How does Halloween candy fit into my obesity prevention strategy?
Well, it doesn't. Really, it's disgusting when you think about it. The epitome of American excess, in the extreme. Fat, sugar, and no nutritional value makes for rotten teeth, hyper kids, and added pounds. What could be worse?
But I think Halloween is fun! It's a little nostalgic for me, remembering all the pumpkins my siblings and I designed (and my Dad carved) lighting up my sister's 16 pane bedroom window in our little cape cod style house. Yes, there were 16 pumpkins carved every year. And I loved almost all of the candy. Remember wax lips? There were, and still are, some candies I don't like. For example, I hated the Boston Baked Bean candy. I always tried to trade that one. I still have some of the Halloween costumes my Mom made for me, and once in a while I can get one of my kids to wear one. This year one of my high school prom dresses has been incorporated into a Queen of Hearts costume for my eleven-year-old. And there was a lot of Daddy/daughter bonding time this month making matching robot costumes out of cardboard boxes.
So, what to do about the candy? I've tried different ideas to deal with it. First, I don't want the supply of candy to last forever. As a kid I can remember still having Halloween candy to eat in the car on the way to Florida for Spring Break! Yuck! I say be done with it in a week, maybe two, but don't let it last. You could have a little splurge of candy eating on the night of trick-or-treating, and just get it over with, then share the rest with Mom and Dad, and their friends at work. You can have kids trade in candy for a different reward--a movie night, laser tag, Bounce Land, a water park, a trip to the mall. You can keep the candy in a public area (not your child's bedroom), and reduce its visibility (start putting it in the cupboard)--lots of kids will forget about it.
Just have some kind of plan that doesn't involve daily candy eating from now until the New Year. Make candy be a little splurge that happens as a special treat. Consider it a privilege, not a right. Incorporate your child's favorite treats into the plan, but discourage them from eating the stuff they don't love. Encourage sharing. Emphasize teeth brushing. Require an apple, banana, or something GREEN be eaten in addition to the treat. Don't put candy in a packed lunch.
Have a parent "tax" on candy. Use this as an opportunity to explain how income taxes work--if your child collects 10 pieces of candy they have to give you one piece, but if they collect 100 pieces of candy they have to give you 30 pieces! I haven't tried this one yet, but my husband is an economist, so I'm sure this is going to happen some time at our house.
Here is an interesting idea--talk to your child before they trick-or treat about what they think is a good way to handle all the candy. You might be surprised at the ideas they have, and you can review good nutrition at the same time.
You can also intervene by limiting the amount of candy your child collects. Go trick-or-treating with your child. Start a little late. Relax, don't run. Have them use a small bag to collect candy, not a pillow case. Stop to socialize with others along the way. Take your time! Insist on good trick-or-treat manners (I think the rules of trick-or-treating are to wear a costume, say "trick-or-treat" and then say "thank you"). Let your child stop and take time to choose and eat a few pieces along the way. Show off your costumes, take pictures. Spend some time decorating your house that night. Maybe your kids would like to pass out candy to others for a while. Do anything you can to slow down the candy collection process and emphasize the fun and fantasy of the night.
Most of all I would suggest having some kind of plan that cuts off the candy after a week (or two). Think about it before you trick-or-treat. Tomorrow I'll be angling for my share of Heath Bars, Almond Joy, Starbursts, and Dots. Then we'll eat a bunch of candy that night, and keep the rest in the kitchen for about a week. And that will be it for Halloween candy at our house.
Good luck to you, and remember to have fun!
Saturday, October 30, 2010
Tuesday, October 12, 2010
Flu and Flu Shots
Hey, I got my flu shot today! Tina (one of Trestlewood's nurses) gave it to me in my left arm about an hour and a half ago. I feel fine. I could hardly tell the needle went in, and my arm doesn't hurt a bit. I don't ache, I don't have a fever, I didn't catch flu from the vaccine, and I am so happy to be protected from this season's flu viruses. I am sure to be exposed to them many times this year.
My girls had their flu vaccines on Sunday, just two days ago. They prefer the FluMist (a flu vaccine that is given via drops squirted in the nose). My husband will probably drop by my office soon and surprise one of Trestlewood's nurses to get his vaccine. Everyone in my family gets a flu vaccine every year. We started this tradition after my oldest got the flu in first grade. It was quickly followed by pneumonia, and then in her weakened state, strep throat. It was awful, and I never wanted a child of mine to go through that again. Unfortunately, my middle daughter had the flu a few years ago. She was coughing, had fevers upwards of 104, and was utterly miserable for a week.
I also take flu shots to Indiana to give to my parents and my mother-in-law. I think giving out flu shots each year is one of the biggest contributions I can make to the health of my community and my loved ones. The other big impact I have on public and individual preventive health is the rest of the recommended childhood vaccines--but that's for another blog.
Flu, at least the flu we vaccinate for, is NOT the stomach flu! I am told daily how this or that family had "the flu" last week, or last month, or last year. Or how they never get "the flu." Or, how the flu vaccine didn't work for them because they still got "the flu." When pressed for details it is clear that most people mean gastroenteritis when they say "the flu." Gastroenteritis is an illness that is very contagious, lasts a day or two, and involves vomiting and diarrhea. The flu I am talking about is influenza, a RESPIRATORY illness.
The symptoms of influenza are fever, severe muscle aches, coughing, sore throat, runny nose, extreme fatigue, chills, with occasionally some stomach symptoms. It lasts for about a week. It is also very contagious. Flu weakens and can kill its victims, especially those who are already debilitated. It can lead to complications, such as pneumonia. At the very least it is a miserable week to spend in bed with a box of tissues, cough drops, and other cough/cold/anti-fever medicines.
Flu vaccine is recommended yearly for everyone who is six months or older who does not have an allergy or other contraindication to the vaccine. While it is especially important for people with chronic illnesses such as asthma or diabetes, it is recommended for all of us. We can all benefit from a yearly flu vaccine.
Have you and your children had your yearly seasonal flu vaccine? Get yours as soon as you can!
