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Your Teen

Overweight Girls Start Periods At Earlier Age

1.45 to read

Early-onset menstruation is linked to later health problems such as breast cancer, said Sarah Keim, a researcher at The Ohio State University College of Medicine in Columbus, who wasn't involved in the new study. Girls who get their period early in life are also more likely to have sex sooner than their peers, Keim added, which increases the risk of teen pregnancy and sexually transmitted diseases.It's nothing new that girls are getting younger and younger when they have their first period, but experts worry that the current obesity epidemic could be fueling that trend.

Overweight or obese girls get their first period months earlier than their normal-weight peers, according to a Danish study. Early-onset menstruation is linked to later health problems such as breast cancer, said Sarah Keim, a researcher at The Ohio State University College of Medicine in Columbus, who wasn't involved in the new study. Girls who get their period early in life are also more likely to have sex sooner than their peers, Keim added, which increases the risk of teen pregnancy and sexually transmitted diseases. About 17 percent of American kids and teens are obese, according to the Centers for Disease Control and Prevention. For the study, researchers used information on body mass index (BMI) -- a measure of weight in relation to height -- and age at first period from about 3,200 Danish girls born between 1984 and 1987. The girls started their period just after they had turned 13, on average, which is about half a year later than in the U.S. Keim said part of the reason for this difference may be that African-Americans tend to start their periods before white girls. On average, a girl got her period about 25 days earlier for every point her BMI increased. For a female of about average height and weight, a one-point change in BMI is equivalent to about six pounds. Overweight and obese girls, for example, got their period three to five months before normal-weight girls, said Anshu Shrestha, a graduate student at UCLA School of Public Health, who worked on the study. There has been past research showing a link between BMI and when girls start menstruating. However, since this study was done more recently, it shows that the link is holding up in today's generation, Keim said. The researchers also found that a girl's mother's weight was related to when her daughter started menstruating, but less so than earlier work had hinted. For every point her mother's BMI when pregnant went up, the girl's period came about a week earlier, according to the new study, which was published in the journal Fertility and Sterility. Keim said the Danish findings reinforce the importance of keeping a healthy weight. "It's important for your entire life, starting from very early on," she told Reuters Health. "And it can even affect your children's health." Talking to your daughter about Menstruation. Most girls begin to menstruate when they're about 12, but periods are possible as early as age 8. That's why explaining menstruation early is so important. But menstruation is an awkward subject to talk about, especially with preteen girls, who are often embarrassed by this discussion. So what's the best way to approach this ticklish topic? If your daughter asks questions about menstruation, answer them openly and honestly. Provide as many details as you think she needs at the time. It's OK to let your daughter set the pace, but don't let her avoid the topic entirely. If she's not asking questions as she approaches the preteen years, it's up to you to start talking about menstruation. Don't plan a single tell-all discussion. Instead, talk about the various issues - from basic hygiene to fear of the unknown - in a series of short conversations. Consider it part of a continuing conversation on how the human body works. Remember, your daughter needs good information about the menstrual cycle and all the other changes that puberty brings. If her friends are her only source of information, she may hear some nonsense and take it for fact. To introduce the subject of menstruation, you might ask your daughter what she knows about puberty. Clarify any misinformation and ask what questions she might have. It may be helpful to time your conversations with the health lessons and sex education your daughter is receiving in school, or you could broach the subject before a routine doctor's appointment. You can tell your daughter that the doctor may ask her whether she's gotten her period yet. Then ask if she has any questions or concerns about menstruation. Girls might prefer to learn about menstruation from a female family member, but sometimes that's not possible. If you're a single father and you're not comfortable talking about menstruation, you might delegate these conversations to a female relative or friend. The key is to make sure the information is relayed somehow. The biology of menstruation is important, but most girls are more interested in practical information about periods. Your daughter may want to know when it's going to happen, what it's going to feel like and what she'll need to do when the time comes. - What is menstruation? Menstruation means a girl's body is physically capable of becoming pregnant. Each month, one of the ovaries releases an egg. This is called ovulation. At the same time, hormonal changes prepare the uterus for pregnancy. If ovulation takes place and the egg isn't fertilized, the lining of the uterus sheds through the vagina. This is a period. - Does it hurt? Many girls have cramps, typically in the lower abdomen, when their periods begin. Cramps can be dull and achy or sharp and intense. Exercise, a heating pad or an over-the-counter pain reliever may help ease any discomfort. - When will it happen? No one can tell exactly when a girl will get her first period. Typically, however, girls begin menstruating about two years after their breasts begin to develop. Many girls experience a thin, white vaginal discharge about one year before menstruation begins. - What should I do? Explain how to use sanitary pads or tampons. Many girls are more comfortable starting with pads, but it's OK to use tampons right away. Remind your daughter that it may take some practice to get used to inserting tampons. Stock the bathroom with various types of sanitary products ahead of time. Encourage your daughter to experiment until she finds the product that works best for her. - What if I'm at school? Encourage your daughter to carry a few pads or tampons in her backpack or purse, just in case. Many school bathrooms have coin-operated dispensers for these products. The school nurse also may have supplies. - Will everyone know that I have my period? Assure your daughter that pads and tampons aren't visible through clothing. No one needs to know that she has her period. - What if blood leaks onto my pants? Offer your daughter practical suggestions for covering up stains until she's able to change clothes, such as tying a sweatshirt around her waist. You might also encourage your daughter to wear dark pants or shorts when she has her period, just in case. Your daughter may worry that she's not normal if she starts having periods before, or after, friends her age do, or if her periods aren't like those of her friends. But menstruation varies with the individual. Some girls have periods that last two days, while others have periods that last more than a week. It can even vary this drastically from month to month in the same girl. The amount of blood lost each month can vary, too, usually from 4 to 12 teaspoons (about 20 to 60 milliliters). It's also common for girls to have irregular periods for the first year or two. Some months might even go by without a period. Once your daughter's cycle settles down, teach her how to track her periods on a calendar. Eventually she may be able to predict when her periods will begin. Schedule a medical checkup for your daughter if: - Her periods last more than seven days - She has menstrual cramps that aren't relieved by over-the-counter medications - She's soaking more pads or tampons than usual - She's missing school or other activities because of painful or heavy periods - She goes three months without a period or suspects she may be pregnant - She hasn't started menstruating by age 15 The changes associated with puberty can be a little scary. Reassure your daughter that it's normal to feel apprehensive about menstruating, but it's nothing to be too worried about and you're there to answer any questions she may have.

