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Daily Dose

Don't Let Your Child Become an Obesity Statistic

Healthy eating begins with the first foods that you feed your infant.An alarming statistic was released today which shows that one in five 4-year-old children are obese and these numbers are even higher in minority children. This study was just published in The Archives of Pediatric and Adolescent Medicine, and followed over 8,000 children looking at height and weight. The findings were quite concerning, showing a trend toward obesity at an age younger than predicted, and numerous long term health problems associated with obesity, such as heart disease, diabetes, high blood pressure and bone and joint problems.

This is a national health issue and a call to action for all families to teach and model healthy eating. One of the problems is that many of the government sponsored food programs provide foods high in carbohydrates, and low in fresh fruits and vegetables, and this promotes obesity. School lunches have also been found to be high in fat and carbohydrate and continue to promote poor food choices. With the bad economy and recession, families have cut back on groceries and may be eating more fast foods, breads and pastas, again providing more carbohydrate than protein. Healthy eating begins with the first foods that you feed your infant. A well balanced diet with grains, fruits, vegetables and meats begins in the high chair and should continue at the family dinner table. The meals may be simple and healthy. Being a short order cook, or providing your child's favorite pizza and fried food on a daily basis, even in a young toddler will have deleterious effects for the rest of their life. Don't let your child become a statistic heading toward lifelong health issues secondary to childhood obesity. Change your own eating habits, improve your children's and remain committed to family meals. We, as parents, cannot afford to raise a generation where obesity is the norm: the change must begin now. That's your daily dose, we'll chat again tomorrow. More Information: 1 in 5 Preschoolers Obese

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.

Daily Dose

Infant Weight Gain & Obesity

1:15 to read

A new study out of Harvard that was published in Pediatrics, looks at infant weight gain and links to childhood obesity. This is an interesting study, as previous studies had typically looked at weight alone as a predicator for future problems with obesity. In this study the authors looked at both weight and length as a measure of fatness.

They also looked at weight as a dynamic process, in other words, it was not how much you weighed, but how quickly you gained the weight in infancy. The authors found that the correlation between rapid infant weight gain and later obesity was striking. Other studies have also looked at the relationship between infant and childhood weight but this study makes a compelling argument that early rapid weight gain, even in the first months of infancy, could have long term health consequences.

So, armed with this knowledge, what can a parent do? Follow the AAP guidelines to exclusively breast or formula feed your baby for the first six months of life. If a your-baby is formula fed, limit their daily intake to an appropriate amount for age. Many parents, for a multitude of reasons, decide to add cereal to their baby's bottle in hopes that this will "make their infant sleep through the night". To my knowledge there has never been any data to confirm this, (maybe the Mommy network) and additional calories in infancy may lead to long-term consequences. Juices and early introduction of your-baby foods may also add unnecessary calories. This study points out the need to modify weight gain in infancy in a manner that will balance the needs of an infant's brain as well as their body, during this time of rapid development.

That's your daily dose, we'll chat again soon.

Daily Dose

Cholesterol & Children

1.00 to read

I have been attending a conference for my continuing education (I still love going to school) and one of the topics was “Universal Cholesterol Screening in Children”.  While adults have known the importance of healthy cholesterol levels for a long time, there is more and more data to validate the need for children to have cholesterol levels monitored as well. 

The current guidelines by the National Heart, Lung and Blood Institute, which are also endorsed by the AAP recommend that ALL children, regardless of family history have either a non-fasting total cholesterol and HDL level or a fasting lipid panel performed between the ages of 9 & 11 years and again between 17-21 years. Again, these are screening tests only. 

The recommendations previously supported screening cholesterol levels for children who had a family history of elevated cholesterol levels or those with familial risk factors for coronary artery disease. Knowing that coronary artery disease is the leading cause of death in the U.S., and also realizing that coronary artery disease really begins in childhood, modifying risk factors in childhood will hopefully lead to a reduction in coronary artery disease later in life. One of these risk factors is elevated cholesterol levels. 

