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Your Teen

Overweight Girls Start Periods At Earlier Age

1.45 to read

Early-onset menstruation is linked to later health problems such as breast cancer, said Sarah Keim, a researcher at The Ohio State University College of Medicine in Columbus, who wasn't involved in the new study. Girls who get their period early in life are also more likely to have sex sooner than their peers, Keim added, which increases the risk of teen pregnancy and sexually transmitted diseases.It's nothing new that girls are getting younger and younger when they have their first period, but experts worry that the current obesity epidemic could be fueling that trend.

Overweight or obese girls get their first period months earlier than their normal-weight peers, according to a Danish study. Early-onset menstruation is linked to later health problems such as breast cancer, said Sarah Keim, a researcher at The Ohio State University College of Medicine in Columbus, who wasn't involved in the new study. Girls who get their period early in life are also more likely to have sex sooner than their peers, Keim added, which increases the risk of teen pregnancy and sexually transmitted diseases. About 17 percent of American kids and teens are obese, according to the Centers for Disease Control and Prevention. For the study, researchers used information on body mass index (BMI) -- a measure of weight in relation to height -- and age at first period from about 3,200 Danish girls born between 1984 and 1987. The girls started their period just after they had turned 13, on average, which is about half a year later than in the U.S. Keim said part of the reason for this difference may be that African-Americans tend to start their periods before white girls. On average, a girl got her period about 25 days earlier for every point her BMI increased. For a female of about average height and weight, a one-point change in BMI is equivalent to about six pounds. Overweight and obese girls, for example, got their period three to five months before normal-weight girls, said Anshu Shrestha, a graduate student at UCLA School of Public Health, who worked on the study. There has been past research showing a link between BMI and when girls start menstruating. However, since this study was done more recently, it shows that the link is holding up in today's generation, Keim said. The researchers also found that a girl's mother's weight was related to when her daughter started menstruating, but less so than earlier work had hinted. For every point her mother's BMI when pregnant went up, the girl's period came about a week earlier, according to the new study, which was published in the journal Fertility and Sterility. Keim said the Danish findings reinforce the importance of keeping a healthy weight. "It's important for your entire life, starting from very early on," she told Reuters Health. "And it can even affect your children's health." Talking to your daughter about Menstruation. Most girls begin to menstruate when they're about 12, but periods are possible as early as age 8. That's why explaining menstruation early is so important. But menstruation is an awkward subject to talk about, especially with preteen girls, who are often embarrassed by this discussion. So what's the best way to approach this ticklish topic? If your daughter asks questions about menstruation, answer them openly and honestly. Provide as many details as you think she needs at the time. It's OK to let your daughter set the pace, but don't let her avoid the topic entirely. If she's not asking questions as she approaches the preteen years, it's up to you to start talking about menstruation. Don't plan a single tell-all discussion. Instead, talk about the various issues - from basic hygiene to fear of the unknown - in a series of short conversations. Consider it part of a continuing conversation on how the human body works. Remember, your daughter needs good information about the menstrual cycle and all the other changes that puberty brings. If her friends are her only source of information, she may hear some nonsense and take it for fact. To introduce the subject of menstruation, you might ask your daughter what she knows about puberty. Clarify any misinformation and ask what questions she might have. It may be helpful to time your conversations with the health lessons and sex education your daughter is receiving in school, or you could broach the subject before a routine doctor's appointment. You can tell your daughter that the doctor may ask her whether she's gotten her period yet. Then ask if she has any questions or concerns about menstruation. Girls might prefer to learn about menstruation from a female family member, but sometimes that's not possible. If you're a single father and you're not comfortable talking about menstruation, you might delegate these conversations to a female relative or friend. The key is to make sure the information is relayed somehow. The biology of menstruation is important, but most girls are more interested in practical information about periods. Your daughter may want to know when it's going to happen, what it's going to feel like and what she'll need to do when the time comes. - What is menstruation? Menstruation means a girl's body is physically capable of becoming pregnant. Each month, one of the ovaries releases an egg. This is called ovulation. At the same time, hormonal changes prepare the uterus for pregnancy. If ovulation takes place and the egg isn't fertilized, the lining of the uterus sheds through the vagina. This is a period. - Does it hurt? Many girls have cramps, typically in the lower abdomen, when their periods begin. Cramps can be dull and achy or sharp and intense. Exercise, a heating pad or an over-the-counter pain reliever may help ease any discomfort. - When will it happen? No one can tell exactly when a girl will get her first period. Typically, however, girls begin menstruating about two years after their breasts begin to develop. Many girls experience a thin, white vaginal discharge about one year before menstruation begins. - What should I do? Explain how to use sanitary pads or tampons. Many girls are more comfortable starting with pads, but it's OK to use tampons right away. Remind your daughter that it may take some practice to get used to inserting tampons. Stock the bathroom with various types of sanitary products ahead of time. Encourage your daughter to experiment until she finds the product that works best for her. - What if I'm at school? Encourage your daughter to carry a few pads or tampons in her backpack or purse, just in case. Many school bathrooms have coin-operated dispensers for these products. The school nurse also may have supplies. - Will everyone know that I have my period? Assure your daughter that pads and tampons aren't visible through clothing. No one needs to know that she has her period. - What if blood leaks onto my pants? Offer your daughter practical suggestions for covering up stains until she's able to change clothes, such as tying a sweatshirt around her waist. You might also encourage your daughter to wear dark pants or shorts when she has her period, just in case. Your daughter may worry that she's not normal if she starts having periods before, or after, friends her age do, or if her periods aren't like those of her friends. But menstruation varies with the individual. Some girls have periods that last two days, while others have periods that last more than a week. It can even vary this drastically from month to month in the same girl. The amount of blood lost each month can vary, too, usually from 4 to 12 teaspoons (about 20 to 60 milliliters). It's also common for girls to have irregular periods for the first year or two. Some months might even go by without a period. Once your daughter's cycle settles down, teach her how to track her periods on a calendar. Eventually she may be able to predict when her periods will begin. Schedule a medical checkup for your daughter if: - Her periods last more than seven days - She has menstrual cramps that aren't relieved by over-the-counter medications - She's soaking more pads or tampons than usual - She's missing school or other activities because of painful or heavy periods - She goes three months without a period or suspects she may be pregnant - She hasn't started menstruating by age 15 The changes associated with puberty can be a little scary. Reassure your daughter that it's normal to feel apprehensive about menstruating, but it's nothing to be too worried about and you're there to answer any questions she may have.

