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The average American consumes about 200 mg of caffeine a day. Based on current studies, this level of caffeine consumption is probably OK and may even have health benefits. So you can breathe a sigh of relief. I am not writing this column to encourage parents to give up their coffee … I’m not that crazy.
What we do need to do is pay attention to our children’s caffeine consumption. There are so many different sources of caffeine bombarding our children today: drinks, candies, bars and even shots of caffeine. They come with promises of “Strength,” “Energy,” “Performance” and even “Style.” These companies slap their logo all over NASCAR races, NFL games and skateboard competitions. Their products show up in school vending machines and at sporting events. I can’t prove this, but I am pretty sure they increase their Internet pop-ups during prime exam/studying times. Despite claims, these products do not deliver on any of their promises.
The major energy drink companies recently issued a statement saying they do not market specifically to children. Go to their websites and see if you agree. I do not.
This is a $12 billion industry. A U.S. Senate committee in July discussed if judicial efforts are needed to ban energy drinks from sponsoring high school events or other marketing measures aimed at teenagers. I suggest we let our Senate worry about more important things and handle this as parents.
So what can a kid who drinks energy drinks count on getting for his $2.50 a bottle? Enough caffeine to equal at least two cups of coffee, almost twice the sugar of a soda and loads of ingredients that they need advanced placement chemistry to be able to pronounce.
“So what,” right? “It’s not gonna kill me … and it gives me a little kick when I am soooo tired.”
Q: I recently had my 4 year old at the dentist, and he has one small cavity. They recommended putting him under full anesthesia (sedative to put him to sleep and then IV to put him completely under) to fill the cavity. This seems extreme to me. Is it safe for a child that age to go under anesthesia?
A: Dentists have many different options to choose from to provide their patients with pain and anxiety control. There are lots of important details that enter into a dentist’s decision on pain control and anesthesia. The following information is taken into consideration before deciding on the appropriate way to treat a dental cavity (or caries) in a child.
Medical Complications: There are risks involved with every single type of sedation. The risks increase with the amount of sedation and with the length of time. Certain risk factors make anesthesia more dangerous, including underlying medical problems like seizures, heart disease or lung disease. When these problems are present it is sometimes safer to do a procedure in an operating room which has more options in terms of monitoring and oxygenation. In the absence of other preexisting conditions
it is usually best to go for the lightest form of anesthesia possible that will still provide the pain control needed.
“Hey boys! Want some chocolate chip cookies?” And just like that, I had my focus group. But I’m getting ahead of myself …
At the request of a reader, I am going to attempt to shed a little light on the vast choices of milk products available to purchase these days. For this column, I looked at cow’s milk (whole, 2 percent and skim), goat’s milk, and hemp, coconut, soy, rice and almond milks. All varieties were the original or unsweetened version. It is easier to think about them in terms of the various nutrients found in milk.
To put it into perspective, depending on their age, children are recommended to get between 13-59 grams of protein each day. Milk serves as a major source of protein for most American children. Cow’s milk, goat’s milk and soy milk are the big winners as sources of protein, with between 7-8 grams per serving. Coconut, rice, hemp and almond milk all have very small amount of protein, 0-3 grams per serving.
To help you judge this one: there are 10 grams of sugar in a Tootsie Pop. This gets tricky when judging milks, because many of them come in flavored options like vanilla, or just “sweetened.” The unsweetened versions of these milks obviously have much less sugar.
Goat and cow have the most sugar, at about 10-12 grams per serving. However, rice milk has a lot of sugar as well, at 10 grams per serving. Hemp, soy, almond and coconut milks all have low levels and even sometimes zero sugar in them. However, if you buy the flavored versions of these milks, 10-15 grams of sugar per serving are added.
There are different types of sugars, and they may affect your ability to digest a milk product. For example, cow’s milk has higher content of lactose, a type of sugar, than does goat’s milk. Coconut milk contains fructose, which is hard for some people to absorb.
Incidentally, there are 16 grams of sugar in the same serving size of human breast milk, so it’s not necessarily true that sugar is a bad thing when it comes to milk.
Calcium and vitamin D
Milk serves as the major source of calcium and vitamin D for kids in our country, and all of the these milk sources are pretty equal when it comes to this essential mineral and vitamin. The non-animal sources often are calcium- and vitamin D-fortified, added during processing. For that reason, many of these products actually beat cow’s milk in their amount of calcium.
