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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 Child

Special Diet for Kids With Crohn Disease, Colitis

1:45

A special diet may help children with Chron disease and ulcerative colitis without the use of medications, according to a new study.

Chron disease is a chronic inflammatory bowel disease (IBD) that was once considered rare in children. It is now recognized as one of the most important chronic diseases that affect children and teens with approximately 20-30 percent of all patients with Chron presenting symptoms when they are younger than 20 years old.

The diet includes non-processed foods, such as fruits, vegetables, meats and nuts. Over 12 weeks, the diet appeared to ease all signs of these inflammatory bowel diseases in eight of the 10 affected children, researchers report.

"The study shows that without other intervention, other changes, we can improve individuals' clinical as well as laboratory markers," said study author Dr. David Suskind. He's a professor of pediatrics and director of clinical gastroenterology at Seattle Children's Hospital.

"I'm not surprised," Suskind added, "primarily because preliminary studies ... opened our eyes to the idea that diet had an impact."

Standard treatment for Chron disease and ulcerative colitis usually includes steroids and other immune-suppressing drugs. With severe symptoms, surgery is sometimes required to remove portions of the intestine.

Suskind and his team put the 10 patients, between the ages of 10 and 17, on a special diet. The diet is known as the specific carbohydrate diet. No other measures were used to treat the study participants' active Crohn's or ulcerative colitis.

The diet removes grains, most dairy products, and processed foods and sugars, except for honey. Those on the specific carbohydrate diet can eat nutrient-rich foods such as fruits, vegetables, meats and nuts.

Suskind noted that scientists aren’t sure why the diet seems to work, but there are several theories.

First, it's known that diet affects the gut microbiome -- the array of bacteria in the digestive tract contributing to digestion and underlying the immune system .

"One of the likely reasons why dietary therapy works is it shifts the microbiome from being pro-inflammatory to non-inflammatory," he said.

"Another potential [reason] is there are a lot of additives in the foods we eat that can have an effect on the lining of the intestines. This diet takes out things deleterious to the mucus lining in the intestinal tract," Suskind said.

Other IBD researchers are praising the small study.

Dr. James Lewis is chief scientist for the Crohn's and Colitis Foundation of America's IBD Plexus Program. He's helping lead national research in progress comparing the effectiveness of the specific carbohydrate diet to the so-called Mediterranean diet in inducing remission in patients with Crohn's disease. The Mediterranean diet stresses eating mostly plant-based foods.

Lewis praised Suskind's new study, noting that despite its small size, it adds to growing research suggesting a potential therapeutic benefit from the specific carbohydrate diet to inflammatory bowel patients.

"Even our most effective [standard] therapies leave a proportion of patients with persistently active disease or the inability to completely heal the intestine," Lewis said. "Because of that alone, we need other therapeutic approaches."

The study was published in the recent edition of the Journal of Clinical Gastroenterology.

Story sources: Maureen Salamon, http://www.webmd.com/ibd-crohns-disease/crohns-disease/news/20170109/special-diet-may-be-boon-for-kids-with-crohns-colitis#1

http://emedicine.medscape.com/article/928288-overview

 

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.

Daily Dose

The Obesity Epidemic Continues

The obesity epidemic continues with no end in sight. It is one of our major public health problems and the ongoing health care concerns of patients with obesity are well known. There have been many different studies looking for a biologic basis for obesity. There is a new study just released from the International Journal of Obesity that suggests that there is behavioral link for obesity.