Your Baby

Kids of Obese Mothers at Higher Risk for Autism, ADHD


A new study points out another reason that obesity and pregnancy can be a bad combination not only for the mother but for her future child as well.

Researchers found that six-year-olds whose mothers were severely obese before pregnancy are more likely to have developmental or emotional problems than kids of healthy-weight mothers.

The lead author of the study, Heejoo Jo of the Centers for Disease Control and Prevention (CDC), and her team reviewed data on 1,311 mother-child pairs collected between 2005 and 2012, including the mothers’ body mass index (BMI, a height-to-weight ratio) before pregnancy and their reports of the children’s psychosocial difficulties at age six.

The researchers also incorporated the children’s developmental diagnoses and receipt of special needs services.

Kids of moms who were severely obese, with a BMI greater than 35, were twice as likely to have emotional symptoms, problems with peers and total psychosocial difficulties compared to kids of moms who had a healthy BMI, between 18.5 and 25.

Their children were three times as likely to have a diagnosis of autism spectrum disorder and more than four time as likely to have attention-deficit/hyperactivity disorder (ADHD), as reported in the journal Pediatrics.

Previous studies have shown a connection with autism and maternal diabetes and obesity.

Researchers took into account pregnancy weight gain, gestational diabetes, breastfeeding duration, postpartum depression and infant birth weight. None of these explained the apparent association.

“We already do know that obesity is related to health problems during pregnancy and throughout the lifetime,” Jo said. “I think this adds to that by suggesting that not only does severe obesity affect a woman’s health but the health of her future children.”

This study could not analyze the mechanism linking severe obesity and later risk for developmental problems, Jo noted.

