Archive for May 2013

Monthly Archive

Value Of Well Baby Check-Ups

Some new data published in the American Journal of Managed Care finds increased value in preventative well baby and toddler check-ups. Not because it keeps pediatricians busy, but really because it potentially can save suffering and hospitalizations for young children that would otherwise hopefully not occur.

A study published this month evaluated over 20,000 babies and toddlers in the Group Health network. They reviewed medical charts to study both rates of hospitalizations and rates that families showed up for their well baby check-ups. They specifically evaluated rates of hospitalizations for what they call, “ambulatory-care sensitive hospitalizations,” in which access to routine care could potentially avoid an illness developing that would require a child to be admitted to the hospital for treatment. Here’s more and how you can find low cost medical or dental clinics for yourself or your child and get help applying for health insurance:

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Love The Sun, Protect Your Skin

Sun protection is essential in childhood. Here’s 3 golden rules, backed by science, for you to use when purchasing, applying/re-applying sunscreen, and protecting children from the sun. Remember, more important than any ingredient or any particular SPF number or brand is the way you use a sunscreen: the best sunscreen is one used early and often.

Sun-protective clothing (those UV shirts, shorts, and hats) is an awesome, affordable, and easy way to protect children from sun without the hassle of sunscreen. Risks for skin cancer increase with sun exposure, family history, and sunburns in particular. Protecting your children from excessive sun exposure and sunburn is an anti-cancer move. That’s power.

3 Rules For Protecting Children From Sun Exposure

  1. Respect the brilliant sun; know your local risk. Enjoy the sun but be smarter. After surviving melanoma, I’ve been forced to change the way my family lives with the sun to decrease our risks. I’ve learned a ton about letting the UV index guide me. UV index is a measure of the radiation you are exposed to when outside. Radiation from the sun increases cancer risk, increases skin aging (wrinkles!), while it decreases eye and immune health. UV index varies with the time of year, the type of weather, the latitude, and the time of day. Check out your UV index today (by zipcode) and download the free app (search “UV index” in your smartphone). Make a habit to check the UV index every day to get a sense of your family’s exposure–I guarantee it will surprise you. Even on cloudy days, the UV index midday can rise to levels that will encourage you to protect your skin. Don’t be scared of the sun, just be smarter. Read full post »

Emergency Preparedness: Make A Communication Plan

Screen Shot 2013-05-20 at 4.19.56 PMThe news from Oklahoma today is heart wrenching and terrifying. Often we feel helpless when we’re far away from a disaster. A donation to The Red Cross is a good use of your time.

Today, in addition to providing donations and support for those suffering the loss and tragedy in Oklahoma, do something really productive to counter the sense of unease and alarm we all get. Prepare your own family. Buddy up with a friend and get part of this done today and tomorrow.

I suggest you make a 3-day disaster kit. Here’s an article I wrote for Parents Magazine that details how to make a kit. If the work of storing water and emergency supplies seems daunting today, start with something equally as important:

Make An Emergency Communication Plan

  1. Teach your child one parent’s cell-phone number or a good contact number for you or your partner. Starting at around age 5, kids are developmentally able to memorize a 7- or 10-digit number. Practice with your child today and tomorrow. Get that number locked in. Experience has taught me to re-visit these numbers as my 6 year-old proves every once and awhile that numbers slip away from memory!
  2. Designate an out-of-state contact. Chose a family or friend distant from your home who answers their phone regularly. This will be a resource and point person for your family to call during an emergency.
  3. Choose a safe location. Designate a location other than your home where your family can meet in case of danger or unsafe conditions in your home. This is the kind of place you may need to go there in case of a fire, tornado, or an earthquake. Your meeting place might be a local park, school, or shelter. Walk to the site with your child so he knows exactly how to get there. Read full post »

The Lunchroom, ADHD, And Obesity


ADHD Diagnosis Prevalence in The United States :

Last week I served lunch at my son’s school. It was a hoot, really, serving an entire K-8 school lunch. Dishing out lasagna, broccoli, pizza, and grilled cheese provided all sorts of insight into what lunch is like in 2013. My son didn’t choose exactly as I’d predict (see below). When a 33-year prospective study published today which connects childhood ADHD with adult obesity, it got me thinking we need to be more involved in how (not just what) our children eat at school. For those children with and without attention challenges.

Previous studies have found that ADHD may increase risk for unhealthy weight because researchers theorize inattention and compulsive behavior in life changes eating patterns. We’re clearly dependent on regulation for achieving and maintaining a healthy weight. The study published today followed boys from age 6-12 years into adulthood, spanning 33 years. Results in this small sample suggest childhood inattention and hyperactivity conferred a two-fold increase in being obese as adult. The study included only Caucasian boys. The development of obesity in those men was found regardless of their ADHD continuing into adulthood or not.

