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.