Weight, Language, and Self-Image

The language we use when talking to a child about their weight is very important. Doctors say that they themselves take great care in the words they choose when they talk to a child or their family member about weight and body mass index, even if their official classification falls under obesity.


The New York Times recently published a piece by pediatrician Dr. Perri Klass, who writes that physicians try to take care in order to avoid further hurting a child who may already be unhappy about their weight. A new policy statement jointly issued from the American Academy of Pediatrics and the Obesity society urges pediatricians to use seemingly neutral words instead of words like “overweight” and “fat.”


Past and ongoing research into the social and emotional effects of obesity agree that comments on weight can have a large impact on a child’s self esteem. According to Dr. Rebecca Puhl, a clinical psychologist who is one of the lead authors of the policy statement, “Weight is now one of the most frequent reasons kids are teased or bullied.” One of her studies followed more than a thousand teenagers into their early thirties, and found that children who were bullied because of weight were correlated with binge eating, poor body image, and eating to cope with emotions (not to mention other eating disorders). These correlations, in turn, were linked to obesity in adulthood as well. The effect was present for men and women, but more pronounced for women.


Dr. Puhl says that healthcare professionals might be some of the few allies overweight children and teenagers can have. After all, they are most likely teased by family members as well as their peers. Another ally that comes to mind is teachers - where appropriate, they can intervene in a bullying situation, as well as promote body positivity and physical activity.


We can all be allies if we understand and recognize that making comments about a weight does not encourage positive change; instead, making comments about weight can result in negative, longterm impacts. It is important to make sure that children and teens have access to healthy, positive influences for their physical, mental, and emotional health.

Our Small Grants Winner: Jessica Trinh


Earlier this year, we invited undergraduate students to submit ideas and develop programs that will promote healthy behaviors in children through behavioral science practices. The student with the most creative and well thought out project that incorporated evidence-based practices was selected to receive a $500 grant to pilot their idea.

We are excited to announce the winner of our 2017 Behavioral Science for Healthy Children Challenge: Jessica Trinh. Jessica has developed a program where children are encouraged to be active participants in the food choices they make.

Get to know Jessica and her winning program for yourself.

Tell us a little bit about yourself.

My name is Jessica Trinh, and I was born and raised in Illinois. I am studying neuroscience at Yale College, and I hope to use my skills to pursue degrees in public health and medicine after completing my undergraduate degree. Besides working on my nutrition program, I also help at HAVEN Free Clinic as a nutrition education counselor and teach health education in New Haven middle schools.

What is your program about?

Research has indicated that student performance in schools are related to the foods they eat. And both schools and educators are taking note. The foods children consume impact growth and development, while increasing healthy habits may help decrease risk for various diseases, including childhood obesity. I hope my program will foster healthy habits that can be carried into adulthood.

Through cooking competitions, I want students to be master chefs in their home kitchens. My program combines nutrition education through demos and healthy recipe booklets I created with a cooking challenge to encourage hands-on learning at home. The goals of the program are to encourage collaboration between students and parents at home as students learn more about food preparation, and increase children's decision-making role in their meals.

How did you come up with your program?

Growing up, I never thought twice about the ingredients in fast food, nor did I think about the importance of eating a balanced diet. It wasn’t until I was older that I came to realize the importance of nutrition and became more conscious of the food choices I was making. From that moment, I became determined to address disparities in nutrition education.

In my last year of high school, my concerns about nutrition education manifested itself in my senior capstone project. I wanted to create an after school program with middle school students that allowed them to grow their own vegetables, so that they can use them as ingredients in dishes we made together as a group. Each week, I taught students about a new nutritious ingredient that they may have not known about before, and taught them how to cook a healthy dish using this ingredient.

At that time, I was awarded a local grant and was able to support my nutrition education program in my hometown of Rockford. From these early experiences, I became inspired in college to start another nutrition education initiative in New Haven, Connecticut.

What does this program mean to you?

