Evaluation of the efficacy and impact of a clinical prediction tool to identify maltreatment associated with children's burns.

Background: An estimated 10%-24% of children attending emergency departments with a burn are maltreated. Objective: To test whether a clinical prediction tool (Burns Risk assessment for Neglect or abuse Tool; BuRN-Tool) improved the recognition of maltreatment and increased the referral of high-risk children to safeguarding services for assessment. Methods: A prospective study of children presenting with burns to four UK hospitals (2015-2018), each centre providing a minimum of 200 cases before and after the introduction of the BuRN-Tool. The proportions of children referred to safeguarding services were compared preintervention and postintervention, and the relationship between referral and the recommended cut-off for concern (BuRN-Tool score (BT-score) ≥3) was explored. Results: The sample was 2443 children (median age 2 years). Nurses and junior doctors mainly completed the BuRN-Tool, and a BT-score was available for 90.8% of cases. After intervention, 28.4% (334/1174) had a BT-score ≥3 and were nearly five times more likely to be discussed with a senior clinician than those with a BT-score <3 (65.3% vs 13.4%, p<0.001). There was no overall difference in the proportion of safeguarding referrals preintervention and postintervention. After intervention, the proportion of referrals for safeguarding concerns was greater when the BT-score was ≥3 (p=0.05) but not for scores <3 (p=0.60). A BT-score of 3 as a cut-off for referral had a sensitivity of 72.1, a specificity of 82.7 and a positive likelihood ratio of 4.2. Conclusions: A BT-score ≥3 encouraged discussion of cases of concern with senior colleagues and increased the referral of <5 year-olds with safeguarding concerns to children's social care.

Gambling in children and adolescents.

INTRODUCTION: Children are susceptible to problems with gambling because of developmental and cognitive immaturities, as well as a sensitivity to peer pressure and marketing. SOURCES OF DATA: This review uses recent UK data from the Gambling Commission and from the Avon Longitudinal Study of Parents and Children, and evidence from recent reviews of gambling in children and adolescents. AREAS OF AGREEMENT: The prevalence of gambling in children worldwide and in the UK is stable, having generally decreased since 2013. Online gambling is increasing in children and young people. A small minority of adolescents who gamble develop a gambling disorder. Adolescents who have problems with gambling tend to have lower self-esteem and a history of hyperactivity and impulsivity, are more likely to have parents who gamble, report less parental supervision and to use more alcohol than their peers. AREAS OF CONTROVERSY: Children's access to slot machines, the relationship between gaming and gambling, and social media advertizing of gambling targeting children. GROWING POINTS: An increase in online gambling and in-play sports betting by adolescents and the use of skins betting in video gaming.Areas timely for developing research: impact on young people of betting on e-gaming. How best to protect children from early exposure to gambling in the current internet age. IMPLICATIONS FOR CLINICIANS: Need to be aware of the growing and complex phenomenon of gaming and gambling, and implications for the mental health of children and adolescents. The effective management of gambling disorders in children and adolescents requires close working with families.

Impact of co-occurring hearing and visual difficulties in childhood on educational outcomes: a longitudinal cohort study.

BACKGROUND: Mild hearing and visual difficulties are common in childhood, and both may have implications for educational achievement. However, the impact of co-occurring common hearing and visual difficulties in childhood is not known. OBJECTIVE: To determine the prevalence and impact of co-occurring common hearing and visual difficulties of childhood on educational outcomes in primary and secondary school. METHODS: The sample was drawn from the Avon Longitudinal Study of Parents and Children, a longitudinal birth cohort study in England. The exposures were hearing and visual difficulties at age 7 (defined as conductive hearing loss or otitis media with effusion, and amblyopia, strabismus or reduced visual acuity, respectively). The outcomes measured were achievement of level 4 or above at Key Stage 2 (KS2) in English, Maths and Science, respectively, at age 11, and attainment of five or more General Certificate of Secondary Education (GCSEs) at grades A*-C at age 16. Multiple logistic regression models assessed the relationship between hearing and visual difficulties and educational outcomes, adjusting for potential confounding factors. RESULTS: 2909 children were included in the study; 261 had hearing difficulties, 189 had visual difficulties and 14 children had co-occurring hearing and visual difficulties. Children with co-occurring hearing and visual difficulties were less likely to achieve the national target at KS2 compared with children with normal hearing and vision, even after adjustment for confounding factors (OR 0.30, CI 0.15 to 0.61 for KS2 English). Differences in IQ, behaviour, attention and social cognition did not account for this relationship. The impact of co-occurring hearing and visual difficulties on GCSE results was explained largely by poor performance at KS2. CONCLUSIONS: Co-occurring hearing and visual difficulties in childhood have an enduring negative impact on educational outcomes. Identification of affected children and early intervention in primary school is essential.

