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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.

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

Bedtime!

1:30 to read

Bedtime….an important word for parents and for children. A new study in Pediatrics just reinforces how important bedtimes for children may be.  The research shows that preschool children who had an earlier bedtime were less likely to become obese in their teenage years. 

The study involved nearly 1,000 children who were born in 1991 and whose parents recorded their bedtimes when they were 4.5 years old.  The researchers then looked at the growth data (height/weight) for these children when they were 15 years of age.

Interestingly, the pre-school children who were in bed by 8:00 p.m. had half the risk of becoming obese as a teenager compared to those children who went to bed after 9 pm. Specifically, of the children who went to bed by 8 pm, only 10 percent were obese as teens, while 16 percent of those who went to bed between 8 and 9 pm developed obesity, and 23 percent of those children   who had bedtimes after 9 pm developed teenage obesity. 

While there has been much research surrounding sleep and obesity (as well as behavior), this study provides even more evidence to the possible “protective effect” of early bedtime and bedtime routines for young children.  If getting to bed on time and earlier can in some way help stem the obesity tide, it would seem like an easy recommendation for many parents to follow.  

As a mother I was always a “fan” of schedules and bedtimes…and actually putting your child to bed at night is such a wonderful time of day. The routine of a bath, snuggles, some books ( with wishes for just one more) and more hugs and kisses is such a wonderful memory I have of my own 3 boys. It just seemed that everyone was happier (and I guess healthier) when we had early bedtimes. I remember I had a friend who always had her 3 young children fed, bathed and in bed by 7:00 p.m. every night..and in those pre cell phone days we did not dare call her house after that time!!  

I also think bedtime routines are important for younger children year round. While it is more difficult to have regular bedtimes for older children during the summer months, children under elementary school age (and maybe even older) really do benefit from continuing on the same bedtime schedule during the summer months.  I think if you told your middle school or teenager this “rule” there  might be mutiny….but I know as well as a working parent, it is much easier to have a routine even when the kids are out of school…they would totally disagree!

I am excited about this study and using it as another resource when discussing sleep habits and bedtime routines with my patients.  This is especially important as we get ready to discuss back to school sleep routines….summer does fly by!

Your Baby

Longer Breast-Feeding Time, Less Childhood Obesity

2:00

A new study looks at the duration of breast-feeding and babies who are high risk for obesity, as they get older. Researchers found that the longer mothers breast –fed these higher risk babies, the less likely the babies were to become overweight later.

"Breast-feeding for longer durations appears to have a protective effect against the early signs of overweight and obesity," said lead researcher Stacy Carling, a doctoral candidate in nutrition at Cornell University, in Ithaca, N.Y.

Carling and her colleagues followed 595 children from birth to the age of 2. They tracked the children's weight and length over this time, and compared individual children's growth trajectories to how long the children breast-fed.

Which children are considered at high risk for extra weight gain? Researchers found that babies whose mothers were overweight or obese, mothers with lower education levels and mothers who smoked during pregnancy were more likely to have overweight children. Almost 59 percent of the children at risk for being overweight had mothers with one or more of these characteristics, compared to about 43 percent of the children not at risk for excessive weight gain.

Higher-risk babies who breast-fed for less than two months were more than twice as likely to gain extra weight than those who breast-fed for at least four months.

Although the study didn’t prove that longer breast-feeding actually reduced risk for obesity, it did provide several reasons why the link between the two may exist.

"Breast-feeding an infant may allow proper development of hunger and satiety signals, as well as help prevent some of the behaviors that lead to overweight and obesity," Carling said.

"Breast-feeding, especially on demand, versus on schedule, allows an infant to feed when he or she is hungry, thereby fostering an early development of appetite control," she said. "When a baby breast-feeds, she can control how much milk she gets and how often, naturally responding to internal signals of hunger and satiation."

The study did not include information on whether the babies were exclusively breast-fed or how often they were getting milk at the breast versus from a bottle, but the time required to reduce obesity risk was not long.

"The difference of two months of breast-feeding may be enough to reap some benefit," Carling said.

There are many reasons mothers choose to breast-feed for shorter periods, and some mothers are not able to breast-feed at all. For mothers that choose to breast-feed, Carling believes they need to be supported on many levels.

"Ultimately, increasing breast-feeding rates in the United States means increasing knowledge and support at a variety of levels from institutional to interpersonal," Carling said. "Our study recognizes the benefit of longer duration breast-feeding in a specific population and, hopefully, this and other studies will lead to more customized breast-feeding promotion in those populations at higher risk for overweight and obesity."

The findings were published in the January print issue of Pediatrics, and funded by the U.S. National Institutes of Health. The authors reported no conflicts of interest.

Source: Tara Haelle, http://consumer.healthday.com/women-s-health-information-34/breast-feeding-news-82/breast-feeding-for-longer-may-protect-infants-at-risk-for-obesity-694218.html

Your Teen

Good Family Relationships Helps Teens Avoid Obesity

1:30

Two of the most valuable resources a teen can have are a stable family and a good relationship with their parents. Adolescents that have these two important components in their lives are more likely to develop healthy habits that may protect them from obesity, according to new study.

"A high level of family dysfunction may interfere with the development of healthful behaviors due to the families' limited ability to develop routines related to eating, sleep or activity behaviors, which can lead to excess weight gain," said the study's lead author, Jess Haines, of the University of Guelph in Ontario.

For the study, the researchers reviewed information on about 3,700 daughters and 2,600 sons, aged 14 to 24, in the United States.

About 80 percent reported having close and stable families. The findings showed that 60 percent of daughters and 50 percent of sons said they had a good relationship with their parents.

Researchers also found that teens with good family relationships are more likely to be more active and get enough sleep. Two factors, in addition to a healthy diet, that contributes to reasonable weight control.

