More Dining-Out Choices for Celiac Patients in New Jersey

IN 2009, Deborah Gianelli, 58, of Montclair, was told she hadceliac disease, a disorder in which the immune system attacks the small intestine in response to gluten, a protein found in wheat, rye and barley.

The diagnosis was“devastating,” she said. Pasta and bread were among her favorite foods. She also enjoyed eating out, especially at Italian restaurants.La Riviera Trattoriain Clifton, where she and her family had been regulars for 15 years, was a favorite.

“I thought,‘Well, that’s the end of that,’ ” she said.

Then, a week after Ms. Gianelli’s disease was diagnosed, Maria Carlino, the daughter of Franco and Danica Carlino, the owners of La Riviera Trattoria, also learned she had celiac disease.

For Ms. Gianelli, being in the same dietary boat as Maria Carlino has helped restore her lifestyle.

“I’m at La Riviera once a week now, almost every Friday night,” she said. A gluten-free menu has been in place, along with the regular menu, since shortly after Ms. Carlino received her diagnosis.

Ms. Carlino, 32, of Bernardsville, is the manager of the 1,200-square-foot, 75-seat restaurant. She is also at the forefront of what Susan Goodstadt-Levin of Glen Rock sees as an effort to“normalize” the dining-out experience for celiac patients in New Jersey. Ms. Goodstadt-Levin is a leader, with Diane Caleca McGee of Paramus, of theNorthern New Jersey Celiac Disease Support Group, also in Paramus.

“A lot of restaurants have become aware of gluten-free products, and they see the value of having them on their menu,” Ms. Goodstadt-Levin said.

Several chain restaurants, includingP. F. Chang’sandUno’sChicago Grill, offer gluten-free selections, and a few independent New Jersey restaurants, including La Riviera Trattoria andHailey’s Harp&Pub, an Irish-themed bar in Metuchen, carryRed Bridge, a gluten-free beer introduced by Anheuser-Busch in 2006. (Park&Orchard, an eclectic restaurant in East Rutherford that offers a celiac-friendly menu, stocksGreens, a double-dark wheat-free beer from Belgium.)

“We started the gluten-free menu two years ago because we just had so many requests,” said Steven Chia, the owner of A Taste of Asia in Chatham; it serves mostly Malaysian cuisine and has been open since 2000.

On a recent afternoon tour of La Riviera Trattoria’s kitchen, Mr. Carlino, of West Caldwell, who is the restaurant’s chef— his son, Antonio Carlino, is the sous-chef— demonstrated what went into accommodating diners who avoid foods containing gluten.

A separate pot is used to boil thepasta. Stainless-steel vats of wheat-free farina, through which cuts of veal and chicken used for parmigiana dishes are dragged, are kept clear of the regular flour vats. Marinara sauces are prepared in a designated skillet with designated products. Even serving dishes are stacked separately.

“We don’t want anybody getting sick,” Mr. Carlino said.

Ms. Carlino hosted two invitation-only gluten-free dinners at La Riviera Trattoria last year. In June, 20 people came. At the second, in November, which included product presentations and sales— Ms. Carlino travels to Italy regularly to investigate new gluten-free foods— attendance swelled to 60. Monday, she will host a third dinner— $50 a person, including appetizers, entree, beverage, dessert and tip— and expects up to 80 people.“That’s all my father can handle,” she said.

The growth in the event may parallel a general increase in the awareness of and interest in gluten-free dining options. According to Diane Holtaway, associate director of client services at theRutgers Food Innovation Centerin Bridgeton, which is part of Rutgers University,“Europe has been ahead of us on gluten-free dining, but now it’s growing by leaps and bounds” in the United States. Dr. Schär U.S.A., a division of a European gluten-free food manufacturer, is making gluten-free bread at the center, she said, and building a production plant in Gloucester County.

“Everyone’s seeing there’s a critical need here,” said Ms. Holtaway, of Turnersville. That is evident at two gluten-free New Jersey bakeries. Kathie Schwarz of Millington openedGluten Free Gloriouslyin Stirling in 2009 after years of home baking.

