I previously posted about the health dangers associated with High Fructose Corn Syrup, a "super sweetener" used in everything from pastries to sweetened beverages, breakfast cereal and even ketchup. It is ubiquitous it seems.
My house is HFCS-free, and thankfully all the kids like to drink water. We have orange juice, and make our own fruit smoothies. I don't keep any other fruit juice in the house, and don't do juice boxes. I am alarmed at how much juice some of the children I see at my office drink. Children of any age should not be drinking more than 6 oz. of juice daily; it is even better if they DON'T drink juice at all. Unfortunately, there is a huge industry pandering juice boxes and pouches to families with children. Some parents mistakenly feel that the "Capri Sun Roarin' Water" is good for their children because it is mostly water -- these beverages may actually be WORSE than juice because they are all sweetened with high fructose corn syrup.
My husband recently e-mailed me an article entitled "9 Reasons to Avoid Sugar As If Your Life Depended On It". Pretty catchy, but is a good summary about the dangers of sugar. Both sugar and HFCS contain fructose. Simple glucose is easily digested and eliminated by the body, but the same is not true of fructose. Fructose is metabolized by the liver; since our liver is busy maintaining normal blood sugar levels in our blood, "extra" fructose is converted into fat -- for us to use later. Too much fructose being diverted this way leads to excess deposition in the liver. Over time, "fatty liver" develops. As we ingest more sugar, our body has a harder time struggling to keep blood sugar levels stable, and our pancreas will make more and more insulin to keep blood sugar levels in a normal range. This "hyperinsulinemia" leads to obesity and increases in fat deposition throughout the body, as well as increases in cholesterol.
Studies looking at people who ingested 25% of their calories in glucose or fructose-sweetened drinks showed that these people had increased levels of LDL ("bad cholesterol"), triglycerides (another blood fat), higher fasting blood sugar and insulin levels and, worse, decreased insulin sensitivity. Increasing amounts of insulin resistance leads to obesity, type two diabetes and metabolic syndrome.
What can be said additionally to all of the above mentioned science is that sweetened beverages add empty calories, calories devoid of nutritional value.
Fructose-sweetened beverages have also been shown to interfere with the normal satiety reflex - fructose drinkers felt less satisfied and were still hungry. Fructose ingestion also did not lessen the body's level of ghrelin - the "hunger hormone". The higher the level of ghrelin, the hungrier one is. Fructose also causes resistance to leptin, another hormone that is released by our fat cells after we have eaten. Leptin basically tells the body, "I am full; stop eating". Obviously, in someone leptin resistant, this signal does not function as intended.
There are also many studies that suggest that the high sugar, western diet can lead to "sugar addiction" or at least a form of sugar toxicity leading to the above medical problems.
As parents, we are responsible for setting examples for our children. If we stress activity and exercise, our children will be active and exercise. If we stress healthy eating habits, our children will be healthier. Beware the dangers of high fructose corn syrup - limit or eliminate fruit juice, and get into the habit of reading labels. Know what you are eating and drinking, eat more fruits and vegetables and limit processed foods.
Monday, March 25, 2013
Thursday, March 21, 2013
Sleep Tips for Teens
I have previously written about sleep issues in toddlers, and have been seeing more older children and teens with sleeping issues lately - specifically, the inability to fall asleep at night or get adequate amounts of sleep.
In studies addressing sleep and children, researchers have found that over 15 million kids get poor sleep. Not getting adequate sleep can lead to poor school performance, daytime sleepiness and mood changes. As parents, sometimes we recognize the cranky, moody, irritable symptoms and blame those on lack of sleep -- even teens sometimes don't have the insight to recognize sleep deprivation as the cause.
Here are some tips to get your older child or teen sleeping better:
1. Aim for an adequate amount of sleep each night - this may vary person to person, although research suggests teens should get 9 hours a night.
2. Maintain a regular sleep-wake cycle -- go to bed the same time every night (weeknight or weekend) and wake up at the same time every morning. This should not vary by more than an hour (as far as bedtime) and one should set an alarm on weekend mornings. This allows you to "jump start" your normal circadian rhythm and biological clock.
3. Sleep in a dark, comfortable room. Maintain a cool room temperature (about 68 F), close all blinds and curtains at night, and open the blinds on waking in the morning. Turn on lights when you wake up in the morning.
4. Use the bed only for sleep -- no computer, cellphone or TV watching in bed. Period.
5. Relaxing bedtime routine - eliminate screen time 30-45 min. before bed. Again, this means no cell phone, e-mail, texting, computer use, video games or TV. Listening to relaxing music is ok, as well as reading.
6. Include a warm bath or shower at night to help relax your child. Soothing scents in the bath or bedroom may also help - try orange blossom, majoram, lavender or chamomile. Chamomile or Valerian herbal teas may also be used prior to bedtime, since they may help you fall asleep easier.
