growth charts for BMI scores.
Associations with altered gut flora in babies three to four months old were strongest for frequent use of household disinfectants such as multi-surface cleaners, which showed higher levels of Lachnospiraceae.
Kozyrskyj said researchers also found there was a greater increase in levels of those bacteria in children whose parents reported more frequent cleaning with disinfectants.
“As the microbiome develops over the first year of life, these microbes increase in their abundance. So it was a matter of dose,” she said in an interview, noting that studies of piglets have found similar changes in the animals’ gut microbiome when they were exposed to aerosol disinfectants in their enclosures.
However, the same association was not found with detergents or eco-friendly cleaners, the CHILD study found. Babies living in households that used eco-friendly cleaners had different microbiota and were less likely to be overweight as toddlers.
“Those infants growing up in households with heavy use of eco cleaners had much lower levels of the gut microbes Enterobacteriaceae (a family of bacteria that includes E. coli). However, we found no evidence that these gut microbiome changes caused the reduced obesity risk,” Kozyrskyj said.
One reason could be that the use of eco-friendly products may be linked to healthier overall maternal lifestyles and eating habits, contributing in turn to the healthier gut microbiomes and weight of infants.
“Antibacterial cleaning products have the capacity to change the environmental microbiome and alter risk for child overweight,” write the authors. “Our study provides novel information regarding the impact of these products on infant gut microbial composition and outcomes of overweight in the same population.”
There are many findings that point to a possible causative role for disinfectants in altering gut flora and subsequently leading to a higher childhood BMI, said Kozyrskyj, noting that in studies of mice, Lachnospiraceae has been shown to cause insulin resistance and increased fat storage.
“I would be comfortable in saying the high use of disinfectants had a contributory role … My advice would be to not overuse them,” she said.
“Some people might say maybe go for an alternative, go for the eco product instead of the disinfectants as a cleaning agent.”
In a related CMAJ commentary, epidemiologists Dr. Noel Mueller and Moira Differding of the Johns Hopkins Bloomberg School of Public Health write: “There is biologic plausibility to the finding that early-life exposure to disinfectants may increase risk of childhood obesity through the alterations in bacteria within the Lachnospiraceae family.”
They call for further studies “to explore the intriguing possibility that use of household disinfectants might contribute to the complex causes of obesity through microbially mediated mechanisms.”
Kozyrskyj agreed, saying there is a need for further research that classifies cleaning products by their ingredients, with an analysis of their potential individual effects.
But experts say if you want to teach your children to be mindful, you have to be mindful, too.
The back-to-school season brings its own unique stressors to just about everyone: young children starting school for the first time, older kids dealing with longer days and social pressures, teenagers who have to make decisions about their futures, and of course to parents who might also feel overwhelmed. But researchers at Vancouver’s Kelty Mental Health Resource Centre have suggested strategies to deal with back-to-school stress.
“Mindfulness” has become a bit of a buzzword recently, along the lines of “radical wellness” and “living your best life.” But beyond the context of GOOP, there’s a lot of value in the idea that we could all focus more on the present moment.
The basic tenet of mindfulness is the idea that stress and pain is often the result of thinking about past regrets or worrying about the future, and that can be combated by coming up with strategies that focus on remaining in the present moment. HuffPost Canada spoke to Dr. Dzung Vo, an adolescent medicine specialist and pediatrician at British Columbia’s Children’s Hospital, about how kids can implement those strategies.
“I define mindfulness as paying attention in a particular way, on purpose, in the present moment, and with unconditional love,” Dr. Vo says. “It’s not meant to be something that you succeed or fail at, it’s more of an intention and an attitude that we orient ourselves to when we practice being in the present moment.”
Studies have shown that mindfulness can reduces stress and anxiety, improve attention and memory, and encourage empathy and monitor your emotions. It’s also been shown to be beneficial physically by lowering blood pressure and heart rate. And new research is currently underway to determine whether it can be a helpful tool to fight against depression.
Vo’s pediatric practice focuses primarily on teenagers, but he says there are effective strategies that can help just about every age group understand their feelings, process their reactions, and live a healthier emotional life.
Babies and toddlers
By far the most important factor in teaching very young children to be mindful is to have a parent or caregiver who is mindful themselves.
