Your Children's Health

By: Hansa Bhargava, MD

I saw an overweight 8 year old in my office not long ago who complained, “I’m too chubby!”  His mother told me she had been trying to adjust her family’s diet by cooking at home and not having junk food in the house. But she was frustrated because at school her son was eating school lunches made up of hot dogs, tater tots, fries and other foods full of empty calories.

As a pediatrician, I’ve heard this type of story several times. Many parents are struggling to serve kids nutritious meals despite having tight budgets and busy lives. They are trying to trade junk food for more vegetables. I applaud their efforts — 1/3 of our nation’s kids are overweight or obese. And more kids have diabetes than ever before. Eating well is such an important part of keeping kids from getting sick because they are overweight. And nutrition begins at home.

But school plays an important part in a child’s day too.  Kids are there for many hours – many eating, breakfast, lunch, and snacks there. School influences what kids eat, the calorie and nutrition content in their food.  And this is why I am excited about the new National Lunch Program.. Starting Oct 1, 2012, your child’s school may choose to enroll in this program. The goal — feed kids healthy, nutritious meals.

Here are some of the changes you could expect:

• Meals that include more vegetables, fruits and whole grains. Whole grains have a lot more nutrition, because they contain more fiber and nutrients.

• Limits on the total calorie count of the meals Offering skim or low fat milk instead of sugary drinks. This way kids get nutrient rich calories instead of empty calories or sugar.

As a mom of two 6-year-olds, I know how hard it is for parents to balance work, kids, homework, planning meals, and running a household. But in this crazy-busy juggle, we still need to make our family’s health a priority. So, as you work hard to serve up the best meals you can, at home and on the go, it’s encouraging to see that schools are making an effort, as well.

How do you feel about the lunch program? Do you think it will make a difference?

For more information on the new school lunches, click here.

By Roy Benaroch, MD

Adding fuel to the debate over corporal punishment, a large study published this summer has found that people who recall harsh physical punishment in childhood are more likely to suffer from mental illness as adults.

Researchers from Canada interviewed almost 35,000 adults, documenting their recollection of harsh physical punishment including slapping or hitting. Adults who recalled severe emotional or physical abuse or neglect were excluded. After adjusting for other factors, the study found that a history of physical punishment was associated with an increased risk of depression, anxiety disorders, and substance abuse. The average increased risk for these problems was about double that of adults who did not recall physical punishment.

The study has some limitations—it looked at adults’ memory of punishment, which may not be accurate. And studies like this cannot determine if physical punishment was the cause of the mental illness. Still, the large sample size and rigorous way that the adults were interviewed certainly supports a connection.

The American Academy of Pediatrics has stated that corporal punishment is not very effective, and can have harmful side effects. Though many parents continue to use spanking and other forms of physical discipline, this study adds to the evidence that hitting your child may not be the best way to teach your child to behave.

By Roy Benaroch, MD

We’ve known for years that over-the-counter cough remedies aren’t very effective, especially in children. Still, it sure would be nice to have some way to help coughing kids. A new study adds to the evidence supporting an older, safe remedy for children past 12 months of age: honey.

Researchers in Israel looked at 300 children from age 1-5 with ordinary coughs—coughs caused by viral respiratory colds. Some of the kids were given different preparations of honey, while others in a comparison group were given a syrup sweetened without honey. The families of children given a teaspoon of honey at bedtime were reported to have the best improvements in coughing. A previous study published in 2007 compared honey with dextromethorphan, the most common OTC cough remedy, and found that natural buckwheat honey was more effective than medicine for coughing.

Why would honey work? It’s soothing, tastes good, and may trigger increased salivation to lubricate the upper airway. It also contains antioxidants, vitamins, and chemicals called “flavenoids” that may have infection-fighting properties.

Honey is far safer than OTC cold and cough remedies, which do have side effects. However, honey should never been given to children less than one year of age because it can transmit botulism to young babies.

Some coughs, like those caused by asthma or lung disease, need to be treated with specific medicines. But most coughs in children are caused by viruses or “chest colds.” These will improve on their own and don’t need medicine—but it’s good to know that there’s a safe and effective remedy to help your child feel better while he’s fighting off a cough.

By Roy Benaroch, MD

With increasing rates of peanut and other food allergies, it’s good to see a study that’s found a way to potentially reverse this trend.

In a paper published this week, Danish researchers looked at about 62,000 mother-baby pairs. The families completed a food-frequency diary to determine how often peanuts or tree nuts were consumed during pregnancy. Then they looked at parents’ reports of asthma and allergy symptoms at 18 months and 7 years. The researchers found that increased peanut and tree nut consumption during pregnancy was correlated with decreased allergic problems in children.

Older advice had suggested that pregnant women avoid certain foods to help prevent allergy. In 2008, the AAP reversed this advice, publishing a review that determined there really wasn’t any good evidence to suggest that delaying or avoiding foods would help. Since then, further studies have actually pushed the pendulum the other way: earlier introduction of foods for pregnant women and babies may actually prevent allergies.

There are still some foods that pregnant women need to avoid, mostly to prevent infections and toxin exposures. But preventing allergy isn’t a valid reason to avoid anything. Of course, if mom is actually allergic herself, the food needs to be avoided.

