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Your Baby

Pregnant? Exercise is Good For You!

2:00

For years, the prevailing thought has been – if you didn’t exercise before, during pregnancy wasn’t the time to start. That’s no longer the case says, Alejandro Lucia, a professor of exercise physiology at the European University of Madrid.

A group of researchers want women to know that when it comes to exercise, there is a strong consensus of benefit for both the mother and developing fetus.

"Within reason, with adequate cautions, it's important for [everyone] to get over this fear," said Lucia.

According to the American College of Obstetricians and Gynecologists (ACOG), which updated its recommendations in 2015, women without major medical or obstetric complications should get at least 20 to 30 minutes of moderate-intensity aerobic exercise — enough to get you moving, while still being able to carry on a conversation — on most days of the week.

Lucia noted that evidence now suggests that starting an exercise program while pregnant can provide health benefits to both the mother and the growing fetus. Obviously, though, if you're new to exercise, take it slowly — you can work up to that 20 or 30 minutes.

The authors of the study say physical activity can prevent excessive weight gain, which can complicate the pregnancy and contribute to obesity. A review of existing research published in 2015 by the Cochrane Library found "high-quality evidence" that exercise during pregnancy can help prevent gaining too much weight, and may possibly lower the likelihood of a cesarean section, breathing problems in newborns, maternal hypertension and a baby that is significantly bigger than average. And of course, exercise promotes general cardiovascular and muscular health.

Other health problems can be helped such as chronic high blood pressure, gestational diabetes and women who are overweight or obese. Researchers say women with these conditions should be encouraged to exercise.

However, there are some health conditions in pregnancy where exercise should be avoided. According to the ACOG guidelines, women should avoid aerobic exercise if they have significant heart disease, persistent bleeding in the second or third trimester, severe anemia and risk of premature labor, among other conditions. And certain symptoms, such as contractions or dizziness during exercise, should be checked out quickly.

The bottom line is that women need to make a plan with their physician, taking into account their exercise history, their health, and the risk of pregnancy complications, says James Pivarnik, a professor of kinesiology and epidemiology at Michigan State University. He wasn't an author of the viewpoint but has conducted research on exercise and pregnancy.

Moderation is the goal during any exercise program. Long distance running and heavy weight lifting are not recommended. ACOG also recommends against contact sports, hot yoga, and exercises done in the supine position, i.e. lying face up, starting in the second trimester.

There are always exceptions to the rule, particularly with women who are highly trained athletes before they become pregnant. These women should still form plan with their OB/GYN on how much and what kinds of exercises are safe for them.

Among the general population and pregnant women specifically, people will respond differently to an exercise program. "But we know if you do the kind of things they're talking about here, the odds are your risk will be lower," says. Pivarnik.

Story source: Katherine Hobson, http://www.npr.org/sections/health-shots/2017/03/21/520951610/exercising-while-pregnant-is-almost-always-a-good-idea

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

Exercise Can Maintain Heart Health

1.30 to read

Moms and dads...you have an exercise plan but what about your kids? Your child's heart health is important too! Heart health is based on genetics, diet and lastly exercise. (For adults and my teen patients as well, need to add smoking and drinking to the discussion).  

While I start talking about healthy eating during infancy the discussion about exercise comes a bit later.  If you have a toddler you know they “exercise”.....all day long, and never stop except to sleep! But as our children get older, once again it is up to the parents to model behavior, including exercise. 

I regularly ask, “how much time does your child play outside?” (I know it is much harder in winter months), “what does your child do for exercise outside of school?” and “do you exercise as a family?’”.  Once a child is older, say 5 or so, I include them in the questioning as well as they are a wealth of information. I ask them “if they ride a bike”....they love to tell me about taking off their training wheels. Then I ask “who they ride with and where do they go?”.  I also ask about bike helmets, you would be amazed at how many children tell me that they wear a helmet, but their parents don’t! (HINT HINT to parents). 

I find that most children under the age of 10 or so do get a fair amount of exercise, but as they get older many have stopped playing sports outside of school and have chosen to spend more time being sedentary.  They are not just watching TV, but have found other interests like music, art, drama, chess and even computer programming.  All of that is great, but children still need exercise and many schools have cut PE programs especially once you get to middle school and high school. This means that parents once again may have to encourage exercise, for the whole family. Walking the dog, family bike rides, tennis matches, front yard kickball or badminton.  Get the family exercising together....they may not even realize. 

The hardest group I have to encourage to exercise are my teens who are just not athletes (I can sympathize).  We all have our talents, but for some sports are not it.  I find myself asking my teenage patients, how much exercise they get and so many say, “None”.  Many say, “walking between classes” is all of their exercise, and the idea of walking to school is long gone for most.  Many of my teens start to gain weight after puberty and have to be reminded that we all stop growing....so you can’t keep gaining weight. Exercise has to be done on a regular basis...again it is about lifestyle. 

So, heart health and exercise should be a focus for families year round, see if you can get your family moving as we head into spring!

Your Child

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

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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

Your Baby

Exercising During Pregnancy

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If you’re pregnant, you may be wondering if you should start or continue exercising. The answer is a resounding, yes!