Daily Dose

Have Your Child's Blood Pressure Checked

1:00 to read

When you take your child in to the pediatrician for a check-up do they check their blood pressure? The American Academy of Pediatrics (AAP) recommends that children, beginning at the age of three years, should routinely have their blood pressure checked.  

In certain circumstances a younger child should have their blood pressure checked too. With the growing epidemic in obesity, pediatricians are seeing more children with abnormal blood pressure readings. It is important that the right sized blood pressure cuff is used for measuring a child’s blood pressure. There are standards for blood pressures for different age children. The standards are also based on a child’s height.

When a child’s blood pressure reading is greater than the 90th percentile for their age they are said to have pre-hypertension. The prevalence of childhood hypertension is thought to be between one and four percent and may even be as high as 10 percent in obese children. Obesity plays a role but, related to that is also inactivity among children, diet, and their genetic predisposition for developing high blood pressure. Then it is appropriate for further work up to be done to evaluate the reason for the elevation in blood pressure.

If I find a child with a high blood pressure reading during their physical exam, it is important to re-take their blood pressure in both arms. I also do not depend on automated blood pressure readings, as I find they are often inaccurate and I prefer to use the “old fashioned” cuff and stethoscope to listen for the blood pressure. If the blood pressure reading is abnormal, then I have the child/adolescent have their blood pressure taken over a week or two at different times of the day. They can have the school nurse take it and parents can also buy an inexpensive blood pressure machine to take it at home. I then look at the readings to confirm that they are consistently high. The “white coat” syndrome, when a doctor assumes that the elevated blood pressure is due to anxiety, may not actually be the case, so make sure that repeat blood pressures are taken. If your child does have elevated blood pressure readings it is important that further evaluation is undertaken, either by your pediatrician or by referral to a pediatric cardiologist.

