Twitter Facebook RSS Feed Print
Daily Dose

Diagnosing Diabetes

1.15 to read

I often see parents who come in worried that their child might have diabetes. I thought this would be a great opportunity to discuss the symptoms of type 1 diabetes, which was previously known as juvenile onset diabetes. 

While there is much in the news about type 2 diabetes, which is typically related to childhood obesity, the mystery of type 1 diabetes has not yet been totally elucidated. Type 1 diabetes affects about 1 in 400 children and adolescents. There does seem to be a genetic predisposition (certain genes are being identified) to the disease and then “something” seems to trigger the development of diabetes. Researchers continue to look at viral triggers, or environmental triggers (such as cold weather as diabetes is more common in colder climates). Early diet may play a role as well, as there is a lower incidence of diabetes in children who were breast fed and who started solid foods after 6 months of age.   

In type 1 diabetes the pancreas does not produce enough ( or any) insulin. Insulin is needed to help sugars (glucose) in the diet to enter cells to produce energy.  Without insulin the body cannot make enough energy and the glucose levels in the blood stream become elevated which leads to numerous problems. Children with type 1 diabetes are often fairly sick by the time they are diagnosed.  

The most common symptoms of type 1 diabetes are extreme thirst (while all kids drink a lot this is over the top thirst) frequent urination ( sometimes seen as new onset bedwetting with excessive daytime urination as well), excessive hunger,  and despite eating all of the time, weight loss and fatigue.  

Any time a child complains of being thirsty or seems to have to go the bathroom a lot, a parent (including me) worries about diabetes. But, this is not just being thirsty or having a few extra bathroom breaks or wetting the bed one night. The symptoms worsen and persist and you soon realize that your child is also losing weight and not feeling well. 

Although diabetes is currently not curable, great strides have been made in caring for diabetics and improving their daily life. I now have children who are using insulin pumps and one mother has had an islet cell transplant. The research being done is incredible, and hopefully there will one day be a cure. 

In the meantime, try not to  worry every time your child tells you they are thirsty or tired, as all kids will complain about these symptoms from time to time.  But do watch for ongoing symptoms.  

Lastly, eating sugar DOES NOT cause type 1 diabetes. Now it may lead to weight gain which can lead to type 2 diabetes....but that is another story. 

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

Your Child

Healthier Choices for Students in School Lunch Lines

1:30

School lunches have changed over the years and in many school cafeterias, food options are healthier than ever before, according to a new study.

Elementary school cafeterias are offering more vegetables, fresh fruit, salad bars, whole grains and more healthy pizzas, while the availability of high-fat milks, fried potatoes and regular pizza has decreased, researchers report.

"School food service programs have worked hard to improve the nutritional quality of school lunches, and largely have been very successful," said lead researcher Lindsey Turner, director of the Initiative for Healthy Schools at Boise State University, in Idaho.

Although in some schools food choices are improving, that’s not the case everywhere. Turner noted that more work needs to be done to make sure every student has the same healthy choices in the lunch line.

In the study of more than 4,600 elementary schools that are part of the U.S. National School Lunch Program, researchers found that school lunches improved significantly between 2006-2007 and 2013-2014.

Despite improvements in food choices, disparities were still found. For example, schools in the West were more likely to offer salad bars than schools in the Northeast, Midwest or South, the researchers found.

Schools with a majority of black or Hispanic children were less likely to offer fresh fruit than schools with a preponderance of white students.

Also, schools in poor areas were less likely to offer salads regularly.

Over the course of the study, Midwestern schools slightly reduced offering pre-made salads in favor of salad bars, but Southern schools were more likely to offer pre-made salads and less likely to have salad bars, the researchers found.

On the other side of offering healthier foods is choosing to eat those foods. Just because there are better food options available, doesn’t mean that kids will eat them. One expert noted that it takes time and effort for kids to change their eating habits. It not only has to look good, it has to taste good.

"It is not only important to improve the quality of school lunches but to make these foods attractive, tasty, easily seen and accessible," said Samantha Heller, a senior clinical nutritionist at New York University Medical Center, in New York City.

Studies have found that putting fresh fruit in a nice bowl, in a conveniently located, well-lit area in the school cafeteria increased sales of fruit by 102 percent, she noted.

"A brightly lit, hot-and-cold salad bar filled with colorful fresh fruits, vegetables, beans and nuts, mushroom and spinach pizza, and veggie tacos center-stage in the lunchroom would be very attractive to students and staff alike," Heller said.

This approach works well at home, too, she added.

"Kids are more likely to grab healthy foods like cut-up melon, carrots, peppers, edamame and hummus when they are upfront and easy to grab in the fridge," Heller said.

