Category Archives: Child and youth

Feeding problems, growth and bone health in cerebral palsy

Torstein VikBlogger: Torstein Vik
Professor in the CEBRA Group at the Department of Laboratory Medicine, Children’s and Women’s Health (LBK)

 

 

Many children with cerebral palsy have feeding difficulties and a significant proportion is malnourished. This may lead to impaired growth, but also to overweight and obesity, since many of the children are unable to walk. Moreover, some of the children are at risk for bone fractures following small traumas.

To further understand the etiology and consequences of these problems were the main topic of MD Ane-Kristine Finbråten’s PhD-thesis, Nutritional status, growth and bone health of children with cerebral palsy, that she defended on November 18th. Among a number of important findings were that nutritional status is not assessed appropriately in this population.

Body mass index (BMI), the most commonly used assessment of nutritional status in children without disabilities, is more or less useless in children with cerebral palsy. In fact, the use of BMI will underestimate nutritional status in many children, and this may increase the risk that the children are overfed, and become obese. Instead, Ane argues that one should measure skinfold thickness with a calliper to assess nutritional status, and that linear growth should be assessed by taking segmental measures, such as knee-height. These measures can be applied to estimate body fat and standing height. Continue reading

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Infants, music and physiotherapy

Blogger: Lars Adde, Paediatric physiotherapist and researcher, NTNU and St. Olavs Hospitaldummy

A unique collaboration between a paediatric physiotherapist and a music research provides hope for sick newborsn.

Spedbarn i bevegelse

The spontaneous “dancing” movements of infants are telling a story about how healthy they are.

Physiotherapists, doctors, music researchers and mathematicians at NTNU, St. Olavs Hospital and the University of Oslo have recently launched a fruitful, interdisciplinary project. They’re filming and analysing spontaneous movements of infants to try to identify cerebral palsy (CP).

The spontaneous “dancing” movements of infants are telling a story about how healthy they are – or rather how healthy their brains are.

Qualities like the variation and flow of the infants “dancing” movements at the age of 3 months after their due date tell us something about what kinds of injuries the brain has – or has not – sustained.

Physiotherapists and doctors can learn to observe the qualities of movement patterns in premature and sick infants as a sign of possible brain damage and an early marker of cerebral palsy.

Using simple video cameras and newly developed software, the movement patterns in infants can be analysed and quantified.

Cerebral palsy is a physical disability that normally cannot be diagnosed before the child is 1 to 2 years old. This makes it hard to train the brain during the important period between the occurrence of the brain damage (around the time of birth) and the time of diagnosis – which also happens to be the peak period for brain plasticity.

Using simple video cameras and recently developed software, the movement quality of infants can be analysed and quantified. Our team at NTNU and St. Olavs Hospital has for several years researched how the movements of infants can be analysed using video analysis. Music researcher Alexander Refsum Jensenius at the University of Oslo’s Department of Musicology researches music and movement. He has developed a computer programme to analyse and quantify the movement qualities of musicians and dancers.

The software has now been modified and adapted to the movements of infants, and his work has turned into a very fruitful collaboration in which the spontaneous movements of sick newborns are recorded on video, analysed and used to identify cerebral palsy at an early stage.

This picture shows the movement history of one of the infants in the study.

This technology is currently being tested in the US, Turkey, China, India and Norway, focusing on the spontaneous “dancing” movements of infants, computer-based movement analysis and early prediction of cerebral palsy. The project is financed by St. Olavs Hospital and NTNU. national collaborators are the neonatal clinics of OUS, UNN, Levanger Hospital and St. Olavs Hospital.

Learn more about this unique research collaboration on NRK1’s Schrødingers Katt Thursday 16 October (in Norwegian).

Contact: Physiotherapist and researcher Lars Adde, Department of Laboratory Medicine, Children’s and Women’s Health (LBK), NTNU.

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30 years of research on small-for-gestational-age and very-low-birth-weight children

boy reachingThirty years ago, the first research project on Small-for-gestation-age (SGA)was started at the Department of Public Health and General Practice at NTNU in Trondheim. At the same time, a separate Very-low-birth-weight (VLBW) children study was organized at the Department of Laboratory Medicine, Women’s and Children’s Health, NTNU.