That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Low Carb Diets

1.15 to read

A recent study in Pediatrics caught my eye as it related to childhood obesity. I spend a good deal of time discussing healthy eating and exercise with my families but I too continue to see children who gain too much weight each year. Some of my patients even qualify as being obese. 

This study out of Cincinnati Children’s Hospital looked at 100 obese 7 -12 year old children and randomly assigned them to one of three different eating plans. One plan followed the wisdom of portion control, another followed a low-carb diet, and the last was a “reduced glycemic load” plan that cut down on certain carbs (like white bread and sweets and white potatoes). 

Over a one year period  all three of the plans worked equally well in helping to control a child’s weight gain. Researchers did find that the low carb plan was tough for kids to stick to. Most of the kids in this group really followed the low carb plan to an extent by reducing carbs and calories, but not to the “strict limits of the low carb plan”. In other words, they modified the plan. 

It seemed that the plan that “reduced the glycemic load” was essentially a modified low carb diet. Children could eat certain “unrestricted” carbs, like fruits and vegetables low in starch as well as whole grains. The limits were only placed on starchy carbs, but even some of those were not “forbidden”. 

The beauty of teaching these kids about modifying their diets early on is that they can see changes in their BMI (body mass index) more quickly than an adult. Why?  They are still growing!! I explain to the kids (and their parents) that a pre-pubertal child grows about 2 inches a year and should gain somewhere around 3 - 6 lbs a year.  All of that changes with puberty as their child’s growth velocity and weight gain both increase. 

But, since a child is growing that by just maintaining their weight, not losing weight, they will see changes in their body. Although children think this is “easy” it still requires effort and changes.   

Small changes like cutting portions and reducing carbs (rather than trying to eliminate them) will reduce total daily calories. Add in daily exercise and your child will see real results. It is still a matter of burning more calories than you consume! 

Lastly, the whole family has to be involved in the changes. You have to pick a plan that the entire family can follow and stick to as families come in all different sizes. 

That’s your daily dose for today.  We’ll chat again tomorrow. 

Your Baby

Kids of Obese Mothers at Higher Risk for Autism, ADHD

1:45

A new study points out another reason that obesity and pregnancy can be a bad combination not only for the mother but for her future child as well.

Researchers found that six-year-olds whose mothers were severely obese before pregnancy are more likely to have developmental or emotional problems than kids of healthy-weight mothers.

The lead author of the study, Heejoo Jo of the Centers for Disease Control and Prevention (CDC), and her team reviewed data on 1,311 mother-child pairs collected between 2005 and 2012, including the mothers’ body mass index (BMI, a height-to-weight ratio) before pregnancy and their reports of the children’s psychosocial difficulties at age six.

The researchers also incorporated the children’s developmental diagnoses and receipt of special needs services.

Kids of moms who were severely obese, with a BMI greater than 35, were twice as likely to have emotional symptoms, problems with peers and total psychosocial difficulties compared to kids of moms who had a healthy BMI, between 18.5 and 25.

Their children were three times as likely to have a diagnosis of autism spectrum disorder and more than four time as likely to have attention-deficit/hyperactivity disorder (ADHD), as reported in the journal Pediatrics.

Previous studies have shown a connection with autism and maternal diabetes and obesity.

Researchers took into account pregnancy weight gain, gestational diabetes, breastfeeding duration, postpartum depression and infant birth weight. None of these explained the apparent association.

“We already do know that obesity is related to health problems during pregnancy and throughout the lifetime,” Jo said. “I think this adds to that by suggesting that not only does severe obesity affect a woman’s health but the health of her future children.”

This study could not analyze the mechanism linking severe obesity and later risk for developmental problems, Jo noted.