7. No caffeine dinnertime or later; no nicotine/smoking cigarettes.
8. Don't go to bed hungry. Have a late night snack before bed if needed - milk, a glass of cereal, fruit or crackers. Avoid a heavy meal within 1-2 hours of bedtime since this can interfere with sleep.
9. Exercise regularly - 30-40 min. 4-5 times per week; exercise when it makes sense for you/your family but try to avoid any exercise within 2-3 hours of bedtime (as this can interfere with sleep).
10. No naps as a general rule; if your child needs to nap while adjusting to a better sleep schedule, limit the nap to 20-30 min. Napping for a long period or later into the evening will make it harder to fall asleep at night.
In studies addressing sleep and children, researchers have found that over 15 million kids get poor sleep. Not getting adequate sleep can lead to poor school performance, daytime sleepiness and mood changes. As parents, sometimes we recognize the cranky, moody, irritable symptoms and blame those on lack of sleep -- even teens sometimes don't have the insight to recognize sleep deprivation as the cause.
Here are some tips to get your older child or teen sleeping better:
1. Aim for an adequate amount of sleep each night - this may vary person to person, although research suggests teens should get 9 hours a night.
2. Maintain a regular sleep-wake cycle -- go to bed the same time every night (weeknight or weekend) and wake up at the same time every morning. This should not vary by more than an hour (as far as bedtime) and one should set an alarm on weekend mornings. This allows you to "jump start" your normal circadian rhythm and biological clock.
3. Sleep in a dark, comfortable room. Maintain a cool room temperature (about 68 F), close all blinds and curtains at night, and open the blinds on waking in the morning. Turn on lights when you wake up in the morning.
4. Use the bed only for sleep -- no computer, cellphone or TV watching in bed. Period.
5. Relaxing bedtime routine - eliminate screen time 30-45 min. before bed. Again, this means no cell phone, e-mail, texting, computer use, video games or TV. Listening to relaxing music is ok, as well as reading.
6. Include a warm bath or shower at night to help relax your child. Soothing scents in the bath or bedroom may also help - try orange blossom, majoram, lavender or chamomile. Chamomile or Valerian herbal teas may also be used prior to bedtime, since they may help you fall asleep easier.
7. No caffeine dinnertime or later; no nicotine/smoking cigarettes.
8. Don't go to bed hungry. Have a late night snack before bed if needed - milk, a glass of cereal, fruit or crackers. Avoid a heavy meal within 1-2 hours of bedtime since this can interfere with sleep.
9. Exercise regularly - 30-40 min. 4-5 times per week; exercise when it makes sense for you/your family but try to avoid any exercise within 2-3 hours of bedtime (as this can interfere with sleep).
10. No naps as a general rule; if your child needs to nap while adjusting to a better sleep schedule, limit the nap to 20-30 min. Napping for a long period or later into the evening will make it harder to fall asleep at night.
Wednesday, March 20, 2013
Side Effects of Psychiatric Medications in Children
More children and teens are being treated with daily psychiatric medications, including ADHD medications (most often stimulants) and antidepressants. Practitioners should discuss monitoring children for side effects when prescribing these medications. Following is a list of side effects to look for with psychiatric medications:
Stimulants (methylphenidate and amphetamine families) - typically prescribed as first-line therapy for ADD and ADHD; all stimulants have the following common side effects - weight loss, insomnia (difficulty falling or staying asleep), headaches, stomachaches, dry mouth, dizziness. Dextroamphetamines typically have more associated weight loss than methylphenidates. Stimulants can also, less commonly, cause new psychological symptoms such as irritability, moodiness, depression symptoms, obsessiveness and anxiety. Rarely, stimulants can be associated with hallucinations (visual or tactile) or manic-type symptoms. Overdose can cause heart arrythmias or seizures. Stimulants, as a rule, may raise a child's pulse and blood pressure slightly. This is usually not significant or any cause for concern. Your child's pulse and blood pressure should be monitored by your health provider.
If your child has any new symptoms after starting any of these medications, mention them to your health provider.
Atomoxetine (Strattera) - a nonstimulant used for ADD/ADHD as well; can cause mood swings, irritability, nausea/stomachaches; chance of weight loss and decreased appetite are less than with stimulants; insomnia may occur but is relatively infrequent. Serious but rare side effects may include suicidal thoughts/behavior and liver toxicity. Your provider may order periodic liver enzyme tests (referred to as LFTs) to monitor for any liver side effects.
Clonidine, Guanfacine, Intuniv - blood pressure-lowering medications originally, they are sometimes used for ADD/ADHD. Since they are blood pressure lowering agents, they may cause dizziness, headache and low blood pressure, but the major side effect is sedation. Often, providers will dose these medications in the evening to decrease notable side effects. These medications may also cause dry mouth, nausea, abdominal pain and constipation.
