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Your Child

Exercise: Reducing Depression - Behavioral Problems in Kids

2:00

Two new studies examined whether kids that have serious behavioral disorders or who may be at a higher risk for depression might benefit from exercise. The results showed positive outcomes for both sets of children participating in the studies.

For one study, researchers focused on children and teenagers with conditions that included autism spectrum disorders, attention deficit hyperactivity disorder (ADHD), anxiety and depression.

They looked at whether structured exercise during the school day -- in the form of stationary "cybercycles" -- could help ease students' behavioral issues in the classroom. Cybercycles are stationary bikes equipped with virtual reality exercising games.

Over a period of seven weeks, the study found it did. Kids were about one-third to 50 percent less likely to act out in class, compared to a seven-week period when they took standard gym classes.

Lead researcher, April Bowling, said the results were meaningful.

"On days that the students biked, they were less likely to be taken out of the classroom for unacceptable behavior," said Bowling, who is now an assistant professor of health sciences at Merrimack College in North Andover, Mass.

"That's important for their learning, and for their relationships with their teachers and other kids in class," she said.

The study was done at a school that enrolls kids with behavioral health disorders, many of whom also have learning disabilities. Their usual gym classes focused mainly on skill building, with only short bursts of aerobic activity at most, according to the researchers.

For seven weeks, 103 students used the stationary bikes during their usual gym class -- twice a week, for 30 to 40 minutes. Their classroom behavior was tracked and compared with a seven-week period without the bikes, when they had gym class as usual.

Overall, the study found, the students were better able to control their behavior in the classroom during the stationary-bike trial.

Another recent study from Norway, adds more evidence to the benefits of exercise in children. Researchers from Norwegian University of Science and Technology measured activity levels in 800 six year olds who were asked about their exercise habits and any depressive symptoms. Follow ups were recorded at 8 and 10 years of age. Overall, children who exercised more, at a moderate to vigorous intensity, showed fewer depressive symptoms years later.

While the researchers noted that exercise alone isn’t a cure for depression, it has been shown to alleviate some depression symptoms.

“I think that physicians, parents and policy makers should facilitate physical activity among children,” says Tonje Zahl, the study’s lead author. “The focus should be on physical activity not just for the here and now benefits, such as improving blood pressure, heart rate and other physical benefits, but for the mental health benefits over the long term,” she says. All children should be targeted for this, she adds.

Experts say there are several theories as to why exercise may help kids control their behaviors. Bowling suggests that exercise may redirect the brain away from worrying.

Another theory is that exercise affects neurotransmitters -- chemical messengers in the brain that help regulate mood and behavior.

Bowling notes that it’s unfortunate that many schools are focusing so much on academics that they are cutting out gym and recess.

"If we really want our kids to do well, they need more movement during the school day, not less", she said

If children are unable to get the exercise they need at school, there’s always active playtime, walking and sports after school that can help provide some of the same benefits.

Both studies were published in the online journal, Pediatrics.

Story source: Amy Norton, http://www.webmd.com/add-adhd/news/20170109/exercise-an-antidote-for-behavioral-issues-in-students#1

Alice Park, http://time.com/4624768/exercise-depression-kids/

 

 

Your Child

Are Playgrounds Too Safe?

1.45 to read

It takes a lot to bore a preschooler. They are so inquisitive that just about everything seems interesting. But, believe it or not, playgrounds may have become so “safe” that they bore even preschoolers. A new report suggests that may be one of the reasons these little ones are not getting enough exercise.

Researchers have found that strict safety rules for equipment and low budgets at childcare centers were largely blamed for playgrounds that don't make kids feel like playing,

Kristen Copeland, MD, of Cincinnati Children's Hospital Medical Center, and her colleagues wrote in the February issue of Pediatrics that fixed playground equipment that meets licensing codes is unchallenging and uninteresting to children.

Another reason kids may not be exercising enough is that schools are focusing on academics at the expense of recess and gym.

"Societal priorities for young children -- safety and school readiness -- may be hindering children's physical development," they wrote in the paper.

According to an online article in Medpagetoday.com, three-quarters of U.S. kids, ages 3-5 years, attend childcare and most of their time is spent being sedentary.

"Because children spend long hours in care and many lack a safe place to play near their home, these barriers may limit children's only opportunity to engage in physical activity," Copeland's group explained. "This is particularly concerning because daily physical activity is not only essential for healthy weight maintenance, but also for practicing and learning fundamental gross motor skills."