What is a healthy cholesterol for a child? A non-fasting lipid panel should look at total cholesterol minus the HDL cholesterol, which gives a non-HDL cholesterol total.  The current guidelines recommend that the non-HDL cholesterol should be < 145mg/dl and the HDL should be > 40 mg/dl. If a fasting lipid panel is used the LDL should be < 130 mg/dl, HDL > 40 mg/dl and non-HDL cholesterol <145 mg/dl as well. 

The guidelines also state that if the cholesterol is abnormal a repeat screen should be done 2 weeks-3 months after the first screening and the results should be averaged before deciding on further investigation or treatment. 

Additionally, there are risk factors such as a history of obesity, high blood pressure, smoking, a history of Kawasaki disease and a family history of early coronary artery disease or sudden cardiac death which should also be considered in the context of evaluating a child’s cholesterol.   

Knowing your child’s cholesterol should help parents engage in diet and lifestyle changes for the entire family. If you know that your child already has a slightly elevated cholesterol work on dietary changes at home.  Try limiting your children’s fat to 25-30% of total calories, and limit saturated fat to 8-10% of calories as well as avoiding trans fat!  Encourage high fiber foods. Have your child’s plate be colorful with a mixture of fruits and vegetables. 

Lastly, to help lower cholesterol you need to exercise.  That is a prescription we doctors should be writing routinely. Get the family out and move! 

More on cholesterol and the use of statins in children in a future daily dose.  Stay tuned!

Your Baby

Starting Baby on Solid Foods

Your goal over the next few months is to introduce a wide variety of foods. If your baby doesn't seem to like a particular food, reintroduce it at later meals. It can take quite a few tries before kids warm up to certain foods.Starting baby on solid foods can be an exciting and perplexing time for parents. What foods should I start with? How much? How often?

The American Academy of Pediatrics currently recommends gradually introducing solid foods when a baby is about 6 months old. Your pediatrician, however, may recommend starting as early as 4 months depending on your baby's readiness and nutritional needs. Be sure to check with your pediatrician before starting any solid foods. Is your baby ready? Breast milk or formula is the only food your newborn needs. Within four to six months, however, your baby will begin to develop the coordination to move solid food from the front of the mouth to the back for swallowing. At the same time, your baby's head control will improve and he or she will learn to sit with support — essential skills for eating solid foods. If you're not sure whether your baby is ready, ask yourself these questions: •       Can your baby hold his or her head in a steady, upright position? •       Can your baby sit with support? •       Is your baby interested in what you're eating? If you answer yes to these questions and you have the OK from your baby's doctor or dietitian, you can begin supplementing your baby's liquid diet. What Foods to Start With. Continue feeding your baby breast milk or formula as usual. Then: •       Start with baby cereal. Mix 1 tablespoon (15 milliliters) of a single-grain, iron-fortified baby cereal with 4 to 5 tablespoons (60 to 75 milliliters) of breast milk or formula. Many parents start with rice cereal. Even if the cereal barely thickens the liquid, resist the temptation to serve it from a bottle. Instead, help your baby sit upright and offer the cereal with a small spoon once or twice a day. Once your baby gets the hang of swallowing runny cereal, mix it with less liquid. For variety, you might offer single-grain oatmeal or barley cereals. Your baby may take a little while to "learn" how to eat solids. During these months you'll still be providing the usual feedings of breast milk or formula, so don't be concerned if your baby refuses certain foods at first or doesn't seem interested. It may just take some time. Do not add cereal to your baby's bottle unless your doctor instructs you to do so, as this can cause babies to become overweight and doesn't help the baby learn how to eat solid foods •       Add pureed meat, vegetables and fruits. Once your baby masters cereal, gradually introduce pureed meat, vegetables and fruits. Offer single-ingredient foods at first, and wait three to five days between each new food. If your baby has a reaction to a particular food — such as diarrhea, a rash or vomiting — you'll know the culprit. •       Offer finely chopped finger foods. By ages 8 months to 10 months, most babies can handle small portions of finely chopped finger foods, such as soft fruits, well-cooked pasta, cheese, graham crackers and ground meat. As your baby approaches his or her first birthday, mashed or chopped versions of whatever the rest of the family is eating will become your baby's main fare. Continue to offer breast milk or formula with and between meals. Foods to Avoid for Now. Some foods are generally withheld until later. Do not give eggs, cow's milk, citrus fruits and juices, and honey until after a baby's first birthday. Eggs (especially the whites) may cause an allergic reaction, especially if given too early. Citrus is highly acidic and can cause painful diaper rashes for a baby. Honey may contain certain spores that, while harmless to adults, can cause botulism in babies. Regular cow's milk does not have the nutrition that infants need. Fish and seafood, peanuts and peanut butter, and tree nuts are also considered allergenic for infants, and shouldn't be given until after the child is 2 or 3 years old, depending on whether the child is at higher risk for developing food allergies. A child is at higher risk for food allergies if one or more close family members have allergies or allergy-related conditions, like food allergies, eczema, or asthma. Introducing Juice. Juice can be given after 6 months of age, which is also a good age to introduce your baby to a cup. Buy one with large handles and a lid (a "sippy cup"), and teach your baby how to maneuver and drink from it. You might need to try a few different cups to find one that works for your child. Use water at first to avoid messy clean-ups. Serve only 100% fruit juice, not juice drinks or powdered drink mixes. Do not give juice in a bottle and remember to limit the amount of juice your baby drinks to less than 4 total ounces (120 ml) a day. Too much juice adds extra calories without the nutrition of breast milk or formula. Drinking too much juice can contribute to obesity can cause diarrhea. Infants usually like fruits and sweeter vegetables, such as carrots and sweet potatoes, but don't neglect other vegetables. Your goal over the next few months is to introduce a wide variety of foods. If your baby doesn't seem to like a particular food, reintroduce it at later meals. It can take quite a few tries before kids warm up to certain foods.

