H1N1 is here. What you need to know.

H1N1 is here. The last 2 weeks the office has been swamped with children and adolescents with high fevers anf flu like symptoms. Many schools have been hit hard with teacher and student absenteeism.

This is not an unusual scenario for the months of January and February. But, it is only October, so it is too early for the typical seasonal influenza season. What we are seeing in local populations is what we suspect to be H1N1 flu.

Pediatricians are getting calls from frantic parents worried about how H1N1 might affect their children.

What they need to know about H1N1 is the following:

1.) if your child is ill, seek medical care early in the illness.

2.) Talk to your doctor about the H1N1 vaccine and who is eligible to get it.

3.) Check the CDC website for the most accurate details on H1N1.

Many parents have healthy chidlren and dont want them to get sick.

Some tips to prevent illness include:

1.) washing hands with soap and warm water

2.) using hand sanitizer if you cannot wash your hands

3.) disinfect surfaces that have multiple people using it

4.) and keep your kids out of school if they have fevers and flu like symptoms

Vegetarian Meals

Most people think that a vegetarian diet must be boring. They know and understand that a vegetarian diet is much better for the environment, but they cant imagine being full on greens.

They are sadly missing out.

So how do vegetarians survive?

1.) They cook with lots of spices, turmeric, cinnamon, cloves, coriander- all known to have health benefits of their own.

2.) Venture out: try and a new cuisine: Burmese food, Indian food, and Thai food all have numerous options

3.) Try your local farmers market, there is always a new vegetable in season, interesting to try. Saute most with onions or garlic and you have a flavor full dish.

4.) Add lentils, tofu and beans to any dish to make it your meals hearty. Dont think that all the lentils that are available are canned. Try some whole mung beans, mung noodles, garbanzo beans or massor dal to make a new tasty dish.

5.) Get creative: barbeque corn, scallion, red peppers, tofu and season with spices for a tasty meal.

Getting vegetables into your teenagers meals.

A recent study published by the CDC demonstrates that less than 10% of teenagers eat their recommended daily intake of fruits and vegetables.

That is no surprise considering that school lunches are rich in meat and dairy,but and deficient in traditional fresh fruits and vegetables.

That said, how do parents and teen go about incorporating more fruits and vegetables into their diet?

1.) Eat more meals together: if you have a family meal at least once a day, then you know what you your children are eating.

2.) Include your teen in meal preparation: go shopping with them and encourage them to pick one new recipe with a new vegetable once a week.

3.) Make nutritious smoothies or shakes for breakfast with yogurt, soy milk and fresh fruits for a quick meal.

4.) Hide vegetables in pizza sauce, pasta sauce and even homemade pancakes.

5.) Try and new vegetable once a week. You and your teen may be surprised.

Taxing Soda to prevent obesity?

Obesity has become the most important public health initiative since cigarette smoking. And like cigarette smoking, The New England Journal of Medicine (NEJM)'s most recent health policy report suggests taxing soda and sugary sweetened beverages. Soda is linked to increased obesity. The NEJM report cites studies which link sugar sweetened beverages to obesity. Because of that, the NEJM report suggests that taxation could decrease soda consumption and in turn, could reduce obesity.

The proponents for taxation on soda and similar beverages assert that this initiative, like the tax on cigarette smoking, will decrease soda and sugary beverage consumption and generate cash.The NEJM reports: "A national tax of 1 cent per ounce on sugar-sweetened beverages would raise $14.9 billion in the first year alone. " The plan for those dollars would then be to put them back into public health initiatives to prevent and treat obesity.

Critics to taxation argue that it is the poor who will be paying the large portion of taxes for these beverages. They also argue that if we start levying taxes on food items such as soda, why not fast food and junk foods which are linked to obesity as well. And will taxation on one item really lead to a decrease in obesity?

Regardless of your thoughts around taxation of soda and sugary beverages it is a fact that obesity has large economic costs. Hospitalizations due to childhood obesity have increased and costs related to that have near doubled in just a few years as documented by Health Affairs. Health care and lost productivity due to obesity cost California $41.2 billion in 2006. California Controller John Chiang estimates "the economic cost to California of adults who are obese, overweight and physically inactive is equivalent to more than a third of the state's total budget." So even if you are not obese, overweight or unhealthy, you are paying for someone who is.

