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Low hormone levels in pregnancy linked to hard birth

  • August 14, 2010 7:13 pm

Expectant mums who are low in a hormone made by the thyroid gland in the neck are more likely to struggle in labour, findings suggest. Too little of the hormone thyroxine is already known to complicate pregnancy, increasing the risk of miscarriage, premature birth and pre-eclampsia.

Now a Dutch team has found even “low to normal” levels of thyroxine may cause problems, Clinical Endocrinology says. Babies were more often positioned wrongly, making labour more difficult. Although still head down, the babies tended to face the wrong way – towards their mother’s back rather than stomach.

Not only are these labours generally longer and harder, they are also more likely to end in an assisted delivery with forceps, ventouse or a Caesarean. It does highlight the importance of checking thyroid hormone levels in pregnancy.

The researchers from the University of Tilburg believe the hormone problem is so common – affecting about one in 10 pregnancies – a blood test for it should become a routine part of the antenatal check. In their study of nearly 1,000 apparently healthy mums-to-be, lower levels of thyroxine at 36 weeks of pregnancy was strongly linked to abnormal positioning of the baby’s head and risk of assisted delivery.

Professor Victor Pop and his team believe the relative lack of hormone might stop the unborn child moving as well as it should. This means that instead of getting into the optimal position for labour, the baby is stuck in a more awkward one.

The thyroid gland in the neck makes hormones that regulate metabolism. Too much of these hormones speeds up metabolism causing symptoms like weight loss and anxiety. Too few of the hormones slows metabolism causing problems like fatigue and weight gain. Medication can correct the imbalance

Professor Pop said: “Recent findings have shown that motor development in children at the age of two is related to low levels of thyroid hormone in pregnancy.
“It follows that impaired maternal thyroid function could also influence foetal movement.” The baby is unable to make its own thyroid hormones until 20 weeks into the pregnancy. Before this, it is entirely reliant on its mother’s stores, he said.

Professor Pop said more work was needed to explain the link found and to see if giving pregnant women extra thyroxine, even if they do not have full-blown thyroid disease, would be beneficial. Professor John Lazarus, an expert in endocrinology at Cardiff University School of Medicine, said the link found was not necessarily causal. “However it does highlight the importance of checking thyroid hormone levels in pregnancy.”

Special Need Parents to get more help?

  • May 3, 2010 5:40 pm

Parents of children with special needs should be given more support, an inquiry is set to recommend.
A government-commissioned study by Brian Lamb says that a significant number of parents are not satisfied with the help they receive. In response, the government will promise measures including a national support helpline and clearer information about rights to support.

Parents have complained that feel they have to “fight the system”. The report by Mr Lamb will reflect calls for more parent-friendly support for families with children with special needs. It will say that parents want to know what help is available and to have clearer guidelines about what should happen in schools.There will also be proposals that the Local Government Ombudsman should be funded to consider parents’ complaints against local authorities.

Special needs tribunals are also set to be improved and and there will be promises for more support for children who face bullying. The National Autistic Society’s chief executive, Mark Lever, said: “A great many parents of children and young people with autism have to fight huge battles to get the education support that should be theirs by right, often at considerable emotional and financial expense. “We hear terrible stories from parents of local authorities flouting the law by ignoring diagnoses, not meeting statutory timescales, failing to write statements properly, and even saying they ‘don’t do’ statements any more.

“It is hardly surprising then that parents have little confidence in the special educational needs system, and they could be forgiven for thinking that this report will do little to change what for them is an often complicated, intimidating, and sometimes infuriating system.” Children’s Secretary Ed Balls said: “In the New Year we will set our plans to address the recommendations that Brian has made to address the changes to teaching and learning that are necessary to improve educational outcomes for children with SEN. “We are now working to ensure all parents have confidence in decision making by giving them and their children a stronger voice at the heart of the SEN system.”

Childhood obesity class divide

  • May 3, 2010 5:37 pm

A Study suggest that a widening class gap is likely to be seen in the coming years in childhood obesity.
Previous research suggested rates in England may be levelling off, however the University College, London team found this was happening most in children aged two to 10 from wealthier backgrounds.