As for the SGA study, a contract worth $ 686,000 that took effect on June 1, 1984 was the first of its kind between the Faculty of Medicine and an external funding agency. On behalf of the National Institute of Child Health and Human Development (NICHD) and in cooperation with Uppsala University and the University of Bergen, the faculty planned, organized and conducted a detailed study of mothers through pregnancy and at birth. A follow-up of selected children during their first year of life (1986-89) and again at 5 years of age (1991-94) was later funded by a second contract ($ 618,000).

A vast amount of data are now available from pregnancy and delivery, at birth and through the first to five years of life which can be analysed longitudinally and/or cross sectionally. In addition to clinical and other information regarding development, health, behaviour, aptitudes and skills an overwhelming amount of serum samples are stored in a modernised biobank. Serum samples were collected longitudinally throughout pregnancy and at birth and are available for research purposes. The study is still in progress with new results from later follow-up studies of the mothers and their offspring.

The VLBW study is chaired by  Professors Ann-Mari Brubakk and Jon Skranes, who have amongst others, followed up around 230 of the Scandinavian SGA study in Trondheim at 14-15 at 19-20 years of age. Comprehensive clinical data have been collected in addition to information about physical development, behaviour, mental qualities, aptitudes, education, and psychiatric disorders and symptoms. A cerebral MRI scan has been conducted on both occasions. An interdependent and interdisciplinary cooperation has been established between the SGA and VLBW studies. The young adults are currently being followed up at age 26 years

An international seminar will now be held to mark the first 30 Years of the NICHD Scandinavian Successive Small for Gestational Age (SGA) Births Study.
The seminar will span Monday 16 June and Tuesday 17 June 2014, is sponsored by the Faculty of Medicine, NTNU and organized by the Department of Public Health and General Practice.
Professor Geir W. Jacobsen has since 1998 been the Principal Investigator of the SGA study and will act as host.

The program can be found on http://www.ntnu.no/ism/sgaseminar
More information on the SGA studies can be found on http://www.ntnu.no/ism/forskning/sga

For participation, please contact: Guri.Helmersen@ntnu.no

 

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Newborns are not tiny adults

Blogger: Eva Brekke Foto: Merethe Wagelund/NTNU Info

One of the mantras from our training in paediatrics was that “children are not small adults”. By this they meant to remind us that we cannot make a direct transfer of what we know about diagnostics and treatment of adults to children, and assume it will be successful.

Our findings show how important it is to do research on different age groups, also within basic research. What works in adults could be potentially harmful in children and newborns, and what does not work in adults could turn out to be a valuable therapy.

This is something I that have experienced through my research, where we have looked at how the brain of seven days old rats work after an episode of blood and oxygen deprivation, also known as hypoxic-ischaemic (HI) brain damage.

HI brain damage during pregnancy or birth is one of the causes of cerebral palsy (CP). We found that the newborn brain cells work very differently from what we know about adult rat brains.

baby2istock

Oxidative stress is one of the mechanisms that damage brain cells when there is a lack of blood and oxygen. A process called the pentose phosphate pathway [1] plays an important role in the defence against oxidative stress by producing substances that are used to renew the body’s own antioxidants. Due to this, the antioxidants can be used again and again to neutralise oxygen radicals.

This could make the newborn brain especially vulnerable to oxidative stress.

In adults the activity of the pentose phosphate pathway increases during oxidative stress [2,3], which probably acts as a defence mechanism in the adult brain. To our surprise, we found that in newborns, however, the activity of the pentose phosphate pathway is reduced after an episode of blood and oxygen deprivation. This could make the newborn brain especially vulnerable to oxidative stress.

Another mechanism that damages the brain cells when there is a lack of blood and oxygen in the brain, is uncontrolled firing of the neurons which releases large quantities of the signalling substance glutamate. Such uncontrolled firing occurs when the neurons have too little energy, and is therefore common during HI when the lack of nutrients and oxygen causes an energy-crisis.