Journal of Epidemiology and Community Health study shows steady sleep patterns affect children’s learning abilities even more than how much sleep they get.
School is back in session, and many parents and teachers are focused on creating a routine which allows for the most academic success possible. You need only ask a second-grader who recently took the DIBELS test, or a seventh-grader who is playing on the school soccer team for the first time, or a 10th-grader who is taking their SATS about stress to understand that there is a lot of pressure on our children. It is a good time to remind everyone about our two biggest weapons in battling stress: sleep and family dinner.
There is some new information on these topics to share, and to save me from sounding like a broken record. However, the message is the same: We all should practice proper sleep hygiene and we should make time to sit down and share a meal several times a week.
Two things have become clear that make these goals easier to obtain:
1. The amount of time your child is asleep is not as critical as the quality of the sleep, and
2. Healthy eating is important for physical health and eating together is important for emotional health.
A recent study published in the Journal of Epidemiology and Community Health proved that a consistent bedtime correlates with higher academic scores. This study has been featured in many places lately, including the Wall Street Journal, because it conclusively shows that sleep patterns have huge effects on a child’s ability to learn and function efficiently.
Q: My son just started all-day kindergarten. He is allergic to peanuts. The school refuses to mandate that the building be peanut-free. How do I fight this decision?
A: Never “fight” your child’s school. Work with them. Don’t approach the situation with anger; you probably won’t get very far. The principal, teachers and staff do not want to deny your child his needs, they only want to be sure that they are supporting a plan that is fair to everyone and that does not interfere with educating their students. So don’t get angry, just get working. Try to apply your energy and passion toward a cohesive relationship with your school.
Sending a food-allergic child to school or daycare can be terrifying. Around 10 percent of fatal food reactions occur in a school setting. It is estimated that 1 in 25 children has a food allergy.
Based on available evidence, making a school peanut-free does not eliminate reactions and has several disadvantages. Mandating that a certain food be unavailable or not allowed in a school is a very divisive decision. Children who are allergic to other things, like dairy, soy, etc., may ask for the same treatment, and eliminating all of these things in a building is impossible. More importantly, it contributes to the development of a lackadaisical attitude about your child’s food allergy. The assumption that since the school is peanut-free there are no risks has proven to be a dangerous one.
Flu shots will be arriving in doctor’s offices and pharmacies across the county very soon. So I thought this might be a good time to recap last year’s “flu season” and talk about a few changes in this year’s flu vaccine.
Last year’s flu season began in early November, which is earlier than usual. Flu cases peaked the week between Christmas and New Year’s, but flu stuck around until mid-March. While not labeled a pandemic like the 2009 H1N1 outbreak, the 2012-2013 flu season was moderately severe and one of the worst years most pediatricians can remember. There were 149 pediatric deaths associated with influenza in the United States last year.
There are many different types of influenza virus and just when we think we understand them all, they mutate and we have to master a whole new species. The CDC monitors worldwide flu data and makes recommendations for each season’s flu vaccine.
In previous years, we always have given a “trivalent” flu vaccine, meaning it protected against three types of flu virus. Last year, the flu vaccine contained two types of influenza A (including H1N1) and one type of influenza B (B/Massachusetts or Yamagata lineage). This year, that same trivalent vaccine will be available, but many health-care providers will also be offering a quadrivalent vaccine.
The quadrivalent vaccine will offer protection against an additional type of influenza B referred to as B/Brisbane or Victoria lineage. If you examine the data from last year, influenza A caused the majority of illness (71 percent) and influenza B was to blame for only about 29 percent of cases. However, there was a late-season surge of influenza in February and into March which was predominantly influenza B. And influenza B was the virus implicated in 79 percent of pediatric deaths nationwide last year.
In a world where I constantly feel like I have to defend my advocacy of full vaccination, it is sometimes reassuring to look backward. There is nothing more profound than the history of the polio vaccine.
Thanks to vaccination, there has not been polio in the United States since 1979. Current new parents barely know what polio is; however, you need only ask someone in their 60s or 70s to be reminded. That generation lived through an era of fear of large groups, families who lost several children, mass quarantines and permanent disabilities.
