Childhood

CHIP CHIP Hooray!

Last week was an exciting one for children’s health. After a harrowing few months of uncertainty over the fate of the Children’s Health Insurance Program (CHIP) — the very important federal children’s health insurance program which covers about 9 million children nationwide — Congress agreed to reauthorize CHIP for another six years. You can read about this fantastic news here at NPR.  

 

We will continue to monitor this big news to examine more closely what this means for children’s health and access in the immediate future. The past few months should have taught us that we should not take the program for granted. After all, the fact that CHIP — an “uncontroversial” program throughout its 20-year history — faced such an existential crisis is an indication of our current political climate. According to NPR, CHIP, which needs to be renewed every few years, was historically a bipartisan priority that legislators worked to renew far in advance. Researchers are still working on finding the impacts of children’s enrollment rates with CHIP within these months of uncertainty.

 

Some analysts say that extending CHIP for 10 years instead of six would save the federal government much more money, but this deal is still a solid one. Also, one analyst suggested that the national anxiety over CHIP might have brought more attention to it in the long run. More people can now be aware of the program and what it does (and possibly be encouraged to enroll), and more people can communicate to lawmakers about the importance of keeping the program alive. States can also start brainstorming safeguards for future use, just in case we are faced with a similar situation in the future. The role of states is especially important since CHIP is based on an architecture of shared responsibility between the states and the federal government.

 

CHIP is the sort of program that we may not have heard enough about if not for events such as the most recent budget crisis. It is, however, a very important source of health insurance for many American children. On his show, host Jimmy Kimmel explains a bit more about CHIL and its significance to his family. As we celebrate the most recent news, we should look ahead and start planning for CHIP’s future, so that we don’t repeat history.

The Parent's Role Amid a Sea of Opinions

A few weeks ago, we wrote about the significance of the language we use when we talk with children about weight. The words that parents and doctors use can have a great impact on how children and teens think about, or perceive, their weight and overall health.

 

Recently, the New York Times published an article by a physician titled, “Do Parents Make Kids Fat?” This rather startling question can be thought of as an extreme example of the influence parents could have on their children’s weight and how they think about weight.

 

The first thing the article pointed out was the “tremendous stigma” we direct at parents of overweight children, whether we intend to or not. As Dr. Julie Lumeng at the University of Michigan, who was interviewed in the article, puts it, “‘Everyone looks at the parent and thinks: That parent is incompetent. They don’t care about their child. Why can’t they just make the child eat less and exercise?’”

 

These questions illustrate several assumptions people may easily make about parents of overweight children. For example, people may think that the parents do not care about their children’s health, or they simply lack the willpower to enforce healthy habits at home or read the nutrition information on the back of food packages.  However, we simply cannot make these assumptions without knowing the full story of a child’s health. This involves family history, health history, and degree of exposure to what doctors today call an “obesogenic” environment in which unhealthy fast food is more accessible and cheaper than healthy food made from scratch.

 

There are many different opinions out there about how to raise healthy children, and while there are general guidelines that indicate what healthy weight ranges may be, different families and children need different things. The physicians mentioned in the article, who even consult each other with questions, agree that a parent must trust their instinct when it comes to their child. Being mindful about the child’s environment can help with this instinct.

 

This is where our campaign with eMindful can be helpful - through increased awareness of our circumstances, we can make healthier decisions for ourselves and for our children.

Consequences of Sugar, Even Before Childhood

We often hear just how bad sugar is for your health. We also know that limiting sugars in children’s diets - in drinks and desserts, for example - is probably a good idea. Furthermore, a recent Harvard study has found that high sugar consumption (particularly fruit sugars and sugary drinks) during pregnancy might lead to increased asthma risks in their children, according to the New York Times.

 

The study builds on existing literature that links “obesity and poor [nutrition]” to “current increases in childhood asthma.” In the study, researchers tracked more than 1,000 women during their pregnancies and looked at their children’s asthma diagnoses by the time they were 3 to 7-years-old. The women who consumed the least amount of sugar in the study had 21 grams per day on average while women who consumed the most amount of sugar in the study had 46 grams per day on average. Researchers also collected data on the mothers’ education level and pre-pregnancy body mass index (BMI), as well as children’s BMI and race.

 

As a result, they found that the children of women who had the most sugar were 58 percent more likely to have asthma than the children of mothers who had the least amount of sugar during pregnancy. A lead author of the study noted that the mechanisms behind this difference is still unknow; however, the idea that a mother’s diet during her pregnancy could impact her children’s health years later is very important.

