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New Obesity Data And Tips To Avoid It

New data published in JAMA today finds that there has been no significant change in rates of overweight/obesity overall for children between age 2 to 19 years of age since 2003. This is unfortunate news in the big fight against overweight and obesity. Conclusions from the study, “Obesity prevalence remains high and thus it is important to continue surveillance.” Obesity rates remain high at with 17% of children and more than 1/3 of adults.

The good news is that there was improvement in one small group, toddlers age 2 to 5. Numbers from National Health and Nutrition Examination Survey(NHANES) show reductions in overweight and obesity for the preschoolers by as much as 43% during the last decade. Really hoping this is a canary in a coal mine situation — perhaps they’re chirping a clue. Learning the “why” behind the reduction in obesity for preschoolers feels like a huge opportunity. However for the mass of people researched in total (over 9,000 from birth to age > 60 years) the data confirms we’re not done tipping the scales.

The research article evaluated rates of overweight and obesity between 2003-04 NHANES data and 2011-12 data on children and adults. The CDC is highlighting the success in the toddlers, stating:

While the precise reasons for the decline in obesity among 2 to 5 year olds are not clear, many child care centers have started to improve their nutrition and physical activity standards over the past few years.  In addition, CDC data show decreases in consumption of sugar-sweetened beverages among youth in recent years. Another possible factor might be the improvement in breastfeeding rates in the United States, which is beneficial to staving off obesity in breastfed children.

It’s wonderful to see signs of improvement in the small population of children included in the NHANES data but this research article doesn’t investigate how the improvements were made and/if they are stable. More research will have to unfold. We’re all desperate — parents, pediatricians, public health experts — for solutions that work in not only curbing, but reversing the rates of overweight and obesity. This data can potentially focus the light on where we need to look to study cause and effect to determine possible success stories and strategies. Five quick tips for parents now: Read More »

Pain Is Inevitable But Suffering Is Optional

This is a guest blog from Lisa M. Peters, MN, RN-BC (in the video above). Lisa is mom of two children and a clinical nurse specialist for the Pain Medicine Program at Seattle Children’s Hospital. She holds a clinical faculty appointment in the Department of Family and Child Nursing at the University of Washington School Of Nursing. She is board certified in pain management from the American Nurses Credentialing Center and is a Mayday Pain & Society Fellow. Lisa has a passion for improving the lives of children in pain. I’ve learned so much from her already!

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Pain is inevitable; suffering is optional. That’s a key message when I partner with parents who bring their kids in for procedures and hear them recount stories of standing by, feeling helpless, as they watch their kids suffer with pain and distress.

It does not have to be that way.

Parents seldom realize the power they have as advocates and as partners with doctors and nurses in managing, and even preventing, their children’s pain. Could that shot at the doctor’s office really be a different experience? Do a few moments of pain really matter in the long run? If I speak up, will they label me and my kid as “troublemakers”?

As a parent, you can make a big difference in your child’s experience with pain. Knowledge is power.

3 Things To Know About Pain:

Poorly treated pain is harmful, both immediately and long term.
Science continues to teach us about the consequences of poorly treated pain on our bodies and minds. There is evidence that it can change how our bodies process pain signals, especially during critical periods of development in childhood. This can lead to highly sensitive areas of our bodies or a generally louder experience of pain. Memories of painful experiences have been shown to shape how we respond; studies show that 10% of the adult population avoids seeking medical care when needed due to fear of needles. Read More »

My Adorable Activity Tracker. I’m Streaking!

First Day With My Shine

Self-tracking, life-logging, activity-tracking, “the quantified-self (QS) movement” as the smarty-pants say, or as some have asked, “What’s with the weird watch?” Well, I’m hooked. I don’t go anywhere these days without my device. My activity tracker had me at hello.

Over the summer I started wearing the Shine. I’d been waiting for it–it had a significantly delayed shipping date–which only heightened my desire. I’ve worn it every day (except one) since. The world really is different to me now. Before you start to criticize and marginalize my proclamations, know that I waited nearly 1/2 a year to write about this to ensure it wasn’t just a fad.

