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Your Baby

Fish Oil During Pregnancy May Reduce Baby’s Asthma Risk

2:00

A Danish study’s results suggests pregnant women that take a fish oil supplement during the final 3 months of pregnancy may reduce their baby’s risk of developing asthma or persistent wheezing.

The study involved 736 pregnant women, in their third trimester. Half the women took a placebo containing olive oil and the other group was given 2.4 grams of fish oil. The women took the supplements until one week after birth.

Among children whose mothers took fish-oil capsules, 16.9 percent had asthma by age 3, compared with 23.7 percent whose mothers were given placebos. The difference, nearly 7 percentage points, translates to a risk reduction of about 31 percent.

In the study, the researchers noted that they are not ready to recommend that pregnant women routinely take fish oil. Although the results of the study were positive, several experts have noted that more research needs to be done before higher doses of fish oil supplements are recommended over eating more fish.

Researchers found no adverse effects in the mothers or babies, the doses were high, 2.4 grams per day is 15 to 20 times what most Americans consume from foods.

One in five young children are affected by asthma and wheezing disorders. In recent decades, the rate has more than doubled in Western countries. Previous research has shown that those conditions are more prevalent among babies whose mothers have low levels of fish oil in their bodies. The new large-scale test, reported in The New England Journal of Medicine, is the first to see if supplements can actually lower the risk.

Before doctors can make any recommendations, the study should be replicated, and fish oil should be tested earlier in pregnancy and at different doses, Dr. Hans Bisgaard, the leading author of the study, said in an email to the New York Times. He is a professor of pediatrics at the University of Copenhagen and the head of research at the Copenhagen Prospective Studies on Asthma in Childhood, an independent research unit.

Dr. Bisgaard said it was not possible to tell from the study whether pregnant women could benefit from simply eating more fish. Pregnant women are generally advised to limit their consumption of certain types of fish like swordfish and tuna because they contain mercury. But many other types are considered safe, especially smaller fish like sardines that are not at the top of the food chain and therefore not likely to accumulate mercury and other contaminants from eating other fish.

“It is possible that a lower dose would have sufficed," the Bisgaard team said.

The supplements didn't seem to affect the odds of a baby or toddler developing the skin condition eczema, or an allergy such as a reaction to milk or egg products, or a severe asthma attack.

An editorial in the same journal by an expert who was not part of the study praised the research, saying it was well designed and carefully performed. The author of that editorial, Dr. Christopher E. Ramsden, from the National Institutes of Health, said the findings would help doctors develop a “precision medicine” approach in which fish-oil treatment could be tailored to women who are most likely to benefit.

If the findings are confirmed in other populations, doctors could test to see who would mostly likely benefit from fish oil supplements. "The health care system is currently not geared for such," Bisgaard said. "But clearly this would be the future."

If you are considering taking fish oil supplements during pregnancy, be sure and check with your OB/GYN for a recommended dose.

All fish oils are not the same. Some brands of fish oil are of higher quality than others. A reputable fish oil manufacturer should be able to provide documentation of third-party lab results that show the purity levels of their fish oil, down to the particles per trillion level. Also, if the supplements smell or taste fishy, they shouldn’t. High quality fish oil supplements don’t. Avoid fish oils that have really strong or artificial flavors added to them because they are most likely trying to hide the fishy flavor of rancid oil.

Story sources: Denise Grady, http://www.nytimes.com/2016/12/28/health/fish-oil-asthma-pregnancy.html?WT.mc_id=SmartBriefs-Newsletter&WT.mc_ev=click&ad-keywords=smartbriefsnl

Gene Emery, http://www.reuters.com/article/us-health-asthma-fish-oil-idUSKBN14H1T3

http://americanpregnancy.org/pregnancy-health/omega-3-fish-oil/

 

Your Baby

Study: Fracking Linked to Babies Low Birth Weight

High volume fracturing, also known as fracking, has increased in production all through the United States. The process allows access to large amounts of natural gas trapped in shale deposits by utilizing natural gas wells.

