MONDAY, April 21 (HealthDay News) -- The American Heart Association on Monday issued recommendations that call for cardiovascular screening before prescribing stimulant treatment for all children diagnosed with attention-deficit hyperactivity disorder (ADHD).

The guidelines are meant to address mounting fears that these medications can raise the risk for cardiac complications among those with underlying heart disease.

"This is new, and it is a shift in our policy," said Dr. Victoria L. Vetter, head of the association's statement writing committee, and a professor of pediatrics at the University of Pennsylvania School of Medicine in Philadelphia.

"But we're not recommending that every child in the country have these heart screenings, rather that they be used as a reasonable tool for this small, particular group of children about to take ADHD medications, so we can ensure the treatment proceeds as safely as possible," she added.

The recommendations were published online Monday in Circulation, a journal of the American Heart Association (AHA).

They include: the taking of a detailed patient and family medical history, particularly regarding heart disease; a full physical exam, including blood pressure and heart beat monitoring; an electrocardiogram (ECG); and a pediatric cardiologist consultation prior to treatment if evidence of heart disease is uncovered.

After treatment begins, the AHA said that children should continue to have blood pressure check-ups once every one to three months, as well as routine health check-ups every six to twelve months.

The AHA noted that ADHD is the most common neurobehavioral disorder among American kids, with estimates indicating that between 4 percent and 12 percent of American school-aged children have the condition.

Currently, more than 2.5 million children in the United States are being prescribed ADHD medications, the organization noted.

According to the U.S. National Institutes of Health (NIH), the most effective ADHD medications typically belong to the "stimulant" class of drugs, which includes amphetamines, methylphenidates and dextroamphetamines.

Some of the names under which these drugs are marketed include Adderall, Concerta, Dexedrine, Focalin, Ritalin, Ritalin SR or LA, and Metadate ER or CD. The new recommendations refer to all of these stimulants, as well as to a newer drug known as Strattera, which was recently approved by the U.S. Food and Drug Administration as a non-stimulant treatment for ADHD.

Though ADHD stimulants increase a child's heart rate and blood pressure, the NIH noted that no evidence has indicated that such medications are addictive, and side effects do not typically pose any danger for most healthy children.

However, children with underlying heart disease who take stimulants for ADHD appear to face an increased risk for sudden cardiac arrest, the AHA noted. This risk association is particularly troublesome for young ADHD patients, because heart disease often goes undiagnosed in children and may be present without noticeable symptoms.

The AHA also pointed to a number of studies that suggest that between 33 percent and 42 percent of pediatric heart patients also have ADHD.

FDA data collected for the period 1999 through 2004 revealed that 19 children following an ADHD prescription regimen had died suddenly, while 26 experienced heart complications such as stroke, heart attack, and/or heart palpitations.

Vetter noted that, in 2005, the Canadian equivalent of the FDA -- Health Canada -- decided to place a ban on Adderall, an amphetamine-based ADHD medication designed for kids over the age of 3. The Canadian decision was actually based on a review of FDA records concerning 12 reported deaths among American children taking ADHD drugs.

Vetter pointed out that the Canadian decision was based on an assessment of collected data based on family self-reports (sometimes in the absence of autopsy records), rather than a complete scientific analysis.

"But the reality is that we were faced with some kids who had ADHD who suddenly died," she said. "And a lot of them were exercising at the time, which is when most of the kids who have electrical malfunctions of the heart would have a sudden cardiac death. So we have to assume they experienced a cardiac death."

In February 2007, the FDA ordered makers of ADHD medications to develop guidelines that alert patients to the heart risks associated with their treatments.

"But it's not that these are dangerous medicines," stressed Vetter. "But by adding the ECG, and by being aware of possible heart disease, and monitoring the kids once you prescribe the medications, one can go ahead and treat the ADHD. And these kids can be very happy."

Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Schneider Children's Hospital in New Hyde Park, N.Y., agreed that the point of expanded screenings is to identify a child's underlying heart complication, not to look for problems with the stimulants themselves.

"Serious cardiac complications from stimulant medications are very rare," Adesman said. "But because there are concerns on the part of parents and some physicians, routine ECG screenings will provide greater reassurance for the vast majority of patients for whom ADHD medications are being considered."

More information

For more on ADHD treatments, visit the National Institute of Mental Health.

THURSDAY, April 17 (HealthDay News) -- Children with migraine headaches are more likely to have sleep disorders, such as sleep apnea and lack of sleep, than children with non-migraine headaches, new research shows.

"Sleeping problems can exacerbate the problems migraine causes on a child's health and may hinder a child's performance at school," study author Dr. Martina Vendrame of Temple University in Philadelphia, said in a prepared statement. "Parents and doctors need to be aware of the strong likelihood of sleep disorders in children with migraine and seek appropriate preventions and treatments."

The study, expected to be presented Thursday at the American Academy of Neurology annual meeting in Chicago, looked at 90 children with headache and sleep problems. Of these children, 60 had migraine, 11 had chronic daily headache, six had tension headache and 13 had non-specific headache. They were studied using a polysomnogram, a sleep test that monitors the brain, eye movements, muscle activity, heart rhythm and breathing.

The children with migraines were almost twice as likely as the others to have sleep apnea, a condition in which the upper airway gets obstructed and causes repeated arousals from sleep. Such sleep-disordered breathing was found in 56 percent of children with migraine versus 30 percent of children with non-migraine headache.

Severe migraine was also associated with shorter total sleep time, longer total time to fall asleep, and shorter REM sleep, which is the stage of sleep in which most dreams can be recalled.

