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Daily Dose

Bedtime!

1:30 to read

Bedtime….an important word for parents and for children. A recent 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.  

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

Your Child

Will 60% of U.S. Children be Obese by Age 35?

2:00

As many as six in ten U.S. children could be obese by the time they are 35 years old. That sobering news comes from a study conducted by "Childhood Obesity Intervention Cost-Effectiveness Study" (CHOICES).

The numbers are a result of data entered into a computer. The investigators first combined height and weight data from five studies involving about 41,500 children and adults. The computer then generated a representative sample of 1 million "virtual" children up to the age of 19, living in the year 2016. The model then predicted how obesity rates would unfold until all the virtual children turned 35.

The model indicated that being overweight or obese early in life bumped up the risk for being obese later in life. In addition, the more overweight or obese someone was as a child, the greater the person's chance of being obese by age 35.

According to the U.S. Centers for Disease Control and Prevention (CDC), roughly 20 percent of American children between the ages of 6 and 19 years of age are currently obese. That reflects a tripling of the number since the 1970s.

The study’s lead author, Zachary Ward, a doctoral candidate in health policy with the Harvard T.H. Chan School of Public Health's Center for Health Decision Science, in Boston, noted that the results were not unexpected.

"It should not be surprising that we are heading in this direction. We are already approaching this level of adult obesity for certain subgroups [and] areas of the country." Ward said.

Still, Ward expressed some surprise at how strongly being obese at a very young age predicted obesity decades down the road. 

"For example, we found that three out of four 2-year-olds with obesity will still have obesity at age 35," he said. "For 2-year-olds with severe obesity, that number is four out five."

Lona Sandon, an assistant professor of clinical nutrition at the University of Texas Southwestern Medical Center in Dallas, was also not surprised at the findings.

"Trends show obesity occurring earlier in adulthood, and [the] current level of childhood obesity suggests that the trend will continue," said Sandon, who was not involved with the analysis. 

Because "obesity is difficult to reverse at any age," she said, prevention is key. Parents should not rely solely on public school nutrition and activity programs to do the job.

Earlier studies have suggested that obesity in children may begin in the womb if the mother is obese when she becomes pregnant, and develops gestational diabetes. This combination can produce a large child at birth. Studies have shown that babies born with higher amounts of fat at birth tend to continue having more body fat in childhood and on into adulthood.

Experts recommend that overweight women that are considering becoming pregnant, first lose the extra weight and be tested for type2 diabetes. If they are found to have type2 diabetes before they're pregnant, they should be treated beforehand; this will help their pregnancy and prevent complications.

Sandon also notes that there are other things parents can do to help insure a healthier child. "Concerned parents can make efforts to prepare and provide healthier foods at home, plan regular scheduled mealtimes, limit screen time, encourage participation in sports, encourage participation in active leisure time activities instead of more sedentary activities and, most of all, set an example by being active, having a healthy relationship with their own food choices and having regular mealtimes as well."

The study by Ward and his colleagues appears in the November issue of the New England Journal of Medicine.

Story sources: Alan Mozes, https://www.webmd.com/children/news/20171129/60-percent-of-us-kids-could-be-obese-by-age-35#1

Lucilla Poston, Professor, https://www.news-medical.net/news/20170111/Childhood-obesity-starts-in-the-womb.aspx

 

 

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 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 Baby

Obese During Pregnancy Linked to Obesity in Offspring

2:00

Not every time, but often, you’ll see obese couples and their kids are either obese or on the threshold of obesity. While adults have the power and the life experience to understand the health issues associated with obesity, their children – depending on their age- are reliant on on their parents making healthy choices for them.  

 Is generational obesity inherited or a case of families making poor choices where food and exercise are concerned – or both?

Researchers from the University of Colorado School of Medicine wondered if children born to obese moms might be predisposed to being obese due to their womb environment.

The team of scientists analyzed stem cells taken from the umbilical cords of babies born to normal weight and obese mothers. In the lab, they coaxed these stem cells to develop into muscle and fat. The resulting cells from obese mothers had 30% more fat than those from normal weight mothers, suggesting that these babies’ cells were more likely to accumulate fat.

