Childhood trauma is a potent risk factor for development of chronic fatigue syndrome (CFS), according to a study by researchers at Emory University School of Medicine and the Centers for Disease Control and Prevention (CDC).  The study is published in the Jan. 5, 2009 Archives of General Psychiatry.

Results of the study confirm that childhood trauma, particularly emotional maltreatment and sexual abuse, is associated with a six-fold increased risk for CFS.  The risk further increases with the presence of posttraumatic stress disorder symptoms.

The study also found that low levels of cortisol, a hallmark biological feature of CFS, are associated with childhood trauma.  Cortisol is frequently referred to as the “stress hormone” and is important to regulate the body’s response to stress.  A lack of cortisol’s effects may cause altered or prolonged stress responses.

“The study indicates that low cortisol levels may actually reflect a marker for the risk of developing CFS rather than being a sign of the syndrome itself,” said Christine M. Heim, PhD, lead author of the study and associate professor in the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine.

The population-based study analyzed data from 113 people with CFS, and a control group of 124 people without CFS, drawn from a sample of almost 20,000 Georgians.  The results confirm earlier findings from a 2006 study conducted in Wichita, Kan.

Study participants completed a self-reported questionnaire on five different types of childhood trauma including emotional, physical and sexual abuse, and emotional and physical neglect.  Researchers also collected saliva samples from participants to record levels of cortisol over one hour after awakening, typically an individual’s highest cortisol levels for the day.

“When looking at CFS cases with and without histories of childhood trauma, only those with childhood trauma had the classic low cortisol levels often seen in CFS cases,” explains Heim.

“It is important to emphasize that not all patients with CFS have been through childhood trauma,” she says.  “CFS may be part of a spectrum of disorders associated with childhood adversity, which includes depression and anxiety disorders.”

Certain experiences children have while the brain is developing and vulnerable can make a difference in the way the body reacts to stress later in life, and may have long-term health consequences.

“Trauma that occurs at different times in childhood may be linked to different long term changes.  It’s an area in which more work is needed,” says Heim.

Children are exposed to a wide range of environmental threats that can affect their health and development early in life, throughout their youth and into adulthood. Writing in a forthcoming issue of the International Journal of Environmental Health scientists from the World Health Organization and Boston University suggest that it is time for both industrialized and developing countries to assess the environmental burden of childhood diseases with the aim of improving children’s environments.

Maria Neira, Fiona Gore, Marie-Noël Bruné, and Jenny Pronczuk de Garbino of the Department of Public Health and Environment, at the World Health Organization, in Geneva, Switzerland, working with Tom Hudson of Boston University, highlight a recent WHO report that estimated that almost one in four illnesses has an environmental cause. Such high levels of disease kill more than ten million children each year and are, the team says, unacceptable.

They point out that environmental hazards are multiplying and becoming more visible because of environmental change, rapid population growth, overcrowding, and the speedy industrialization uncontrolled pollution of many regions. Those environmental factors that have the greatest disease burden lead to diarrheal diseases, lower respiratory infections and malaria, as well as malnutrition, poisonings, and perinatal conditions.

Work must now be done, they stress, to distinguish the main environmental threats affecting children’s health so that nations can identify the various factors and address them through remediation and education through better-informed policy-making decisions. Factors such as polluted indoor and outdoor air, contaminated water and lack of adequate sanitation, chemical and other toxic hazards, disease vectors, ultraviolet radiation and degraded ecosystems are all important environmental risk factors affecting children around the world.

It is crucial to recognize that children are more vulnerable than adults to environmental risks because they are generally constantly growing and more active and so breathe more air, consume more food and drink more water weight for weight than adults. The child’s developing central nervous, immune, reproductive, and digestive systems, are also more susceptible to irreversible damage from toxins and pollutants.

They also point out that two other important factors affect the environmental risks experienced by children differently from adults. First, children play and crawl on the ground where they are exposed to dust and chemicals that accumulate on floors and soils. Secondly, they have far less control over their environment than adults have and are usually less aware of risks and unable to make choices to protect their health.

The team hopes that taking action to address all such issues will ultimately reduce the burden of disease affecting children globally and so contribute towards the Millennium Development Goals (MDGs).

Following an extensive evidence review, the U.S. Preventive Services Task Force (USPSTF) concluded that doctors, nurses, hospitals and health systems have a role to play in encouraging and supporting breastfeeding.  In an update to its 2003 recommendation on counseling to promote breastfeeding, the USPSTF recommends primary care interventions before, around, and after child birth to encourage and support breastfeeding.  The recommendation appears in the October 21, 2008, issue of Annals of Internal Medicine, the American College of Physicians’ flagship journal.

