Philadelphia, Pa. (April 8, 2012) – The antibiotic drug minocycline yields “modest” but meaningful improvements n functioning and mood for children with fragile X syndrome (FXS), reports a study in the April Journal of Developmental & Behavioral Pediatrics, the official journal of the Society for Developmental and Behavioral Pediatrics.  The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Three months of treatment with minocycline in children with FXS resulted in greater overall improvement than placebo treatment, according to the study by Dr Mary Jacena S. Leigh of University of California Davis Medical Center, Sacramento, and colleagues. They write, “This study is important because minocycline is a targeted treatment for FXS that is currently available by prescription.”

‘Global Improvement’ with Minocycline in Kids with FXS

Fragile X syndrome, which causes intellectual disability and behavioral and learning problems, affects about 1 in 4,000 males in the United States.  It also occurs in females, but typically causes less severe impairment. Caused by mutations of a gene called FMR1, FXS is the most common cause of inherited intellectual disability and the most common genetic cause of autism and autism-spectrum disorders.

In the study, 66 children with FXS were randomly assigned to three months of treatment with minocycline or inactive placebo.  After three months, they were switched to the other treatment. Parents and doctors were unaware of which treatment the child was receiving until the child completed the study.

Fifty-five patients completed the study. The children had small but significant improvements in certain areas during treatment with minocycline, compared to placebo. In particular, they scored better on the Clinical Global Impression Scale, where doctors rated their overall impression of the patients’ status.  Average scores on the 7-point rating scale were 2.5 points for children taking minocycline versus 3 points for those taking placebo:  a 0.5-point improvement with minocycline in comparison to placebo.

Children taking minocycline also had greater improvement in anxiety and mood-related behaviors, as rated by parents.  Other outcomes were not significantly better with minocycline, including behavior problems and verbal functioning.

Side effects were generally similar between groups, with no serious adverse effects. Minocycline may cause some discoloration of the teeth—a known side effect of minocycline and related antibiotics, which was seen in both treatment arms.

Minocycline Is Only Available ‘Targeted Treatment’ for FXS

Minocycline is an older antibiotic, perhaps most commonly used for treatment of severe acne.  Animal experiments and initial studies in humans have suggested that it might have beneficial effects in the treatment of FXS.  Minocycline has also been studied as a potential “neuroprotective” treatment in other conditions, such as multiple sclerosis.

This preliminary clinical trial shows small but significant benefits of minocycline in children with FXS. Other treatments for FXS are being investigated, including a new class of drugs called mGluR5 inhibitors. However, minocycline is the only targeted FXS treatment that is currently available by prescription. Because of its long history of use, the side effects and safety characteristics of minocycline are well known.

More research will be needed to determine how minocycline exerts its beneficial effects in FXS, and to clarify the most effective dose and length of treatment. “Further studies including long term follow up on individuals treated with minocycline are warranted with a careful assessment of side effects and benefits,” Dr Leigh and colleagues conclude.

About the Journal of Developmental & Behavioral Pediatrics

Written for physicians, clinicians, psychologists and researchers, each bimonthly issue of the Journal of Developmental & Behavioral Pediatrics (www.jrnldbp.com) is devoted entirely to the developmental and psychosocial aspects of pediatric health care. Each issue brims with original articles, case reports, challenging cases and reviews—the latest work of many of today’s best known leaders in related fields—that help professionals across disciplines stay current with the latest information in the field. Relevant areas covered include learning disorders, developmental disabilities, and emotional, behavioral, and psychosomatic problems. Journal of Developmental & Behavioral Pediatrics is the official journal of the Society for Developmental and Behavioral Pediatrics.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2012 annual revenues of €3.6 billion ($4.6 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Philadelphia, Pa. (September 4, 2012) – Children who swallow powerful neodymium magnets are at risk of serious complications, requiring emergency evaluation and possible treatment.  That’s the message of a new clinical algorithm published in the September issue of The Journal of Pediatric Gastroenterology and Nutrition, official journal of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN).  The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health

Developed by an NASPGHAN expert panel, the algorithm provides doctors with a recommended, step-by-step approach to managing children who have swallowed these powerful magnets.  “The algorithm is a concise guide to the evaluation and treatment of magnet ingestions meant to reduce the gastrointestinal complications in children,” commented lead author Dr R. Adam Noel of Children’s Hospital of New Orleans.

Informal Survey Identified More Than 80 Cases

“Neodymium or rare earth magnets are not our grandfather’s magnets,” Dr Noel and coauthors write.  “Composed of iron, boron & neodymium, they are at least five to ten times more powerful than traditional magnets.”  Used in many industrial products, the powerful magnets are also marketed as “desk toys” or “stress relievers” for adults.

Because of their “formidable” attractive force, neodymium magnets pose a serious health hazard if swallowed.  That’s because ingested magnets can “find each other” even if they are in different areas of the digestive system.  “The magnets can therefore cause two pieces of bowel to stick together with great strength and do not separate,” the authors explain.  This can result in gastrointestinal perforation or obstruction, sometimes requiring surgery.

An informal survey of NASPGHAN members highlighted the frequency and seriousness of the problem.  Pediatric gastroenterology specialists responding to the survey reported more than 80 children with magnet ingestion.  Most patients required endoscopy to remove the magnets or surgery to repair damage to the bowels.  Twenty-six children had bowel perforation; three needed major surgery to remove a section of damaged intestine.

Emphasis on Rapid Medical Evaluation of Swallowed Magnets

In response, a NASPGHAN task force was formed to develop a new algorithm for evaluation and management of ingested neodymium magnets.  X-rays are needed to confirm that the child has swallowed magnets and to show their location.  Because the magnets are usually small, there may be no or only mild symptoms.