 

Once a baby is born, environmental and hereditary factors may influence the baby’s future health. Yet it seems that in some respects, prenatal environment may also contribute to children’s long-term health.






 

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.

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.

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.

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.

Children's Health, Today and Now

The New York Times wrote a piece looking back on the accomplishments and frustrations of Dr. Irwin Redlener, one of the founders of the Children’s Health Fund, who is stepping down from his administrative position this week.

 

Dr. Redlener’s team began the Children’s Health Fund in 1987 as a response to the poverty he saw in NYC. Today, it has more than 50 mobile pediatric clinics nationwide, and it is an important model for other initiatives in urban areas where poverty and systemic inequality endanger the health of children. Dr. Redlener lived his life to his word when he said, “life and work are based on a simple message: Kids can’t wait.” He points out that the consequences of failing to address a child’s health needs at each stage of development are real and irreversible. For example, failing to treat a child’s ear infection with antibiotics - a relatively simple thing to do - can lead to hearing loss in the long run, which is both a personal disability and a societal cost.

 

In NYC, the number of children living in city shelters have doubled since 1986. According to the New York Times, there are about 22,000 children living in city shelters today. This statistic has grave implications for children’s health. If these children do not have homes, their nutrition, education, and immunizations are all at risk. Economic factors have worsened the housing situation in NYC for the poor over the past few decades, and society has not come up with sufficient mechanisms to compensate for that.

 

Instead, at the national level, lawmakers seem determined to chip away at the existing social safety net even further in cuts to Medicaid under the proposed healthcare bill. Dr. Redlener told the New York Times that such cuts would leave children in more danger than ever during his career of over 30 years. He said that politicians have certainly frequently debated the parameters of what Medicaid would cover, but to gut the program as it is now being proposed had never entered the picture.

 

It is clear that we are at a critical juncture for the future of children’s healthcare, especially for children living in urban areas. Prioritizing the health of children today means preserving the societal health of the future.

 

To learn more about Dr. Relener and his work, read the full New York Times article. You can also read his upcoming book, "The Future of Us: What the Dreams of Children Mean for Twenty-First-Century America,” which will be published this September.

Healthcare Costs and Exercising Children

An article in the New York Times describes a new study that used complex models to imagine what the health landscape of American children would look like if children exercised every day. The study found that the United States could save more than $120 billion a year in healthcare costs alone if all children exercised every day.

Researchers at the Global Obesity Prevention Center at Johns Hopkins University used computerized models that created avatars for each of the 31.7 million children in the United States currently between eight to 11-years-old. In keeping with real-life statistics, they programmed two thirds of these children to rarely exercise. The researchers then modeled each child’s calorie intake and “virtual body change” day by day, year by year, and tracked these simulated childhoods into adulthood. After these avatars reached adulthood, their health was modeled based on the predictive risk for heart disease, stroke, high blood pressure, etc.

The results were sobering. The models predicted that if eight to 11-year-olds were as inactive as predicted almost $3 trillion in medical expenses would be spent on this population. Furthermore, they would have lost productivity each year once they reach adulthood.

Even if this estimate is not perfectly precise, it is undeniable that the social price tag of physical inactivity is significant - inactive kids will grow to be sedentary adults whose health problems are not only expensive to treat but also cost the economy in lost wages and productivity. Childhood obesity and Type 2 diabetes are only some of the many risks associated with a lack of exercise.

The same researchers also looked at the counterfactual and model of  how society would benefit if these children did exercise regularly. If half of the children in the U.S. were able to receive at least half an hour of exercise three times a week (the recommendation by the Centers for Disease Control and Prevention), childhood obesity would fall and the societal costs of obesity-related disease would drop by $32 billion. 

The numbers are undeniably compelling. The societal burden of disease stemming from lack of exercise would impact us all, regardless of how healthy we imagine ourselves to be. Today’s adolescents live with an unprecedented amount of distractions that might make physical activity seem less appealing, but getting proper exercise is not only a short-term benefit but also a long-term investment.

Water Quality in NYC Schools

A recent article in The New York Times reports that new lead testing in New York City schools reveals that many schools have lead levels that are higher than those recommended by the Environmental Protection Agency.

 

After high lead levels were exposed in Flint, Michigan, New York City officials were prompted to check lead levels in schools. However, the first round of testing was considered illegitimate after it was revealed that officials had run water for hours before testing the water for lead, a process called flushing that can artificially lower the lead levels in water.