How My Activity Tracker Is Changing Me:

First things first: I realized how sedentary some of my days are. Especially when I’m writing or working intensely; knowing this has changed how I think about walking. Secondly, I’m really much happier knowing how much movement I have during a day rather than guessing about it. Even when I’ve hardly moved a few paces, I’m thankful for the insight. I mean, some days we pig out, some days we aren’t as hungry and eat salad, some days we run miles. Other days we work and write and sit far too long. My activity tracker helps me understand the patterns and think about new ways to live differently. The boys always want to know how much we’ve moved. This tracker has power around here. If there’s any New Year’s “resolution” that may be worth committing to–it may simply be to check in on how you’re moving. Find a tool to give you observable data. Behavior change perhaps will follow.

To be clear, it isn’t the device I’m attached to that is changing my life, it’s the new experiences I’ve having because of it. New insight from my Shine changes my mood, the way I map out my day, and has undoubtably made me more self-aware. I’m thankful for my consultant.

Reality is, many of us are tracking our lives and our movement without realizing it. Before you write we trackers off, read on.

Read More »

Peanut Brittle For Preggers

Photo from Edwart Visser Flickr Creative Commons

Photo from Edwart Visser, Flickr Creative Commons

“Children appear to be less at risk for developing peanut or tree nut allergies if their mothers are not allergic and ate more nuts during pregnancy,” according to a study published today in JAMA Pediatrics. And although this doesn’t mean that you need to run out for the peanut brittle the minute you’re pregnant, it may mean we can reassure pregnant women that if they have no allergies themselves, what they eat during pregnancy should contain nuts, among other things.

As you’ve likely heard, children with peanut allergies have more than tripled in the United States this last 15 years. Food allergies affect 1 in 13 children in the United States and up to 40% of children have had a life-threatening or severe reaction. Any family with a food-allergic child will tell you this is a BIG deal.

The rapid rise of food allergies is incompletely understood, but more and more research suggests that waiting to introduce “high allergy” foods (traditionally thought of as peanut, egg, or shellfish for example) may have actually caused more allergies than prevented them. As this was being discovered this last decade or so, flip-flopping recommendations on what to eat ourselves when pregnant and what to feed our babies have left many of us confused.

When Should I Start Baby Food?

New recommendations really encourage introduction of a variety of foods, including nuts, eggs, shellfish, wheat, and soy within the first year of life. The theory is that early introduction of the components of these foods allow a child’s developing body to create a tolerance to them, thus potentially avoiding any allergy or reaction to them later on. Read More »

Arriving Early: World Prematurity Day

Screen Shot 2013-11-13 at 10.03.17 PM

I think about the essay Welcome to Holland by Emily Perl Kingsley a lot. Her explanation of what it’s like to raise a child with a disability helps approximate (for me) the unexpected realities that ensue for families who encounter significant pediatric health challenges. Although her essay is not about prematurity and it’s not new, when I sat down to write about World Prematurity Day I couldn’t help but think back to her words and her metaphor. What’s marvelous, of course, is that her essay is built of love so all of us have a chance to understand it.

Sunday, World Prematurity Day, is a day to think cautiously, bravely, and empathetically about the opportunity to improve the lives of children born prematurely, all around the world. When a child arrives early there are obviously significant health challenges not only to survival but to a long life thereafter, sometimes with significant disability. Parents all over world suffer and learn to thrive with and after prematurity every single day. In fact,

Prematurity is the leading cause of death in newborns. Although some risk factors are known for preterm birth, we don’t know very much about the cause.

None of us will really ever know what it’s like to survive and thrive in someone else’s experience. So we share stories, quotes, photos, and moments as best we can to help others understand. As I’ve met and been invited to help care for parents, families and children who are born prematurely, one thing is certain — it’s a journey. It starts often with surprise and evolves individually. The essay by Kingsley is clearly about the journey, not about the diagnosis of prematurity at the time of birth.

Here’s what a colleague and friend, Kim, shared with me about her experience with her twin daughters who were born over three months early: Read More »

No More Clean Plate Club

Some new advice allows us to do less, not more. Turns out, new research finds that controlling parenting styles may hinder children’s healthy eating habits. New data published in April 2013, finds that not only are controlling, food-related, parenting practices common, they aren’t helping teens maintain a healthy weight. In the Pediatrics study, researchers found that parents often encourage teens of healthy weight to finish all their food, providing pressure to eat. While parents to overweight teens ban some foods and encourage restriction. Neither practice is proven to improve teens’ habits or improve their health.

We really want our children to self-regulate their energy intake (food) and mounting evidence reports that controlling habits hinder this essential skill.

