I discuss video games a lot when I see kids for well child visits. There are definitely positives and negatives about video games, and I think it is important to know what your kids are playing. I have three kids and a husband that I play games with at home. At our house, we have "game night" every Saturday night. I don't have the manual dexterity of my husband or stepson, but I can sing Journey songs on Rock Band 3 with the best of them :)
I read an article recently discussing Internet/video game addiction by Mike Rich, who runs the Center on Media and Child Health in Boston. This is a link to his website, which is pretty informative:
http://cmch.typepad.com/mediatrician
Tuesday, April 10, 2012
Thursday, March 22, 2012
Is Ground Beef Safe to Eat?
Much ado lately about "pink slime" - ground beef filler found in many brands of ground beef sold commercially. Here is the latest from CNN about chain grocery stores making the decision not to carry ground beef that contains fillers:
http://www.cnn.com/video/#/video/health/2012/03/21/exp-cohen-and-pink-slime-in-ground-beef.cnn
Many years ago, when mad cow disease was a concern, I stopped eating ground beef altogether. The last few years I admit I have slacked. I don't buy ground beef often at the store, and when I do, I tend to choose organic meat. However, my family eats out a fair amount and I admit a nicely done burger can be pretty tasty. The latest information on pink slime has me worried though - think I will stay away from ground beef again. With our children eating at school, and eating out on their own with friends, it makes me concerned about their consumption too.
Has anyone else out there changed their eating patterns based on what they are reading about ground beef? Staying informed makes you more educated about what you choose to eat, and that is a good thing.
http://www.cnn.com/video/#/video/health/2012/03/21/exp-cohen-and-pink-slime-in-ground-beef.cnn
Many years ago, when mad cow disease was a concern, I stopped eating ground beef altogether. The last few years I admit I have slacked. I don't buy ground beef often at the store, and when I do, I tend to choose organic meat. However, my family eats out a fair amount and I admit a nicely done burger can be pretty tasty. The latest information on pink slime has me worried though - think I will stay away from ground beef again. With our children eating at school, and eating out on their own with friends, it makes me concerned about their consumption too.
Has anyone else out there changed their eating patterns based on what they are reading about ground beef? Staying informed makes you more educated about what you choose to eat, and that is a good thing.
Wednesday, March 14, 2012
Allergy Treatment
It is the time of year that brings many people in with questions about allergies and the medications used to treat them. Here is the rundown on available treatments for seasonal allergies:
1. Daily antihistamines (brand names Claritin, Zyrtec, Allegra) - usually the first line treatment; all of these medications are available over the counter, can be given once a day, and usually do not cause sleepiness (unlike our old standby, Benadryl). The exception to this is Zyrtec, which can cause sedation in some children. I usually dose these medications in the evening before bed to minimize this side effect.
2. Steroid nasal spray (brand names Fluticasone, Flonase, Nasonex) - anti-inflammatory medication that blocks the body's allergic response to environmental allergens; the first choice of many doctors due to their potency and the rapid onset of relief of symptoms. I usually recommend these if patients have not gotten better with antihistamines or if parents want to avoid antihistamine side effects. The major side effects of steroid nasal sprays are nasal membrane dryness and nosebleeds. Steroid nasal sprays are prescription-only, so your child will need to be evaluated by his/her doctor to see if nasal spray would be beneficial. Your child would have to be able to tolerate a nasal spray - this is a drawback for some kids.
3. Mucinex - mucolytic medication that thins nasal mucus to decrease postnasal drip; also helps with cough associated with postnasal drip. I sometimes add this medicaiton for night-time cough associated with allergies.
4. Singulair/ class of medication called leukotriene inhibitors - originally developed as an asthma medication, decreases the inflammatory response in the airways to allergens. These medications are sometimes used as an adjunct to the above allergy medications. I find this most helpful for children who have BOTH allergies and asthma, since it treats both conditions. As an allergy medication alone, it is not as powerful at controlling symptoms as steroid nasal spray or antihistamines. These medications also have side effects including behavior/mood changes, so any use should be discussed with your child's pediatrician.