Glutamate in large quantities is poisonous to the brain cells. In adults the formation of glutamate is reduced during and after and HI episode [4,5]. In newborns the production is also reduced in the phase after HI, but with one important difference: Compared with other processes, the production of glutamate is actually prioritised over for example energy-production! This could be a contributing factor to the brain cells not being able to optimise the energy levels, with the result that this new glutamate is released and damages the surrounding brain cells.

Both oxidative stress and high doses of glutamate can lead to cell death even after the cells have regained sufficient blood supply. This means that brain cells are still being damaged at a stage when it may be possible to offer treatment. It is believed that much of the damage in the newborn brain happens after the blood supply has been restored. If we could give effective treatment at this stage, much of this damage could possibly be avoided.

These are two examples of how the brain seems to function differently in newborn and adult rats.

These are two examples of how the brain seems to function differently in newborn and adult rats. If the same differences exist between newborn and adult humans, this could lead us onto new ways of treating newborns that have experienced episodes of too little blood or oxygen to the brain during a difficult pregnancy or a complicated birth.

Our findings show how important it is to do research on different age groups, also within basic research. What works in adults could be potentially harmful in children and newborns, and what does not work in adults could turn out to be a valuable therapy.

This blog post is based on the paper “The Pentose Phosphate Pathway and Pyruvate Carboxylation after Neonatal Hypoxic-Ischemic Brain Injury”, which was recently published in the Journal of Cerebral Blood Flow and Metabolism: http://www.nature.com/jcbfm/journal/vaop/ncurrent/full/jcbfm20148a.html

Links:

[1] The Pentose Phosphate Pathway: http://en.wikipedia.org/wiki/Pentose_phosphate_pathway

[2] Bartnik BL, J Neurotrauma 2005: http://www.ncbi.nlm.nih.gov/pubmed/16238483

[3] Domańska-Janik K., Resuscitation 1988: http://www.ncbi.nlm.nih.gov/pubmed/2839885

[4] Håberg A, Neurochem Int 2006: http://www.ncbi.nlm.nih.gov/pubmed/16504342

[5] Håberg A, JCBFM 2001: http://www.ncbi.nlm.nih.gov/pubmed/11740207

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Genetic profiling and side-effects of blood cancer treatment in children

Blogger: Bendik Lund Bendik Lund

 

 

 

During treatment of childhood blood cancer, great variations in side-effects are seen – both in terms of prevalence and seriousness. Some children get more serious side-effects than others. Potentially, the diversity in the toxicity burden for individual patients could reflect the normal genetic variation between patients.

A bone marrow smear at high magnification taken at diagnosis. Most of the blue cells are leukaemic cells. Normal red blood cells are also seen. (Photo: Bendik Lund)

A bone marrow smear at high magnification taken at diagnosis. Most of the blue cells are leukaemic cells. Normal red blood cells are also seen. (Photo: Bendik Lund)

In parallel with the biotechnological development over the last 10-15 years, we have gained extensive knowledge about the normal sequence variation in DNA, which differs from person to person. This sequence variation might explain some of the differences between people, for example height, hair colour, risk of diseases and the body’s reactions to medicines (pharmacogenetics).

There are many types of DNA-variations and one of the most common ones is single nucleotide polymorphism (SNP), where one letter in our genetic code has been replaced by another letter. DNA consists of long chains of base pairs (letters, totalling around 3 billion) and a SNP occurs approximately for every 300th base pair.

We wanted to study what role the natural genetic variation plays in the development of side effects in children treated for leukaemia (cancer of the blood). The most common form of blood cancer in children is acute lymphoblastic leukaemia, and 30-40 children are diagnosed in Norway every year with this type of leukaemia. The treatment consists of chemotherapy given over a period of 2.5 years, and the survival rate today is around 85%. The treatment causes many side effects including reduced immune function and infections. In some cases, the treatment can lead to so serious side effects that the patient dies from the toxicity.

