Tag Archives: child

Genetic testing guidelines under fire

If you underwent a genetic test for a heart condition, but the test also revealed that you have a high risk of colon cancer, would you want to know? A respected scientific society says your doctor should tell you, but the group is receiving criticism for its recommendation that “incidental findings” of genetic tests be shared with patients. Incidental findings are unexpected results, unrelated to the reason for testing. What to do with these findings has been a controversial issue for adults undergoing genetic testing, as well as children. In March, the American College of Medical Genetics and Genomics (ACMG) released guidelines saying that when patients receive genetic testing for any medical reason, they should be screened for mutations in an additional 57 genes, including mutations that strongly increase the risk of breast, ovarian and colon cancer. The ACMG argues that doctors have an obligation to look for and report these mutations because there are ways that people can act to reduce their of developing a medical disorder. However, some researchers and bioethicists say the new recommendations go too far, and take away patients' rights to refuse medical information they do not wish to know. Informed consent A crucial part of genetic testing ethics is ensuring that patients understand what a test might find, and what those findings could mean for future treatment. Under the new recommendations, a patient who consents to any genetic test is consenting to be screened for mutations in an additional 57 genes. Some bioethicists take issue with this approach, because patients may not wish to know their results for all of these genes. A positive result for any one of these mutations may increase patients' anxiety, or cause them to live their life differently, said Susan Wolf, a professor of law, medicine and public policy at the University of Minnesota. Under the new guidelines, “unless they are willing to have this extra analysis done, the only option is to walk away from the sequencings altogether,” Wolf said. “It's all or nothing.” Arthur Caplan, a bioethicist at New York University School of Medicine's Division of Medical Ethics, agreed that patients should have an opportunity to refuse. “People do not have any obligations to accept any findings that they hadnt been expecting,” Caplan said. And even calling such findings “incidental” is a misnomer, Wolf said, because under the new guidelines, researchers have to actively test for these gene mutations. What about kids? Earlier this year, both the American Academy of Pediatrics and the AMCG advised that children not be screened for genetic conditions that occur in adulthood (such as breast cancer), unless some action in childhood can lower the risk of disease or death. Children should wait until they are at least 18 years old to decide if they want to know their risk, the guidelines say. But under the new recommendations, children should be informed about any findings from the extra screening, including those that relate to adult disorders. Supporters of the new recommendations say that they are not at odds with earlier guidelines. Dr. Robert Green, of Harvard Medical School, and colleagues, wrote in the May 16 issue of the journal Science that if doctors are screening a child for a genetic disease that occurs in adulthood, the child would presumably have a family history of the disease. With incidental findings, no other family members, including the child, would be known to be at risk. So reporting an incidental finding could alert the child, as well as other family members including adults, to their risk of a certain condition, Green said. But others disagree, saying the new recommendations contradict earlier guidelines, and are not in children's best interest. “You've deprived the child of their own choice later as an adult,” Wolf said. Practical issues The guidelines also say that patients should be counseled about the implications of genetic testing before the test is ordered. But some argue that discussing all 57 genes would be demanding. “That is going to be a rather time consuming process,” said Dr. Harry Ostrer, a medical geneticist at the Albert Einstein College of Medicine in New York City. Wolf and others are calling on the AMCG to reconsider the new guidelines. The AMCG says that the guidelines will be reviewed yearly and updated in light of new evidence. But in the meantime, doctors are in a bind about what to do when screening patients. “It really creates a big dilemma because, when an organization like the AMCG makes a recommendation, it's seen as establishing a standard of care,” Ostrer said. If doctors don't follow the guidelines, patients could sue for malpractice if it turns out they are a carrier of a mutation that the additional screening would have caught, Ostrer said. Ostrer said he would like to see more evidence about how patients respond to being told about incidental findings. Studies looking at this question are being carried out now, he said. Copyright 2013 LiveScience, a TechMediaNetwork company. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.source : http://www.foxnews.com/health/2013/05/20/genetic-testing-guidelines-under-fire/