The investigators conducted nine focus groups with a total of 49 childcare providers taking care of preschool-age children at 34 centers in Cincinnati, which varied from inner-city to suburban locations and included some Head Start and Montessori centers.

The providers interviewed were nearly all women with at least some college education. These providers commonly expressed concern that the children they cared for had little chance of outdoor playtime when they went home, particularly those who were picked up late in the day or whose parents worked multiple jobs.

Many of the parents didn't have a dedicated room indoors where kids could be active during bad weather.

To prepare kids for grade school, an emphasis has been placed on teaching children shapes, colors, and skills that prepare them for reading, but not giving them time for outdoor and active play- both of which have been shown to increase a child’s learning ability.

That pressure came directly from parents -- both upper- and lower-income families -- as well as from state early-learning standards.

Some parents also told providers to keep their children from participating in vigorous activities so that they would not be injured.

Providers felt that the playground equipment was safe to let kids play on because of beefed up state inspections and stricter licensing codes, but all the safety measures sort of back-fired and kids just weren’t interested.

"To keep it challenging, teachers noted that children would start to use equipment in (unsafe) ways for which it was not intended," the researchers wrote.

They quoted one provider who explained that with new equipment fitting the tighter standards, "you see children trying to climb into places they're not supposed to climb in because it's just not challenging. They're walking up the slide much more than they ever did with the other one. You can see they are just trying to find those challenges."

Pediatricians may be able to help address this problem by emphasizing the learning and physical benefits of active outdoor play, encouraging parents to dress their child for it, and not suggesting that physical activity is inherently dangerous when giving injury prevention advice, the researchers noted.

Source: http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/30493

Daily Dose

Sudden Cardiac Deaths in Young Athletes

2.00 to read

I have received several questions via our iPhone App about recent discussions in both the media and in the medical community surrounding sudden cardiac death (SCD) in young athletes.

Each year between 10–12 million kids in the U.S. participate in sports.  The tragedy of a sudden death in an otherwise  “presumably healthy” child causes not only sadness, but concern as to how the death might have been prevented. Doctors are often asked, “isn’t there a test or something to prevent this? “.

Depending on the studies I have read, the sudden cardiac death of a child or adolescent accounts for about 100 deaths a year in the U.S.  The prevalence rate for sudden cardiac death is 1:100,000- 200,000 and is higher among males than females.  Statistics show that 90% of these sudden deaths occur immediately post training or competition with football and basketball having the highest incidence.

In 2007 the American Heart Association came out with guidelines to evaluate athletes who may be at risk for sudden cardiac death. The most important screening mechanism has been found to be the “gold standard” in medicine, a thorough history and physical exam.

The history that should be taken on any athlete who is being screened for sports participation should include a history of any unexplained or sudden death in a family member. Are there any family members with unexplained fainting episodes or seizures? Are there family members who had unexplained deaths (drowning or single car accidents)?   Are there any family members with a known genetic disorder that predisposes to sudden cardiac death?  The history should also ask about any fainting (syncope) in the athlete.

After a good history is taken (which should be updated yearly), the child/adolescent needs a complete and thorough physical exam. This exam should include blood pressure measurements, and a careful cardiac exam looking for new murmurs.  Symptoms such as palpitations during exercise, visual changes, fainting while exercising or immediately after exercise, and chest pain should all warrant further evaluation.

Studies show that about half of pediatric patients who succumb to sudden cardiac death had experienced a warning sign.  There are about 20 causes for SCD, with the most common causes being hypertrophic cardiomyopathy, anomalous coronary artery, and myocarditis.

While some may advocate routine EKG screening and echocardiograms on athletes (this is done in Italy), many studies have been done which show that it would take the screening of 200,000 student athletes to prevent 1 death.   At the same time you will certainly identify some children with clear risk factors for SCD, but for every positive finding there may be 10–20 athletes who have “borderline” or questionable findings that would require even more expensive follow up.

These pediatric patients might also be told they cannot participate in sports during the evaluation time and some might be told that they cannot participate even if they were not found to have disease, but were excluded just due to liability concerns.  There does not seem to be one right answer to this issue.

If your child is going to begin competitive sports make sure to see your pediatrician for a complete physical exam including a good family history.  Also advocate that your school have automatic external defibrillators viable at all times and personnel that know how to use them.

That’s your daily dose for today.  We’ll chat again tomorrow.

