Even Low Lead Exposure Hinders Kids’ Reading

The negative impact lead has on our children is becoming more and more dangerous. All recent studies are suggesting that lead is much more of a problem at lower levels, than was previously thought. This will make us rethink the lead pipes in many of our homes. Especially for sensitive children, lead and other toxic metals can threaten their ability to grow and thrive normally.

By Nancy Walsh, Staff Writer, MedPage Today

Published: May 13, 2013: Reviewed by F. Perry Wilson, MD, MSCE; Instructor of Medicine, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Young children exposed to lead — even at low levels — are at risk for not meeting reading readiness benchmarks in kindergarten, a large study of urban children found.

On tests of reading readiness, children with blood lead levels between 5 and 9 mcg/dL scored 4.5 points (95% CI −2.9 to −6.2) lower than those with levels below 5 mcg/dL, according to Pat McLaine, DPH, of the University of Maryland in Baltimore, and colleagues.

And those with lead levels of 10 mcg/dL and higher had scores 10.1 points (95% CI −7 to −13.3) lower, the researchers reported online in Pediatrics.

Almost 25 years ago the CDC established 10 mcg/dL as a “level of concern” for blood lead levels in children, and more recently determined that children whose levels are 5 mcg/dL should be targeted for intervention.

“Learning to read is critical to the entire process of formal education,” McLaine and colleagues stated.

This requires “proficiency in phonologic processing skills (using the sounds of one’s language to process written and oral language) and in the ability to decode new words,” they explained.

A possible association between lead exposure and reading readiness has not previously been examined, but cooperation between school and public health authorities in Providence, R.I., provided an opportunity to consider this.

Using linked data from the Rhode Island Department of Health and Providence’s public school district records, McLaine’s group compared results among 3,406 children who had been tested for blood lead levels an average of three times before entering kindergarten.

Reading readiness was assessed on the Phonological Awareness Literacy Screening-Kindergarten (PALS-K) instrument, which measures reading-relevant cognitive abilities.

The test is given in the fall of kindergarten, and children who score lower than 28 out of a total of 102 are given additional classroom instruction throughout the year, the researchers explained.

The goal is for children to score 81 or higher by the time the test is repeated in the spring.

The study population was diverse and largely low income, with almost 60% being Hispanic and more than 90% qualifying for federal school lunch assistance.

The median blood level of lead in the entire group was 4.2 mcg/dL.

One in five children had had at least one blood level reading of 10 mcg/dL or higher, and more than two-thirds had at least one level of 5 mcg/dL or above.

“These results are markedly higher than [National Health and Nutrition Examination Survey] estimates from the same time and suggest that national population estimates may seriously underestimate the lead problem in urban schools,” the researchers observed.

The highest levels were seen in blacks and children whose first language was not English or Spanish, such as those of Asian descent.

About 35% of the children tested below the cutoff score on the PALS-K in the fall. These low scores were most commonly among boys, Hispanics, those receiving free lunches, and those with blood lead levels of 10 mcg/dL or higher.

Low scores also were seen in children whose mothers hadn’t completed high school or had public insurance at birth.

More than two-thirds of children whose blood levels were below 5 mcg/dL passed the cutoff PALS-K score, compared with only half of those whose levels exceeded 10 mcg/dL.

The prevalence ratio for not meeting the PALS-K benchmark score on the fall test was 1.21 (95% CI 1.19 to 1.23) among children whose blood lead levels fell between 5 and 9 mcg/dL and 1.56 (95% CI 1.51 to 1.60) for those with levels of 10 mcg/dL or higher.

This analysis found a “clear dose-response relationship” between early-life lead exposure and kindergarten reading readiness, even after adjustment for socioeconomic status, language spoken, and other demographic factors.

“Our results suggest the need to evaluate current screening approaches for early reading intervention and to determine whether adding a history of elevated [blood lead levels] could improve targeting of children who are at risk of school failure and are not presently being captured in that system,” the researchers stated.

They plan to follow these children during elementary school “to better understand the long-term impacts of both kindergarten reading readiness and childhood lead exposure on school success.”

These findings offer a caution about children who are exposed to fairly low levels of lead, according to Kevin Chatham-Stephens, MD, of Mount Sinai Medical Center in New York, who was not involved in the study.

“This study reinforces the fact that levels we used to think were safe — up to 5 mcg/dL — actually can impact children’s growth and neurodevelopment,” Chatham-Stephens told MedPage Today.

Limitations of the study included unclear reliability of measures of lead levels and possible residual confounding.

The study was supported by the National Institute for Occupational Safety and Health Education and Research Center for Occupational Safety and Health, the CDC, and the U.S. Department of Health and Human Services.

The authors reported no financial conflicts.

Primary source: Pediatrics

Source reference: McLaine P, et al. “Elevated blood lead levels and reading readiness at the start of kindergarten” Pediatrics 2013; DOI: 10.1542/peds.2012-2277 .

How Food Sensitivities Can Negatively Affect Children with ADHD

Our take:

“Food sensitivities do not just affect the digestive system. When we eat foods that our body does not agree with, it can lead to neurological problems such as hyperactivity, acting out and the inability to pay attention. The following is a recent research article the shows this relationship. The important thing to remember is that these food sensitivities can be reversed with proper treatment.”

Effects of a Restricted Elimination Diet on the Behaviour of Children with ADHD

 

Background

The effects of a restricted elimination diet in children with attention-deficit hyperactivity disorder (ADHD) have mainly been investigated in selected subgroups of patients. We aimed to investigate whether there is a connection between diet and behaviour in an unselected group of children.