The following are some links to reliable information about the flu and flu vaccine. This year's vaccine includes the H1N1 subtype, so a separate shot for that one isn't necessary. Children under age nine who are getting the flu vaccine for the first time, or who have not had at least two previous seasonal flu vaccines plus one of last year's H1N1 vaccines, will need two doses of flu vaccine spaced one month apart to be completely immunized.
http://www.cdc.gov/flu/
http://www.healthychildren.org/English/tips-tools/Symptom-Checker/Pages/Influenza.aspx
My girls had their flu vaccines on Sunday, just two days ago. They prefer the FluMist (a flu vaccine that is given via drops squirted in the nose). My husband will probably drop by my office soon and surprise one of Trestlewood's nurses to get his vaccine. Everyone in my family gets a flu vaccine every year. We started this tradition after my oldest got the flu in first grade. It was quickly followed by pneumonia, and then in her weakened state, strep throat. It was awful, and I never wanted a child of mine to go through that again. Unfortunately, my middle daughter had the flu a few years ago. She was coughing, had fevers upwards of 104, and was utterly miserable for a week.
I also take flu shots to Indiana to give to my parents and my mother-in-law. I think giving out flu shots each year is one of the biggest contributions I can make to the health of my community and my loved ones. The other big impact I have on public and individual preventive health is the rest of the recommended childhood vaccines--but that's for another blog.
Flu, at least the flu we vaccinate for, is NOT the stomach flu! I am told daily how this or that family had "the flu" last week, or last month, or last year. Or how they never get "the flu." Or, how the flu vaccine didn't work for them because they still got "the flu." When pressed for details it is clear that most people mean gastroenteritis when they say "the flu." Gastroenteritis is an illness that is very contagious, lasts a day or two, and involves vomiting and diarrhea. The flu I am talking about is influenza, a RESPIRATORY illness.
The symptoms of influenza are fever, severe muscle aches, coughing, sore throat, runny nose, extreme fatigue, chills, with occasionally some stomach symptoms. It lasts for about a week. It is also very contagious. Flu weakens and can kill its victims, especially those who are already debilitated. It can lead to complications, such as pneumonia. At the very least it is a miserable week to spend in bed with a box of tissues, cough drops, and other cough/cold/anti-fever medicines.
Flu vaccine is recommended yearly for everyone who is six months or older who does not have an allergy or other contraindication to the vaccine. While it is especially important for people with chronic illnesses such as asthma or diabetes, it is recommended for all of us. We can all benefit from a yearly flu vaccine.
Have you and your children had your yearly seasonal flu vaccine? Get yours as soon as you can!
The following are some links to reliable information about the flu and flu vaccine. This year's vaccine includes the H1N1 subtype, so a separate shot for that one isn't necessary. Children under age nine who are getting the flu vaccine for the first time, or who have not had at least two previous seasonal flu vaccines plus one of last year's H1N1 vaccines, will need two doses of flu vaccine spaced one month apart to be completely immunized.
http://www.cdc.gov/flu/
http://www.healthychildren.org/English/tips-tools/Symptom-Checker/Pages/Influenza.aspx
Croup and a Croupy Cough
It's easy to be scared when you wake up in the middle of the night to hear your baby or young child coughing with a deep, loud, barky cough and making raspy sounds when she breathes. Chances are this is croup!
It's important to hear what croup sounds like. The following videos are from YouTube. All give a pretty good idea of the distinct barky, croupy cough. It sounds like a barking seal.
CROUPY COUGH
A croupy cough sounds loud and barking, like a seal's bark:
STRIDOR
Raspy breathing, also known as stridor, is another characteristic of croup:
This next link is to a video that demonstrates a significant case of stridor, just click on the link to go to YouTube (the video did not allow itself to be embedded):
http://www.youtube.com/watch?v=Z1_uKqmPyLA
Croup is usually caused by a virus (a common one is parainfluenza virus). It causes cold symptoms (runny nose, stuffy nose, cough, fever) and it likes to settle in the upper airway. It causes swelling in the upper airway and vocal cords, giving the funny sounding cough, causing raspy breathing, and a hoarse voice (laryngitis). The barky cough and raspy breathing are always worse at night.
Croup often sounds much worse than it is. In two of the videos above, the ones demonstrating stridor, you can see completely happy babies who have raspy breathing. They look pink, are smiling or talking, and are not bothered by the "trouble" they are having with their breathing. Croup can be serious, and require a trip to the emergency room. However, usually it is manageable at home.
For a croup attack, first sit your child up, and then calm him down. Sitting up usually helps the airway stay open. Crying and panicking tend to make the airway close even more. Take your child into a steamy bathroom. To do this--run the hot water in your shower and don't turn on the fan. Sit in the bathroom and sing to your child, rock her, read to her. Try this for about fifteen minutes at a time. If it works, you can put your child back to bed--then repeat the treatment as needed through the night.
Another home treatment is taking your child outside into the cold night air (assuming it is cold outdoors!). The point is to try the opposite of hot steam, if the steam wasn't working for her. You can also put a cool mist vaporizer into your child's room.
If a croup attack is very severe, your child can't breathe despite home treatments, or is looking quite pale, bluish, or lethargic, you should go to the emergency room. There your child can receive breathing treatments (to temporarily open the airway), oxygen (if required), and steroids (to reduce swelling in the airway). Remember, however, that croup can look and sound much worse than it really is--so if your child is happy and playful, able to nurse or drink from a bottle or sippy cup pretty well, it's unlikely that you need to go to the emergency room for croup.
If you make it through the night, but had a rough time getting to morning (needing recurring steam or outdoor treatments) you should bring your child to the office the next morning. Symptoms may appear to be gone in the daytime, but croup comes back each night for a few nights before it turns into a regular cold.
After a few days of the croupy stage the cough will change into a phlegmy, wet cough. This almost always happens with croup, and is a sign that the croup is starting to clear up. However, when the cough changes into something else, every parent worries that it is turning into something more serious. When it changes, watch your child closely. If she is sleeping better, is more playful, more hungry, and the fever is mostly gone, then your child IS improving and you can handle the rest of the croup illness at home, like you would for the average cold virus.
Croup is contagious in the way a regular cold is contagious. It is spread by respiratory droplets (mucous, cough, sneezing), and is most contagious in the first 2 to 3 days of the illness. If there is no fever, and the child is sleeping pretty well at night, croup is not a reason to keep kids out of daycare or school.