It’s well established that children who are overweight have a higher risk of being overweight or obese adults. And what makes this research important is that unlike previous studies, it didn’t matter if the boys ADHD remitted in adulthood. Meaning that even if boys outgrew their ADHD, their risk of adult obesity persisted. Researchers theorize that those eating habits and attention challenges of childhood may change lifetime risk. Because the findings go against previous data that unlinked obesity and ADHD in adulthood, it will likely trigger more research. Read full post »

The 7-Minute Workout

7-Minute Scientific Workout from The New York Times Magazine

7-Minute Scientific Workout from The New York Times Magazine

Exercise got thrown out the window for me in a routine way after my boys were born. It wasn’t a lack of interest, just a lack of organization of our time. Just now, as my boys get older and more independent, I’m integrating regular exercise back into my life. My experience with malignant melanoma this past year also was a big nudge. Seeing a glimpse of mortality does implore you to stay alive.

That’s why the 7-minute workout saves me. It’s the first no-excuse-not-to workout I’ve ever seen (I know others exist, they’re just not on my dashboard). The best part of discovering the 7-minute workout was the reality that in getting it done I didn’t need any equipment, any large chunk of time, or any childcare. On May 9th, The New York Times published an article that elevated the research article behind this workout and concept. Authors who created the workout hail the benefits of high-intensity-circuit-training (HICT). They say, “HICT is not a new concept, but it is growing in popularity because of its efficiency and practicality for a time-constrained society. The combination of aerobic and resistance training in a high-intensity, limited-rest design can deliver numerous health benefits in much less time than traditional programs. When body weight is used as resistance, it eliminates the limiting factors of access to equipment and facilities.”

This will likely be familiar: the day the article ran 5pm rolled around and I’d yet to exercise. The night was packed as we were headed to the school spring concert. The idea of a 10pm run wasn’t enticing. I’d just read about that 7-minute workout and the authors’ details of benefits including building whole body muscle groups, burning fat, and improving markers of health like insulin resistance. Felt like I had zero excuse.

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Texting And Other Risky Moves

bumpy roadI’m going to sound very middle-aged in this post. Whenever I talk about texting and driving I tend to show my age. I don’t know how it happened or when it was that I truly became a grown-up, but when it comes to texting and driving I feel nothing like a sixteen year-old.

Unfortunately, teens are particularly vulnerable in the car. Motor vehicle accidents are the number one killer of teens between 16 to 19 years of age. The reason is established: teens die most often in cars in part because teenagers are more dangerous and inexperienced on the road but also because they are one of the groups that has the lowest rate of seat belt use out there. Teens are also more prone, compared to experienced drivers, to making mistakes while driving when distracted. There’s some new information published in Pediatrics today that lends insight into teens and distraction, especially when it comes to texting.

Research at the Center for Disease Control (CDC) has established that about 1/3 of American adults say they text and drive. The reality is, it’s worse for teens: data published today from 2011 CDC surveys find that about 45% of teens said they had texted during the most recent month.

What is particularly interesting (and potentially helpful) from the new data is that some groups of teens take more risks than others. Obvious statement, yes, but something to think about especially if we can help deter those risk-takers more wisely. Teens who text are also more likely to be the ones who don’t don the seatbelt and who would get in a car with a teen who has been drinking. This data may offer up an opportunity to target approaches for interventions.

Americans, Teens Who Text & Drive

  • Car crashes are leading cause of death for teens age 16 to 19.
  • Teens are inexperienced & more dangerous drivers.
  • Teens (age 14-17) send an average of 100 texts/day yet we also know that girls send more texts than boys.
  • 33 States and Washington DC restrict cell phone use in car while an additional 5 states ban use for new drivers.
  • About 1/3 American adults say they text and drive. Read full post »

Day In, Day Out

There happens to be whole, large parts of adult American life that no one talks about in commencement speeches.

It’s the season for commencement speeches. A season I love, I keep a post-it note on my own computer from Steve Jobs’ 2005 Stanford commencement address. The post-it note is faded and bent, worn and tired. But there’s rarely a day I don’t see it. I see it right now…

Advice at the moment of transitions in our lives is helpful, but rarely sinks past the skin at the moment we hear it. Sometimes it’s upon reflection and maturation that we look back and realize how much we value wisdom we’ve heard. It’s as if advice has to brew. It’s just this past year or so that I’ve really embodied the concept of “Be a willow, not an oak.” That was the message delivered at my older brother’s high school graduation. Clearly it struck me then, enough to remember it, but the advice only got heart-deep this past year, some 20+ years after I first heard it.

This 9-minute snippet from David Foster Wallace’s 2005 commencement address at Kenyon College (my beloved Alma Mater) is worth your time. I’ve listened to it three times in three days. I suggest this will change not only your day, but your year. This is the type of parenting advice I love most: it’s marketed as life advice, college-graduate advice, or advice for the young. Yet all the while it’s actually perfect for we frenzied, over-worked, tired, callous-handed parents. The monotony, the hard labor of caring for young children is rarely glamorized and never snags enough attention to make it worthy of a speech. I think David Foster Wallace’s wisdom is profound and on-point.

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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 full post »