Research suggests that obesity rates among the lower classes were likely to be significantly higher by 2015 – for girls the levels may even be double. They analysed data gathered by the government-funded Health Survey for England. Currently 6.9% of boys and 7.4% of girls are obese – with the difference between the lower and higher classes 0.6% and 1.5% respectively for boys and girls.

The widening socio-economic gap may be partly due to difficulties to reach and communicate health messages to families from lower socio-economic groups. Using historical trends, they predicted that by 2015 obesity rates could be above 10% for boys and 8.9% for girls.

Depending on the extent of the “levelling off” reported last month, the overall rates could be even lower.
However, it is the findings for social class that have shed even more light on the obesity problem.
The obesity rates for girls are likely to diverge from now on, the team said. Among those from lower classes it is expected to keep rising to 11.2%, while for those from professional backgrounds it is likely to fall to 5.4%.

Among boys, both groups are likely to see a rise, but it will be faster in the lower class group, meaning 10.7% of this class boys will be obese compared with 7.9% of those from wealthier backgrounds. Similar trends will also be seen in older aged children.

Lead researcher Dr Emmanuel Stamatakis said: “This highlights the need for public health action to reverse recent trends and narrow social inequalities in health.” “The widening socio-economic gap may be partly due to difficulties to reach and communicate health messages to families from lower socio-economic groups.”
Tam Fry, of the National Obesity Forum, agreed awareness was more likely to be greater among wealthier families.

But he added: “It is also often quite expensive and time-consuming to buy healthy food and that puts wealthier parents at an advantage.” He said it was not clear why the differences were so marked in girls, although he said he suspected it was partly to do with the fact that boys tend to be more active generally.
The Department of Health said there was still more to do despite the levelling off which had been seen.
A spokesman said: “Obesity levels are still too high. We’ll only turn the tide on obesity for good if everyone – government, families and industry – play their part.”

Child Cancer Heart Risk

  • April 6, 2010 9:45 am

Children who battle and survive cancer run a higher risk of heart problems and must be closely screened, say experts. Aggressive cancer treatments like chemotherapy and radiotherapy can harm the heart, multiplying the patient’s death risk by seven, data shows.

UK guidelines recommend routine heart trace checks every five years. But many survivors currently receive no follow-up, US doctors, who studied data on 14,000 childhood cancer survivors, say in an article published at bmj.com. With the number of survivors steadily rising thanks to improved cancer care, health workers need to look out for signs of heart problems in their patients, say the specialist cancer doctors.

Most checks have focused on heart damage related to a cancer drug called anthracycline.
But latest work shows that young adult cancer survivors are at risk for a variety of cardiovascular complications, including heart attacks, inflammation of the heart and heart valve abnormalities, as late as 30 years after therapy. The largest study on the issue yet, which looked at data from more than 14,000 childhood cancer survivors, also shows damage can occur at lower exposures and with more types of cancer treatment than previously appreciated.

Lead researcher Professor Daniel Mulrooney, of the University of Minnesota, said that young adults who survived childhood or adolescent cancer were at risk of serious heart problems not usually recognised within their age group. “Such individuals require ongoing clinical monitoring, particularly as they approach ages in which cardiovascular disease becomes more prevalent.”

Professor Mike Hawkins, a childhood cancer survival expert from the charity Cancer Research UK, said: “This study is useful in helping healthcare professionals understand the risks of heart disease for those who have had cancer as a child or teenager – and especially which groups will be most at risk.”
However, he said that while the research was based on feedback given by survivors who filled in a questionnaire reporting heart disease, the questionnaire responses were not confirmed by doctors.
He said Cancer Research UK was currently confirming all reports of heart disease in this group.
“This will provide valuable information about the best ways to monitor and help young British cancer survivors.”

Coil- Nightmare

  • February 28, 2010 7:36 pm

In attempt to stop my hellish periods, which are that bad I end up having to use maternity pads to deal with them, the doctors decided to try the Mirena Coil. I figured it was worth a try given I’ve tried the pill and the implant, neither of which worked.

So I went to the appointment went through all the routine questions not a problem, it was after that the problems started. With no warning what so ever the doctor performed a pelvic exam which had me climbing the walls. She then tried to fit the coil, unfortunately what should have been a straight forward procedure was extremely painful, unsurprisingly my cervix went into spasm and the whole thing had to be abandoned.