“One theory that we could not look at and needs further research was some small studies have linked maternal obesity to increased inflammation, which might affect fetal brain development,” she told Reuters Health by phone.

While it sounds cliché because we’ve heard it so much; obesity in America has reached epidemic status. Almost 30 percent of Americans are obese and the prevalence of maternal obesity has risen rapidly in the last two decades.

In the USA, approximately 64% of women of reproductive age are overweight and 35% obese.

Women’s health specialists recommend that obese women considering pregnancy lose weight before they conceive to help reduce health risks for themselves as well as their child.

The Academy of Pediatrics recommends that all children be screened for developmental delay or disability at nine, 18 and 24 or 30 months of age.

Health experts strongly suggest that women who were obese or severely obese when they became pregnant make sure that their children receive these developmental screenings.

Sources: Kathryn Doyle,

James R. O'Reilly, Rebecca M. Reynolds,

Daily Dose

Kids, Media & Obesity

1.45 to read

A recent study released in Pediatrics looks at mounting research showing that a child’s media use may be linked to their body weight, not only due to the fact that they don’t get as much exercise if they are watching TV and using other media, but also due to other issues related to media exposure. The policy statement from the American Academy of Pediatrics, entitled “Children, Adolescents, Obesity and the Media” states that, “American society couldn’t do a worse job at the moment of keeping children fit and healthy – too much TV, too many food ads, not enough exercise, and not enough sleep.” It has become my routine during well child exams, beginning as young as 2 years of age, to ask parents as well as older children, “Do you have a TV in your room?”, “Do you have a computer or DVD player in your room?” I am still amazed at the number of young children who answer “yes” to this question.  Fortunately, many also respond “No”, and then ask me when they may have a TV in their room?  My standard answer is “When you leave home and go to college or work.”  Most parents are relieved with this response. A few don’t understand why I am even asking the question. This new policy statement reiterates that parents need to be paying attention to the amount of “screen” time their children get daily. Total non-educational screen time (again, the definition of educational may vary from family to family), should be no more than 2 hours per day. This limit on screen time should also be enforced in child care centers, after school program and in community centers. According to the statement, the numerous ads on air for junk foods and fast foods, only increases a child’s desire for these foods. It is easy to keep your child from buying Cocoa Puffs or Fruit Loops (just randomly selected, you can fill in your cereal) when they have never seen the cute ad for these sugary cereals. I still remember, “Trix are for kids!”  Children who are allowed to stay up late at night watching TV are not only exposed to numerous ads, but at the same time do son get enough sleep, and the combination puts them at greater risk for childhood obesity. Dr. Victor Strasburger, one of the lead authors states, “Kids see 5,000 to 10,000 food ads per year, most of them for junk food and fast food.” By asking parents and their children about screen time pediatricians can encourage a family to have a well thought out plan for limiting screen time while encouraging outside activity. These recommendations will hopefully translate into less screen time, less exposure to advertising, less sedentary activity and ultimately a healthier weight for children. What do you think? I would love your comments and feedback.

Your Baby

Obese During Pregnancy Linked to Obesity in Offspring


Not every time, but often, you’ll see obese couples and their kids are either obese or on the threshold of obesity. While adults have the power and the life experience to understand the health issues associated with obesity, their children – depending on their age- are reliant on on their parents making healthy choices for them.  

 Is generational obesity inherited or a case of families making poor choices where food and exercise are concerned – or both?

Researchers from the University of Colorado School of Medicine wondered if children born to obese moms might be predisposed to being obese due to their womb environment.

The team of scientists analyzed stem cells taken from the umbilical cords of babies born to normal weight and obese mothers. In the lab, they coaxed these stem cells to develop into muscle and fat. The resulting cells from obese mothers had 30% more fat than those from normal weight mothers, suggesting that these babies’ cells were more likely to accumulate fat.

No cause and effect was established, but the scientists noted that further research was needed. “The next step is to follow these offspring to see if there is a lasting change into adulthood,” says the lead presenter, Kristen Boyle, in a statement.

