Category Archives: diet

Good eating habits as a way of preventing obesity and eating disorders

Back-to-school time involves changes in just about everything: schedules, homework, sports, family time—even eating. Being rushed in the mornings makes having a decent, healthy breakfast a challenge. Families have to decide if kids will take lunch or buy the school lunch. Then comes the evening meal with people going in different directions, and often little time to prepare or eat a meal together. It’s no wonder that healthy eating and family time often take a back seat to homework, sports, and other activities.

As we all know by now, obesity among children and teens in our country is a widespread problem, and eating disorders (EDs) are also more common than before.

An article published last week on the website of the American Academy of Pediatrics (AAP) discusses how the same attitudes and habits can lead to both obesity and EDs. According to one study, dieting can actually be a precursor to obesity and EDs. Dieting “was associated with a twofold increased risk of becoming overweight and a 1.5-fold increased risk of binge eating… Another study found that normal weight girls who dieted in ninth grade were three times more likely to be overweight in 12th grade compared with non-dieters.”

In addition to dieting as a cause, “weight talk”—no matter how well-intentioned—and “weight teasing” can lead to EDs and obesity. “Weight talk, or comments made by family members about their own weight or to the child to encourage weight loss, has been linked to both overweight and EDs. Teasing children about their weight also has been associated with the development of overweight, binge eating and extreme weight-control behaviors in girls and overweight status in boys. Body dissatisfaction is a known risk factor for both obesity and EDs.”

So, how does a parent help a child be satisfied with her or his body? How do you encourage your teen toward a healthy relationship with food? “Adolescents who are more satisfied with their bodies report parental and peer attitudes that encourage healthful eating and exercise to be fit, rather than dieting.”

The article contains recommendations for pediatricians, and that guidance also applies to parents:

“Discourage dieting, skipping of meals or use of diet pills to lose weight. The focus should be on a healthy lifestyle rather than on weight.
Encourage more frequent family meals, which provide an opportunity to model healthy food choices and provide time for teenagers and parents to interact.
Promote a positive body image among adolescents. Body dissatisfaction should not be used as a reason to lose weight.
Encourage families not to talk about weight but rather to talk about healthy eating and being active to stay healthy.
Carefully monitor weight loss in an adolescent who is obese or overweight to ensure the teen does not develop the medical complications of semi-starvation.”

Don’t forget family meals. Though your children and teens may roll their eyes, the time spent together around the table is a time to connect over healthy food and discussions about topics great and small. Turn off the television and cell phones (including yours!) and enjoy each other’s company. It will make all of you healthier.

Diabetes testing and prediabetes

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Our last two blogs have been about diabetes, types 1 and 2. Now, let’s look at risk factors, testing, and what is called prediabetes.

Risk factors are slightly different for the two types of diabetes (see our previous two blogs to learn more about those types). We’ve gleaned these sets of factors from an article by the Mayo Clinic. Check out that article for more detailed explanation.

Type 1 risk factors

Family history
Environmental factors (such as exposure to certain illnesses)
The presence of damaging immune system cells (autoantibodies)
Dietary factors—though studies don’t show a direct cause and effect, there seems to be some relation to things like early consumption of cow’s milk and cereals, for example
Geography—people who live in some northern European countries have greater risks

Type 2 and prediabetes risk factors

Being overweight or obese
Inactivity
Family history
Race—it’s unclear why certain races (including blacks, Hispanics, American Indians and Asian-Americans) are at higher risk
Age—although type 2 diabetes is increasing at alarming rates among children and youth, risk increases with age
High blood pressure
Abnormal cholesterol and triglyceride levels

Other risk factors in the article pertain to adults.

Prediabetes is a condition that means your blood sugar levels are higher than normal but not yet in the “diabetic” range. It also means that you are at an increased risk of developing type 2 diabetes.

The American Diabetes Association has an online test you can take to determine possible risk. If you believe your child is at risk, talk to your pediatrician.

Please note that the top two risk factors for type 2 diabetes are things over which you likely have a great deal of control. A healthy diet and age-appropriate activity are your best tools for prevention, for your child and for you.

When to start fighting tooth decay? When the baby’s FIRST TOOTH starts to come in.

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You are so excited about your child’s first teeth that it doesn’t occur to you to think about tooth decay yet. But the fight against tooth decay, according the American Academy of Pediatrics (AAP), starts from the first baby tooth. That is also when they recommend starting to brush with a tiny amount of fluoride toothpaste.