My hope is that students become more active participants versus passive consumers. I believe that motivating students by involving them in food preparation and educating them about their food can improve nutrition outcomes. Rather than imposing restrictions on what students can or can’t eat, I want students to feel empowered to become key players in the decision-making process of choosing what they eat. Through my program, I would like to show them that they can be creative in making healthy substitutions in their meals without sacrificing flavor.

How are you implementing your nutrition program so far?

With the CHIL grant, I am working to set up a healthy cooking competition for students at East Rock Magnet Middle School, a New Haven public school. I designed and produced a booklet of healthy recipes and plan to distribute them to students. Using the recipe booklet, I challenge students to prepare and cook meals (with parent/guardian help when necessary). I hope this will encourage students to be more open to trying new, healthier foods. I also hope that it raises awareness in making healthier substitutions in their food choices.

If this program is successful, I hope to expand my program by working with other schools!

What do you do in your free time when you’re not out trying to save the world, one nutrition program at a time?

I enjoy spending time with friends, watching The Great British Baking Show, and exploring different libraries around campus. One of my greatest joys is being able to cook and bake for family and friends.

Congratulations, Jessica! We are so thrilled to see your program thrive! 



Understanding Toddlers and Tantrums

An interesting piece in the NYTimes this week discusses temper tantrums, and what they do or do not tell us about a young child’s emotional state. Tantrums are most common around ages two or three, and gradually decrease as a child grows older. According to Dr. Egger, chairwoman of child and adolescent psychiatry at NYU, childhood tantrums can be thought of as frustrations from a child who is fearful or angry but is still developing language skills to express these feelings.


According to the article, approaching childhood tantrums with adult reasoning or anger might not be productive or helpful. The neuroscientist interviewed in the article, Dr. Potegal, describes the emotions in a tantrum as a combination of anger and distress - anger usually subsides in a tantrum, but distress might remain fairly constant.


Dr. Egger said that a parent’s role during a tantrum is not to become stressed or angry herself - a parent should instead act as a container for the child’s feelings, since the child will not feel in control of the situation. Tantrums “typically happen when children are hungry or tired or when there has been some significant change in their routine,” and confusion and frustration can easily manifest themselves in these situations.


Experts say the tantrums parents should be concerned about are the ones that occur in public and the ones where children or toddlers become violent and bite or kick. If parents find themselves changing their routines or avoiding triggers in fear of setting off a tantrum, they should seek help instead of struggling on their own. Though this usually isn’t the case, tantrums might be an indication of an underlying developmental problems such as ADHD, or even a medical one.

Mindfulness - Something for Everyone

The timing couldn’t be better - not long after our recent post on ways to be in the present, the New York Times published a piece on “Mindfuless for Children.” The author defines mindfulness as “the simple practice of bringing a gentle, accepting attitude to the present moment,” and argues that even the youngest children can benefit from this approach.


The graphics in this article are beautiful and worth checking out, but we’ve condensed some of the main points here:


Mindfulness starts young. Even infants can notice the difference between a stressed, distracted parent and a smiling, “present” parent. Mindfulness experts say that eye contact is important to establish a connection between an infant and a parent; unfortunately, smartphones have become a huge distraction in establishing that connection. Experts recommend putting down the phone, however briefly, to interact with infants. The same goes for raising toddlers - as they start to learn to express themselves, helping them identify and describe their feelings is very important.


Mindfulness is important throughout childhood, from infancy to early childhood to teenage years. The appearance of mindfulness can evolve. For example, a focus on gratitude and recognizing happy moments for young children evolves to a focus on healthy interpersonal relationships in teenage years. A surprising number of diverse factors are involved in mindfulness. For example, increase in movement and activity relieves stress and improves physical health for guardians and children alike.