Knowledge about pharmacogenetic variation is already used in the standard treatment for acute lymphoblastic leukaemia when using the chemotherapy 6-mercaptopurine. This drug is dosed based on the patient’s SNP variants for the enzyme that metabolises 6-mercaptopurine (TPMT-genetic variants).

We have collaborated with a research group at the laboratory in Copenhagen (Bonkolab, Rigshospitalet) and, based on existing literature, around 2300 candidate genes that could be significant for children with acute lymphoblastic leukaemia have been identified. Furthermore, the group has made a cost-efficient analysis method where 34,000 genetic variants (SNPs) per patient within these genes (extended candidate gene model) are analysed. Samples from several patients can also be analysed in the same sample tube (multiplexing).

The test tube to the left contains a blood sample from a healthy person. The test tube to the right contains a blood sample form a child with leukaemia. “Leukaemia” means “white blood”, and one can clearly see why when looking at the white layer of cells in the test tube to the right. (Photo: Bendik Lund)

The test tube to the left contains a blood sample from a healthy person. The test tube to the right contains a blood sample form a child with leukaemia. “Leukaemia” means “white blood”, and one can clearly see why when looking at the white layer of cells in the test tube to the right. (Photo: Bendik Lund)

We used this method in a study where we included 69 Danish children with leukaemia and compared the gene variant pattern with clinical data for infections that occurred during the first 50 days of treatment. We identified a SNP profile which with great accuracy can predict the risk for infections in this early phase of the treatment, where many infections are life-threatening.

If these findings are confirmed in similar studies, we may in the future be able to quickly determine whether a patient has an increased risk for serious infections by taking a simple blood test. If the patient is at high risk for serious infections, the treatment could be adapted accordingly for example giving prophylactic antibiotics, or by reducing the intensity of the chemotherapy. Hopefully this will lead to less side effects and higher survival rates.

Further reading:

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Can computer games help memory skills?

Blogger: Kristine Hermansen GrunewaldtKristine-Hermansen-Grunewal

Preterm children often have a reduced working memory capacity, which makes it more difficult to learn new things and overcome everyday challenges. But what if playin gcomputer games could improve their working memory?

Our research group at NTNU and St. Olavs Hospital decided to explore whether a computer-based training programme could help a group of severely premature nursery school children with a birth weight of below 1500 grams with their memory and even other cognitive skills.

dataspill1

Computer games improved children’s working memory. (Photo:  Screen dump Cogmed©)

After 5 weeks of training, the children achieved better results on tests focusing on their working memory. They also got better scores for other cognitive skills that are essential for their ability to learn, memorise and pay attention at school.

After 5 weeks of training, the children achieved better results on tests focusing on their working memory.

Premature children are more likely to develop neurological disorders than children born at term. Moreover, they often have reduced concentration skills and working memory capacity compared to children born on or after their due date.

These are all skills we need to be able to learn, plan and solve problems in everyday life. Problems with these skills can therefore have serious consequences fo the child, both socially and in terms of learning disorders and accomplishments at school, which in turn can have negative consequences that last well into adulthood.

Recent studies show that our working memory can be improved through training, and a computer-based training programme developed at Karolinska Institutet in Stockholm has previously shown promising results on children with ADHD and teenagers who were prematurely born with a very low birth weight.

Recent studies show that our working memory can be improved through training.

Our study included 20 preschool children aged 5 to 6 years with a birth weight of below 1500 grams (3.3 pounds). The children used the programme to train at home for 10 to 15 minutes per day, 5 days a week for a total of 5 weeks.

The programme is set up like a computer game where the children visit an amusement park with 7 different rotating exercises (Image 1). The child sees an  image on the computer screen showing a few dots of wool with friendly faces appearing in a specific order (Image 2). Afterwards, the child has to remember the sequences and click on the same dots of wool in the correct order.

dataspill2

Dots of wool with friendly faces enjoy the swimming pool. (Photo: Screen dump Cogmed©)

The programme is designed to increase the difficulty as the child gets better and is able to correctly remember several sequences in a row.