Ms. Schwarz, 52, said her disease was diagnosed nine years ago.“I was baking out of my house, out of necessity, because anything you could get gluten-free nine years ago tasted like Styrofoam,” she said.“Now we have people coming from New York, from Pennsylvania.”

Ms. Schwarz, who specializes in Italian bread and wraps, makes her products at the 1,000-square-foot bakery but sells most of them frozen, to avoid staleness.“They defrost great,” she said.

AtFallon’s Gluten Free Bake Shopin Fords, the emphasis is on fresh-baked products.“We do biscotti, muffins, cupcakes, pizza shells,” said Bob Hyer, an owner of the 800-square-foot shop with his wife, Tina, and daughter Fallon.“They’re all fresh, not frozen, because that’s hard for people with celiac to find.” Fallon Hyer, 23, who has celiac disease, is the baker.

The cost of the New York crumb cake, a popular item there ($3.50 a slice), reflects the price of its ingredients.

“One of the hardships when you eat gluten-free is the cost of food,” Ms. Holtaway said.“It’s very expensive, and you have to use totally different ingredients and processes.”

At La Riviera Trattoria, some gluten-free entrees cost $2 to $3 more than their counterparts on the regular menu. Holding up a small package of gluten-free pasta during the kitchen tour, Ms. Carlino said,“A bag of this pasta costs $7 retail.”

Where to Go

These restaurants offer gluten-free options; the bakeries are entirely gluten-free. For a more extensive list of establishments:glutenfreeceliacweb.com.

LA RIVIERA TRATTORIA421-27 Piaget Avenue, Clifton;larivieratrattoria.comor (973) 478-4181. $16.95 for spruzzopastawith marinara, basil, garlic and olive oil to $21.95 for veal parmigiana.

HAILEY’S HARP&PUB400 Main Street, Metuchen;haileysharpandpub.comor (732) 321-0777. $8.99 for“naked” chicken wings to $12.99 for corned beef and cabbage.

PARK&ORCHARD240 Hackensack Street, East Rutherford; (201) 939-9292 orparkandorchard.com. $19.95 for dairy- and wheat-free lasagne to $27.95 for Jasper’s crabmeat pasta with rice penne or linguine (both include soup orsalad).

A TASTE OF ASIA245 Main Street, Chatham;atasteofasianj.comor (973) 701-8821. $11 for Asian bok choy (baby greens lightly stir-fried with ginger and garlic) to $18.50 for Asam fish fillet (turbot fillet simmered in tamarind broth with vegetables). 

GLUTEN FREE GLORIOUSLY267 Main Avenue, Stirling;glutenfreegloriously.comor (908) 647-7337. $1 to $2 each forcookiesand brownies to $16 for a 14-inch pepperoni pizza.

FALLON’S GLUTEN FREE BAKE SHOP339 Crows Mill Road, Fords; (732) 710-3338 orfallonsglutenfreebakeshop.com. $3.50 for a slice of New York crumb cake; $8 for a pound-and-a-half loaf of multigrain bread; about $65 for an eight-inch birthday cake.

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Melatonin Makes a Comeback, Leaving Experts Unrelaxed

With names like Lazy Cakes, Kush Cakes and Lulla Pies, these products are sold online and at stores like 7-Eleven, Walgreens, smoke shops and even at the Harvard Square Coop, the university’s student bookstore, for roughly $3 to $4 each. (A bottle of 60 8-milligram melatonin tablets costs about $11.) At some places, the drug-packed desserts can be paid for with food stamps.

Although theFood and Drug Administrationhas not approved melatonin as a food additive or deemed it safe, the dessert makers are marketing their products as a harmless way to promote relaxation. And the snacks are increasingly being endorsed by fans on Facebook and Twitter as an antidote to stress and sleep deprivation. (Who needsyoga?) On theFacebook pagefor Lazy Cakes, one woman who said she hasbipolar disorderwrote that the treat“helps a lot with my sleeping andpanic attacksI can lay off my Xanax a little.”