I had to book another appointment, this time I was told to take 6mg of Diazepam. So I turned up for the appointment, went through the same routine as the 1st attempt only this time after 6 attempts they finally managed to get the bloody thing in.

Since then it’s all gone downhill, I feel like crap, I’ve had bleeding heavier than my usual period; which I didn’t think was possible. To add insult to injury I found out that I’ve got a few torn ligaments in my pelvis and I have pelvic Inflammatory Disease from the damn thing. So all in all not a happy bunny.

For more information about the coil or PID see these websites:
Pelvic Inflammatory Disease
Mirena Coil

School Phobia – Fact or Fiction?

  • February 6, 2010 7:17 pm

A school is being asked to apologise to the family of a boy it prosecuted for truancy. The boy was diagnosed as having “school phobia”, but what is that?

Most adults can remember days when they didn’t want to go to school. There would be claims of illness, and of the danger of passing on an unpleasant disease, before the eventual acceptance that the journey into school was inevitable. So it is not surprising that many might react with scepticism to the idea that there is such a thing as “school phobia”.

According to Nigel Blagg, author of School Phobia and Its Treatment, it is a condition that has been recognised since the 1960s. “They will experience extreme anxiety. They are off school, typically with their parents’ knowledge and approval. And they often have symptoms like tummy aches, head aches and nausea. Some of them suffer severely with depression. “Any attempts to get them to school, when they are at their worst can lead to quite extreme behaviour – temper tantrums, screaming, kicking. It is very distressing for the adults.”

The sceptics categorise these children as truants, but, says Mr Blagg, a former local authority educational psychologist who now runs a private practice, they are quite distinct in background and behaviour: “They are typically well behaved, socially conforming who are usually doing quite well. Normally they come from caring families. The truant group are the ones who [miss] school because they want to… often involved in delinquent behaviour.”

It is thought the worst ages for school phobia are five to six and 11-14, says Mr Blagg. There are no precise numbers for how many children suffer the condition, but he notes one estimate is that 1% of children will have it at one point during their school careers. A day at school is not every child’s idea of fun.

But the diagnosis is not without controversy, and even the term is subject to dispute, says Mr Blagg. “In the psychological world the preferred term these days is school refusal. [But] school refusal doesn’t convey the extreme distress, anxiety and panic, the physical symptoms that these children experience or the fact that it isn’t a volitional state.” There is a recognition among psychologists and other education professionals that school phobia/school refusal covers a range of different problems.

Some of the younger sufferers can be diagnosed as having “separation anxiety”, leaving them distressed at parting from their parents at the school gate. But some psychologists say this is more about refusal, not phobia – a true school phobic will experience a reaction even if their parents are present. “Other children could be classified as having a social phobia to do with performance aspects of school – reading out loud or changing for PE,” says Mr Blagg. Other children might be off sick for a prolonged period, fall behind with work and fall out of a routine. Some might simply have changed school and lost friends they relied on to feel secure at school. Still others may have had a single distressing experience. “More typically what you have is an accumulation of stresses to do with home and school that add up over time and cause the child to be anxious,” says Mr Blagg.

School phobia – irrational fear of school or the school situation
School refusal – Refusal on the part of a child to attend school
Refusal to go to school may be caused by a school phobia but most school refusals due to separation anxiety
In a true school phobia a child will show the phobic reaction even if his or her parents are present
Source: Penguin Dictionary of Psychology

“The avoidance leads to greater problems. They fall behind with school work. They worry what friends will say. The longer they are out the worse the problems get. If they are told they don’t have to go they feel fine and the symptoms disappear.”

Not only is there disagreement over the name for the condition, but also how to treat it, and whether it exists at all. Sociologist Prof Frank Furedi, author of Wasted: Why Education Isn’t Educating, is not convinced. “You take an understandable anxiety about going to school and turn it into a disease… Children will internalise it and play the role that’s been assigned to them. It cultivates the idea that these [exaggerated medically diagnosable] anxieties are normal. You do begin to encourage children to think in these terms.”

Even if you do accept that school phobia exists, there can still be disagreement over the best approach to tackling it. Mr Blagg insists that while educational psychologists, teachers and parents must be sensitive to the child’s needs, they must recognise that confrontation and getting the child back to school is necessary.
“They need that very firm handling and confronting them and getting them back to school. You might have to take them to school and escort them [in].” For those who have been away schools should assign tutors, help them catch up and offer them quiet space to be in while they are adjusting.