“One theory that we could not look at and needs further research was some small studies have linked maternal obesity to increased inflammation, which might affect fetal brain development,” she told Reuters Health by phone.

While it sounds cliché because we’ve heard it so much; obesity in America has reached epidemic status. Almost 30 percent of Americans are obese and the prevalence of maternal obesity has risen rapidly in the last two decades.

In the USA, approximately 64% of women of reproductive age are overweight and 35% obese.

Women’s health specialists recommend that obese women considering pregnancy lose weight before they conceive to help reduce health risks for themselves as well as their child.

The Academy of Pediatrics recommends that all children be screened for developmental delay or disability at nine, 18 and 24 or 30 months of age.

Health experts strongly suggest that women who were obese or severely obese when they became pregnant make sure that their children receive these developmental screenings.

Sources: Kathryn Doyle, http://www.reuters.com/article/2015/04/28/us-obese-pregnancy-adhd-kids-idUSKBN0NJ2FC20150428

James R. O'Reilly, Rebecca M. Reynolds, http://www.medscape.com/viewarticle/776504

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Childhood Obesity

Childhood Obesity & Weight Management

Daily Dose

Get Your Toddlers Walking!

With childhood obesity numbers rising, get your toddlers out of a stroller and walking!I walked into our office waiting room recently and was shocked at how crowded it was!! It really wasn’t that there were that many patients waiting, but it was the fact that there were about 6 “triple wide” strollers holding children of various ages who were being wheeled in and parked in the waiting room.

Not one toddler was walking or even standing!! I had a huge epiphany, children don’t walk anymore!! So, after looking out at the parking lot in our waiting room, I watched as these strollers maneuvered around hallways and doors as mothers brought their children to an exam room. Now, I must tell you, these children were not infants, or even new walkers. They were not twins or triplets either. These strollers were often holding a 5 year old, 3 year old and 1 year old, all being pushed toward their destination. In many cases, the older children were playing with a Nintendo DSL or their mother’s iPhone oblivious to the fact that their mother was struggling to push the “wide load” down the hallway.  It was reminiscent of a Cleopatra movie, while she was being carried eating grapes! I know I'm showing my age, but what happened to the day that the baby was in a stroller while the parent held the older children’s hands as they walked into our office, or a store or a restaurant. You may have even tried to maneuver around one of these mega strollers while shopping alone.  They take up entire aisles and should have to have a “wide load” sign with flashing lights. Not only are they a “road hazard” I think that they promote inactivity. Knowing that we have a terrible problem with childhood obesity, it seems that these” strollers on steroids”, only help promote inactivity. Not only are these toddlers and young children not walking on their own, they are missing out on many learning opportunities.  How many times do you remember saying or hearing,  “hold my hand” before you started walking through grocery store the parking lot?  How about “we have to stop and look both ways” as you came up to an curb or intersection.  If there were more than 1 or 2 children it was not uncommon to hear “hold your brother’s hand and he will hold my hand and we will all walk together”. These are important skills/lessons for a child to learn as they begin to establish some independence and autonomy.  You have to learn to ”run before you walk” and you have to learn how to navigate on your own by following simple “rules of the road” for safety, all of which needs to be achieved under a parent’s watchful eye during those early childhood years. These skills cannot be mastered when you are being “wheeled” around town without the need to pay attention to what is happening around you. At the same time that a child is inactive in the stroller, they are often eating cookies, goldfish, cheerios or granola bars and drinking from the sippy cup which is conveniently strapped to the side of their seat.  The combination of inactivity and snacking cannot be a positive way to promote a healthy lifestyle. I challenge mothers and fathers to get their children back on terra firma, and to hold hands and walk with their children rather than push those heavy children around. (can’t be good for the parent’s backs either).  Talk about where you are going, what you see along the way, and practice your child’s listening skills and following directions.  Return the mega stroller to the store and get those toddlers and pre-schoolers some good walking shoes! What do you think?  Send me your comments! That's your daily dose for today. We'll chat again tomorrow. Send your comment or question to Dr. Sue!