Mindfulness can’t be “outsourced.” People who work with children and teens to bring mindfulness into their lives emphasize the key role parents and guardians can have in contributing to children’s health. Mindfulness “isn’t like piano lessons,” where parents can simply drop off their kids to get their weekly lesson. The author of the article concedes that parenting is hard work, and often very stressful, but they are the main figures in their children’s young lives. Caregivers don’t have to be expert meditators; instead, they can focus on things like forgiveness and appreciation of the present along with their children. Having this approach will have positive mental health impacts for everyone involved.

Prize-Winning Behavioral Economics

Earlier this month, Professor Richard Thaler at the University of Chicago Booth School of Business won the 2017 Nobel Prize in Economics. Professor Thaler’s work in behavioral economics has impacted our understanding of human behavior, and has also influenced government's’ approach to behavior as well.


A recent article in the New York Times explains some of Thaler’s work and contributions. Standard economic theory assumes that human beings behave “rationally.” Economists knew this was not precisely true, but operated on this assumption for a long time. Professor Thaler pushed the field to try to truly model human behavior by observing the fact that humans consistently behave in ways that deviate from what is expected - in other words, even if people behave “irrationally,” we can still model and predict their behavior.


Professor Thaler has found, for example, that people who own a good will value it much more than other people who do not own that good. This is called the endowment effect. This could suggest, for example, that people who own fitness technology or pedometers might value them more than other people do. If they value them more, Thaler’s work suggests that people may be more likely to use them.


Thaler also found that people will punish what they perceive to be unfair behavior, “even if they do not benefit from doing so.” It would be interesting to see the link between this sort of behavioral finding and application to health care and children’s health. Since there are so many actors involved in children’s health - the children themselves, providers, teachers, public officials, parents and guardians, and more - unfair practices or policies could be a real complaint that affects relationships between these actors.


Thaler hopes that behavioral economics, now part of mainstream economics, will move beyond the discipline alone to become an integral part of how we think about human behavior. More research in its intersection with health and children’s healthcare will be very exciting to see!


Some Thoughts on Recent Events

Fall is a time of many changes, from the weather to the new school year starting. This year, though, it has been an especially anxious time. On the heels of successive events such as the effects of natural disasters and ongoing recovery efforts, the senseless tragedy in Las Vegas, and political divisions especially within our government, children listening to the news lately would likely alarm parents with questions.


It’s not a stretch to imagine the impact these events can have on societal and children’s health: federal funding for health insurance for many children is still up in the air; food and water are in short supply in Puerto Rico; and gun violence has become a public health issue and its impact on children is hard to ignore.


There is no real advice to be given in times like these, but there are many conversations parents, educators, and caregivers can have with children to talk about stresses from these events. At CHIL, we hope that adults and children alike embrace the fact that people impact lives more directly than any policy change can, as dramatic as the latter may be.


Mindfulness is always important but feels especially relevant today.

A Follow-Up on the Children’s Health Insurance Program

The NYTimes reports that a bill to refinance CHIP, the popular children’s health insurance program we discussed in a previous blog post, has moved from the Senate to the House of Representatives, only to get stuck in the latter. If this bill survives partisan gridlock, then its provisions would set aside more than $100 billion over the next five years for the nearly nine million children enrolled in this program.


Although the main architects of the Senate bill hailed it as a “prime example of what government can accomplish when both parties work together,” there are still many points of contention between Republicans and Democrats when it comes to healthcare spending. The only thing they seem to be able to agree on at the moment is the urgency of the situation.


Federal funding for CHIP expired a few days ago, and apparently, there is no way to predict when a bill might be ready to move on to the White House. Several states have already tapped into emergency federal provisions in order to offset spending while Congress deliberates. Three states are scheduled to run out of CHIP funds at the end of this year, and a total of 30 states will be out of cash by March 2018.

Fast Food, Slow Improvements - Kids' Meals Today

Ron Shaich, the CEO of Panera Bread made headlines when he challenged CEOs of other fast food restaurant chains to try eating their kids’ meal menus for a week. He says that the CEOs of Wendy’s, Burger King, and McDonald’s have yet to respond to this challenge. Of course, NPR points out that kids’ meals at Panera Bread aren’t exactly the healthiest either. For example, their mac and cheese has even more sodium than a four-piece chicken nugget option offered by these rival chains.