“What we know from neuroscience is that the parent’s own mental and neurologic state has a profound influence on regulating the child,” Vo told HuffPost Canada. “If the parent or caregiver can be mindful, present, attentive, and attuned with unconditional love and presence, then that will affect the child in very deep and healthy ways.”
One of the principles of mindfulness is approaching a subject with “beginner’s mind” — a sense of curiosity and presence you might use if you were trying something for the first time. This is something young children generally do anyways. “Kids are actually pretty naturally in the moment, so it’s not too hard to do,” Vo says.
Studies have shown that mindfulness can reduces stress and anxiety
School-age kids
Vo suggests adding brief mindfulness exercises into the routine of slightly older children, maybe at bedtime or when they get home from school. One idea is to get them to lie with a teddy bear on top of their belly and ask them to slowly breathe in and out, he says. Watching the teddy bear go up and down with their breath will put them in tune with their bodies, and put them in a state of calm.
Another useful activity can be to sing songs with lyrics that remind kids to think about where they are and how they feel — he suggests “Planting Seeds” by Zen master Thich Nhat Hanh. “As kids go through their day, when they need a mindful moment, they just sing the song,” he says. “Singing it actually is a practice, because it cultivates that mindful attitude.”
Crafts and artwork, approached with the “beginner’s mind,” are another helpful way to practice mindfulness. Vo suggests gently guiding children to be curious and really focus on their surroundings and what they might be engaging in.
“Maybe they’re drawing a flower in front of them,” he says. “Encourage the child to really pay attention to it by asking them: What are you seeing there? What are you noticing? What are the colours? What are the shapes?”
It isn’t particularly important that children understand the idea of mindfulness, he says.
“It’s more important to have experiences than to talk too much about the concepts.” And again, he stresses that the most important way to teach mindfulness to kids is the mindful presence of the parent or caregiver.
Teenagers
In his sessions with teens, Vo will often get them to try out their “beginner’s mind” by slowly eating one single raisin. “That might seem very simple and boring, but when you bring curious attention to it, you find experiences that seem tedious or boring may be quite interesting, or quite relaxing, or quite enjoyable in ways that we hadn’t considered when we go through them in autopilot mode.”
Many teenagers will bring what Vo calls “informal meditation” to a wide variety of day-to-day activities: breathing deeply and considering their senses while walking the dog, or waiting for the bus, or washing dishes. It can particularly help before a stressful situation at school — right before writing an exam, for instance.
There isn’t a lot of research on the benefits of mindfulness for teens, but Vo says that he believes that’s the time of life when those practices would be most beneficial.
Studies of adults have demonstrated that mindful practices can actually change the parts of the brain linked to memory, self-image, and emotional regulation. Because adolescent brains are changing quickly and profoundly, Vo says he thinks the effects would be even more significant. One of the biggest adolescent brain changes involves the prefrontal cortex, the part of the brain responsible for emotional regulation and executive functioning, which develops throughout the teenage years up until the early 20s. It develops through focused attention and concentration, he says, which suggests that the more that they use these neurologic pathways to help regulate their brains, the stronger those connections will get.
“To paraphrase Ralph Waldo Emerson, who you are will speak more loudly to your kids than anything you say.” ~ Eric Grietens, former Navy SEAL and Governor of Missouri
Parenting is hard work.
Children, by their very nature, lack the emotional and cognitive resources to navigate life without help. They’ll whine, cry, shout, beg, and complain for no reason. We may feel anger, annoyance, frustration and even guilt for how our child behaves.
But kids will be kids, as they say.
Despite the inevitable challenges of parenting, it is our responsibility to teach and set the example. Not all parents embrace this responsibility – and the effects can be devastating.
Parenting is an obligation that we must take on with the utmost sincerity. Indeed, how we decide to raise our children will profoundly influence the type of person he or she becomes.
There comes a time in every parent’s life when they question their parenting abilities. This is natural, and it is nothing for which to be ashamed.
Perhaps the most humble and righteous thing that a good parent can do is admit they don’t know everything. Being a parent is not something that happens – it is a process. Birth ‘happens’; parenting evolves.
This article focuses on eight science-backed methods of raising happy and prosperous children. As you read through, you’ll notice a diverse set of opinions and topics.
The common thread behind all of this advice is a scientific consensus, from psychologists, professors, social workers, and, most importantly, parents. The science of child development, while not perfect, provides a useful framework from which to operate.
