The Latest Newsletters from Dr. Joe Barber
The holidays are fun but they also are a time for emergency department visits due to injuries from toys. Toys provide children the opportunity to explore the world and develop or refine skills. It is vital every child be given the freedom and encouragement to explore but that does not mean they should be unsupervised. One child in the US is treated in an emergency department every three minutes for toy related injuries. This adds up to over 3 million children receiving treatment from 1990 until 2011 and the number of injuries has increased by 40% since 1990.
The best way to protect your child is by buying toys that are age, interest and skill level appropriate. Read up on the toys you want to purchase before you buy them. Check into the safety record for the toy and make sure there has not been a recall. Make sure all the materials in a toy are labeled non-toxic. This includes lead paint and is especially important when purchasing used toys. Always follow the manufacturer age and restrictions guidelines and never use a toy before you have read all the instructions. This is especially important for all chemistry kit toys that may contain dangerous or toxic chemicals.
Certain types of toys are more risky than others. Toys that must be plugged into a wall outlet are never to be used by a younger child. Electricity can kill your child. Make sure all toys that plug into the wall are UL approved. Also beware of choking injuries due to objects that are small enough to be swallowed or inhaled and block your child’s airway. Always think big for young children and avoid objects smaller than a ping pong ball. Beware of button batteries, magnets, balloons and plastic tags. Toys that have a rope, string or ribbon attached can cause strangulation and all riding toys such as a scooter should only be used with supervision and with a properly fitting helmet.
Beware of loud toys that can damage your child’s hearing and be especially careful when using ear buds or head phones. Always turn on the sound before the ear buds or head phones are placed in or over the ears. Stuffed animals pose the risk of toxic stuffing or stuffing that can be swallowed or aspirated. Loose plastic pellets should never be used for stuffing and beware of toys made of plastic where small pieces can be broken off and choked on. Broken plastic toys often have sharp edges that can cut your child.
Home safety is also important over the holidays. Make sure you properly use safety gates and beware of your child climbing on or falling off of raised surfaces. Electric rockers, exercise machines, recliners and lift chairs can cause entrapment injuries. Extremities and fingers can be caught and crushed. Lastly, be cautious about all furniture and objects that have sharp edges or glass components. These can lead to cuts and blunt trauma injuries.
Most injuries happen when your child is left unattended or unsupervised. Your informed, active and attentive presence is the best protection for your child. Keep all toys organized and in working order. Toys should be cleaned periodically to kill and wash away germs and they should never be used in unintended ways that place your child at risk for injury. Hanging crib toys pose a special risk for choking or strangulation and any toy that shoots objects into the air can cause eye injuries.
A final safety tip is to choose safe places to use a toy. Many toys are safe when used in one location but not in another. Store toys in a location where toys for older children can be kept away from younger children since many toys for older children are very eye catching to young children and can cause injury to a younger child who is not developmentally ready to use that toy.
Follow these guidelines and active play can be safe and a time of discovery and exploration for your child.
Healthier fast food starts at home. Do your best to pack a meal or snack instead of stopping for fast food. Eating before leaving home is also important. Vacations and road trips are high risk occasions for increased fast food intake. Try to help your child prefer to eat at home rather than out by preparing healthy meals and snacks your child enjoys. A favorite home meal always trumps fast food choices.
Food and portion choice are two other important skills. Portion control and food choice are best taught at home and not when you are at the fast food restaurant. Teach your child that self-control is overrated. It is best to avoid calorie rich and unhealthy food both at home and when you are out. Eating should never be for comfort or distraction. Mindless eating is never healthy.
Make eating a social event rather than an escape or comfort event. Eating healthy is a key component of a healthy lifestyle and when paired with stress reduction, adequate sleep and an active lifestyle it leads to a long and healthy life. By decreasing sedentary time and helping your child stay active you will be making exercise an actual meal portion and reduce excess calorie intake risk.
How can you lower your child’s risk? Downsize food portions and beware of cheese, condiments and side dishes. Skip the fries and choose fruit or nonfat yogurt as a side order. Choose baked or grilled chicken and avoid chicken nuggets that are high in fat and are imposters of real chicken. Avoid liquid calories by choosing water and only drink low fat milk. Lastly, choose fruit and leave the chips and cookies behind.
