Midterm election round-up: Highlights & implications in healthcare

A number of historic “firsts” came with the Midterm election occurring last Tuesday, November 6th. The first Native American women, the youngest woman, and the first Muslim women were elected to Congress, and the first female governors in Maine and South Dakota and the first openly gay governor in the U.S. were also elected, among other “firsts”. There will also be more than 100 women in the U.S. House of Representatives, a new record. In addition to the expanding diversity of candidates running for office and being elected, this election also brought historic “firsts” in healthcare. We have listed below some of the various health-related highlights of last Tuesday, as well as its implications in the local and federal level. Specifically, what issues do voters care about, and what do they mean for the future of healthcare and policymaking in this country?

  • At preliminary exit polls during Tuesday’s elections, 41% of surveyed voters noted that healthcare is a top issue they are concerned about. In addition, CNBC reports that ~70% of voters, regardless of party affiliation, indicated that the “U.S. healthcare system needs ‘major changes’”. The weight voters put on healthcare may make it an important future point of discussion in Congress as well as in local and state legislatures.

  • With a Democrat majority in the House of Representatives, the Affordable Care Act (ACA) and/or cuts to Medicaid will probably not be heavily challenged for repeal in Congress.

  • Utah, Nebraska, and Idaho passed ballot measures to expand Medicare in their states. This could mean that over 300,000 low-income individuals in all three states will be eligible to gain health insurance coverage through Medicaid. Only 14 states have not expanded Medicaid thus far in the U.S.

  • Alabama and West Virginia voters passed measures to “ban abortion in their state constitutions”. Both states also have laws that ban abortion; however, these measures technically cannot be implemented due to the Supreme Court’s Roe v. Wade decision in 1973. According to the decision, it is unconstitutional for state laws to ban abortion.

Check out some more health-care related highlights from the 2018 Midterm election here!

Emotional Mindfulness Exercise for Kids: Body Mapping

Kids are constantly experiencing new emotions. Learning how to appropriately cope with and express them is easy to overlook, but very important. Internalizing negative feelings can be unhealthy and can contribute to harmful behavior, even if a child is not acting out. A psychoeducation tool called ‘body mapping can useful for encouraging kids to reflect on their emotions, and we’ll will take you through some of the how-to’s below!

The goal of the body map is to visualize emotional responses in order to become acquainted with them and reduce confusion about them. Note that it may be helpful for an adult mentor to complete the exercise alongside the child as an example.

  1. Start with having children draw an outline of their bodies on unlined paper. This can be life-size if you have larger sheet paper available, or just a standard piece.

  2. Pick an emotion or an event that will be the focus of the exercise (i.e. “think of a time when you felt angry”). If you are working with older kids who can better understand abstract activities, you can also allow them to choose the focus (“when ___ happened, think about how you felt”).

  3. Have children to draw on their face the emotion selected (or the emotion(s) associated with the event). It is useful to have different drawing tools/colors available!

  4. Have children jot down the other words they associate with the emotion.

  5. Have children reflect on how this emotion felt in their body (i.e. “did you feel this emotion in your stomach? In your heart? Did your neck tense up? Did your breathing change?”), and then have them express that bodily reaction on their outline. Encourage kids to get creative—perhaps they may draw a tornado in their stomachs, firecrackers near their heads, etc. Having diverse material like stickers, watercolors, or patterned paper and scissors may help them get ideas flowing.

  6. Ask children what kind of thoughts they have or had when they feel/were feeling this way. Have them write these down as thought bubbles around their depiction.

  7. When kids are finished with their maps, allow some time for them to share the different aspects of their maps. What did they include and why did they choose to represent it that way? Be mindful that not everyone may be comfortable sharing their map as their art may be personal, and that is okay. You may also encourage kids, when sharing, to discuss how they address their responses (i.e. “how do you cope with your heart beating fast when you’re angry? How do you calm your heart?”)

Many variations of this exercise are possible. For example, body mapping additionally has been used as tool to aid kids specifically in overcoming trauma (physical or emotional). Ultimately, body mapping can be an informative and cathartic method to take abstract emotions and get them down on paper in a way that facilitates meaningful and expressive conversation—something that can be particularly challenging for young ones.

An update on transgender rights and policy change

We recently wrote a blog post in August about how anti-discrimination federal rules that required insurance plans to cover preventive services for transgender and gender non-conforming youth were in discussion to be removed. Further reports of potential federal policy change have been discussed since then, that will affect millions of transgender and gender non-conforming individuals in the U.S.

Just last week, the Justice Department informed the Supreme Court that employers can discriminate against their employees based on their gender identity. A recent report also states that the Department of Health and Human Services is considering defining gender as, according to the New York Times, a “biological, immutable condition determined by genitalia at birth”. In the past, “sex” was understood to be defined on the basis of chromosomal makeup, while gender was defined by the individual in how they choose to identify. However, experts repeatedly state how the terms gender and sex are not interchangeable, and how both are not necessarily defined by biology. Both sex and gender are non-binary and can be modified, which the proposed definition fails to address.