All the children took a series of neuropsychological tests before and after their training. Parents also responded to questions about their children’s adaptive function, anxiety and symptoms of attention disorders, both before and after the training.

After the training, the premature preschool children showed an improvement in results on both prepared and non-prepared working memory tests. They also displayed a clear, positive effect in terms of auditory/phonological attention – which is important for language skills that, in turn, are important in learning and developing reading and maths skills – as well as in visual and verbal memory. 

This appears to show that training the working memory can have an effect on other cognitive functions as well..

Our study was performed on a relatively small number of children, which means that larger studies must be performed before we can give specific recommendations for working memory training in preschool for severely premature children.

Nevertheless, our results are a good indicator that introducing a computer-based working memory programme at preschool age may help preterm children with a birth weight of below 1500 grams. This training can possibly reduce cognitive problems, which could affect future education and working life.

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Understanding viral respiratory tract infections in young children

Ingvild Bjellmo Johnsen and her co-workers from NTNU work on viral infections and especially viral respiratory tract infections in young children, which is the leading cause of death in developing countries. Knowledge about these mechanisms may lead to development of effective anti-viral treatment and prevent misuse of antibiotics.

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Does daycare cause stress in small children?

Blogger:May Britt DrugliMay Britt Drugli

 

 

 

Research from several different countries has shown that spending time in child daycare institutions may cause increased levels of stress in small children. In Norway 80 percent of 1-year-olds attend daycare. We know nothing about their stress levels.

In the international studies the children’s stress levels have been measured through analysing the levels of cortisol, also called “the stress hormone”, in spit samples taken at different times in the cause of a day. Our levels of the hormone cortisol increase in situations involving danger and make our bodies prepared for situations perceived as difficult or threatening.

Illustration: Photos.com

Illustration: Photos.com

Normally, our levels of cortisol are highest in the morning, decrease during the day and are at their lowest in the evening. Research in other countries has shown that many of the smallest children attending daycare institutions have cortisol levels that remain high throughout the day. When the children spend a day at home their cortisol levels act normally again, falling during the day. This finding indicates that some small children are constantly alert in order to tackle challenges and difficulties when they are in daycare. Perhaps they are spending too much time on their own without support from grown-ups they feel secure with.

Small children need attentive and available adults around them that can help them when they need it. This is not always the practice during busy days in a daycare institution, not in Norway either. Some small children are assumed to be more exposed for experiencing daycare as stressful, because they for instance have a more vulnerable temperament. It is also assumed that a large number of activities controlled by grown-ups and plenty of time spent in a big group can cause higher stress levels in small children.

Negative stress over time can cause a weakened immune system and reduced memory, capability to regulate own behaviour and handle future stress situations. At present, there is not enough knowledge to say if stress caused in child care institutions has these effects.

This autumn we start collecting data for the study “Small in daycare” (“Liten i barnehagen”), where around 400 parents from Trondheim and Oslo will be invited to participate with their children. We will be measuring the children’s levels of cortisol both in daycare and at home as part of the research. Further, we will observe the interaction between the children and the personnel to see if there is a connection between positive interplay and reduced stress levels in the children. We will also investigate factors such as physical buildings, the size of the group of children and number of children per grown-up.

The research project is collaboration between the Regional Centre for Child and Youth Mental health and Child Welfare at NTNU and the Regional Center for Child and Adolescent Mental Health – Region East and South. In addition international researchers on child care will take part in the research.

Data about the participants has been collected already from pregnancy, a fact that makes the project unique, also on an international level. By controlling other factors that also may cause stress we can be sure that it actually is stress related to the child care institution we are examining. We can also investigate if some children are more vulnerable than others when it comes to kindergarten-related stress. So far, little research has been conducted on this topic internationally.

Our research project will show if the youngest children in daycare in Norway are less stressed than small children in other countries. Perhaps Norwegian daycare institutions are of such a quality that this is the case, but so far we do not know.

References:

Badanes, L.S., Dmitrieva, J. & Watamura, S.E. (2012). Understanding cortisol reactivity across the day at child care: The potential buffering role of secure attachment to caregivers. Early Childhood Research Quarterly, 27, 156-165.

