The U.S. National Library of Medicine offers these suggestions when talking to children about death:

• Keep your explanation honest, simple, and on a level that's appropriate for the child's age.
• Understand that death can cause fears and confusion in many children.
• Talk about it as openly as possible when they ask questions or if a situation occurs that requires you to discuss it.
• Talk about your feelings -- fear, sadness, anger and anything else you feel. Show your child that the emotions they have are normal.
• Help children understand that they had nothing to do with the death. The person did not die because of something the children did, and they could not have prevented it from happening.

In research with mice, they found this class of drugs also suppresses the adaptive rewiring of the brain necessary for neural development in young animals. The findings are in the May 8 issue of Neuron.

One such drug is rimonabant (Acomplia), which was developed by Sanofi-Aventis and is awaiting approval by the U.S. Food and Drug Administration. Other pharmaceutical companies are developing similar drugs.

In this study, researchers concluded that a cannabinoid receptor-blocking drug called AM 251 affected experience-dependent cortical plasticity in the brains of juvenile mice. This plasticity is the experience-prompted adaptive rewiring of the brain that plays an critical role in the neural development of young animals.

"Our finding of a profound disruption of cortical plasticity in juvenile mice treated with AM 251 suggests caution is advised in the use of such compounds in children," wrote Mark F. Bear and his colleagues, of the Howard Hughes Medical Institute, The Picower Institute for Learning and Memory, Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, in Cambridge, Mass.

More information

The Nemours Foundation has more about childhood obesity.

In a large, international study, researchers found that for each standard deviation increase in blood sugar, there was a greater risk of complications, such as having a large birth weight baby or needing a Caesarean section delivery.

"We found strong independent associations between a mother's blood sugar levels during an oral glucose tolerance test and 28 weeks of gestation and the pregnancy outcomes," said the study's lead author, Dr. Boyd Metzger, the Tom D. Spies professor of metabolism and nutrition at the Feinberg School of Medicine at Northwestern University in Chicago.

What this means for pregnant women right now, however, isn't clear.

"Because the relationship between the mother's blood glucose level and risk tend to be continuous and linear, it is not clear where the risk reaches the point where treatment should optimally begin," said Metzger.

"We were hoping there would be a breakpoint," explained another of the study's authors, Dr. Don Coustan, professor and chair of obstetrics and gynecology at the Warren Alpert Medical School of Brown University in Providence, R.I. "But, the relationship between glucose levels and outcomes were continuous, which means it will be difficult to decide where to put the 'treating' point."

Coustan added that there will be a conference in June where pregnancy and diabetes experts will likely debate the pros and cons of treating hyperglycemia. For now, he said, he suspects that "doctors will still use the glucose threshold they're currently using."

One thing that was clear from the study is that higher odds of complications, like an increased risk of C-section or a large baby, are related to high blood sugar and not to other conditions, such as obesity or older maternal age, according to Metzger.

Results of the study were published in the May 8 issue of the New England Journal of Medicine.

The study included more than 23,000 pregnant women from 15 centers in nine countries. None of the women had diabetes. All of the women underwent glucose tolerance testing between 24 and 32 weeks of gestation. This test is performed by first taking a fasting blood sugar reading, then having the woman drink a high-carbohydrate liquid -- in this case a 75-gram carbohydrate drink; 100 grams is standard in the United States -- and then rechecking blood sugar levels at one and two hours to assess how the body is processing the high sugar load.

The higher a woman's blood sugar levels were, the more likely she was to have a C-section, to develop preeclampsia, have premature delivery and to have the delivery complication known as shoulder dystocia, the study found.

Babies born to women with higher glucose levels were more likely to have high insulin levels, low blood sugar, and to have a large birth weight, all indications of exposure to high glucose levels.

The odds of these complications changed continuously as blood sugar levels rose. For example, a woman with the highest levels of blood sugar (but not diabetes) had large babies 26 percent of the time, compared to just 5 percent for women with the lowest blood sugar levels.