Sleep-disordered breathing was also frequent in the studied children with non-specific headache and those who were overweight.

Half of children with tension headache grind their teeth at night compared to 2.4 percent of children with non-tension headache, the study found.

More information

The National Headache Foundation has more about migraines  .

FRIDAY, April 11 (HealthDay News) -- Children who talk on a cell phone may not be able to cross the road safely.

A study being presented in Miami Friday at the National Conference on Child Health Psychology, hosted by the University of Miami, finds that children who are distracted this way may be more likely to be hit by a vehicle or cross streets in an unsafe manner.

"It's important for children to know, as it is for drivers, the importance of safety when talking on the cell phone," said study author Katherine Byington, a doctoral candidate in psychology at the University of Alabama at Birmingham. "We need to educate children and parents of the risk and danger that's involved in that."

"The message from this study is that children, particularly in this age group, are certainly at higher risk due to distraction," added Dr. Judy Schaechter, an associate professor of pediatrics at the University of Miami Miller School of Medicine and director of the Injury Free Coalition for Kids of Miami. "Of course, one doesn't know what would happen in real life, if the caller on the other side were not a researcher but instead was your best friend, the boy you like, your recent ex or the parent you're arguing with. I would imagine those types of conversations would put more of a demand on a child's attention and thus be more dangerous."

A related study, also from the University of Alabama at Birmingham, found that one-third of children aged 10 to 12 own a cell phone.

According to background information from the authors, the seemingly simple act of crossing the street actually involves complex brain processes. And "unintentional pedestrian injury" is a leading cause of death in middle childhood.

At the same time, more and younger children have cell phones. "There's a big market to children with cell phones these days," Byington said. "Kids don't drive at that age. They walk to school or friends' houses. We wanted to see if that would interfere with safety crossing streets."

One marketing research firm recently estimated that 54 percent of 8- to-12-year olds would own cell phones by 2009, or double the rate in 2006.

The first study, led by Byington, was small yet seems to be the first of its kind.

Seventy-seven children aged 10 to 12 were set up in a virtual-reality environment which simulated a street with traffic coming from both directions. Children stood on a platform (the "curb"). When they stepped down from the curb, an avatar crossed the virtual street in their place.

Children practiced the exercise six times while talking on a cell phone and six times while not talking on a cell phone.

"The children who were on the cell phone and were distracted during their crossing were significantly more likely to get hit by a car in the virtual environment," Byington reported. "They were getting hit or almost getting hit at least [once], while the kids that weren't on the cell phone didn't get hit [at all]."

Parents can take away a lesson here, too, Schaechter said.

"The change has to be with the parent," she added. "Parents need to consider the risk before they buy the young child a cell phone, and parents need to lay down rules and clear consequences for cell phone use, which includes not using it when crossing the street or not on sidewalks. The research provides an opportunity to teach children responsible behavior before they get behind the wheel of a car."

The second study surveyed 77 children and their parents about cell phone use.

Investigators found no gender differences in cell phone use, although black children who had phones tended to use them more than their white counterparts. Older children tended to use phones more than younger ones. Cell phone use was not affected by the family's income level.

More specifically: 33 percent of children surveyed own a cell phone themselves; 85 percent use a cell phone regularly (their own or a parent's or sibling's); 65 percent "almost always" took a cell phone with them when leaving home; 87 percent talk on the mobile less than 10 minutes a day, while 10 percent used up time 11 to 20 minutes daily; 17 percent talk on the cell when walking outside.

The key author of this study, Kayla Fanaei, was shot dead on Oct. 8, 2007, as she pulled into an elementary school parking lot to avoid conducting a cell phone conversation while driving. The lab of David C. Schwebel, which conducted both studies, finished her work.

More information

Visit Safe Kids Worldwide   for more on child safety issues.

THURSDAY, April 3 (HealthDay News) -- The way mothers and their 2-year-olds relate to each other affects the quality -- but not the frequency -- of conflict during the "terrible twos." And a child's temperament plays a role in both quality and frequency of such conflicts, according to a new study.

Interactions between 60 mothers and their children were observed during two sessions -- a 50-minute lab visit when the children were 30 months old, and a 90-minute home visit when the children were 36 months old. The Lehigh and University of California, Davis, researchers recorded details of all episodes of conflict, including whether mothers and children displayed compromise, justification or aggravation (simple insistence without explanation or threats), and whether there was a resolution.

In both sessions, mother-child conflict occurred an average of 20 times an hour, with a large degree of variation in frequency of conflict (from five to 55 times an hour) and the quality of conflict.

Children's temperament affected frequency and quality of conflict. Children who were highly active and had difficulty controlling their behavior had more run-ins with their mothers than less active children who could control their behavior. Highly active children and those who frequently and intensely experienced negative emotions had less constructive conflict with their mothers (less resolution, less justification, more aggravation) than children without these traits, the study found.

Attachment security -- the degree of trust children have in their mothers' responsiveness and availability -- affected conflict quality, but not frequency. Mothers and children who had secure relationships had constructive conflict featuring high levels of resolution, compromise, and justification, the study found.

The findings were published in the March/April issue of the journal Child Development.

"Children with difficult temperaments tend to have more frequent and less constructive conflict with mothers," lead author Deborah Laible, associate professor of psychology at Lehigh University, said in a prepared statement.

"High-quality relationships between mothers and children were associated with more constructive conflict between mothers and children. In secure relationships, both mothers and children seem committed to maintaining relational harmony by resolving conflict, compromising, and justifying their side of an argument," Laible said.

More information

The American Academy of Pediatrics has more about children's temperaments  .