As always, my blog is designed to give you general information about your child's health and illness. One of the main reasons I posted this topic is to provide the links to videos of a croupy cough and stridor. My advice here is not meant to replace the more personal advice you can receive from your child's own pediatrician.
Lots of information about croup is available on the web. Here are some possible links, if you want more information:
http://www.askdrsears.com/html/8/t084200.asp
http://www.healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/Croup-Treatment.aspx
Post updated 1/26/2014 (a new video added to replace one no longer available, two links replaced with embedded videos).
It's important to hear what croup sounds like. The following videos are from YouTube. All give a pretty good idea of the distinct barky, croupy cough. It sounds like a barking seal.
CROUPY COUGH
A croupy cough sounds loud and barking, like a seal's bark:
STRIDOR
Raspy breathing, also known as stridor, is another characteristic of croup:
This next link is to a video that demonstrates a significant case of stridor, just click on the link to go to YouTube (the video did not allow itself to be embedded):
http://www.youtube.com/watch?v=Z1_uKqmPyLA
Croup is usually caused by a virus (a common one is parainfluenza virus). It causes cold symptoms (runny nose, stuffy nose, cough, fever) and it likes to settle in the upper airway. It causes swelling in the upper airway and vocal cords, giving the funny sounding cough, causing raspy breathing, and a hoarse voice (laryngitis). The barky cough and raspy breathing are always worse at night.
Croup often sounds much worse than it is. In two of the videos above, the ones demonstrating stridor, you can see completely happy babies who have raspy breathing. They look pink, are smiling or talking, and are not bothered by the "trouble" they are having with their breathing. Croup can be serious, and require a trip to the emergency room. However, usually it is manageable at home.
For a croup attack, first sit your child up, and then calm him down. Sitting up usually helps the airway stay open. Crying and panicking tend to make the airway close even more. Take your child into a steamy bathroom. To do this--run the hot water in your shower and don't turn on the fan. Sit in the bathroom and sing to your child, rock her, read to her. Try this for about fifteen minutes at a time. If it works, you can put your child back to bed--then repeat the treatment as needed through the night.
Another home treatment is taking your child outside into the cold night air (assuming it is cold outdoors!). The point is to try the opposite of hot steam, if the steam wasn't working for her. You can also put a cool mist vaporizer into your child's room.
If a croup attack is very severe, your child can't breathe despite home treatments, or is looking quite pale, bluish, or lethargic, you should go to the emergency room. There your child can receive breathing treatments (to temporarily open the airway), oxygen (if required), and steroids (to reduce swelling in the airway). Remember, however, that croup can look and sound much worse than it really is--so if your child is happy and playful, able to nurse or drink from a bottle or sippy cup pretty well, it's unlikely that you need to go to the emergency room for croup.
If you make it through the night, but had a rough time getting to morning (needing recurring steam or outdoor treatments) you should bring your child to the office the next morning. Symptoms may appear to be gone in the daytime, but croup comes back each night for a few nights before it turns into a regular cold.
After a few days of the croupy stage the cough will change into a phlegmy, wet cough. This almost always happens with croup, and is a sign that the croup is starting to clear up. However, when the cough changes into something else, every parent worries that it is turning into something more serious. When it changes, watch your child closely. If she is sleeping better, is more playful, more hungry, and the fever is mostly gone, then your child IS improving and you can handle the rest of the croup illness at home, like you would for the average cold virus.
Croup is contagious in the way a regular cold is contagious. It is spread by respiratory droplets (mucous, cough, sneezing), and is most contagious in the first 2 to 3 days of the illness. If there is no fever, and the child is sleeping pretty well at night, croup is not a reason to keep kids out of daycare or school.
As always, my blog is designed to give you general information about your child's health and illness. One of the main reasons I posted this topic is to provide the links to videos of a croupy cough and stridor. My advice here is not meant to replace the more personal advice you can receive from your child's own pediatrician.
Lots of information about croup is available on the web. Here are some possible links, if you want more information:
http://www.askdrsears.com/html/8/t084200.asp
http://www.healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/Croup-Treatment.aspx
Post updated 1/26/2014 (a new video added to replace one no longer available, two links replaced with embedded videos).
Friday, September 24, 2010
Obesity Part II: Early Prevention (Prenatal through Preschool)
Is there anything you can do to prevent obesity in your child? YES, YES, YES!
First, look at your child's risk factors. Family history is important. One study showed that a child born to an obese parent (or parents) has an 80% chance of becoming obese herself. There could also be diseases in the family which are influenced by obesity. These would include diabetes, high blood pressure, cardiovascular disease, and stroke.
Conditions during pregnancy, such as gestational diabetes and maternal smoking, may contribute to a child's difficulty maintaining a normal weight. Babies born small for gestational age may have a predisposition to glucose intolerance. Breastfeeding may help reduce the chance of obesity.
By assessing risk factors I don't mean to introduce more guilt in your life as a parent. We all have a family history, we all have our own health issues, complications occur in pregnancies, and not everyone can breast feed their baby! I know all of this. However, in preventing obesity and its related diseases from happening it is important to know what the risk is from the beginning.
Early in infancy it is important to feed your baby when he is hungry, and allow him to stop when he is full. Watch for signs of hunger such as rooting and crying. Listen for the cry that means hunger, versus the cry that means irritability or sleepiness. Feed your baby "on demand." If the baby just ate and seems to be acting hungry again try cuddling, soothing, swaddling, or a pacifier before offering another feeding. If your baby is bottle feeding, watch closely for signs of her being full. Don't try to get her to just finish that last ounce. If she stops sucking, lets milk pour out of her mouth, or pulls away and turns her head, recognize these as signs she has had enough. Hold your baby when you feed her a bottle. Never prop a bottle for a baby.
As your baby gets older and learns to smile and interact socially, you can try toys and other distractions to keep her happy when she is fussy but not really hungry. The more you interact with your baby, the more you will get to know her and understand what she needs. Often it will be hunger, but sometimes it will be boredom, fatigue, or loneliness that needs to be addressed.