Your Child

Importance of Breakfast

When your child was an infant, you were diligent about feeding them on schedule. So, why do so many parents let their children skip breakfast before heading out to school? A new study shows that 12 to 35 percent of adolescents skip breakfast and that number increases with age.

“Breakfast is another time to spend with your child,” says pediatrician Dr. Sue Hubbard. She says a healthy breakfast should have protein, fiber and calcium. “Try and stay away from sugar coated cereals” she advises. Dr. Hubbard also emphasizes that parents need to read cereal box labels and stay from breakfast bars because many of them contain large amounts of sugar. “A good thing as you’re running to the door and getting in carpool is a piece of peanut butter toast on whole wheat grain bread with some milk on the side,” she says. “Breakfast gives your child fuel for the day.”

Your Teen

Early Puberty and Bone Health

1.50 to read

The normal rate of bone mass decline in adulthood is about 1 to 2 percent each year. This means that a 10 to 20 percent increase in bone density resulting from a naturally early puberty could provide an additional 10 to 20 years of protection against normal age-related decline in bone strength, according to the researchers.A new study suggest the earlier your child starts puberty, the lower the risk he or she will have osteoporosis later in life.

The research was based on 78 girls and 84 boys, who were studied from the time they began puberty until they reached sexual maturity. The investigators found that adult bone mineral density was influenced by age at puberty onset, with greater bone mass linked to early puberty and less bone mass associated with later puberty. However, bone strength did not seem to be affected by how long puberty lasted. "Puberty has a significant role in bone development," study leader Dr. Vicente Gilsanz, director of clinical imaging at the Saban Research Institute of Children's Hospital Los Angeles, said in a hospital news release. "During this time, bones lengthen and increase in density. At the end of puberty the epiphyseal plates close, terminating the ability of the bones to lengthen. When this occurs, the teenager has reached their maximum adult height and peak bone mass," Gilsanz explained. Reduced bone mineral density leads to osteoporosis, which affects 55 percent of Americans aged 50 and older. The normal rate of bone mass decline in adulthood is about 1 to 2 percent each year. This means that a 10 to 20 percent increase in bone density resulting from a naturally early puberty could provide an additional 10 to 20 years of protection against normal age-related decline in bone strength, according to the researchers. The study was published in the January issue of the Journal of Pediatrics. Pediatricians have long understood the role of pediatric bone development in osteoporosis prevention. The tween and teen years are critical for bone development because most bone mass accumulates during this time. In the years of peak skeletal growth, teenagers accumulate more than 25 percent of adult bone. By the time teens finish their growth spurts around age 17, 90 percent of their adult bone mass is established. Following the teen years, bones continue to increase in density until a person is about age 30. The need for calcium in the diet. Calcium is critical to building bone mass to support physical activity throughout life and to reduce the risk of bone fractures, especially those due to osteoporosis. The onset of osteoporosis later in life is influenced by two important factors: •   Peak bone mass attained in the first two to three decades of life •   The rate at which bone is lost in the later years Although the effects of low calcium consumption may not be visible in childhood, lack of adequate calcium intake puts young people at increased risk for osteoporosis later in life. Other foods, including dark green, leafy vegetables such as kale, are also healthy dietary