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Your Child

Antibiotics Often Prescribed When Not Needed

2.00 to read

By now, most parents understand that antibiotics are not effective for viral infections, only for illnesses caused by bacteria.

However, that hasn’t deterred many physicians from over-prescribing antibiotics for children with ear and throat infections.

More than 11 million antibiotic prescriptions written each year for children and teens may be unnecessary, according to researchers from University of Washington and Seattle Children's Hospital. This excess antibiotic use not only fails to eradicate children's viral illnesses, researchers said, but also supports the dangerous evolution of bacteria toward antibiotic resistance.

"I think it's well-known that we prescribers overprescribe antibiotics, and our intent was to put a number on how often we're doing that," said study author Dr. Matthew Kronman, an assistant professor of infectious diseases at Seattle Children's Hospital.

"But as we found out, there's really been no change in this [situation] over the last decade," added Kronman. "And we don't have easily available tools in the real-world setting to discriminate between infections caused by bacteria or viruses."

 Doctors have limited resources when it comes to differentiating between bacterial or viral infections. Physicians can use the rapid step test to determine if the streptococcus bacteria is the cause of a child’s sore throat, but that is about it for immediate diagnostic tools.

Most colds are virus related and one of the first symptoms will be a sore or scratchy throat. It will typically go away after the first day or so and other cold symptoms will continue. Strep throat is often more severe and persistent.

A virus often causes ear infection as well. Many doctors treat ear infections as though they are bacterial to be on the safe side and avoid serious middle ear infections.

To determine antibiotic prescribing rates, Kronman and his colleagues analyzed a group of English-language studies published between 2000 and 2011 and data on children 18 and younger who were examined in outpatient clinics.

Based on the prevalence of bacteria in ear and throat infections and the introduction of a pneumococcal vaccine that prevents many bacterial infections, the researchers estimated that about 27 percent of U.S. children with infections of the ear, sinus area, throat or upper respiratory tract had illnesses caused by bacteria.

But antibiotics were prescribed for nearly 57 percent of doctors' visits for these infections, the study found.

Kronan hopes that the study’s results will encourage the development of more diagnostic tools and will spur doctors to think more critically about prescribing antibiotics unless clearly needed.

Previous research has shown that parents often pressure their doctor to prescribe an antibiotic to treat their child’s ear or sore throat symptoms. However, when parents are given other suggestions on how to alleviate the symptoms they have been much more receptive than when their doctor just flat out says he won’t prescribe antibiotics.

Many physicians and researchers are concerned that the amount of antibiotics being prescribed these days is setting us all up for future problems when dealing with bacterial infections. Bacteria are adaptable and mutate over time becoming less responsive to antibiotics. When possible, it’s much healthier in the long run to treat your child’s symptoms with simpler therapies. Ask your physican ways you can make your little one more comfortable until the symptoms pass. 

The study was published online in the journal Pediatrics.

Source: Maureen Salamon, http://consumer.healthday.com/infectious-disease-information-21/antibiotics-news-30/antibiotics-prescribed-twice-as-often-as-needed-in-children-study-says-691686.html

Daily Dose

No Screen Time for a Week!

Kids are spending over 7 hours a day in front a screen: TV, watching video, playing games event texting. How much is too much?So, how much screen time does your child have?  You know what I mean, TV time, computer time, playing video games, using a cell phone (including texting). The list goes on and on!