Pediatricians do inform their patients about the risks of soda consumption. Unfortunately, soda and similar beverages are inexpensive and easily accessible. Our American cultural acceptance of soda and sugary sweetened beverages plays a role in the excess consumption of these beverages. Before reading the NEJM report, I was reluctant to consider taxing my patients and their parents, because in these hard economic times, every penny counts. However, my goal is to keep my patients healthy. And despite my multiple discussions with families on nutrition and exercise, I rarely see measurable progress. This is heart breaking for me, because I understand the medical challenges related to obesity which including heart disease and diabetes. So, if taxation is the one way that these kids will decrease their consumption then I believe it is worth considering.

Are School Lunches Making the Grade?

National School Lunch Program, Making the Grade?
Valerie came to see me with her three obese children. She knew her children were overweight, but she felt stuck. Despite working 40 hours per week, Valerie cooked healthy home-made dinners. Her kids were active despite her long work schedule. So Valerie relied on the schools to provide healthy lunches for her kids. Unfortunately, school lunches are not healthy and are contributing to obesity nationwide. This year Congress will be deciding what our kids eat at school. Parents like Valerie need to talk to Congress about changing these school lunches now.

I recently met with Congressman Miller's office to discuss whole fresh foods as the cornerstone of school meals. Currently, a weekly school lunch menu at a Vallejo public school includes the following entrees:chicken ring things, Reduced fat grilled cheese on whole grain stix ,turkey patty on a bun, hot dog bun or taco pocket , honey BBQ chicken nuggets with rice, or extreme bean & cheese burrito, wedge pepperoni pizza. On a daily basis the school serves milk, juice, a green salad and a fruit cup with other sides.
Sound healthy? It is not. Instead it is like a menu at the mall's food court, and Valerie's kids, and maybe yours, are eating this daily. How could Congress assume that this is healthy? Did they forget to check in with the US Department of Agriculture which educates us with the food pyramid? The USDA's food pyramid schema emphasizes meals where fruits,vegetables and grains are take up most of a plate of food while meat, dairy and sweets have very little room on the plate. Obviously, this is the reverse of a school lunch menu.These are hard economic times and school lunch issues can easily be forgotten.
But how we can we stand by and let our children eat food that is more chemicals than actual food? By offering the current options for school lunches, Congress is sitting idly by giving the children obesity. This will lead to and eariler onset of diseases like high blood pressure and diabetes.

So how do the schools decide what to feed our children? The Child Nutrition Act is the law that gives us the National Schools Lunch Program(NSLP). They decide what food items (broccoli vs meat) are provided to schools through commodities (inexpensive subsidized foods). To participate in the NSLP, schools must create menus which provide the USDA's nutritional requirements. This seems logical. However, schools are given a flexible method by which to "count" a serving of fruit or vegetable. Based on their guidelines, tomato paste can "count" as a serving of a vegetable in a days diet. Crazy.

Schools can count 100% fruit juice as nutritionally equaivalent to a serving of fruit. The American Academy of Pediatrics policy statement on juice includes this:"It is important to encourage consumption of the whole fruit for the benefit of fiber intake. Excessive juice consumption... may contribute to the development of obesity." Once the juice is processed it leaves sugar and water. Not healthy.

Many parents feel that at least their kids get their protein servings with school lunches. However, the meat the students receive is processed and has an excess of fat and salt to enhance taste. Schools provide more than the necessary servings of meat and dairy because they are inexpensive. Parents like Valerie are struggling with the work- life balance, making ends meet and the challenge of keeping their kids eating healthy. This is made more difficult because the school lunches are so grossly unhealthy.
So why are our children being served specifically excess meat and dairy instead of vegetables?
The Physicians Committee for Responsible Medicine estimates that "in 2005, the federal government purchased more than $385 million of beef and cheese for food assistance—most notably school meals, contrasted with about $50 million for fresh fruits and vegetables." Vegetables were given only 13% of the total subsidies.

This year congress will be voting on the re-authorization of the Child Nutrition Act. The law as last signed in 2004.The funds allocated to meat and dairy were not proportional to what the USDA recommends a typical plate of food should look like. That needs to change and it must change now. Parents must stop the obesity epidemic by talking to Congress.The first step would be revamping the Child Nutrition Act by offering increased subsidizes for fruits and vegetables. Tipping the scales so that the federal subsidies look more like a proportional relationship to the food pyramid.
If we dont do anything now, we are only painting a picture of poor health for our kids translating into larger health care costs for our society. Regardless of political preference, it makes sense to revamp the NSLP.
Talk to your congressperson about getting the school lunches real fresh foods.

Top 6 Kid Friendly Places in the Bay Area

We are lucky to have access to great parks and great weather in Northern California.
Here is a list of 6 child friendly places to explore in the Bay Area:
1.) Lake Anza--nice lake with sand hidden in Tilden Park
2.) Mocha- love art? this is art in the making for kids!
3.) Ardenwood farms- see a train, check out the animals.
4.) Roaring Camp Railroads- choo choo
5.) Oakland Zoo- great for kids and adults of all ages
6.) Lindsay Wildlife Museum- humane habitat for injured animals.

