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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

Ear Infections

1:30 to read

Musings from the very busy pediatric office:  with all of the advances in technology over the last 30 years why is it that examining a child’s ears and visualizing their eardrum continues to be challenging?  I started thinking about this while examining a very unhappy, strong and febrile toddler….probably the 20th patient of the day. 

 

During the “sick season” many of the patients who come to my office are young children whose parents are worried that they may have an ear infection.  This concern is one of the most frequent reasons for pediatric office visits. While I realize that many of my colleagues are in the operating room operating on brains or doing open heart surgery (truly saving lives) the one advantage that they have is that their patient is under anesthesia while they are doing complicated procedures. Which only means that they are not trying to wrestle, cajole, or coax a child into letting them look into their ear canal, and then only to find that you can’t see a thing as the canal is full of wax (cerumen).  

 

At times examining ears can be fairly simple and straight forward, but some days it seems that it may be easier to attempt to fly than to look at a 16 month old child’s ears. Today was one of those days. It seemed that every child I saw had a temperature over 102 degrees, and they all had “waxy” ears. While there are several ways to remove wax from the ear canal, none of them is easily done in a toddler, especially when the wax is hard and difficult to remove. Having 3 children myself and one who had recurrent ear infections and tympanostomy tubes, I know what it is like to have to hold your child on the pediatrician’s exam table while they irrigate or “dig” wax out of the ears.  Not fun….!!!  But, at the same time I realize that this is the only means to see if the ear is infected and if there is the need for an antibiotic. 

 

With the advent of the HIB and Pneumococcal vaccines the incidence of ear infections has dropped significantly, as these bacteria were common causes of otitis. But, ear infections are still the #1 reason that a child receives an antibiotic, especially in the first 2 years of life.  Therefore, a good ear exam is one of the most important things your pediatrician does, as I know you don’t want your child to receive an unnecessary antibiotic!

 

Please know that pediatricians do not enjoy making a child uncomfortable, but somehow that ear drum needs to be seen…especially in a sick child.   

 

So…why has some brilliant medical device inventor not found a way to wave a magic wand over a child’s ear to “tell me” if their ear is infected?  To date, I have not seen any “new” ways to accurately examine an ear other than with the otoscope…and a clean ear canal…which means unhappy children (and parents ) while I try to clean their ears.  

 

Remember, don’t use q-tips in your child’s ears and if your pediatrician has to struggle a bit to clean out  your child’s ears, it is only because they are doing a good job!!  I am waiting for the “easy” button.

   

Daily Dose

Twisted Neck?

1:30 to read

Under the heading of “continuing to learn” every day…comes a new case.

 

A patient of mine who is 4 years old was playing with his brother the other morning while his mother was making their breakfast. He was a “well child” and woke up in a good mood, ready to eat and go to preschool.  She could see the boys playing while she was cooking and then suddenly the 4 year old started to scream and cry that his “neck hurt”.  At first she thought “he was pretending or over reacting” as there did not overtly seem to be anything wrong. The only thing she noticed is that he refused to turn his neck and held his head in an awkward position.

 

He continued to cry and actually scream - so she tried to calm him down and gave him some ibuprofen as well. Despite this he would not move his neck and was unconsolable, to the point that she almost took him to the ER but instead she brought him to the office.  He was noted to be crying and seemed uncomfortable and refused to move his neck at all.  His exam was otherwise normal. Even with careful questioning there was no history of trauma. He had slept through the night before this had occurred. He had a cold several weeks before, but had since improved. He did not have a fever.

 

He seemed to be in such pain that he was sent for neck X-rays which were read as normal. But he continued to be miserable….so who do you call?? 