The average American child spends 7 hours a day involved with some type of media, which is more than any other activity besides SLEEP! With that being said, this is National Turn Off Week!  My colleagues at the American Academy of Pediatrics are supporting an effort to encourage parents to implement a “screen free week” in their home. If the average child spends over 1000 hours a year involved in some type of media but only 900 hours a year in school it seems obvious that we are doing something wrong. The solution is to start limiting screen time beginning at the earliest ages. With so many parents believing that Baby Einstein videos will make their infant smarter (there is no proof), and parents who are teaching their children to use a computer or I-phone or I-pad by the age of two, early guidelines regarding time spend “on screen” are exceedingly important. The AAP endorses a “no TV for children under the age of two” rule and limiting TV/media time to 2 hours per day for children and teens.  Unfortunately, many parents may know that their children are home, but are not clear about what they are doing while at home, which often involves screen time in the “privacy” of their own rooms. I ask every patient and or parent about media time and if there is a TV or computer in the child’s room. I am continually amazed at how often the answer is yes, even for the elementary school set. Parents often view putting a TV in their child’s room as a “right of passage” despite the fact that there are really good studies to show that having a TV in a child’s room contributes to poor sleep habits which may impact children in many negative ways. I must say, there isn’t a teenager that I take care of that is “happy” that we are discussing media time, but just like other subjects that need to be addressed during a pediatric visit, this one may be more important than previously thought. For all of this interactive screen time may actually be becoming new “peer group” for a child, rather than having face to face time with their peers. So by turning off the “screens” and spending some time enjoying one another, a new normal could be started.  Families cooking together after the homework is finished, or going outside for a family walk or quick game, or reading together, or even playing board games, the list seems endless.  What a treat to get back 2, 3 or even 4 hours a day with your child.  Think about the  benefits that come from decreasing screen time, which include better academics, better sleep, less depression and anxiety and even an impact on obesity. I know it is challenging for all of us, but this is a “do-able” task for a week. While all of the screen are in the “OFF” mode, talk about new guidelines for when the screens go back on.  In this case the adage “less is more” seems appropriate. That's your daily dsoe for today.  We'll chat again tomorrow. Send your question or comment to  Dr. Sue!

Your Child

Super-Lice Resistant to OTC Treatment

1:45

Well, this certainly isn’t good news.

The American Chemical Society recently reported a new study shows that certain lice in at least 25 states are now resistant to over-the-counter (OTC) treatments.

Study author Kyong S. Yoon, PhD, assistant professor in the Biological Sciences and Environmental Sciences Program at Southern Illinois University, has been researching lice since 2000. His research is still ongoing, but what he’s found so far in 109 samples from 30 states is startling: the vast majority of lice now carry genes that are super-resistant to the OTC treatment used against them.

Permethrin, part of the pyrethroid class of insecticides, is the active ingredient in some OTC treatments. Certain lice have developed a trio of mutations that make it resistant to the pyrethroids. What happens is you end up with a new kind of super-lice that doesn’t respond to typical treatment any longer.

“It’s a really, really serious problem right now in the U.S.,” Yoon says.

Six million to 12 million U.S. children are infested with head lice every year, "with parents spending about $350 million dollars annually on permethrin-laced over-the-counter and prescription treatments," Yoon said. Lice infestations occur in rich neighborhoods as well as poor ones.

Currently, there are 25 states, including Arizona, California, the Carolinas, Connecticut, Florida, Georgia, Illinois, Maine, Massachusetts, Texas and Virginia where lice have what Yoon calls "knock-down resistant mutations". This involves a triple whammy of genetic alterations that render them immune to OTC permethrin treatments.

Lice in four states, New Jersey, New Mexico, New York and Oregon, have developed partial resistance, the researchers found.

Michigan's lice have no resistance as yet. Why that is remains unclear.

Fortunately, there are prescription medications that still work in treating lice. They are more expensive than over-the-counter formulas and do not contain permethrin. These prescriptions may contain benzyl alcohol, ivermectin, malathion and spinosad; all powerful agents or insecticides. Lindane shampoo is another alternative for difficult-to-treat cases.

If your child has head lice and OTC medicines haven’t worked, you can check with your pediatrician or family doctor for a prescription treatment. 

Sources: Mandy Oaklander, http://time.com/4000857/lice-treatment/

Alan Mozes, http://health.usnews.com/health-news/articles/2015/08/18/head-lice-now-resistant-to-common-meds-in-25-states

 

Your Baby

Can More Fruit Consumed During Pregnancy Raise Baby’s IQ?

1:30

The USDA recommends that women consume 2 cups of fruit daily. This can include fruits that are fresh, canned, dried or frozen, as well as 100-percent fruit juice.

Fruit not only contains important vitamins, minerals and fiber but may also provide benefits for the children of moms-to-be who consume more fruit during pregnancy.

According to a new study from Alberta, Canada, the children of mothers that consumed higher levels of fruit during pregnancy, had better cognitive development by the time they were one-year-old.

Researchers said the effects of eating more fruit on test scores were significant.

"It's quite a substantial difference," Dr. Piush Mandhane, an associate professor of pediatrics at the University of Alberta, said in a press release.  "We know that the longer a child is in the womb, the further they develop -- and having one more serving of fruit per day in a mother's diet provides her baby with the same benefit as being born a whole week later."

For the study, researchers analyzed data on 688 one-year-old children collected as part of the Canadian Healthy Infant Longitudinal Development study, and considered the amount of fruit their mothers consumed during pregnancy, gestational age at birth, parental lifestyle factors, including income and education, and cognitive tests given to the children.