Understanding H1N1!

August is when kids and parents are preparing for the beginning of the new school year. Families are busy buying new gear for school, shuttling kids to sports try- outs and annual school exams.
For pediatricians, back to school is also a time when we talk about the upcoming flu season and flu shots with families.
Parent have many questions about the flu, here are the top 5 most important things to understand about swine flu.
1.) Who is at risk for H1N1 (swine flu)?
High risk individuals for H1N1 include pregnant women, and those with other chronic medical conditions including diabetes, heart disease, asthma and kidney disease.
Vaccines are assumed to become available in October. The CDC currently is advising vaccination for those who are at greatest risk for H1N1 including the following:
1.)pregnant women, 2.)people who live with or care for children younger than 6 months of age, 3.)health care and emergency medical services personnel, 4.) persons between the ages of 6 months through 24 years of age, and people from ages 25 through 64 years who are at higher risk for novel H1N1 because of chronic health disorders including diabetes, asthma, heart and kidney disease.
2.) Do I need the H1N1 vaccine if I get the seasonal flu vaccine.Yes. The H1N1 vaccine is to be given in conjunction with the seasonal flu vaccine. They can be administered on the same day.
3.) What are the symtpoms of H1N1?They symtopms are similiar to seasonal flu and include, fever, cough, sore throat, chills, faitgue. Some people have reported vomiting and diarrhea also.swine flu symptoms are simliar to regualr
4.) How is H1N1 (swine flu) different from seasonal flu?it affects more people less than age 25 than the older population and most individuals with serious complications were between 25-64 years old. Seasonal flu generally causes more seroious complications in the population greater than 65 years.
5.) Who needs tamiflu, the anti-retroviral medication?The CDC recommends it only for those kids who are at high risk for severe complications or those with severe disease. Not for those with mild H1N1.

Obama's Speech Speech

Over the last few days there has been much said about President Obama's school speech delivered today.
Many concerned parents and citizens argue that having children in school listen to his speech is tantamount to propaganda. Advocates argue that the President is just trying to inspire the children.
As a health care advocate, I see kids in the office who can't name the vice president of the U.S. They are not involved in politics and cannot tell you what is going on in the world politically.
If parents choose to ban their children from listening to a speech, how can we expect these children to grow into adults engaged in their communities welfare?
Like him or not, our president is reaching out to our children. If parents do not like his message to their kids, then it is imperative upon them to have a dialoge with their kids about what they consider an better alternative to his message.
What does listening to the President of the U.S. do for the kids?
Firstly and most importantly it provides an opportunity to the children to be curious and to take an interest in something greater than their own personal needs. Listening to their President may inspire them to seek ways to change the system they don't like or get more involved with a system they do like. It may spark discussions with teachers and peers, allowing them to open themselves to greater possibilities. Without the option to hear the President, how can children be involved in their future, their country and ultimately their health.

Firework safety guide

For many families fireworks are as much a part of fourth of July as the parades, picnicking and food.

However, many states have banned the personal use of fireworks. Individual states have different laws, California law prohibits the use of most personal fireworks making exception for a few types of personal fireworks.

However, the only advice for firework safety is don't do it.

This phrase deserves repeating "don't do it". Fireworks are dangerous.

Why? Fireworks pose the obvious fire hazard which has tremendous cost related to fire damages and the unaccounted environmental cost. Injuries related to firework usage top the list of problems. The national council on firework safety reports that the Consumer Product and Safety Commission estimates that 9,600 people were treated for fireworks-related injuries in 2004. The National Council also estimates that approximately 30% of these injuries occur with illegal or homemade fireworks.

And who suffers the most injuries from these fireworks? The American Academy of Pediatrics reports that in past years over 45 % of injuries occur in children under 15 years. These kids suffer with burns to the eyes, hands and face.

Many adults remember growing up using sparklers with fond memories. The American Academy of Pediatrics reports that over 2/3 of sparkler injuries were to kids under 5 years. Most parents don't realize that the sparklers can reach temperatures of 1000 degrees Fahrenheit at the tip and can cause deep burns. Many parents think it is okay to use fireworks labeled "safe". It is important to remember that every type of consumer firework has been associated with serious injury or death.

So what is safe?

Watch a free firework show.