Your Child

Study: Exercise, Once Again, Improves Kid’s Learning Skills

2:00

While the debate on whether to bring back recess to school curriculums continues across the U.S., a small study from the Netherlands once again shows that adding exercise to a child’s school day can improve their learning skills.

Researchers worked with 500 children in second and third grade, giving half of them traditional lessons while the rest received instruction supplemented with physical activity designed to reinforce math and language lessons.

The approach was a creative and unique way to helping children better comprehend math and spelling.  Instead of taking a recess break – exercise was actually incorporated into the lesson.

After two years, children who got the physically active lessons had significantly higher scores in math and spelling than their peers who didn't exercise during class.

"Previous research showed effects of recess and physical activity breaks," said lead study author Marijke Mullender-Wijnsma, of the University of Gronigen in The Netherlands.

"However, we think that the integration of physical activity into academic lessons will result in bigger effects on academic achievement," Mullender-Wijnsma added in an email to Reuters Heath.

Mullender-Wijnsma and colleagues developed a curriculum that matched typical lessons in academic subject matter but added physical activity as part of instruction. They tested it in 12 elementary schools.

Here’s how it worked.

Lessons involved constant practice and repetition reinforced by body movements. For example, children jumped in place eight times to solve the multiplication problem 2 x 4.

Children in the exercise group received 22 weeks of instruction three times a week during two school years. These lessons were up to 30 minutes long, and evenly split between math and spelling instruction.

During the first year of the study, there wasn’t a great deal of difference found between the students receiving exercise during the class and those that didn’t, when speed was the focus in the math tests.

However, after two years, children who received exercise-based instruction had significantly higher scores on the math speed exams than students who didn't. The difference over two years equated to more than four months of additional learning for the students who had physically active lessons.

When the focus was on lesson comprehension, students receiving exercise outperformed students who did not receive the exercise instruction in both the first and second year. Again, the progress amounted to about four more months of learning.

For spelling, there wasn't a significant difference between the student groups after one year. But by the end of the second year they did have significantly better test scores, once again, adding an additional four more months of learning.

For reading, there wasn’t much difference between the two groups. It's possible that physical activities may be more beneficial to learning that involves repetition, memorization and practice of lessons from previous classes, the researchers conclude.

Researchers did point out that there were limitations that could have impacted the results of the study during the first year. The exercise group received specially trained teachers and individual schools administered the tests.

The research team did not examine why exercise might have helped students do better during tests.

 Sara Benjamin Neelon, of Johns Hopkins University and colleagues write in an accompanying editorial that it’s not clear whether these types of classes would work in countries where the population is larger, more diverse and students come from different socioeconomic backgrounds.

"However, the take-home message for parents and teachers is that physically active lessons may be a novel way to increase physical activity and improve academic performance – at the same time," Benjamin Neelon said by email.

More and more studies show that exercise appears to help the brain function better in children and adults. Whether all U.S. school administrations will see adding recess or exercise back into school curriculums is anybody’s guess, but according to science – it sure couldn’t hurt and might even help students develop stronger learning skills.

The study was published in the online journal Pediatrics.

Story source: Lisa Rapaport, http://www.reuters.com/article/us-health-children-fitness-learning-idUSKCN0VX26V

Daily Dose

Get Your Toddlers Walking!

With childhood obesity numbers rising, get your toddlers out of a stroller and walking!I walked into our office waiting room recently and was shocked at how crowded it was!! It really wasn’t that there were that many patients waiting, but it was the fact that there were about 6 “triple wide” strollers holding children of various ages who were being wheeled in and parked in the waiting room.