Prediction of school outcome after preterm birth: a cohort study.

OBJECTIVE: To identify if the educational trajectories of preterm infants differ from those of their term peers. DESIGN: This work is based on the Avon Longitudinal Study of Parents and Children (ALSPAC). Educational measures were categorised into 10 deciles to allow comparison of measures across time periods. Gestational age was categorised as preterm (23-36 weeks) or term (37-42 weeks). Multilevel mixed-effects linear regression models were derived to examine the trajectories of decile scores across the study period. Gestational group was added as an interaction term to assess if the trajectory between educational measures varied between preterm and term infants. Adjustment for possible confounders was performed. SUBJECTS: The final dataset contained information on 12 586 infants born alive at between 23 weeks and 42 weeks of gestation. MAIN OUTCOME MEASURES: UK mandatory educational assessments (SATs) scores throughout educational journal (including final GCSE results at 16 years of age). RESULTS: Preterm infants had on average lower Key Stage (KS) scores than term children (-0.46 (-0.84 to -0.07)). However, on average, they gained on their term peers in each progressive measure (0.10 (0.01 to 0.19)), suggesting 'catch up' during the first few years at school. Preterm infants appeared to exhibit the increase in decile scores mostly between KS1 and KS2 (p=0.005) and little between KS2 and KS3 (p=0.182) or KS3 and KS4 (p=0.149). CONCLUSIONS: This work further emphasises the importance of early schooling and environment in these infants and suggests that support, long after the premature birth, may have additional benefits.

The ALSPAC Coordination Test (subtests of the Movement ABC): Methodology and data on associations with prenatal exposures to lead, cadmium and mercury.

As part of the Avon Longitudinal Study of Parents and Children (ALSPAC), measures of child motor skills were collected in research clinics. The ALSPAC Coordination Test was derived from subtests of the Movement ABC at age 7 years in children participating in ALSPAC. Maternal blood lead, cadmium and mercury concentrations were measured by inductively-coupled plasma mass spectrometry in samples from women at a median gestation age of 11 weeks. Maternal reports at 32 weeks' gestation were used to generate data on a range of potential confounders. The data were used to determine the associations between prenatal exposure to lead, cadmium and mercury and child motor skills at age 7 years. For results, please see Taylor et al. [1].

Association of Autistic Traits With Depression From Childhood to Age 18 Years.

Importance: Population-based studies following trajectories of depression in autism spectrum disorders (ASD) from childhood into early adulthood are rare. The role of genetic confounding and of potential environmental intermediaries, such as bullying, in any associations is unclear. Objectives: To compare trajectories of depressive symptoms from ages 10 to 18 years for children with or without ASD and autistic traits, to assess associations between ASD and autistic traits and an International Statistical Classification of Diseases, 10th Revision (ICD-10) depression diagnosis at age 18 years, and to explore the importance of genetic confounding and bullying. Design, Setting, and Participants: Longitudinal study of participants in the Avon Longitudinal Study of Parents and Children birth cohort in Bristol, United Kingdom, followed up through age 18 years. Data analysis was conducted from January to November 2017. Main Outcomes and Measures: Depressive symptoms were assessed using the Short Mood and Feelings Questionnaire (SMFQ) at 6 time points between ages 10 and 18 years. An ICD-10 depression diagnosis at age 18 years was established using the Clinical Interview Schedule-Revised. Exposures were ASD diagnosis and 4 dichotomized autistic traits (social communication, coherence, repetitive behavior, and sociability). An autism polygenic risk score was derived using the Psychiatric Genomics Consortium autism discovery genome-wide association study summary data. Bullying was assessed at ages 8, 10, and 13 years. Results: The maximum sample with complete data was 6091 for the trajectory analysis (48.8% male) and 3168 for analysis of depression diagnosis at age 18 years (44.4% male). Children with ASD and autistic traits had higher average SMFQ depressive symptom scores than the general population at age 10 years (eg, for social communication 5.55 [95% CI, 5.16-5.95] vs 3.73 [95% CI, 3.61-3.85], for ASD 7.31 [95% CI, 6.22-8.40] vs 3.94 [95% CI, 3.83-4.05], remaining elevated in an upward trajectory until age 18 years (eg, for social communication 7.65 [95% CI, 6.92-8.37] vs 6.50 [95% CI, 6.29-6.71], for ASD 7.66 [95% CI, 5.96-9.35] vs 6.62 [95% CI, 6.43-6.81]). Social communication impairments were associated with depression at age 18 years (adjusted relative risk, 1.68; 95% CI, 1.05-2.70), and bullying explained a substantial proportion of this risk. There was no evidence of confounding by the autism polygenic risk score. Analysis in larger samples using multiple imputation led to similar but more precise results. Conclusions and Relevance: Children with ASD and ASD traits have higher depressive symptom scores than the general population by age 10 years, which persist to age 18 years, particularly in the context of bullying. Social communication impairments are an important autistic trait in relation to depression. Bullying, as an environmental intermediary, could be a target for interventions.