The study was published in the journal Preventing Chronic Disease.

Story source: Steven Reinberg, http://consumer.healthday.com/vitamins-and-nutrition-information-27/food-and-nutrition-news-316/america-s-school-lunches-getting-healthier-study-709097.html

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.

Your Child

Are Kid’s Sack Lunches Healthier?

2:00

For some kids who bring their lunch to school, a new study suggests that as far as nutrition goes, they’d be better off buying their meal at the school cafeteria.

Researchers found that student’s bag lunches typically contained foods that were higher in sodium and sugar with fewer vegetables and whole grains compared with standards set for school cafeterias.

The findings are not necessarily surprising, said the study's senior researcher, Karen Cullen, a professor at Baylor College of Medicine in Houston.

"Parents often pack lunches based on their children's preferences," she noted. Plus, she added, some other recent studies have found a similar pattern.

The study involved 12 elementary and middle schools in one Houston-area school district. Over two months, the researchers observed more than 300 students who brought their lunch from home -- noting what they ate and what they threw away.

On average, bag lunches were low on fruits and whole grains, and especially vegetables and milk.

School guidelines say kids should have three-quarters of a cup of vegetables (which really isn’t much) with every lunch. The average elementary school bag lunch had about one-tenth of that amount, according to the study.

Lunches brought from home also contained way too much sodium. The average bag lunch averaged 1,000 to 1,110 mg, versus a limit of 640 mg in elementary school lunches.

About 90 percent of the home lunches contained a dessert, sugary drink or snack chip. Guess what? Kids ate those items whereas between 20 and 30 percent of vegetables ended up in the garbage, according to the study.

Packing milk and palatable vegetables is tricky, noted Dr. Virginia Stallings, a pediatrician at Children's Hospital of Philadelphia who specializes in nutrition.

Giving your kids money to buy it at school can help solve the milk dilemma, said Stallings, who wrote an editorial published with the study. With vegetables, though, it can be challenging to go beyond carrot sticks, she added.

"I think that's one of the advantages of the school lunch," Stallings said. "Kids can have a hot meal, with cooked vegetables." She added that schools are working on making meals that are tasty without relying on salt, and expanding to include culturally diverse choices.

I don’t really think that kid’s attitudes have changed much about school lunches in the last few decades. As long as I can remember, kids eat what they want, trade foods with others and throw out the rest. They often gripe about their lunch food whether it comes from home or the school cafeteria.. That’s just what kids do.

So, if they are going to complain anyway you might as well fix them a lunch that will help them develop strong bones and hearts. The school systems have finally started paying attention to nutrition after all these years. They’re working on creative recipes that just might temp kids to eat better.

You already know that there are way too many American children that are eating poorly, not exercising and developing diabetes at a young age. It’s important what our children eat. Sometimes a school lunch is best and sometimes a lunch brought from home is best. Many times parents split the difference and do both.

Source: Amy Norton, http://consumer.healthday.com/kids-health-information-23/education-news-745/kids-bag-lunches-not-meeting-nutrition-guidelines-694048.html

Daily Dose

Preschool Nutrition Can Be Challenging

With all of the back-to-school discussions surrounding getting back to healthy breakfasts, nutritious lunches and family dinners, I thought it was a good time to discuss preschooler nutrition too. Preschool children, specifically the two- to five-year-old set are notoriously picky eaters, and parents need to recognize that this is developmentally appropriate, although frustrating for parents.

This is an appropriate time to begin teaching children the importance of healthy eating habits to encourage a lifetime of good health and prevent obesity. A good place to start to get information is “MyPyramid for Preschoolers”, a Web site sponsored by the U.S. Department of Agriculture. This Web site not only covers what your children should be eating, but also is full of good advice on handling picky eaters, how to monitor your child’s growth and ideas to encourage physical activity. The Web site encourages parents to lead by example and let your children see you eating a wide array of foods including fruits, vegetables, and whole grains throughout the day. There are ideas for healthy snacks that can be eaten on the run, as you get back into carpools and after school activities. Even the toddler set is busy after school! Remember: do not let food choices become a battle or an issue. Do not make negative food comments around your children, and keep trying new things. It may take up to 20 attempts or more before your child will try something new, but if you don’t keep trying you will never know if they might really like broccoli. Also, no “yucky faces” for the adults and older children while at the table and eating their meal. That will only discourage your toddler from trying unfamiliar foods. Put on that happy face, even if it is not your favorite food, it might be your child’s. The most important message is to make mealtime and snack time pleasant and healthy. Even a toddler can help with planning and preparing a meal. This Web site is really quite good and interactive as you can enter your child’s first name, age, gender and typical amount of activity and the site will generate a plan just for your child! Can’t be easier than that. That’s your daily dose, we’ll chat again tomorrow.