HERE ARE 8 THINGS PARENTS TEACH KIDS FOR SUCCESS:
1. DEVELOP EMOTIONAL INTELLIGENCE
Decades of research show that emotional intelligence is as critical to success– if not more so – than cognitive intelligence. Per a study conducted by TalentSmart, emotional intelligence (‘E.I.’) is the most reliable predictor of performance, blowing past I.Q. and personality.
The most important thing a parent can do to cultivate a child’s emotional intelligence is to model good behavior and E.I.-related traits.
2. FORGET ‘HELICOPTER PARENTING.’
Helicopter parenting, or overparenting, is one of the most significant problems parents have according to Julie Lythcott-Haims, the former dean of freshman at Stanford University.
Parents who hover around their kids (hence the word ‘helicopter’) aren’t doing them any favors. The same can be said of overprotection.
Giving your child more freedom can be difficult for parents. We love our kids and don’t want to see them get hurt. But, we must be willing to let our kids try new things, fail, and experience consequences; it is essential to the maturity process.
3. LEARN HOW TO GIVE PRAISE EFFECTIVELY
Continually praising a child for their innate gifts, like intelligence, makes it less likely that they will apply said gifts to bettering themselves. (They know they’re smart!)
Carol Dweck, professor of psychology at Stanford University, examined the difference between a growth mindset and a fixed mindset. She discovered that praising children for developing novel approaches to solving problems, even when unsuccessful, teaches them the importance of seeing things through, giving effort, and realizing their intentions.
4. GIVE THEM OUTSIDE PLAY TIME
The booming tech age is both exciting and novel. But the increasing reliance (addiction?) resulting from overuse of technology is troubling. There is perhaps nothing more disturbing than the child who comes home from school and spends the rest of their evening on an iPad, cell phone, or computer.
Research shows that overusing technology hampers a child’s social skill development, encourages a sedentary lifestyle, and inhibits a child’s academic growth.
When they want to go to a friend’s house, let them. If there’s space in front of your home, your kid should be spending at least an hour or two outside per day.
5. GIVE THEM CHORES
Lythcott-Haims found that one common trait among successful adults is that they reported having additional responsibilities (chores) as kids.
She says “By making them do chores – taking out the garbage, doing their own laundry – they realize I have to do the work of life in order to be part of life. It’s not just about me and what I need in this moment.”
6. BE A BIT PUSHY ABOUT SCHOOL
According to researchers in from the University of Essex in the U.K., parents who have high expectations for their children – and consistently remind them of these expectations – are more likely to raise academically-successful kids.
Researchers note in the study “The measure of expectations in this study reflects a combination of aspirations and beliefs about the likelihood of attending higher education reported by the main parent, who, in the majority of cases, is the mother.”
(Thanks, Mom!) raising kids
7. TEACH THEM RESILIENCE
Resilience, or the ability to rebound from setbacks, is a common trait shared among successful people. A high level of resilience enables one person to survive and thrive in circumstances that may defeat someone else.
How do you teach resilience to kids? Set a good example, demonstrate commitment and follow through, practice gratitude, and act as a mentor.
8. TEACH THEM ABOUT SERVING OTHERS
We live in a highly individualistic and cynical world. In fact, studies show that most people, given a choice, will commit an act out of selfishness rather than the common good.
We need more people who serve others and who act as servant-leaders.
Emma Seppala, Ph.D., science director at Stanford University’s Center for Compassion and Altruism Research and Education, says “The best-kept secret to happiness is to be of service to others,” and that “Multiple studies have shown that happiness makes people 12 percent more productive.”
The more of the foods they consumed, the higher their IQs.
A diet low in sugars, fats and processed foods consumed at a young age may increase your intelligence, research finds.
Children under 3-years-old fed diets that are packed full of nutrients and vitamins have higher IQs.
The more healthily they eat, the higher their IQ.
The study followed the wellbeing and health of 14,000 children born between 1991 and 1992 in the UK.
What they ate was tracked up to the age of 8, when they were given an intelligence test.
The results showed that children who ate a health-conscious diet including more salad, rice, pasta, fish and fruit had higher IQs at age 8.
Those consuming more junk food high in fats and sugars had lower IQs.
