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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

Diagnosing Celiac Disease

How do you diagnose celiac disease. I received an email via our iPhone App from a mother who was concerned because her 2 year old son had skinny arms and legs, but a “big tummy” and she thought this might be a symptom of celiac disease.  Most toddlers have “big tummies” even if they are skinny kids as their abdominal musculature (future 6 pack) is not developed.

I often have questions from concerned parents whose children are growing perfectly normally, but their “belly sticks out”.  This is often a comment made about little girls (gender specific concerns already!) and I tell the parents that there are not many toddlers that don’t have protuberant little tummies. If you go to the pool in the next several months, check out the baby pool,  as this is not a good age to wear a bikini or “speedo” with that big tummy pushing down the bottoms,   save that look for later on. Now, what do you typically look for in  child who you suspect might have celiac disease?  Celiac disease typically causes failure to thrive in young children. I know this well,  as I got this question wrong on my oral boards many years ago, and have spent the last 20 years making sure never to miss a case. (maybe I should leave that little tidbit out?) At any rate, you see symptoms like persistent diarrhea, weight loss or failure to gain weight, a large protuberant abdomen, and a lack of appetite (no, being a picky eater does not count).   Because celiac disease is an auto-immune disease where the body responds abnormally to a protein (gluten) found in foods like wheat,  rye, barley and many other prepared foods, it differs from a food allergy.  A food allergy typically causes symptoms like hives, wheezing or vomiting. The first step in testing for possible celiac disease will be a blood test on your child.  This will show if there are elevated levels of antibodies, called tissue-trans-glutaminase (tTG), in the blood. If a child has high levels of these antibodies (tTG), then a biopsy of the small intestine may be taken to confirm the diagnosis. A small bowel biopsy is done while a child is sedated, through an endoscope, and actually takes a small piece of the lining of the intestine to see if the villi are flattened and damaged.  The gluten in the diet of a child with celiac disease causes these changes to the intestine, and once gluten is removed from the diet the villi will return to normal and normal absorption of food will take place. If a child is confirmed to have celiac disease (which is as lifelong problem) they have to remain on a gluten free diet, which means restricting many foods and drinks.  A gluten free diet, while seemingly difficult to adhere to at first, will allow the child to grow and develop normally and your child will typically have more energy and feel better in general.  After being on a gluten free diet another blood test may be done to confirm that the tTG level has come down. With the advent of more gluten free products it has become easier for parents and children to follow a gluten free diet. There are many websites that help teach a family to read labels (similar to those with a food allergy) and to also provide resources for recipes or products that are gluten free. Although I continue to look for a patient with celiac disease, I have yet to diagnose one, and remember to consider the diagnosis in any child who is having “failure to thrive”. That's your daily dose for today.  We'll chat again tomorrow! Send Dr. Sue your question now!

Daily Dose

Picky Eating: Magic Words Offer Food for Thought

1:15 to read

I am trying to clean up my desk and I have been looking through stacks of pediatric articles that I felt were really interesting. An article by Dr. Barbara Howard entitled “Three Magic Words Offer Food for Thought” made a wonderful point regarding family meals and eating habits.

She states that one of the best questions to ask a child during a “well-child” visit only requires three words, but offers so much insight into a family’s interactions. What are the magic words? “How are your meals?” I know you know how much I believe in, and promote, families eating together.

There has been a lot of data substantiating the many positive side effects that stem from family meals.  Not only does eating together as a family help improve food choices which may help prevent obesity, it also leads to children who have improved vocabulary and language skills, social skills and manners. Family meals have also been shown to lessen the chance of risk taking behaviors in adolescents. There has also been an association with fewer eating disorders among adolescents who have regular family meals. So, when I ask children about their meals, I also get parental feedback. The biggest complaint is that their children are “picky eaters”. Many children and parents will say that they don’t eat together as a family as everyone eats something different. I don’t think being a “short order cook” is a job requirement of any parent.

Social worker Ally Slater, delineates parent’s responsibilities with regard to food as “what, when and where” while leaving children, “how much and whether”. I love that!! Parents control the grocery cart, meal and snack choices and food offerings on the plate. It is nice to always offer at least one food that most family members like. Once that food is offered and we are gathered together to eat, parents need to back off. Is that easier said than done? Maybe in the beginning, but over time it actually simplifies family life. I think it is really fairly easy if you “buy into” the idea of family meals and know that children will make better and wider food choices if given that opportunity. It may take up to 100 times, and many months for your child to try different foods, but eventually you will be pleased that you have a child who is a healthy eater, and who also enjoys a wide variety of foods. Trust me, your children when raised this way, really turn out to be great eaters as adolescents and young adults.  I think my boys are less “picky” than I am! (No sushi for me).