 

Eighty three percent of school buildings in New York have at least one outlet with a lead level above the threshold of 15 parts per billion. Two school buildings in Queens had some of the worst results: in one school with 1,500 students, 34 outlets had levels above 15 parts per billion.

 

The New York City Department of Education (NYCDOE) responded quickly, sending home letters detailing these results and pledging action. NYCDOE has turned off outlets in question and will not be turning them back on until their levels are found to be under the threshold.  The potential impact of this finding cannot be overstated. It reflects a deeply ingrained system of negligence in the largest school system in the United States (over 1.1 million students attend more than 1,800 schools in New York City).  Despite a gradual decrease of children lead poisoning cases in New York City over the past decade, a problem of this scope shows that the tragedy of Flint is not unique to one particular city.

 

Children are a vulnerable portion of the population when it comes to environmental hazards. They spend their childhood in old school buildings with other students and teachers and will suffer consequences if lawmakers or officials shirk their duty to protect them. Parents are also left similarly helpless if a school system, as large as New York City’s, does not work to maintain the health of its students.

 

Thankfully, this detection occurred before cases of lead poisoning led to tragedy. Perhaps New York is indebted to Flint in that respect. Hopefully, New York City can set a model of decisive, proactive prevention of lead poisoning for future cities and school districts.  In the meantime, it is important for parents to stay involved and informed of their children’s health at school, and for parents to work with schools in order to provide the best possible learning environment for young students.

Securing a Good Start to Education

Today’s topic addresses one that may seem obvious to us, but also surprising in the United States. Children who grow up hungry in the first few years of childhood have been shown to lag behind classmates in school years later. Food insecurity, or being without reliable access to nutritious food, is a phenomenon that can be found in the United States: more than 13 million children are currently living in food-insecure homes nationwide. A recent article summarized in NPR (originally published in the journal Child Development) found that children who live in these homes before the age of five are more likely to lag behind their classmates in school socially and cognitively.

 

Also, it appears that these children don’t catch up to their peers. Researchers used data from the U.S. Department of Education from 2000 to 2006 to follow more than 10,000 children born in these households throughout their young childhood. They also interviewed the parents of these children to ask them about recent times they may have worried about food for the household. The researchers found that the younger that children were when they were exposed to food hardship, the stronger the negative effect on their performance in kindergarten (performance was measured by their ability to pay attention in class, their tendency to be hyperactive or throw tantrums, and their math and reading skills).

 

This negative effect might not be entirely attributable to the children themselves. After all, if children are hungry, then their parents are likely to be as well. The researchers affirmed that parents who are hungry can be more irritable and tired, and are less likely to engage with their children. These findings are certainly not surprising, but they confirm some important facts about early childhood and the important link between nutrition, parent interaction, and school performance. It is difficult to design interventions for very young children before they attend daycare or preschool, but the projections from this stage in life to performance in school cannot be ignored.


Food insecurity is definitely not just a foreign phenomenon, and not just an adult one. That there are millions of American children at risk of being insufficiently prepared for school should shock us all - but thanks to this kind of research, we’ll be able to lay the groundwork for erasing this gap in potential for children starting now.

Navigating Sick Days

The question of whether or not a child should stay home when they’re feeling under the weather inspires a lot of varying advice. According to an article recently published in NPR, rules in elementary schools about when to keep a sick child at home are more liberal than those in daycare centers. Also, surveyors of 1,442 parents with kids who are 6 to 18 years old found that parents had different attitudes about their children missing school based on their children’s age.

 

Some common reasons cited by parents for keeping their kids at home included: diarrhea, a single episode of vomiting or a slight fever. Interestingly, parents of older children were more likely to worry about their kids missing tests at school than parents of younger children did, suggesting that tests and exams might complicate the stay-at-home decision for parents when their children are sick. My own parents definitely also strictly adhered to the “No fever? No skipping” rule.

 

Another important factor parents consider is how contagious they perceive their children’s conditions to be. Evidence on how contagious kids can be are less definitive in older school children since they are usually not confined in a single space all day with ill classmates. For younger children who are in daycare all day, however, they may be prone to stomach bugs, ear infections, and colds than young children who stay at home.

 

Different daycare centers may also have varying suggestions for parents when it comes to children’s attendance. Some daycare facilities may have guidelines that recommend children to stay at home even though their rules don’t always align with pediatricians’ suggestions. This can be aggravating especially if parents cannot stay at home with their sick children, or cannot bring their kids with them to work.