These proposed policy changes have been part of a string of federal actions that have affected many transgender and gender non-conforming Americans, who comprise about 1.4 million of the U.S. population. For instance, guidelines that “protected transgender students who wanted to use bathrooms that correspond to their gender identity” were removed in February 2017, thus effectively discarding reported cases of discrimination in educational environments by gender expansive children and youth.

Among these alterations in practice, the recently federal policy proposals and changes in defining ‘gender’ and ‘sex’ have reverberating effects beyond the federal level. CNN reports how changes in the definition may exclude many transgender and gender non-conforming Americans from seeking civil rights protections when discriminated against. In addition, many gender expansive youth and their families feel anxious and unsure of how such a policy change will affect name and gender changes on birth certificates and other ID documents, and subsequently their identity at school, work, or other legal and social institutions. With these recent federal proposals, many civil rights groups are hoping to challenge how the U.S. stands on discrimination against gender diverse individuals.

Talking to kids about #MeToo

2018 has been dubbed the year of #MeToo. People of all backgrounds, ages, and gender identities have come forward with their stories of sexual harassment and assault, demanding perpetrators’ behaviors no longer be tolerated. Not only has this changed the way Americans think about sexual health and consent, it’s exposed the emotional trauma and long-term damages to well-being that frequently follow sexual misconduct. The hashtag has spread over social media platforms, reaching audiences of many ages. What is the younger generation to make of it all?

Some adolescents, as survivors of sexual misconduct or crimes, consider themselves a part of the movement. Teenage femmes have spoken out to tell their own stories and to support their friends. High-profile cases like the recent Kavanaugh hearings, which involved alleged misconduct in high school, may have been familiar to them. What role do adult figures play in addressing #MeToo with teenagers, as well as with younger children trying to digest the adult conversations around them?

NPR asked experts in sexual health education, and we’ve synthesized them below:

1)   It’s adults’ job to give them information— kids learn about sexual health somewhere, and it’s best if that somewhere is from a willing and knowledgeable adult. Use #MeToo as a teachable moment!

2)   It’s not too soon— even for parents or educators of elementary-aged children where explicit conversations around sexual health are not appropriate, consent can be a habit encouraged in kids from the get-go. Instilling healthy behaviors in kids is critical as it can impact their actions in the long-run.

3)   Be “askable”— kids should feel comfortable approaching adults with their uncomfortable questions. Mentors bringing up tough topics themselves can set an example of the conversations their okay having. Adults who can’t fulfill this role should ensure another older figure can.

4)   Talk with potential perpetrators, not just survivors— #MeToo has been about supporting victims, but also about raising a new generation who respect consent in a way their predecessors never learned. In other words, not only should young kids be given the tools they need to express themselves if there is a problem, they should also be taught how to cope with being told “no.”

It’s National Dental Hygiene Month!

We couldn’t let October go by without talking about National Dental Hygiene Month! We want to discuss this topic because most news-related articles and our blog posts relate to body health, however there is rarely a focus on oral health. Oral hygiene is just as important as body hygiene, with the Mayo Clinic even calling oral health “a window to your overall health.” Poor oral health is linked to various conditions such as diabetes or cardiovascular disease. The relationship goes both ways: diseases such as diabetes, Alzheimer’s and HIV/AIDS can cause problems or exhibit symptoms in your oral cavity, while poor oral hygiene can also lead to serious conditions like heart infections or giving birth prematurely for pregnant women.

Good oral health is important for everyone! Although there are multiple ways to maintain good overall oral health, such as regularly seeing the dentist, flossing daily, eating healthy, or not smoking, we want to focus this blog post on how to brush your teeth properly. You are supposed to brush your teeth with fluoride toothpaste twice daily, but do you know the proper technique for brushing your teeth? Here are some pointers to remember.

  • Make sure you are brushing with a 45-degree angle to where your gums meet your teeth.

  • When you brush your teeth, use “tooth-wide” strokes. Brush the front teeth, back teeth, and the “chewing surface”, which is the part of your teeth you use to bite and chew food!

  • It is important to keep your gums healthy as well! Brush along the gum line with gentle strokes.

  • Brush the backside of your front teeth with “up-and-down” strokes.

  • Remember to brush your tongue at the end! This can help your breath stay fresh and take out any remaining food particles in your mouth.

The ADA has also released some tips on motivating kids to brush their teeth. Check it out here!


Tips to help teens get more sleep!