These types of wells were once more likely to be found in rural settings but are now increasingly located in and near populated neighborhoods.

A new study from the University of Pennsylvania has found a link between mothers who live close to high volume fracking wells and an increased risk of having a lower birth weight baby.

Researchers analyzed the birth records of more than 15,400 babies born in Pennsylvania's Washington, Westmoreland and Butler counties between 2007 and 2010.

Women who lived close to a high number of natural gas fracking sites were 34 percent more likely to have babies who were "small for gestational age" than mothers who did not live close to a large number of such wells, the study found.

Small for gestational age means a baby is smaller than normal based on the number of weeks the baby has been in the womb, according to the March of Dimes.

The findings held true even after other factors were accounted for such as whether the mother smoked, her race, age, education and prenatal care. Also taken into account was whether she had previous children and the baby’s gender.

Like other cities around the country, the number of fracking sites in Pennsylvania’s Marcellus Shale has increased substantially in the last few years. In 2007 there were 44 wells; by 2010, more than 2,800.

"Our work is a first for our region and supports previous research linking unconventional gas development and adverse health outcomes," study co-author Bruce Pitt, chair of the University of Pittsburgh Graduate School of Public Health's Department of Environmental and Occupational Health, said in a university news release.

"These findings cannot be ignored. There is a clear need for studies in larger populations with better estimates of exposure and more in-depth medical records," he added.

The main concerns around fracking sites are the air and noise pollution and waste fluids.

"Developing fetuses are particularly sensitive to the effects of environmental pollutants. We know that fine particulate air pollution, exposure to heavy metals and benzene, and maternal stress all are associated with lower birth weight," Pitt said.

While the study provides an association between fracking and lower weight babies, it does not prove that living close to a high concentration of natural gas fracking sites causes lower birth weights. Researchers said that they believe the study’s findings warrant further investigations.

The study was published online in the June edition of the journal PLOS One.

Source: Robert Preidt, http://consumer.healthday.com/environmental-health-information-12/environment-health-news-233/fracking-linked-to-low-birth-weight-babies-700018.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 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 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

 

Parenting

Any Benefits From Eating Your Own Placenta?

2:00

Here’s a medical study I never thought I’d read –“Are there health benefits associated with eating your own placenta after giving birth”?

Well…no, according to a research team from Northwestern University in Chicago. In fact, there may be a few health risks associated with ingesting placenta.

As I read the study’s findings, I began to wonder; who thought this was a good idea in the first place?

It turns out that throughout history there have been some cultures in which women ate the placenta after giving birth. It’s called placentophagy.

Some animals are known to also eat their afterbirth.

Apparently its’ also become the thing among a few celebrity mothers. While some believe that fresh placenta provides the most benefits, others elect to make a smoothie or have it dried, processed and made into pills.

However, the question still remains – is there any real benefit from eating placenta whether it’s raw, processed, made into a smoothie or pill, grilled or baked?

Scientists from Northwestern University pored over accumulated research that has been done on the topic.  The bottom line is that they could not find any evidence that there are any health benefits to placentophagy and that there may be unknown risks to mothers and their infants.

"Our sense is that women choosing placentophagy, who may otherwise be very careful about what they are putting into their bodies during pregnancy and nursing, are willing to ingest something without evidence of its benefits and, more importantly, of its potential risks to themselves and their nursing infants," study lead author and psychologist Cynthia Coyle said in a Northwestern news release.

In the study, Coyle's team reviewed data from 10 published studies. They found no data to support that eating the placenta -- either raw, cooked or in pill form -- protects against postpartum depression, reduces pain after childbirth, increases a woman's energy, helps with lactation, improves mother-child bonding, replenishes iron in the body, or improves skin elasticity. All touted as reasons many of the celebrity moms chose to give it a try.