Two-thirds of the population falls between 85 and 115 on the traditional IQ scale, with the average at about 100. The researchers found if pregnant mothers ate six or seven servings of fruit or fruit juice per day, their children scored six or seven points higher on IQ tests at one year old. There was no improvement in learning when only the babies were fed fruit.

The researchers noted that future studies will explore longer-term benefits of increased fruit consumption during pregnancy beyond one year of life, as well as whether higher intake of fruit affects development of other parts of the brain.

"We found that one of the biggest predictors of cognitive development was how much fruit moms consumed during pregnancy. The more fruit moms had, the higher their child's cognitive development," Mandhane said.

Experts recommend that pregnant women eat a variety of foods throughout the day to make sure they and their baby get the nutrients they need. A balanced diet contains fruits and vegetables, breads and grains, protein and dairy. Doctors often prescribe prenatal vitamins just in case a mom-to-be isn’t able to get all the nutrients she needs by diet alone.

While fruit is important to one’s overall diet, pregnant women should consult with their OB/GYN about their intake if they are diabetic or susceptible to gestational diabetes.

The study was published in the online edition of EBioMedicine,

Story source: Stephen Feller, http://www.upi.com/Health_News/2016/05/26/Eating-fruit-while-pregnant-helps-babys-cognitive-development-study-says/3311464273928/?spt=sec&or=hn

Your Child

Exercise Boosts Kids’ Grades!

2:00 to read

We all know that exercise is good for the heart, lungs, weight-control and now a new study suggests that it’s good for increasing academic performance as well.

The Dutch researchers reviewed several prior studies conducted in the United States, one from Canada and another out of South Africa. What they discovered was that all the studies showed that the more physically active students are, the better they do in the classroom.

"We found strong evidence of a significant positive relationship between physical activity and academic performance," the researchers, led by Amika Singh of the Vrije Universiteit University Medical Center at the EMGO Institute for Health and Care Research in Amsterdam, the Netherlands, said in a journal news release.

"The findings of one high-quality intervention study and one high-quality observational study suggest that being more physically active is positively related to improved academic performance in children," the authors noted.

A total of 14 studies were reviewed. They involved students between the ages of 6 and 18. Some studies were smaller, working with 50 students, while another study had as many as 12,000 students. 

Researchers noted that students who exercised had increased blood flow and oxygen to the brain. These school-age children did better in the schoolroom. The analysis suggests that exercise also increases the levels of hormones responsible for curtailing stress and boosting mood, while at the same time establishing new nerve cells and synapse flexibility.

In recent years, there has been increasing evidence that has shown that many functions of the brain are highly dynamic, or “plastic”, meaning that the brain is able to continually change in response to stimulus and experience. This flexibility is thought to be a key property in allowing the nervous system to support short-term and sustained changes in output, associated with learning and memory.

Other studies have shown that people with early dementia benefit from exercise. Again, the increased blood flow and oxygen to the brain helps improve memory and learning function.

So, getting the kids off the couch and onto the playground (no matter whether it’s a public playground or the backyard) can help children stay physically fit and mentally alert.

The Dutch researchers would like to see more high quality studies conducted in this area of investigation.

"Relatively few studies of high methodological quality have explored the relationship between physical activity and academic performance," they acknowledged. "More high-quality studies are needed on the dose-response relationship between physical activity and academic performance and on the explanatory mechanisms, using reliable and valid measurement instruments to assess this relationship accurately."

It’s a pretty safe bet though, that the more a family exercises together, the healthier everyone will be.

The findings are published in the January issue of the Archives of Pediatrics & Adolescent Medicine.

Sources: http://consumer.healthday.com/Article.asp?AID=660288 / http://www.sussex.ac.uk/aboutus/annualreview/2011/mindandbrain

Your Child

Household Bleach Causing Flu and Infections in Kids?

1:30

One of the most popular disinfectants used in household cleaning is bleach. From cleaning wipes to straight out of the bottle, bleach is used to clean surfaces, remove mold and brighten clothes.

As far back as 3000 B.C. a form of bleach was used to brighten white clothes. Shakespeare even made reference to bleaching in 1598. But it was around 1913 that bleach was touted as a disinfectant. In many of today’s households, products containing bleach are used as a surface sanitizer to kill bacteria.