Not one toddler was walking or even standing!! I had a huge epiphany, children don’t walk anymore!! So, after looking out at the parking lot in our waiting room, I watched as these strollers maneuvered around hallways and doors as mothers brought their children to an exam room. Now, I must tell you, these children were not infants, or even new walkers. They were not twins or triplets either. These strollers were often holding a 5 year old, 3 year old and 1 year old, all being pushed toward their destination. In many cases, the older children were playing with a Nintendo DSL or their mother’s iPhone oblivious to the fact that their mother was struggling to push the “wide load” down the hallway.  It was reminiscent of a Cleopatra movie, while she was being carried eating grapes! I know I'm showing my age, but what happened to the day that the baby was in a stroller while the parent held the older children’s hands as they walked into our office, or a store or a restaurant. You may have even tried to maneuver around one of these mega strollers while shopping alone.  They take up entire aisles and should have to have a “wide load” sign with flashing lights. Not only are they a “road hazard” I think that they promote inactivity. Knowing that we have a terrible problem with childhood obesity, it seems that these” strollers on steroids”, only help promote inactivity. Not only are these toddlers and young children not walking on their own, they are missing out on many learning opportunities.  How many times do you remember saying or hearing,  “hold my hand” before you started walking through grocery store the parking lot?  How about “we have to stop and look both ways” as you came up to an curb or intersection.  If there were more than 1 or 2 children it was not uncommon to hear “hold your brother’s hand and he will hold my hand and we will all walk together”. These are important skills/lessons for a child to learn as they begin to establish some independence and autonomy.  You have to learn to ”run before you walk” and you have to learn how to navigate on your own by following simple “rules of the road” for safety, all of which needs to be achieved under a parent’s watchful eye during those early childhood years. These skills cannot be mastered when you are being “wheeled” around town without the need to pay attention to what is happening around you. At the same time that a child is inactive in the stroller, they are often eating cookies, goldfish, cheerios or granola bars and drinking from the sippy cup which is conveniently strapped to the side of their seat.  The combination of inactivity and snacking cannot be a positive way to promote a healthy lifestyle. I challenge mothers and fathers to get their children back on terra firma, and to hold hands and walk with their children rather than push those heavy children around. (can’t be good for the parent’s backs either).  Talk about where you are going, what you see along the way, and practice your child’s listening skills and following directions.  Return the mega stroller to the store and get those toddlers and pre-schoolers some good walking shoes! What do you think?  Send me your comments! That's your daily dose for today. We'll chat again tomorrow. Send your comment or question to Dr. Sue!

Your Teen

90% of High School Kids Need More Exercise

1:30

Nine out of ten high school students are not exercising enough to stay healthy and fit, setting up a pattern that often continues after they graduate, according to a new study published in the journal Pediatrics.

Researchers followed students at 44 high schools for four years, and found that only 9 percent met current exercise recommendations throughout that time. For the most part, those habits held steady after high school -- though college students were more active than non-students.

For students that continued to college, those living on campus exercised more than those living at home.

It's not clear why those students were more active. They might have been more involved in sports, for example, or simply walked more -- running from classes to dorms and other campus buildings, said lead researcher Kaigang Li.

"The walkability of your environment is important," said Li, an assistant professor of health and exercise science at Colorado State University, in Fort Collins.

This is not the first study to look at the physical condition of high school and college students.  Several other studies have found that these two groups struggle with getting enough meaningful exercise. 

According to Peter Katzmarzyk, a professor at Louisiana State University's Pennington Biomedical Research Center, in Baton Rouge, "This study really confirms the low levels of physical activity in adolescents, which appear to be maintained over time as they transition into young adulthood."

The strength of this study, he said, is that it objectively measured teens' activity levels: Students wore devices called accelerometers, which tracked how much they moved over the course of a week.

Katzmarzyk, who was not involved in the study, conducts research on child exercise patterns, obesity and health.

According to the U.S. Centers for Disease Control and Prevention (CDC), teenagers should get at least one hour of physical activity each day that includes exercise that boosts the heart rate, such as running. Kids should also try some strength-building activities -- for example, push-ups or lifting light-weights.

The CDC noted that a lack of physical education in U.S. schools may be a contributing factor in students’ understanding of exercise and how it can improve their health. 

At one time, PE was a part of every student’s daily school activities, today, according to the CDC, only 29 percent of high school students have gym class every day.

The evidence from this new research and other studies makes a good argument for more physical education, according to Katzmarzyk.

"Any way that we can increase physical activity levels in adolescence might translate into maintaining higher levels of physical activity in young adulthood," he said. "So physical education in high school is certainly an important outlet for this."

Still, Li said, there are probably numerous reasons for teenagers' low exercise levels.

He noted that in elementary school, most U.S. kids do get enough physical activity. But there is a steep drop-off after that. According to Li, that could be related to many factors -- including heavier homework loads starting in middle school, and more time on cellphones and computers.

While schools and communities can advance opportunities for kids to be more physically fit, families that put a high priority on exercise and a healthy lifestyle give their children the ability to independently remain physically fit for a lifetime.

Story source: Amy Norton, https://consumer.healthday.com/kids-health-information-23/adolescents-and-teen-health-news-719/9-of-10-teens-don-t-get-enough-exercise-study-shows-715167.html

Your Teen

Preventing ACL injuries in Young Athletes

2.00 to read

A new report states that young athletes are more susceptible to serious and potentially debilitating knee injuries. 