When it comes to kids’ meals, the first things that come to mind can be chicken nuggets, fries, and soft drinks. However, these food options and food chains are so common that it is difficult to avoid them. It’s imperative that companies make real efforts to improve the content and quality of kids’ meals.


As a way to address this issue, Panera Bread will include smaller portioned version of the main menu to their existing kids’ menu. That way, kids’ can have a wider variety of ingredients in their meals at Panera Bread. Other chains have also made important changes to kids’ menus. For example, apple slices are now standard in every McDonald’s Happy Meal. They are also making efforts to replace fountain drinks in kids’ meals with milk and low-sugar fruit juice options instead.


There is still a long way to go before kids’ meals at fast food restaurants actually offer fiber-rich, fresh vegetable-filled, whole grain-dense meals that health experts recommend. Until then, as consumers, we should be aware of ongoing improvements and treat kids’ meals as something to eat sparingly.


An Implicit Bias with Real Consequences

In 1998, researchers suggested that “weight-based bias,” which could lead to actual behavior like discrimination, could be found in children as young as 3 years old. That means that feelings of prejudice based on someone’s weight could be a part of anyone’s childhood. Often, people (adults and children alike) do not realize they hold these feelings. However, this implicit bias definitely impacts everyday behavior.


Now, nearly 20 years later, the New York Times reports that researchers at Duke University have found more evidence to suggest that “implicit weight bias” in children could be as strong as “implicit racial bias” in adults. This is startling news, since we know just how consequential any sort of racial bias continues to be. Also, the distinction of implicit weight bias being this powerful was an important point the researchers made. Dr. Asheley Skinner, lead author of the Duke University study, said that implicit weight prejudices can predict behavior more accurately than explicit ones.


Our prejudices and biases are shaped by a culture that promotes “ultra-slimness” and blames people for being fat. The NYTimes article suggests that parents might play a big role in shaping these implicit biases in their children, even if they certainly do not intend to. For example, parents might “comment on their own weight issues and tell their children they shouldn’t be eating certain foods or remark about how much weight they’re gaining,” according to Dr. Skinner.


Children who grow up hearing comments about their weight gain or weight stigma might become more self-conscious in eating, and in extreme cases, develop issues having to do with body image or eating disorders. We think of the teen years as an especially susceptible time for these developments, but bullying because of a child’s weight remains an issue that even elementary school faculty and parents should always remain vigilant of.


Remarks made and habits developed in childhood have a lasting effect on children’s health. However, they also impact how children internalize messages concerning weight from their peers and from the media. With this perspective, it is important to think carefully about how we talk about healthy habits and body positivity with young children and students.

Children's Health Insurance: Legislation and Impact Today

On September 30th, the Children’s Health Insurance Program (CHIP) will be up for renewal in Congress, according to NPR. This “popular federal state-program” provides health insurance for more than 9 million children of families who may otherwise be unable to afford health care.


Some health experts fear that CHIP’s deadline will fall by the wayside while Congress deals with urgent matters in providing relief for Hurricanes Harvey and Irma. In addition, they also fear that fierce division within Congress and budget-related government shutdowns could push CHIP down the priority list. As a result, states would be left with no choice but to start scaling down the reach of CHIP, leaving many children without health insurance at a point in their lives when regular healthcare is crucial.


Among the multiple reasons for the importance of CHIP, one that stands out is the population of children it affects the most. The children who currently benefit from this program come from families who are in lower- or middle-income brackets but do not qualify for Medicaid. As a result, they may be forced to pay more medical bills out of pocket, increasing health and economic insecurities among this population.