A new study from the Netherlands says the cleaning agent may increase children’s risk for flu, tonsillitis and other infections. The study did not prove cause and effect, but suggested that bleach and other similar cleaning products may be contributors to these types of illnesses.

The study was led by Lidia Casas, of the Center for Environment and Health at KU Leuven in Leuven, the Netherlands. Her team looked at more than 9,000 children, aged 6 to 12, in the Netherlands, Finland and Spain.

Those whose parents used bleach to clean their homes at least once a week had higher rates of respiratory and other types of infections. Specifically, Casas and colleagues found that these children had a 20 percent higher risk of having the flu at least once in the previous year, a 35 percent higher risk of recurrent tonsillitis and an 18 percent higher risk for any recurrent infection.

According to the study’s authors, airborne components of bleach and similar products may irritate the lining of children's lungs, triggering inflammation and making it easier for infections to take hold. Or, bleach may somehow suppress the immune system, making infections more likely, the team said.

The American Cleaning Institute (ACI), which represents makers of bleach and bleach products, responded quickly to the study.

"Since there was no data presented on the children's actual exposure to bleach -- nor any diagnoses of actual diseases -- the authors are merely speculating," the ACI said in a statement. The group also said that disinfecting household surfaces with bleach can protect people from bacterial infection.

Responses to the study from medical specialists have been mixed.

"While this study observes higher respiratory effects of bleach on children, it is not a cause-and-effect study, and other factors or household cleaners may be involved," said Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City.

"There is evidence that high concentrations of bleach can cause asthmatic reactions when ventilation is not adequate, but the leap to increased incidence of infections is less clear," he said.

Dr. Jacqueline Moline, vice president of population health at North Shore-LIJ Health System in Great Neck, N.Y., noted, "These results are in line with other studies that show the impact of cleaning products on the health of young children."

Moline also said that parents might want to consider using a different product for household cleaning, "the take-home message from this study is that one should be prudent in the use of harsh household cleaners with bleach or other chemicals, especially in homes with young children, and seek out less toxic or harsh products to clean the home."

The study was published online in the April edition of the journal Occupational & Environmental Medicine.

Source: Robert Preidt, http://consumer.healthday.com/respiratory-and-allergy-information-2/asthma-news-47/could-household-bleach-raise-kids-risk-for-flu-other-infections-698036.html

Your Teen

What do Energy Drinks Actually Do to the Body?

2:00

There’s been a lot of discussion over whether caffeine-spiked “Energy Drinks” are really safe for consumption, particularly for kids and young adults.  Although many manufacturers add the advisory statement “not recommended for children, pregnant or nursing women and persons sensitive to caffeine” on their label, it often goes ignored.

The Substance Abuse and Mental Health Services Administration reports that as these drinks have become more popular, the incidences of caffeine related overdoses and deaths have increased.

In one heartbreaking example, 14-year-old Anais Fournier died from cardiac arrest due to caffeine toxicity after consuming two 24- ounce cans of Monster energy drink a day apart.

While the Food and Drug Administration (FDA) has been investigating whether there is causal link to the drinks and health problems, Mayo Clinic researcher Anna Svatikova and her colleagues wanted more information about exactly what happens in your body after you consume one of the drinks.

She and her team recruited 25 volunteers. All were young adults age 18 or older, nonsmokers, free of known disease, and not taking medications. They were asked to drink a 16-ounce can of a Rockstar energy drink and a placebo -- with the same taste, texture, color and nutritional contents but without the caffeine and other stimulants -- within five minutes on two separate days.

The energy drink had the following stimulants: 240 mg of caffeine, 2,000 mg of taurine and extracts of guarana seed, ginseng root and milk thistle. All typical ingredients associated with energy drinks.

Researchers took numerous measurements first before they drank and 30 minutes after. With the placebo, there was very little change. With the energy drink, however, many of the changes were marked:

•       Systolic blood pressure (the top number) - 6.2 percent increase

•       Diastolic blood pressure (the bottom number) - 6.8 percent increase

•       Average blood pressure - 6.4 percent increase

•       Heart rate - none

•       Caffeine in blood - increase from undetectable to 3.4 micrograms/mL

•       Norepinephrine level (the stress hormone, which can give you the shakes when you have too much caffeine) in blood - increase from 150 pg/mL to 250 pg/ML

Writing in JAMA, the researchers said that these changes may predispose those who drink a single drink to increased cardiovascular risk.

This may explain why a number of those who died after consuming energy drinks appeared to have had heart attacks.