If allergy medications do not control the symptoms, consider making an appointment with an allergist for an evaluation and possible allergy testing.
1. Daily antihistamines (brand names Claritin, Zyrtec, Allegra) - usually the first line treatment; all of these medications are available over the counter, can be given once a day, and usually do not cause sleepiness (unlike our old standby, Benadryl). The exception to this is Zyrtec, which can cause sedation in some children. I usually dose these medications in the evening before bed to minimize this side effect.
2. Steroid nasal spray (brand names Fluticasone, Flonase, Nasonex) - anti-inflammatory medication that blocks the body's allergic response to environmental allergens; the first choice of many doctors due to their potency and the rapid onset of relief of symptoms. I usually recommend these if patients have not gotten better with antihistamines or if parents want to avoid antihistamine side effects. The major side effects of steroid nasal sprays are nasal membrane dryness and nosebleeds. Steroid nasal sprays are prescription-only, so your child will need to be evaluated by his/her doctor to see if nasal spray would be beneficial. Your child would have to be able to tolerate a nasal spray - this is a drawback for some kids.
3. Mucinex - mucolytic medication that thins nasal mucus to decrease postnasal drip; also helps with cough associated with postnasal drip. I sometimes add this medicaiton for night-time cough associated with allergies.
4. Singulair/ class of medication called leukotriene inhibitors - originally developed as an asthma medication, decreases the inflammatory response in the airways to allergens. These medications are sometimes used as an adjunct to the above allergy medications. I find this most helpful for children who have BOTH allergies and asthma, since it treats both conditions. As an allergy medication alone, it is not as powerful at controlling symptoms as steroid nasal spray or antihistamines. These medications also have side effects including behavior/mood changes, so any use should be discussed with your child's pediatrician.
If allergy medications do not control the symptoms, consider making an appointment with an allergist for an evaluation and possible allergy testing.
Thursday, February 23, 2012
Tips for Reading to Young Children
February is "Reading Month" at my daughter's preschool. They get stars for every book they "read" for the month and they get prizes at the end of the month when they have a special "Dr. Seuss" party. My daughter has decided she wants to get the most books on her list for her class. She is entertainingly competitive :)
In honor of reading month, here are some tips for reading to your young child:
1. If your child has a short attention span, try using your own words to describe what is going on in the book, rather than reading the text. Point to objects on the page to engage your child's interest. Early board books are "sing-songy" which also captivates their interest.
2. Be expressive. Adopt different voices for different characters. Children easily learn to imitate this when they are old enough to read for themselves.
3. Move your fingers around the page if there is movement going on in the story. Show them where the action is in the story.
4. Point out new objects so that your child hears new words and learns to associate them. When they are old enough, use "Show me the ..." to involve them.
5. With older children, ask them to tell you what THEY see in the story, ask things like "What is going on here?"
6. At 12-18 months, teach your child to turn pages. If they turn quickly (which often happens), revert to telling the story rather than reading the text.
7. I recently read this and it is so true: kids sometimes like reading time not for the books but for the bonding experience and cuddle time they get with their parents/caregivers. Just another way that reading to kids benefits us too :)
In honor of reading month, here are some tips for reading to your young child:
1. If your child has a short attention span, try using your own words to describe what is going on in the book, rather than reading the text. Point to objects on the page to engage your child's interest. Early board books are "sing-songy" which also captivates their interest.
2. Be expressive. Adopt different voices for different characters. Children easily learn to imitate this when they are old enough to read for themselves.
3. Move your fingers around the page if there is movement going on in the story. Show them where the action is in the story.
4. Point out new objects so that your child hears new words and learns to associate them. When they are old enough, use "Show me the ..." to involve them.
5. With older children, ask them to tell you what THEY see in the story, ask things like "What is going on here?"
6. At 12-18 months, teach your child to turn pages. If they turn quickly (which often happens), revert to telling the story rather than reading the text.