Gabby Bevel, 22, a writer from Norman, Okla., and an insomniac who took Ambien and Lunesta in high school, said in an interview that she slept 13 hours after eating one Lazy Cakes snack recently.“I don’t like the idea of needing something unnatural to help me with anything,” she said.“Really, I think part of the appeal is it does come in a brownie.”

But these snacks contain roughly 8 milligrams of melatonin per brownie or cookie, so selling them is similar to a parent serving an unsuspecting child applesauce containing a crushed aspirin tablet to make it go down easier.“It’s making it much more difficult for the consumer to recognize that they are taking a drug,” said Dr. Charles A. Czeisler, the chief of the division of sleep medicine at Harvard’s Brigham and Women’s Hospital.

Nick Collado, a 26-year-old insomniac and the founder of Lulla Pies, argued that the melatonin they contain, while synthetic, is more“natural” than the Ambien he used to take.“I realized there’s got to be more people like me who don’t want to take prescription drugs anymore, who want to take an alternative,” Mr. Collado said.

But Dr. David S. Seres, the director of medical nutrition at Columbia Medical Center, cautioned that consumers should consult their doctors before trying such products.

“The promoters of these are appealing to people who think it’s better to do things outside of the medical establishment,” he said, adding that“the desire to help people is an extremely strong motivator, but so is money.” He pointed to a section of the National Institutes of Health’s Web site that lists several drugs, includingsedativeslike clonazepam andbirth controlpills, whose efficacy might be altered by melatonin.

“A hangover effect has been reported” with large doses, said Anna Rouse Dulaney, a toxicologist with the Carolinas Poison Center. But she added,“I don’t want to go on the record saying this drug‘can’ cause respiratory issues, that should be a‘may.’ ”

Lazy Cakes appear harmless, even amusing, with swirly purple packaging; Kush Cakes have a tie-dye-printed wrapper. But they are not to be underestimated.

Of melatonin, Dr. Seres warned,“If you take it while you’re driving a car, you will find yourself in a ditch.”

Maybe.Dr. Alfred J. Lewy, a professor ofpsychiatryat Oregon Health and Science University who has studied melatonin, a neurohormone, estimated that only a third of the population is susceptible to its effects in a supplement.

And yet Tracy Evans, who owns a bar where musicians perform in Erie, Pa., that has sold hundreds of Lazy Cakes, said she instructs employees to tell partygoers,“I highly recommend you wait to where you’re going to be at the end of the night before eating.”

Why?“It knocks you out— in a good way, not a bad way,” said Ms. Evans, 34.“For me, it’s not to chill. For me, it’s to get a good night’s sleep.”

Yet the products, intended for adults only, are being marketed as a novel way to relax in a stressed-out, wired world. Labels on Lazy Cakes and Mary J’s brownies that were bought online urge users to“Take½ brownie, two times a day.” With tiny type, the labels warn against operating heavy machinery or driving.

But some medical professionals are concerned that the chocolate taste might encourage indiscriminate gobbling.

“It’s a colossally bad idea to put melatonin in food,” Dr. Czeisler said.“It should not be permitted by the F.D.A.”

Technically, it is not. Stephanie Yao, a spokeswoman at the F.D.A., wrote in an e-mail that any item that uses melatonin“as an additive may be subject to regulatory action.”

That is why the makers of these new baked goods label them“Not for food use.” They want them to be considered dietary supplements, which do not need the F.D.A.’s premarket approval and are not required to be proved safe or effective.

“It sounds to me like they are trying to claim that the entire brownie is like a tablet, which is, of course, preposterous,” Dr. Czeisler said.

Tim Barham, the vice president of HBB, the maker of Lazy Cakes, said,“We look at the brownie as a supplement.”

News reports have classified Lazy Cakes as dietary supplements, but last month, Douglas Karas, an F.D.A. spokesman, said in an e-mail that the agency“has not made a determination on Lazy Cakes’ status as either a food or a dietary supplement.”