TV is a very poor substitute for interaction with you. Children grow up in the presence of lots of media. They learn to be entertained, rather than to entertain themselves. They learn to be inactive, and to stop using their brains. Developing minds and bodies do not need TV. It does not benefit young children at all. Yes, babies will watch videos, and appear mesmerized and happy, but they aren't learning anything that will help them later. Instead they are learning from an early age to be what we all don't want to be--couch potatoes! Add snacks and beverages consumed while watching TV and we are thoroughly indoctrinating them into the inactive lifestyle led by many Americans. No TV at all until age 2 or older is the best way to go.
In the toddler years trouble spots for weight control seem to center around excessive juice, excessive milk, and "grazing." Grazing is allowing your child to nibble on things throughout the day. Usually these are foods like fishy crackers, cereal, fruit snacks, puffs, pretzels, and other foods that are mostly made up of carbohydrates. Sippy cups allow toddlers to walk around all day sipping on milk or juice. These practices cause lots of eating problems. Children can get too many calories from this constant sipping and nibbling. They never feel hungry, so then they don't eat well and are very picky at meal times. As soon as they are the slightest bit hungry they whine and cry about wanting food. To top it off, they even are learning to treat boredom (and possibly negative emotions) with food.
You can help your toddler control his weight, be less picky, and be hungry for meals by feeding three meals and two or three quality snacks ONLY per day. At other times the kitchen is CLOSED! Also, limiting milk to 16-20 oz. per day, and juice to 4-6 oz per day will help your cause. Make snacks count--serve fruits, cheese, yogurt sweetened with applesauce or fruit, vegetables, hard-boiled eggs, and more at snack time. Don't give your child anything else to drink other than milk, water, and a tiny bit of juice. Pop? Do you have to ask?
Allow your child to become hungry before meals, then serve the stuff that's good for him first! My sister-in-law always dished out big bites of broccoli to her kids and mine while they complained of hunger and the rest of the meal wasn't quite ready. Guess what? The broccoli (or peas, green beans, or carrots) was devoured by many picky little people who were also quite hungry!
Save the empty calories (fruit snacks, fishy crackers) for an occasional little treat, or a difficult part of the week (the check-out line at the grocery store). Allow your child to freely drink water from their sippy cup, and give the milk and juice at meal and snack time. Teach your child to drink milk and juice from a regular cup and ditch the sippy cup as soon as possible.
As your child gets older--into the preschool years--keep up the practice of three meals a day, and two snacks. Make your child what she likes to eat at breakfast and lunch. Then, at dinner (if this is your family meal) serve one meal to your family. Do not make your child a separate meal. A few items in your meal should be kid-friendly. You can always set out some fruit, or a bowl of applesauce. At first, aim for good table manners--no saying "yuck" or throwing or pushing the food off the plate. Your first goal is to get your child to tolerate the presence of the food in front of him. Then you work towards a taste of everything, and then a few bites (cut them very small and ask for three bites from a three year old, four bites from a four year old...) of a less desirable food. If your child leaves the table hungry, there is always tomorrow and a good breakfast around the corner. No guilt here--you served the food, it was your child's choice not to eat it.
Please consider avoiding fast food restaurants. If you can get the food at the drive through window I would really question its nutritional value. Watch the video Super Size Me. I have not taken my own kids to that fast food restaurant (and most others) since I watched that movie! Most toddlers (and definitely preschoolers) recognize the golden arches, and will happily eat a meal consisting of chicken nuggets and fries. But why develop those taste buds when you could be working on the taste buds that some day will hopefully enjoy salad, whole grains, fruits, and vegetables? Why cultivate a taste for fatty, high calorie, high salt food that is low in nutritional value?
Encourage free outdoor play. Allow your young child to run, climb, dig, race, throw and kick balls, twirl, swing, slide, swim, and be free outdoors. Limit time in front of the TV or any media screen to one hour a day on most days, and definitely no more than two hours a day. Try to have twice as much outdoor play time as time in front of the TV. Children under the age of two should not watch TV.
Children should have a minimum of one hour a day of very active play.
Take care of yourself, too. Are you eating healthy food? Exercising? Limiting your time in front of the TV? It is much easier to help your child be healthy if you are also living a healthy lifestyle.
I am trying to give you ideas to help keep your child at a healthy weight with a good level of fitness, to minimize the risk of obesity related diseases, and to promote better self-esteem and enjoyment in life. All of us are a work in progress, and this goal is something to work toward. I hope I have given you something to think about, and some practical ideas you can put to use. As always, the advice in my blog is quite general, and is not meant to substitute for more specifically tailored instructions from your own personal pediatrician! Good luck.
As far as resources I used--the same ones I sourced in my first Obesity blog (Part I) were used here, as well relying heavily on my own experience as a pediatrician in general practice.
First, look at your child's risk factors. Family history is important. One study showed that a child born to an obese parent (or parents) has an 80% chance of becoming obese herself. There could also be diseases in the family which are influenced by obesity. These would include diabetes, high blood pressure, cardiovascular disease, and stroke.
Conditions during pregnancy, such as gestational diabetes and maternal smoking, may contribute to a child's difficulty maintaining a normal weight. Babies born small for gestational age may have a predisposition to glucose intolerance. Breastfeeding may help reduce the chance of obesity.
By assessing risk factors I don't mean to introduce more guilt in your life as a parent. We all have a family history, we all have our own health issues, complications occur in pregnancies, and not everyone can breast feed their baby! I know all of this. However, in preventing obesity and its related diseases from happening it is important to know what the risk is from the beginning.
Early in infancy it is important to feed your baby when he is hungry, and allow him to stop when he is full. Watch for signs of hunger such as rooting and crying. Listen for the cry that means hunger, versus the cry that means irritability or sleepiness. Feed your baby "on demand." If the baby just ate and seems to be acting hungry again try cuddling, soothing, swaddling, or a pacifier before offering another feeding. If your baby is bottle feeding, watch closely for signs of her being full. Don't try to get her to just finish that last ounce. If she stops sucking, lets milk pour out of her mouth, or pulls away and turns her head, recognize these as signs she has had enough. Hold your baby when you feed her a bottle. Never prop a bottle for a baby.