Research indicates how teenagers need an average of 9 hours of daily sleep; however, the average American teen reports sleeping around 7 hours daily. A recent NPR article reported on how varied and unpredictable schedules, in addition to stress from school and social activities, can cause teens to have trouble falling asleep, staying asleep, or waking up. In addition, over fifty-percent of parents believe that their children’s constant use of electronic devices causes sleep problems. Although electronic devices may contribute to the issue, experts suggest that parents should listen and speak to their kids about other barriers to getting good sleep, and how the family can address them. On NPR, researchers Sarah Clark and Mary Carskadon suggest a number of tips on how to improve sleep quality. CHIL has pulled some other tips from various clinics and online resources that can hopefully help you too!

  • Try to keep the same daily wake-up time: Try also having the same bedtime! When you have consistency in your schedule, it helps set a sleep-wake cycle in your body. Even on weekends, try not to deviate from your schedule by more than an hour.  

  • Exercise helps!: When you exercise, your body tends to get better quality sleep and longer sleep. Exercise helps increase the amount of time you spend in deep sleep, which is a sleep phase that helps improve immunity and manage stress. Also, when you exercise and use a lot of energy earlier in the day, your body feels ready to go to sleep by nighttime. The benefits can be even greater when exercise is a regular part of your schedule!

  • Time management is key: School can be stressful, especially with what feels like never-ending work. Experts suggest to section your work into chunks of time during the whole day, such as the extra time you have between two classes or the time you have before a meeting. This may help with efficiency and finishing your work before your bedtime.

  • Do not nap too late in the day: Napping after 5:00pm makes it harder to fall asleep or stay asleep at night. Also, make sure that your naps are short! Long naps can have you feeling groggy while waking up, or affect your sleep quality at night.

Let us know if you have any additional tips you would like to share!

Disaster & child health in the wake of Hurricane Florence

Hurricane Florence hit the shores of North Carolina, South Carolina, and Virginia a little less than two weeks ago. While the storm has passed, the damages are daunting. Recovery from the disaster will take immense efforts in certain areas, given some homes and businesses experienced massive flooding. But the hurricane didn’t just impact  physical infrastructure—amidst recovery conversations, it’s important to bear in mind the toll natural disaster takes on mental health and emotional well-being as well.

In a recent Atlantic interview, Shannon Self-Brown, the chair of health policy and behavioral science at Georgia State University’s School of Public Health, explained children are particularly at risk of developing lasting emotional trauma from natural disasters because they might not be old enough to understand why the event happened specifically to them. Studying the impacts of Hurricane Katrina, She and her colleagues found that 71% of the 426 children were resilient, showing no signs of Post Traumatic Stress Disorder (PTSD) like hyperarousal or reexperiencing the event in their heads. 25% of kids showed temporary signs of PTSD, meaning the symptoms went away within 2 years, and the remaining 4% of kids studied had signs of chronic PTSD. Unsurprisingly, increased exposure to the hurricane correlated with worse PTSD outcomes. Good social support, on the other hand, correlated with more resiliency.

But establishing good social support—meaning an active and strong peer group—after a natural disaster can prove challenging for families that have been displaced. Often, by encouraging experience-sharing and establishing routines, this is where educators can play a role, even for children who have had to change schools.

In applying other aspects of her research to the present aftermath of Hurricane Florence, Self-Brown recommended opening up a dialogue with kids about the disaster and what happened. This can be done in a number of ways, like coming up with a song, drawing a picture, writing a story, or having a simple conversation. If behavioral changes are occurring in children under the age of 4, Self-Brown notes caretakers should self-evaluate for stress of their own. Toddlers repeatedly acting up can be an indication they sense Mom isn’t doing okay.

The stress of dealing with an unexpected disaster cannot be overstated. Family upheaval affects even the youngest family members, who don’t necessarily understand the nitty gritty of, say, insurance coverage. Other resources for coping with hurricane recovery can be found on the National Child Traumatic Stress Network’s website, and more general information is posted on affected states’ department of human and health services websites.

Are toddlers more similar to adults than we realize?

The Millennial generation has inspired a number of names over the years, from Generation Y to Trophy Kids. The term ‘Trophy Kids’ comes from a common conception that millennials are spoiled, entitled, and seek acknowledgment as “winners” from a young age just for participating in an activity. Many older generations believe that children should only be rewarded for achieving a goal through hard work, and that kids will not learn this value if they are awarded medals for “just showing up” every time. In contrast to this belief, recent research shows that children from a young age may not favor all types of “winners”, but rather individuals that “win” using appropriate means.   

A recent article in NPR describes how young children are similar to adults in that they notice social ranks. In the 1970s, research at daycare centers showed how young children form social hierarchies as early as 18 months old. New research from Harvard and University of California, Irvine demonstrates how toddlers specifically favor “winners” that are dominant yet win fairly.

In one study, toddlers were shown two scenarios in which two puppets crossed a stage to opposite sides and bumped into each other mid-way. In the first scenario, when both puppets bump into each other, one puppet yields and allows the other puppet to pass to reach its goal on the opposite side of the stage. In the second scenario, when both puppets bump into each other, one puppet pushes the other one out of the way and continues moving to the other side of the stage. Toddlers tended to favor the puppet that “won” the scenario when the other puppet gave way. The toddlers did not prefer the puppet that “won” by using force to push the other puppet out of the way.