In the study 226 families, both children and their parents were followed over three years with serial height and weight measurements. The results showed that obese mothers were 10 times more likely to have obese daughters, while obese fathers had a six-fold chance of having an obese son. In both cases, children of the opposite sex were not affected. Researchers therefore believe that the link for obesity may be behavioral rather than genetic. It would be very unusual to have genetics influence children only along gender lines. Rather, it seems that there may some form of “behavioral sympathy” related to becoming overweight. It seems that daughters copy lifestyles of their mothers, and sons their fathers. Looking further, researchers noted that eight in 10 obese adults were not severely overweight or obese when they themselves were children. In other words, the parents are passing their eating habits and behaviors on to their children, which brings us back to “modeling behavior”. I bring up the discussion of eating habits and nutrition when children are beginning their first table foods. Parents want to feed their children healthy foods, but they also worry if their child will not eat what the parent has prepared. Starting from the first foods the “notion” of eating healthy needs to be positively re-enforced. One way to do this is by preparing meals together which can teach cooking skills along with making healthy food choices. The idea that our children are going to like everything that we make, or clean their plates is obsolete. I think that our job as parents is to provide good food choices, a happy family mealtime and to be models of healthy eating. With this should come daily exercise. This study seems to confirm that it may be nurture, not nature that is contributing to the worldwide obesity problem. That’s your daily dose, we’ll chat again tomorrow.

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.”

Daily Dose

When to Start Baby Food in Infants

I get numerous questions everyday from parents who are eager to start your-baby foods in their infants. It seems that there are a lot of “myths” about starting foods, things like “your your-baby will sleep through the night after you start your-baby food”, “it is important to start your-baby food sooner than later”, and “just put rice cereal in their bottles”.

The recommendation from the AAP is to begin your-baby food, typically rice cereal when your infant is between five and six months of age. An infant does not need any other nutrition besides breast or formula in the first six months. There are plenty, if not the majority of babies who will have been sleeping through the night long before beginning cereal, so there is no correlation between sleep and introducing your-baby food. The other thing that you will notice is that infants have a prominent tongue thrust in the first four and five months of life, so they are pushing things out of their mouths (like the pacifier we have discussed previously) and don’t do well with a spoon feeding until they are a little older. There is no magic to beginning cereal and you always want to start something new when your your-baby is in a good mood. This is often in the morning, a short while after having their morning bottle or breastfeeding. Think of it like having your cup of coffee and then having breakfast a little later on. I think it is easiest to feed a your-baby from their high chair, and by this age they are able to sit fairly well in the chair with a back supporting them. Mix a couple of tablespoons of rice cereal in a small bowl and with formula/breast milk to the consistency of cereal you would eat off of a spoon, not too thick, not too runny, but “just right”. As you start spoon feeding your your-baby their body language will tell you how much to feed them, let them lead the dance, a few bites to start or more if they want. There is no magic to first feedings, some babies take to it quickly and others take a few days or weeks to get used to spoon-feeding. Don’t be frustrated or worried if it takes awhile for your your-baby to get the hang of it, the adage “try, try again” comes to mind. Next step veggies, but more about that another time. That’s your daily dose, we’ll chat again tomorrow.

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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

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.

Your Teen

Obese Children More Likely to Have Allergies

Children who are obese are 26 percent more likely to have some kind of allergy, especially to food a new study finds. Researchers from the National Institute of Environmental Health Sciences (NIEHS) said it is not clear from the study of obesity causes the allergies, but it suggests controlling obesity in young people may be important for lowering rates of childhood asthma and allergies.

"We found a positive association between obesity and allergies," said lead researcher Dr. Darryl Zeldin. The study appears in the Journal of Allergy and Clinical Immunology. "The signal for allergies seemed to be coming mostly from food allergies. The rate of having a food allergy was 59 percent higher for obese children," said another researcher. The team looked at data on 4,000 children aged two to 19 that included information about allergies and asthma. They looked at several factors including total antibody levels to indoor, outdoor and food allergens, body weight and responses to a questionnaire about diagnoses of hay fever, eczema and allergies. For the study, children who had a body mass index (BMI) that was in the top 95 percent of children of their age were considered obese. The researchers found antibodies for specific allergens were higher among children who were obese or overweight. "While the results from this study are interesting, they do not prove obesity causes allergies. More research is needed to further investigate this potential link," Dr. Zeldin said.

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DR SUE'S DAILY DOSE

Nutrition and your baby.

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