She and her colleagues are already studying the cells to see whether they use and store energy any differently from those obtained from normal-weight mothers, and whether those changes result in metabolic differences such as inflammation or insulin resistance, which can precede heart disease and diabetes.

Other studies have found a high correlation between parents’ Body Mass Index (BMI) numbers and their children ‘s BMI, particularly between mothers and their kids. Further, the BMI of grandmother’s and their grandchildren is also high.

What is a healthy weight gain for a pregnant woman? It depends on how much you weigh before getting pregnant.

The guidelines for pregnancy weight gain are issued by the Institute of Medicine (IOM); most recently in May 2009. Here are the most current recommendations:

•       If your pre-pregnancy weight was in the healthy range for your height (a BMI of 18.5 to 24.9), you should gain between 25 and 35 pounds, gaining 1 to 5 pounds in the first trimester and about 1 pound per week for the rest of your pregnancy for the optimal growth of your baby.

•       If you were underweight or your height at conception (a BMI below 18.5), you should gain 28 to 40 pounds.

•       If you were overweight for your height (a BMI of 25 to 29.9), you should gain 15 to 25 pounds. If you were obese (a BMI of 30 or higher), you should gain between 11 and 20 pounds.

•       If you're having twins, you should gain 37 to 54 pounds if you started at a healthy weight, 31 to 50 pounds if you were overweight, and 25 to 42 pounds if you were obese.

These recent findings point out again, how important it is for pregnant women to consider the possible long - term health affects on their unborn offspring when making decisions about their own health.

The report was presented in May to the American Diabetes Association.

Sources: Alice Park,


Daily Dose

Sugary Drinks & Kids

1.15 to read

Do you buy soft drinks?  Several recent studies have been in the news and seem to confirm what I have thought for a while - sugary soft drinks really have no place in a child’s diet.  I must admit I was a mom who purchased different soft drinks of every color of the rainbow.  But about 15 years ago, I just stopped buying them altogether as I was convinced that not only did they all have enormous amounts of sugar, they were expensive, and if I bought them they somehow “disappeared” quickly from the refrigerator. They were like many other foods: “can’t just eat one”. 

Over time my kids stopped complaining that we didn’t have any “Cokes” and my husband decided that he would drink sugar free drinks if he was going to have a soft drink at all.  I would occasionally buy soft drinks for a party or something, but other than that our children resorted to drinking milk, water and Gatorade after sporting events. And guess what, they didn’t run away from home, even after threatening that it was “not fair”. 

I have routinely asked parents and children if they drink soft drinks.  I am continually amazed at how many families have soft drinks as their beverage of choice for dinner.  Calories, calories, calories, and all unnecessary, yet alone the cavities that might be forming. 

New research now confirms that drinking sugary beverages interacts with genes that affect weight, and in certain individuals will cause even greater weight gain and eventually may pack on pounds leading to obesity. With 1/3 of U.S. children being overweight or obese, this research would confirm that children (and I would ditto this for adults) DO NOT NEED to drink sugary soft drinks at all. Several other studies have shown that by giving overweight or obese children alternatives to sugary drinks, such as water of sugar free alternative beverages,  you can reduce a child’s weight gain.  Those children who continued to drink sugar sweetened beverages during different studies gained anywhere from 2-4 lbs more per year than those who cut out the sugary drinks.  If this is per year, then think of the cumulative effect. 

Lastly, many tweens and teens not only drink sugar sweetened drinks but they “super size” them or get free refills. Just recently NYC made headlines when a law was passed restricting the sale of drinks larger than 16 ounces, all in hopes of helping combat obesity. 

So parents take a stand and stop buying the drinks. If they are not in the house or available, most kids would not have access. Limit them for a special occasion.  That is a good place to start.

Daily Dose

Plate Size & Childhood Obesity

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While I have been trying to change up my eating habits a bit and talking to patients about trying some new foods, I came upon an interesting study in the journal Pediatrics.  

The hypothesis for the study, which was done among school children in Philadelphia, was “can smaller plates promote age-appropriate portion sizes in children?”.

There have been previous studies in the adult literature that have shown that dish ware size influences self-serve portion sizes and caloric intake. Whether the same conclusions with children were true had yet to be examined, but it does make sense that it might.