In January last year, the F.D.A. sent a warning letter to Peter Bianchi, the creator ofDrank, a purple drink with 2 milligrams of melatonin in each can that went on the market in 2008, spawning several competitors.

The letter cited safety concerns about melatonin in food, specifically research indicating that melatonin reduced glucose tolerance for people withType 1 diabetesand that some men using it had reported enlarged breasts. It also warned that women who are pregnant or trying to conceive should avoid melatonin“based on possible hormonal effects.” (Drank’s bottle now say it is a dietary supplement.)

Dr. Lewy dismissed the idea that harm might lurk in a melatonin-laced brownie.“It really doesn’t have any documented side effects except for making you sleepy at bedtime, which is good,” he said. That said, he would not advise eating Lazy Cakes, partly because he was not sure that their other purportedly sleep-inducing ingredients like valerian root work and partly because food delays rather than hastens the absorption of melatonin.

Also, Dr. Lewy said,“I don’t need thecalories.”

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Great Day to Be Outdoors in New York, if Not for Allergies

A 65-year-old law professor who lives on the Upper East Side tentatively follows suit, baring his chest, figuring he knows no one in the area anyway.

Eying them both, Mark Cilla, 55, a budget manager from Commack, N.Y., tapping on a laptop, feels emboldened and spontaneously shrugs out of his button-down.

“This is heaven,” Mr. Cilla says to himself as his belly reddens in the sun.

Steps behind him, in the leaf-tattooed shade, Larry Ferruzzi is in hell. His head swims, his eyes water and his nose itches and runs.“This is really rough, the worst ever,” says Mr. Ferruzzi, 67, who sells industrial lighting, as he presses a white linen handkerchief to his nose.“I can’t stopsneezing,” he says, then sneezes again.

After a punishing winter and a cruel, rainy April, the weather this past week in New York has indeed seemed heaven-sent— or at least from California: crisp, cloudless days with temperatures hovering around 70 degrees. Sun- and warmth-starved New Yorkers surfaced like worms after a rain, arraying themselves on every available bench, chair and patch of grass.

But such idyllic meteorological conditions— dry and not too hot— also provide ideal reproductive conditions for some trees. Specifically, oak, beech and maple, whose tiny flowers have been releasing copious amounts of pollen, which have been carried far and wide by gentle winds, unimpeded by rain and, for the most part, leaves, and into the noses of allergy sufferers.

Allergy sufferers, in turn, find themselves facing an ugly choice: Crack open the windows, for now is that fleeting time when neither air-conditioners nor radiators are needed, enjoy the gorgeous weather, and accept the consequences.

The city’s pollen count is officially“high.” According toPollen.com, on Thursday it was 9.9 on a scale of zero to 12, having fallen from 11.1 a week earlier.Allergiesworsenasthmaattacks, and earlier this week, the city’s health department counted more asthma-related emergency room visits than at the same time last year.

Dr. Benjamin Aubey, a pediatrician at Harlem Hospital Center, has seen several children who had been sent home from school because the staff thought they had pinkeye.“But it’s just allergies flying,” Dr. Aubey said.

Drugstores are struggling to keep allergy medicines on their shelves. Jesenia Fuentes, a clerk at a Duane Reade in Midtown, said a shipment that arrived early Thursday would very likely be gone within hours.

Jimmy Lee, 52, who lives in Hell’s Kitchen and works in the hotel business, said he prepared for heavy demand for his allergy medicine.“I get it by the case,” said Mr. Lee as he sat in the pedestrian strip along Broadway by 41st Street, sniffling. Staying inside, he said, was not an option.“For the first time ever, this winter I had cabinfever,” he said.

And so it went throughout the city, with many New Yorkers, ever conflicted, both loving and hating the weather.