Up to 1 in 5 children suffer from a mental disorder, CDC says

Up to 20 percent of children in the United States suffer from a mental disorder, and the number of kids diagnosed with one has been rising for more than a decade, according to a report released on Thursday by the U.S. Center for Disease Control and Prevention. In the agency's first-ever study of mental disorders among children aged 3 to 17, researchers found childhood mental illnesses affect up to one in five kids and cost $247 billion per year in medical bills, special education and juvenile justice. Children with mental disorders - defined as “serious deviations from expected cognitive, social, and emotional development” - often have trouble learning in school, making friends, and building relationships later in life, the report said. They are more likely to have other chronic health problems, such as asthma and diabetes, and are at risk for developing mental illnesses as adults. “This is a deliberate effort by CDC to show mental health is a health issue. As with any health concern, the more attention we give to it, the better. It's parents becoming aware of the facts and talking to a healthcare provider about how their child is learning, behaving, and playing with other kids,” Dr. Ruth Perou, the lead author of the study, said in an interview. “What's concerning is the number of families affected by these issues. But we can do something about this. Mental health problems are diagnosable, treatable and people can recover and lead full healthy lives,” Perou added. The study cited data collected between 1994 and 2011 that showed the number of kids with mental disorders is growing. The study stopped short of concluding why, but suggested improvements in diagnoses as one possible explanation “Changes in estimated prevalence over time might be associated with an actual change in prevalence, changes in case definition, changes in the public perception of mental disorders, or improvements in diagnosis, which might be associated with changes in policies and access to health care,” the study said. Perou said more research was needed to determine the specific causes of mental disorders, and that greater awareness could lead to an uptick in diagnoses. A host of environmental factors, including chemical exposure and poverty, can also affect a child's mental health, she said. Lead, for example, is known to be “one of the biggest toxins to impact behavior and learning,” Perou said. Poor children are at a higher risk for developing certain conditions, according to the study. The most prevalent mental health diagnosis, as reported by parents, was Attention Deficit/Hyperactivity Disorder (ADHD), which affects 6.8 percent of children. Also common were behavioral conduct problems (3.5 percent), anxiety, which consists mostly of fears and phobias (3 percent), depression (2.1 percent) and autism spectrum disorders (1.1 percent). Many of these disorders occur together, the report said. Boys were found more likely to have most of the listed disorders except for depression and alcohol abuse, which affect more girls. The study also noted that suicide, which can be precipitated by an untreated mental illness, was the second leading cause of death (after accidents) among children 12 to 17 years old. The CDC report was based on multiple other studies that collected data and interviewed children and their guardians about their diagnoses, habits, behaviors and other factors.source : http://www.foxnews.com/health/2013/05/17/up-to-1-in-5-children-suffer-from-mental-disorder-cdc-says/

Small amounts of formula may promote breastfeeding in some babies

Feeding newborn babies small amounts of carefully regulated formula before a mother’s milk comes in does not disrupt the child’s ability to breastfeed – and may ultimately improve breastfeeding success in the future, the New York Times reported. In a new study published in the journal Pediatrics, researchers examined 38 newborns who had lost 5 percent or more of their body weight in the first few days after birth.  Each infant was randomly assigned to either breastfeed alone or breastfeed along with a formula supplement – administered through a syringe to avoid so-called “nipple confusion” between the mother’s nipple and the bottle’s nipple. This concept is up for debate among mothers and pediatricians.  The supplement was given after a feeding, to boost the child’s hunger for the next breastfeeding. After the first week of observation, all of the babies were still breastfeeding, but nine of the 19 infants who began exclusively with breastfeeding were now using formula.  After three months, 79 percent of the babies who had been given an early formula supplement were breastfeeding exclusively, compared to 42 percent of those who had begun with just breastfeeding. Many mothers and doctors encourage women to exclusively breastfeed their children, but this new study suggests small amounts of formula may help struggling newborns get the nutrition they need in the early stages of life. “Most babies don’t need formula,” said the lead author, Dr. Valerie J. Flaherman, a pediatrician at the University of California, San Francisco, Benioff Children’s Hospital. “But some kids are at risk for weight loss, and this could be an option.” Click for more from the New York Times.source : http://www.foxnews.com/health/2013/05/13/small-amounts-formula-may-promote-breastfeeding-in-some-babies/