Since its adoption in 1997, CHIP has enjoyed bipartisan support, and has been a big factor in the reduction of uninsured children from 13.9 percent in 1997 to 4.5 percent in 2015. Its impact is universally acknowledged, but up for immediate debate are the enhancements the 2010 Affordable Care Act added to CHIP. The ACA increased federal spending for CHIP by 23 percentage points, but “forbid states to restrict eligibility rules.” However, like the ACA as a whole, these enhancements may be changed in the near future.


The need to renew and secure CHIP’s future is urgent. Without congressional action, several states could run out of CHIP funding as soon as next year. While CHIP could be reauthorized “with no strings attached,” its uncertainty means that parents, health care providers, and community members should stay aware of its status. This is crucial if we believe, as we do here at CHIL, that the health of children is a bipartisan, long-term priority.

Lunches For Students in NYC Schools

The new school year in New York City has just begun, and this year there is big news to accompany it: New York City will start offering free lunch at all of its public schools starting this year, according to The New York Times. All 1.1 million NYC public school students will benefit from this program. The universal free lunch is a welcome addition to the already-existing universal free breakfast for NYC public school students.


This announcement is notable for several reasons. Although NYC is not the first major city to offer free lunch at public schools (it follows Boston, Chicago, Detroit, and Dallas), it has far more children to feed than the cities listed above. Also, a majority of NYC public school students (75%) already come from families that qualify for free or reduced-price lunches. The combination of these facts means that this new expansion in free lunches affects many New York students and families. According to the Times, this change will impact 200,000 students and save each of their families about $300 per year.


New York schools are encouraging families to fill out household income forms that will help the state to better identify students it can aid. The state recently updated the ways in which it tracks and matches families that qualify for benefits like Medicaid. With the updated changes, the new lunch policy should not cost the city more money.


School lunches have been making headlines recently for at least two major reasons. Strong evidence for the link between a healthy lunch and school performance or emotional health exists, and researchers are continually confirming this fact. Also, the stigma some students face in a phenomenon known as lunch-shaming - or “holding students publicly accountable for unpaid school lunch bills” - has been generating debate nationwide. The new initiative should directly bolster the former [finding] and work to reduce the latter.


Children should have access to all the resources that are possible in order to help them succeed in school. A lunch program for the public school students of the largest city in the US is a big step in the right direction.


Friends for Life - They're Lifesaving

A quick Google search on friendships and its correlation to health results in many articles concerning the elderly, but a new study has focused on studying teens, for whom the conversation around mental health is especially important. Child Development recently found that close friends among adolescents can have lasting mental health benefits, which can be carried into adulthood, according to NPR.


The study, conducted over 10 years, followed 169 15-year-olds until they were 25-years-old. At age 15 and 16, researchers asked participants to record conversations with their friends. Teenage friends discussed the importance and level of trust and communication that was in their relationship at the time. Then, the participants completed annual surveys about their levels of anxiety and self-worth.


Researchers found that after 10 years, teenagers with strong, close friendships were more likely to report an improvement in anxiety and self-worth at age 25 than adults who did not have strong emotional links to their friends as teenagers. Stable friendships - especially same pairs of friends who showed up together year after year - seemed to provide participants with the greatest mental health gains.


The implications are fairly strong here. Teenagers who find support among each other are more likely to be able to weather challenges that they may face, according to the authors of the study. They also learn how to maintain close, important relationships from a young age, which lays the foundation for future healthy relationships.


At CHIL, our projects encourage friends to engage with each other as they participate in activities that can benefit their health. Friendships and teamwork go hand in hand, and a close friendship can be an extra incentive for children and students to invest time in themselves and each other. The importance of friends is a theme that pops up over and over again, but it should not become a cliche - it can really have an impact on a young person’s health in the long-term.

Home Visitors: a Source of Support for Families

Home visitors play a big role in the lives of many young families around the country, but home visitation programs are perhaps not as well known as they should be. These programs provide young families with support and instruction in child development, helping parents to cope with stress and employment while expecting or raising a young child. A recent piece on NPR demonstrates the need for such programs by following a family support worker, Rosendo Gil, as he works to help one California couple raise their daughter.