Here are some options in and around San Francisco:

1.) Fisherman's Wharf

2.) Berkeley Marina

3.) Concord Downtown

4.) All other Bay Area

Get Outside

Summer is upon us. School is out and the kids are home. With 30% of our children obese it is important to remember to get your children off the couch out into the fresh air. Even if your child is not obese, your child is in school all year, now is the time to take advantage of the weather and get them breathing the fresh air. In these economic times it may be difficult to find things to do which are educational, fun, outdoors and budget friendly. Here are some great places to take kids of all ages in the Bay Area. If you don't live in the Bay Area check your local mother's group, the local paper or ask another mom for some good ideas.

1.) Pick your own fruits! http://www.harvest4you.com/ Pick fruits with your kids! Let them learn about where their food comes from. They will enjoy it more. Then go home and cook with them.

2.) Ardenwood Farms http://www.ebparks.org/parks/ardenwood

3.) Hiking with the Kids http://www.trails.com/activity.aspx?area=15004

4.) Picnic in the park can't find time to go anywhere or have no budget for travel expenses: a picnic in the park always brings families together: bring a frisbee, bring some balls, learn how to juggle, blow bubbles, or bring a water squirt gun. But go outside!

Parental Refusal of Vaccines, are your kids safe?

You and your newborn daughter arrive to pick up your son from school. You walk into your child's school and learn that there has been an outbreak of whooping cough. You decide not to worry because your son received his vaccinations. But wait, what about your newborn girl?

Many parents feel safe from vaccine-preventable diseases like whopping cough and measles. That feeling of safety is partly because the public health initiatives to vaccinate children had been successful. In the past, most children remained unvaccinated only for medical or religious reasons. Currently, anti-vaccine advocates are dominating the news with flashy celebrities  and their misinformation on vaccine safety. That has left many parents confused about vaccines. Due to this, many parents have chosen not to vaccinate leaving many communities and schools exposed to preventable disease.

An article by the New England Journal of Medicine cites that parents in over 48 states can choose not to vaccinate their kids for any non medical reason. Did I emphasize, any non-medical reason?  The same New England Journal of Medicine article states "Major reasons for vaccine refusal in the United States are parental perceptions and concerns about vaccine safety and a low level of concern about the risk of many vaccine-preventable disease(s)." 

Parents of unvaccinated children assume that their children are safe from disease. As a pediatrician, and a mother, it seems incredible that their assumption is that whooping cough is safer than the vaccine.  These parents rely on herd immunity , the likelihood that your vaccinated children will not be ill and therefore will not pass disease along to their unvaccinated children. 

But are these unvaccinated children really safe from disease? A recent study in the June 2009 Pediatrics journal  demonstrated that children who were not vaccinated for whooping cough are 23 times more likely than the vaccinated children to get the disease.  The herd immunity works only if the entire herd is vaccinated. If you have more people in the community choosing not vaccinate the concept no longer applies. So, contrary to those parents beliefs, unvaccinated children are more likely to get whooping cough.

Parents of vaccinated children may think that their children are safe from these diseases. However, in the case of an illness such as whopping cough, the vaccines immunity can wane with time or the vaccine can fail to cause immunity. Enter an unvaccinated child with whooping cough in a large school and vaccinated children can be affected also. Now bring home a new baby brother or sister,  a grandparent or an immunosurpressed individual and the  entire community is affected with severe disease . The same New England Journal of Medicine article  states "Vaccine refusal not only increases the individual risk of disease but also increases the risk for the whole community." Recently in the US , we are experiencing the largest measles outbreaks in years partially due to the increased number of unvaccinated children. 

As a parent, it seems unfair that another parents decision not to vaccinate can have harmful consequences for my community and my family. The question many physicians and parents are asking is, does a parent have a right to refuse a vaccine for a non-medical reason?   As a parent, I do believe parents should have the right to choose for their children. However,  that right to opt out of vaccination process should come with disease and vaccine education. I will repeat myself here: the consequences of a single parents decision not to vaccinate can affect entire communities and cost innocent people their lives.  The same NEJM  study describes a proposed law in Arkansas which would  "suggest that parents seeking non medical exemptions be provided with counseling on the hazards of refusing vaccination."

Parents need to stand together to protect our children and communities. 

 

When Mommy and Baby Are Ill

Help!

As recently as yesterday, I felt horrible. Vomiting, diarrhea, and all the rest of it. Gross I know, but you get the picture.

I was weak and tired, wanting to sleep, sleep all day. Pre-baby, no problem, I would call in sick to work and then rest became my drug of choice.

Since the birth of my daughter all of that has changed.  I am ill this week and  so is my little girl. Trying to juggle a regular day with baby,home and work is hard enough. But when my daughter is ill, the neediness is exponentially increased. Add to that my run down immune system. I felt like I was drowning, with no energy to fight back to the top.