Leslie Castillo, a 37-year-old allergy sufferer, said she would stay indoors but for her two children.“It’s ruined spring a little bit for me,” Ms. Castillo said as she sat in the grass at McCarren Park in Williamsburg, Brooklyn, with her 2-year-old, taking in the glorious day with itchy, reddened eyes.

At Sheep Meadow in Central Park, Aziza Azim, 20, a fashion student at Parsons, stretched out on a blanket with two friends a few hours after one of them woke up and declared,“We need to tan.” Ms. Azim, who is allergic to pollen and horses, had girded for the excursion withClaritin.“If I take my medicine, I know it’s fine,” she said, and then proceeded to sneeze three times.

Compounding the woes of allergy sufferers is a high-pressure system wedged between two low-pressure systems, creating dry, stagnant air in New York City. But Ross Dickman, a meteorologist in charge of the National Weather Service for the city, forecast that all would change this weekend.“It’s going to be cloudy, wet, almost miserable for May,” Mr. Dickman said.“That will help bring some of the allergens out of the air, kind of sterilize the atmosphere a little bit.”

Meanwhile, the trees’ pollination will abate, easing allergy conditions, at least until late May, when grass allergies break out, said Robert F. C. Naczi, curator of North American botany at The New York Botanical Garden.“So there’s at least two weeks of a reprieve.”

Anemona Hartocollis and Juliet Linderman contributed reporting.

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New Testing Estimates Football Helmet Models’ Concussion Risk

The Riddell VSR-4, a recently discontinued model still worn by about 75,000 high school and college players, and the Adams A2000, a less prevalent helmet now available for purchase, were the lowest-ranked models in a new testing regimen designed to estimate concussion risk. The full results were to appear on aVirginia TechWeb siteas the first publicly available objective data on football helmet performance.

Industry experts have various degrees of concern about the reliability of the system, but the researchers said they were trying to pull the curtain back on the mysteries of helmet performance. Recent concerns about industry testing standards and specific companies’ advertising has led to an investigation by the United StatesConsumer Product Safety Commissionand possibly the Federal Trade Commission.

“Currently, if you go to buy a helmet, all you’re looking at are aesthetics and price, and whatever the manufacturer tells you to try to convince you it’s good,” saidStefan Duma,Virginia Tech’s lead biomedical engineer on the project.“We wanted to develop a system to quantify which helmets perform better specifically with risk of concussion.”

The only standardized test on helmets today assesses whether a helmet might allow askull fracture, not a less serious injury like a concussion. It is overseen by the National Operating Committee on Standards for Athletic Equipment, a volunteer group that includes manufacturers and other interested parties.

Riddell’s Revolution Speed model earned a five-star rating on the Virginia Tech scale, followed by five four-star helmets made by Riddell, Schutt and Xenith. Only helmets designed for players of high school age and older were examined.

“For example, half our team is in the VSR-4— and there is a significant reduction in concussion risk in newer helmets, so by fall ball we’re going to be in new ones,” Duma said of the Virginia Tech football team. A prominent college program having used outdated helmets would indicate how rural high schools might be affording players inferior protection.

Virginia Tech has for eight years had players at college programs nationwide wear helmets outfitted with accelerometers to track the number and severity of hits to the head, as well as documented concussions. That data indicates, for example, how a side impact that results in 100 g’s of force reaching the skull leads to a diagnosed concussion 1 percent of the time.

Helmet models were drop-tested from five heights to assess how much force they allow to reach the skull; the lower that force, the lower the risk of concussion, and the better the helmet scored. The methodology has been peer reviewed and accepted for publication by theAnnals of Biomedical Engineering.

As an example of the use of his system, Duma said,“You can cut your risk of concussion 55 percent by switching from the VSR-4 to the Xenith X1.”

Critics have cited several limitations of Virginia Tech’s approach. It does not consider rotational forces believed to cause a substantial number of concussions. The data collection from players came through helmets designed by Riddell, perhaps skewing results. Additionally, only some concussions get reported, so the injury’s true prevalence remains too much of a mystery to justify such exact statements.