Four Golden Eating Rules

  • Divide responsibilities. Parents have the job of purchasing and serving healthy food. Infants, children, and teens have to choose what to eat and how much of the food that’s offered. The division of responsibilities allows you less of a role. Every parent knows that you can’t force a child to eat–the best thing to do is stop trying. Let mealtime be about feeding your body. If they don’t eat much, wait until the next meal to offer food. Children eat for themselves, not for their parents. Turn the TV off and let children feel their fullness when it arrives. 
  • Eat when your body is hungry. Stop when your body is full. Infants do this naturally when breastfeeding and when starting solids. We have to do our best to maintain that natural habit throughout toddler to teen years. This skill of responding to natural hunger and normal cues of satiety can be a huge asset for children for their entire lives. Do your best to stop engineering how much your children eat and let them learn to feel necessities.
  • Don’t make children Clean The Plate. There’s absolutely no reason to provide pressure to eat for children with normal development and normal health. Don’t reward children for finishing their dinner with more food (ie dessert) as children will often eat past their fullness. New research also finds that using smaller plates can also help control portion sizes and ultimately will reduce number of calories eaten. The benefit: it will also trigger less need to ask them to clean their plate, they’ll do so naturally on a smaller plate.
  • Eat together. The most potent education we give our children comes from our modeling habits and behaviors we think are most important. Eat together with children at meals from infancy until they leave home. Make a goal for at least one meal a day, and it doesn’t need to be dinner. That being said,  I love the book The Family Dinner by Laurie David. There’s no reason to cook special food for your children. Involve them in any part of meal prep you can, eat the same foods, and share your love of eating.

Home Births: Polarizing Views

baby OLike so many controversial parenting topics, discussing home births brings out dynamic opinions. These controversial topics unfortunately often tear us apart from one another. This week, the American Academy of Pediatrics (AAP) issued a policy statement on home births that will hopefully help inform. In general, the policy statement identified data confirming it’s safer to have birth in a hospital, but outlined ways to decrease risks for moms and families, midwives, and doulas that want to partner with moms to have their babies at home, as safely as possible.

  • Home births only occur in about 1% of births here in the United States although interest in increasing. Distance from the hospital matters~ if it takes more than 20 minutes to get into a hospital from home, risk of complications including infant mortality are higher. Data shows that home births carry at 2-3 fold higher risk for infant death when compared to hospital births. 
  • The AAP states home births should only be considered if no maternal health problems, if it’s a term baby (after 37 weeks and before 41 weeks gestation), labor started at home spontaneously or as an outpatient, and it’s a single pregnancy that isn’t breech. Having had a previous C-section makes a home birth a no-no in their mind.
  • The AAP recommends having at least 2 people attending the birth with at least one person at the birth who’s sole job is to care for and tend to the baby after the birth. They outline that the baby’s caregiver needs to know how and why to resuscitate a newborn. The team caring for mom and baby need access to consultation with obstetricians and pediatricians and a well-planned way to access the hospital or medical team easily if needed.
  • The AAP says, “Every newborn infant deserves health care that adheres to the standards highlighted in this statement.” Care described includes warming the baby and initial transitions, glucose monitoring, infection monitoring, feeding assessment, jaundice checks, vitamin K shot, Hepatitis B shot, eye infection prevention, hearing screen, newborn blood screen, and follow-up care plans.

I believe we each have the right to make health care decisions that are best for our families. We also must have access to un-biased information on safety. Every single health decision we make is a process where we weigh risks against benefits. Home birth versus hospital birth is no exception.

My disclaimers: I had 2 hospital births which required all sorts of intervention and intensive care—2 C-sections, a bedside resuscitation for my newborn, and a short NICU stay for one of my sons. I would never have wanted to have a home birth after my training in pediatrics. That being said, there were aspects of the hospital care that really upset me. I didn’t have a birth plan, per se. I wanted this: a healthy baby and to survive the delivery without complication. I got both, thank goodness, but it wasn’t perfect. The beginning of motherhood was a challenge for me both times around and in part, I’ve always looked back feeling I should have been a stronger mom in the hospital… Read More »

Why Do Babies Wake Up At Night?