How, how does anyone do it? Work, get sick, take care of yourself, and your child while baby daddy ploughs away at work. I am not sure there are any good answers to that one, except, get help fast from anyone and everyone.

Here are some of my suggestions to surviving your families illnesses:

1.) make your doctor's visit early on.

2.) take your medicine, (especially if it is sleep)

3.) have a back up plan ; someone to help you, a friend, neighbor, relative or a babysitter.  If you cant get a sitter, find another mommy, have a barter "illness" system worked out. She looks after your kid while you are ill and you look after hers the next time.

4.) take shortcuts. I am not one to take a shortcut to most things, must be the medical training. But if there is anytime to take shortcuts now is it!

5.)have frozen food ready for your kid, go online to get groceries, ask a friend to run an emergent errand. 

6.)and occasionally, if it is really bad, call in sick to work or ask your spouse to.

A-typical day

A-typical day

A close friend of mine is 8 months pregnant. In her pre-pregnant life, she was and is an ambitious, witty professional.  She is not in the world of health care. And she is scared ****less about what comes after the pregnancy. Just like I am nervous about my 15 month old daughter's impending adolescence.

My friend wanted to know what motherhood was like. I could not give her just one answer. I could only tell her about my greatest challenge. The work and home life balancing act.

When I was pregnant, I pressed my supervisors to grant me the extended extended 6 month maternity leave. You know the kind that is only available in Australia. I felt so lucky when they said yes! The first 5 months of my daughter's life I knew she benefited greatly from my being at home. After all the griping I did about the difficulty of breastfeeding, I stuck with it, she and I were bonded and she was thankfully happy and healthy. But really, it took me awhile to realize that it was me who needed to be home with her. 

I needed to be the one person who knew her the best. She may have needed me for sustenance, but I needed her for so much more. Early in the morning my husband would bring her into our room, and despite my chronic exhaustion, when she looked at me with a smile of recognition and sounds gushing from her mouth, I became silly putty. Even now. No matter how tired I was, I was as in love.

Time just flew by. She was one month old and then five months old. With all the sleepless nights, I am at a loss for which month she developed which skill. And I'm supposed to be a pediatrician. 

But, the 5th month something changed in me. I don't know when it hit me exactly. I think it was gradual, but it hit me hard. I needed, I had to go back to work. The incessant routine, which I loved: nursing, burping, changing, napping, playing and then starting over was great, but I needed more. 

Before my daughter was born I decided that I would be back at work at 6 months. So I was only a month away. I was excited to get back to work, be a part of an adult world and return to my professional persona. However, I knew that I had learned so much while staying home and I now loved now so much more.  Thinking all of this made feel guilty.

How could I be excited about going back to work. What about my daughter's well being? But what about my needs? This was my ongoing mental ping pong. 

The first day came. With all of the physical preparation of training the babysitter I did not feel any less stressed out. Add to that, my daughter did not sleep at all the night before my first day back at work. It didn't matter though, I was up until midnight also, wondering if after 6 months of maternity leave I would remember how to practice medicine.  Morning came, and leaving was not easy. I can usually separate emotions enough to keep going, a trait most doctors learn in medical school. But today, this time, I could not. I called and checked on her every hour. Asked about every feeding, nap, pee and poo. I was even thinking of her between diagnosing a child with appendicitis and telling a mother her child had asthma. 

My daughter is now 15 months old. She still misses and wants to be with mostly just me. But life for me is the art of balance, and I am hoping the balance of mommy at work a few days and mommy at home a few days is healthy for both of us.

Nutrition-ista

I hate cooking. I mean I really hate cooking. Growing up, I would tell my mom I wanted to become a doctor so I would not have to cook. (as if doctoring and cooking were mutually exclusive.)  My mom would try to make cooking fun and interesting but I could not be convinced. Many meals and years later, I still hate cooking.

Strangely, however, I love the science of nutrition. Nutrition has been a passion of mine since I was 10 years old.  I have always been a curious investigator about the health consequences of food. As a teenager I remember reading food labels (the few items that had them). As an adult I bought into the low fat diet. However, after doing my own investigations, I have shifted my views.

So instead of a low fat or low carb or low-anything diet, I like to eat foods that are whole and fresh (verus processed or preserved).  Like fresh fruits and vegetables. I limit dairy,eggs and meat. I avoid fried and sugary foods. (The sugary part is really hard for me, I have sweet tooth). 

 

Many people wonder what types of foods I choose for my daughter. With my passion for nutrition and dislike for cooking I try and keep it simple.