There are some advocates of home schooling who believe that rather than being a psychological aberration requiring a cure, the symptoms of school phobia may simply indicate that the child is best educated away from the school, at home. Ann Newstead, a spokesperson for the home tuition charity Education Otherwise, says school phobia is a “very real condition”. “I see a lot of families where they are in that situation – you only have to meet the children and families to see that it’s not a made up condition. It’s genuine. Not sending your child to school is something parents can be prosecuted for. You don’t risk prosecution lightly. You wouldn’t dream of forcing an adult to engage in an environment that wasn’t beneficial to them. So why do we think it’s ok to treat children in this way?”

But aren’t children more malleable? Doesn’t keeping them back from school indulge their fear rather than tackle the problem? “I agree with the tackling but not the forcing of it. That’s like treating someone who is scared of spiders by putting a spider in their hand. You tackle these things gradually, help someone to overcome a phobia and home education is a way of doing that.” More generally, many schools seek to make some of the changes for children less stressful, for example working on acclimatisation for children moving up to secondary school but Prof Furedi does not believe that such a sensitive treatment is necessarily always helpful. “Kids going from primary school to secondary school often get transitional counselling. If you tell them enough times this is an extremely difficult, painful step, you make the kids more anxious.”

The sceptics of this theory are making their voices heard here are just a few:

  • Bill Thorpe: “Thirty years of teaching in inner city schools has shown me that as soon as a “syndrome” is named, you can be sure that you’ll have a rash of ‘diagnosed’ sufferers within a few weeks. (Tourettes for example). Even if “School phobia” is real; and the pupil who have been prosecuted is a sufferer.. Why should the school apologise? Presumably the evidence of non-attendance was real and provable. The “syndrome” is a circumstance that can be considered by the court. The school is right to pursue truants, their only evidence is attendance records.”
  • Yes, phobias exist in school settings, but I don’t think that there is actually a school phobia. The reason why the profile of all these school phobiasts are “well behaved, socially conforming….” is for the simple fact that they are suck ups that probably get whatever they want, and their mommies and daddies cradle their kids until their out of college. I think everybody at some point or for a period of time didn’t want to go to school. This was probably because we had to deal with something we didn’t want to, like: giving a speech, a bully, or maybe getting up too early. These fears or anxieties are normal for everybody. Being afraid of a public institution is just another way to label something else we want to have as an excuse to coddle our kids.
  • This is ridiculous. There is always a name for anything that makes us as adults uncomfortable. I am a teacher and i have dealt with children who don’t want to come to school, one is now okay as he realised nobody was going to put up with his nonsense. The other left the school as he was very good at manipulating his mother who just did whatever her children wanted. We need to stop labelling children and helping them to come up with excuses. I am sure when they grow up with no qualifications and become yet again another burden on society we will think of another psychological condition to excuse. The problem with the west, too many excuses for bad and manipulative behaviour!!

To be honest me and my partner accept that there is anxiety for some children with regards to school but we’re are uncertain about whether there is such a thing as school phobias. With things like this it raises concerns about the impact on both the education system and the NHS. The education system will become too afraid to act if they suspect truancy and the NHS will be inundated with claims of children who allegedly have school phobia; Not only that but you risk creating a self fulfilling prophercy, if you tell someone something often enough they start to believe it. You are also providing truants with another excuse to skip school

Children can imagine away pain

  • November 14, 2009 7:40 pm

American researchers have found that children can be taught to use their imagination to tackle frequent bouts of abdominal pain. It is thought that the technique works particularly well due to their fertile imaginations. The research suggests that 1 in 5 children suffer with frquent abdominal pain with no identifiable cause. There were 30 children aged between 6 and 15 in the study half had 20 minute sessions of “guided imagery” this is where the patient is prompted to imagine things which will reduce their discomfort. The other half had the mainstream care.

It is thought that the treatment is very positive because it is inexpensive and is able to be self administered, which potentially opens the door for easily enhancing treatment outcomes for a lot of children sufering from frequent stomach aches.