Prenatal lead, cadmium and mercury exposure and associations with motor skills at age 7 years in a UK observational birth cohort.

BACKGROUND: Lead and mercury are freely transferred across the placenta, while cadmium tends to accumulate in the placenta. Each contributes to adverse neurological outcomes for the child. Although prenatal heavy metal exposure has been linked with an array of neurodevelopmental outcomes in childhood, its association with the development of motor skills in children has not been robustly studied. AIMS/OBJECTIVE: The aim of the present study was to investigate the association between prenatal exposure to lead, cadmium and mercury, measured as maternal blood concentrations during pregnancy, and motor skills, measured as subtests of the Movement Assessment Battery for Children (Movement ABC) at age 7 years in a large sample of mother-child pairs enrolled in a UK observational birth cohort study (Avon Longitudinal Study of Parents and Children, ALSPAC). METHODS: Whole blood samples from pregnant women enrolled in ALSPAC were analysed for lead, cadmium and mercury. In a complete case analysis (n = 1558), associations between prenatal blood concentrations and child motor skills assessed by Movement ABC subtests of manual dexterity, ball skills and balance at 7 years were examined in adjusted regression models. Associations with probable developmental coordination disorder (DCD) were also investigated. RESULTS: The mean prenatal blood levels were: lead 3.66 ±â€¯1.55 µg/dl; cadmium 0.45 ±â€¯0.54 µg/l; mercury 2.23 ±â€¯1.14 µg/l. There was no evidence for any adverse associations of prenatal lead, cadmium or mercury exposure with motor skills measured at age 7 years with Movement ABC subtests in adjusted regression models. Further, there were no associations with probable DCD. CONCLUSIONS: There was no evidence to support a role of prenatal exposure to heavy metals at these levels on motor skills in the child at age 7 years measured using the Movement ABC. Early identification of symptoms of motor skills impairment is important, however, to enable investigation, assessment and treatment.

A review of guidance on fish consumption in pregnancy: is it fit for purpose?

OBJECTIVE: Public health messages to reduce Hg exposure for pregnant women have focused exclusively on advice on fish consumption to limit Hg exposure, with little account being taken of the positive contribution of fish to nutritional quality. The aim of the present review was to compare and contrast the content and presentation of national guidelines on fish consumption in pregnancy, and comment on their evidence base and impact on consumption. DESIGN: We searched for national and international guidelines on fish consumption in pregnancy using Internet search strategies. The detailed content and style of presentation of the guidelines were compared. The evidence base for the guidelines, and evidence for the impact of the guidelines on fish consumption levels, were assessed. RESULTS: We identified nineteen national guidelines and three international guidelines. There was great variation in the content, complexity and presentation style. The guidelines were based largely on the Hg content of fish with far less consideration being given to the positive beneficial effects of nutrients provided by fish. The complexity of the guidelines may lead to pregnant women reducing their fish intake, or not eating fish at all. CONCLUSIONS: Guidelines on fish consumption in pregnancy should take the beneficial effects of fish into account. Guidelines need to be clear and memorable, and appropriately disseminated, to achieve impact. Guidelines could include visual rather than narrative content. Use of technology, for example apps, could enable women to record their fish consumption in real time and log compliance with guidance over a week or other time period.