They also exposed the volunteers to two-minute physical, mental, and cold stressors after consuming the energy drinks to see how that might affect blood pressure and other body functions.

The physical stressor involved asking participants to squeeze on a handgrip; the mental one to complete a series of mathematical tasks as fast as possible; and the cold one immersing their one hand into ice water. Interestingly, there was no further change.

Another thing that is typically overlooked when people choose one of these drinks is the serving size. A 16-ounce can is two servings. A 24-ounce can has three servings. Caffeine and sugar content is often listed per serving. But honestly, how many people drink a third or half a can at a time? Besides caffeine, other stimulants are often added to energy drinks such as Ginseng and Guarana. Most people have no idea what they are, what they do and if they negatively interact with medications.

The American Beverage Association defends the drinks and said in a statement  that "there is nothing unique about the caffeine in mainstream energy drinks, which is about half that of a similar sized cup of coffeehouse coffee" and that drinking coffee would have produced similar effects.

“The safety of energy drinks has been established by scientific research as well as regulatory agencies around the globe. Just this year the European Food Safety Authority (EFSA) confirmed the safety of energy drinks and their ingredients after an extensive review," the organization said.

It’s up to parents to decide whether these drinks are beneficial to their family or if they should re-think purchasing one for themselves or their child. A family discussion about the pros and cons of energy drinks with pre-teens and teenagers could give the kids the information they need to make a good choice.

Source: Ariana Eunjung Cha, http://jama.jamanetwork.com/article.aspx?articleID=2469194

Your Child

Young Girls Less Likely to See Women as “Really, Really Smart”

2:00

One of the surprise box office hits this year is “Hidden Figures.” It’s based on the true story of a team of female African-American mathematicians at NASA in the late 50s and early 60s that helped launch the first U.S. astronaut into space. The women were brilliant but faced enormous challenges for acceptance because of their race and gender.

According to a new study, you might could say that there are millions of "hidden figures" in who young girls and boys’ perceive as someone who is “really, really smart.”

Researchers wanted to try and figure out why women are underrepresented in the science, technology, engineering and mathematics, or STEM, fields. While most women make the decision to pursue these courses in high school or college, the scientists found that children develop a stereotype of which gender is naturally smarter early in life.

The study involved 400 children, aged 5 to 7 and included a story told by Lin Bian, a co-author and psychologist at the University of Illinois.

“There are lots of people at the place where I work, but there is one person who is really special. This person is really, really smart,” said Bian. “This person figures out how to do things quickly and comes up with answers much faster and better than anyone else. This person is really, really smart.”

She then showed them pictures of four adults—two men and two women—and asked them to guess which was the protagonist of the story. She also gave them two further tests: one in which they had to guess which adult in a pair was “really, really smart”, and another where they had to match attributes like “smart” or “nice” to pictures of unfamiliar men and women.

The results were revealing.  The 5 year-old boys and girls associated the “smart” person with their own gender. But among those aged 6 or 7, only the boys still held to that view. At an age when girls tend to outperform boys at school, and when children in general show large positive biases towards their own in-groups, the girls became less likely than boys to attribute brilliance to their own gender.

As the boys continued to believe in their own intelligence, the girls – on average – tended to see everyone on more equal terms.

Bian also found that the older girls were less interested in games that were meant for “really, really smart” children.

The stereotype that brilliance and genius are male traits is common among adults. In various surveys, men rate their intelligence more favorably than women, and in a recent study of biology undergraduates, men overrated the abilities of male students above equally talented and outspoken women.

Bian’s study suggests that the seeds of this bias are planted at a very early age. Even by the age of 6, boys and girls are already diverging in who they think is smart.

The findings could help illuminate the challenge schools face in combating gender stereotypes, even though girls often outperform boys in school. Girls drop out of high school at a lower rate than boys. Women are more likely than men to enroll in college, and they earn more college degrees each year than men.

Other games were played and social tests were given during the study with similar results. The 5 year-olds were equally interested in participating, but the 6 and 7 year-old girls were less interested in the ones that relied on “being smart.” Both genders were attracted to the games requiring persistence and hard work.

In today’s business and scientific world, more educators, policymakers and corporations are making an effort to include women in leadership roles, but breaking through the stereotypes developed at such a young age can hinder girls and women in those and other disciplines.

Children model what they see. If they are raised in an environment that diminishes young girls’ achievements but rewards young boys for the same achievements, it often sets up a life-long struggle for them to feel and accept their own self-value. 