"Basically, what they found out is that there is no threshold where you know to treat. That makes it difficult to know what to do with these findings," said Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City.

A second study in the same issue of the journal looked at the use of the oral diabetes medication metformin, versus insulin, the standard treatment for gestational diabetes. The study included 751 women, randomly assigned to receive metformin or insulin treatment.

The researchers found that metformin was well-tolerated, although almost 43 percent of the women eventually required the use of supplemental insulin. There were no serious adverse events reported for mother or baby from the use of metformin, according to the study.

Of this study, Zonszein said, "My guess is that until we have larger studies, there's not going to be a big change in recommendations, because we have so much experience with insulin." But, he added, many women and obstetricians may welcome these findings because "giving a pill is easier than giving insulin." He said another oral medication, glyburide, was also found effective in another small trial.

More information

To learn more about gestational diabetes, visit the American Diabetes Association.

"This is the first paper that helps us understand what causes this childhood cancer," said lead researcher Dr. John M. Maris, director of the Center for Childhood Cancer Research at The Children's Hospital of Philadelphia. "We expected for decades that this cancer was a genetic disease, but we have had a hard time understanding what abnormalities in our genetic makeup lead to this cancer."

Neuroblastoma, a cancer of the peripheral nervous system that usually appears as a solid tumor in the chest or abdomen, is the most common solid tumor malignancy seen in early childhood. Among infants, it can disappear with minimal treatment, but in older children, it can be an aggressive cancer spreading throughout the body. Neuroblastoma accounts for 7 percent of all childhood cancers but causes 15 percent of all childhood cancer deaths. There are about 700 new cases diagnosed each year in the United States, the researchers said.

Maris' team found a common genetic variation of the gene 6p22 on chromosome 6, which doubles the risk of getting this disease. "This finding supports our assumption that there are a number of minor variations that work together -- in sort of a perfect storm -- to give a child this disease," he said. "This finding is the discovery of the first of these genetic variants."

Maris noted that this is the first time a childhood cancer has been found to be influenced by rather common genetic changes "that can be in you or me or anyone."

In addition, Maris said that having this particular genetic variation not only increases the risk of developing neuroblastoma, but also increases the risk of developing the more aggressive form of the disease. "This leads us to believe that the disease we call high-risk or low-risk neuroblastoma are really different diseases," he said.

The findings were published in the May 7 online edition of the New England Journal of Medicine.

For the study, Maris' team analyzed blood samples from 1,032 children with neuroblastoma and 2,043 children without the disease. The researchers honed in on three single nucleotide polymorphisms (SNPs) -- which are variations in DNA -- that were more common in patients with neuroblastoma than in patients without the disease. The three SNPs were clustered in the 6p22 region of chromosome 6. There are two genes in this region, but exactly what they do is unknown, the researchers said.

To confirm their findings, Maris' group analyzed blood samples from additional neuroblastoma patients and children without the disease. Among these additional patients, the researchers also found that variants in the 6p22 region were associated with increased risk for neuroblastoma.

"This finding gives us the motivation to continue this line of research to discover all of the different genetic variations that work together," Maris said. "We have already discovered additional variations."

Knowing the complete genetic influences on neuroblastoma may eventually lead to new treatments, he said.

Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, said that the new findings could one day lead to better diagnosis and treatment of the malignancy. "We still need to understand what these genes do, because little is known about these genes," he said.

Lichtenfeld added that, while the new research is important, it's still very preliminary. "Ultimately, what you want to do is to analyze the cancer and gain clues as to what the prognosis may be and what the appropriate treatment may be," he said. "This does not get us there, but it is one step along that pathway."

More information

For more on neuroblastoma, visit the American Cancer Society.

TUESDAY, May 6 (HealthDay News) -- Doctors coaching new nursing mothers will find little practical advice to share from some of the classic obstetrics textbooks, a new study suggests.

Some of the texts omit key information for solving breast-feeding problems and others are inaccurate about the key steps involved, according to a study presented at this week's annual meeting of the Academy of Obstetricians and Gynecologists, in New Orleans.