Raising suspicion of maltreatment from burns: Derivation and validation of the BuRN-Tool.

BACKGROUND: 10-25% of childhood burns arise from maltreatment. AIM: To derive and validate a clinical prediction tool to assist the recognition of suspected maltreatment. METHODS: Prospectively collected data from 1327 children with burns were analyzed using logistic regression. Regression coefficients for variables associated with 'referral for child maltreatment investigation' (112 cases) in multivariable analyses were converted to integers to derive the BuRN-Tool, scoring each child on a continuous scale. A cut-off score for referral was established from receiver operating curve analysis and optimal sensitivity and specificity values. We validated the BuRN-Tool on 787 prospectively collected novel cases. RESULTS: Variables associated with referral were: age <5years, known to social care, concerning explanation, full thickness burn, uncommon body location, bilateral pattern and supervision concern. We established 3 as cut-off score, resulting in a sensitivity and specificity for scalds of 87.5% (95% CI:61.7-98.4) and 81.5% (95% CI:77.1-85.4) respectively and for non-scalds sensitivity was 82.4% (95%CI:65.5-93.2) and specificity 78.7% (95% CI:73.9-82.9) when applied to validation data. Area under the curve was 0.87 (95% CI:0.83-0.90) for scalds and 0.85 (95% CI:0.81-0.88) for non-scalds. CONCLUSION: The BuRN-Tool is a potential adjunct to clinical decision-making, predicting which children warrant investigation for child maltreatment. The score is simple and easy to complete in an emergency department setting.

Data relating to prenatal lead exposure and child IQ at 4 and 8 years old in the Avon Longitudinal Study of Parents and Children.

As part of the Avon Longitudinal Study of Parents and Children (ALSPAC), measures of child IQ were collected by trained psychologists. The Wechsler Pre-school and Primary Scale of Intelligence - Revised UK edition (WPPSI) was used at age 4 years in a subsample of children enrolled in ALSPAC (the Children in Focus cohort), chosen at random from the last 6 months of ALSPAC births (about 10% of the participants). At age 8 years all children enrolled in the main cohort were invited to complete a short form of the Wechsler Intelligence Scale for Children (WISC)-III UK. Prenatal blood lead (B-Pb) concentrations were measured by inductively-couple plasma mass spectrometry in samples from women at a median gestation age of 11 weeks. Child blood lead was measured by atomic absorption spectrometry in samples from children attending the Children in Focus clinic at age 30 months. Maternal reports at 32 weeks' gestation were used to generate data on a range of potential confounders. The data were used to determine the associations between prenatal exposure to lead and child IQ at 4 and 8 years. The effect of child B-Pb at 3 years as a moderator of these associations was tested. (For results, please see doi:10.1016/j.neuro.2017.07.003 Taylor et al., (2017)).

Effects of low-level prenatal lead exposure on child IQ at 4 and 8 years in a UK birth cohort study.

BACKGROUND: The association between childhood exposure to lead (Pb) and deficits in cognitive function is well established. The association with prenatal exposure, however, is not well understood, even though the potential adverse effects are equally important. OBJECTIVES: To evaluate the association between low prenatal exposure to lead and IQ in children, to determine whether there were sex differences in the associations, and to evaluate the moderation effect of prenatal Pb exposure on child IQ. METHODS: Whole blood samples from pregnant women enrolled in ALSPAC (n=4285) and from offspring at age 30 months (n=235) were analysed for Pb. Associations between prenatal blood lead concentrations (B-Pb) and child IQ at age 4 and 8 years (WPPSI and WISC-III, respectively) were examined in adjusted regression models. RESULTS: There was no association of prenatal lead exposure with child IQ at 4 or 8 years old in adjusted regression models, and no moderation of the association between child B-Pb and IQ. However, there was a positive association for IQ at age 8 years in girls with a predicted increase in IQ (points) per 1µg/dl of: verbal 0.71, performance 0.57, total 0.73. In boys, the coefficients tended to be negative (-0.15, -0.42 and -0.29 points, respectively). CONCLUSION: Prenatal lead exposure was not associated with adverse effects on child IQ at age 4 or 8 years in this study. There was, however, some evidence to suggest that boys are more susceptible than girls to prenatal exposure to lead. Further investigation in other cohorts is required.

