SUNDAY, April 13 (HealthDay News) -- New research suggests that muscle weakness in a child with autism may point to an underlying genetic defect that's causing mitochondrial disease, which means the muscles don't get the energy they need.

Conversely, it's possible that the mitochondrial disease may also play a role in the development of autism, perhaps by preventing the brain from getting the energy it needs to perform properly, the researchers noted.

"In large studies of kids with autism, about 20 percent have markers of mitochondrial disease in the blood," explained Dr. John Shoffner, an associate professor of biology at Georgia State University and president of Medical Neurogenetics.

Shoffner recently completely a retrospective analysis of 37 children with autism spectrum disorders and found that 65 percent of these children -- children who had been referred to him because their doctors suspected additional problems -- had mitochondrial defects.

He was expected to present the findings April 13 at the American Academy of Neurology's annual meeting, in Chicago.

Mitochondria are found in every cell of the body, with the exception of red blood cells, according to the United Mitochondrial Disease Foundation (UMDF). Mitochondria are vital to survival, because they make oxygen available to cells and metabolize food into energy for cells to thrive. Defects in mitochondria can lead to cell injury, or even cell death, according to UMDF.

Symptoms of mitochondrial disease depend on which body system is affected but may include muscle weakness, loss of muscle control, poor growth, heart disease, diabetes, developmental delays, an increased risk of infection and more.

Shoffner said that the mitochondrial energy production system is the only one in the body that requires two genomes to work -- genes inherited from both the mother and the father, and genes exclusively from the mother. "To make this system work, it requires a lot of genes. Hence the opportunity for lots of problems," said Shoffner, who added that there are several hundred known mitochondrial disorders.

Twenty-four (65 percent) of the children included in this study had genetic defects in their skeletal muscles. However, that doesn't mean that 65 percent of children with autism likely have mitochondrial disease. This was a select population of kids with autism, ones that had specifically been referred, because their doctors suspected a problem.

But, Shoffner pointed out that as many as one in five youngsters with autism spectrum disorders have shown signs of mitochondrial disease.

"If you're talking about 20 percent of kids with autism, that's a whole lot of children, and may represent an important segment of the autism spectrum disorder population. And we may be getting a foothold into the underlying cause of autism spectrum disorders," he said, adding, "This is a really important step forward that lets us put effort into understanding the mechanisms of disease."

"This study is a call to action. We need to know what is the real prevalence of mitochondrial conditions in children with autism," said Geraldine Dawson, chief science officer for Autism Speaks. "The more we can identify these subgroups of kids, the more we're going to parse apart the many forms of autism. This gives us clues to etiology."

"If we find that mitochondrial disease is a prevalent condition, having a better understanding of the kinds of symptoms that children may show if they have it might be helpful for parents," she said.

Shoffner said these findings may also open up new avenues of research into potentially more effective treatments for the future.

More information

To learn more about autism, visit Autism Speaks  .

FRIDAY, April 11 (HealthDay News) -- The group that accredits most U.S. hospitals issued guidelines Friday to help prevent medication errors in hospitalized children.

Among the recommendations: Children should be weighed in kilograms -- the global standard and the standard for medication dosing -- when they are admitted to a hospital.

"The vast majority of countries utilize the metric system, and the recommendations for pediatric medication use are based on the metric system," said Dr. Peter Angood, vice president and chief patient safety officer for The Joint Commission, which announced the "Sentinel Event Alert" at a teleconference.

"Sadly, there seems to be a lack of widespread appreciation even among health-care providers that children have unique safety and medication needs," said Dr. Matthew Scanlon, assistant professor of pediatrics-critical care at the Medical College of Wisconsin and a member of the Joint Commission's Sentinel Event Advisory Group. "The issues of having to adapt products -- be it technology or medications -- that were created for adults and apply those to pediatric patients is terribly problematic and really is the source of a great deal of work that has to be performed on a daily basis among pediatric health-care providers."

Added Catherine Tom-Revzon, clinical pharmacy manager at Children's Hospital at Montefiore in New York City: "This is definitely increasing the public awareness that at least something's being done to address the medication errors that occur in children."