You may be thinking, “What?! My pediatrician (or dentist) told me no fluoride before the age of two years.” You’d be right. This is a BIG change in recommendations, and it is indeed new.

Dental health is important for overall health, and tooth decay can start early. Decay in a young child’s teeth “is the single greatest risk factor” for decay in permanent teeth, according to a recent article by the AAP, which also states that “59% of 12- to 19-year-olds” have at least one cavity.

The administration of fluoride in a proper amount is still one of the best ways to prevent tooth decay, as it preserves the enamel that coats the tooth. Many children and teens don’t get enough fluoride to act against tooth decay.

How to make sure your child is getting enough fluoride:

Start at the very beginning. As soon as you see the first tooth erupting from the gum, you should brush it with a fluoride toothpaste, but only a very small amount. The AAP guidelines, which you can find here, recommend a “smear” about the size of a grain of rice until the age of three.
For 3- to 6-year-olds, increase the amount to pea-sized. Brush teeth twice a day, with adult assistance, and make sure that the child doesn’t swallow the toothpaste. It’s even best if they don’t rinse with water.
Drink tap water. In Scott County the public water is fluoridated, but if you use a well or cistern your water will only contain minimal amounts of fluoride. Bottled water typically doesn’t contain much, if any, fluoride. If you worry about tap water, use a filter.
Check with your pediatrician or dentist especially if you don’t have public water to make sure your child or teen is getting enough fluoride.

Are there any downsides to using fluoride? Yes, it’s possible to get too much and create a rare condition called fluorosis, that causes discoloration of the teeth. You can read about fluorosis here. Again, this is rare, but if you’re concerned about it, speak to your pediatrician or dentist.

For other information on preventing tooth decay, check out these AAP articles:

“Brushing Up on Oral Health: Never Too Early to Start” about dental health in babies.
“Preventing Tooth Decay in Children.”
“Toothbrushing Tips for Young Children.”

Take good care of your child’s teeth for beautiful smiles throughout their lives.

Back in School, Part 1: Staying Healthy

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Now that your child is back in school, the sometimes easy-breezy days of summer have turned hectic with schedules, deadlines, homework, complex relationships. For the next few weeks we’ll be running a series about things to keep in mind during the school year ahead.

Today we start with how best to insure a healthy year at school.

You already know the best way to stay healthy, but it bears repeating: prevention is always the best medicine. Here are some pointers.

Checkups. Has your child had her annual well child checkup? If not, now is the time to schedule it. The doctor will look at health history, height and weight, and will discuss age-appropriate health topics with you and your child. If you have a specific concern (social behaviors, learning difficulties, chronic ear infections, etc.) to discuss, you’ll want to let the office know when you call for the appointment to make sure they schedule a longer visit for you.
Immunizations. Yes, we harp on this a lot, but it’s for good reason. Immunizations protect children, families, and even whole communities from dangerous diseases. The state requires that you keep certain ones up to date; we have others we recommend. Check with our office (or on the patient portal) for your records.
Exercise. Sitting all day at school, then coming home and sitting in front of the TV or at the computer and homework desk is not good for your kid. He needs to get moving. Don’t expect physical education classes to provide all the exercise he needs. Unstructured play is good for all children, and organized sports are a great way to learn things like discipline, teamwork and a sense of accomplishment.
Germs. Let’s be honest. There’s no way to avoid germs at school. Uncovered coughs and sneezes, shared desks and close quarters give viruses all sorts of opportunities to infect students. Some exposure is good to develop immunity, but keeping hands clean is a great way to stave off colds and flu. Send hand sanitizer to school in your children’s backpack, and remind them to clean their hands before eating and after they use the restroom. Every time. Don’t share drinks or eating utensils. And, while we’re at it, remind them not to share combs, brushes or hats, which is the most common way to spread head lice.
Sleep. A good night’s sleep is an essential ingredient in the learning process. Sleep also helps mood and strengthens the immune system. Set a regular bedtime and stick with it, making sure your child or teen has an age-appropriate amount of sleep.
Balanced diet. Eating right feeds both body and brain. This webpage at the American Academy of Pediatrics site lists several of their articles regarding diet. Don’t forget we have a dietician on staff who can help you come up with an action plan for your young athlete, picky eater, diabetic, or can help you plan easy lunches and snacks to pack for school.

Keep these things in mind throughout the school year and they will help your child have a successful and healthy school year.

Probiotics

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You’ve likely heard the term “probiotics”. Maybe you’ve also wondered what it means and what, if any, benefit probiotics could provide for your family’s health.