As your baby gets older and learns to smile and interact socially, you can try toys and other distractions to keep her happy when she is fussy but not really hungry. The more you interact with your baby, the more you will get to know her and understand what she needs. Often it will be hunger, but sometimes it will be boredom, fatigue, or loneliness that needs to be addressed.
TV is a very poor substitute for interaction with you. Children grow up in the presence of lots of media. They learn to be entertained, rather than to entertain themselves. They learn to be inactive, and to stop using their brains. Developing minds and bodies do not need TV. It does not benefit young children at all. Yes, babies will watch videos, and appear mesmerized and happy, but they aren't learning anything that will help them later. Instead they are learning from an early age to be what we all don't want to be--couch potatoes! Add snacks and beverages consumed while watching TV and we are thoroughly indoctrinating them into the inactive lifestyle led by many Americans. No TV at all until age 2 or older is the best way to go.
In the toddler years trouble spots for weight control seem to center around excessive juice, excessive milk, and "grazing." Grazing is allowing your child to nibble on things throughout the day. Usually these are foods like fishy crackers, cereal, fruit snacks, puffs, pretzels, and other foods that are mostly made up of carbohydrates. Sippy cups allow toddlers to walk around all day sipping on milk or juice. These practices cause lots of eating problems. Children can get too many calories from this constant sipping and nibbling. They never feel hungry, so then they don't eat well and are very picky at meal times. As soon as they are the slightest bit hungry they whine and cry about wanting food. To top it off, they even are learning to treat boredom (and possibly negative emotions) with food.
You can help your toddler control his weight, be less picky, and be hungry for meals by feeding three meals and two or three quality snacks ONLY per day. At other times the kitchen is CLOSED! Also, limiting milk to 16-20 oz. per day, and juice to 4-6 oz per day will help your cause. Make snacks count--serve fruits, cheese, yogurt sweetened with applesauce or fruit, vegetables, hard-boiled eggs, and more at snack time. Don't give your child anything else to drink other than milk, water, and a tiny bit of juice. Pop? Do you have to ask?
Allow your child to become hungry before meals, then serve the stuff that's good for him first! My sister-in-law always dished out big bites of broccoli to her kids and mine while they complained of hunger and the rest of the meal wasn't quite ready. Guess what? The broccoli (or peas, green beans, or carrots) was devoured by many picky little people who were also quite hungry!
Save the empty calories (fruit snacks, fishy crackers) for an occasional little treat, or a difficult part of the week (the check-out line at the grocery store). Allow your child to freely drink water from their sippy cup, and give the milk and juice at meal and snack time. Teach your child to drink milk and juice from a regular cup and ditch the sippy cup as soon as possible.
As your child gets older--into the preschool years--keep up the practice of three meals a day, and two snacks. Make your child what she likes to eat at breakfast and lunch. Then, at dinner (if this is your family meal) serve one meal to your family. Do not make your child a separate meal. A few items in your meal should be kid-friendly. You can always set out some fruit, or a bowl of applesauce. At first, aim for good table manners--no saying "yuck" or throwing or pushing the food off the plate. Your first goal is to get your child to tolerate the presence of the food in front of him. Then you work towards a taste of everything, and then a few bites (cut them very small and ask for three bites from a three year old, four bites from a four year old...) of a less desirable food. If your child leaves the table hungry, there is always tomorrow and a good breakfast around the corner. No guilt here--you served the food, it was your child's choice not to eat it.
Please consider avoiding fast food restaurants. If you can get the food at the drive through window I would really question its nutritional value. Watch the video Super Size Me. I have not taken my own kids to that fast food restaurant (and most others) since I watched that movie! Most toddlers (and definitely preschoolers) recognize the golden arches, and will happily eat a meal consisting of chicken nuggets and fries. But why develop those taste buds when you could be working on the taste buds that some day will hopefully enjoy salad, whole grains, fruits, and vegetables? Why cultivate a taste for fatty, high calorie, high salt food that is low in nutritional value?
Encourage free outdoor play. Allow your young child to run, climb, dig, race, throw and kick balls, twirl, swing, slide, swim, and be free outdoors. Limit time in front of the TV or any media screen to one hour a day on most days, and definitely no more than two hours a day. Try to have twice as much outdoor play time as time in front of the TV. Children under the age of two should not watch TV.
Children should have a minimum of one hour a day of very active play.
Take care of yourself, too. Are you eating healthy food? Exercising? Limiting your time in front of the TV? It is much easier to help your child be healthy if you are also living a healthy lifestyle.
I am trying to give you ideas to help keep your child at a healthy weight with a good level of fitness, to minimize the risk of obesity related diseases, and to promote better self-esteem and enjoyment in life. All of us are a work in progress, and this goal is something to work toward. I hope I have given you something to think about, and some practical ideas you can put to use. As always, the advice in my blog is quite general, and is not meant to substitute for more specifically tailored instructions from your own personal pediatrician! Good luck.
As far as resources I used--the same ones I sourced in my first Obesity blog (Part I) were used here, as well relying heavily on my own experience as a pediatrician in general practice.
Sunday, September 12, 2010
Obesity: Part I
Big boned, husky, chunky, chubby, overweight, obese...we all know it's something we want to avoid. Many adults struggle with their own weight, and all of us worry about our children. We feel better when we are fit, when our clothes aren't too tight, and when we can move and breathe easily.
Screening for overweight and obesity is now a routine part of a pediatric check-up. A Body Mass Index (or BMI) can be calculated for children ages 3 and older. Just like a growth chart, children are compared to others of the same age and gender using percentiles. A BMI that falls into the 5th to 85th percentile is considered a normal weight. A BMI in the 85th to 95th percentile is overweight, and over 95th percentile is obese. If you aren't sure what a percentile is, check the end of this post and I'll do my best to explain it.
To calculate your child's BMI I would suggest a website that lets you plot it on a graph, gives you percentiles, and tells you what kind of calories per day your child needs: www.kidsnutrition.org (just click on the BMI calculator when you get to the site)
A healthy weight is important not only for a positive self-image, but for the body's current and future health. With one out of three children weighing in with a BMI of 85th percentile or higher our society is seeing problems with high cholesterol, high blood pressure, pre-diabetes, type II diabetes, orthopedic problems, non-alcoholic fatty liver disease, and more--both in adulthood AND DURING CHILDHOOD.