“I’m unmoved by this information, and I would say that no matter how our helmet was ranked,” said Xenith’s chief executive, Vin Ferrara, whose X1 model was ranked among the most protective available.“We find this type of ranking concept to be detrimental to consumer understanding and detrimental to the development of superior helmets.”

Schutt said in a statement:“We have not seen any relationship between testing results and the accurate prediction of what is happening on the field. There are many questions to be asked about this testing.”

Adams’s chief executive, David Wright, did not respond to requests for comment regarding the company’s A2000 helmet.

Riddell’s Dan Arment praised Virginia Tech for affirming performance differences between helmet models; as for the company’s low-performing VSR-4, he said users could trade in that helmet and receive $50 off a Revolution model.

Helmet companies have for years agreed among themselves not to disclose this type of testing data to the public because of how it can be misinterpreted. This has led to spurious advertising claims and other practices currently under government examination.

Duma said the public needed an independent compass to make more educated decisions on football head protection. He also emphasized how even the best head protection can still allow injuries like concussions and that individual athletes’ risks can vary because of genetic differences and prior injuries.

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Can Eating Local Honey Cure Allergies?

Among allergy sufferers, there is a widespread belief that locally produced honey can alleviate symptoms— the idea being that the honey acts like a vaccine.Beesthat jump from one flower to the next end up covered in pollen spores, which are then transferred to their honey. Eating that honey— just a spoonful a day— can build upimmunitythrough gradual exposure to the local allergens that can make life so miserable for allergy sufferers.

Or at least that’s the thinking behind it. But whenUniversity of ConnecticutHealth Center researchers did a test, they found that the honey had no such effect.

In the study, published in the Annals of Allergy,Asthmaand Immunology in 2002, the scientists followed dozens of allergy sufferers through the springtime allergy season. The subjects were randomly split into three. One consumed a tablespoonful daily of locally collected, unpasteurized and unfiltered honey; another ate commercial honey; and a third was given a corn syrup placebo with synthetic honey flavoring.

After tracking the subjects’ symptoms for months,the scientists found that neither of the honey groups saw improvementsover the placebo group.

Dr. Stanley Fineman, president-elect of the American College of Allergy, Asthma and Immunology, said he has seen a growing number of patients ask about local honey.“Seasonalallergiesare usually triggered by windborne pollens, not by pollens spread by insects,” he said. So it’s unlikely that honey“collected from plants that do not cause allergy symptoms would provide any therapeutic benefit.”

THE BOTTOM LINE

There’s no evidence that local honey relieves allergy symptoms.

ANAHAD O’CONNOR

scitimes@nytimes.com

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Screen Fixation and A.D.H.D.

“She’s worried about how he can’t sit still in school and do his work,” the mother said.“He’s always getting into trouble.”

But then she brightened.“But he can’t have attention deficit, I know that.”

Why? Her son could sit for hours concentrating on video games, it turned out, so she was certain there was nothing wrong with hisattention span.

It’s an assertion I’ve heard many times when a child has attention problems. Sometimes parents make the same point about television: My child can sit and watch for hours— he can’t haveA.D.H.D.

In fact, a child’s ability to stay focused on a screen, though not anywhere else, is actually characteristic of attention deficit hyperactivity disorder. There are complex behavioral and neurological connections linking screens and attention, and many experts believe that these children do spend more time playing video games and watching television than their peers.

But is a child’s fascination with the screen a cause or an effect of attention problems— or both? It’s a complicated question that researchers are still struggling to tease out.

The kind of concentration that children bring to video games and television is not the kind they need to thrive in school or elsewhere in real life, according to Dr. Christopher Lucas, associate professor of childpsychiatryatNew York UniversitySchool of Medicine.“It’s not sustained attention in the absence of rewards,” he said.“It’s sustained attention with frequent intermittent rewards.”

The child may be playing for points accumulated, or levels achieved, but the brain’s reward may be the release of the neurotransmitterdopamine. Children with A.D.H.D. may find video games even more gratifying than other children do because their dopamine reward circuitry may be otherwise deficient.