Blas Lopez and Lluvia Padilla are the parents of 3-year-old Leilanie Lopez. Gil has provided support for this couple and have taught them how to deal with the stresses of juggling everyday life while raising a child. He’s taught them what to do when Leilanie has a fever, and the importance of reading to her each night. Services like the one that Gil provides offer necessary guidance for young parents to raise healthy children.


“He’s like a friend,” says Lopez, a former migrant worker who is studying to get his high school diploma. “We have counted on him.”


In 2010, the Affordable Care Act became the first piece of federal legislation to provide funding for home visiting organizations nationwide. The NPR article reports that annual federal grants totaling $400 million fund these organizations, helping new parents face the challenge of raising healthy children amidst poverty, substance abuse, depression and domestic violence. In 2016 alone, 160,000 parents and children were reached through home visiting organizations.


However, without reauthorization from Congress, this funding is set to expire in about a month. Advocates and health providers are urgently asking Congress to renew this funding and possibly extend its reach. Regardless of what happens in September, it is probably important to consider the impact that home visitation programs have been shown to have: the programs “help improve child and maternal health,” and “reduce abuse and neglect.” Importantly, these programs help parents avoid “revert[ing]” in stressful situations to the ways they themselves were parented, and overcome cyclical challenges, such as substance abuse, according to the article.


It’s evident that the health of the home and family directly impacts a child’s development, and any resources that aid young parents in adjusting to their new roles can have a huge impact. Programs like home visitation are well worth researching further, with the hope that more of these programs could work with schools and communities to enrich children’s health on a larger scale.

(M)apping Health for Children

The Boston Children’s Hospital recently announced a new app called Caremap. This app, which was created using Apple CareKit, streamlines and organizes details for families with children with complex medical needs. According to the Boston Children’s Hospital, half a million children in the U.S. need frequent hospital visits, doctor visits, and/or medications and procedures. Families are understandably concerned about the security of their children’s health information, but also face the challenges of intensive care regimens that can be exhausting.


The app was created with children with complex needs in mind, but can be used for any child. Caremap can keep track of many parameters including sleep, exercise, pain, or custom metrics, and can produce graphs based on trends in this data. Identification of trends is very important for care and health maintenance in general. Developers are looking to add more parameters, including school attendance and temper tantrums, according to this report. Caremap also allows family members to communicate with healthcare providers.


This is the sort of innovation that is long overdue in the age of mobile technology that we live in. Of course, security is of utmost concern, and should be a top priority for app users and developers alike. Caremap and similar apps could help families keep track of all the details of their children’s health amid overwhelming amounts of information and stress. Comprehensive apps such as Caremap can also encourage the development of healthy habits - keeping track of how much sleep a child gets, or how she is doing at school - can help parents maximize the information they have in order to make good decisions for their children.


iPhones come with a Health app in which users can log information about sleep, weight, exercise, and nutrition (Apple received a patent application approval this week for an “electronic device that computes health data”). Perhaps the successful launch of something like Caremap could remind parents of the advantages of using this sort of tool to keep track of their children’s health over time.


Teens and Smartphone Use: Connected, but Lonely?

We’ve often talked about smartphones and social media on this blog. A recent NPR piece opens with a startling thought: for the first time ever, a generation of teenagers is growing up without knowing the world before smartphones. Psychologist Jean Twenge calls this cohort of adolescents “iGen,” and says that smartphones are contributing to their overall increased risk of mental health problems compared to previous generations.


Twenge told NPR that teenagers and young adults born between 1995 and 2012 are statistically safer than ever before - they are driving later, drinking less, and having safer sex than previous young adults. However, Twenge contends that these same young people are more likely to say they are anxious or lonely than previous generations were because of a reduced amount of time spent interacting in person with their peers. Adolescents and young children need these interactions in order to learn, to read, and to develop social cues, skills necessary to build support networks.