A child who is overweight or obese should have a medical evaluation. Usually this will mean a check-up that will include a detailed history, checking height, weight, and blood pressure, calculating BMI, and a complete physical exam. Blood work is not a routine part of an obesity evaluation in a child, and would be decided upon individually. Family history is important in the evaluation of obesity.
There are some rare genetic syndromes and medical conditions that can make it more likely that a child will become obese, however, it is more common for obesity itself to CAUSE medical problems than the other way around.
The first step in dealing with obesity is recognizing it as a problem. I certainly see it daily in my office. I also see normal weight children who have a family history of obesity, or who have eating and activity patterns that put them at risk. There is much we can do to prevent and deal with obesity. But there is no easy answer, no pill, no surgery. The long-term, sustainable solution involves a change in attitudes, habits, and lifestyle. And solutions like these are always the most difficult.
In future posts I hope to touch on prevention and treatment, as well as recommendations for feeding your child. Dealing with this problem for your child and yourself could be one of the most important, life-changing things you can do as a parent.
I have used the following resources in preparing my blog:
Pediatric Obesity: Prevention, Intervention, and Treatment Strategies for Primary Care, Sandra G. Hassink, American Academy of Pediatrics, 2007.
Pediatric Obesity Clinical Decision Support Chart 5210, Sandra G. Hassink, American Academy of Pediatrics, 2008.
Addendum: Regarding percentiles: If your daughter has a BMI that is at the 50th percentile, this means she is right in the middle for her age (50% of girls her age would have a lower BMI). I also look at it like this: If there were one hundred girls her age and height, 50 of them would weigh less. If your son has a BMI at the 95th percentile, this means that 95% of boys his age have a lower BMI (I like to think of it this way: If there were 100 boys his age and height, 95 of these boys would weigh less).
Screening for overweight and obesity is now a routine part of a pediatric check-up. A Body Mass Index (or BMI) can be calculated for children ages 3 and older. Just like a growth chart, children are compared to others of the same age and gender using percentiles. A BMI that falls into the 5th to 85th percentile is considered a normal weight. A BMI in the 85th to 95th percentile is overweight, and over 95th percentile is obese. If you aren't sure what a percentile is, check the end of this post and I'll do my best to explain it.
To calculate your child's BMI I would suggest a website that lets you plot it on a graph, gives you percentiles, and tells you what kind of calories per day your child needs: www.kidsnutrition.org (just click on the BMI calculator when you get to the site)
A healthy weight is important not only for a positive self-image, but for the body's current and future health. With one out of three children weighing in with a BMI of 85th percentile or higher our society is seeing problems with high cholesterol, high blood pressure, pre-diabetes, type II diabetes, orthopedic problems, non-alcoholic fatty liver disease, and more--both in adulthood AND DURING CHILDHOOD.
A child who is overweight or obese should have a medical evaluation. Usually this will mean a check-up that will include a detailed history, checking height, weight, and blood pressure, calculating BMI, and a complete physical exam. Blood work is not a routine part of an obesity evaluation in a child, and would be decided upon individually. Family history is important in the evaluation of obesity.
There are some rare genetic syndromes and medical conditions that can make it more likely that a child will become obese, however, it is more common for obesity itself to CAUSE medical problems than the other way around.
The first step in dealing with obesity is recognizing it as a problem. I certainly see it daily in my office. I also see normal weight children who have a family history of obesity, or who have eating and activity patterns that put them at risk. There is much we can do to prevent and deal with obesity. But there is no easy answer, no pill, no surgery. The long-term, sustainable solution involves a change in attitudes, habits, and lifestyle. And solutions like these are always the most difficult.
In future posts I hope to touch on prevention and treatment, as well as recommendations for feeding your child. Dealing with this problem for your child and yourself could be one of the most important, life-changing things you can do as a parent.
I have used the following resources in preparing my blog:
Pediatric Obesity: Prevention, Intervention, and Treatment Strategies for Primary Care, Sandra G. Hassink, American Academy of Pediatrics, 2007.
Pediatric Obesity Clinical Decision Support Chart 5210, Sandra G. Hassink, American Academy of Pediatrics, 2008.
Addendum: Regarding percentiles: If your daughter has a BMI that is at the 50th percentile, this means she is right in the middle for her age (50% of girls her age would have a lower BMI). I also look at it like this: If there were one hundred girls her age and height, 50 of them would weigh less. If your son has a BMI at the 95th percentile, this means that 95% of boys his age have a lower BMI (I like to think of it this way: If there were 100 boys his age and height, 95 of these boys would weigh less).
Sunday, September 5, 2010
Calling the Doctor After Hours
Every time I am on call I answer after hours calls from worried parents. I have been on call, on average, 7 days a month for the last thirteen years. That would be 1092 call nights/days since I joined Trestlewood. If I average 10 calls a night (weekends more, weeknights less, winter more, summer less, but averaging it all out) that means I have answered over 10,000 calls from worried parents so far in my career! I have a lot of experience answering after-hours questions from parents via my cell phone. I know what are the most common reasons people call and what advice to give them. I know what really scares parents in the middle of the night, and how to tell parents what to look for if the illness is getting worse.
Still, after all these years, I greatly prefer that face-to-face contact in the office. It is still sometimes hard for me to figure out how sick a child is when I am talking to a parent over the phone. A description of a rash, swelling, injury or bug bite by the parent, using their frame of reference and experience, may conjure up a completely inaccurate mental picture in my mind when I try to match it to my frame of reference. Thermometers are broken, degrees are added or subtracted from temperatures, weights are not known, allergies are not remembered. Sometimes the person calling me isn't even with the child, so they are themselves telling me information they received from a third party.
And I often think my goals for the phone call and the parent's goals for the call differ wildly. My primary interest is to quickly and accurately provide an assessment of the nature and severity of the illness and whether it is possible to use home/natural methods to provide comfort until the child can be seen in the office. I think many people want more out of the phone call than that--it would be nice to be able to go back a month, or year, or years in the history to be able to arrive at an exact diagnosis, prognosis, and prescription, and possibly a note for school or daycare, and sometimes even a refill on another medication that has run out.
So with that preface I will provide you with my perspective, as an experienced after-hours phone call answerer, of what a parent should expect from the doctor answering the phone after hours.