The research described above provides evidence on how most individuals, toddlers and adults alike do not favor bullies or people who put others down in order to achieve success. One scientist hypothesized that as we created communities and adapted to living with other humans thousands of years ago, the way we socially interact may have become wired in us. Who knew that toddlers could be just like adults!

The costs of pursuing an American tradition: Long-term risks of football injuries start in youth leagues

From youth leagues to the NFL, fall in the United States brings the beginning of football season. American football has been around for centuries and keeping people active since its inception. Not only is it a great source of exercise for kids, it also builds on skills like teamwork which apply both on and off the field. For some young athletes, it’s their ticket to college admission and/or scholarships. However, like many recreational activities, playing football carries risk of injury. In the past decade,, a growing body of research (reported in the New York Times) has been linking football to Chronic Traumatic Encephalopathy, or CTE.

CTE is a brain injury resulting from repeated blows to the head—not just concussive blows, but any “closed-head impact injury.” This means football players may be developing CTE despite showing no signs of brain trauma, like concussions or even headaches. Once CTE progresses to a certain point, symptoms like memory loss, confusion, depression and dementia arise. Notably, these symptoms can begin years after the hits to the head have stopped. And the risk is clear: when Dr. McKee, a neuropathologist and director of the CTE Center at Boston University, examined the brains of 111 deceased NFL players, she found evidence of CTE in 110 of them.

Moreover, CTE does not solely affect professional football players. A Boston University study found that starting tackle football before the age of twelve was associated with emotional and cognitive problems later in life. In response, football league leaders have changed some of the rules for youth leagues, including decreasing the number of players on the field and, in some regions, promoting flag-football (a version with no tackling and much fewer hits to the head).

Given these findings on CTE, some scholars outside the football world have gone so far as to suggest football be outlawed. Of course, this brings up debates about individual autonomy and the right to participate in activities which put health at risk. Dr. Lee Goldstein, another lead CTE researcher at Boston University, told his high school football-playing neighbor: “I know I might not stop you, but I feel like education [about the risks of football is] the most important thing here.” As much as he had hoped his neighbor would stop playing football after learning about CTE, Dr. Goldstein understood that the issue was not so cut-and-dry.  

Football is deeply ingrained into some American families. It’s not just a recreational sport: it’s their social world, and it contributes to their livelihoods. The New York Times reports, “Education in America is widely seen as a path to success, but all kids don’t have access to the same paths. The system is girded by property taxes, leaving residents of poorer neighborhoods with underfunded schools.” For kids in these neighborhoods, football can provide an alternative “path to success,” fostering social mobility where public education is failing. Dr. Goldstein just aims to make sure football players and their families are informed participants, but, ultimately, until other structures like America’s public school system are repaired, poorer and minority students may continue to take on football’s risks (even when well-informed).

Football has a distinct hold on American culture, but we should pay attention to the growing research on its potential risks for young adults. We’ve provided an overview of the CTE issue, but we encourage families (especially families who participate in football) to seek additional information on the risks of CTE online or from a physician.

The importance of addressing perinatal depression

During pregnancy, expectant mothers may worry about high blood pressure, miscarriage, or any illnesses that could impact the baby. However, many mothers are often surprised by a different kind of complication called perinatal depression, a condition common among many pregnant and new mothers that can last up to 1 year after a baby’s birth.

Prominent celebrities such as Serena Williams have recently detailed their struggles with perinatal depression and the lack of discussion on the topic. Recently, the U.S. Preventive Services Task Force released recommendations on this issue, asking physicians to screen for new mothers and pregnant women that “are at risk of becoming depressed.” The screenings are important considering that approximately 1 in 7 pregnant women and new mothers are depressed during pregnancy or within a year after giving birth. For young mothers and mothers at the lower end of the socioeconomic spectrum, as many as 1 in 3 women are at risk for perinatal depression.

Depression during or after pregnancy not only impacts the mother, but also the child and the entire family unit. Studies have shown that perinatal depression is linked to premature birth, babies with lower birth weight, and also cognitive delays for children. In severe episodes of perinatal depression, mothers may even become suicidal or harm herself and the baby.

What makes perinatal depression so difficult to prevent in our healthcare system? First and foremost is access to care. Generally, cities have better access to mental health care services compared to rural areas. In addition, many OB-GYNs are not properly trained to treat perinatal depression. Most only know how to screen and diagnose for depression, however the physicians may not have the necessary skills or easy access to psychiatric services to address mental health complications that come during and after pregnancy.