Indeed, at least one study has found that when children with A.D.H.D. were treated with methylphenidate (Ritalin), which increases dopamine activity in the brain, they played video games less. The authors suggested that video games might serve as a kind of self-medication for these children.

So increased screen time may be a consequence of A.D.H.D., but some researchers fear it may be a cause, as well. Some studies have found that children who spend more time in front of the screen are more likely to develop attention problems later on.

In a 2010 study in the journal Pediatrics, viewing more television and playing more video games were associated with subsequent attention problems in both schoolchildren and college undergraduates.

The stimulation that video games provide“is really about the pacing, how fast the scene changes per minute,” said Dr. Dimitri Christakis , a pediatrician at theUniversity of WashingtonSchool of Medicine who studies children and media. If a child’s brain gets habituated to that pace and to the extreme alertness needed to keep responding and winning, he said, the child ultimately may“find the realities of the world underwhelming, understimulating.”

But a 2007 study in the journal Media Psychology compared television watching in a group of children diagnosed with A.D.H.D. and a group without. The researchers concluded that most differences were accounted for by family factors and environment, including whether the children had televisions in their bedrooms. A.D.H.D. by itself didn’t seem to make the difference. The connections between A.D.H.D. and screens, the authors concluded, were complex.

Elizabeth Lorch, a professor ofpsychologyat theUniversity of Kentuckyand one of the authors of that study, also studied children’s ability to comprehend televised stories. While children with A.D.H.D. were able to recall facts from the stories they watched just as well as other children, there was a difference in their ability to understand the narrative and to separate out what was important.

“Why did an event happen, why did a character do this— that’s where the comprehension and recall of children with A.D.H.D. tends to fall down,” she said.

Her co-author Richard Milich, also a professor of psychology at the University of Kentucky, suggested that besides the primary implications of this problem for academic performance, this finding may also shed light on social difficulties.

“This inability to see causal relations may affect this social problem we’ve known for 30 years,” he said.“These kids have dramatic social problems. They’re highly rejected by their peers.”

It may be a self-perpetuating loop, experts say: Children who have trouble with their social skills may be thrown back even more to the screen for electronic companionship.

Children whose brains need neurochemical rewards seek out an activity that provides it. Children with social problems spend more time alone, facing a screen. Children struggling in the classroom develop mastery in a virtual world. I talk to parents of children with A.D.H.D. about basic dos and don’ts: No screens in the child’s bedroom. Pay attention to the content of the games, especially to violence. Set limits on screen time, and look for other ways to manage family interactions.

If I can’t tell parents what they hope to hear, at least I can argue that these children’s fascination with the glowing screen may teach us something about their brains, the neurobiology, the rewards, and even the yearning and learning.

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Does Having Your Tonsils Removed Cause Weight Gain?

Despiteconcerns about its effectiveness, the childhoodtonsillectomyis common. Each year more thanhalf a million children in the United States have their tonsils removed. But scientists have noticed what appears to be an unexpected side effect: Children who have the surgery are at greater risk of becoming overweight.

At first glance it makes little sense. Tonsils are typically removed after they become enlarged from repeated infections. Why would that have any effect on weight? One theory is that enlarged tonsils cause difficulty swallowing, prompting a child to eat less. Once the tonsils are removed, appetite returns.

No one knows how to explain it, but studies show a link between the surgery and weight gain. In the most recent and exhaustive report, published this year in the journal Otolaryngology— Head and Neck Surgery, researchers analyzed data from 11 studies, following 1,549 children for up to seven years.

Obviously, the children put on weight as they aged, but the analysis showed thatthe gains were much greater than expected after the surgeryand greater than the weight gain in children who had not had their tonsils removed.

Butso far only an association has been confirmed, not a direct causal effect. For now, experts say parents should simply keep an eye on a child’s weight after the surgery.

THE BOTTOM LINE

Studies show tonsillectomies are associated with weight gain, but it’s not clear there’s a causal relationship.

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