Here are the top 4 on my list. 

1.) Avocados are an amazing source of nutrients. More importantly, they are a good source of healthy fats.

2.) Walnuts , flax seed , and almonds are yummy. A handful of nuts a day with a fruit can keep you satiated longer than eating the fruit alone. And the nuts are packed with omega 3  

     fatty acids to help prevent heart disease.

3.) Blueberries , raspberries, and strawberries are all packed with antioxidants.

4.) Amaranth its a grain, my daughter eats it as a cereal with cinnamon and ground nuts and berries. She loves it. It is packed with iron and has a low glycemic load.

It is hard to eat fresh foods without staying out of the kitchen. So I do end up cooking.

The most important to do's on the cooking healthy list include:

• Prepare fresh foods daily (avoid things in boxes or packages). I know I said this, but it is so important it deserves to be repeated.
• Prepare your foods in a healthy way.  For example, french fries are unhealthy because they are deep fried. Baked potatoes carry a high glycemic load. The best option is to steam the potato.
• In general, try and cook at temperatures less than 350 degrees to help maintain the nutritional value of the food.
• Use olive oil for sauteing at low temperatures. Use coconut to almond oils for deep frying as they do not turn into free radicals at high heats.
• Mix it up, try adding new ingredients to an old recipe to give it a fresh flavor.
• Cook with flavor. add garlic, cinnamon, ginger, turmeric. These are all good for you with numerous health benefits.

In short, food is medicine, and you are what you eat. So what do you want to be today?

   

 

Parenting from a Teen's Perspective?

An interesting twist indeed.

Vanessa Van Petten and her crew of teen writers gets it right with her blog Radical Parenting.

She offers parents an inside look at how teens are thinking about life. To make it useful, she offers parents practical advice on how to handle difficult situations. 

Some of my favorites include:

1.) Teacup Parenting: Is your Child Too Fragile? :

Vanessa's view on the 4 types of kids she sees and their pitfalls and strengths

2.) 10 Rules Kids Wished Their Parents Lived By

Vanessa and her Teen Team create a list of radical parenting principles they wish parents could hear

3.) Cotton Candy Friends

How social networking, texting, IMing and the Internet are changing teen's friendships

My favorite blog is Cotton Candy Friends. It offers an inside peak to your teenagers reality.

Happy Parenting.

Sexting= teens, sex and pictures

Sexting= Teens, Sex and Pictures

Recently, I had a 15 year-old girl in my office. We'll call her Emma. She was sexting. 

She was sexting many young men at the same time.

Never heard the term "sexting"? You are not alone.

Sexting is sending sexually explicit pictures (of yourself or another) from your computer or cell phone, to another.

Teens are doing it all the time. A study done by the National Campaign to prevent teen and unwanted pregnancy shows that approximately 20% of teens send sexually explicit pictures. There are some experts who doubt that number. But after having asked my patients over the last month, I can say that most of my teens knew someone who had been "sexting".

Why do teens send nude or partially nude pictures of themselves? The national campaign to prevent teen and unwanted pregnancy research indicates that some teens send pictures to people they know online (have never met), while other send them to people they want to hook up with. Some teens send them to boyfriends or girlfriends and end up with complications, as is the case of one young girl in Cincinnati. This high school senior sent a picture to her boyfriend. He shared that picture with other friends. Embarrassed and possibly depressed, she ultimately committed suicide.

The developmental stages of adolescence include concerns with body image and the very real influence of peers. Certainly, like alcohol and drugs, experimentation is another stage of adolescence. If one teen is doing it another can be pressured to do the same. Even if it were something they would not ordinarily do. The study above states that approximately 40% of teens feel pressured to send these pictures.

Unfortunately, in the wrong hands, the pictures can spread like a bad case of the flu. From one teen to another, from one school to another. After the pictures are sent and re-sent, the photographed child can be left exposed often evolving into a victim of bullying and cyberbullying.

Cyberbullying is anew phenomenon that has risen with the advances in technology. From a 2007 report the CDC estimates that cyberbulying is still the least common form of bullying. Those number are likely to increase with technology rapidly becoming accessible to the masses. The repercussions of cyberbullying include low self esteem, difficulty at school and ultimately depression.

Legal ramifications have been a newsworthy complication of sexting. Strictly speaking, sending nude pictures of underage teens is considered child pornography, even if it sent by the teen. It is presumed that receiver and re-sender of these pictures are culpable under current law. Many cases such as this are pending. But, even so, may courts, school and law officer are not sure what to do with complaints of sexting.