 

I spoke to a pediatric orthopedic surgeon and he said he really did not have any ideas. Next call, the pediatric neurosurgeon. After hearing the symptoms he immediately said that he thought this little boy had “rotatory dislocation/subluxation” of the two upper cervical vertebrae in his neck (C-1 and C-2). He explained to me that in most cases the displacement resolves spontaneously, but in some cases the child continues to be uncomfortable as there is associated spasm of the sternocleidomastoid muscle, which causes the torticollis. (twisted neck).It may be seen in children after a recent upper respiratory infection and is then called Grisel Syndrome.

 

Treatment for the acute condition…pain control and muscle relaxation.  This was all news to me and I had to go to textbook (online of course) to even read about the condition.  The neurosurgeon walked me through treatment and the child was sent home on a very low dose of valium and continued ibuprofen. When I spoke to the mother later that evening the child was already more comfortable and had started to move his neck. 

 

I called her the following morning and she said that he had not required any further valium and slept well and was actually on his way to preschool! WOW….I was thrilled he was better so quickly and that I was that much “smarter”. Wonder if I will ever see rotatory subluxation of the cervical vertebra again? I’ll be ready.

Parenting

Parents, Encourage Your Child to Stand Up to Bullying!

2:00

We’ve all read the stories about how a crowd of bystanders have not intervened or called the police for help, as someone was being bullied, attacked or beaten. It’s a horrible thought that if you need assistance, no one will respond.

When children grow up in a home that encourages standing up to bullying, they are more likely to step up to the challenge than kids who’ve been taught to stay out of it, according to a recent U.S. study.

About one in 10 children are victims of bullying, and many anti-bullying programs are focused on getting bystanders to intervene, researchers note in the Journal of Clinical Child and Adolescent Psychology. While previous research has linked certain parenting practices to higher odds that kids will be victims or perpetrators of bullying, less is known about how parents impact what children do as bystanders.

Researchers surveyed more than 1,400 fourth and fifth graders about how their classmates responded in a bullying situation. On average, the kids participating in the study were 11 years old.

They also interviewed parents at home and gave them hypothetical bullying scenarios, asking them how they would advise their children to respond.

In school, kids whose classmates said they might intervene to stop bullies and to comfort victims were more likely to have parents at home who told them getting involved was the right thing to do, the study found. At the same time, kids whose parents told them to stay out of it were both less likely to help victims and more likely to become perpetrators. 

“We were surprised to find that when parents told children not to get involved, children were actually more likely to join in the bullying,” said lead study author Stevie Grassetti, a psychology researcher at the University of Delaware. 

Based on the study results, it makes sense for school anti-bullying efforts to involve parents and endeavor to give children consistent messages about prevention in both settings, the authors conclude.

One limitation of the study is that during school visits; researchers didn’t define what constitutes bullying the authors noted. With home visits, researchers assumed parents gave kids the same advice about the hypothetical incidents that they would offer in real life, which might not always be the case, the researchers also point out.

Parents are role models for how children learn to respond to life’s unpredictable situations. They see and absorb everything their parents say and do. To teach your child compassion and courage, start by being a good example of both and letting them know that standing by and doing nothing to remedy the situation is not an option.

Story source: Lisa Rapaport, http://www.reuters.com/article/us-health-children-bullying-parents-idUSK...

Parenting

Your Child: Multitasking and Homework

2:00

Does your child multitask with media while doing his or her homework? If so, they’re not alone and most likely they are spending a lot more time trying to finish an assignment.

What might at first glance seem harmless, doing homework or studying while watching TV, texting or checking social media can actually impair learning the material as well as lower test scores. Research has shown that it's one of the worst study habits a student can develop.

Why is that?  Our brains are wired to focus on one activity at a time. It’s how we’ve survived over the centuries.

Doing two things at once actually comprises the brain, shifting its processing from one neural network to another. Each shift comes with a cost of consuming time, mental effort, and brain fuel. Microseconds are wasted as the brain turns off the active network and turns on the next. This not only costs time (which adds up) but also depletes the brain’s critical resources of glucose and oxygen. The result – less gets done and less is remembered. While the brain is switching gears – trying to focus on the next thing required- it’s retaining less and less.