The alert follows publication this week of a study that found that medication errors, including accidental overdoses and adverse reactions, affect about one of 15 -- or 7 percent -- of hospitalized children. The study was published in the April issue of the journal Pediatrics.

That 7 percent figure is much higher than previous estimates. And it underscores growing concerns about medical errors involving hospitalized children -- an issue that generated headlines in November when actor Dennis Quaid's newborn twins were accidentally given life-threatening overdoses of a blood thinner.

What's to blame for the problem? According to Angood, most medications are made and packaged for adults, and most health-care facilities are built and organized around the needs of adults, not children. Also, process issues -- including miscommunication, lack of standards for labeling and packaging, and the misidentification of medications -- are at fault, he said.

Even recent innovations in technology often don't help the pediatric population. A system for computer order entry of medications implemented by Scanlon's hospital did not have weight-based dosing. "Pediatric providers were left to cobble together weight-based dosing," he said.

Similarly, bar coding of medications is sometimes not readable for children because of the range of size.

"Technology holds great promise," Scanlon said. "Unfortunately, today, that hasn't been realized and lack of explicit attention to the needs of children certainly has not helped that matter."

Perhaps the simplest solution proposed by the commission is for hospitals and health-care providers to weigh children in kilograms to arrive at the proper dosing.

"This should become the standard of recording pediatric patient weights," Angood said.

The commission is also suggesting that caregivers who prescribe medications to children be required to write out and document how they arrived at particular doses. "In other words, show the math," Angood said. "This means nurses or doctors can easily double-check the calculations of any medications administered."

The family and, if possible, the child should also be involved in the medication management process, and should be asked to repeat back any medication-related instructions, according to the guidelines.

"What's really important from the patient's or parents' perspective is not only know the child's weight [in kilograms] but also maintain a current list of a child's medications -- whether they be prescription, over-the-counter or both," Tom-Revzon said. "Also, as part of that list, it should include any allergies to medication or foods, so that even if the child doesn't end up going to the hospital, even if they go to the emergency [room] or to a different doctor, that list will help prevent potential drug interactions and duplications."

Angood added: "We can and we're obligated to do better. We really do owe it to those patients who depend on us."

More information

To learn more about the new recommendations, visit The Joint Commission  .

MONDAY, April 7 (HealthDay News) -- Babies who get less than 12 hours of sleep a day face twice the risk of being overweight as preschoolers.

And, some parents may inadvertently contribute to their child's sleep problems by taking steps intended to soothe the child that, in reality, lead to disrupted sleep.

That's the conclusion of two reports in April's special issue of the Archives of Pediatrics & Adolescent Medicine, which is devoted to children and sleep.

"The combination of too little sleep and too much TV is associated with markedly elevated risk of obesity," explained Dr. Elsie M. Taveras, an assistant professor of ambulatory care and prevention at Harvard Medical School and lead author of the first study.

For the study, Taveras and her colleagues collected data on 915 children whose mothers reported on their child's sleep habits during the first two years of life. Using this information, researchers were able to determine how much sleep the children had each day between 6 months and 2 years of age.

On average, the children slept 12.3 hours a day. When the children reached 3 years of age, 83 were overweight. The researchers found that 3-year-olds who slept less than 12 hours a day as infants weighed more for their age and sex, compared with children who slept 12 hours a day or more as babies.

Also, babies who watched two or more hours of television a day had a 16 percent increased risk of being overweight, compared to a 1 percent risk for babies who didn't watch TV, Taveras said.

"The combination of low sleep and high TV might be acting independently to be a higher risk for obesity," Taveras said. The explanation may trace to hormones that control appetite, she added.

In the second study, Valerie Simard, of the Hopital du Sacre-Coeur de Montreal and the University of Montreal, and colleagues found that parents' behavior at bedtime was linked to sleep disturbances of their children.

