Friday, April 18, 2014
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Tips

POSTED: Wednesday, April 16, 2014, 5:30 AM
Filed Under: Tips
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Today's guest blogger is Heather Manning who lives in Bethlehem, Pa. with her partner and their sons, Lucas and Miles. Together they hike, paddle, run, swim, visit farms, and attend festivals throughout the Philadelphia and Lehigh Valley area.  A version blog originally appeared on Kids Outdoors Philadelphia, a free online community from the Appalachian Mountain Club.

One of our favorite family activities is going on nature walks. Whether we’re hiking all day or just taking a short walk in the woods, it is one way we stay grounded, balanced, and connected to nature. And after this very snowy and cold winter, we are eager to spend time outdoors, looking for signs of spring. It’s an exciting time for my 2-year-old, Miles, since these spring experiences are somewhat new to him. For Lucas, my 8-year old, it is just a thrill to be out and about again enjoying the outdoors without lugging winter gear around.

Below are some ways to start getting your kids excited for warmer weather and looking for signs of spring:

POSTED: Thursday, April 10, 2014, 5:30 AM
Filed Under: Flaura Winston | Tips
Where do you go for medical advice and support in caring for your child? You are increasingly going digital, according to The Pew Charitable Trusts. Seven in 10 people like you looked online for health information last year and found this information through search engines like Bing and Google. This strategy might be a good first step to find out what is available, but may not tell you whether it’s information you can trust.

We are all amazed with the power of digital solutions to get us information – quickly, with minimal or no cost, and in the comfort of our homes. It feels like the Wizard of Oz is sitting behind our laptop screen. We type in a question and get an answer. When looking for an answer to a trivia question or what toaster to buy, the consequences are not great if the information is inaccurate or misleading. For information about your health or that of someone you love, it could be life-threatening. 

Digital search results are determined by algorithms – all of the processes and methods that make sure that answers people “like” are shown first. Sadly, we all know that much of medicine is not what we “like” – getting immunizations, checking our weight, limiting snacks – and there are many people who are happy to tell us what we want to hear. A secret about search is that it can be manipulated. A huge industry manages digital content to ensure that algorithms find their content and place them first (to promote a product, a cause, a viewpoint, or a celebrity).

POSTED: Tuesday, April 8, 2014, 5:30 AM
Filed Under: Beth Wallace | Nutrition | Tips
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Whether your child has a sweet tooth or not, parents often have questions about sugar. Sugar is a type of carbohydrate that the body uses as a source of energy. Some foods naturally contain sugar like fruit (fructose) and dairy (lactose).

Added sugars are the biggest dietary concern because excessive intake of sugar can cause unnecessary weight gain. In children, early excessive weight gain can lead to type 2 diabetes and other adult-type conditions like high triglycerides. 

In recent years, there seems to be a growing list of sweetening options available on grocery store shelves, but here are 5 things you really need to know.

  1. Your child’s body doesn’t know the difference between all of those added sugars.  Whether it’s honey, cane sugar, or plain old white granulated, your child’s body will use each source for energy, and store the excess as fat.  There are some specific medical situations when a child’s body can’t tolerate a certain kind of sugar (fructose or lactose intolerances), but most often, the body won’t differentiate the rest.
  2. Know your sugar terminology.  All of the following are added sugars that can be found in the ingredient list.  Remember, no one is particularly better (or worse) for your child:  Corn syrup, Cane sugar, fruit juice concentrate, honey, agave, sucrose, molasses, maple sugar, brown sugar, and raw sugar. 
  3. Other than sweetened beverages, breakfast is one of meals highest in added sugar.  Sweetened breakfast cereals, breakfast pastries, muffins, jelly, syrup…all are common sources of sugar in a child’s diet.  If one of these items is on the menu, consider making some adjustments in the snacks and other meals for the day to balance the diet.  
  4. The food label does not distinguish between added and naturally occurring sugars.  In order to get an idea about how much added sugar the product contains, look at the ingredient list.  Ingredients are listed by weight, so the earliest items in the list are the major components of the product. If sugar or a sweetening product is one of the first three ingredients, leave it on the shelf.
  5. Don’t be fooled by manufacturer’s labels. Recently, companies have started to make their own claims on product packages, but these claims are not often regulated.  Just because the manufacturer tells you it’s a good choice, doesn’t mean it would meet your requirements for a healthy item. Always check the ingredients.
A child’s consumption of sugar sweetened foods and beverages is particularly concerning because these foods may take the place of more healthy foods needed for growth and development. Trying to limit the added sugar in your child’s diet to zero may be impossible, but this is  one true instance where moderation is the golden rule.

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.

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

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: Thursday, March 20, 2014, 5:30 AM
Filed Under: Growing Pains | Mario Cruz | Parenting | Tips
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Guest blogging today with regular contributor Mario Cruz, MD, is Nova Ashanti, MD, a pediatric resident at St. Christopher's Hospital for Children.

While you may not want to be reminded about your child’s rapidly changing body and emerging sexuality (yikes!), puberty remains a life transition that parents and teens must navigate together.

During puberty, children are especially vulnerable to depression and to participating in a number of risky behaviors. Regular conversations with your child may help them deal better with these physical and emotional changes.

POSTED: Monday, March 3, 2014, 4:00 AM
Filed Under: Tips
A new study has found that infant sleep machines can contribute to noise-induced hearing loss if played too loudly. Find out how use them safely. (istockphoto.com)

Today's guest blogger is Yell Inverso, Au.D, Ph.D, CCC-A, a pediatric audiologist at Nemours/Alfred I. duPont Hospital for Children.

As the mother of a 24 month old, I am well aware that when baby gets a good night's sleep, we all get a good night's sleep. And in talking with other new parents, we all agree that we'll work toward that goal –by any means necessary! One product on the market that I'm sure many parents have tried is the infant sleep machine (ISM), which can play music, natural sounds, or white noise. I personally use the "sleep sheep" type of ISM with my son. These products actually add noise to a baby's environment and can help soothe some babies while they fall asleep –and help them stay asleep.

But a study published online today in the journal Pediatrics found that ISMs can contribute to noise-induced hearing loss if played too loudly. As an audiology doctor, my desire to sleep is only outweighed by my concern for my son's delicate and tiny ears. The premise of these devices is a good one; however, only if they are used safely.

POSTED: Thursday, February 13, 2014, 5:30 AM
Filed Under: Stephen Aronoff | Tips
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A child with fever is one of the most complex problems in the field of pediatrics. Unlike adults, children will respond to simple viral infections with spectacular elevations in temperature.  The approach to the febrile child varies depending on the child’s age, state of health, and associated symptoms. 

While a myriad of studies have been published on the subject, there is surprisingly little evidence that provides definitive guidance so I will try to focus on several myths and facts when it comes to children with fevers.

Myth #1:  Any temperature over 98.6 F is a fever.

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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