Oftentimes, this lack of retention shows up as poorer grades, less intercommunication skills and generally being more distracted.

In a study of 8-18 year old students done by the Kaiser Family Foundation, nearly one third of the students surveyed confessed that when they were doing homework, they were also watching TV, texting, or listening to music. Victoria Rideout, the lead author of the study, warns parents about the dangers of media multitasking. This concern is distinct from worrying about how much kids are online or how much kids are media multitasking overall. “It’s multitasking while learning that has the biggest potential downside,” she says.

Dr. David Meyer, a psychology professor at the University of Michigan observed that “under most conditions, the brain simply cannot do two complex tasks at the same time. Listening to a lecture while texting, or doing homework and being on Facebook—each of these tasks is very demanding, and each of them uses the same area of the brain, the prefrontal cortex." Most students incorrectly believe that they can perform two challenging tasks at the same time, according to Meyer. They may like to do it, they may even be addicted to it, but there’s no getting around the fact that it’s far better to focus on one task from start to finish.”

Multitasking takes up a lot more time than focusing on one activity. Finishing homework can last much later into the evening causing kids to get less sleep than they need. 

Parents of students have to take an active role in their children’s study habits. During homework time, your child’s phone and the TV need to be turned off.  You may even have to put the phone in a different location in the house until homework is completed. A quick lesson refresher with your child after homework is finished can help you see how much your child is retaining and whether all the assignments have been completed.

The Internet can be a helpful tool when researching certain school topics; the trick is to stay on point without falling into the trap of checking out other tempting sites such as social media. Once on the computer, it takes a lot of self-control to stay focused on a singular subject. You may need to help your child stay the course during this time.

Be sure and praise your child for their accomplishments instead of making homework a battleground. The more they are able to develop good study habits, the less time it will take to complete their assignments and the sooner they’ll be able to check back in with their friends and find out what’s been going on.

Story sources: Michael Howard, http://www.beyondbooksmart.com/executive-functioning-strategies-blog/distracted-by-technology-focusing-attention-on-homework

Judy Willis M.D., M.Ed, https://www.psychologytoday.com/blog/radical-teaching/201611/the-high-costs-multitasking-you-and-your-kids

 

Daily Dose

Codeine & Children

1:30 to read

I order to keep us all safe, the FDA is constantly monitoring drugs and their side effects.  For many years codeine was prescribed for children for pain relief as well as to suppress coughs.  Over the last few years there has been more and more discussion about limiting the use of narcotics in children, but I continue to see some children who come from seeing other physicians and have received a prescription that contains codeine.

 

The FDA just issued new warnings against using prescription codeine in children and adolescents. The FDA reviewed adverse event reports from the past 50 years and found reports of severe breathing problems and 24 deaths linked to codeine in children and adolescents. Genetic variation in codeine metabolism may lead to excessive morphine levels in some children.

 

The FDA also performed a literature review which noted excessive sleepiness and breathing problems, including one death, in breast-fed infants whose mothers used codeine.

 

Due to these findings the FDA is now recommending that “codeine should not be used for pain or cough in children under 12 years of age”. They have also issued a warning that codeine should not be used in adolescents aged 12-18 “who are obese or have conditions associated with breathing problems, such as obstructive sleep apnea or severe lung disease”. In retrospect, codeine was prescribed to more than 800,000 children younger than11 years in 2011. Amazingly, codeine is currently available in over-the-counter cough medicines in 28 states.  

 

Lastly, the FDA “strengthened the warning” regarding codeine and breast feeding. They now recommend that breast- feeding women do not use codeine…which may change the post delivery pain protocol. Nonsteroidal anti-inflammatories (Ibuprofen) and acetaminophen (Tylenol) are preferred and are effective for mild to moderate postpartum pain. As a pediatrician it is important that I discuss this with new breast-feeding mothers as well. 

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