Make family meal time a priority. Your children will respect the rules, learn table manners, and enjoy dinnertime conversation, while eventually developing a more mature palate. It just takes time. That’s your daily dose, we’ll chat again tomorrow.

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.

Parenting

Is Your Child Becoming an Emotional Eater?

2:00

You may be tempted to appease your child with food after a fall or tears for short-term relief, but this could actually set your child up for long-term unhealthy eating patterns.

What happens is that children begin to identify eating with self-comforting or relieving boredom instead of nutrition or eating when they’re actually hungry.

Almost all children, teens, and adults may engage in emotional eating at one time or another.

Hunger associated with emotional eating comes on quickly and feels urgent. It's often triggered by a specific event or mood. It's not like typical physical hunger, which gradually builds and is a result of an empty stomach. Physical hunger can be satisfied by a number of different foods, but cravings usually involve particular foods. Examples might be ice cream or candy after a fight with a friend or a tough day at school.

Why is emotional eating unhealthy? Emotional eating isn’t really about hunger or nutrition; it’s about filling an emotional need. It can lead to overeating and over time, lead to extra weight gain or obesity. It also sets up a pattern of handling uncomfortable situations by eating instead of by learning how to solve social and psychological problems.

There are lots of reasons kids may seek out food for comfort such as:

  • Anger
  • Boredom
  • Change
  • Confusion
  • Depression
  • Frustration
  • Loneliness
  • Loss
  • Resentment
  • Stress

Even positive emotions such as excitement and happiness can result in emotional eating once it becomes a go-to as a reward. 

If you notice signs of emotional eating in your child, talk to him or her about your concerns. Be gentle. Stay positive. Helping your child might be as simple as having a warm and loving conversation.

Help your child develop a healthy response to his or her problems, such as focusing on solutions. Encourage your child to talk about the emotions that trigger his or her emotional eating. Brainstorm other ways to deal with those emotions. For example, your child could exercise or become involved in sports when he or she feels stressed out, or call a friend when he or she is bored.

Emotional eating can be learned, so your influence as a parent or primary caregiver is one key to prevention. Be sure to model healthy eating habits for your child. Also, avoid using food to celebrate occasions or to reward your child for good behavior. Instead, use verbal praise and give other types of rewards (for example, stickers for a young child or a fun activity with an older child).

There are signs you can look for in children to let you know if your child is an emotional eater. They are:

  • Eating in response to emotions or situations, not to satisfy hunger
  • Feeling an urgent need to eat
  • Craving a specific food or type of food
  • Eating a larger amount of food than usual
  • Eating at unusual times of day (for example, late at night)
  • Gaining excess weight
  • Feeling embarrassed or guilty about eating
  • "Sneaking" food during high-stress times
  • Hiding empty containers of food

A recent study from Norway found that kids offered food for comfort at ages 4 and 6 displayed more emotional eating at ages 8 and 10.

Also, the researchers found signs that kids who felt more easily comforted by food were fed more by parents for that purpose.

Emotional eating typically starts early in life but can really begin at any age; it seems like an easy fix for anxiety at the time, but can lead to health problems if not brought under control.

Story source: https://familydoctor.org/emotional-eating-in-children-and-teens/

Daily Dose

Don't Give In To Picky Eating

2.00 to read

I am trying to clean up my desk and I have been looking through stacks of pediatric articles that I felt were really interesting.

An article by Dr. Barbara Howard entitled “Three Magic Words Offer Food for Thought” made a wonderful point regarding family meals and eating habits. She states that one of the best questions to ask a child during a “well-child” visit only requires three words, but offers so much insight into a family’s interactions. What are the magic words? “How are your meals?” I know you know how much I believe in, and promote, families eating together. There has been a lot of data substantiating the many positive side effects that stem from family meals.

You can look at some of the studies by going to The Promoting Family Meals Project, http://www.cfs.purdue.edu/CFP/promotingfamilymeals. Not only does eating together as a family help improve food choices which may help prevent obesity, it also leads to children who have improved vocabulary and language skills, social skills and manners.

Family meals have also been shown to lessen the chance of risk taking behaviors in adolescents. There has also been an association with fewer eating disorders among adolescents who have regular family meals. So, when I ask children about their meals, I also get parental feedback. The biggest complaint is that their children are “picky eaters”. Many children and parents will say that they don’t eat together as a family as everyone eats something different. I don’t think being a “short order cook” is a job requirement of any parent.