Moderate Prenatal Cadmium Exposure and Adverse Birth Outcomes: a Role for Sex-Specific Differences?

BACKGROUND/AIM: Studies on the effects of moderate prenatal exposure to cadmium (Cd) on birth outcomes have been contradictory and it has been suggested that effects may be partly masked by sex-specific effects. Our aim was to examine the association of Cd exposure in a large group of pregnant women with birth outcomes in the whole group of participants and by sex. METHODS: Pregnant women were enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC). Whole blood samples for singleton pregnancies with a live birth were analysed for Cd (n = 4191). Data collected on the infants included anthropometric variables and gestational age at delivery. Data were analysed using SPSS v18. RESULTS: There were adverse associations of maternal blood Cd level with birthweight (unstandardized B coefficient -62.7 g, 95% CI -107.0, -18.4) and crown-heel length (-0.28 cm, 95% CI -0.48, -0.07) in adjusted regression models. On stratification by sex, maternal blood Cd level was adversely associated with birthweight (-87.1 g, 95% CI -144.8, -29.4), head circumference (-0.22 cm, 95% CI -0.39, -0.04), and crown-heel length (-0.44 cm, 95% CI -0.71, -0.18) in girls but not in boys in adjusted regression models. CONCLUSION: In these pregnant women with moderate prenatal Cd exposure there evidence of adverse associations with birth anthropometry variables in the whole group. However, there was evidence of associations with anthropometric variables in girls that were not evident in boys. Sex-specific effects require further investigation in large cohorts as a possible contributor to the lack of associations generally found in mixed-sex studies.

Low level lead exposure and pregnancy outcomes in an observational birth cohort study: dose-response relationships.

BACKGROUND: National and international guidelines on safe levels for blood Pb in pregnancy focus on a threshold above which exposure is of concern. However, it has recently been suggested that the decrease in birth weight per unit increase in blood Pb is actually greater at lower than at higher concentrations of Pb without evidence of a lower threshold of effect. Our aim was to investigate whether there was evidence for a differential effect of maternal Pb levels on birth outcomes and/or a threshold value for effects. METHODS: Blood samples from pregnant women enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC) were analysed. Data collected on the infants included anthropometric variables. We fitted adjusted multivariable fractional polynomial models for birth outcomes. RESULTS: Adjusted models that assumed a linear relationship between untransformed blood Pb and the outcomes provided the best fit: an increase of 1 µg/dl was associated with changes in birth weight of -9.93 (95 % CI -20.27, 0.41) g, head circumference -0.03 (95 % CI -0.06, 0.00) cm and crown-heel length -0.05 (95 % CI -0.10, 0.00) cm. CONCLUSION: There was no evidence in this study to suggest a supralinear dose-response relationship or a lower threshold for the effect of maternal blood Pb on birth outcomes. This has implications for consideration of national and international guidelines on levels of concern in pregnancy. Exposure to Pb should be kept as low as possible during pregnancy to minimise adverse outcomes.

Blood mercury levels and fish consumption in pregnancy: Risks and benefits for birth outcomes in a prospective observational birth cohort.

BACKGROUND: To avoid exposure to mercury, government advice on fish consumption during pregnancy includes information on fish species to avoid and to limit, while encouraging consumption of least two portions of fish per week. Some women may, however, chose to avoid fish completely during pregnancy despite potential benefits to the fetus. OBJECTIVES: Our aims were to evaluate the effects of blood mercury levels in pregnant women on birth outcomes in the UK, and to compare outcomes in those who ate fish with those who did not. METHODS: Pregnant women were enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC). Whole blood samples for singleton pregnancies with a live birth were analysed for Hg by inductively coupled plasma dynamic reaction cell mass spectrometry (n=4044). Fish intake was determined by a food frequency questionnaire during pregnancy. Data collected on the infants included anthropometric variables and gestational age at delivery. Regression models were adjusted for covariates using SPSS v23. RESULTS: There were no significant associations of maternal blood Hg level with birthweight, head circumference or crown-heel length in adjusted linear regression models. Similarly, there were no increased odds of low birthweight or preterm delivery in adjusted logistic regression models. When the models were repeated after stratification into fish-eaters and there were no associations except for a negative association with birthweight in non-fish-eaters (unstandardised B coefficient -58.4 (95% confidence interval -113.8, -3.0) g, p=0.039). CONCLUSION: Moderate mercury levels in pregnancy were not associated with anthropometric variables, or on the odds of low birthweight or preterm birth. Fish consumption may have a protective effect on birthweight. Consumption of fish in line with government guidelines during pregnancy should be encouraged.