No cause and effect was established, but the scientists noted that further research was needed. “The next step is to follow these offspring to see if there is a lasting change into adulthood,” says the lead presenter, Kristen Boyle, in a statement.

She and her colleagues are already studying the cells to see whether they use and store energy any differently from those obtained from normal-weight mothers, and whether those changes result in metabolic differences such as inflammation or insulin resistance, which can precede heart disease and diabetes.

Other studies have found a high correlation between parents’ Body Mass Index (BMI) numbers and their children ‘s BMI, particularly between mothers and their kids. Further, the BMI of grandmother’s and their grandchildren is also high.

What is a healthy weight gain for a pregnant woman? It depends on how much you weigh before getting pregnant.

The guidelines for pregnancy weight gain are issued by the Institute of Medicine (IOM); most recently in May 2009. Here are the most current recommendations:

•       If your pre-pregnancy weight was in the healthy range for your height (a BMI of 18.5 to 24.9), you should gain between 25 and 35 pounds, gaining 1 to 5 pounds in the first trimester and about 1 pound per week for the rest of your pregnancy for the optimal growth of your baby.

•       If you were underweight or your height at conception (a BMI below 18.5), you should gain 28 to 40 pounds.

•       If you were overweight for your height (a BMI of 25 to 29.9), you should gain 15 to 25 pounds. If you were obese (a BMI of 30 or higher), you should gain between 11 and 20 pounds.

•       If you're having twins, you should gain 37 to 54 pounds if you started at a healthy weight, 31 to 50 pounds if you were overweight, and 25 to 42 pounds if you were obese.

These recent findings point out again, how important it is for pregnant women to consider the possible long - term health affects on their unborn offspring when making decisions about their own health.

The report was presented in May to the American Diabetes Association.

Sources: Alice Park, http://time.com/3906135/obese-moms-wire-kids-obesity-during-pregnancy/

http://www.babycenter.com/0_pregnancy-weight-gain-what-to-expect_1466.bc

 

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

Kids, Media & Obesity

1.30 to read

A new study looks at the link between a child's media use and body weight. A recent study in the July issue of Pediatrics looks at mounting research showing that a child’s media use may be linked to their body weight, not only due to the fact that they don’t get as much exercise if they are watching TV and using other media, but also due to other issues related to media exposure.

The new policy statement from the American Academy of Pediatrics, entitled “Children, Adolescents, Obesity and the Media” states that, “American society couldn’t do a worse job at the moment of keeping children fit and healthy – too much TV, too many food ads, not enough exercise, and not enough sleep.” It has become my routine during well child exams, beginning as young as 2 years of age, to ask parents as well as older children, “Do you have a TV in your room?”, “Do you have a computer or DVD player in your room?” I am still amazed at the number of young children who answer “yes” to this question.  Fortunately, many also respond “No”, and then ask me when they may have a TV in their room?  My standard answer is “When you leave home and go to college or work.”  Most parents are relieved with this response. A few don’t understand why I am even asking the question. This new policy statement reiterates that parents need to be paying attention to the amount of “screen” time their children get daily. Total non-educational screen time (again, the definition of educational may vary from family to family), should be no more than 2 hours per day. This limit on screen time should also be enforced in child care centers, after school program and in community centers. According to the statement, the numerous ads on air for junk foods and fast foods, only increases a child’s desire for these foods. It is easy to keep your child from buying Cocoa Puffs or Fruit Loops (just randomly selected, you can fill in your cereal) when they have never seen the cute ad for these sugary cereals. I still remember, “Trix are for kids!”  Children who are allowed to stay up late at night watching TV are not only exposed to numerous ads, but at the same time do son get enough sleep, and the combination puts them at greater risk for childhood obesity.  Dr. Victor Strasburger, one of the lead authors states, “Kids see 5,000 to 10,000 food ads per year, most of them for junk food and fast food.” By asking parents and their children about screen time pediatricians can encourage a family to have a well thought out plan for limiting screen time while encouraging outside activity. These recommendations will hopefully translate into less screen time, less exposure to advertising, less sedentary activity and ultimately a healthier weight for children. What do you think? I would love your comments and feedback.

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.

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