What are probiotics? According to the Centers for Disease Control and Prevention, “Probiotics are defined by the Food and Agriculture Organization of the World Health Organization as live microorganisms that, when administered in adequate amounts, confer a health benefit on the host.” Sound appetizing?

Every human intestinal tract contains beneficial bacteria that helps break down food products into compounds that are more easily absorbed into the body. Sometimes the beneficial bacteria need a boost over the harmful bacteria that share the same space, or during or after a round of antibiotics that may kill the good bacteria along with the bad.

Probiotics contain the helpful bacteria. According to the American Academy of Pediatrics, giving probiotics early in the course of “acute viral gastroenteritis can reduce its duration by one day. Probiotics also have been found to be modestly effective in preventing antibiotic-associated diarrhea in otherwise healthy children, though there is no evidence probiotics are effective at treating this type of diarrhea.” [Italics ours.] Note the term “healthy children.” Probiotics don’t have any proven effects on treating chronic diarrhea, Crohn’s Disease or other chronic illnesses.

When a mother cannot breastfeed, special probiotics can be introduced to the formula that will help to replace the natural ones found in breast milk. Ask your pediatrician about this before trying these products.

Where do you get probiotics? They are available over the counter in drug stores and healthcare departments of grocery and discount stores. They come in foods or as supplements. Buy from a manufacturer you trust, remembering that probiotics are not regulated the same way prescription drugs are.

As always, eat a balanced diet, which is the best road to gastrointestinal health.

E. coli and other nasty things: how to have good food safety for your cookout or picnic

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The holiday weekend approaches, with plans for picnics, cookouts, reunions, and fun! At the same time we’re hearing about a recall of nearly 2 million pounds of ground beef that is possibly contaminated with E. coli bacteria. How can you be sure about the safety of the food you’re serving your family?

You are right to be cautious. Foodborne illnesses can be very serious, even deadly. E. coli, in particular, can cause organ failure, and children may be especially vulnerable.

Here are some basic rules to keep in mind.

Cook ground meats ALL the way through. Pink interiors mean raw meat, and when that meat is ground, microbes that used to be on the surface of the meat can now be deep inside it. If the meat is fully cooked, any E. coli should be taken care of.
Cook poultry completely through. Chicken, in particular, can be contaminated with Salmonella.
Don’t reuse the plate that held raw meat or poultry. It must be washed before being used to hold cooked meat or other foods. The same goes with knives and other utensils.
Keep food separate. Fruits and vegetables shouldn’t be stored in the same container with uncooked meat and poultry, for example.
Chill leftovers soon. This is important when you’re at a picnic and far from your refrigerator. Take a cooler and ice packs.
Keep your hands clean. Wash them often. Take hand sanitizer on your picnic. Don’t change a baby’s diaper while preparing food.
Wash your fruits and vegetables. When you clean poultry in the sink, be sure to sanitize the sink afterwards so that you don’t contaminate food, dishes and utensils.

More information is available here from the Centers for Disease Control and Prevention.

A fun holiday is a safe holiday. Enjoy the time together and have a great weekend!

I’m thirsty!

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School is almost out and warmer weather is on its way. Hydration is always important, but never more so than when you’re active in warm temperatures. What are the best things to give your kids to drink, and are there drinks they should avoid?

First, drinks to avoid completely:

Energy drinks. Make sure you know the difference between sports drinks and energy drinks. Energy drinks contain stimulants like caffeine and are not appropriate for children and teens. According to the American Academy of Pediatrics: “Caffeine… has been linked to a number of harmful health effects in children, including effects on the developing neurologic and cardiovascular systems.” Caffeine is a drug, and is addictive.
Caffeinated soft drinks. (See bullet point above about the ill effects of caffeine on children and teens.)

Drinks that are okay for occasional use:

Sports drinks. These replace electrolytes and calories lost from prolonged exercise.
Non-caffeinated soft drinks. They are okay on special occasions, but only for older children. Sodas are acidic and therefore are harmful for teeth. Add sugar to that equation and you could be creating some real dental health problems.
Sugary drinks, carbonated or not. These have been linked to childhood obesity in children as young as 4. As with soft drinks, all sugary drinks can cause tooth decay.
Fruit juices. Better options than carbonated drinks, and often a good source of vitamins, they are still calorie rich and shouldn’t be overused.