An increasing number of American children and teens are tearing up their knees, particularly kids who are involved in sports such as basketball, soccer, volleyball and gymnastics.  The most dangerous injury is a tear in the anterior cruciate ligament (ACL), which provides stability to the knee.

Specific types of training can reduce the risk of an ACL tear by as much as 72 percent, the report from the American Academy of Pediatrics (AAP) says.

"Neuromuscular training programs strengthen lower-extremity muscles, improve core stability and teach athletes how to avoid unsafe knee positions," lead author Dr. Cynthia LaBella, medical director and associate professor of pediatrics at Northwestern University Feinberg School of Medicine, and a member of the academy's council on sports medicine and fitness, said in an academy news release.

The AAP recommends that coaches who run these types of sports programs should learn more about the exercises that can help athletes strengthen their muscles and encourage their athletes to use them.

The risk of ACL injury among young athletes increases at age 12 for girls and age 14 for boys. The largest numbers of ACL injuries occur in female athletes ages 15 to 20. After an ACL tear, girls are much more likely to have surgery and less likely to return to sports than boys, experts said.

"After puberty, girls have a 'machine motor mismatch,'" report co-author Timothy Hewett, professor and director of research at Ohio State University's sports medicine department, said in the news release. "In contrast, boys get even more powerful relative to their body size after their growth spurt. The good news is that we've shown that with neuromuscular training, we can boost the power of girls' neuromuscular engine, and reduce their risk of ACL injuries."

Before some of the newer less-invasive surgical treatments were available, surgery was often delayed until the child’s skeletal structure was fully mature. Now though, improved treatment can avoid impact to the developing growth plates, which means that they can have surgery to stabilize the knee.

Overall, ACL surgery is about 90 percent successful in restoring knee stability, according to the report published online April 28 and in the May print issue of Pediatrics.

"In many cases, surgery plus rehabilitation can safely return the athlete back to sports in about nine months," report co-author Dr. William Hennrikus, professor of pediatric orthopedic surgery at Penn State Hershey Bone and Joint Institute, said in the news release. "Parents who are considering surgery for their child should seek out a pediatric orthopedic surgeon with sports medicine training."

ACL tears can have long-lasting effects. People who suffer an ACL tear are up to 10 times more likely to develop early-onset degenerative knee osteoarthritis, which can lead to chronic pain and disability, the report said. "This is important, because it means athletes who suffer an ACL tear at age 13 are likely to face chronic pain in their 20s and 30s," LaBella said.

If your child participates in any of these sports, check with your child’s coach to see if they are providing the appropriate amount of muscle strengthening exercises to fortify your child’s knee support system.

If you feel they are not getting any or enough of these needed exercises, consider enrolling your child in a muscle strengthening exercise program or begin doing them together at home.

Source: Robert Preidt, http://www.philly.com/philly/health/topics/HealthDay687065_20140428_Training_Programs_Protect_Young_Athletes_From_ACL_Tears__Report.html#cPXEpJy1wK9xQl6s.99

Daily Dose

Make Sure Your Playground is Safe

This is the best time of year for children playing on playgrounds and in the front yard.I was outside with the neighbors and their children on this beautiful evening and realized that the longer days of spring are here. This is the best time of year for children playing on playgrounds and in the front yard. With those outside activities come concerns about safety for children of all ages. From falling off the slide to running into the street to chase a ball and being hit by a car, accidents and injuries are far too common.

Approximately 20 children under the age of 14 die each year from injuries sustained on playgrounds. Many of these deaths occurred on backyard playgrounds. Thousands of other kids will make trips to the E.R. for fractures and sprains, cuts that need stitching, and head and neck injuries. The best way to ensure safe play is to ensure that the equipment they are playing on is safe, and that there is good parental supervision. Swings may pose a choking and hanging hazard, so check out that home made rope swing. Check out the slide for sharp edges or hooks that may cause lacerations. Burns may occur from slides that heat up in the heat of the midday sun (that may only be a southern experience!) Another source of injury is due to inappropriate surfaces beneath the playground equipment. Look into installing a protective shock-absorbing surface beneath your swing set or fort. Make sure that the surface extends far enough in all directions to cover jumps from swings and slides. Playing outside is a rite of passage, and a great way for a both family and friends to have fun, and get exercise. Just make the experience as safe as possible. That's your daily dose, we'll chat again tomorrow.

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

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