Many parents are opposed to the rigorous laws that hold teens accountable for sending these pictures. A young teen journalist wrote for SF gate, "sexting itself is just not that serious." I disagree.

From a health perspective it can be bad. Depression and legal ramifications are only a couple of problems that come with sexting. There are the obvious sexual issues related with sexting. Are these teens left vulnerable to sexual predators? Does sexting make them more likely to engage in sexual activity? Are these teens already engaged in sexual behaviour? The data from the national campaign to prevent teens and unwanted pregnancy seems to indicate that sexting dose make the teen more likely to engage in sexual behaviors.

So who is responsible for the complications of sexting? schools? parents? the law? the website? For now, many of these questions remain unclear because this is a new phenomenon.

Currently, schools and parents are blaming each other. No one is sure what to do. For sure, schools and parents need to work together in educating teens.

An important message teens need to hear comes form the National Campaign to prevent teens and unwanted pregnancy:

1.)  Nothing you send is anonymous

2.) Once you click "send", anyone can get it

3.) It can be illegal

So what happened to Emma? She ran away from home with help of the young adult male who she was sexting. He lives in another state. She stayed with him and did engage in sexual activity with him and another young adult male. She is now back at home with her parents, without a cell phone or Internet access. And fortunately, she is without STD's or an unwanted pregnancy.

Electronic Babysitting

When my husband and I moved into our suburban utopia, sans kids, we bought a giant flat screen TV. A few months later we could boast of having 3 computers, at home. Media (television/Internet) is like breathing, a necessity to my survival. Embarrassing, but true.


As a pediatrician and mother, if you ask me how I feel about television for my 12 month old daughter, all I can say is no thanks. Not now, anyway. That opinion is supported by the American Academy's Policy statement of television viewing in kids under 2 years. In a nutshell, no TV before age 2.

When I mention this at routine well child visits, many parents tell me that they allow their infants to watch 30 minutes to 1 hour day. They go on to say that they use only what they call "educational DVDs", like the popular Baby Einstein. Most parents, assume that these DVDs are actually educational and help kids learn. To be sure, Baby Einstein was created by a single individual, and as far as I understand has no scientific research to prove educational value.


Until now, it has been challenging for me to convince overwhelmed parents that avoiding the television before 2 years is best. I often explain that talking and singing to your child is better than the 30 minutes of television. Most parents understand my thoughts, but they explain life gets in the way: laundry, dinner, dishes etc. And so, visit after visit, parents tell me that their kids get "educational time" with the tube.

But most pediatricians know, intuitively that TV is not helpful for a child's growth. The March 2009 Pediatrics journal describes a study on the relationship between infants, TV and learning. The study concludes that for kids under 3, television does not assist in learning.

The researchers came to that conclusion by studying children from birth to 3 years. They tracked how much time a child spent watching TV from birth until 2 and at age 3 tested cognitive outcomes. What they found was, that kids who watched television did not have increased language and visual skills.


But what I find fascinating is that Baby Einstein uses this same study in the March 2009 journal of pediatrics on its website as a reason to explain why television is not bad for your child. I was stunned when a blog writer for the NY times writes about this same study and says "But here’s what else the study showed: contrary to what the researchers had expected to find, those babies were not WORSE off, either."



I don't know how anyone can draw that conclusion considering that many previous studies have linked children watching television to ADHD, obesity, violent behaviour, and decreased language and motor skills. Other studies have linked television with irregular sleep patterns in kids less than 2. Early television exposure has also been linked to hyperactivity. An important concept to consider when placing your infant in front of the tube. But, again when you read the baby Einstein websites, they handpick only a few studies from the vast research and then suggest that there is no harm.

The study in this months' pediatric journal did have some shortcomings. The researchers did not address exactly what the infants were watching. It also measure outcomes at age 3, and it is possible that this may be too early to test for improvement or detriments in visual and cognitive skills. An earlier study, tested kids at age 6 and determined that watching TV did lead to lower cognitive outcomes. Despite that the study seems to have many strengths. However, I do not interpret the study to suggest that television is not at all detrimental to a child's health.

That said, I, like many of my parents, am tempted to reach out and place my little girl in front of the TV. So far we have avoided putting her in front of the television. (And I do understand that if I had multiple children, it would be much harder to avoid television for the younger child.) I don't believe that my daughter will never watch television. Remember, I live and breathe media. But, I am going to hold out for as long as I can, hopefully until she is 3 years old.

When she does start watching television, it will be limited as the American Academy of Pediatrics recommends. My goal will be to be particular about what she watches, watch television with her, and talk her to about what she is watching. This will help ensure she gets the messages I want her to get.