Bratterud, Å., Sandseter, E.B. & Seland, M. (2012). Barns trivsel og medvirkning i barnehagen. Trondheim: Barnevernets Utviklingssenter, Rapport 21/12.

Gunnar, M.R., Kryzer, E., van Ryzin, M.J. & Phillips, D.A. (2010). The rise in cortisol in family day care: Associations with aspects of care quality, child behavior, and child sex. Child Development, 81, 853-870.

Phillips, D.A., Fox, N.A. & Gunnar, M.R. (2011). Same place, different experiences: Bringing individual differences to reserach in child care. Child Development Perspectives, 5, 44-49.

Sajaniemi, N., Suhonon, E., Kontu, E., Rantanen, P., Lindholm, H., Hyttinen, S. & Hirvonen, A. (2011). Children’s cortisolpatterns and the quality of early learning environment. European Early Childhood Education Research Journal, 19, 45-62.

Vermeer, H.J. & IJzendoorn, M.H. (2006). Children’s elevated cortisol levels at daycare: A review and meta-analysis. Early Childhood Research Quarterly, 21, 390-401.

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How important is parent involvement in school?

Blogger: Bente KirkhaugBente Kirkhaug

 

 

 

Parental involvement in their children’s education is one of the strongest predictors of children’s school success and has a powerful influence on the children’s achievement and adjustment.

As part of my PhD project at the Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU) I have examined parent involvement in relation to children’s behavioural problems and social competence in school. For children with behavioural problems, parent involvement is especially important for how the children cope in school.

Ilustrasjon: Photos.com. Mann som hjelper sønnen med leksene

Illustration: Photos.com

Parental involvement in school involves behaviour by parents in school settings and at home that is intended to support their children’s educational development. These are behaviour like getting involved with school/ teacher, attending parent-teacher conferences and school meetings and encourage the child’s positive attitude towards education, e.g.; helping the child with its homework, playing games to teach the child new things, taking the child to the library, reading to child and so on.

Positive involvement between parents and school/teachers has been shown to improve the children’s academic accomplishment on all levels as well as their social functioning in school. For children in general, parental involvement in school is reported to lead to improved behaviour, attitudes and attendance at school, as well as better emotional adjustment and greater well-being.

For the youngest children in school, parental involvement is associated with early school success, this including academic and language skills and social competence. Further; parent’s expectations and involvement in school seem to have a stronger influence on the youngest children’s achievement compared to children in the later years of elementary school.

For children with behavioural problems, parent involvement is especially important for how the children cope in school.

In general, children with behaviour problems often have learning difficulties and lack social competence and therefore tend to be rejected by prosocial children. For these children parent involvement in school and co-operation between parents and school/ teacher is in particular important.Young children with high levels of behaviour problems are considered less academically competent, they have poorer reading and verbal skills, they perform worse in school and they receive more negative feedback from teachers than their more behaviourally competent peers.

Positive parent–school involvement for children with behaviour problems is a predictor of later social and academic success and the lack of parental involvement may contribute to extend the child’s behavioural problems.

Maintaining a good working relationship between parents and school is a mutual responsibility. Good communication between home and school, as well as mutual respect is decisive for good cooperation.

 

Reference:

Kirkhaug, B., Drugli, M.B., Klöckner, C.A., & Mørch, W-T. (2013). Association between parental involvement in school and child conduct, social, and internalizing problems: teacher report. Educational Research and Evaluation, 1-16.

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Theme of the month: Back to school and kindergarten

Illustration: Photos.com

Illustration: Photos.com

In August, Norwegian children start kindergarten and school after the summer holiday. This is an exciting time for many families. Some have a toddler in the family going to kindergarten for the first time, while others may have a kid starting in a new class with new classmates.

“Back to school and kindergarten” is the main theme for this blog in August.  Experts within a range of fields, from physical and psychological health to educational science and social science will write about themes related to kindergarten and school. Perhaps we can share some new insights and tips?

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