This technique is an amazing breakthrough because this means that children can be treated by other means instead of drugs which is definately a positive. Also it means that more children can be treated without massive waiting lists which can be a definate plus for the NHS and the parents of the children who are suffering from abdominal pain and there is nothing they can do

Child Swine Flu Jabs Trials

  • October 9, 2009 8:43 am

On Saturday 26th September a trial began involving 1,000 children to test two swine flu vaccines before the launch of a UK vaccination. The information is limited but the trial will allow the experts to observe immune reactions and any side effects which may occur.

The children participating in this trial are aged between six months and 12 years from Oxford, Southampton, London, Bristol and Devon. Participation in the trial is voluntary and consenting parents were be briefed on the risks. The children are given two doses of the vaccine three weeks apart, then a blood test three weeks after that.

The aim of the trial is to find out if one of the vaccines is better than the other in terms of immune reactions. They also want to ensure that the side effects are minimal before launching the UK vaccination programme.

One of the main problems the study seems to be having is recruiting enough children under the age of three, getting older children didn’t seem to be a problem just the younger ones, Doctor Saul Faust suggests that the younger children don’t usually respond to vaccines as well as adults and older children but says that they need to find out how the younger children respond before the vaccine becomes available to the UK. This could be because the younger children are deemed to be one of the high risk groups because young children, especially those that are under five, do seem to be at risk of serious illness. Also flu epidemics and pandemics are spread very efficiently by children.

The Department of Health has said that they will have enough vaccine for half of the population by the end of the year and that the high risk groups which are medical staff, the elderly and the very young will be immunised first.

RPOC – what is it?

  • August 5, 2009 1:57 pm

RPOC stands for retained products of conception. This is where all or part of the placenta or membranes are left in the uterus during the final stage of labour. In most cases this is detected following the examination of the placenta after delivery.

Retained placenta can be caused by:

  • failed separation due to failure of uterine contraction or morbid adherence e.g. to a fibroid or scar
  • separated but retained due to e.g. a snapped cord contracted uterus, closed cervix

Reports suggest that retained placenta is one of the mosts common causes of postpartum haemorrhage.

There are a number of options for treating RPOC here is the most commonly used

Women with a retained placenta oxytocin injection into the umbilical vein with 20 IU of oxytocin in 20 ml of saline is recommended, followed by proximal clamping of the cord. If the placenta is still retained 30 minutes after oxytocin injection, or sooner if there is concern about the woman’s condition, women should be offered an assessment of the need to remove the placenta. Women should be informed that this assessment can be painful and they should be advised to have analgesia or even anaesthesia for this assessment

It is worth pointing out that this is very rare and that it very rarely causes any problems however in few cases a hysterectomy may be needed as a PPH occurs or a severe infection.

Tamiflu causing side effects in kids

  • August 3, 2009 8:38 pm

There are claims that over half of the children taking Tamiflu to cure swine flu suffered side effects such as nausea, insomnia and nightmares. The statistics show that 1 in 5 children had a neuropsychiatric side effect, such as poor concentration, inability to think clearly, problems sleeping, and feeling dazed or confused. The research that was carried out was flawed as there was no control group therefore it is impossible to say whether the symptoms were a result of the drug or the virus; however, there were no serious long term side

Participants for the study were selected differently in the three schools. In two schools (one primary and one secondary school) the researchers selected all the classes who were offered prophylaxis, (age 4-11 years in the primary school), and all of one year group in the secondary school (age 13-14 years). In the other secondary school, the questionnaire was offered only to pupils in four of the classes in the year group (age range 11-13 years). This is a flawed sample as there is no fixed criteria for selecting the participants for the research.

Here are a few of the questions that were asked to the sample:

  • Whether children who had been offered Tamiflu had taken it?
  • How long they took it for?
  • Were they taking any other medication with Tamiflu?
  • Were there symptoms after taking Tamiflu (including specific gastrointestinal and neuropsychiatric symptoms)?

Out of 256 schoolchildren, 103 replied which is 40% of the participants. The number of responses from the secondary school were higher than those from the primary school. The results show that only 48% of the primary schoolchildren in comparison to the 76%of the secondary schoolchildren. The most common side effects were nausea and vomiting, followed by mild neuropsychiatric effects such as difficulty sleeping, nightmares and poor concentration.

It is worth pointing out that Tamiflu has not been withdrawn and is still used to treat swine flu. All drugs come with side effects and not everybody experiences them, thus suggesting that Tamiflu is no different to any other medicine.