•  In the USA, there is an issue of vaccine hesitance when it comes to children
• When kids get the flu shot, there is, however, a general reduction in flu hospitalisations
• An expert described children as ‘magnifying influenza’

When elementary school students get their annual flu shot, everyone benefits, a new study shows.

An increased vaccination rate among grade-schoolers in California was associated with a decrease in flu hospitalisations for people in every other age bracket, researchers report.

The results come as no surprise to public health experts, given children’s well-earned reputation as a major vector for the spread of viral diseases.

“It basically correlates with everything we know about public health, about vaccination, and about children and children’s impact on spreading viral illness throughout a community,” said Dr Eric Cioe-Pena, director of global health for Northwell Health in New Hyde Park, New York.

Vaccine hesitance

However, the study does highlight the continuing need to convince reluctant parents of the importance of getting their kids an annual flu shot, Cioe-Pena added.

“We have an issue of vaccine hesitance in [the United States] when it comes to children,” said Cioe-Pena. “To me, if you don’t get to the root cause of the hesitance, it probably won’t have much of an impact.”

For this study, researchers led by Jade Benjamin-Chung, from the University of California, Berkeley, tracked a city-wide school flu vaccine program in Oakland, California, and compared its success to rates of flu-associated hospitalisations.

After four years, the programme had improved vaccination coverage by 11% among children attending more than 95 preschools and elementary schools in Oakland, the researchers reported.

The increased vaccination rate was associated with 37 fewer flu-related hospitalisations per 100 000 people among all other people in the community – children aged four and younger as well as people aged 13 and older.

Fewer school absences

There were also 160 fewer influenza hospitalisations per 100 000 among people aged 65 and older, the results showed.

The elementary school children also benefited; researchers observed a decrease in illness-related school absences during the flu season.

The findings were published online on 18 August in the journal PLOS Medicine.

“We know that children magnify influenza,” said Dr Amesh Adalja, a senior scholar with the Johns Hopkins Center for Health Security in Baltimore. “Trying to increase children’s vaccination rates can be expected to have a cascading impact on the flu season. Making it easy for children to get vaccinated is one way to improve our ability to deal with influenza.”

Children tend to benefit more from the flu vaccine, because their immune systems are fresher and more responsive, Adalja added.

Congregational settings

“In younger people, the vaccine induces more antibodies than in individuals 70 years or older,” Adalja explained. “Older people’s immune systems do not respond to the vaccine as well as a younger individual does. That’s why we use high-dose vaccines with the elderly population.”

Given these results, it might make sense to promote flu shots for children as much as they are promoted for the elderly and health care workers, said Dr Waleed Javaid, director of infection prevention and control at Mount Sinai Downtown in New York City.

“When we can enhance our protection of any aspect of society where we have congregational settings and people are going to mingle with each other – like [the] military or hospitals or schools – that protects society in general,” Javaid said.

Adalja agreed.

“Our goal in the United States is to vaccinate everybody above the age of six months with influenza vaccine. That should still be the goal,” Adalja said. “If you’re trying to prioritise within that group, then children should be a major priority group to be vaccinated because they do drive it, but I do think you also have to vaccinate the vulnerable – the elderly and people with other medical conditions. They have to be a priority group as well.”

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For parents hoping their “picky” eater will grow out of it, a new study may be unwelcome news.

Researchers found that choosy four-year-olds were still turning their noses up at many foods at age nine – suggesting their finicky eating is more of a trait than a phase.

The study, which followed over 300 children, found three patterns: The majority were consistently middle-of-the-road when it came to food fussiness – sometimes shunning unfamiliar cuisine, but remaining relatively open to trying new foods.

A sizable minority (29%) consistently ate everything their parents offered up.

No signs of underweight

Then there was the picky 14%. From age four to nine, they routinely refused new foods and maintained a limited culinary repertoire.

Still, researchers saw bright spots in the findings, published on in May in the journal Pediatrics.

For one, there were no signs that picky eaters were underweight. And the fact that the fussiness seems to be a trait – and not a failure on the parents’ part – might bring some solace.

“It can be very stressful for parents to deal with a picky eater,” noted senior researcher Dr Megan Pesch, a paediatrician at the University of Michigan’s C.S. Mott Children’s Hospital in Ann Arbor.

But if parents think they did something wrong to cause it, she added, these findings suggest otherwise.