Certain states like Massachusetts have established programs to increase access to psychiatry services for new mothers. However, such programs are not established in many states yet. Due to a lack of state sponsored programs, it is important for women to discuss with their doctor during their pregnancy about the possible complications of depression, especially if they have a history of anxiety, depression, or other mood disorders. It is also important for new or expectant mothers to surround themselves with a solid support system in the case they experience unanticipated depression. Hopefully, the recent focus on perinatal depression in the news can be leveraged to start new preventive initiatives across the country, or at the very least, open dialogue between healthcare professionals and new mothers.

California makes restaurant kids’ meals healthier, puts children’s health first

On Tuesday, California became the first state to pass explicit legislation holding restaurants more accountable for children’s health. The new law, referred to as the “healthy kids’ meal bill,” requires that restaurants include healthy beverages like milk or water as the default with their kids’ meals. Though children or their accompanying adult(s) may still request to substitute the child’s default drink with a more sugary alternative like juice or soda, policymakers hope this menu change will reduce kids’ consumption of unhealthy drinks at restaurants. This change comes after six top chain restaurants—including Wendy’s, McDonald’s, and Dairy Queen—already have taken soda off their kids’ menus altogether.

This kind of legislation had started in several California localities before becoming state law. Right now, other cities like New York City, Baltimore, and Louisville are considering implementing a similar bill. California’s precedent sends an important message to beverage industries, which have previously lobbied against public health measures that potentially threaten sales: “the movement to address sugary drink consumption and protect public health marches forward,” the Center for Science and Public Interest reports.

 

The notion that requiring “opting-out” of a default healthier choice will lead to more of its use than requiring “opting-in” is not new. In fact, behavioral economists have long studied this type of subtle nudging, and it already exists in many legislations around us. For example, schools expect enrollees to have received certain immunizations before the start of classes. Of course, students can receive exemptions from this stipulation, but if these immunizations were optional altogether, then schools would see many fewer students getting their shots than they do under the current “opting-out” scheme.

California’s new policy shows the state’s commitment to improving children’s health. If previous “opting-out” laws are any indication, their “healthy kids’ meal bill” will be able to reduce aggregate sugary drink consumption, while still ultimately preserving consumer choice. This is only one small step toward encouraging healthier diets for kids, but it is a step forward nonetheless.

France bans smartphone use in schools: implications

Recently, France enacted a law that bans young students, ages 3 to 15, from using smartphones at school. The law was introduced to address phone addiction for children, and to encourage children to be active and interact more with each other, rather than stare at a screen. Although schools can enact the ban in how they deem appropriate, students are still required to turn their phones off or leave them at home during school hours. There are also some exceptions to the rule. Students with disabilities can use technological devices if necessary, and instructors can still use technology for educational purposes.

France’s law is not the first to address the issue of phone addiction. New York City previously banned smartphones in public schools for eight years. However, the law was overturned in 2015 due to parents complaining about the difficulty of contacting their children if necessary during school hours. In addition, multimedia companies like Apple and Google have introduced new initiatives to address the addictive nature of smartphones. Parents can now monitor their child's phone use through Apple’s Family Sharing and Google Play settings.

It seems that with this measure, France does not want personal technology use to overtake children from having a “real” childhood during school hours. It is also laudable that the French government views it as a “public health message”, since according to the American Academy of Pediatrics, screen time and exposure to digital media should be minimal for children. Previous studies have indicated how teens addicted to smartphones show less attentiveness and higher levels of insomnia, impulsiveness, anxiety, and depression. In addition, a 2016 survey by Common Sense Media showed that roughly 50% of teens “felt addicted to their devices” and 72% of teens “felt pressured to respond immediately to texts, notifications and social media messaging.” The ban seems promising, however it will be interesting to see how France balances their smartphone ban with parental needs, and whether schools, cities, or states in the U.S. follow suit.

What’s children’s health got to do with criminal justice reform?

Much of the recent discourse on criminal justice reform centers around incarcerated individuals themselves and the crimes that put them in prison. The impact of imprisonment on inmates’ families, however, often flies under the radar. Dr. Nia Heard-Garris of Northwestern University and her team recently took a closer look.

In their study published by the American Academy of Pediatrics last month, Heard-Garris et. al. use a survey to determine the effects of mother and/or father incarceration on adolescent health. They find associations between parent incarceration and forgone medical care and prescription drug abuse. Since caregiving responsibilities are likely to shift when a parent begins a prison sentence, these correlations make sense. Disruptions in what used to be regular doctors’ appointments become the new normal. Mother incarceration, specifically, correlates with a higher number of emergency department visits by her child(ren). This is a problem as emergency rooms aren’t meant to be sites for primary care. It also could indicate children of incarcerated mothers (or their new caretakers) are too often waiting until their ailments become absolutely urgent before seeking care. Father incarceration, on the other hand, correlates with illicit injected drug use by his child(ren).

Given the U.S. has the highest incarceration rate in the world, and nearly 60% of incarcerated adults in the U.S. are parents to minors, these findings are extremely significant. Notably, Heard-Garris et. al. limited the definition of parents in their study to biological father and mother, suggesting that the impact may be even greater if imprisonment of any primary caregiver were studied.