Balance ability in 7- and 10-year-old children: associations with prenatal lead and cadmium exposure and with blood lead levels in childhood in a prospective birth cohort study.

OBJECTIVES: Most studies reporting evidence of adverse effects of lead and cadmium on the ability to balance have been conducted in high-exposure groups or have included adults. The effects of prenatal exposure have not been well studied, nor have the effects in children been directly studied. The aim of the study was to identify the associations of lead (in utero and in childhood) and cadmium (in utero) exposure with the ability to balance in children aged 7 and 10 years. DESIGN: Prospective birth cohort study. PARTICIPANTS: Maternal blood lead (n=4285) and cadmium (n=4286) levels were measured by inductively coupled plasma mass spectrometry in women enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC) during pregnancy. Child lead levels were measured in a subsample of 582 of ALSPAC children at age 30 months. MAIN OUTCOME MEASURES: Children completed a heel-to-toe walking test at 7 years. At 10 years, the children underwent clinical tests of static and dynamic balance. Statistical analysis using SPSS V.19 included logistic regression modelling, comparing categories of ≥ 5 vs <5 µg/dL for lead, and ≥ 1 vs <1 µg/L for cadmium. RESULTS: Balance at age 7 years was not associated with elevated in utero lead or cadmium exposure (adjusted OR for balance dysfunction: Pb 1.01 (95% CI 0.95 to 1.01), n=1732; Cd 0.95 (0.77 to 1.20), n=1734), or with elevated child blood lead level at age 30 months (adjusted OR 0.98 (0.92 to 1.05), n=354). Similarly, neither measures of static nor dynamic balance at age 10 years were associated with in utero lead or cadmium exposure, or child lead level. CONCLUSIONS: These findings do not provide any evidence of an association of prenatal exposure to lead or cadmium, or lead levels in childhood, on balance ability in children. Confirmation in other cohorts is needed.

Are diet and feeding behaviours associated with the onset of and recovery from slow weight gain in early infancy?

Infants with slow weight gain cause concern in parents and professionals, but it is difficult to be certain whether such infants are genetically small or whether their energy intake is insufficient. The aim of the present study was to assess the impact of diet and feeding behaviours on slow weight gain early in infancy. The sample was 11 499 term infants from the Avon Longitudinal Study of Parents and Children (ALSPAC). A total of 507 cases of slow weight gain from birth to 8 weeks were identified and the remaining 10 992 infants were used as controls. It was found that infants who gained weight slowly between birth and 8 weeks were more likely to exhibit feeding problems such as weak sucking and slow feeding during this period. Feeding problems were substantially reduced during the recovery phase (8 weeks to 2 years) when these infants exhibited enhanced catch-up in weight. The proportion of mothers breast-feeding in the 4th week after birth was higher for slow weight gainers, but they were more likely to switch to formula at the start of recovery. During recovery, slow-weight gain infants had a slightly higher energy intake from formula and solids than controls. In conclusion, feeding problems seem to be the most important factors associated with the onset of early slow weight gain. Subsequently, a reduction of feeding problems and an increase in overall energy intake may contribute to their weight recovery. Health professionals should look for feeding problems in the first few weeks after birth and help mothers establish adequate feeding practices.

Intake of game birds in the UK: assessment of the contribution to the dietary intake of lead by women of childbearing age and children.