According to Twenge, reports of loneliness in teens started to rise suddenly in 2012. It was this year that, by year’s end, most Americans had a smartphone. Causation is a tricky business, but social media and smartphones have undeniably changed the landscape of adolescence in the years since then.


The question of parenting and its role in this change will undoubtedly be of a lot of interest to parents today. Children who use smartphones today are aware of their potential adverse effects - they are well versed in this subject and live its reality everyday. It is challenging for adults themselves to limit their own smartphone usage, so it is doubly important for parents to be proactive in encouraging children to be mindful of the importance of limiting hours spent staring at that small screen. Apps that limit usage and the time of access to a smartphone’s functions exist, but a parent’s role is probably the most effective when they are showing their teens the benefits of person-to-person contact and communication.


When Children Talk About Loss

The New York Times recently addressed a difficult topic: when a child dies, how does their death impact their siblings and family in the short and long-run? The author of the post, a professor of pediatrics, noted that as devastating a child’s death is for a parent, the loss felt by a sibling must be even more unbearable. After all, siblings often share more time together than with parents, and have shared much of their young lives together at school.


According to the article, a sibling’s untimely death can have numerous physical and mental health repercussions for living siblings and families. Living siblings might also primarily be affected by the same disease or disorder that caused the first death, exacerbating existing health problems, and raising risks of long-term health, social, and behavioral problems.


This phenomenon is the main subject of a recent study in JAMA Pediatrics, referenced in the New York Times article. Researchers who followed children in Denmark and Sweden from 1973 through 2013 found that the children who lost a sibling before age 18 were 70 percent more likely to die in the decades following the event. The death of a sibling is not a causal factor for increased mortality, but it is definitely a part of the picture. Of course, another factor that could lead to increased risk of death after that of a sibling is the emotional damage of grief, and the difficulty of coping with that grief.


This means that support for bereaved siblings needs to be a priority for family members and healthcare professionals. It’s important for major publications like the New York Times to report on findings from the medical community that might be difficult subject matters. Similarly, it’s important for family members and parents to have conversations about loss in order to help children cope with grief and to build resiliency.


“Family resilience” is found in at least one academic paper on the subject of recovery after the loss of a child. This study had two findings that are especially relevant: families that viewed the grieving and recovery process as a challenge to overcome, and families that felt community support were related to the family’s grieving and recovery process, adapted better than families who did not have a strong community support. The interaction between a bereaved family and the rest of society can be an indication of how well-equipped everyone is to deal with loss.


Other ways people are dealing with the impact of loss in the family is to open doors for conversation. For example, Facebook COO, Sheryl Sandberg, wrote an article in The New York Times a couple of months ago after the sudden loss of her husband. In order to foster resiliency in her children, and to support them in their remembrance of their father, Sandberg is determined to keep open communication a constant. This approach would transform hardship into a growth opportunity, with the goal of resiliency.


We may all know people in our lives that have experienced loss. If more people knew about these findings, then support systems in schools and other community settings can work with families to have a positive impact on children’s lives as they overcome loss.

New School Lessons: Eating Healthy

We hear a lot about the obesity epidemic in the United States, especially among children and adolescents. However, the impact that school meals have on childhood weight and overall health has been overlooked. A piece in the Wall Street Journal earlier this year looks at five creative ways schools can encourage students to eat more healthily. These interventions have been formulated to help schools meet the guidelines under the Healthy Hunger-Free Kids Act of 2010.


Intervention One: Product Placement

Salad bars that feature at the front, or in the center, of a school lunch line are much more likely to attract students. Some Maryland elementary schools opened all-you-can-eat salad bars that featured five different fruits and five different vegetables a day and saw the number of students buying salad go up. In fact, one study found that strategic placement of vegetable options can increase consumption by as many as five times. Other schools planned the timing of vegetable snacks, so that hungry students were more likely to reach for them before a meal.