 A critical step is determining how many magnets the child has swallowed.  A single magnet will likely pass through without causing any harm.  However, if two or more magnets have been swallowed (or a magnet with another piece of metal), attraction between them may result in serious complications.  Because magnets may overlap, multiple x-rays from different angles are needed.

Rapid evaluation is critical, as complications appear more common if the child is not seen within twelve hours.  The algorithm recommends removal of the magnets using an endoscope, if possible—although this can be difficult because the magnets can get stuck on the sides of the removal instrument.  Surgery may be needed if medical care is delayed, if the magnets pass out of the stomach, or if complications occur.

While the new article was being prepared for publication, the U.S. Consumer Products Safety Commission (CPSC) took action to ban the sale of neodymium magnets as toys.  But Dr Noel notes that the CPSC action affects only the small magnets that make up adult magnet toys and that the biggest company selling the toys is resisting.  In addition, the ban won’t apply to magnets used in other products, such as children’s toys and tools.

“Therefore there will be a significant exposure to the extremely small powerful magnet for the foreseeable future,” commented Dr Noel.  “I hope for our children’s sake that the CPSC action will stick.  But even so, the magnets that are already in our environment are a clear and present danger.”

Coauthor Dr Mark Gilger of Texas Children’s Hospital agrees, suggesting that cases of magnet ingestion in children may even increase over the short term.  He added, “If one used a risk/benefit analysis on neodymium magnet desk toys, it’s quite simple:  the risk of injury to children is high and the population benefit is little or none.  Do we need this toy, really?”   

About The Journal of Pediatric Gastroenterology and Nutrition

The Journal of Pediatric Gastroenterology and Nutrition provides a forum for original papers and reviews dealing with pediatric gastroenterology and nutrition, including normal and abnormal functions of the alimentary tract and its associated organs, including the salivary glands, pancreas, gallbladder, and liver. Particular emphasis is on development and its relation to infant and childhood nutrition.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Philadelphia, Pa. (September 4, 2012) – An educational program for parents helps to reduce pressure on children to eat—which may reduce the child’s risk of obesity, reports a study in the September Journal of Developmental & Behavioral Pediatrics, the official journal of the Society for Developmental and Behavioral Pediatrics.  The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Parents educated in an approach based on “division of responsibility” (DOR) for eating put less pressure on their children to eat certain foods, according to the new research, led by Dr. W. Stewart Agras of Stanford University.  The study adds to the evidence that the DOR approach can promote healthy development of appetite and eating behaviors in young children.

Education Takes Pressure off Tots’ Eating Behaviors

The study included 62 families with a toddler (aged two to four) considered at high risk of obesity—with at least one parent who was obese or overweight.  One group of parents was educated in the DOR concept, which takes a child-development approach to “parent/child feeding interactions.”  Dr Agras explains, “At the family level parent feeding practices, such as taking control over their child’s eating, appear to contribute to childhood overweight.”

In the DOR approach, parents take responsibility for providing and serving food, while children are responsible for deciding whether or not to eat and how much to eat.  “The primary principle is that crossing parent or child boundaries leads to feeding problems,” according to the authors.  The other group of parents was assigned to the National Institutes of Health’s “We Can” program, which seeks to promote healthy eating and increased physical activity.

At follow-up, parents educated in the DOR approach were putting less pressure on their child to eat, compared to those taught about the “We Can” program.  Two parental factors affected the pressure to eat:  “disinhibition,” reflecting the parents’ tendency to overeat, and hunger or food cravings in the parents.  Parents who learned about DOR put less pressure on their children to eat, regardless of their own disinhibition or hunger scores.

In contrast, for the “We Can” group, parents with low disinhibition and low hunger scores (that is, less control over eating and lower hunger/cravings) put more pressure on their children.  Thus an approach that teaches parents to promote consumption of healthy foods may have actually led to a decrease in positive feeding practices

Parents in the DOR group were less likely to restrict food choices in girls, although not in boys.  It may be that parents are more focused on girls’ eating patterns, “in line with the greater concern about female weight and shape,” the researchers write.

Children whose parents are obese or overweight are at risk of becoming obese themselves, possibly because the family environment reinforces “maladaptive” eating behaviors.  There’s evidence that parents becoming over-involved in their child’s eating behavior—such as taking excessive control over their child’s eating—contributes to childhood overweight.  Excessive parental control over eating may interfere with the child’s perceptions of hunger and feeling full (satiety).

Although the new study is only preliminary, it adds to the evidence that parents taught the DOR approach put less pressure on their child at mealtimes.  A larger study with longer follow-up will be needed to determine whether the changes lead to a lower risk of childhood overweight or obesity.  Dr Agras and colleagues add, “Efforts to increase consumption of healthy foods in toddlers should include counseling parents to model eating such foods and not to pressure children to eat them.”

About the Journal of Developmental & Behavioral Pediatrics

Written for physicians, clinicians, psychologists and researchers, each bimonthly issue of the Journal of Developmental & Behavioral Pediatrics (www.jrnldbp.com) is devoted entirely to the developmental and psychosocial aspects of pediatric health care. Each issue brims with original articles, case reports, challenging cases and reviews—the latest work of many of today’s best known leaders in related fields—that help professionals across disciplines stay current with the latest information in the field. Relevant areas covered include learning disorders, developmental disabilities, and emotional, behavioral, and psychosomatic problems.  Journal of Developmental & Behavioral Pediatrics is the official journal of the Society for Developmental and Behavioral Pediatrics.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com