The study highlights how problems of the criminal justice system extend beyond just convicted felons. Furthermore, young black adults in the survey experienced disproportionate rates of parent incarceration, raising concerns about the community experience of parent incarceration (in addition to the individual impacts the study evaluated). For example, what does it mean for a child to experience parent incarceration alongside many his friends also experiencing parent incarceration? The authors’ research underscores the importance of considering the children of convicts amidst critical conversations on criminal justice reform.

Coverage for transition-related healthcare may be in trouble for transgender youth

In 2015 and 2016, new anti-discrimination federal rules required insurance plans to cover preventive services for transgender and gender non-conforming youth, in addition to prohibiting plans from denying insurance and service coverage for transgender youth. The expansion and victories for transgender-based rights during this period were momentous, however recent national discussion to remove the anti-discrimination laws is worrisome.

The number of transgender children and youth is rising, as seen by the increase in individuals seeking care for gender dysphoria. Gender dysphoria is defined by the American Psychiatric Association as “a conflict between a person’s physical or assigned gender and the gender with which he/she/they identify,” which can often lead to feelings of strong discomfort and distress. Gender nonconformity (or gender expansiveness) is not the same thing as gender dysphoria, as gender nonconformity relates to “behaviors not matching the gender norms” of an individual’s gender assigned at birth.

Research shows how transgender-based youth are high at risk for self-harm, depression, anxiety, substance abuse, and other mental-health concerns, with many also facing harassment and discrimination in every-day life. Utilizing gender-affirming healthcare such as hormone therapy, puberty-blockers, or gender-reassignment surgery can minimize the challenges many children, youth, and adults face, providing a better quality of life. This fact is what makes recent policy shifts more troubling.


NPR recently featured an article about one particular youth who initially lost coverage for a gender-reassignment operation in Wisconsin, when the state’s Group Insurance Board voted to “exclude coverage for gender reassignment or sexual transformation” for state employees. The  decision came during the recent national rhetoric of many socially conservative politicians calling the 2016 anti-discrimination rule “unlawful”. Although the youth was ultimately able to get her surgery by striking a deal with her hospital to pay about $20,000 upfront, many people may not be able to afford this privilege. There are more stories out there of children and youth facing difficulty with transgender-based insurance coverage and experiences in the healthcare setting. It is imperative that policymakers and local and national officials realize the negative consequences of discriminatory national discourse and policy changes for the mental, social, and physical health and wellbeing of transgender-based children and youth.  

The Benefits of Breastfeeding

Earlier this month at a United Nations assembly, the Trump administration’s delegate opposed a resolution encouraging breastfeeding. This has re-sparked some decades-old debates on breastfeeding versus formula and the strong arm of the baby formula industry, both in the United States and globally.

CHIL has looked to the literature on breastfeeding, which informs international maternal-child health policy like the World Health Organization and UNICEF’s recommendation of exclusive breastfeeding for the first 6 months after birth (their recommendation, of course, is directed toward women for whom breastfeeding is an option). Here’s what we’ve found:

  • A history of breastfeeding correlates with “a reduction in the risk of acute otitis media, nonspecific gastroenteritis, severe lower respiratory tract infections, atopic dermatitis, asthma, obesity, type 1 and 2 diabetes, childhood leukemia, and sudden infant death syndrome” among babies

  • The correlation between breastfeeding and reduced obesity risk carries into the child’s adulthood

  • Breastfeeding is associated with higher intelligence and cognitive ability in children

  • Mothers who breastfeed experience reduced risk of type 2 diabetes, breast, and ovarian cancer

  • Breastfeeding saves families money

Note that most of these findings show correlation, not causation, and may have confounding influences like family income or education level. Nonetheless, given all of the positive incentives for children and mothers, CHIL follows global health organizations in encouraging breastfeeding for women able to choose. For mothers unable to breastfeed, whether due to physical or lifestyle constraints, formula certainly can be a strong alternative offering convenience and variety. Be sure to discuss your feeding options with your OBGYN and/or your child’s pediatrician. Additionally, there are abundant resources online to help guide formula selection.

 

What we can teach our children about the environment

A recent article in the Philly Voice discusses the value of teaching our children to be eco-friendly, and how respecting our planet can lead to healthier surroundings and families. However, “being green” can be expensive. Underserved communities may not be able to prioritize green living as a result, although they still bear a large burden from environmental degradation. Even small steps can help communities move towards more sustainable living, and families can still be friendly and conscious of the environment on a budget. We have compiled a list of easy things parents and children from all walks of life can learn and do to live a greener and healthier life.