Most babies wake up at night. And although some superhero babies sleep 10-12 hours straight starting around 3-4 months of age, most infants wake up during the night and cry out for their parents. There are scientific reasons and some developmental and behavioral explanations for these awakenings. I spoke with my friend Dr Maida Chen, a pediatric pulmonologist, mother to three, and director of the Pediatric Sleep Disorders Center to put a list together regarding why babies do this. Leave questions and comments below if we can explain more. I’ll author a follow-up blog on ways you can help your baby when they wake up, too.

10 Reasons Babies Wake Up At Night:

  1. Sleep Cycle: Babies wake up during the night primarily because their brain waves shift and change cycles as they move from REM (rapid eye movement) sleep to other stages of non-REM sleep. The different wave patterns our brains make during certain periods define these sleep cycles or “stages” of sleep. As babies move from one stage of sleep to another during the night, they transition. In that transition, many babies will awaken. Sometimes they call out or cry. Sometimes they wake hungry. It’s normal for babies (and adults) to wake 4-5 times a night during these times of transition. However, most adults wake up and then fall back to sleep so rapidly that we rarely remember the awakening. At 4 months of age, many parents notice awakenings after a first chunk of deeper sleep. This is normal, and often due to development of delta wave sleep (deep sleep). The trick for parents is to do less and less as each month of infancy unfolds during these awakenings; we want to help our babies self-soothe more and more independently (without our help) during these awakenings so that sleeping through the night becomes a reality. Read More »

When Should I Start Baby Food?

first foodsWhen to start baby food? The timing on starting baby food may seem confusing. If you survey your neighbors, your own moms, the doctors you see, and the child care or daycare providers who help you, I bet you’d get about 4 different answers backed with 4 different theories and rationales. The reason is, the pendulum on when and how to start baby food has changed. Bits and pieces of old data mixed with contrasting new research findings are getting tossed around. Most new parents I talk with are a bit puzzled on what is truly best.

It’s okay to start your baby on baby foods or “complementary foods” when they show signs of readiness if they are at least 4 months of age. Signs of readiness include watching you eat (following your spoon’s every movement at a meal), lip smacking and licking when they smell food, and opening their mouths when you present them with a spoonful of food. Most babies ready to eat have also doubled their birth weight and started cooing and laughing, sitting up with assistance, and rolling over.

I used to advise families to wait until 6 months to start baby foods but new research over the last couple of years has caused me to change my tune. Read More »

Is It Really An Ear Infection?

Screen Shot 2013-02-26 at 9.46.22 AMEar infections cause significant and sometimes serious ear pain, overnight awakening, missed school, missed work, and lots of parental heartache. For some children, infections in the ear can be a chronic problem and lead to repeated clinic visits, multiple courses of antibiotics, and rarely a need for tube placement by surgery. For most children, ear infections occur more sporadically,  just bad luck after a cold. Fortunately the majority of children recover from ear infections without any intervention. But about 20-30% of the time, they need help fighting the infection.

Ear infections can be caused by viruses or bacteria when excess fluid gets trapped in the middle portion of the ear, behind the eardrum. When that space fills with mucus or pus it is put under pressure and it gets inflamed causing pain. Symptoms of ear infections include pain, fever, difficulty hearing, difficultly sleeping, crankiness, or tugging and pulling at the ear. This typically happens at the time or soon after a cold—therefore the fluid in the ear can either be filled with a virus or bacteria.

The most important medicine you give your child when you first suspect an ear infection is one for pain.

Antibiotics only help if bacteria is the cause. When a true infection is present causing pain and fever, antibiotics are never the wrong choice. Often you’ll need a clinician’s help in diagnosing a true ear infection.

Three’s been a lot of work (and research) over the last 15 years to reduce unnecessary antibiotics prescribed for ear infections. There has been great progress. Less children see the doctor when they have an ear infection (only 634/1000 in 2005 versus 950/1000 back in the 1990’s) and they’re prescribed antibiotics less frequently. Recent data finds that less than half of children with ear infections receive antibiotics (only 434 of every 1000 children with ear infections). However, the far majority who go in to see a doctor do still receive a prescription for antibiotic (76%).

The American Academy of Pediatrics(AAP) just released new guidelines to help physicians do a better job treating ear infections. Sometimes children really benefit from using antibiotics and new research has led to an update on the 2004 previously published recommendations. Over-use of antibiotics can lead to more resistant and aggressive bacteria so we want to use them at the right time. These recommendations may help improve care for children.

In my opinion, NPR published the best article I’ve read covering the new recommendations. I especially liked the balance provided: Read More »