Compliance with healthy dietary rules is essential. Choosing a children’s meal with healthy substitutions allows your child to participate in food choice. Never ban sweets entirely since this decreases compliance and often increases behavior issues.
Healthy children’s meal alternatives include: Kraft macaroni and cheese with apple slices and bottled water at Arby’s (205 calories). Veggie or turkey breast delight (without cheese) on whole wheat with apple slices and fruit juice at Subway (285 calories). Chicken nuggets (4) with sweet and sour sauce and apple slices and unsweetened iced tea at Burger King (265 calories); Grilled chicken nuggets (4) with barbecue sauce and fruit cup and low fat milk at Chick-fil-A (260 calories); Chicken drumstick with green beans and low fat milk and string cheese at KFC (365 calories); Chicken McNuggets (4) with barbecue sauce and a double portion of apple slices and low fat milk at McDonald’s (370 calories); Hamburger with apple slices and low fat milk at Wendy’s (380 calories).
For teenagers choose a fajita with grilled chicken and vegetables or baked or grilled chicken instead of breaded chicken or macaroni. Always leave off the cheese. Order a baked potato instead of French fries and leave off the fat laden trimmings. When in doubt always order a salad with grilled chicken and low fat or fat free dressing. Order non-fat yogurt with fresh fruit instead of dessert or cereal and consider a fruit smoothie instead of a regular milkshake.
Limiting fast food visits and following these guidelines will help your child eat healthier.
Childhood obesity is a common problem in the US. One in three children has high cholesterol and almost 20% of children between the ages of 6 and 11 years are obese. This number has tripled since 1980. The risk of obesity in teens has quadrupled in the last 30 years. Obesity has been linked to heart disease, diabetes, stroke, cancer and an early death.
Every parent needs to know the fast food industry and eating outside the home has grown dramatically in the last few decades. The US has almost one million restaurants and approximately 10,000 new restaurants are added each year. In the US about half a trillion dollars is spent every year by people who eat out and the fast food industry spends about 700 million dollars a year marketing directly to children through advertising and gifts given to children to entice a return for another children’s meal. Children and teens view between three and five fast food ads every day and 75% of these ads focus on unhealthy foods. The fast food industry is now pursuing social media as the new wave of influence to further expand the fast food market for children and teens using deceptive marketing and advertising.
What is the risk of fast food? Fast food choices are high in fat, carbohydrates and salt. The portions are large and sugar-laden drinks are encouraged. These factors lead to excess calorie intake and unhealthy weight gain.
Sugar-laden drinks provide liquid calories with minimal nutritional benefit and increase your child’s risk for obesity and diabetes. Many protein choices increase the risk for heart disease and stroke due to a waxy substance called cholesterol that clogs blood vessels. High fat cheeseburgers, unhealthy fried chicken or chicken nuggets and highly processed meats provide large amounts of saturated fat, low amounts of fiber and increase the risk of cancer, diabetes and heart disease.
Excess salt intake is another risk. Most food choices have a high sodium content which increases the risk for high blood pressure, heart disease and stroke. They also increase the risk for certain types of cancer. Excessive intake of these types of foods increase your risk of premature death by 20%.
What is the best response for parents? Your best response is to eat outside of the home as little as possible and to choose wisely and healthier when you eat out. Know the calories and salt content of the foods you choose for and with your child. Remember to downsize the portion, skip the fries, choose your protein wisely, avoid the cheese and condiments and choose water or fat free milk.
Healthier fast food is possible but the best plan is to avoid fast food and plan ahead.
Food choice and learning to deal with stress rather than using food for comfort are essential to eating right. Always choose whole fruit for snacks and desserts and consider adding fruit to your salad. Add beans, peas and lentils to salads, soups and main dishes and try to eat more red, orange and dark green vegetables like tomatoes, sweet potatoes and broccoli. When using canned fruit always choose fruit canned in water or 100% fruit juice and choose canned vegetables with no added salt. Frozen fruit and vegetables are always a good choice as is whole grains for bread, rolls, cereal, bagels, crackers, pasta and rice. Always check to make sure whole grain is first on the ingredient list.
When choosing your protein for a meal, consider substituting seafood, peas, beans and nuts instead of animal protein. When an animal protein is chosen make sure it is 90% lean and trim and drain fat from the meat.