  • “Reduce, reuse, recycle” -- Whether it be getting takeout food with your own reusable containers, using hand-me-downs, or recycling boxes and bottles; these are all great habits to teach your kids and practice yourself. Even setting an alarm for showering or other types of water or electricity consumption can be helpful to make these actions eventual habits! New York City and Philadelphia also provide information on recycling spots in different neighborhoods. A simple Google search for other communities may help you find out where you can recycle and when your neighborhood recycle collection days are!

  • Rethinking Plastic -- Buy some cheap cloth bags that can be used when going grocery shopping, instead of receiving plastic bags from the market. Even this small gesture can make a huge difference in the way families consume plastic.

  • Parks & Beaches -- In some of our previous blog posts, we’ve discussed the value of taking children outdoors and keeping their brains occupied, especially during the summer. Trade in a movie marathon one day for a walk in the park.

  • Walk, Bike, Carpool, or Use Public Transportation! -- Not only can these options be cheaper than using a car, but they also reduce the amount of toxins or greenhouse gases released into the air. Encourage your children to do the same, and teach them the value of eco-friendly transportation options!

  • Back to the Basics -- Practicing the following habits at home and teaching them to children can go along way in living a greener life:

    • Use both sides of paper in notebooks and for school homework

    • Turn off the lights when you leave the room

    • Don’t keep the faucet running while brushing your teeth or washing the dishes

Parents can also encourage their kids to grow vegetables or fruit of their liking inside or outside of the house, or go to a local library to check out books about environmentally friendly practices like The Lorax by Dr. Seuss. There are plenty more ways to learn and practice living a greener life. Check out this website for more tips!

Persisting pregnancy discrimination hurts health of mothers, children

Last month, the New York Times published an article entitled “Pregnancy Discrimination Is Rampant Inside America’s Biggest Companies.” Authors Natalie Kitroeff and Jessica Silver-Greenburg had interviewed several women regarding their experiences in various workplaces. Their findings are troubling.

One woman, whose job at Walmart involved lifting heavy boxes, informed her boss that her doctor advised she perform light duty for the remainder of her pregnancy. When her boss dismissed the doctor’s orders, the woman had to choose between regular 50-pound lifting and a paycheck. She had to choose between putting her baby’s life at risk or putting her family’s livelihood at risk. She continued the heavy lifting. Towards the end of her pregnancy period, after inquiring about maternity leave, she was laid off. Walmart would “no longer be needing [her] services.” She remained unemployed for an entire year.

This type of pregnancy discrimination threatens both the health of the mother and the life of her unborn child. Moreover, pregnancy discrimination across industries indirectly hurts children by compromising the income of mothers (or future mothers). Given the health care and living expenses of raising newborns, new mothers especially cannot afford to be unemployed (and perhaps without health insurance) long-term.

Even for women working in offices and without direct, physical danger to their babies during pregnancy, their professional progress is hindered. The NYT reports each child reduces mothers’ hourly wages by 4%. At the same time, fathers’ wages increase by 6%. This subtle discrimination reinforces traditional gender roles: Mom is the primary caregiver; Dad’s career comes first. These norms are passed on to children as they observe their working parents. And families without the nuclear mother and father—single mothers, lesbian mothers—may not receive the family salary boost statistically awarded to fathers.

This report illuminates the persisting structural sexism within the professional world, and the risks it imposes on the health of women and their children. While legal battles may help some individual families, the comprehensive, long-term solution for families lies in a broader culture shift away from the unfair bias against pregnant women and mothers in the working world. CHIL encourages readers to stand up against pregnancy discrimination in your workplace, and actively set an example of treating the professional abilities of mothers equitably—for both your coworkers and children.

More than what we see: the role of fathers in the wellbeing of children

This past June 17th, Father’s Day was celebrated around the country and globe. Even with a day dedicated to commemorating fathers, we often overlook the crucial role fathers play in the development of their children, beyond what is conventionally considered or is traditionally applied to mothers.

In any type of family, traditional or nontraditional, the family unit involves teamwork in a child’s upbringing regardless of who raises the child. For those families with a father present, recent research showcases that the involvement of a father in his child’s life can have a large impact on the child’s diet, discipline, and exercise, among other aspects of the child’s immediate well-being. More engaged fathers can also affect long-term development of children, such as improving self-esteem, enhancing performance in school, and leading to lower rates of depression, anxiety, or teenage pregnancy.  

This does not mean that a father’s involvement in his child’s life is required to be of the same nature as a mother’s. A father can occupy his own “unique role” in a child’s upbringing, different from the mother’s--in fact, recent studies show that the way mothers and fathers interact with a child stimulates “different parts of a child’s brain.”

For many fathers, it can be difficult to be highly involved in a child’s life, especially in a country like the United States, where most states and companies do not provide paid paternal leave. In fact, the United States is the only country in the industrialized world that has no paid family leave for mothers or fathers. This can make it especially challenging for fathers to spend quality time with their children after birth, or even cope with the stressors that afflict many families after welcoming a new child. For instance, many new fathers face similar challenges to new mothers, such as gaining weight or experiencing depressive symptoms after the birth of a child.

