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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 Teen

Study: Freshman 15 Weight Gain Is Real

A new study shows that nearly one in four freshmen gain at least five percent of their body weight during their first semester.A new study shows there is some truth behind what has long been considered an urban legend about the infamous freshman 15. The study, published in Nutrition Journal, shows that nearly one in four freshmen gain at least five percent of their body weight, an average of about 10 pounds, during their first semester.

“Almost one quarter of students gained a significant amount of weight during their first semester of college,” say researchers Heidi J. Wengreen and Cara Moncur of the department of nutrition and food sciences at Utah State University in Logan. “This study provides further evidence that the transition to college life is a critical period of risk for weight gain, and college freshmen are an important target population for obesity prevention strategies.” Other studies have documented the phenomenon of the freshman 15 weight gain but researchers say few have examined the changes in behaviors that occur as students transition from high school to college that may contribute to unhealthy weight gain. The study followed 159 students enrolled at a mid-sized university in the fall of 2005. Each student’s weight was measured at the beginning and end of the fall semester, and the participants also filled out a survey about their diet, physical activity, and other health-related habits during the last six months of high school and during the first semester at college. Researchers found the average amount of weight gained during the study was modest, at about 3.3 pounds. But 23 percent of college freshmen gained at least five percent of their body weight and none lost that amount. There was no significant difference in the amount of weight gained by women and men in the study. Those who gained at least five percent of their body weight reported less physical activity during their first semester at college than in high school and were more likely to eat breakfast and slept more than those who didn’t gain as much. Previous studies have shown teens and adults who skip breakfast are more likely to gain weight, and researchers say they were surprised to find that eating breakfast regularly was linked to greater weight gain in the first three months of college. They say it may reflect more frequent meals at all-you-can-eat dining facilities at college, and more research is needed to clarify this finding. “In general, our findings are consistent with the findings of others who report the transition from high school to college promotes changes in behavior and environment that may support weight gain,” they conclude.

Your Baby

Longer Breast-Feeding Time, Less Childhood Obesity

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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!

Daily Dose

Rice Cereal & Childhood Obesity

Does white rice cereal cause childhood obesity? One pediatrician thinks so.I recently saw Dr. Alan Greene on TV discussing infant feeding practices and how that may relate to the problem of childhood obesity. Dr. Greene, like most pediatricians, has long been a proponent of healthy eating. He recently launched his “White Out” campaign to change how babies are introduced to solid foods.

His argument is that an infant’s first food has long been rice cereal.   Rice cereal is typically introduced to a baby between 5 – 6 months of age when they are just beginning to sit up in a high chair, and may be fed with a spoon. Rice cereal  typically comes in a box and breast milk or formula is added to the dried flakes in order to make it the consistency where the  baby may be  offered a few bites from a spoon. Although rice is a “white grain” there are also other infant cereal products available, and there are no “directives” that say that a brown rice or mixed grain cereal may not  be used. As I understand it, the whole idea is really just to get the baby used to spoon feeding and then I begin introducing my infant patients to vegetables and fruits. So, the idea that the baby rice cereal is somehow linked to the entire problem of childhood obesity seems somewhat shortsighted to me. An infant is only fed rice cereal one or two times a day while still receiving either breast milk or a formula. Remember that breast milk and formulas contain carbohydrates too. Infant cereal whether it be brown or white rice should not be the only food a baby is introduced too, nor should they eat cereal all day long. While Dr. Greene is concerned that babies will “get hooked on the taste of highly processed foods”, I'm more concerned that parents will quickly forgo rice and whole grain cereals, fruits, veggies and meats and begin feeding their children frosted or honey nut cheerios (a favorite early finger food),  as wells as goldfish and puffs, pasta and other white foods.  These are the foods I  am most likely to see in my office, not a bowl fruits and vegetables. Babies really get the  majority of their calories from breast milk or formula until about 9 – 12 months of age. Parents should be encouraged to feed their babies a wide array of healthy foods including cereals, vegetables, fruits and meats.  Dr. Greene is right,  a baby doesn’t tell you he won’t eat brown rice, or oatmeal or spinach or prunes. For the most part an infant happily opens their mouths and will take what is fed to them. The problem occurs a little later as babies start to show a preference for foods , whether that is by making a face, or pushing food away, they definitely show preferences. This is when the idea of getting “hooked on foods” really begins. It is not uncommon for me to hear a parent of a one year old say, “my baby doesn’t like…… squash, or cereal, or peaches.”  Soon thereafter you hear, “my toddler will only eat…..fill in the blank”. Those are the words that send shivers down my spine. Trying to get those parents to buy into the fix the meal and they will eat it if they are hungry is quite a difficult concept at times. The issue is not only beginning a baby on rice cereal, the problem is more complex. It is getting parents to understand that our children will always have food preferences, that does not mean that we need to acknowledge them or submit to them. It means that we need to make good healthy meals for our families, white rice or brown rice is only the beginning of the story. That's your daily dose for today. What do you think? Leave your comments below!