Social worker Ally Slater, delineates parent’s responsibilities with regard to food as “what, when and where” while leaving children, “how much and whether”. I love that!! Parents control the grocery cart, meal and snack choices and food offerings on the plate. It is nice to always offer at least one food that most family members like. Once that food is offered and we are gathered together to eat, parents need to back off. Is that easier said than done? Maybe in the beginning, but over time it actually simplifies family life.

I think it is really fairly easy if you “buy into” the idea of family meals and know that children will make better and wider food choices if given that opportunity. It may take up to 100 times, and many months for your child to try different foods, but eventually you will be pleased that you have a child who is a healthy eater, and who also enjoys a wide variety of foods. Trust me, your children when raised this way, really turn out to be great eaters as adolescents and young adults. I think my boys are less “picky” than I am! (no sushi for me).

Make family meal time a priority. Your children will respect the rules, learn table manners, and enjoy dinnertime conversation, while eventually developing a more mature palate. It just takes time.

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

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.

Daily Dose

The Danger in BPA Bottles

2.00 to read

I have been getting plenty of question about BPA in baby bottles.I recently received an email from a parent who’s 4 year old son is a patient of mine, and she is pregnant and due with a baby girl in the next month. On top of all of that she is also a pediatrician. At any rate, her question was regarding BPA (bisphenol A) in bottles, and whether I thought she should throw out bottles that she had used with her son in favor of newer bottles.

I will tell you that her son is a perfectly delightful, bright, inquisitive and developmentally normal little boy and he received breast milk and formula from BPA containing bottles. With that information, and knowing that I am thrifty, I thought long and hard and decided that in my opinion I would toss the old bottles in favor of the newer BPA free bottles. The top manufacturers of baby bottles voluntarily stopped using BPA in their bottles at the end of 2008. These bottles include, Dr. Brown, Avent, Playtex, Evenflo and numerous others. It is easy to find BPA free bottles that are well marked and most large chain stores are no longer selling your-baby bottles containing BPA. The cost involved to replace old bottles seems minimal, and the data regarding the safety of BPA to infants and children continues to be released with more ongoing studies underway. There will be more data available in the coming months and years. The Endocrine Society who held their annual meeting last week presented “worrying” evidence about the effects of BPA , including the statement that “endocrine disruptors (which includes BPA) do have effects on male and female development, prostate cancer, thyroid disease, and cardiovascular disease”. There are concerns that infants and children may be particularly susceptible to BPA and possible long term effects on brain development and behavior. So, with these recent studies and more concern regarding the levels of BPA found in baby bottles as well as comparison data of exposure to BPA between breast and bottle fed infants, it seems prudent to me to purchase newer bottles that are BPA free. Cross this issue off of the mother worry list. The cost of new bottles is minimal as compared to future concerns about BPA. That's your daily dose for today. We'll chat tomorrow!

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Daily Dose

Surviving Picky Eating

It's been a busy day in the office and a lot of parents have had questions about picky eaters.It was a busy week in my pediatric office (always is!) and one of the hot topics surrounded picky eating.  The issue of picky eating seems to be on every parent's list from one to 18 years. Actually, picky eating is not as much of a subject in the older kids, seems that there are bigger issues and also hopefully the picky eating resolved when the child was younger.

I think that food is important for nutrition, nurturing, time spent together over a meal, etc....but it is not a big issue if you are relaxed about feeding your child. If you begin preparing your child healthy meals from the age of one year, provide them with many opportunities to experience different foods, and realize that most toddlers are picky regardless of what you feed them, they will eventually become good eaters. Parents worry that "they will starve" if I don't fix their favorite food every night. Children are SMART and they are smarter than we are, they self regulate and eat when they are actually hungry. If you provide a well-balanced meal three times a day, most younger kids will eat one fairly well and may pick at two. That does not mean that they need a different meal when they pick or refuse to eat, it just means they are not hungry at that time and should nicely be reminded that they might be hungry later, but not forced to eat. Along those same lines, when it is snack time later in the day, they should be given something healthy (even that sandwich or fruit that they refused at lunch) and not crackers and goldfish. Again, let them decide whether to eat it. IF you take the high road on this issue, hang in there for a LONG time, you will be pleasantly surprised that they become "good eaters", eat a wide variety of foods and know that you are not the short order cook at home. Those picky toddlers continue to gain weight, learn their colors and alphabet and grow into children that enjoy mealtime together. That's your daily dose, we'll chat tomorrow.

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