The daughters in these families ate less fast food, and were less likely to be overweight or obese, the researchers discovered.

They also noted that fathers play an important role in helping their sons develop better choices that allow them to maintain a healthy weight.

"Much of the research examining the influence of parents has typically examined only the mother's influence or has combined information across parents," Haines said in a university news release.

"Our results underscore the importance of examining the influence fathers have on their children, and to develop strategies to help fathers support the development of healthy behaviors among their children," she said.

"It appears the father-son parent relationship has a stronger influence on sons than the mother-daughter relationship has on young women," said Haines.

As kids grow into adolescents, a tug of war between independence and parental control often develops. Research has shown that ongoing positive family relationships offer protective influences for teens against a range of risky behaviors. Sometimes it may feel like as our teens mature, family influence begins to wane - but that’s not the reality. This study points out how important a stable home life and good relationships are in helping teens develop a lifetime of healthy habits.

The study was published recently in the International Journal of Behavioral Nutrition and Physical Activity.

Story source: Mary Elizabeth Dallas, https://consumer.healthday.com/public-health-information-30/family-health-news-749/parents-play-key-role-in-teens-health-712354.html

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

Plate Size & Childhood Obesity

1.15 to read

While I have been trying to change up my eating habits a bit and talking to patients about trying some new foods, I came upon an interesting study in the journal Pediatrics.  

The hypothesis for the study, which was done among school children in Philadelphia, was “can smaller plates promote age-appropriate portion sizes in children?”.

There have been previous studies in the adult literature that have shown that dish ware size influences self-serve portion sizes and caloric intake. Whether the same conclusions with children were true had yet to be examined, but it does make sense that it might.

So, the hypothesis was correct and when children were given larger bowls, plates and cups, they served themselves larger portions and in turn more calories. In the study, 80% of the children served themselves more calories at lunch when using adult-size plates and bowls.

This is really great news, in that by changing the size of the plate we might be able to affect a child’s portion size without them even really being aware!

I remember that our kids all had children’s bowls, plates and cups that they loved to use and eventually they either broke, got lost, or we just decided to have everyone eat off of the same plates. But, maybe it would make more sense to continue to have our children use child sized plates until they reach puberty?  Certainly seems that it wouldn’t hurt and if schools did the same thing we might be able to impact some of the obesity problem by just changing one behavior.  It is definitely worth trying!

Daily Dose

School Lunches & Obesity

1.30 to read

Since we have been talking about healthier school lunches, I thought I would share with you an interesting article in last month’s Pediatrics which related to regulations on school snacks.  

While the nutrition standards for school meals changed for the 2012-2013 school year, the new guidelines do not effect foods in vending machines, snack bars or other venues within the school that are not a part of the regular school meal programs. These foods (typically snacks and drinks) are termed “competitive foods” as they compete with school breakfasts and lunches. 

This study looked at weight changes for 6,300 students between 2004-2007 and followed the students from fifth to eighth grade.  They found that adolescents in states with strict laws regulating the sale of “competitive foods” gained less weight over this 3 year period than those living in states without laws. 

As the childhood obesity epidemic continues (the CDC now estimates that 1/5 of American children are obese), public health officials continue to look at ways to improve a child’s eating habits during the school day.  The laws surrounding snack foods at school differ by state. There are no laws in some states, weak laws (where recommendations were made but there were no specific guidelines), and strong laws (where detailed nutritional standards were issued). 

The study did not conclude that strong laws were directly responsible for the differences in a student’s weight gain, but it did conclude that these outcomes tended to happen in states with strong laws.  That would seem to make sense to me as most children including my own, if given the opportunity, would at times choose vending machine snacks over a healthy school lunch. 

I also think that this is more common as the children become teens and seem to “snack” for lunch while multi-tasking rather than sitting down to eat a well balanced lunch. I continually hear this comment from adolescent patients of mine when I ask them about their lunch habits, and many of whom eat “off campus” if allowed, and choose fast foods over a healthy school cafeteria lunch.  Off school lunches seem to be another issue as well. 

One of the lead authors on the study stated, “competitive-food laws can have an effect on obesity rates if the laws are specific, required and consistent”. It seems like this might be a good cause to discuss with your own state representative.

Daily Dose

Cut Soda to Fight Childhood Obesity

Getting rid of sugar-laden drinks and replacing them with water has a dramatic impact on the amount of calories children consume and could help in the fight against childhood obesity. Researchers from Columbia Mailman School of Public Health in New York found that children get 10 to 15 percent of the daily caloric intake from empty calories.

"The key observation is that when kids substitute sugar-sweetened beverages with water, there is a significant decline in total energy intake without any compensatory increase in the consumption of other beverages or food," said Dr. Y. Claire Wang. Dr. Wang also noted that substituting calorie-free beverages "is a simple and effective way of eliminating the excess calories while improving the diet quality." Sugar-sweetened beverages "should be viewed as treats, not necessities, and water is a perfect substitute for the purpose of thirst-quenching," Wang said. Wang and her colleagues looked at diet data from the 2003-2004 National Health and Nutrition Survey of over 4,000 children aged two to 19 years. They found that substituting sugar-sweetened beverages with water was associated with significant reductions in total calories consumed. Wang and colleagues estimate that replacing all sugary drinks with water could cut out an average of 235 calories out of kids' diets each day. Since the late 1970s, consumption of sugary drinks by children and adolescents has increased "substantially," and is thought to be "an important contributing factor to obesity," the researchers point out in the Archives of Pediatrics and Adolescent Medicine. "Replacing these liquid calories with calorie-free beverage alternatives therefore represents a key strategy to eliminate excess calories and to prevent obesity in childhood," they conclude.

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What can you do if your child stinks?

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