The findings of this Danish study are only applicable to children without allergies. Kids who are allergic to foods like peanuts or tree nuts need to strictly avoid eating these items and follow their doctor’s advice on ways to safely retest or re-challenge children safely. Though we are learning that under certain controlled circumstances some exposures may help children outgrow allergy to egg or peanut, this needs to be done carefully and under supervision.

By Roy Benaroch, MD

In a reversal of their previous policy announced in March 2012, the FDA this past week  announced a ban on the chemical BPA in baby bottles and children’s drinking cups. Still, their spokesman says the chemical is safe, and it can continue to be used in other food packaging, including packaging for infant formula. And they’re still looking into it, and they may change their minds again. Confused?

BPA is a chemical commonly used in the manufacture of food containers and many other products. It’s gotten quite a bit of media attention over the past five years or so, as many people have become convinced that it could cause a number of health problems in adults and children. I’ve written about the issue before, pointing out that studies have been inconclusive and that it’s impossible to be 100% absolutely certain about the safety of things in our environment, including chemicals.

With BPA, several studies do hint at health problems. The most recent one (summarized here) looked at children who had had dental fillings made with BPA, and showed small but real differences in their behavior as they grew. Ironically, the BPA-produced fillings were probably chosen because some people are afraid of the older, mercury-containing silver amalgams (which in that same study showed no ill effects.) The authors of the study acknowledge that the differences in behavior are very small and unlikely to be noticed, but it is possible that the effects might be larger in some children than others.

Because of public concern, most manufacturers had already chosen to remove this chemical from their baby bottles and other products. So the “ban”, in fact, just tells companies to keep doing what they’ve decided to do.
Science can be slow, and often there isn’t a 100% clear answer. People, I think, can understand that. The FDA still claims that the weight of the evidence shows that BPA is safe. I’m not sure that their partial ban is going to help anyone feel more confident about that.

By Roy Benaroch, MD

Last week I wrote about staying safe at the big amusement parks. What about heading overseas to London for the 2012 Games? The CDC has released some health guidance to keep everyone safe while having a good time.

Make sure all of your routine vaccinations are up to date, especially vaccines to protect against measles (MMR) and pertussis (also called whooping cough, this is part of the DTaP and Tdap vaccines.) Unfortunately these diseases have made a big comeback, especially in Europe, where vaccination rates have fallen.

Think ahead about medical insurance — does your coverage extend to overseas? Consider buying travel insurance for coverage if health services are needed during travel.

Learn how to access emergency health services. In London, you don’t dial 911 — the emergency number there is 999 or 112. Wherever you travel, do your research ahead of time: know how to call, and whether your home cell phone will work.

Even in English-speaking countries, names may be different. In London, it’s not an Emergency Room or an Emergency Department. It’s an “Accident and Emergency Department,” usually abbreviated “A&E”. The CDC information page includes other words and phrases that are different in the United Kingdom.

Don’t let traffic surprise you. You may not realize it, but in the U.S. you’re used to looking left, then right, then left again before you cross a street. London traffic comes from the other direction! Make sure to look both ways every time, and remember that the closer traffic will be coming from your right side.

Consider registering ahead of time with the U.S. State Department’s Smart Traveler Enrollement program. By sharing your travel plans, you can make it easier to get assistance with medical or other emergencies while traveling abroad.

By Roy Benaroch, MD

Disney, Universal, Six Flags– huge places, huge crowds, and huge fun! Of course, there are dangers too, but a few simple steps can help keep your family safe so you can have great time without the worry.

If you’re visiting with young children, you’ll want to make sure that no one gets lost or separated. Consider wearing bright, matching shirts so you can spot each other in a crowd. Teach your children what to do if they can’t find a parent– they ought to stick together and stay where they are for a few minutes. If you don’t reappear, kids should find the closest park employee and ask for help. When you first get to a park, practice spotting employees and walking up to them to ask for help. Young children may not be able to memorize your mobile number, so it can be a good idea to write the number on their tummy with a sharpie. All they’ll have to do is lift up their shirt! Another good idea: take a photo of your kids when you get to the park, so if someone does stray you’ll already have a picture of them in their correct clothes to show to park employees.

Older children can safely explore on their own, but you ought to set up meeting places and times. Make sure phones are charged and ringers are turned up to maximum, and remind your children that they need to look at the time and check messages now and then!

For everyone: keep drinking plenty of fluids, and don’t forget your sunscreen. In a long day, sunscreen will have to be re-applied several times. It may be cooler and less busy in the evening, but in the summer there’s still plenty of sun in the late afternoon.

By Roy Benaroch, MD

A study published this week in the journal Pediatrics is good news for dog lovers everywhere. Babies growing up in homes with dogs get sick less often

Finnish researchers studied the families of about 400 babies over the first year of life, tracking their health status with weekly questionnaires. They found that babies growing up with dogs in the home were sick less often, needed fewer courses of antibiotics, and had fewer ear infections. Overall, babies with no dogs were reported as healthy about 65% of the time, compared to 73% for those living with one or more dogs. The presence of cats, on the other hand, made little difference.

