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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.

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.

Daily Dose

Infant Weight Gain & Obesity

1:15 to read

A new study out of Harvard that was published in Pediatrics, looks at infant weight gain and links to childhood obesity. This is an interesting study, as previous studies had typically looked at weight alone as a predicator for future problems with obesity. In this study the authors looked at both weight and length as a measure of fatness.

They also looked at weight as a dynamic process, in other words, it was not how much you weighed, but how quickly you gained the weight in infancy. The authors found that the correlation between rapid infant weight gain and later obesity was striking. Other studies have also looked at the relationship between infant and childhood weight but this study makes a compelling argument that early rapid weight gain, even in the first months of infancy, could have long term health consequences.

So, armed with this knowledge, what can a parent do? Follow the AAP guidelines to exclusively breast or formula feed your baby for the first six months of life. If a your-baby is formula fed, limit their daily intake to an appropriate amount for age. Many parents, for a multitude of reasons, decide to add cereal to their baby's bottle in hopes that this will "make their infant sleep through the night". To my knowledge there has never been any data to confirm this, (maybe the Mommy network) and additional calories in infancy may lead to long-term consequences. Juices and early introduction of your-baby foods may also add unnecessary calories. This study points out the need to modify weight gain in infancy in a manner that will balance the needs of an infant's brain as well as their body, during this time of rapid development.

That's your daily dose, we'll chat again soon.

Your Baby

Longer Breast-Feeding Time, Less Childhood Obesity

2:00

A new study looks at the duration of breast-feeding and babies who are high risk for obesity, as they get older. Researchers found that the longer mothers breast –fed these higher risk babies, the less likely the babies were to become overweight later.

"Breast-feeding for longer durations appears to have a protective effect against the early signs of overweight and obesity," said lead researcher Stacy Carling, a doctoral candidate in nutrition at Cornell University, in Ithaca, N.Y.

Carling and her colleagues followed 595 children from birth to the age of 2. They tracked the children's weight and length over this time, and compared individual children's growth trajectories to how long the children breast-fed.

Which children are considered at high risk for extra weight gain? Researchers found that babies whose mothers were overweight or obese, mothers with lower education levels and mothers who smoked during pregnancy were more likely to have overweight children. Almost 59 percent of the children at risk for being overweight had mothers with one or more of these characteristics, compared to about 43 percent of the children not at risk for excessive weight gain.

Higher-risk babies who breast-fed for less than two months were more than twice as likely to gain extra weight than those who breast-fed for at least four months.

Although the study didn’t prove that longer breast-feeding actually reduced risk for obesity, it did provide several reasons why the link between the two may exist.

"Breast-feeding an infant may allow proper development of hunger and satiety signals, as well as help prevent some of the behaviors that lead to overweight and obesity," Carling said.

"Breast-feeding, especially on demand, versus on schedule, allows an infant to feed when he or she is hungry, thereby fostering an early development of appetite control," she said. "When a baby breast-feeds, she can control how much milk she gets and how often, naturally responding to internal signals of hunger and satiation."

The study did not include information on whether the babies were exclusively breast-fed or how often they were getting milk at the breast versus from a bottle, but the time required to reduce obesity risk was not long.

"The difference of two months of breast-feeding may be enough to reap some benefit," Carling said.

There are many reasons mothers choose to breast-feed for shorter periods, and some mothers are not able to breast-feed at all. For mothers that choose to breast-feed, Carling believes they need to be supported on many levels.

"Ultimately, increasing breast-feeding rates in the United States means increasing knowledge and support at a variety of levels from institutional to interpersonal," Carling said. "Our study recognizes the benefit of longer duration breast-feeding in a specific population and, hopefully, this and other studies will lead to more customized breast-feeding promotion in those populations at higher risk for overweight and obesity."

The findings were published in the January print issue of Pediatrics, and funded by the U.S. National Institutes of Health. The authors reported no conflicts of interest.

Source: Tara Haelle, http://consumer.healthday.com/women-s-health-information-34/breast-feeding-news-82/breast-feeding-for-longer-may-protect-infants-at-risk-for-obesity-694218.html

Daily Dose

Parenting Gone Too Far?

1.15 to read

I recently read an article in The New York Times about another new “parenting” book. I am not sure I understand this latest addition to a group of what I would call “extreme parenting” books. 

Similar to the Tiger Mom, or the American mother who extolled the French “method” for parenting, this new book, to be titled “ The Heavy”, is written by a mother who discusses her daughter’s weight issue and how she “enforced her daughter to diet”. 

Dara Lynn Weiss’s book deal stems from a recent article she has written for Vogue detailing her own parenting methods for dealing with her 7 year old overweight daughter.  In the article, Ms. Weiss discusses placing her daughter on a “strict” diet and punishing her for making poor food choices. 

She has gotten a lot of buzz on TV, radio and online for her methods, which included not only restricting her daughter’s food choices, but humiliating her daughter as well as discussing her own adult issues surrounding body image and weight control. 

I see far too many young children who are overweight and have ongoing issues with food choices. I also spend a great deal of time trying to help educate the parents of these children on how they can help their child become a “healthier eater” without using the word DIET.  

For a child who is 7-8 years old, as is Ms. Weiss’s daughter, the majority of the discussion revolves around the food that is available in the home, how the entire family eats, how much exercise a child gets, and what the child eats for lunch (whether they take their lunch or buy a school lunch). The discussion never includes words like “shame, punishment, or humiliation”, but rather terms like “healthy eating for growing bodies, modeling eating habits, and teaching children about better food choices.”  