Methods

The Impact of Nutrition on Children with ADHD (INCA) study was a randomised controlled trial that consisted of an open-label phase with masked measurements followed by a double-blind crossover phase. Patients in the Netherlands and Belgium were enrolled via announcements in medical health centres and through media announcements. Randomisation in both phases was individually done by random sampling. In the open-label phase (first phase), children aged 4—8 years who were diagnosed with ADHD were randomly assigned to 5 weeks of a restricted elimination diet (diet group) or to instructions for a healthy diet (control group). Thereafter, the clinical responders (those with an improvement of at least 40% on the ADHD rating scale [ARS]) from the diet group proceeded with a 4-week double-blind crossover food challenge phase (second phase), in which high-IgG or low-IgG foods (classified on the basis of every child’s individual IgG blood test results) were added to the diet. During the first phase, only the assessing paediatrician was masked to group allocation. During the second phase (challenge phase), all persons involved were masked to challenge allocation. Primary endpoints were the change in ARS score between baseline and the end of the first phase (masked paediatrician) and between the end of the first phase and the second phase (double-blind), and the abbreviated Conners’ scale (ACS) score (unmasked) between the same timepoints. Secondary endpoints included food-specific IgG levels at baseline related to the behaviour of the diet group responders after IgG-based food challenges. The primary analyses were intention to treat for the first phase and per protocol for the second phase. INCA is registered as an International Standard Randomised Controlled Trial, number ISRCTN 76063113.

Findings

Between Nov 4, 2008, and Sept 29, 2009, 100 children were enrolled and randomly assigned to the control group (n=50) or the diet group (n=50). Between baseline and the end of the first phase, the difference between the diet group and the control group in the mean ARS total score was 23·7 (95% CI 18·6—28·8; p<0·0001) according to the masked ratings. The difference between groups in the mean ACS score between the same timepoints was 11·8 (95% CI 9·2—14·5; p<0·0001). The ARS total score increased in clinical responders after the challenge by 20·8 (95% CI 14·3—27·3; p<0·0001) and the ACS score increased by 11·6 (7·7—15·4; p<0·0001). In the challenge phase, after challenges with either high-IgG or low-IgG foods, relapse of ADHD symptoms occurred in 19 of 30 (63%) children, independent of the IgG blood levels. There were no harms or adverse events reported in both phases.

Interpretation

A strictly supervised restricted elimination diet is a valuable instrument to assess whether ADHD is induced by food. The prescription of diets on the basis of IgG blood tests should be discouraged.

Foundation of Child and Behaviour, Foundation Nuts Ohra, Foundation for Children’s Welfare Stamps Netherlands, and the KF Hein Foundation.

SOURCES:

The Lancet, Volume 377, Issue 9764, Pages 494 – 503, 5 February 2011

Dr Lidy M Pelsser MSc , Klaas Frankena PhD, Jan Toorman MD, Prof Huub F Savelkoul PhD , Prof Anthony E Dubois MD, Rob Rodrigues Pereira MD, Ton A Haagen MD, Nanda N Rommelse PhD, Prof Jan K Buitelaar MD

‘Love Hormone’ May Buffer Kids From Mom’s Depression

Our take:

“Oxytocin is a safe and effective treatment for numerous disorders including autism and ADHD. We find that it can solidify the bond between parents and children and bring increased communication and sense of wellbeing to your child.”

 

Anxiety, Conduct Disorders More Prevalent in Children with Low Oxytocin Levels

By Robert Preidt

FRIDAY, Dec. 9 (HealthDay News) — Children born to mothers with postpartum depression are at increased risk for mental health problems, but a hormone called oxytocin may reduce the risk, according to a new study.

Oxytocin, which is produced naturally in the body and has been associated with feelings of love and trust, may help protect kids from the negative effects of maternal depression, the researchers found. A synthetic version of the hormone is available as medication.

In the study, Israeli researchers looked at 155 mother-child pairs. By the time they were 6 years old, 60 percent of children born to mothers who were consistently depressed for the first year after giving birth had mental health problems, mainly anxiety and conduct disorders.

Among the 6-year-old children whose mothers did not have postpartum depression, only 15 percent had mental health problems, the investigators noted.

The study also found that children born to mothers with extended postpartum depression were less verbal and had lower levels of playfulness and creativity, less engagement with their mothers, diminished social involvement, and less empathy for the pain and distress of others.

These children and their mothers also had disordered functioning of the oxytocin system, as shown by lower levels of oxytocin in their saliva and a variant on the oxytocin receptor gene that increases the risk of depression, according to study leader Ruth Feldman, a professor in the psychology department and the Gonda Brain Sciences Center at Bar-Ilan University, and colleagues.

Among the children born to depressed mothers, the 40 percent who did not have mental disorders by age 6 had normal functioning of the oxytocin system and normal levels of oxytocin in their saliva.

The study was slated for presentation Thursday at the annual meeting of the American College of Neuropsychopharmacology, in Hawaii.

“We found the functioning of the oxytocin system helps to safeguard some children against the effects of chronic maternal depression,” Feldman said in a college news release. “This study could lead to potential treatment options for postpartum depression and methods to help children develop stronger oxytocin systems.”

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

SOURCE:

American College of Neuropsychopharmacology, news release, Dec. 8, 2011