7. I recently read this and it is so true: kids sometimes like reading time not for the books but for the bonding experience and cuddle time they get with their parents/caregivers. Just another way that reading to kids benefits us too :)
Tuesday, February 14, 2012
Child Car Seat Recommendations
This has come up a lot at work lately. There are new recommendations about child car safety seats - you can find this published at www.nhtsa.gov.
INFANTS should be in a rear-facing car seat; most infant car seats are "bucket-style" and fit into a base which stays belted into your car LATCH system. Newly recommended: keeping your young child REAR-FACING until age 2, even after you switch to a convertible car seat. Be sure to check your manufacturer specifications - I know both Graco and Britax have weight and height recommendations on their websites. Your carseat should have a sticker on it with these listed. Many children reach the HEIGHT limit before they reach the WEIGHT limit. If they get close to the height limit or their head is obviously above the top of the car seat, it is time to buy a new seat.
CHILDREN 1-3 year old: keep rear-facing as long as possible, now preferably up until age 2. When your child reaches the height limit for your car seat, you can convert to a forward-facing car seat with a harness. A five-point or harness restraint is preferred.
CHILDREN 4-7 years old: Forward-facing car seat with a harness until the weight/height limit is reached. At that time, you can convert to a booster seat in the backseat. Most of the time, booster seats are recommended until a child reaches the height of 4'9".
CHILDREN 8-12 years old: Keep your child in a booster seat until he or she is big enough for a shoulder and lap belt to fit correctly on the body. The shoulder belt should lie snug across the shoulder and chest and not cross the neck or face. The lap belt should lie across the upper thighs and not across the stomach. Your child should remain in the back seat - it is safer there.
CHILDREN 12-13 and up (depending on size) can sit in the front passenger seat.
INFANTS should be in a rear-facing car seat; most infant car seats are "bucket-style" and fit into a base which stays belted into your car LATCH system. Newly recommended: keeping your young child REAR-FACING until age 2, even after you switch to a convertible car seat. Be sure to check your manufacturer specifications - I know both Graco and Britax have weight and height recommendations on their websites. Your carseat should have a sticker on it with these listed. Many children reach the HEIGHT limit before they reach the WEIGHT limit. If they get close to the height limit or their head is obviously above the top of the car seat, it is time to buy a new seat.
CHILDREN 1-3 year old: keep rear-facing as long as possible, now preferably up until age 2. When your child reaches the height limit for your car seat, you can convert to a forward-facing car seat with a harness. A five-point or harness restraint is preferred.
CHILDREN 4-7 years old: Forward-facing car seat with a harness until the weight/height limit is reached. At that time, you can convert to a booster seat in the backseat. Most of the time, booster seats are recommended until a child reaches the height of 4'9".
CHILDREN 8-12 years old: Keep your child in a booster seat until he or she is big enough for a shoulder and lap belt to fit correctly on the body. The shoulder belt should lie snug across the shoulder and chest and not cross the neck or face. The lap belt should lie across the upper thighs and not across the stomach. Your child should remain in the back seat - it is safer there.
CHILDREN 12-13 and up (depending on size) can sit in the front passenger seat.
Saturday, February 11, 2012
Why is High Fructose Corn Syrup Bad for You?
Everyone knows that obesity is a rising problem in the U.S. When counseling people on their diets, we commonly focus on eliminating extra calories, "empty calories" such as those found in sweetened beverages. Many beverages contain high fructose corn syrup (HFCS) - not just regular soda, but sweet tea, lemonade, fruit drinks, and even some sports beverages. In a NHANES study done from 1999-2004, it was found that US adults consumed 12% of their total daily energy intake from sweetened beverages. For adolescents and children, the numbers were 13% and 10% respectively. Those at higher risk for obesity amd cardiometabolic disease, minorities and those in lower socioeconomic groups, tend to consume the largest amounts of sugar-sweetened beverages. Aside from the actual number of extra calories one is ingesting, HFCS itself is thought to be dangerous to one's health.