The study’s authors conclude that:
“…a poor diet associated with high fat, sugar and processed food content in early childhood may be associated with small reductions in IQ in later childhood, while a healthy diet, associated with high intakes of nutrient rich foods described at about the time of IQ assessment may be associated with small increases in IQ.”
There was little effect on IQ from what children ate between ages 4 and 7.
The authors say:
“This suggests that any cognitive/behavioural effects relating to eating habits in early childhood may well persist into later childhood, despite any subsequent changes (including improvements) to dietary intake.
It is possible that good nutrition during this period [under 3 years-old] may encourage optimal brain growth.”
The study was published in the Journal of Epidemiology and Community Health (Northstone et al., 2011).
“Anxiety is a normal part of childhood, and every child goes through phases. A phase is temporary and usually harmless. But children who suffer from an anxiety disorder experience fear, nervousness, and shyness, and they start to avoid places and activities.” ~ Anxiety and Depression Association of America
It is estimated that anxiety disorders affect one in eight children. Studies show that children with untreated anxiety are more likely to engage in substance abuse, under-perform academically, and remove themselves from important social development experiences.
According to the Anxiety and Depression Association of America (ADAA), 80 percent of children with a diagnosable anxiety disorder are not getting treatment. This is particularly troublesome considering that the brain undergoes tremendous growth during childhood; thus, increasing the chances that the anxiety becomes hardwired.
In this article, we’re going to discuss signs of childhood anxiety, how to reduce a child’s anxiety, and other possible treatment options.
SIGNS OF CHILDHOOD ANXIETY
Parents of a young girl named Ella share their story:
“Ella was a worrier. Every morning, she worried that she wouldn’t make the bus on time, even though she hadn’t missed it once all year. And every afternoon, she worried that she wouldn’t get her favorite spot at the lunch table, or that she might have a pop quiz in science class and wouldn’t be prepared. At night, she worried about getting her homework done and whether her clothes would look right at school the next day.”
As you can gather from these parents’ story, child anxiety is quite apparent provided adequate attention is being given. Anxious kids display their anxiety in many ways – at home, school, and in social settings.
Per kidshealth.org, kids suffering from anxiety will have one or more of the following signs:
– excessive worry most days of the week, for weeks on end
– trouble sleeping at night or sleepiness during the day
– restlessness or fatigue during waking hours
– trouble concentrating
– irritability
THINGS THAT REDUCE CHILDHOOD ANXIETY
When children experience chronic anxiety, it’s easy for parents to fall into the trap of trying to protect their child. However, overprotection is counterproductive to relieving anxiety – and exacerbates many of the symptoms.
Per the Child Mind Institute, here are 10 pointers for helping children escape the cycle of anxiety before kids
1. UNDERSTAND THAT ELIMINATING ANXIETY ISN’T THE GOAL – BUT MANAGING IT.
It can be discouraging to see your kid deal with anxiety. It’s painful for us. But as much as we would like to get rid of everything that causes anxiety, it’s just not possible.
Instead, it’s all about teaching the child to tolerate their anxiety as best they can, even when they’re anxious.
Eventually, the anxiety will subside.
2. ALLOW THE CHILD TO CONFRONT THEIR ANXIETY.
While helping children avoid the things they’re afraid of may help in the short-term, it exacerbates the problem in the long run.
It’s important for parents to understand that pulling their child out of every anxiety-provoking situation reinforces avoidance – a poor coping mechanism for anxiety and stress.
3. SET POSITIVE AND REALISTIC EXPECTATIONS.
Setting positive and realistic expectations is all about instilling a sense of self-confidence. Often, expressing confidence that your child will be okay allows them to manage their anxiety well enough to see things through.
4. RESPECT, BUT DON’T EMPOWER, THOUGHTS AND FEELINGS.
You don’t want to belittle your child’s anxiety, but you don’t want to amplify it either. If your child is fearful about going to the doctor, address (don’t ignore) her concerns.
Listen and be empathetic, and say something along the lines of “I know you’re scared now, and that’s okay. We’ll get through this together.”
5. DON’T ASK ANTICIPATORY QUESTIONS.
If you have a vague feeling that something may be bothering your child, make sure to ask open-ended questions – and not leading them.
For example, the question “How is studying going for your exams?” encourages your child to express themselves more than “Are you anxious about your mid-terms?”