Daily Dose

Family Dinners Help Fight Obesity

1.15 to read

Sadly, the problem with obesity in America does not seem to be going away, and is not even improving!! The latest data shows that adult obesity rates have risen in 23 states in 2009 and the trend continued through 2010 and 2011.

Obesity and the problems associated with it, type 2 diabetes, heart disease, joint problems etc. begin in childhood. If we cannot change our children’s eating and exercise habits we have no hope of stemming the tide of ongoing obesity. By 2020 the headlines might read, “Obesity rising in all 50 states” with the majority of the population dealing with this crisis. In that vein we must not only begin modeling better eating habits for our children, but do so by returning to the idea of family meals. Family meals were the “norm” when I was growing up. We were fortunate to have breakfast and dinner at home each day and we were expected to be present for those meals. I know it was hard for my mother to do this as she worked when I was young, and my father travelled a great deal of the time. But parental sacrifice has not changed over time, and we all know that we will often do things “just for the kids”. The good thing about preparing meals these days is that the grocery stores have made it quite easy for even a very busy family to be able to prepare a “home cooked” meal. All of the chains have rotisserie chickens available and also offer prepackaged meats such as meat loaf, pre-made hamburger patties, or fish filets. The salads are also prepackaged and you can even buy fruit already cut up. I am “thrifty” and don’t mind making my own hamburger patties or cutting up fruit, but picking up a chicken on the way home from work is often a quick way to begin a dinner. The chicken can be used in a salad or used as a main course. We parents just have to be a little more inclined to drive through the grocery store rather than the fast food restaurant. I am still convinced that our children will eat what we prepare and gather together for meals if that becomes the norm once again. Our kids are busy too, and they will appreciate knowing that dinner will be there every night, and that it will be healthy. Leading by example is the best way to begin. We can’t afford not to try! That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Chubby Toddlers & Weight Gain

1.15 to read

So, what goes on behind closed doors? During a child’s check up, I spend time showing parents (as well as older children) their child’s growth curve. This curve looks at a child’s weight and height, and for children 2 and older, their body mass index (BMI). This visual look at how their child is growing is always eagerly anticipated by parents as they can compare their own child to norms by age, otherwise called a cohort. 

I often then use the growth curve as a segue into the discussion about weight trends and a healthy weight for their child. I really like to start this conversation after the 1 year check up when a child has  stopped bottle feeding and now getting regular meals adn enjying table food. 

This discussion becomes especially important during the toddler years as there is growing data that rapid weight gain trends, in even this age group, may be associated with future obesity and morbidity. Discussions about improving eating habits and making dietary and activity recommendations needs to begin sooner rather than later. 

I found an article in this month’s journal of Archives of Pediatrics especially interesting as it relates to this subject.  A study out of the University of Maryland looked at the parental perception of a toddler’s (12-32 months) weight. The authors report that 87% of mothers of overweight toddlers were less likely to be accurate in their weight perceptions that were mothers of healthy weight toddlers. 

They also reported that 82% of the mothers of overweight toddlers were satisfied with their toddler’s body weight. Interestingly this same article pointed out that 4% of mothers of overweight children and 21% of mothers of healthy weight children wished that their children were larger. 

Part of this misconception may be related to the fact that being overweight is becoming normal.  That seems like a sad statement about our society in general. 

Further research has revealed that more than 75% of parents of overweight children report that “they had never heard that their children were overweight” and the rates are even higher for younger children. If this is the case, we as pediatricians need to be doing a better job.  

We need to begin counseling parents (and their children when age appropriate) about diet and activity even for toddlers. By doing this across all cultures we may be able to change perceptions of healthy weight in our youngest children in hopes that the pendulum of increasing obesity in this country may swing the other way. 

That’s your daily dose for today.  We’ll chat again tomorrow.

Your Child

USDA New Rules: Healthier School Lunches

1.45 to read

Government funded school lunches will offer more fruit and vegetables and less fat on their lunch plates starting next September.