sources of calcium. But, it takes 11 to 14 servings of kale to get the same amount of calcium in 3 or 4 8-ounce glasses of milk. In addition to calcium, milk provides other essential nutrients that are important for optimal bone health and development, including: •       Vitamins D, A, and B12 •       Potassium •       Magnesium •       Phosphorous •       Riboflavin •       Protein The role of physical activity in bone development. Weight-bearing physical activity helps to determine the strength, shape, and mass of bone. Activities such as running, dancing, and climbing stairs, as well as those that increase strength, such as weight lifting, can help bone development. For children and teenagers, some of the best weight-bearing activities include team sports, such as basketball, volleyball, soccer, and softball. Studies show that absence of physical activity results in a loss of bone mass, especially during long periods of immobilization or inactivity.

Daily Dose

The Importance of Vitamin D

New research is showing that vitamin D is equally important in preventing heart disease and diabetes.Doctors have known the importance of calcium and vitamin D for children's bone health and for preventing osteopenia and osteoporosis later in life. Now new research is showing that vitamin D is equally important in preventing heart disease and diabetes. Infants are breast-fed or formula fed until their first birthday and then begins drinking milk as their main source of calcium and vitamin D.

For many children who "choose" (I don't get the choice thing) not to drink milk they may substitute soft drinks, juices or water. Unfortunately none of the other beverages contains the necessary calcium and vitamin D and this may lead to vitamin D deficiency. Recommendations in the last year have added that babies that are exclusively breast fed should be given a daily vitamin supplement, like poly vi sol or tri vi sol, to ensure that they are getting at least 400 IU of vitamin D per day. The recommendations also suggest that all children need at least 400 IU of vitamin D per day, and studies are being to conducted to see if the requirements are even higher. In addition children need to continue getting somewhere between 1,000 mg - 1,500 mg of calcium per day, depending on their age. The current research by the American Heart Association looked at teens and vitamin D levels. Their findings showed that teens with the lowest vitamin D levels had a four times greater chance of developing metabolic syndrome (putting them at risk for diabetes) and a 2.4 times greater risk of developing high blood pressure. How do you ensure adequate vitamin D and calcium for your family? A healthy diet should contain fortified milk and orange juice, as well as other dairy products with added vitamin D, egg yolks, tuna and salmon and some ready to eat breakfast cereals. Read the labels; look for vitamin D and calcium in foods. Sunshine is also a good source of vitamin D, but wear your sunscreen! That's your daily dose, we'll chat again tomorrow.

Your Teen

Energy Drinks

Just about every store you go into these days has a shelf of energy drinks, many of them marketed towards our teenage children. “Many are marketed as energy drinks but should be called stimulant drinks” says pediatrician Dr. Sue Hubbard. Many of these drinks contain large amounts of caffeine.”

Dr. Hubbard warns that too much caffeine in a teenager’s system can cause anxiety, rapid heartbeat, insomnia, nervousness and upset stomachs. “It can also mess up a child’s sleep cycle, which is not good” she says. Dr. Hubbard recommends that parents read the labels of the drinks their children are consuming. She also recommends that if you need to hydrate your child during sports or other physical activity, give them water or a true sports drink, like Gatorade, and not energy drinks.

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A new warning about codeine.

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