For the study, the Task Force evaluated more than 25 randomized trials of breastfeeding interventions conducted in the United States and in developed countries around the world.  The Task Force concluded that coordinated interventions throughout pregnancy, birth, and infancy can increase breastfeeding initiation, duration, and exclusivity.  For example, a cluster-randomized trial of more than 17,000 mother-infant pairs in the Republic of Belarus found that breastfeeding interventions increased the duration and degree (exclusivity) of breastfeeding.  Infants in the intervention group were significantly more likely than those in the control group to be exclusively breastfed (exclusive breastfeeding is when an infant receives no other food or drink besides breast milk).  The intervention emphasized health care worker assistance with initiating and maintaining breastfeeding and lactation and postnatal breastfeeding support.

“Our review produced adequate evidence that multifaceted breastfeeding interventions work,” said Task Force Chair Ned Calonge, MD, MPH, who is also Chief Medical Officer for the Colorado Department of Public Health and Environment, Denver.  “We found that interventions that include both prenatal and postnatal components may be the most effective at increasing breastfeeding duration.  Many successful programs include peer support, prenatal breastfeeding education, or both.”

In 2005, 73 percent of new mothers initiated breastfeeding, nearly reaching the U.S. Healthy People 2010 goal of 75 percent.  However, only 14 percent of infants were exclusively breastfed for their first six months, as recommended by the American Academy of Pediatrics, the American Academy of Family Physicians, and the U.S. Surgeon General.

Breastfeeding has substantial health benefits to babies and their mothers.  Babies who are breastfed have fewer infections and allergic skin rashes than formula-fed babies and also are less likely to have sudden infant death syndrome (SIDS).  After breastfeeding ends, children who were breastfed are less likely to develop asthma, diabetes, obesity, and childhood leukemia.  Women who breastfeed have a lower risk for type 2 diabetes, breast cancer, and ovarian cancer than women who have never breastfed.

“We hope that these recommendations will help women and their physicians understand what they need to do to start and continue breastfeeding their babies,” said Dr. Calonge.  “Simply telling mothers they should breastfeed or giving them pamphlets is not enough.”

In infancy, genes are the key influence on a child’s ability to deal with stress. But as early as 6 months of age, parenting plays an important role in changing the impact of genes that may put infants at risk for responding poorly to stress.That’s the message from a new study by researchers at the University of North Carolina-Chapel Hill, Pennsylvania State University, the University of North Carolina-Greensboro, and North Carolina State University. It appears in the September/October 2008 issue of the journal Child Development.

The researchers looked at 142 infants who had been placed in a stressful situation—being separated from their mothers—when they were 3, 6, and 12 months old. They measured infants’ heart rates while they were exposed to the stressor, isolating a cardiac response called vagal tone. Vagal tone acts like a brake on the heart when the body is in a calm state, but during a challenging situation, this brake is withdrawn, allowing heart rate to increase so the body can actively deal with the challenge.

They also collected DNA to determine which form of a dopamine receptor gene the infants carried; specific forms of this gene are related to problems in adolescence and adulthood including aggression, substance abuse, and other risky behaviors. To assess the mothers’ behavior as high or low in sensitivity, they also videotaped the mothers and their infants playing together for 10 minutes when the babies were 6 months old.

Both genes and parenting were found to be important to the infants’ development of the way in which the brain helps regulate cardiac responses to stress. At 3 and 6 months old, those infants with the form of the dopamine gene associated with later risky behaviors did not display an effective cardiac response to the stressor (a decrease in vagal tone which takes the brake off the heart so it can respond appropriately), while those infants with the non-risk version of the gene did. At these early ages, the researchers found, it didn’t appear to matter whether mothers were sensitive or not.

However, by the time the infants were 12 months old, the pattern changed. Infants with the risk form of the gene who also had mothers who were highly sensitive now showed the expected cardiac response while they were exposed to the stressful situation. Those infants with the risk form of the gene who had insensitive mothers continued to show the ineffective cardiac response to the stressor. These findings suggest that although genes play a role in the development of physiological responses to stress, environmental experience (such as mothers’ sensitive care-giving behavior) can have a strong influence, enough to change the effect that genes have on physiology very early in life. The researchers suggest this may be because of the cumulative effect on infants of exposure to their mothers’ behavior.

“Our findings provide further support for the notion that the development of complex behavioral and physiological responses is not the result of nature or nurture, but rather a combination of the two,” says Cathi Propper, research scientist at the University of North Carolina-Chapel Hill and the study’s lead author. “They also illustrate the importance of parenting not just for the development of children’s behavior, but for the underlying physiological mechanisms that support this behavior.

“Lastly, infancy is an important time for developing behavioral and biological processes. Although these processes will continue to change over time, parenting can have important positive effects even when children have inherited a genetic vulnerability to problematic behaviors.”

With more new mothers in the workplace than ever before, there has been a corresponding increase in the number of child-care facilities in the United States.

The current research was supported in part by the Berkowitz Fellowship of the department of nutrition, Harvard School of Public Health; an Early Childhood Longitudinal Study, Birth Cohort training grant from the National Center for Education Statistics; and training grants on statistical analysis for education policy from the American Educational Research Association.