New guidelines by the U.S. Department of Agriculture (USDA)   were announced Wednesday when First Lady Michelle Obama, and Agriculture Secretary Tom Vilsack, visited with elementary students.

"Improving the quality of the school meals is a critical step in building a healthy future for our kids," said Vilsack. "When it comes to our children, we must do everything possible to provide them the nutrition they need to be healthy, active and ready to face the future – today we take an important step towards that goal."

It’s been more than 15 years since the school lunch program has had an overhaul. The changes will affect over 32 million kids who eat at school. The new regulations will be phased in over the next three years, starting in the fall.

Under the new regulations, schools will be required to offer fruits and vegetables every day, increase the amount of whole-grain foods and reduce the sodium and fats in the foods served. Schools will also be required to offer only fat-free or low-fat milk. In addition, the menus will pay attention to portion sizes to make sure children receive calories appropriate to their age, according to Kevin Concannon, USDA under secretary for food, nutrition and consumer services.

The new requirements are part of the Healthy, Hunger-Free Kids Act signed into law last year by President Barack Obama and championed by the First Lady Michelle Obama as part of her Let's Move! campaign.

"As parents, we try to prepare decent meals, limit how much junk food our kids eat, and ensure they have a reasonably balanced diet," Mrs. Obama said. "And when we're putting in all that effort the last thing we want is for our hard work to be undone each day in the school cafeteria."

The new guidelines apply to lunches that are subsidized by the federal government. The government will help school districts pay for some of the increased costs. Schools will receive an additional 6 cents per meal in federal funding. The overall cost to implement the changes is expected to be about $3.2 billion. To help with the costs, Concannon said schools will have more flexibility in how the program is administered. Students, for example, will be allowed to pick and choose more items as they move through the line, rather than getting a plate served to them.

Some of the changes will take place as soon as this September; others will be phased in over time. The subsidized meals are served as free and low-cost meals to low-income children. The 2010 law will also extend to nutrition standards of other foods, sold in schools, that aren't subsidized by the federal government. Included will be "a la carte" foods on the lunch line and snacks in vending machines. Those standards will be written separately and have not yet been proposed by the department.

Wendy Weyer, director of nutrition services for Seattle Public Schools, said her district is already complying with many of the new USDA standards, and taking other steps, such as having partnerships with local farmers and planting school gardens. "Seattle has been very progressive with changing the way we offer meals, offering fruits and vegetables every day, as well as whole grain-rich foods," she said.

Weyer said the biggest challenge is reducing sodium content, "while keeping the meals palatable for our students."

Statistics show that about 17 percent of U.S. children and teenagers are obese, according to the Centers for Disease Control and Prevention. The new standards are aimed at providing a higher nutritional content as well as a variety of healthier choices. 

“We strongly support the regulations,” said Diane Pratt-Heavner, spokeswoman for the Maryland-based School Nutrition Association. “The new nutrition standards for school meals are great news for kids.” Pratt-Heavner said parents will play an important role in supporting the new standards.  ”We all have to work to get the kids to make these healthier choices,” she said. “Students are more apt to pick up a fruit or vegetable in the lunch line if they have been introduced to those foods at home.” 

Vilsack said food companies are reformulating many of the foods they sell to schools in anticipation of the changes. "The food industry is already responding," he said. "This is a movement that has started, it's gaining momentum."

The new standards did not come easily. Congress last year blocked the Agriculture Department from making some of the desired changes, including limiting french-fries and pizzas. Conservatives in Congress called the guidelines an overreach and said the government shouldn't tell children what to eat. School districts also objected to some of the requirements, saying they go too far and would cost too much.

Some schools are already making voluntary changes in their menus, but others still serve children meals high in fat, calories and sodium.  The guidelines are designed to combat childhood obesity and are based on 2009 recommendations by the Institute of Medicine, the health arm of the National Academy of Sciences.

Sources: http://usnews.msnbc.msn.com/_news/2012/01/25/10234671-students-to-see-healthier-school-lunches-under-new-usda-rules,  http://www.google.com/hostednews/ap/article

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