While this approach may seem boring it does work.  Parents truly are the “boss” of the majority of their child’s food choices for the first 8-10 years of a child’s life. Why do you have to berate or punish a child in order to promote good nutrition? We are not talking about a teen who is driving through fast food joints, or eating from the 7-11 counter. 

Lately it seems that unless you’re writing “books on parenting that anger parents” or cause a huge backlash on Internet sites, no one wants to read them?  

A good parent does not need to use EXTREMES.  Is there no middle ground any more?  Can we not go back to the days of “everything in moderation”. The pendulum seems to have swung so far that a mother can score a major book deal while berating her young daughter and in my mind setting her daughter up for a serious eating disorder in the future. Yes, I also take care of a fair number of anorexic and bulimic patients (mainly girls) and unfortunately many of them have mothers with body image and eating disorders as well. 

So, while I do agree with Ms. Weiss that overweight and obese children must have parental involvement and  the necessary diligence to change their eating habits, I don’t agree with her methods. I am happy that the issue is being discussed but there has to be a better way.  Another bestseller? I hope not for my patients. 

What do you think? I would love your feedback!

Your Teen

Good Family Relationships Helps Teens Avoid Obesity

1:30

Two of the most valuable resources a teen can have are a stable family and a good relationship with their parents. Adolescents that have these two important components in their lives are more likely to develop healthy habits that may protect them from obesity, according to new study.

"A high level of family dysfunction may interfere with the development of healthful behaviors due to the families' limited ability to develop routines related to eating, sleep or activity behaviors, which can lead to excess weight gain," said the study's lead author, Jess Haines, of the University of Guelph in Ontario.

For the study, the researchers reviewed information on about 3,700 daughters and 2,600 sons, aged 14 to 24, in the United States.

About 80 percent reported having close and stable families. The findings showed that 60 percent of daughters and 50 percent of sons said they had a good relationship with their parents.

Researchers also found that teens with good family relationships are more likely to be more active and get enough sleep. Two factors, in addition to a healthy diet, that contributes to reasonable weight control.

The daughters in these families ate less fast food, and were less likely to be overweight or obese, the researchers discovered.

They also noted that fathers play an important role in helping their sons develop better choices that allow them to maintain a healthy weight.

"Much of the research examining the influence of parents has typically examined only the mother's influence or has combined information across parents," Haines said in a university news release.

"Our results underscore the importance of examining the influence fathers have on their children, and to develop strategies to help fathers support the development of healthy behaviors among their children," she said.

"It appears the father-son parent relationship has a stronger influence on sons than the mother-daughter relationship has on young women," said Haines.

As kids grow into adolescents, a tug of war between independence and parental control often develops. Research has shown that ongoing positive family relationships offer protective influences for teens against a range of risky behaviors. Sometimes it may feel like as our teens mature, family influence begins to wane - but that’s not the reality. This study points out how important a stable home life and good relationships are in helping teens develop a lifetime of healthy habits.

The study was published recently in the International Journal of Behavioral Nutrition and Physical Activity.

Story source: Mary Elizabeth Dallas, https://consumer.healthday.com/public-health-information-30/family-health-news-749/parents-play-key-role-in-teens-health-712354.html

Daily Dose

Low Carb Diets

1.15 to read

A recent study in Pediatrics caught my eye as it related to childhood obesity. I spend a good deal of time discussing healthy eating and exercise with my families but I too continue to see children who gain too much weight each year. Some of my patients even qualify as being obese. 

This study out of Cincinnati Children’s Hospital looked at 100 obese 7 -12 year old children and randomly assigned them to one of three different eating plans. One plan followed the wisdom of portion control, another followed a low-carb diet, and the last was a “reduced glycemic load” plan that cut down on certain carbs (like white bread and sweets and white potatoes). 

Over a one year period  all three of the plans worked equally well in helping to control a child’s weight gain. Researchers did find that the low carb plan was tough for kids to stick to. Most of the kids in this group really followed the low carb plan to an extent by reducing carbs and calories, but not to the “strict limits of the low carb plan”. In other words, they modified the plan. 

It seemed that the plan that “reduced the glycemic load” was essentially a modified low carb diet. Children could eat certain “unrestricted” carbs, like fruits and vegetables low in starch as well as whole grains. The limits were only placed on starchy carbs, but even some of those were not “forbidden”. 

The beauty of teaching these kids about modifying their diets early on is that they can see changes in their BMI (body mass index) more quickly than an adult. Why?  They are still growing!! I explain to the kids (and their parents) that a pre-pubertal child grows about 2 inches a year and should gain somewhere around 3 - 6 lbs a year.  All of that changes with puberty as their child’s growth velocity and weight gain both increase. 

But, since a child is growing that by just maintaining their weight, not losing weight, they will see changes in their body. Although children think this is “easy” it still requires effort and changes.   

Small changes like cutting portions and reducing carbs (rather than trying to eliminate them) will reduce total daily calories. Add in daily exercise and your child will see real results. It is still a matter of burning more calories than you consume! 

Lastly, the whole family has to be involved in the changes. You have to pick a plan that the entire family can follow and stick to as families come in all different sizes. 

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

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

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!

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