More Information: MyPyramid for Preschoolers
Daily Dose

Follow Up on Food Allergies

A food intolerance is not an allergic event, in other words, it is not immune mediated.We had a lively and informative discussion on food allergies on the show yesterday. We were fortunate to have a pediatric allergist as a guest along with an ER doctor whose son was diagnosed with numerous food allergies when he was an infant. Between the two of them, they were a wealth of information for anyone who is concerned about the possibility of food allergies in their children. We had a lot of good phone calls, but unfortunately did not have the opportunity to answer all of the questions as we ran out of time, so will hit a few of the high points here.

One of the take home messages was to identify the difference between a true food allergy and food intolerance. A food intolerance is not an allergic event, in other words, it is not immune mediated. People who have a food intolerance may complain of nausea with a certain food, or abdominal cramps. They do not demonstrate allergic symptoms such as hives, swelling of the lips or tongue or breathing or wheezing problems seen with a food allergy. With anaphylaxis you also have a drop in blood pressure and it is a life-threatening emergency. Food allergies usually present early in life, often when the child has their first known exposure to the offending food, and they usually have symptoms within minutes to an hour after ingestion. Several callers today wanted to know what to do if they think that their child had had "a" reaction to a food. If the allergic reaction was significant, you have probably already been through an emergency room and have been referred to a pediatric allergist. If you are unsure if they have had an allergic reaction, make an appointment with your pediatrician to discuss the history. History is the most important part of the puzzle, but there are screening blood tests that may be done to look at allergic antibodies to foods (most commonly nuts, milk, eggs, fish). The gold standard for diagnosis is an evaluation and skin testing with a pediatric allergist and then most importantly education about food allergies. That's your daily dose, we'll chat again tomorrow.

Daily Dose

New Iron Recommendations for Children

A new study says many U.S. children are iron deficient. How much iron do children need to stay healthy? New recommendations from the American Academy of Pediatrics.An article released in the journal Pediatrics from the American Academy of Pediatrics committee on nutrition, sets new guidelines for iron intake in infants and children.  The news is not good.  According to Dr. Frank Greer, who is the co-author of the report, “iron deficiency remains common in the United States”.

The effects of being iron deficient not only cause anemia, but may also cause “long term  irreversible effects on children’s cognitive and behavioral development.  Because of these findings it is imperative that adequate iron is provided in infancy and early childhood. Studies have shown that 4 percent of 6 month olds, and 12 percent of 12 month olds are iron deficient.  Children between the ages of 1-3 years of age have rates of iron deficiency between 6-15 percent. Preterm infants, infants who are exclusively breastfed and infants who are at risk for developmental disabilities seem to be at higher risk to develop iron deficiency. The committee recognized that the ideal way to prevent iron deficiency and iron deficiency anemia would be with a diet consisting of foods that are naturally rich in iron, but realized that in some cases “children will still need liquid iron supplements or chewable vitamins to get the iron they need. The AAP guidelines now recommend that: 1.  Term healthy babies that are exclusively breast fed should receive an iron supplement (1 mg per day) beginning at 4 months of age 2.  Whole milk should not be started until 12 months of age 3.  Infants 6–12 months of age need 11 mg of iron per day, which should be met via the use of “complementary” foods.  Red meat and vegetables with high iron content should be introduced early, as well as the use of iron fortified cereals. 4.  Toddlers ages 1-3 years need 7 mg of iron per day, and again this is best if iron comes from foods. 5.  Children should have their hemoglobin checked sometime between 9–12 months of age, and again between 15-18 months of age, and follow-up for iron deficiency treatment and testing is recommended 6.  Children who do not meet their iron needs via foods should receive a daily iron supplement The article contains a table which shows many foods from each food group that are good sources of iron.  Foods like meat, shellfish, beans, iron fortified cereals, and fruits and vegetables that contain vitamin C (which aids in iron absorption) are all encouraged. Thanks to my mother, I have always known that liver is a good source of iron (never my favorite dinner as a child), but who would have known that clams and oysters are also high in iron.  While oatmeal is a good iron source, molasses is also high in iron.  Tofu and wheat germ are also high in iron, as are edema me beans, which many kids love. By getting creative with foods that are high in iron beginning early in a child’s life, iron deficiency may be avoided.  You never know what your child will eat, unless you try it! That's your daily dose for today.  We'll chat again tomorrow. Send your question to Dr. Sue!

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.”

Pages

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.

 

DR SUE'S DAILY DOSE

What can you do if your child stinks?

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.

 

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.