Daily Dose

Bedtime!

1:30 to read

Bedtime….an important word for parents and for children. A recent study in Pediatrics just reinforces how important bedtimes for children may be.  The research shows that preschool children who had an earlier bedtime were less likely to become obese in their teenage years. 

The study involved nearly 1,000 children who were born in 1991 and whose parents recorded their bedtimes when they were 4.5 years old.  The researchers then looked at the growth data (height/weight) for these children when they were 15 years of age.

Interestingly, the pre-school children who were in bed by 8:00 p.m. had half the risk of becoming obese as a teenager compared to those children who went to bed after 9 pm. Specifically, of the children who went to bed by 8 pm, only 10 percent were obese as teens, while 16 percent of those who went to bed between 8 and 9 pm developed obesity, and 23 percent of those children   who had bedtimes after 9 pm developed teenage obesity. 

While there has been much research surrounding sleep and obesity (as well as behavior), this study provides even more evidence to the possible “protective effect” of early bedtime and bedtime routines for young children.  If getting to bed on time and earlier can in some way help stem the obesity tide, it would seem like an easy recommendation for many parents to follow.  

As a mother I was always a “fan” of schedules and bedtimes…and actually putting your child to bed at night is such a wonderful time of day. The routine of a bath, snuggles, some books ( with wishes for just one more) and more hugs and kisses is such a wonderful memory I have of my own 3 boys. It just seemed that everyone was happier (and I guess healthier) when we had early bedtimes. I remember I had a friend who always had her 3 young children fed, bathed and in bed by 7:00 p.m. every night..and in those pre cell phone days we did not dare call her house after that time!!  

I also think bedtime routines are important for younger children year round. While it is more difficult to have regular bedtimes for older children during the summer months, children under elementary school age (and maybe even older) really do benefit from continuing on the same bedtime schedule during the summer months.  I think if you told your middle school or teenager this “rule” there  might be mutiny….but I know as well as a working parent, it is much easier to have a routine even when the kids are out of school…they would totally disagree!

I am excited about this study and using it as another resource when discussing sleep habits and bedtime routines with my patients.  

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

1.15 to read

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

Family Dinners Help Fight Obesity

1.15 to read

Sadly, the problem with obesity in America does not seem to be going away, and is not even improving!! The latest data shows that adult obesity rates have risen in 23 states in 2009 and the trend continued through 2010 and 2011.

Obesity and the problems associated with it, type 2 diabetes, heart disease, joint problems etc. begin in childhood. If we cannot change our children’s eating and exercise habits we have no hope of stemming the tide of ongoing obesity. By 2020 the headlines might read, “Obesity rising in all 50 states” with the majority of the population dealing with this crisis. In that vein we must not only begin modeling better eating habits for our children, but do so by returning to the idea of family meals. Family meals were the “norm” when I was growing up. We were fortunate to have breakfast and dinner at home each day and we were expected to be present for those meals. I know it was hard for my mother to do this as she worked when I was young, and my father travelled a great deal of the time. But parental sacrifice has not changed over time, and we all know that we will often do things “just for the kids”. The good thing about preparing meals these days is that the grocery stores have made it quite easy for even a very busy family to be able to prepare a “home cooked” meal. All of the chains have rotisserie chickens available and also offer prepackaged meats such as meat loaf, pre-made hamburger patties, or fish filets. The salads are also prepackaged and you can even buy fruit already cut up. I am “thrifty” and don’t mind making my own hamburger patties or cutting up fruit, but picking up a chicken on the way home from work is often a quick way to begin a dinner. The chicken can be used in a salad or used as a main course. We parents just have to be a little more inclined to drive through the grocery store rather than the fast food restaurant. I am still convinced that our children will eat what we prepare and gather together for meals if that becomes the norm once again. Our kids are busy too, and they will appreciate knowing that dinner will be there every night, and that it will be healthy. Leading by example is the best way to begin. We can’t afford not to try! That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue!

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DR SUE'S DAILY DOSE

New report says not enough babies are getting much needed tummy time!

DR SUE'S DAILY DOSE

New report says not enough babies are getting much needed tummy time!

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