What to Expect From After-Hours Phone Calls
If your child is an established patient at Trestlewood Pediatrics we want you to feel confident that, even when the office is closed, there is a physician available to help you with urgent questions about your ill child. We wrote these notes thinking it would be helpful for families to understand how our after-hours phone system works. The after-hours phone number for established patients of Trestlewood Pediatrics is available on our office answering machine, and is on our business/appointment cards. As of 2010 there is no charge for an urgent, brief, after-hours phone call. Most calls of this type take less than 3 to 4 minutes.
Office Cell Phone
When you call you will be pleased to notice that we do not use an answering service. Instead you will speak to the doctor on call directly on our office cell phone. If the doctor cannot take the call immediately (perhaps while driving, or taking another call), then the call will be returned using information you have left on our voice mail. We strive to return calls within 30 minutes. Sometimes we are at the hospital or answering other calls, however, and a return call is delayed. You should call back if you have not heard from us within 30 to 60 minutes.
The most important information to leave on the voice mail is your name, your child’s name and age, and your phone number. A few words about the problem can be helpful (“she is wheezing,” “I think he broke his arm.”). If the message is too long it will delay us in returning the call.
Our Goals in Answering Calls
When the doctor talks to you about your child he/she is trying to determine how serious of a problem this is and what needs to be done for it right now. This is called “triage.” For example, is it best to treat this problem at home with over the counter medications or home comfort measures and see the child in the office tomorrow, or should the child go to the emergency room now?
After hours the doctor does not have your child’s medical record, information about medication and allergies, and other important data needed to provide a thorough assessment and treatment plan. While a worried parent might understandably hope for a complete evaluation, diagnosis, plan, and prescription, this is actually very difficult for the doctor to do over the phone. In most cases the doctor’s goal after hours is to get your child through the night in the safest, simplest way we can until we can provide more thorough and personal care in the office.
It would be unusual for the doctor to call in a prescription, such as an antibiotic, without seeing your child in the office.
Calling About Specific Problems
Our web site might be helpful in addressing some simple questions, thus making some phone calls unnecessary. Also, the patient folder has information about common illnesses (fever, vomiting, diarrhea, sore throat, ear pain, pink eye, constipation, coughs, colds). The fever information includes a dosing chart for children under 35lbs. for acetaminophen (Tylenol) drops and suspension, and for ibuprofen (Motrin, Advil) drops and suspension.
Because we can’t see the child, rashes are very difficult to diagnose over the phone. With a rash we will attempt to determine if it represents a serious illness (the child would appear extremely ill in that situation) or if it is an allergic rash (such as hives). To receive a diagnosis beyond this the child would need an appointment in the office.
Still, after all these years, I greatly prefer that face-to-face contact in the office. It is still sometimes hard for me to figure out how sick a child is when I am talking to a parent over the phone. A description of a rash, swelling, injury or bug bite by the parent, using their frame of reference and experience, may conjure up a completely inaccurate mental picture in my mind when I try to match it to my frame of reference. Thermometers are broken, degrees are added or subtracted from temperatures, weights are not known, allergies are not remembered. Sometimes the person calling me isn't even with the child, so they are themselves telling me information they received from a third party.
And I often think my goals for the phone call and the parent's goals for the call differ wildly. My primary interest is to quickly and accurately provide an assessment of the nature and severity of the illness and whether it is possible to use home/natural methods to provide comfort until the child can be seen in the office. I think many people want more out of the phone call than that--it would be nice to be able to go back a month, or year, or years in the history to be able to arrive at an exact diagnosis, prognosis, and prescription, and possibly a note for school or daycare, and sometimes even a refill on another medication that has run out.
So with that preface I will provide you with my perspective, as an experienced after-hours phone call answerer, of what a parent should expect from the doctor answering the phone after hours.
What to Expect From After-Hours Phone Calls
If your child is an established patient at Trestlewood Pediatrics we want you to feel confident that, even when the office is closed, there is a physician available to help you with urgent questions about your ill child. We wrote these notes thinking it would be helpful for families to understand how our after-hours phone system works. The after-hours phone number for established patients of Trestlewood Pediatrics is available on our office answering machine, and is on our business/appointment cards. As of 2010 there is no charge for an urgent, brief, after-hours phone call. Most calls of this type take less than 3 to 4 minutes.
Office Cell Phone
When you call you will be pleased to notice that we do not use an answering service. Instead you will speak to the doctor on call directly on our office cell phone. If the doctor cannot take the call immediately (perhaps while driving, or taking another call), then the call will be returned using information you have left on our voice mail. We strive to return calls within 30 minutes. Sometimes we are at the hospital or answering other calls, however, and a return call is delayed. You should call back if you have not heard from us within 30 to 60 minutes.
The most important information to leave on the voice mail is your name, your child’s name and age, and your phone number. A few words about the problem can be helpful (“she is wheezing,” “I think he broke his arm.”). If the message is too long it will delay us in returning the call.
Our Goals in Answering Calls
When the doctor talks to you about your child he/she is trying to determine how serious of a problem this is and what needs to be done for it right now. This is called “triage.” For example, is it best to treat this problem at home with over the counter medications or home comfort measures and see the child in the office tomorrow, or should the child go to the emergency room now?
After hours the doctor does not have your child’s medical record, information about medication and allergies, and other important data needed to provide a thorough assessment and treatment plan. While a worried parent might understandably hope for a complete evaluation, diagnosis, plan, and prescription, this is actually very difficult for the doctor to do over the phone. In most cases the doctor’s goal after hours is to get your child through the night in the safest, simplest way we can until we can provide more thorough and personal care in the office.
It would be unusual for the doctor to call in a prescription, such as an antibiotic, without seeing your child in the office.
Calling About Specific Problems
Our web site might be helpful in addressing some simple questions, thus making some phone calls unnecessary. Also, the patient folder has information about common illnesses (fever, vomiting, diarrhea, sore throat, ear pain, pink eye, constipation, coughs, colds). The fever information includes a dosing chart for children under 35lbs. for acetaminophen (Tylenol) drops and suspension, and for ibuprofen (Motrin, Advil) drops and suspension.