So, the hypothesis was correct and when children were given larger bowls, plates and cups, they served themselves larger portions and in turn more calories. In the study, 80% of the children served themselves more calories at lunch when using adult-size plates and bowls.

This is really great news, in that by changing the size of the plate we might be able to affect a child’s portion size without them even really being aware!

I remember that our kids all had children’s bowls, plates and cups that they loved to use and eventually they either broke, got lost, or we just decided to have everyone eat off of the same plates. But, maybe it would make more sense to continue to have our children use child sized plates until they reach puberty?  Certainly seems that it wouldn’t hurt and if schools did the same thing we might be able to impact some of the obesity problem by just changing one behavior.  It is definitely worth trying!

Daily Dose

School Lunches & Obesity

1.30 to read

Since we have been talking about healthier school lunches, I thought I would share with you an interesting article in last month’s Pediatrics which related to regulations on school snacks.  

While the nutrition standards for school meals changed for the 2012-2013 school year, the new guidelines do not effect foods in vending machines, snack bars or other venues within the school that are not a part of the regular school meal programs. These foods (typically snacks and drinks) are termed “competitive foods” as they compete with school breakfasts and lunches. 

This study looked at weight changes for 6,300 students between 2004-2007 and followed the students from fifth to eighth grade.  They found that adolescents in states with strict laws regulating the sale of “competitive foods” gained less weight over this 3 year period than those living in states without laws. 

As the childhood obesity epidemic continues (the CDC now estimates that 1/5 of American children are obese), public health officials continue to look at ways to improve a child’s eating habits during the school day.  The laws surrounding snack foods at school differ by state. There are no laws in some states, weak laws (where recommendations were made but there were no specific guidelines), and strong laws (where detailed nutritional standards were issued). 

The study did not conclude that strong laws were directly responsible for the differences in a student’s weight gain, but it did conclude that these outcomes tended to happen in states with strong laws.  That would seem to make sense to me as most children including my own, if given the opportunity, would at times choose vending machine snacks over a healthy school lunch. 

I also think that this is more common as the children become teens and seem to “snack” for lunch while multi-tasking rather than sitting down to eat a well balanced lunch. I continually hear this comment from adolescent patients of mine when I ask them about their lunch habits, and many of whom eat “off campus” if allowed, and choose fast foods over a healthy school cafeteria lunch.  Off school lunches seem to be another issue as well. 

One of the lead authors on the study stated, “competitive-food laws can have an effect on obesity rates if the laws are specific, required and consistent”. It seems like this might be a good cause to discuss with your own state representative.

Daily Dose

Cut Soda to Fight Childhood Obesity

Getting rid of sugar-laden drinks and replacing them with water has a dramatic impact on the amount of calories children consume and could help in the fight against childhood obesity. Researchers from Columbia Mailman School of Public Health in New York found that children get 10 to 15 percent of the daily caloric intake from empty calories.

"The key observation is that when kids substitute sugar-sweetened beverages with water, there is a significant decline in total energy intake without any compensatory increase in the consumption of other beverages or food," said Dr. Y. Claire Wang. Dr. Wang also noted that substituting calorie-free beverages "is a simple and effective way of eliminating the excess calories while improving the diet quality." Sugar-sweetened beverages "should be viewed as treats, not necessities, and water is a perfect substitute for the purpose of thirst-quenching," Wang said. Wang and her colleagues looked at diet data from the 2003-2004 National Health and Nutrition Survey of over 4,000 children aged two to 19 years. They found that substituting sugar-sweetened beverages with water was associated with significant reductions in total calories consumed. Wang and colleagues estimate that replacing all sugary drinks with water could cut out an average of 235 calories out of kids' diets each day. Since the late 1970s, consumption of sugary drinks by children and adolescents has increased "substantially," and is thought to be "an important contributing factor to obesity," the researchers point out in the Archives of Pediatrics and Adolescent Medicine. "Replacing these liquid calories with calorie-free beverage alternatives therefore represents a key strategy to eliminate excess calories and to prevent obesity in childhood," they conclude.

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.


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