The researchers also said that there are no studies examining the risks associated with eating the placenta, which acts as a filter to absorb and protect fetuses from toxins and pollutants.

Coyle noted that "there are no regulations as to how the placenta is stored and prepared, and the dosing is inconsistent. Women really don't know what they are ingesting."

If placentophagy appeals to you, be sure and check with your hospital or birthing center first. Many hospitals dispose of the placenta as bio-hazardous waste along with the other medical waste that occurs during birth (needles, blood, gloves etc.). You’ll most likely have to make arrangements ahead of time or find a more accommodating provider.

Source: Robert Preidt, http://www.webmd.com/baby/news/20150604/new-moms-gain-no-benefit-from-eating-placenta-studies-show

Your Child

Study: Exercise, Once Again, Improves Kid’s Learning Skills

2:00

While the debate on whether to bring back recess to school curriculums continues across the U.S., a small study from the Netherlands once again shows that adding exercise to a child’s school day can improve their learning skills.

Researchers worked with 500 children in second and third grade, giving half of them traditional lessons while the rest received instruction supplemented with physical activity designed to reinforce math and language lessons.

The approach was a creative and unique way to helping children better comprehend math and spelling.  Instead of taking a recess break – exercise was actually incorporated into the lesson.

After two years, children who got the physically active lessons had significantly higher scores in math and spelling than their peers who didn't exercise during class.

"Previous research showed effects of recess and physical activity breaks," said lead study author Marijke Mullender-Wijnsma, of the University of Gronigen in The Netherlands.

"However, we think that the integration of physical activity into academic lessons will result in bigger effects on academic achievement," Mullender-Wijnsma added in an email to Reuters Heath.

Mullender-Wijnsma and colleagues developed a curriculum that matched typical lessons in academic subject matter but added physical activity as part of instruction. They tested it in 12 elementary schools.

Here’s how it worked.

Lessons involved constant practice and repetition reinforced by body movements. For example, children jumped in place eight times to solve the multiplication problem 2 x 4.

Children in the exercise group received 22 weeks of instruction three times a week during two school years. These lessons were up to 30 minutes long, and evenly split between math and spelling instruction.

During the first year of the study, there wasn’t a great deal of difference found between the students receiving exercise during the class and those that didn’t, when speed was the focus in the math tests.

However, after two years, children who received exercise-based instruction had significantly higher scores on the math speed exams than students who didn't. The difference over two years equated to more than four months of additional learning for the students who had physically active lessons.

When the focus was on lesson comprehension, students receiving exercise outperformed students who did not receive the exercise instruction in both the first and second year. Again, the progress amounted to about four more months of learning.

For spelling, there wasn't a significant difference between the student groups after one year. But by the end of the second year they did have significantly better test scores, once again, adding an additional four more months of learning.

For reading, there wasn’t much difference between the two groups. It's possible that physical activities may be more beneficial to learning that involves repetition, memorization and practice of lessons from previous classes, the researchers conclude.

Researchers did point out that there were limitations that could have impacted the results of the study during the first year. The exercise group received specially trained teachers and individual schools administered the tests.

The research team did not examine why exercise might have helped students do better during tests.

 Sara Benjamin Neelon, of Johns Hopkins University and colleagues write in an accompanying editorial that it’s not clear whether these types of classes would work in countries where the population is larger, more diverse and students come from different socioeconomic backgrounds.

"However, the take-home message for parents and teachers is that physically active lessons may be a novel way to increase physical activity and improve academic performance – at the same time," Benjamin Neelon said by email.

More and more studies show that exercise appears to help the brain function better in children and adults. Whether all U.S. school administrations will see adding recess or exercise back into school curriculums is anybody’s guess, but according to science – it sure couldn’t hurt and might even help students develop stronger learning skills.

The study was published in the online journal Pediatrics.

Story source: Lisa Rapaport, http://www.reuters.com/article/us-health-children-fitness-learning-idUSKCN0VX26V

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