HFCS is a corn-based sweetener which has been around since the early 1970s. It currently accounts for greater than 40% of the sweeteners added to foods and beverages. It is the sole sweetener in soft drinks and sodas in the U.S. It is a mix of fructose and glucose, is easily produced and, because it doesn't take much of it to sweeten a food, it doesn't take up much storage space. Additionally, it is relatively cheap -- hence why we find it in so many foods and drinks now.
The fructose in HFCS bypasses the regular metabolism of carbohydrates in the body and is immediately synthesized into fatty acids. What this means is that HFCS is rapidly converted into triglyceride and VLDL (blood fats). Triglycerides are quickly converted into adipose ((fatty tissue) which causes obesity. Fat is also deposited into the liver which, over time, can lead to fatty liver, insulin resistance and eventually, elevated blood cholesterol. Insulin resistance can lead one over time to develop Type II diabetes. Fructose also promotes the synthesis of uric acid, which can contribute to the development of high blood pressure. Fructose ALSO reduces our body's secretion of insulin which is necessary to process the sugar load that we just ingested. A blunted insulin response interferes with the "satiety signal" -- in other words, we don't feel full. Which, of course, leads us to ingest more calories. There is actual science to this -- studies show that adolescents who ingest 8 oz or more of non-diet soda daily ingest more total calories than their peers who drink non-sweetened beverages.
Those of us who drink diet soda shouldn't feel totally left out -- the caramel coloring in colas may increase insulin resistance and inflammation due to the caramelization process.
What does this all mean? We should all be more cognizant of what we are ingesting. If HFCS is one of the first ingredients listed on a food label, we probably shouldn't be eating that. The biggest culprits are sweetened soda and sweetened breakfast cereals. But HFCS is found in lots of other things too - fruit juices, pancake syrup, fruit-flavored yogurt, ketchup, canned pasta sauce and soups, canned fruits.
Limiting processed foods is good, but reading labels is a good life-long habit which will benefit your health. You can find canned fruit and applesauce without HFCS - sugar, brown sugar and honey are also used as sweeteners. You can buy organic ketchup which doesn't have HFCS and use pure maple syrup instead of the heavily processed and cheaper varieties. Read the labels of breakfast cereals and pick those that don't contain HFCS. Thankfully, most grocery stores have an increasing number of all natural and organic options. Of course, eating more whole fruits and vegetables will be better for you than relying on processed foods.
HFCS is a corn-based sweetener which has been around since the early 1970s. It currently accounts for greater than 40% of the sweeteners added to foods and beverages. It is the sole sweetener in soft drinks and sodas in the U.S. It is a mix of fructose and glucose, is easily produced and, because it doesn't take much of it to sweeten a food, it doesn't take up much storage space. Additionally, it is relatively cheap -- hence why we find it in so many foods and drinks now.
The fructose in HFCS bypasses the regular metabolism of carbohydrates in the body and is immediately synthesized into fatty acids. What this means is that HFCS is rapidly converted into triglyceride and VLDL (blood fats). Triglycerides are quickly converted into adipose ((fatty tissue) which causes obesity. Fat is also deposited into the liver which, over time, can lead to fatty liver, insulin resistance and eventually, elevated blood cholesterol. Insulin resistance can lead one over time to develop Type II diabetes. Fructose also promotes the synthesis of uric acid, which can contribute to the development of high blood pressure. Fructose ALSO reduces our body's secretion of insulin which is necessary to process the sugar load that we just ingested. A blunted insulin response interferes with the "satiety signal" -- in other words, we don't feel full. Which, of course, leads us to ingest more calories. There is actual science to this -- studies show that adolescents who ingest 8 oz or more of non-diet soda daily ingest more total calories than their peers who drink non-sweetened beverages.
Those of us who drink diet soda shouldn't feel totally left out -- the caramel coloring in colas may increase insulin resistance and inflammation due to the caramelization process.
What does this all mean? We should all be more cognizant of what we are ingesting. If HFCS is one of the first ingredients listed on a food label, we probably shouldn't be eating that. The biggest culprits are sweetened soda and sweetened breakfast cereals. But HFCS is found in lots of other things too - fruit juices, pancake syrup, fruit-flavored yogurt, ketchup, canned pasta sauce and soups, canned fruits.