6. DON’T REINFORCE THEIR FEARS.
In other words, don’t give your child a reason to be afraid. If your child has a negative experience with a bully, for example, the last thing you want to do is give him or her a reason to fear the big, strong kid in class.
Again, empathize and listen. If you don’t know how to respond, do some research and come back to the discussion. Whatever you do, don’t say “there’s a good reason for your fear” unless there is.
7. MOTIVATE THE CHILD TO TOLERATE HER ANXIETY.
It’s important to let your child know how proud you are of them enduring anxiety. Anxiety and fear aren’t easy things for anyone to contend with, much less a young child.
We should know that we all possess what is called the “habitation curve.” As we are exposed to the thing(s) that we fear, we slowly but surely get over them; which is precisely what a child – and all of us, for that matter – needs to do.
8. MAKE SURE TO REACH A CONCLUSION.
We all live busy lives and may leave things unfinished from time to time. However, adequately addressing your child’s anxiety issues isn’t something to put off.
Commit to finding a resolution and resolve to keep that commitment no matter how long it may take.
9. SET A GOOD EXAMPLE.
If your child is dealing with stress and anxiety issues, the best thing you can do is keep a stiff upper lip about your problems.
Again, stress and anxiety hit all of us. If you must release some pent-up tension, do it away from the child. Certainly, do not involve the child in such scenarios.
10. LISTEN WITH FULL INTENT.
When we’re dealing with a child who is obviously anxious, we’d be wise to lend an attentive ear. Not only is this part of being an adult, but attentively listening to a troubled child both sets a good example and helps to reach a solution earlier.
Myth has it that fish is brain food – but it just might be more than myth, a new study suggests.
Kids who ate fish at least once a week had intelligence quotients, or IQs, that were nearly 5 points higher than the IQs for kids who ate less fish or none at all, the study found. Fish eaters also slept better.
Though the study was done among Chinese children, American kids are just as likely to benefit from fish, according to lead researcher Jianghong Liu, an associate professor of nursing at the University of Pennsylvania School of Nursing in Philadelphia.
“We need to modify the American diet for the betterment of our children,” she said.
“If parents want their children to be healthy and higher-performing, they should put fish on the table once a week,” Liu said. “That is not too much to ask.”
Although the study cannot prove that eating fish accounted for the higher IQs and better sleep, they do seem to be associated, she said.
According to the researchers, the benefit in IQ can be pinned to the better sleep afforded by omega-3 fatty acids found in many types of fish.
Good foods for brain health
To find out if fish was linked to benefits in children’s health, Liu and her colleagues studied the eating habits of more than 500 boys and girls in China, 9 to 11 years old. The children completed a questionnaire about how often they’d eaten fish in the past month, with options that ranged from never to at least once a week.
The kids also took the Chinese version of an IQ test that rates verbal and nonverbal skills, called the Wechsler Intelligence Scale for Children-Revised.
In addition, the children’s parents answered questions about their child’s sleep quality. The information collected included how long kids slept, how often they woke during the night and whether they were sleepy during the day.
Liu’s team also took into account other factors that could influence the findings, such as the parents’ education, occupation and marital status and the number of children in the home.
The team found that children who ate fish at least once a week scored 4.8 points higher on the IQ tests than those who seldom or never ate fish. Kids whose meals sometimes included fish scored slightly more than 3 points higher.
Moreover, eating more fish was linked with better sleep.
One U.S. nutritionist, however, says that advice to eat fish should be taken with a grain of salt.
“It’s not that eating fish is unhealthy per se, but there are issues that need to be considered before parents go overboard feeding fish to their kids to make them smarter and sleep better,” said Samantha Heller, a senior clinical nutritionist at New York University Medical Center in New York City. She was not involved with the study.
Fish is a good source of lean protein and is high in omega-3 essential fatty acids, she said. These acids are highly concentrated in the brain and play important roles in neurological function. They are essential for brain, eye and neurological development in fetuses. They are also necessary for eye, heart and brain health in adults and may reduce systemic inflammation, Heller said.
“The concern with eating fish is not only the overfishing of our seas, but the amount of mercury – a neurotoxin – found in fish,” she said.
The U.S. Food and Drug Administration recommends only one to two 2-ounce servings of low-mercury fish a week for children ages 4 to 7; 3 ounces for children 8 to 10; and 4 ounces for children 11 and older, Heller said.