Drinks that are best:

Water. Always the best way to hydrate, water can be a great part of the healthy child’s diet throughout the day, even when they’re not thirsty. Your kid doesn’t like water? Check out the flavor packets and squirts that add flavors to water.
Low fat milk. If your child or teen can tolerate milk, it is an indispensable source of calcium. If she is unable to drink milk, talk to the pediatrician about alternate sources of calcium.

Finally, a note about very young children.

Nothing but breast milk or formula should go in a baby’s bottle. Even fruit juice is too sugary and can lead to tooth decay. Read here about beverages for the very young.
Children can start learning to use a cup at about 6 months. Still, limit juice to 4-6 ounces per day until the age of 2.
Wean completely from bottles at about 12-15 months of age.

What we drink becomes habit, and starting good drinking habits in childhood is an excellent way to build healthy bodies and teeth for a lifetime.

Stomach virus recovery

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“Stomach bugs” are making their rounds right now. Rotavirus, in particular, is quite contagious and may have even made the rounds through every member of your household. It causes diarrhea, vomiting, stomach pain, etc. Sound a little too familiar?

What to do?

According to the American Academy of Pediatrics, usually, the virus goes away on its own. Watch, though, for dehydration and high fever. Dehydration can be serious in a small number of cases. Give small amounts of fluids until the vomiting ceases. Water is fine, but fluids like Gatorade can add electrolytes. Stay clear of acidy drinks (like orange juice) and milk.

Be watchful regarding dehydration. Pay attention to the frequency of urination. The urine will become more concentrated and less frequent, but child should still be urinating.

While your child is sick, give a very bland diet: avoid dairy, fried foods, fast foods, hot dogs, etc. Some good foods are bananas, rice, applesauce and toast (BRAT).

However, it’s recommended that as soon as the stomach is settled, you should return to a balanced diet of fruits, vegetables and protein (meat, yogurt).

Call the pediatrician if diarrhea and vomiting don’t subside within three days, if there’s been no urine output for 10 hours, or if the fever is high or doesn’t subside. See our blog about when to be concerned about a fever.

As always, stay healthy!

Should we go gluten-free?

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“Gluten-Free” is the new catchword for “healthy diet,” or so it would seem if you read grocery store labels. Do gluten-free foods really make your family healthier? It’s not always a simple answer.

Just what is gluten? It’s a protein found in wheat and some other grains. Why do some people avoid gluten? There are several reasons.

Less than 1% of the population cannot eat gluten because they have celiac disease. According to the National Institutes of Health page on the subject, “celiac disease is an immune reaction to gluten, a protein found in wheat, rye, and barley.” It can be diagnosed as early as infancy or at any later time, and you can find a list of symptoms here from the American Academy of Pediatrics. The only way to get relief from those symptoms is to completely eliminate gluten from the diet, a task that isn’t easy because so many products contain wheat flour.

Others think that a gluten-free diet makes them feel better, though that could simply be because they are eating fewer carbohydrates and calorie-laden fast foods.

Still others believe that gluten contributes to behavioral problems or may even have a link to autism. Those ideas remain unproven, but there is a great article here.

Gluten-free advocates often tout a huge list of health benefits that are completely without scientific basis.

Celiac disease cannot be diagnosed without specific tests. If it’s something you suspect your child may have, talk to your pediatrician. And if you have to put your child on a gluten-free diet, you need to speak to a dietician about what nutrients you may be missing in the process. Don’t forget that our office has a dietician on staff for just this type of consultation.

Bottom line: there’s nothing wrong with eating gluten-free foods, but don’t go totally gluten-free without consulting your pediatrician.

Our own dietician on staff!

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Did you know that Georgetown Pediatrics has our very own dietician? Amy Crist has been with us for about 9 months and is available by appointment through our office.

Working part-time for us, Amy is a registered dietician (RD) with a master’s degree, has also worked at Georgetown Community hospital, and makes her home right here in Georgetown.

Amy loves working with infants, children, adolescents and their parents in developing healthy eating habits, including those who have dietary restrictions. She is a frequent speaker at local elementary schools to teach children about healthy eating and nutrition. She’s even led a support group on breast feeding. She is happy to have an appointment with you and your child or teen to discuss:

breast feeding,
dietary restrictions and planning as a result of disease or condition (diabetes, drug therapies, etc.),
concerns about weight or eating disorders,
helping the whole family develop healthy eating habits,
diet and sports,
picky eaters,
and anything else you want to talk over with a dietician.

Call our office and set up an appointment soon!

Amy Crist, our dietician