Teachers also play an important role in encouraging all children to reach their highest achievement level.

Young girls, as well as young boys, should be recognized for their intelligence and encouraged to pursue science, technology, engineering and math studies – the rest of the world will benefit.

The research can't explain how these messages are getting to kids or how they could be changed, says Andrei Cimpian, a professor of psychology at New York University and an author of the study, He is planning a long-term study of young children that would measure environmental factors, including media exposure and parental beliefs. That would give a better idea of what factors predict the emergence of stereotypes, and what levers are available to change attitudes.

The study was published in the journal Science.

Story sources:  Ed Yong, https://www.theatlantic.com/science/archive/2017/01/six-year-old-girls-already-have-gendered-beliefs-about-intelligence/514340/

Katherine Hobson, http://www.npr.org/sections/health-shots/2017/01/26/511801423/young-girls-are-less-apt-to-think-women-are-really-really-smart

Nick Anderson, https://www.washingtonpost.com/news/grade-point/wp/2017/01/26/research-shows-young-girls-are-less-likely-to-think-of-women-as-really-really-smart/?utm_term=.fc30e9030500&wpisrc=nl_sb_smartbrief

 

Your Teen

Early Puberty and Bone Health

1.50 to read

The normal rate of bone mass decline in adulthood is about 1 to 2 percent each year. This means that a 10 to 20 percent increase in bone density resulting from a naturally early puberty could provide an additional 10 to 20 years of protection against normal age-related decline in bone strength, according to the researchers.A new study suggest the earlier your child starts puberty, the lower the risk he or she will have osteoporosis later in life.

The research was based on 78 girls and 84 boys, who were studied from the time they began puberty until they reached sexual maturity. The investigators found that adult bone mineral density was influenced by age at puberty onset, with greater bone mass linked to early puberty and less bone mass associated with later puberty. However, bone strength did not seem to be affected by how long puberty lasted. "Puberty has a significant role in bone development," study leader Dr. Vicente Gilsanz, director of clinical imaging at the Saban Research Institute of Children's Hospital Los Angeles, said in a hospital news release. "During this time, bones lengthen and increase in density. At the end of puberty the epiphyseal plates close, terminating the ability of the bones to lengthen. When this occurs, the teenager has reached their maximum adult height and peak bone mass," Gilsanz explained. Reduced bone mineral density leads to osteoporosis, which affects 55 percent of Americans aged 50 and older. The normal rate of bone mass decline in adulthood is about 1 to 2 percent each year. This means that a 10 to 20 percent increase in bone density resulting from a naturally early puberty could provide an additional 10 to 20 years of protection against normal age-related decline in bone strength, according to the researchers. The study was published in the January issue of the Journal of Pediatrics. Pediatricians have long understood the role of pediatric bone development in osteoporosis prevention. The tween and teen years are critical for bone development because most bone mass accumulates during this time. In the years of peak skeletal growth, teenagers accumulate more than 25 percent of adult bone. By the time teens finish their growth spurts around age 17, 90 percent of their adult bone mass is established. Following the teen years, bones continue to increase in density until a person is about age 30. The need for calcium in the diet. Calcium is critical to building bone mass to support physical activity throughout life and to reduce the risk of bone fractures, especially those due to osteoporosis. The onset of osteoporosis later in life is influenced by two important factors: •   Peak bone mass attained in the first two to three decades of life •   The rate at which bone is lost in the later years Although the effects of low calcium consumption may not be visible in childhood, lack of adequate calcium intake puts young people at increased risk for osteoporosis later in life. Other foods, including dark green, leafy vegetables such as kale, are also healthy dietary sources of calcium. But, it takes 11 to 14 servings of kale to get the same amount of calcium in 3 or 4 8-ounce glasses of milk. In addition to calcium, milk provides other essential nutrients that are important for optimal bone health and development, including: •       Vitamins D, A, and B12 •       Potassium •       Magnesium •       Phosphorous •       Riboflavin •       Protein The role of physical activity in bone development. Weight-bearing physical activity helps to determine the strength, shape, and mass of bone. Activities such as running, dancing, and climbing stairs, as well as those that increase strength, such as weight lifting, can help bone development. For children and teenagers, some of the best weight-bearing activities include team sports, such as basketball, volleyball, soccer, and softball. Studies show that absence of physical activity results in a loss of bone mass, especially during long periods of immobilization or inactivity.

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DR SUE'S DAILY DOSE

Which viruses are gearing up for summer?

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