Regular exercise throughout your pregnancy can help you stay healthy, improve your posture and help decrease common discomforts such as backaches and fatigue.

There is even evidence that physical activity may help prevent gestational diabetes, relieve stress and build more stamina needed for labor and delivery.

All of these benefits are good things.

If you were physically active before your pregnancy, there’s no need to stop. However, don’t try to exercise at your former level; instead, do what's most comfortable for you now. Low impact aerobics are encouraged versus high impact.

Check with your obstetrician for guidance if you are a competitive athlete, you may need specialized monitoring.

What if you have never been into exercise, should you start now that you are pregnant?  Absolutely!

You can safely begin an exercise program during pregnancy after consulting with your health care provider, but do not try a new, strenuous activity. Walking is considered safe to initiate when pregnant.

The American College of Obstetrics and Gynecology recommends 30 minutes or more of moderate exercise per day on most if not all days of the week, unless you have a medical or pregnancy complication.

While exercise is great for most moms-to-be, there are some women who should not exercise during pregnancy. They are women with medical problems such as asthma, heart disease or diabetes. If you have one of these conditions, check with your OB/GYN about your options and follow his or her recommendations.

Exercise may also be harmful if you have a pregnancy-related condition such as:

           ·      Bleeding or spotting

           ·      Low placenta

           ·      Threatened or recurrent miscarriage

           ·      Previous premature births or history of early labor

           ·      Weak cervix

Talk with your health care provider before beginning an exercise program. Your health care provider can also give you personal exercise guidelines, based on your medical history.

Most exercises are safe to perform during pregnancy as long as you don’t overdo it.

The safest and most productive activities are swimming, brisk walking, indoor stationary cycling, step or elliptical machines, and low-impact aerobics (taught by a certified aerobics instructor). These activities carry little risk of injury, benefit your entire body, and can be continued until birth.

What about jogging, tennis and racquetball? All these activities require balance and coordination– which may change as you progress during your pregnancy.  If you’re healthy and have discussed these sports with your OB/GYN, go ahead and enjoy, but in moderation.

There are certain exercises that can be harmful during pregnancy. What exercises should be avoided? They are:

·      Holding your breath during any activity.

·      Activities where falling is likely (such as skiing and horseback riding).

·      Contact sports such as softball, football, basketball, and volleyball.

·      Any exercise that may cause even mild abdominal trauma such as activities that include jarring motions or rapid changes in direction.

·      Activities that require extensive jumping, hopping, skipping, bouncing, or running.

·      Deep knee bends, full sit-ups, double leg raises, and straight-leg toe touches.

·      Bouncing while stretching.

·      Waist-twisting movements while standing.

·      Heavy exercise spurts followed by long periods of no activity.

              ·      Exercise in hot, humid weather.

Stretching exercises can help make the muscles limber and warm, which can be helpful during pregnancy.

Kegal exercises can help strengthen the muscles that support the bladder, uterus and bowels. By strengthening these muscles during your pregnancy, you can develop the ability to relax and control the muscles in preparation for labor and birth.

Tailor exercises strengthen the pelvic, hip, and thigh muscles and can help relieve low back pain.

Many health providers have DVDs, websites or exercise pamphlets with instructions and examples available for their pregnant patients. There are also classes with instructors trained in leading exercise programs specifically for pregnant women.

What should a pregnancy program consist of?

A total fitness program should strengthen and condition your muscles. Don’t forget to drink plenty of water and never exercise to the point of exhaustion.

Exercising during pregnancy has many advantages, but there are warning signals you should look out for. Stop exercising immediately and contact your health provider is you:

             ·      Feel chest pain.

             ·      Have abdominal pain, pelvic pain, or persistent contractions.

             ·      Have a headache.

             ·      Notice an absence or decrease in fetal movement.

             ·      Feel faint, dizzy, nauseous, or light-headed.

             ·      Feel cold or clammy.

            ·      Have vaginal bleeding.

            ·      Have a sudden gush of fluid from the vagina, or a trickle of fluid that leaks steadily.

            ·      Notice an irregular or rapid heartbeat.

           ·      Have sudden swelling in your ankles, hands, face, or calf pain.

           ·      Are short of breath.

           ·      Have difficulty walking.

           ·      Have muscle weakness.

The big question many women have after delivery is – when can I start working off these extra pounds? It’s best to start fitness routines gradually and follow your health provider’s recommendations. Too often, women who have just given birth are inundated with images of celebrities who look as though they have dropped 50 pounds and returned to their former sleek selves within weeks after delivery. However they accomplish this (think spandex & a personal trainer that works you relentlessly), it’s not necessary or even healthy to try to capture your former body immediately.

Most women can safely perform a low-impact activity one to two weeks after a vaginal birth (or three to four weeks after a cesarean birth). Do about half of your normal floor exercises and don't try to overdo it.

Exercising during pregnancy is not a “one routine fits all” kind of thing. You can strengthen your muscles and reap the benefits of exercise while pregnant, just do it under the guidance of your health provider. He or she knows your limits, your medical history and will be able to help you achieve the best results.

Story source:

Traci C. Johnson, MD, http://www.webmd.com/baby/guide/exercise-during-pregnancy.

 

 

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

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

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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