Anti-depressants in the SSRI class - include fluoxetine, sertraline, fluvoxamine, citalopram, escitalopram; as a class, these drugs have similiar side effects but individual patients can vary greatly in their response to certain medications or the side effects they encounter with the specific medication they are taking. The most common side effects include "changes in alertness" (which may be sedation or insomnia), increased or decreased appetite, nausea, constipation, restlessness and headaches. Rarely, some children may have develop a phenomenon known as "behavioral activation" - hypomanic symptoms of impulsivity, agitation, irritability, silliness and mood changes. A serious, but very rare risk is serotonin syndrome - extreme agitation, ataxia, diarrhea, hyperactive reflexes, mental status changes and tremor. Any serious side effects should be reported to your medical provider immediately. There is a "black box warning" for the SSRI class regarding suicide ideation. There have been conflicting studies looking at this topic, but it is important to realize that depressed children who develop suicidal thoughts (medication-related or otherwise) should seek immediate medical attention.
Anti-psychotic medications - most commonly in a class known as "atypical antipsychotics", they seriously but rarely cause extrapyramidal symptoms including muscle rigidity, tremors and muscle tics. More commonly, these medications can cause longer term issues with weight gain, excessive appetite, high blood sugar and high cholesterol. Your medical provider will monitor your child's weight and will order lab work periodically to monitor blood sugar and cholesterol levels. Any significant weight gain is cause for concern and should be discussed with your provider.
It is also important to realize that children who are on two (or more) psychiatric medications are at higher risk for side effects. Safety issues, as well as periodically reassessing the need for medication in general, should be discussed with your medical provider.
Stimulants (methylphenidate and amphetamine families) - typically prescribed as first-line therapy for ADD and ADHD; all stimulants have the following common side effects - weight loss, insomnia (difficulty falling or staying asleep), headaches, stomachaches, dry mouth, dizziness. Dextroamphetamines typically have more associated weight loss than methylphenidates. Stimulants can also, less commonly, cause new psychological symptoms such as irritability, moodiness, depression symptoms, obsessiveness and anxiety. Rarely, stimulants can be associated with hallucinations (visual or tactile) or manic-type symptoms. Overdose can cause heart arrythmias or seizures. Stimulants, as a rule, may raise a child's pulse and blood pressure slightly. This is usually not significant or any cause for concern. Your child's pulse and blood pressure should be monitored by your health provider.
If your child has any new symptoms after starting any of these medications, mention them to your health provider.
Atomoxetine (Strattera) - a nonstimulant used for ADD/ADHD as well; can cause mood swings, irritability, nausea/stomachaches; chance of weight loss and decreased appetite are less than with stimulants; insomnia may occur but is relatively infrequent. Serious but rare side effects may include suicidal thoughts/behavior and liver toxicity. Your provider may order periodic liver enzyme tests (referred to as LFTs) to monitor for any liver side effects.
Clonidine, Guanfacine, Intuniv - blood pressure-lowering medications originally, they are sometimes used for ADD/ADHD. Since they are blood pressure lowering agents, they may cause dizziness, headache and low blood pressure, but the major side effect is sedation. Often, providers will dose these medications in the evening to decrease notable side effects. These medications may also cause dry mouth, nausea, abdominal pain and constipation.
Anti-depressants in the SSRI class - include fluoxetine, sertraline, fluvoxamine, citalopram, escitalopram; as a class, these drugs have similiar side effects but individual patients can vary greatly in their response to certain medications or the side effects they encounter with the specific medication they are taking. The most common side effects include "changes in alertness" (which may be sedation or insomnia), increased or decreased appetite, nausea, constipation, restlessness and headaches. Rarely, some children may have develop a phenomenon known as "behavioral activation" - hypomanic symptoms of impulsivity, agitation, irritability, silliness and mood changes. A serious, but very rare risk is serotonin syndrome - extreme agitation, ataxia, diarrhea, hyperactive reflexes, mental status changes and tremor. Any serious side effects should be reported to your medical provider immediately. There is a "black box warning" for the SSRI class regarding suicide ideation. There have been conflicting studies looking at this topic, but it is important to realize that depressed children who develop suicidal thoughts (medication-related or otherwise) should seek immediate medical attention.
Anti-psychotic medications - most commonly in a class known as "atypical antipsychotics", they seriously but rarely cause extrapyramidal symptoms including muscle rigidity, tremors and muscle tics. More commonly, these medications can cause longer term issues with weight gain, excessive appetite, high blood sugar and high cholesterol. Your medical provider will monitor your child's weight and will order lab work periodically to monitor blood sugar and cholesterol levels. Any significant weight gain is cause for concern and should be discussed with your provider.
It is also important to realize that children who are on two (or more) psychiatric medications are at higher risk for side effects. Safety issues, as well as periodically reassessing the need for medication in general, should be discussed with your medical provider.
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