Limiting processed foods is good, but reading labels is a good life-long habit which will benefit your health. You can find canned fruit and applesauce without HFCS - sugar, brown sugar and honey are also used as sweeteners. You can buy organic ketchup which doesn't have HFCS and use pure maple syrup instead of the heavily processed and cheaper varieties. Read the labels of breakfast cereals and pick those that don't contain HFCS. Thankfully, most grocery stores have an increasing number of all natural and organic options. Of course, eating more whole fruits and vegetables will be better for you than relying on processed foods.
Thursday, January 26, 2012
Is Organic Food Better For You?
Many patients ask me about buying organic foods, and whether they should buy organic. I tend to buy organic foods for my family whenever possible, and I do recommend it for certain foods. Here is the lowdown: Organic foods have been shown to be lower in pesticide residue, as well as more free from additives. When you are shopping for milk and meat, buying organic means you are not exposing yourself (and your kids) to unnecessary antibiotics and growth hormones. Read labels carefully though - packaging that says that the product is "all natural" doesn't mean that the animals weren't given these drugs.
The "dirty dozen" foods that were highest in pesticide residue in 2011 were: peaches, apples, bell peppers, celery, nectarines, lettuce/kale/spinach, blueberries (frozen blueberries are a good option if you can't find organic - my family loves Wyman's), strawberries, beef, eggs and milk. Potatoes can be higher in pesticide residue, but sweet potatoes are not, and have more nutrients also. Surprisingly, coffee can have pesticide residue - in addition to organic coffees, you can also look for "fair trade" and "shade grown" varieties which have less pesticides and are more "bird-friendly".
The "clean 15" list of the foods lowest in pesticide residue includes onions, sweet corn, pineapples, mango, kiwi, asparagus, eggplant, domestic cantelope, watermelon and grapefruit.
In addition to trying to find organic produce and meats, I am also a strong advocate of farmers' markets where you can buy locally grown produce. My local farmers' market also sells sausage, beef and buffalo which is locally grown and harvested. A good resource for buying local organics is LocalHarvest.org.
Update 1/20/15:
The "dirty dozen" list gets updated periodically, and I have seen mention lately of a pesticide called chlorpyrifos, a particularly nasty substance sometimes used on crops. The top five sources of produce contamination with this pesticide are: grapes, apples, peaches (which includes nectarines and plums), tomatoes and, in addition, dairy/milk products from nearby farms. As mentioned before, here is a list to concentrate on when trying to shop organic.
The "dirty dozen" foods that were highest in pesticide residue in 2011 were: peaches, apples, bell peppers, celery, nectarines, lettuce/kale/spinach, blueberries (frozen blueberries are a good option if you can't find organic - my family loves Wyman's), strawberries, beef, eggs and milk. Potatoes can be higher in pesticide residue, but sweet potatoes are not, and have more nutrients also. Surprisingly, coffee can have pesticide residue - in addition to organic coffees, you can also look for "fair trade" and "shade grown" varieties which have less pesticides and are more "bird-friendly".
The "clean 15" list of the foods lowest in pesticide residue includes onions, sweet corn, pineapples, mango, kiwi, asparagus, eggplant, domestic cantelope, watermelon and grapefruit.
In addition to trying to find organic produce and meats, I am also a strong advocate of farmers' markets where you can buy locally grown produce. My local farmers' market also sells sausage, beef and buffalo which is locally grown and harvested. A good resource for buying local organics is LocalHarvest.org.
Update 1/20/15:
The "dirty dozen" list gets updated periodically, and I have seen mention lately of a pesticide called chlorpyrifos, a particularly nasty substance sometimes used on crops. The top five sources of produce contamination with this pesticide are: grapes, apples, peaches (which includes nectarines and plums), tomatoes and, in addition, dairy/milk products from nearby farms. As mentioned before, here is a list to concentrate on when trying to shop organic.
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