However, countries like Sweden are trailblazers when it comes to addressing these issues. Sweden has sought to increase the involvement of fathers in family roles and improve gender equality by legally providing 480 days off from work (to be shared by both parents) for each child in their home. The goal of such policies is to improve “social benefits” while also allowing women more freedom to “become more active members of the workforce.” Paid family leave is the norm in Sweden--many Swedes claim that it can even be looked down upon if a father does not take days off from work after the arrival of a new child. Regardless of whether such policies will eventually come to the U.S., one thing is for certain--in families with dads, fathers play a more crucial role than we realize.

CHIL’s Guide to Community Health Clinics

In CHIL’s blog post last week, we mentioned Mary’s Center, a community health clinic in Washington D.C. This week, we want to emphasize that clinics like this one are available all over the nation. In fact, there are about 1,400 community health clinics (CHCs) in the U.S. While undocumented immigrants and Dreamers are ineligible to enroll in the federally-subsidized health insurance plans provided via the Affordable Care Act, CHCs often offer a good alternative for anyone seeking affordable health care—both citizens and non-citizens alike.

Additionally, these clinics do not operate under any low-income or insurance coverage eligibility requirements; that is, a family with a working parent covered by some form of health insurance is welcome at places like Mary’s Center, too. Medical costs in the United States’ largely privatized system indeed can be overwhelmingly burdensome, even for people with steady employment.

So, how do CHCs operate? What services do they provide for individuals and families, and at what cost?

CHCs are nonprofits that receive funding from a myriad of sources including federal, state, or local grants and/or Medicaid payments. Some may partially rely on private funding sources as well. Because several institutions finance each CHC, in most cases, this provides the centers with a safety net. If one funding source is compromised—something common in the U.S. as administrations shift—CHCs have other means to remain afloat.

In order to qualify for public funds, CHCs must:

  • Be located in a medically underserved area or serve medically underserved populations (determined by the federal government)

  • Provide comprehensive primary care

  • Adjust fees according to a sliding scale based on patient income

  • Be governed by a community board, of which at least 51% of members are patients of the CHC themselves

Apart from providing comprehensive primary care, CHCs may address local needs like care in foreign languages or medical translators (for which their local community board can advocate). Another example is Mary’s Center partnership with Briya Public Charter School. Briya holds classes at Mary’s Center, providing an educational space for both parents and their children. Briya’s model works well for teenage parents who otherwise may have had to forgo public education. They also offer a counseling and educational group for (future) parents to attend throughout pregnancy; a program called "centering." These two programs are particularly useful for the areas Mary’s Center serves, where there are many young families.

The localized care many CHCs provides sets them apart from other medical facilities and makes them integral to the health of thousands of children living in the U.S. today, particularly living in vulnerable and underprivileged families. If you or your kids are in need of affordable health care, CHIL recommends looking into your local CHCs for medical services. This search tool can help: https://findahealthcenter.hrsa.gov/.

The detrimental and lingering effects of migrant family separations

In the past couple weeks, immigrant officials at the U.S.-Mexico border have separated migrant children from their parents, prompting national outcry. Despite the signing of an executive order last week to halt the practice, evidence shows that trauma from separation can persist in a child, even after reuniting with their parents.

Children are susceptible to the same stress response as adults. However, not having a parent to comfort or alleviate their stress can cause harmful and sometimes irreversible effects. Their immune systems may become weaker and less able to fend off infections. In addition, the stress response in children can induce long-term effects such as post-traumatic stress disorder (PTSD), depression, or substance abuse.

Some migrant children are able to join foster parents; however, many others are held at detention centers across the country. The detention centers’ ability to provide support to children is often complex and ambiguous, due to strict rules sometimes limiting physical contact between staff workers and children. Although children crossing the border in the past couple years were predominantly adolescents, many children detained recently are younger than age five and  have very different needs. In addition, even if placed with foster families, children with trauma display abnormal behavior for their age, such as crying constantly, having separation anxiety, and being unable to leave their foster parents’ side. It surely does not help that some of these children are also fleeing violence in their home countries, facing residual trauma from those experiences as well.

A recent executive order now allows families to be kept together when taken to detention facilities at the U.S. border. Moreover, a recent court ruling requires previously separated minors to be reunited with their families within thirty days by U.S. officials. Of utmost importance is the provision of mental health services to migrant children--not only to those separated in the past month, but also those crossing the border today, with or without family. Programs like the Mary’s Center in Washington D.C. work toward this goal, by providing therapy and assisting migrant children in schools. However, public services to aid undocumented individuals are oftentimes limited in the U.S. In addition, many undocumented individuals may find it difficult to seek help due to fear of retaliation. Given the adverse health effects migrant children may face, efforts to alleviate the long-term traumatic consequences of immigration on inculpable and vulnerable minors is imperative.