In the United States, we typically administer a polio vaccine at ages 2 months, 4 months, 6 months and 4-5 years. It is a well-tolerated vaccine with very few side effects.
Worldwide polio eradication remains a goal. In 2012, there were 223 cases of polio in the world. A very powerful collaboration between The World Health Organization, UNICEF, the CDC and Rotary International has been formed with the goal of complete polio eradication by 2018.
This goal is not going to be easy to achieve. Let’s go over the obstacles.
1. Science: Oral polio vaccine (OPV) is the preferred method of mass vaccination in disadvantaged countries. It is easy to give, provides excellent immunity, is inexpensive to produce and, because it is a live virus vaccine, it can provide herd immunity. Herd immunity means that people who have recently received the vaccine are capable of transmitting the vaccine virus to people who have not had the vaccine, thus providing them with a “passive immunity.”
But there are techniques you can try to break the cycle
by Dr. Pia Fenimore
A very attentive grandmother in my office asked me if I would cover the topic of night terrors in children.
Night terrors, or sleep terrors, are when a child appears to awaken out of sleep and be terrified. They might scream, jump out of bed or flail their arms. They may even speak in phrases like “go away,” or “get off.” They will appear scared by sweating, breathing fast or facial expressions.
These can be very upsetting for the caregiver, but they are very benign to the child and have no long-term consequences. In fact, most children have no idea that they even occurred.
Another type of sleep disturbance, similar to a night terror, is “confusional arousal,” when a child sits up in bed and cries, moans or appears confused.
The above occurrences fall under the classification of parasomnias, or things that disturb sleep. Specifically, night terrors and confusional arousals are parasomnias associated with non-REM sleep. This gives them the following characteristic qualities.
Night terrors are isolated to the very young, preschool-age child (ages 2-6). They are very common and occur in 40 percent of kids in this age group. By age 7, the incidence is down to almost zero.
Q: I have a grandson with some issues. I am not sure if he is autistic or
not but am looking for some support groups in my area. He has problems with loud noises, food textures, swings. He is 4 and not potty trained yet. I have him every other week. I had him tested by the IU but
haven’t heard anything yet. Any suggestions will be appreciated. Thanks.
A: Your grandson is very lucky to have you so keenly involved. I am sorry that you are worried about him hopefully you can find some help to get on the right track. There are two things to stay focused on when approaching a child with developmental or behavioral difficulties. 1. Finding the right diagnosis and 2. Getting the right support services. Both of these goals are often attained in different manners and one is not necessarily more important than the other.
My personal bias is always to prioritize finding treatments that will help over finding a diagnosis. However, in the case of developmental or behavioral problems it can be very helpful to do testing to pin point where the problem is coming from. Giving a child the label of a developmental disability, like autism, has very different ramifications than the label of a behavioral disability like oppositional defiance disorder, even though, in many cases, they are treated with similar interventions. To help discern what exactly is going on with your grandson you may want to have him evaluated by a developmental pediatrician. These are pediatricians who after their 3 year pediatric residency do a fellowship in developmental pediatrics. They become experts at diagnosing autism, cognitive delays, metabolic delays, and behavioral delays. There are developmental pediatricians at Hershey Medical Center, The Center for Autism and Developmental Disabilities in Lancaster, Johns Hopkins Children’s Hospital, DuPont Hospital for Children, and many more. It can often take 9-12 months to get an appointment with these physicians as they are in high demand, but for the goal of diagnosis it is worth the wait.
Q: My daughter has had a rash around her mouth for the past month or more. She is six months old. It started when she was almost five months old right after she was in the hospital with RSV. Do you think it is just a teething rash, or could she likely be allergic to something in my diet? We have just started giving her food the past week or so, so I don’t think it is anything she is eating. She does use a pacifier and has had a runny nose off and on since her RSV. She
has a bit around her eye also. Thanks!
A: I am so sorry, but this is the one type of question that is impossible to answer in this forum. A rash can be so many things and is typically diagnosed by its appearance, which I can’t do this way. From your description it could be anything from impetigo to food allergy to eczema to baby acne.
I am sorry, but I have to recommend that you see your pediatrician to get it diagnosed and treated. Most rashes at her age are pretty easy to get rid of with the right treatment.