Five commonly eaten fish that are low in mercury are shrimp, canned light tuna, salmon, pollock and catfish, according to the FDA.
“A healthy, balanced diet, plenty of exercise and limited computer and screen time can all help kids sleep better and do better in school,” Heller said.
The study was published online Dec. 21 in the journal Scientific Reports.
When Garrett Pohlman was diagnosed with strep throat in 2007, his illness didn’t respond to antibiotics. Then the strange behaviors began.
Diana Pohlman says her son, who was 7 years old at the time, had been easygoing up to that point. But he developed severe obsessive compulsive disorder (OCD) symptoms overnight. He became paranoid – worrying about things like radiation from the TV and light switches. He had tics and anorexia and started having frequent episodes of rage.
“He was not anyone I recognized. He was a completely different child,” she says. “It was a nightmare. At first I thought maybe he had been molested. Then I thought he had a brain tumor.
“He became so delusional he would climb on the roof thinking it was the front door. He would jump in front of cars and out of moving cars, and he had self-harm fantasies. He was afraid to leave the house. We had to pick him up and wrap him in a sheet to get him out of the house. At the age of 7,” Pohlman says.
He was not anyone I recognized.
He was a completely different child.
Diana Pohlman
The search for answers was long and expensive. After many months, the family found their way to a psychiatrist who knew about a disorder called pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, or PANDAS, a condition she says several specialists didn’t know about. That led to medical treatment that included long-term antibiotics, having his tonsils and adenoids removed, and eventually two rounds of immunoglobulin, or IVIG treatments.
Recovery was slow, but after 2 years, by the age of 9, Pohlman says the severe symptoms stopped. For another 2 years, he had what she calls mild and manageable symptoms that eventually dissipated.
But rather than move on from PANDAS, the boy’s mother decided she needed to help other parents trying to figure out these mysterious symptoms. She founded the nonprofit PANDAS Network in 2009 to raise awareness, support families, and push for more research to better understand how to diagnose and treat the condition.
“When I realized doctors didn’t understand it, I thought I better not quit working on this because how will anyone else ever get help,” Pohlman explains. “It is abysmal. It has been shocking how misinformed doctors are about the term ‘PANDAS.’ ”
Little is known about how or why the syndrome happens, and not all doctors believe there is a connection. The American Academy of Pediatrics does not recognize a link between strep and the syndrome.
“You will not find consensus from pediatric infectious disease doctors that PANDAS even exists, much less what to do about it and how to manage the patients,” says Meg Fisher, MD, a pediatrician and infectious disease specialist at Unterberg Children’s Hospital at Monmouth Medical Center in Long Branch, NJ. “We still haven’t had the definitive article or study or demonstration to really get some solid clinical evidence behind this. My problem is, even if you believe in the syndrome, it’s totally unclear what you should do to help those patients. All of the information is anecdotal.”
What Is PANDAS/PANS?
Susan E. Swedo, MD, at the National Institute of Mental Health (NIMH), first identified PANDAS in the 1990s after she reported on a link between the fast onset of OCD and group A streptococcus, more commonly known as strep.
You will not find consensus from pediatric infectious disease doctors that PANDAS even exists, much less what to do about it and how to manage the patients.
Meg Fisher, MD, Unterberg Children’s Hospital, Monmouth Medical Center
PANDAS happens when strep triggers a misdirected immune response that causes inflammation in a child’s brain. Pediatric acute-onset neuropsychiatric syndrome, or PANS, is a larger umbrella term that has to do with cases with a trigger other than strep, including infections like walking pneumonia or the flu.
Both disorders appear in childhood, typically between the ages of 3 and 12. While blood tests may help identify infections, there are no lab tests or other indicators for PANDAS or PANS.
Doctors diagnose the syndrome when children suddenly get severe OCD or eat a lot less food, along with at least two of the following symptoms: anxiety, depression, irritability or aggression, behavioral regression, ADD- or ADHD-like symptoms affecting schoolwork, sensory or motor problems, troubled sleep, and frequent urination.
The PANDAS Network says in some cases, the emotional symptoms can weaken children and make them homebound. Other children are OK at school but fall apart at home. The NIMH describes the start of symptoms as “dramatic,” happening “overnight and out of the blue.”
