Thursday, April 24, 2014
Inquirer Daily News

POSTED: Wednesday, April 2, 2014, 5:30 AM
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In my clinical practice, I specialize in treating children with selective eating disorder (aka Avoidant/Restrictive Food Intake Disorder).  In a recent post, I addressed the question of whether picky eating is harmful.  The short answer was “yes:” prolonged picky eating compromises a child’s nutrition, inhibits their ability to eat like their peers at social and school events, and generally makes mealtimes a battleground (harmful to family harmony, not to mention parental sanity).

The following are my recommendations to help your picky eater.  They are probably most appropriate for kids aged 5 to 10, the age group that I generally treat. The list assumes that you have already seen a physician to rule out any medical cause for the picky eating, such as swallowing difficulties or gastro-intestinal problems.

  1. Believe that your child is capable of eating just about any food.  That extreme distress he displays whenever there’s pressure to try a new or nonpreferred food?  It is not the result of a physical or psychological incapability. Rather, it is the result of years of avoidance. A basic rule of the brain is this: The longer something is avoided, the more distressing and impossible it seems. This goes for just about anything, from completing a big homework assignment, to starting a complicated project at work, to calling someone up and asking for a date.  It’s also true for a food.
  2. What’s needed, then, is repeated exposure to foods until your child habituates to them.  Habituation is just a fancy word for “learned safety” or “the brain gets used to it.”  Research has shown that young children need an average of 8 to 15 exposures to habituate to and accept a new food.  Unfortunately, how many times do most parents offer a food before deciding their child will never like it? Just 3-5
  3. For the picky eater, exposure means tasting and swallowing the food.  It does not, in this case, mean merely having the food on the plate, looking at it, touching it, or smelling it.
  4. You are no doubt wondering, “But how do I get my kid to swallow it?”  Answer: By making it worth his while. Plenty of research confirms that kids will eat nonpreferred foods for rewards.  In my experience, the easiest and most motivating reward is access to screen time after a meal.
  5. Establish a consistent pattern, such as requiring your child to taste and swallow a new or nonpreferred food each night at dinner. Start with very small bites and then work up to larger and larger amounts as your child gets over the initial days of distress and comes to accept that a nightly “challenge food” is just another dreary fact of daily life.  
  6. Many desperate parents have tried telling their children that they can’t leave the table until they have eaten a nonpreferred food. In my experience, this leads to a child who sits at the table for hours, whining loudly and often.  My recommendation is to require that he eats that nightly challenge food within the first 5 minutes of a meal. Go ahead and set a timer. The 5-minute rule means he gets it over with right at the start of the meal and then everybody can relax.
  7. Reward successes and mostly ignore failures. He eats the nightly challenge food = lots of praise and access to rewards/privileges. He doesn’t = “No screentime for the rest of the night, but I know you can do it tomorrow” said once, with sincerity and optimism.
  8. Don’t worry about rewarding or restricting privileges based on eating: There are no credible, converging lines of scientific evidence that doing so causes eating disorders or self-esteem problems.  Think about it: parents require their children do things they don’t want to do for their own good all the time (teeth brushing, taking a bath, getting homework done).  That’s called good parenting. Why should it be any different when it comes to insisting your child eat a varied and healthful diet?
  9. Remember, this will not happen overnight.  It will not happen over many nights. It will happen over many months – so be patient.  With enough successful exposures, your child will eventually habituate to enough foods that his diet is greatly expanded and mealtimes are a peaceful experience for everyone.

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POSTED: Tuesday, April 1, 2014, 5:30 AM
Filed Under: Rima Himelstein | Sex | Tips
Can we talk?  While most of us agree it would be best for our teenagers to wait until they are older to have sex, at least half are having sex by the time they graduate high school.  And what’s more troubling is that their behavior is sometimes based on myths, which puts them at a high risk for sexually transmitted infections (STIs) and pregnancy.  Here are eight of the myths that I hear most often from my teenage patients and how I respond:

1. Myth: STIs and pregnancy won’t happen to me.

My response: You are normal to believe “it won’t happen to me” because it is a normal part of adolescence (the “personal fable”) to feel that way.  But STIs and pregnancy can happen to you.

POSTED: Monday, March 31, 2014, 9:30 AM

Looking for a resource that has all you need to know about vaccines from a trusted source? The Vaccines on the Go: What You Should Know app from The Vaccine Education Center at The Children's Hospital of Philadelphia offers a breadth of information on vaccines in an easy navigable format.

The app includes information about:

  • Vaccines and the diseases they prevent, along with potential side effects
  • Vaccine safety topics, including autism, vaccine safety monitoring systems, and too many vaccines
  • Types of vaccines and how they’re made
  • Recommended immunization schedules for children, teens and adults

You can also find a list of vaccine-related videos, such as vaccines for babies, and human papillomavirus and the HPV vaccine.

POSTED: Friday, March 28, 2014, 5:35 AM
Filed Under: Recipes

Liz Coover, RD, LDN is a clinical dietitian for the Healthy Weight Program at The Children's Hospital of Philadelphia.

Smoothies are maintaining their reign as a popular and “healthy” way to pack in plenty of fruits and vegetables for breakfast or a quick snack. But beware of store-bought drinks – they may have so much added sugar that you might as well be drinking a milkshake!

Skip the calorie laden smoothie bar and try our very own nutrient-packed version made with whole fruits and vegetables. The only sugar you will find in these shakes is fructose, the natural kind found in fruit in appropriate portions. Feel free to substitute a dairy alternative milk or yogurt (this will alter fiber and protein amounts).