The authors speculate that the protective effect of dogs could be because families in dog-oriented households tend to spend more time outdoors. Also, dogs tend to track around some dirt and bacteria, which may provide some protective effects. Other research has confirmed that early animal exposures can reduce the risk of allergic disorders in addition to the infectious illnesses studied in this report.

Healthy dog ownership does require some care from parents. As toddlers explore, they need to be taught how to approach a dog safety. Kids should know not to bother a dog that is sleeping or eating, and not to approach strange dogs outside without asking an adult first.

So give your dog an extra treat. In addition to chasing mice and barking at strangers, your family pooch can help keep your children healthy. That’s something to wag about!

By Roy Benaroch, MD

With the Supreme Court’s decision to uphold the central portions of the Patient Protection and Affordable Care Act (often called “Obamacare”), the legal struggles over the legislation are largely settled. It’s now time to focus on the implementation of this complex set of laws. State and federal administrators and lawmakers ought to focus on helping to make the law meet a few simple goals.

Lost in the recent headlines is the underlying issue, one with which I believe most Americans agree: there are significant problems with the delivery of health care in the United States. Access for many is restricted, and insurance companies have been able to hold all of the cards. By excluding preexisting conditions, insurance companies have been able to ensure that the people who most need health insurance may be been unable to get it. The biggest problem, though, is that health care is just too expensive. Premiums are huge. Whether paid directly by you or indirectly through your employer, someone is paying, big time, and it’s not clear at all that we’re getting good value for our money.

So what will the law do to solve these problems? Access to health insurance might improve, as the mandate for everyone to buy health insurance is paired with laws that disallow the exclusion of people with pre-existing conditions from health care plans. However, just having more people on insurance rolls won’t actually make it easier to see doctors, unless there are more doctors and offices and open hours and appointment slots. Some ways to do that would be to reduce the expense of a medical education, provide increased incentives to primary care physicians (that is, pay more), or provide alternative health care access through clinics or non-MD physician “extenders”. Providing access to insurance is good, but it isn’t the whole picture. In fact, unless something is done to increase the pool of health care providers, having more people jostling for the same number of appointments might actually make it harder to get in to see your doctor.

The health reform law, as it’s currently being discussed and implemented, doesn’t seem to do much to help control the cost of health care. There’s no provision to help address malpractice reform to reduce unnecessary “defensive medicine”, and there are no meaningful provisions to reduce wasteful ER visits or the use of unnecessarily expensive medicines or tests. Unless costs are controlled, more people with government-organized insurance will only bankrupt us that much sooner.

Implementation of health care reform will be a complex task, and it’s difficult to look ahead at the ramifications of this sweeping legislation. I urge lawmakers to keep a few, simple principles in mind. Access to affordable, quality care should be the goal of health care reform.

By Roy Benaroch, MD

Hypertension, or an elevated blood pressure, is far more common in adults than children. Still, it can occur at any age. And the younger the child, the more likely an elevated blood pressure could be from an important medical issue that needs to be addressed quickly.

A “normal” blood pressure in a child isn’t a single number. It depends on the child’s age, sex, and height, and it’s best to refer to a specific table to see what a healthy BP is for a specific child.

In children, the most common cause of an elevated BP is incorrect measuring technique. If a BP cuff is used that’s too small, the measured value will be artificially high. A muscular 14-year-old almost certainly needs an adult cuff, or even an “adult large” cuff. Assuming that the right cuff is used, it’s important to see if the BP is elevated in different circumstances by having the family check it at home or a fire station or drug store a few times. Keep in mind, though, that an elevated BP does need to be addressed one way or the other—its not something that ought to wait until next year’s check up.

Causes of a truly elevated BP in a child could include:

* Medications (including decongestants, ADD medicines, steroids, birth control pills, and others)

* Kidney disease

* Heart disease

* Obesity

* Sleep apnea

* Chronic pain or illness

The workup for a child with a consistently elevated BP usually includes a urinalysis and blood tests (to look for kidney disease and metabolic problems) and a kidney ultrasound. Sometimes a cardiac workup is also good idea. The younger the child, the more likely these tests are to reveal a specific underlying cause of elevated BP that needs to be addressed, and the more quick and aggressive the workup needs to be.

In adults, most hypertension is called “essential hypertension” or “primary hypertension”—that is, an elevated blood pressure that doesn’t really have a specific cause. This kind of hypertension leads to long-term issues with heart disease, stroke, and eye and kidney disease. We used to think this was only a disease of adults, but it’s clear that some teenagers already have this kind of chronic hypertension and ought to be treated the same way as adults to reduce their long-term health risks. Children and adults with primary hypertension should also be evaluated for other health risks that often go hand-in-hand with hypertension: obesity, diabetes, and elevated cholesterol. The “first line” therapy should include healthy eating and exercise habits, followed by medicines to lower blood pressure if necessary.

Parents of teens often think they grow up so fast—and in today’s world, that sometimes means that diseases of adults can start young. Blood pressure should be checked at least once a year in all kids down to age 3, and even in children below three with special risk factors. Too young? Maybe. But it won’t help to not look.