In the mean time, I will be spending time with my daughter. The developmental studies have proven that talking, singing and spending time with your child, does greatly assist in your child's cognitive development.

So when families do come back to me trying to figure out how to get their kids away from the TV, I offer the following ideas:

Get outside and get moving.

Talk, sing, dance and jump around.

Sit down and play together

Read together

Make up your own stories

Create art
Build something

Cook together

Use your local libraries, parks and recreation areas.

Hopefully, parents who do use television when they really need to do not feel guilty about it. But, it is important to have the correct information before you decide to put your infant in front of the tube.

Demystifying puberty

As a reminder, this blog does not provide any medical advice, just my mommy opinion.  Please talk to your child's pediatrician about any questions you may have.

My daughter is almost one. When I look into her innocent eyes a part of me wants her to remain exactly where she is. The other part of me is enjoying watching her grow, change and evolve. Regardless, someday soon, she will reach the period of adolescent evolution that we call puberty. 

This is what most of us think about when we hear the word puberty:

Most of us, remember silly anecdotes of puberty from our own adolescence. Being physically and socially awkward was what my favorite 80's movies were about.

So here are some reminders of what is happening to your child outwardly.

With girls, their bodies start to change between 8 to 13 years of age. 

Initially, you may notice their breasts starting to form followed by sparse pubic hair. Later, you'll notice a little hair under the arms or body odor. The average female starts menstruation at around 12 years. Generally, your daughter's growth spurt occurs before menstruation.

It is important to remember that every child is different, and can vary from the listed above. If your child, has any signs of puberty before 8 or has not started menstruation by 15, contact your child's pediatrician. 

For boys, the process begins a little later than girls usually between 9-14 years. Initially, the testes increase in size, later the penis increases and then pubic hair arrives.  You may note hair under the arms, and as he progresses he may develop acne and voice changes. Girls usually get their growth spurt earlier than boys of the same age. Just remember, to contact your child's doctor for any questions.

Back to those 80's teen movies. They did a great job of demonstrating the awkwardness of the teen years. But, it is important for parents to recognize the psychosocial impacts of puberty. 

The cognitive development of teen is divided into early (11-13years), middle (13-15) and late (15+) adolescence. It is important to recognize that most teens struggle with the search for independence,their own identity and the need to be "normal".  That need to be "normal"often leads teens to act with their peers, even when they know better.  Teens influence other teens, so know who your child is befriending.  That last sentence is worth repeating. Your teens greatest influence is other teens, so get involved in their life and know who their friends are.

Adolescence is also a time when teens start to exhibit risk taking behaviours, experimenting with sex, drugs, and smoking. Teens struggle with their sexual identity as well. Unfortunately,  teens often do not understand the consequences of their spontaneous behavior. So, talk to your teen, and guide them about how they will handle situations where they are faced with choices about sex and drugs. Teens are often left with less parental supervision as they move towards adulthood. But it seems to me, this is a period of change, where parental supervision is he most important.

All of this leads me stress the importance of communication. You need to communicate often, early and clearly with your teen.  Schools, doctors and family are important tools to help the parent as part of the communication process. But, parents are always around, and know their teens. That is why it is important to have the conversation about puberty and all that comes with it often and at an early age.  If you are comfortable discussing puberty with your teen, your teen may eventually become comfortable discussing it with you as well. Instead of waiting for your teenager to ask you about sex, drugs, and all those taboo topics, you, the parent should start the conversation.  Other problems which appear around adolescence include, depression and eating disorders.

Puberty is an ongoing process, so the dialogue around it should be ongoing as well.  Instead of just "one" conversation about puberty,  go to the library, check the Internet,  and get information together to learn about puberty together.  Talk about her fears, pressures of being a teen, long term goals, short term goals. This openness will allow you to understand how to guide your teen. When in doubt, seek professional help.

This is how we should be thinking about puberty and all the changes that come with it with the bulk of the responsibility on families.

                                   

For links to helpful information on this topic click on www.thedrmommy.blogpspot.com and scroll to the bottom of the post.

www.kidshealth.org

www.nichd.nih.gov/health/topics/puberty/cfm

www.familydoctor.org/onling/famdocen/home/children/parents/parents-teens/445.html

Books:

Age: 6-10  

Where do babies come from? by Ruth S. Hummel

Age 9-12

It's Perfectly Normal: Changing Bodies, Growing up, Sex, and Sexual Health; by Robie Harris; 

Age 13-18

The Underground Guide To Teenage Sexuality; An Essential Handbook for Today's Teens & Parents, by Michael Basso

Remember, get them involved in the search, you don't have to have all the answers, pick up a book and learn together.