Salt intake must also be managed. Sodium is often hidden in foods. Canned vegetables are often high in sodium. Always choose no salt added canned vegetables. One teaspoon of salt contains about 2,500mg of sodium. The amount of sodium needed per day varies by age. Estimated intake allowances include the following: 1 to 3 years: 1,500mg; 4 to 8 years: 1,900mg; 9 to 13 years: 2,200mg and 14 and up: 2,500mg. Packaged, processed, restaurant and fast food options are high in sodium. Avoid salty snacks and always choose low sodium products.
The golden rules for healthy eating include choosing a luncheon plate rather than a dinner plate for your meals. Half of the plate should be for fruits and vegetables. One fourth of the plate should be for your whole grains and the rest for your protein. Meat should be considered a garnish rather than the main part of your meal. Consider serving low fat cheese and low fat yogurt for two of your three recommended servings of milk products per day and the serving size for milk is only four ounces. Never drink sweetened drinks. The sugar intake for 12 ounces of soda is 10 teaspoons (40 grams) of sugar. The recommended intake of refined sugar per day is 16 grams for children and 32 grams for adults.
Serving sizes must be understood or portions often are over-sized. A serving of cereal, potatoes, pasta, rice or vegetables is equal to a closed fist or computer mouse (1/2 cup). One serving of leafy vegetables is equal to a baseball or a cupped hand (1 cup). A deck of playing cards or an iPod is the size of one serving of fish, poultry or beef and a checkbook is the size of one serving of a fish fillet. A CD case is one serving of bread and a thumb or two 9 volt batteries is equal to one serving of low fat cheese. A thumb tip or a pair of dice is equal to a 1 teaspoon serving of high fat foods such as mayonnaise or peanut butter. Two handfuls of baked chips or pretzels or one handful of nuts are equal to one serving. The recommended servings per day are 3 to 5 vegetables, 2 to 4 fruit, 5 to 10 whole grains, 3 protein and 3 dairy products.
By following these simple rules you can be a healthy food model for your child and your child will eat right.
One-third of all children in the US are overweight or obese and being overweight is a stigma that leads to teasing and bullying. One study found that over 85% of children report seeing an overweight peer being teased and bullied during gym class. It is more common than gender issues, race, ethnicity, physical disability or religion. Children and especially teenagers are very sensitive to the social effects of being singled out as overweight. Children who are overweight are bullied since they are viewed by others as being different or undesirable. Weight is a visible way to stigmatize children.
Overweight bullying leads to increased stress and social isolation. It diminishes self-esteem and self-worth and causes children to be excluded from social opportunities. It often leads to depression, anxiety, loneliness and sadness. Children who are bullied due to their weight are more prone to become bullies themselves and often rely on binge eating for comfort.
When a parent is told about this type of bullying the focus must be on attentive, sensitive and responsive reflective listening. Parents must be attuned to the feelings and needs of their child and tell the child: “I am sorry this happened, and I am glad you told me.” The child must be told teasing is never right or fair. The parent must explain how teasing hurts others and is always wrong. The focus of the discussion is then pivoted to the fact that how much a person weighs does not define who they are. Weight is only one of many measures of good health, and it is a measure that can be changed and controlled.
The language that is chosen when talking about being overweight is very important. Judgmental or stigmatizing language causes overweight children to shut down and withdraw and hinders discussions. The weight-based terminology you choose will have a lasting effect on your child’s willingness to lose weight. Parents must emphasize how their love is unconditional no matter what the child’s weight is, and how the extra or added weight the child is carrying can make the body work extra hard and cause the child to have less energy. The child should be asked: “How does the extra weight make you feel?” At the same time the parent reaffirms the importance of a healthy lifestyle and why how you feel is more important than how you look. For the final step the parent explains how working together will help the child to lose weight and become healthier.
Losing weight is never easy. It takes time, consistency and effort. Small incremental changes in dietary intake and activity level are essential as are stress reduction and adequate sleep. The modeling of a healthy lifestyle and weight pattern by parents is also essential. By increasing active time and time spent outdoors risk factors such as excessive screen time and sedentary time are decreased. An emphasis on family play time and joint activity time also helps as does shopping together for healthy foods such as fruits and vegetables. Choosing and preparing healthy and favorite recipes together increases compliance and make losing weight a more enjoyable experience.
It is vital for every parent to strive to stop weight based bullying and its consequences. By working with the government, schools, organizations and other parents this stigma can be eliminated as the most common cause of victimization and bullying in the US.