Three of these bibles of obstetrics are not as "up-to-date or nearly as complete as they should be," contended study researcher Dr. Tony Ogburn, director of the department of obstetrics and gynecology at the University of New Mexico.

Ogburn believes that breast-feeding has been a neglected problem for some time, because some physicians have passed the buck -- each seeing it as the provenance of another physician specialty, or of nurses who specialize as lactation consultants.

While doctors in urban areas may be able to defer to lactation consultants, those who have a broader scope of practice in rural areas will miss the training they need on breast-feeding, added Dr. Adam Aponte, chair of pediatrics and ambulatory care at Manhattan's North General Hospital. He was not involved in the new research.

Breast-feeding is not as easy as people think and "needs a lot of encouragement and support early on," he added, and "with frustration, mothers can switch very quickly to the bottle."

On the other hand, gentle and accurate instruction about how to hold the baby to the breast properly can reduce some of the discomfort some nursing mothers experience, Aponte said.

The new review covered what the authors called "the five most popular obstetrics and gynecology textbooks based on sales." Ogburn gave two of the textbooks in the study -- the 2003 edition of Maternal-Fetal Medicine, edited by Robert K. Creasy and Robert Resnick, and the 2007 edition of Obstetrics: Normal and Problem Pregnancies, edited by Steven G. Gabbe, et al. -- high marks for providing complete and accurate information on breast-feeding.

But he said doctors' "general lack of interest in breast-feeding is reflected in three other textbooks" -- Williams Obstetrics, 2005 edition, edited by F. Gary Cunningham, et al., Danforth's Obstetrics and Gynecology, 2003, edited by James R. Scott, et al., and the 2006 edition of Beckmann's Obstetrics and Gynecology, edited by Charles R.B. Beckmann, et al.

"There's not the focus on it or interest that there should be," Ogburn contends.

In their review of five widely used textbooks, Ogburn, along with colleagues at Boston University, found the omission of key information and, in some cases, actual errors, he said.

For example, one text mistakenly advised that putting newborns on a feeding schedule is fine, while research shows that babies should be fed "on demand" -- that is, whenever they are hungry, Ogburn said. Mothers sometimes fear that they won't have sufficient milk if they nurse too often, but nursing actually stimulates increased milk production, he said.

Another text also omitted a discussion of the inadvisability of supplementing mothers' milk with formula within the first 48 to 72 hours after delivery, Ogburn added. Suckling is crucial in this postnatal period to stimulate the mother's breast milk. Meanwhile, nursing infants receive colostrum (especially healthy "first" or "immune" milk) from the mother's breast. Colostrum passes on the mother's immunity to the baby and protects it in the first month of life, Ogburn explained. He added that mothers who supplement breast-feeding with formula during the first 72 hours are less likely to breast-feed later.

Aponte agreed that standard medical text books should address breast-feeding more thoroughly. "Textbooks are so academic and so focused on the academic portion of medicine," he explained. "This is sort of softer, this is less scientific."

Dr. Ruth Lawrence, a professor of pediatrics at the University of Rochester who authored the breast-feeding section in one of the praised texts, said she and others have been trying for a number of years to increase the number of physicians who are well-informed about breast-feeding.

"Everybody knows that breast-feeding is good," she said. "But not everybody knows how to help mother succeed."

The federal government's Healthy People 2010 goals and a policy statement from the American Academy of Pediatrics recommend exclusive breast-feeding for the first six months, Ogburn said. Healthy People 2010 has set a goal for 50 percent of mothers to be nursing when their infants are six months old, compared with the 29 percent reported in 1998.

The benefits of breast-feeding for the child range from fewer upper respiratory infections to better bonding and lower rates of diabetes, Ogburn noted. And the American Academy of Pediatrics says that benefits to the mother include an earlier return to pre-pregnancy weight and a decreased risk of breast and ovarian cancer.

More information

Find out more about breast-feeding at the American Academy of Pediatrics.