“The consensus of scientists and clinicians is that it needs to be sudden and severe,” says Margo Thienemann, MD, co-director of the PANS program at Stanford University Medical Center in California. “Sudden can be overnight. Some people can say exactly what time it started or that it happened over a couple of days. But they all say this isn’t their child anymore. Even if they don’t believe someone can be possessed, it feels that way. What happened? Why are they doing these things? Why can’t they stop?”
Swedo estimates that it impacts about 1% of elementary school-aged children and is likely under-diagnosed. The PANDAS Network estimates 1 in 200 children have it. Thienemann says her program at Stanford has seen more than 250 patients since it started in 2012. But she says that since their staff is small, they have to narrow down who gets in. One year, they turned away 1,000 patients because they couldn’t handle any more.
Thienemann says this is why they have helped write guidelines to allow health care providers to identify and treat these children. “It takes a multidisciplinary team to manage. A psychiatrist, pediatrician, or rheumatologist can’t do it alone. You need all these different vantage points to diagnose and coordinate care,” she says.
There are now PANS centers in California and Arizona, and some doctors around the country treat the disorder.
The NIMH says research suggests IVIG can ease symptoms and may be used in severe PANDAS cases, but it warns it has many side effects — including nausea, vomiting, headaches, and dizziness — and there is a chance of infection with this sort of procedure. Parents say it is also expensive and often not covered by insurance.
Some families say they also see improvement when they have their children’s tonsils and adenoids removed, although no studies show that works.
streptococcus pneumonia bacteria
Controversy
Not all in the medical community agree that strep or other infections can trigger these kinds of behaviors. There is also much debate about whether treatments are effective.
While the American Academy of Pediatrics does not recognize a link between strep and PANDAS, a March 2017 article in AAP News, sent to the group’s 66,000 pediatrician members, discusses the disorders and the controversy around them. While it’s not the group’s official policy, the article says pediatricians should consider PANS anytime a child “has an abrupt behavior change with obsessive thoughts,” and it points them to material that shows them how to diagnose it.
Fisher says it’s complicated for pediatricians, since there is no evidence that taking out tonsils and adenoids is helpful or that antibiotics work. She says many pediatricians worry that young patients will become resistant to antibiotics if you prescribe them long-term, and many have concerns about IVIG side effects.
“I understand the parents’ frustration, because finding a physician for these patients is very difficult. There are a lot of doctors who are, quote unquote, PANDAS specialists, but there is nothing that is evidence-based about what they are doing,” she says. “Our goal is first do no harm, and it is hard to know how best to help these patients. It is a very frustrating thing. I wish someone would come up with some solutions.”
Thienemann says most parents who find their way to her program are frantic because they can’t get help anywhere else. “Part of that desperation is nobody would listen to them. People say my pediatrician won’t do anything, and my child is trying to jump out of moving cars or a window. They can’t get out of the house, can’t sleep, are urinating on themselves, and have severe separation anxiety,” she says.
There is something medically wrong. There isn’t a finger to be pointed. There are questions to be asked and answered.
Ali Claypoole
Parents say it is obvious something isn’t right.
“I thought she had schizophrenia or severe mental illness,” says Kelly, a mother in Maryland who asked that we not use her last name to protect the privacy of her 7-year-old daughter, Maggie, who has PANDAS. “It was rapid-onset OCD, and then we were spending our entire life trying to keep her from jumping out of cars, hurting herself, biting us, and losing her mind.”
“There is something medically wrong. There isn’t a finger to be pointed. There are questions to be asked and answered,” adds Ali Claypoole, whose son, now 9 years old, first showed PANDAS symptoms at the age of 6. “Our world is turned upside down, and from where I am, it’s almost like parents are more informed than the doctors. I find the civilian community is much more understanding, interested, and willing to learn about this than the medical community. It makes me mad.”
Going Forward
More research is now being done.
In a 2017 large-scale study of key parts of the PANDAS theory, researchers looked at 17 years of data out of Denmark and found that young patients with a positive strep test had higher chances of having of mental disorders, especially OCD and tic disorders, compared with those without a positive strep test. Non-strep throat infections also carried a higher chance of these types of mental disorders in children, although it was less – perhaps pointing to the chance that other infections can trigger the symptoms.
It is really the brain inflammation
that is central to this disease.