Because we can’t see the child, rashes are very difficult to diagnose over the phone. With a rash we will attempt to determine if it represents a serious illness (the child would appear extremely ill in that situation) or if it is an allergic rash (such as hives). To receive a diagnosis beyond this the child would need an appointment in the office.
Saturday, September 4, 2010
Please Wear Your Helmet!
Every day I tell kids they should wear helmets. They should wear bike helmets whenever they are on something with wheels (bikes, skateboards, scooters, rip-sticks, roller-blades...) or ski helmets if skiing or snowboarding. They should wear the appropriate helmet for a motorized dirt bike or for off-road vehicles, as well.
Every day I have small children tell me they don't need a helmet because they never fall. Then I realize I have to convince both child and parent (mostly parents in this age group of kids) that the point of a helmet is to protect in case of an accident. I don't doubt the child's skill on the bike, or the quiet cul-de-sac the family lives on. I say that a helmet is like a seatbelt in the car. You always wear your seat belt in the car, right? But do you really think your Mom or Dad will get in a crash? No! So why wear the seatbelt? Just in case of an accident, in case something happens that we didn't know would happen. Helmets are the same kind of thing. They protect you in case of an accident, and we wear them because we don't know when accidents will happen.
I also tell kids (getting to a little older group now) something Dr. Van Es told one of my girls during her check up with him. I loved this explanation, and now I use it all the time. Doctors are good at fixing broken arms and legs, we just put them in a cast and a few weeks later everything is as good as new. Also, we can put band-aids on scrapes, and sew up cuts with stitches. But doctors are not good at fixing brains. If your head cracks open and you hurt your brain, there isn't much that we can do other than wait and see what kind of damage was done (and I add my own spin on it here, especially for adolescents). For example, a bad brain injury can take away your ability to talk, you might not be able to walk and have to use a wheelchair, you might not be able to control yourself to get to the bathroom and therefore need to wear a diaper, you might not be smart anymore...etc. So the helmet is extra important when you are on your wheels because it gives your brain an extra hard layer of protection in case of an accident.
And after feeling really good about how I have educated everyone I drive home for lunch in the summer and see lots of kids (many are my patients) in my neighborhood biking, skateboarding, rip-sticking, and scootering around with NO HELMETS. And they are in the street!
But street versus sidewalk is worth mentioning when it comes to helmets. The worst head injury from a device in this category of someone in my pediatric practice was a six year old girl who lived across from the elementary school and was a friend of my oldest daughter. She was on her little scooter on the sidewalk in front of her house, unhelmeted. Mom was gardening in the yard, right there to supervise. She hit a little crack or rock, fell off the scooter and hit her head hard on the pavement. Forty-five minutes later she was vomiting and very drowsy and lethargic, and within another hour or two was in the operating room having the bleed into her brain drained by a neurosurgeon. She is ok, but fortunate to have such a good outcome. Probably this was preventable if she had been wearing a bike helmet.
It is not enough to just tell kids to wear their helmets. They don't believe they need helmets because they don't think they will fall. As parents it is our responsibility to make our kids wear their helmets, with consequences if they do not wear them. We need to get all the parents in the neighborhood in on this rule, so one child doesn't have to feel the stigma of being the only one who has to wear a helmet. And we as parents have to set a good example! We need to wear helmets, too. It's a little funny to see families riding around town with three helmeted kids on bikes, but the parents on bikes have bare heads. How long do you think those kids will be wanting to wear helmets?
Every day I have small children tell me they don't need a helmet because they never fall. Then I realize I have to convince both child and parent (mostly parents in this age group of kids) that the point of a helmet is to protect in case of an accident. I don't doubt the child's skill on the bike, or the quiet cul-de-sac the family lives on. I say that a helmet is like a seatbelt in the car. You always wear your seat belt in the car, right? But do you really think your Mom or Dad will get in a crash? No! So why wear the seatbelt? Just in case of an accident, in case something happens that we didn't know would happen. Helmets are the same kind of thing. They protect you in case of an accident, and we wear them because we don't know when accidents will happen.
I also tell kids (getting to a little older group now) something Dr. Van Es told one of my girls during her check up with him. I loved this explanation, and now I use it all the time. Doctors are good at fixing broken arms and legs, we just put them in a cast and a few weeks later everything is as good as new. Also, we can put band-aids on scrapes, and sew up cuts with stitches. But doctors are not good at fixing brains. If your head cracks open and you hurt your brain, there isn't much that we can do other than wait and see what kind of damage was done (and I add my own spin on it here, especially for adolescents). For example, a bad brain injury can take away your ability to talk, you might not be able to walk and have to use a wheelchair, you might not be able to control yourself to get to the bathroom and therefore need to wear a diaper, you might not be smart anymore...etc. So the helmet is extra important when you are on your wheels because it gives your brain an extra hard layer of protection in case of an accident.
And after feeling really good about how I have educated everyone I drive home for lunch in the summer and see lots of kids (many are my patients) in my neighborhood biking, skateboarding, rip-sticking, and scootering around with NO HELMETS. And they are in the street!
But street versus sidewalk is worth mentioning when it comes to helmets. The worst head injury from a device in this category of someone in my pediatric practice was a six year old girl who lived across from the elementary school and was a friend of my oldest daughter. She was on her little scooter on the sidewalk in front of her house, unhelmeted. Mom was gardening in the yard, right there to supervise. She hit a little crack or rock, fell off the scooter and hit her head hard on the pavement. Forty-five minutes later she was vomiting and very drowsy and lethargic, and within another hour or two was in the operating room having the bleed into her brain drained by a neurosurgeon. She is ok, but fortunate to have such a good outcome. Probably this was preventable if she had been wearing a bike helmet.
It is not enough to just tell kids to wear their helmets. They don't believe they need helmets because they don't think they will fall. As parents it is our responsibility to make our kids wear their helmets, with consequences if they do not wear them. We need to get all the parents in the neighborhood in on this rule, so one child doesn't have to feel the stigma of being the only one who has to wear a helmet. And we as parents have to set a good example! We need to wear helmets, too. It's a little funny to see families riding around town with three helmeted kids on bikes, but the parents on bikes have bare heads. How long do you think those kids will be wanting to wear helmets?
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