OBJECTIVE: Concern has recently been expressed about Pb levels in Pb-shot game meat. Our aim was to determine the consumption of game birds in a representative sample population in the UK, and in children and women of childbearing age in particular. DESIGN: Population-based cross-sectional cohort study. Data from 4 d diet diaries from the UK National Diet and Nutrition Survey (NDNS; 2008-2010) were extracted to analyse data on game bird consumption in the sample population, in women of childbearing age (15-45 years old) and in children ≤6 years old. SETTING: Home-based study in representative areas of the UK. SUBJECTS: Participants in the NDNS (2008-2010; n 2126, age 1·5 to >65 years). RESULTS: Fifty-eight participants (2·7 %) reported eating game birds. The mean intake was 19·5 (sd 18·1) g/d (median 15·6, range 1·3-92·9 g/d). In women of childbearing age (15-45 years), 11/383 (2·9 %) reported eating game birds, with a mean intake of 22·4 (sd 25·8) g/d (median 15·6, range 2·0-92·9 g/d). In children aged ≤6 years old, 3/342 (0·9 %) were reported as eating game birds, with a mean intake of 6·8 (sd 9·7) g/d (median 2·4, range 1·3-23·2 g/d). CONCLUSIONS: The prevalence of consumption of game birds by women of childbearing age and children ≤6 years old was relatively low and intakes were small. However, any exposure to Pb in these two groups is undesirable. As are uncertainties about the ability of the diet diary method to capture the consumption of food items that are infrequently consumed, alternative methods of capturing these data should be used in future studies.

Sleep patterns in children with autistic spectrum disorders: a prospective cohort study.

OBJECTIVE: To investigate longitudinal sleep patterns in children with autistic spectrum disorders (ASDs). STUDY DESIGN: Prospective longitudinal study using Avon Longitudinal Study of Parents and Children, an English cohort born in 1991-1992. Parental reports of sleep duration were collected by questionnaires at 8 time points from 6 months to 11 years. Children with an ASD diagnosis at age 11 years (n=73) were identified from health and education records. RESULTS: From aged 30 months to 11 years old, children with ASD slept for 17-43 min less each day than contemporary controls. No significant difference in total sleep duration was found in infancy, but from 30 months of age children with ASD slept less than their peers, a difference that remained significant after adjusting for sex, ethnicity, high parity and epilepsy. The reduction in total sleep was wholly due to changes in night rather than daytime sleep duration. Night-time sleep duration was shortened by later bedtimes and earlier waking times. Frequent waking (3 or more times a night) was also evident among the children with ASD from 30 months of age. Age-specific decreases of >1SD within individuals in sleep duration across adjacent time points was a predictor of ASD between 18 months and 30 months of age (p=0.04) and from 30 months to 42 months (p=0.02). CONCLUSIONS: Sleep duration in children with ASD is reduced from 30 months of age and persists until adolescence.

Environmental factors predicting blood lead levels in pregnant women in the UK: the ALSPAC study.

BACKGROUND: Lead is a widespread environmental toxin. The behaviour and academic performance of children can be adversely affected even at low blood lead levels (BLL) of 5-10 µg/dl. An important contribution to the infant's lead load is provided by maternal transfer during pregnancy. OBJECTIVES: Our aim was to determine BLL in a large cohort of pregnant women in the UK and to identify the factors that contribute to BLL in pregnant women. METHODS: Pregnant women resident in the Avon area of the UK were enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC) in 1991-1992. Whole blood samples were collected at median gestational age of 11 weeks and analysed by inductively coupled plasma dynamic reaction cell mass spectrometry (n = 4285). Self-completion postal questionnaires were used to collect data during pregnancy on lifestyle, diet and other environmental exposures. Statistical analysis was carried out with SPSS v19. RESULTS: The mean±SD BLL was 3.67±1.47 (median 3.41, range 0.41-19.14) µg/dl. Higher educational qualification was found to be one of the strongest independent predictor of BLL in an adjusted backwards stepwise logistic regression to predict maternal BLL <5 or ≥5 µg/dl (odds ratio 1.26, 95% confidence interval 1.12-1.42; p<0.001). Other predictive factors included cigarette smoking, alcohol and coffee drinking, and heating the home with a coal fire, with some evidence for iron and calcium intake having protective effects. CONCLUSION: The mean BLL in this group of pregnant women is higher than has been found in similar populations in developed countries. The finding that high education attainment was independently associated with higher BLL was unexpected and currently unexplained. Reduction in maternal lead levels can best be undertaken by reducing intake of the social drugs cigarettes, alcohol and caffeine, although further investigation of the effect of calcium on lead levels is needed.