 

Sick days are something we all experience at one point or another growing up. Since there is little uniformity about what symptoms are considered severe or contagious, it’s challenging to find or apply one suggestion to all parents or all students. Keeping an eye out for further research is probably the best thing to do as we continue to adhere to healthy behaviors such as washing our hands, staying hydrated, eating nutritious food, and getting plenty of exercise.

Sunlight and Your Eyes: A New Link?

Here’s a quirky idea: computer and television screens can damage eyes because the lack of sunlight can reshape the eyes and impair vision over time, according to a growing community of researchers. A new article in the New York Times cites a study published recently in the Journal of the American Medical Association (JAMA Ophthalmology) that offers an explanation for the growing prevalence of myopia, or nearsightedness, especially in children and young adults.

 

Nearsightedness is a condition in which the eyeball is longer than normal, altering the angle at which light meets the eye, which can cause problems for people when focusing on faraway objects. It is a condition that really illustrates the debate between “nature and nurture” -- even if you develop it as a child, nearsightedness can progress as you become an adult depending on a complex calculus of genetics factors and the environment.

 

Volunteers were given eye exams and asked how much time they spent outside during their childhood. Researchers found a strong correlation between “current eyesight and lifelong exposure to sunlight.” It’s important to remember that this particular study was a survey and not an experiment where the researchers imposed certain conditions to, say, measure the effect of sunlight exposure on prescriptions for eyeglasses. The researchers observed a trend where those who had been exposed to the most sun as teenagers were less likely to be nearsighted in middle age.

 

The link is not necessarily a causal one, but the implications are clear. Despite the fact that excessive exposure to sunlight certainly poses its own dangers, such as the risk of skin cancer, a healthy amount of exposure can really be positively correlated to multiple aspects of health, including vision. The observed correlation between sun exposure and healthy vision only strengthens the case against excessive exposure to screens and monitors indoors. Moderation is key, but it looks as if we are still unlocking the many benefits the sun has to offer.

Picky Eaters and Their Families

We may often be quick to judge a child or their parents when we see a picky eater. Picky eaters can be perceived as unadventurous or a product of poor parenting skills. However, parents of picky eaters have more to worry about than social judgement. Pediatricians say that children who develop picky eating at an early age can have growth and development problems.

Parents of picky eaters have real reason to worry about their children’s proper intake of proteins, vitamins and minerals, and vegetables. After all, a child’s appetite is a major indicator of his or her health. Picky eaters are also hard to pinpoint because they generally eat as much as other children do, and they can also be thin or overweight. This means that even though they are probably not eating properly, they are getting their caloric intake in ways that are not nutritionally ideal. Parents look to pediatricians to reassure them that their child is growing at a normal rate, which is usually the case. However, in rare instances, doctors will test for developmental disorders like autism, gastrointestinal disorders, or food allergies. These abnormalities are definitely not the norm, but even the original issue alone - pickiness - can be a cause of major stress for parents.

Here are three tips that parents can do to alleviate picky eating habits:

  • According to Dr. Natalie Muth, a pediatrician interviewed for the New York Times, it’s important to expose children to new flavors even while their mother is pregnant and breastfeeding. It is ideal for children who are starting to eat solid foods (between 6 and 18 months) to have frequent exposure to many different foods at an early age.  

  • It’s ultimately up to the child to choose what to eat. Pediatricians recommend following a division of responsibility at the table: parents can provide diverse food choices and show that other family members, including other children, are trying different kinds of food.

  • Children who are learning about tastes may exhibit some sort of neophobia - fear of the new and unknown. They may be partial to eat “white foods” such as fried foods, breads, rice, and chips. Families who cater to children who are partial to these foods by giving them separate meals from everyone else in the household are actually encouraging picky eating.  In the New York Times article, Dr. Muth suggests that one family should eat one meal together. By eating one meal as a family, children can be eased into different types of food as they watch other family members eat the same meals.

Training young children at an early age to appreciate a variety of foods will help children develop healthy eating behaviors, therefore benefiting their health in the long run. Parents can help with children’s learning process by actively engaging with them to establish a dialogue about their food preferences. That way, parents can also encourage autonomy and responsible decision-making in their children by allowing them to make healthy food choices. The act of eating itself can be an activity for the family, and a way for a child to invest in his or her future.