POSTED: Thursday, March 27, 2014, 5:30 AM
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What incredible advances have taken place in world health during the past half century! From the mid-20th century on, discoveries like penicillin, steroids, and other drugs and vaccines have changed the trajectory of human health.  Thanks to these advances, the average human life span has doubled from the mid-40s to the mid-80s in less than a century. Amazing progress!

Yet for all our success in treating polio, malaria, and bacterial infections, many diseases are far more prevalent today than they were in decades past. And despite advances in treatment, they remain hard to control. One such example is asthma. Rates of asthma are increasing every year and we don’t quite know why. Asthma is a complex condition. There seem to be factors in “westernization,” including microbial exposure, lifestyle changes, and obesity that have affected our immune systems, making them function in a different way.

Today, there are an astounding 300 million people with asthma globally. The number of people diagnosed with asthma grew by 4.3 million from 2001 to 2009. During that period, asthma rates rose the most among black children, almost a 50 percent increase, according to the Centers for Disease Control and Prevention. In the United States, about 22 million people have asthma, including 6.5 million children. Among kids, asthma accounts for 13 million school days lost and 200 deaths annually.  Direct health care expenditures for asthma total more than $14 billion a year in this country.  

POSTED: Wednesday, March 26, 2014, 5:30 AM

Two-year-old Joey had been playing in the basement near the laundry room while his mom was cleaning up in the kitchen after dinner.  About a half an hour later, he started throwing up while in the bath.  His mom smelled laundry detergent in his vomit. Then she found an empty packet of an All laundry detergent pod – a small, single-use concentrated packet – on the laundry room floor. While being cleaned up, he could barely stand up and became unresponsive within a few minutes. His mom called the Poison Control Center hotline and his dad called 911. 

On arrival to the Emergency Department, Joey was very drowsy and barely breathing. A tube was placed in his airway and he was hooked to a ventilator.  He spent the night in the pediatric intensive care unit.  The next day, specialists performed an endoscopy and found no damage to his breathing tube or to the lining of his esophagus and stomach. Later that day, he became more alert and was breathing on his own. He spent another day in the hospital and when he was able to eat and drink without difficulty, he was discharged home without any anticipated long-term problems.

Household cleaning products, such as laundry detergent and bleach, rank in the top five most common exposures for children 5 years and younger.  Until 2012, although about 6,500 cases of young children per year came into contact or swallowed liquid or powdered laundry detergent, injuries were minor, such as mouth irritation or mild vomiting. Children often swallowed very little or would immediately spit them out because of these products’ foul taste.

POSTED: Tuesday, March 25, 2014, 3:14 PM
Filed Under: Anna Nguyen | Product Recalls

Wal-Mart recalled about 174,000 My Sweet Love / My Sweet Baby Cuddle Care baby dolls in the United State sand Canada because they have a circuit board in the chest, which can overheat. This can cause the surface of the doll to get hot, posing a burn hazard to a child. The 16 inch doll comes in pink floral clothing and matching knit hat, and comes packaged with a toy medical check-up kit including a stethoscope, feeding spoon, thermometer and syringe.

Wal-Mart has received 12 reports of incidents, including two reports of burns or blisters to the thumb. For more information, go to the U.S. Consumer Product Safety Commission website.


Have a question for the Healthy Kids panel? Ask it here. Read more from the Healthy Kids blog »

POSTED: Tuesday, March 25, 2014, 5:30 AM
Filed Under: Child Abuse | Janet Rosenzweig
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Each year, April is designated as child abuse prevention month by public officials all over the United States and it serves as a reminder of the need to focus on healthy child development. Happy, healthy children grow into happy, healthy, and productive adults and strengthen the economic and social fabric of our community.  

Given the United States’ rank in child well-being in a recent UNICEF report, we need to focus extra hard this year. The UNICEF report released last May showed that the U.S. is ranked 32nd out of 34 industrialized nations in terms of child poverty, with 23.1 percent of children living in relative poverty. Other UNICEF reports have shown similar disappointments: A 2011 report shows our country is ranked 26th out of 29th for overall child well-being, and was ranked in the bottom third in every category measured including material well-being, health and safety, education, behaviors and risks, and housing and environment.

Pennsylvania Department of Health statistics tell us that in Philadelphia, more than one-third of all children live in poverty and that the city’s infant death rate is almost 50 percent higher than Pennsylvania as a whole, at 10.7 per 1000 here, compared to 7.3 for Pennsylvania.  We know that almost half of all pregnant moms did not receive prenatal care in their first trimester. We know that more than half of all kids have smoked a cigarette by the time they graduate high school, and 10 percent of them smoked before the age of 13. We need to reverse these trends.

About this blog
The Healthy Kids blog is your window into the latest news, research and advice around children's health. Learn more about our growing list of contributors here.

If you have questions about your child's health, ask them here.

Anna Nguyen Healthy Kids blog Editor
Stephen Aronoff, M.D., M.B.A. Temple University Hospital
Christopher C. Chang, M.D., Ph.D Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical Colg
Mario Cruz, M.D St. Christopher’s Hospital for Children, Drexel University College of Medicine
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist - The Anxiety Behaviors Clinic, CHOP
Gary A. Emmett, M.D. Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Lauren Falini Bariatric exercise physiologist, Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Crozer-Keystone Health System
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, RD Children's Hospital of Philadelphia
W. Douglas Tynan, Ph.D. Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical Colg
Flaura Koplin Winston, MD, PhD Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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