The researchers had the parents of 987 children fill out questionnaires about their children's sleep habits each year from the time the children were 5 months old until they were 6 years old. They found that sleep disturbances among very young children (5 to 17 months old) were primarily due to "maladaptive parenting behaviors," such as the mother being present when the child was going to sleep, or feeding the child after he or she woke up. And "co-sleeping" -- when a parent sleeps with a child -- was found to make it harder for a child to fall back asleep after awakening.

"Our findings clarify the long-debated relationship between parental behaviors and childhood sleep disturbances," the authors concluded. "They suggest that co-sleeping and other uncommon parental behaviors have negative consequences for future sleep and are thus maladaptive."

In another study in the journal, Australian researchers found that children with attention-deficit/hyperactivity disorder were more likely to have sleep problems than children without the disorder.

"Sleep problems in schoolchildren with ADHD are extremely common and strongly associated with poorer quality of life, daily functioning and school attendance in the child and poorer caregiver mental health and work attendance," wrote the researchers, who were headed by Valerie Sung, of the Centre for Community Child Health in Parkville.

"Implementation of a sleep intervention in children with ADHD could feasibly improve outcomes beyond treatment of ADHD alone. It is possible that such intervention could reduce the need for medication in some children," they added.

A fourth study, led by Alice M. Gregory of the University of London, found that children who get less sleep are more likely to suffer from symptoms of anxiety, depression and aggression later in life. Among 2,076 children studied, the researchers found that those who had sleep problems when they were 4 to 16 years of age scored higher on measures of anxiety, depression and aggressive behavior when they were 18 to 32 years of age.

"The results suggest that children reported to sleep for short periods may be at risk for later difficulties," the authors concluded.

One expert thinks that good sleep behaviors for infants are extremely important and need to be started early.

"We have to pay attention to the very early effects of sleep and health and eating in children. It probably does pave the way for a lifestyle, even in early childhood, that is going to be difficult to steer away from," said Dr. Ann Halbower, medical director of the Pediatric Sleep Disorders Program at Johns Hopkins University Children's Center in Baltimore.

Halbower thinks good sleep behaviors for infants need to be taught to parents before the child is born.

"If I meet with moms while they are pregnant and start discussing sleep behaviors, sleep routines, proper sleep habits and safe sleep for their child, they were much more likely to start that pattern than trying to change a behavior after it had become routine," she said.

More information

To learn more about children and sleep, visit the National Sleep Foundation  .

MONDAY, April 7 (HealthDay News) -- Babies born to women who use cocaine, alcohol or tobacco during pregnancy may have brain structure changes that persist into early adolescence, a new U.S. study says.

Researchers at Children's Hospital Boston and the Boston Medical Center used MRI scans to study the brains of 35 children, average age 12, who were exposed to the substances while in the womb.

"We found that reductions in cortical gray matter and total brain volumes were associated with prenatal exposure to cocaine, alcohol or cigarettes," study first author Dr. Michael Rivkin, a neurologist at Children's Hospital Boston, said in a prepared statement.

The more substances a child was exposed to, the greater the reduction in brain volume.

The study, published in the April issue of the journal Pediatrics, is the first to document joint long-term effects of prenatal cocaine, alcohol and tobacco exposure on brain structure, Rivkin said.

Previous studies that documented brain effects of prenatal alcohol exposure were mostly limited to children with fetal alcohol syndrome. Children with that condition were excluded from this new study.

Rivkin noted that his study was too small to find statistically significant effects of single substances after factoring in exposure to other substances, and was also too small to document the effects of different levels of prenatal exposure.

However, Rivkin said the overall findings are highly suggestive, and he and his colleagues would like to continue their research into this important public health matter. It's estimated that more than one million babies born each year in the United States have been exposed to at least one of these substance while in the womb.

Health-care providers should offer pregnant women comprehensive care to help them reduce the use of all harmful substances. And public health campaigns shouldn't ignore the risks of some substances while focusing on others, since the greater the number of total prenatal exposures, the more likely there will be harmful and lasting effects on a baby's developing brain, the study authors said.

More information

The American Pregnancy Association has more about pregnancy wellness  .