“It’s not your fault,” Pesch said. “It seems to be part of a child’s disposition.”

Ultimatums don’t help

Nor do the findings mean that parents cannot do anything about picky eating, she stressed. The study merely followed families to see what happened naturally – and did not test any intervention to change kids’ habits.

What does seem clear is that mealtime ultimatums do not help.

In this study, mothers of picky eaters reported more efforts to control what their child consumed – including limits on sugary, fatty foods. (When kids are high on the finicky scale, Pesch noted, they often stick to those types of foods.)

Despite those battles, children’s fussiness held strong.

In fact, coercion is probably destined to fail, according to Nancy Zucker, director of the Duke Center for Eating Disorders at Duke University in Durham, North Carolina.

Zucker, who wrote an editorial published with the study, pointed to one of its key findings. Based on mothers’ responses to a standard questionnaire, the pickiest eaters also tended to be emotionally reactive in general.

Brighten the mood around food

And those kids will not respond well to dinner-table demands – “It won’t work,” Zucker said. “These children will just shut down.”

She agreed that the findings suggest picky eating is a trait.

“These kids may be more harm-avoidant,” Zucker said. “And when you think about it, eating is breaking a barrier – allowing something into your body. These children hold back when everyone else is running to the food.”

So what can parents do?

Zucker said that making meals a pleasant experience may at least brighten children’s moods around food. And that could, at some point, ease their boundaries.

Including kids in shopping and meal preparation, Zucker said, is one way to make it more enjoyable for them.

Concern about nutritional quality

Pesch agreed, adding that simple exposure may help, too. That is, keep making varied meals for the family so that the picky eater gets used to the sights and smells.

“But keep it low-pressure,” Pesch said. “Don’t try to force them to ‘clean their plates’.”

The study included 317 mother-child pairs who were followed from the time the child was about four until age nine. Mothers completed a “food fussiness” questionnaire, and 14% of kids scored high enough, and consistently enough, to be deemed persistently picky.

What’s the harm in being a picky eater? This study found no weight consequences: Finicky kids tended to weigh less than those who liked lots of foods – but they were not underweight.

There is, however, a concern, Zucker said, about the nutritional quality of their diets, as well as problems like chronic constipation.

Pesch also pointed out that the study looked at run-of-the-mill picky eating – where kids adhere to childhood favourites like macaroni and cheese, hot dogs and cereal. If a child is severely limiting food intake, she said, parents should talk to their paediatrician.

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• Nausea and vomiting during pregnancy can have a big impact on the lives of sufferers
• Pregnant women may experience nausea and vomiting all day long
• The term ‘morning sickness’ is, therefore, incorrect and can cause confusion

As many expectant mothers can unhappily attest, the nausea and vomiting known as “morning sickness” can occur at any time of the day.

In a new study, British researchers analysed diaries kept by 256 women from the day they learned they were expecting until the 60th day of their pregnancy.

While vomiting was most common between 7 a.m. and 1 p.m., nausea was likely all day long. And many women reported vomiting even into the evening.

The most common hour for nausea and vomiting was 9 a.m. to 10 a.m., when 82% experienced nausea and 29% experienced vomiting.

Significant negative impact

About 94% of the women had one symptom or the other during the study, and 58% experienced both, according to findings published recently in the British Journal of General Practice.

By comparing symptoms across the first seven weeks of pregnancy, the researchers found that the chances of nausea and vomiting rose.

The likelihood of nausea was highest in weeks five through seven, and vomiting in week seven. The study only examined the first seven weeks.

“If a pregnant woman experiences sickness in the afternoon she may feel that this is unusual and wrong, or if she experiences no vomiting but feels nauseous all day she might think she is not covered by the term ‘morning sickness’,” said study author Roger Gadsby. He’s an associate clinical professor at the University of Warwick Medical School in Coventry, UK.

Gadsby also noted that those women who have severe symptoms feel the term trivialises the condition.

“Nausea and vomiting in pregnancy (NVP) can have a significant negative impact on the lives of sufferers,” he pointed out in a university news release.

“It can cause feelings of depression, of being unable to look after the family, and of loss of time from paid work. Very severe NVP, called hyperemesis gravidarm, is the commonest cause of admission to hospital in the first trimester of pregnancy,” Gadsby said.

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