Dritan Agalliu, PhD, Columbia University Medical Center
In 2016, Dritan Agalliu, PhD, an assistant professor in the Department of Neurology at Columbia University Medical Center in New York City, published a study showing that immune cells produced in the nose after multiple strep infections appear to be the culprit for the disease. These cells enter the brain via the nerves that are responsible for the sense of smell, and they damage the blood vessels and synapses in the brain.
Agalliu says this research helped explain a crucial step in the disease: how antibodies that the body makes to attack strep or other infections cross the blood/brain barrier in these children and attack parts of their brain by mistake; similar to what happens in other autoimmune diseases of the brain, like multiple sclerosis.
The NIHM recently awarded Agalliu nearly $2 million to keep studying the disorder. He says it should be called post-streptococcal basal ganglia encephalitis, or inflammation of the brain. He’s also doing research funded by a private donor, looking at genetic chances of having the disorders to understand why a small number of children who get multiple strep infections are prone to get the disease.
“It is really the brain inflammation that is central to this disease. If we think about PANDAS/PANS this way, it will relieve a lot of controversy and make therapies more acceptable for patients,” Agalliu says. “I am hoping with our next publication, we can alleviate any potential question that this is an autoimmune disease.”
There’s also increasing interest in looking at PANDAS as a type of Sydenham chorea, defined by abnormal movements, OCD, mood swings, and other emotional symptoms that follow strep infection.
The NIMH now has a group for PANDAS and PANS. The PANDAS Network is working to make information about the disorders part of continuing medical education for pediatricians, and a working group has created handouts to educate school personnel nationwide to help children with these disorders get back to their classrooms.
So will children outgrow PANDAS? Like most other things associated with this disorder, there is no consensus.
Doctors who focus on the disorders say when patients can get to them, improvement is possible. “If we get people as early as possible, maybe even at the onset of illness, I think we do a good job of being able to tamp down inflammation and help them a lot and maybe get them all the way better,” Thienemann says. “If someone has been dealing with it for 10 years, I think they may develop ongoing autoimmune problems and there may be damage to their brain. Recovery might not be as complete, but I think we can still help them.”
Three years after he first showed symptoms, Claypoole’s son had a full remission at the age of 9 after IVIG treatments. But after a few months, he got strep again and the PANDAS symptoms returned, but they were less severe. Kelly’s daughter Maggie has seen her symptoms subside for a while, only to return. Her doctors prescribe antibiotics and anti-inflammatories after each new episode. She takes both medications daily for months on end. She has also had two rounds of IVIG. “Every time we do an intervention, the baseline gets better, but it doesn’t end the problem. She is not symptom-free,” Kelly says.
Pohlman says her son, now 17, is a straight-A student who plays football and the cello and is applying to college. He is symptom-free.
“Once I understood that Garrett’s brain was on fire from an infectious illness, I barely could believe his body would have the capacity for a full recovery,” she says. “Could he have the normal life I had expected for my child? So I look at him now in amazement.”
By Jennifer Clopton Nov. 10, 2017 WebMD Article Reviewed by Hansa D. Bhargava, MD on November 10, 2017
Sources Ali Claypoole, Maryland. Kelly, Maryland. (Requested not using last name) Dritan Agalliu, PhD, Columbia University Medical Center, New York City. Meg Fisher, MD, Unterberg Children’s Hospital at Monmouth Medical Center, Long Branch, NJ. Diana Pohlman, executive director, PANDAS Network, Stanford, CA. Patricia Rice Doran, EdD, associate professor, Department of Special Education, Towson University, Maryland. Margo Thienemann, MD, Stanford University School of Medicine, Stanford, CA. AAP News: “PANDAS/PANS treatments, awareness evolve, but some experts skeptical.” American Academy of Pediatrics Red Book: “Group A Streptococcal Infections.” National Institute of Mental Health: “PANDAS, Questions and Answers.” National Institute of Mental Health: “Guidelines published for treating PANS/PANDAS.” PANDASNetwork.org: “What is PANS?” “What is PANDAS?” Symptoms,” “Statistics,” “Our Mission.” K. Chang, Journal of Child and Adolescent Psychopharmacology, Feb. 1, 2015. R. Kurlan, Pediatrics, June 2008. S Orlovska, JAMA Psychiatry, July 1, 2017. K.A. Williams, Brain Research, August 18, 2015. T Dileepan, The Journal of Clinical Investigation, January 4, 2016.