Intervention Two: New and Improved Advertising

Changing children’s preferences can be as simple as slicing up fruits for those with orthodontic appliances, or using more colorful bins to display fruits at lunch. “Stealth nutrition,” according to the WSJ piece, can also come in the form of food names that appeal to a young crowd (e.g. “X-Ray Carrots or Turbo Tomatoes.”) Attention-grabbing cartoon stickers on fruits can also increase consumption.


Intervention Three: Tracking Real Consumption

This is an intervention that can reduce waste, and at the same time, determines which foods are popular with students and which are not.  Researchers at some Chicago elementary schools recorded what foods were purchased and thrown out in order to determine the relative popularity of certain food groups.


Such measures can also increase parental involvement: some schools send home weekly report cards that record what a child ate throughout the week, based on lunch swipe summaries. Instead of remaining in the dark about what their children eat at school, parents can talk with their children about their meals or even compensate for missing nutrients at home.


Intervention Four: Bring in the Experts

Children can’t be expected to enjoy food that adults would also avoid. Chefs can consult for school menus or cook directly in schools. Over time, partnerships with chefs and local food sources can have a big impact.


Intervention Five: Field Trip!

Nutrition education should not have to be boring. In fact, it absolutely should not be, since a child’s first impression of a food item is crucial. Some elementary schools have started taking students on field trips to local farms, teaching ways of sustainability along with familiarizing students with new fruits and vegetables. They encourage students to make note of how a fruit smells, or what color a vegetable might be.  In NYC, the Wellness in School Program encourages students to make healthy choices for themselves based on what they observe in the fresh produce and nutrition labels they encounter.


Childhood Staple, Harmful Chemical?

A recent study, described in the New York Times, found that many types of boxed mac and cheese contain phthalates, a potentially harmful chemical that has already been banned in children’s toys. According to the article, phthalates are “industrial chemicals used to soften plastics and are used as solvents, in adhesives and in ink on packaging.”


Although the chemical interferes with hormones and has been linked to birth defects, the FDA has yet to ban phthalates. The chemical can be found in many processed foods, including mac and cheese. Two million boxes of mac and cheese are sold a day in the United States. Among the types of mac and cheese tested for phthalates, “organic” varieties also tested positive for the chemical with some products containing as many as six different phthalates.


Since processed foods are often more affordable and accessible than fresh, unprocessed foods, children with less access to healthy foods might be more risk for health problems. Even processed foods labeled as “organic” are likely to be more expensive yet do not offer the clear superiorities to other foods that might be implied.


The findings in the article show that it can be difficult to avoid dangerous chemicals, especially found in many unprocessed food. It will take real effort on the part of the consumer as well as regulatory bodies in order to protect children’s health.

The Public Health Crisis We Aren't Talking About

The Editorial Board of the New York Times wrote a piece last week calling attention to a public health crisis that does not get enough attention: the lethal combination of gun violence and children. According to a report in Pediatrics, cited by the Board, about 7,100 children are killed or sent to the hospital each year with gun-related injuries. That translates to about 25 children who are killed by guns each week. This rate is far beyond that of any other wealthy nation in the world.


The disparities among the pediatric victims are, discouragingly, along geographic and class lines.  African American children are at far greater risk for gun-related injuries, as are boys and children living in the South. At the same time, however, deliberate gun deaths among children are distinctly related to white or American Indian children, according to the study.


Even the most cursory research indicates that this is an American crisis, and one that does not show any signs of improving soon. However, the most striking aspect of this crisis is the inability of federal agencies to conduct meaningful research on guns in the country. The passing of a congressional amendment several years ago “forbid[s] federal money to be used ‘to advocate or promote gun control.’” In other words, the government of the most firearm-dangerous country for children in the world prohibits itself from researching the effects of its laws and policies.


Gun violence is a distinctly American crisis that affects children from all races and socioeconomic classes. In that regard, gun violence is an unparalleled public health crisis - gun violence impacts all facets of American society, and especially its most vulnerable citizens.