Parents

Prioritizing Well-Being Over Stress

It’s important to motivate children and teens to succeed and do what they love, but a recent newscast in NPR talks about the risks of pushing kids too hard to do well. (The NPR newscast includes a 7-minute talk about this topic which you might find interesting!) It is not a stretch to say that students today feel immense pressure to compete against their classmates and friends to do well, and this stress can be a major contributing factor to anxiety and depression.

 

Some parents admit that they “totally bought into the idea” that their job is to push their kids to succeed and overcome obstacles. But if the pressure is too much, this effort can backfire. One high school in New York invited a psychologist to evaluate the student body using the Youth Self-Report, and found evidence of high levels of stress. This includes internalizing symptoms, or feelings of sadness, anxiety and depression; physical symptoms like headaches and stomachaches, and drug and alcohol use.

 

According to experts, substance abuse is actually something that affluent teenagers may use even more than inner-city kids, as “a form of self-medication” against the stress of high expectations to do as well as peers or parents.  This means that the need for conversation around mental health applies to inner-city and wealthy suburban schools alike.

 

Parents can play a huge role in promoting well-being as a priority that takes precedence over grades. They can have constructive conversations about stresses their families face, which are not likely to be ones they face in isolation. They can also work with schools in order to improve environments at school and at home. Research-based “resilience training programs” that teach “coping and happiness skills” are taking off at school, even for elementary students. Researchers today are finding that “resilience training can help reduce symptoms of depressive or negative thinking among children”

 

Student-directed initiatives also give students an opportunity to talk with each other about topics they might not readily share with parents or teachers, and gives them an active role in their own mental health.

 

All of these efforts should be directed towards valuing well-being and celebrating diverse kinds of passion and success. As a society, we should acknowledge that “a culture shift” is necessary to value all kinds of success instead of prioritizing and zeroing in on certain academic successes or career paths.

 

As Flu Season Continues, Symptoms to Look Out For

Many news outlets are reporting that this year’s flu season is one of the worst in recent years. It is widespread and has tragically proven fatal for dozens of children. Those of us in CHIL who work at children’s hospitals have definitely seen emergency departments swell with flu patients the past few weeks, and doctors warn that the flu may remain a major problem for some time.

 

Since 2018, it may seem difficult to believe that the flu could still be so lethal. However, it is true that children, especially ones who already have chronic health conditions, are at risk. Media outlets like the New York Times have assembled lists of symptoms to look out for in children that could signal the need to seek medical care right away. The most common causes of complications from the flu include pneumonia, sepsis, and dehydration. Warning signs that a child may need immediate medical attention include: a fever that goes away only to return, confusion, extreme pain, severe vomiting, and a tinted blue color to the skin.

 

Of course, most cases of the flu are less serious than these, and healthy children can usually get over them with medication, proper rest, and hydration. However, the article says that some doctors still recommend the flu vaccine at this point, since there are at least “several weeks” left in the season.

 

The article in the New York Times referenced here gives important information, but what was also insightful was the comment section for this piece. Quite a few comments touched on some several themes, including the importance of vaccination (and the consequences of refusing it for a child), as well as socioeconomic factors that may increase a child’s risk factors for severe flu. However, many readers agreed with the theme of the article — we need to balance finding prompt care for sick children while avoiding overcrowded emergency rooms. If emergency rooms are overwhelmed, less timely care is available for everyone. Questions that remain unanswered by this sort of advice should probably be directed to a child’s pediatrician or primary care provider.  




 

 


 

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.

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.

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.

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.



 

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.

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.

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.

Staying Safe Online Together

A new article in NPR suggests that there aren’t enough apps out there to protect teens online and  also actively engages them to develop their own decisionmaking. Parents are understandably worried their children will be exposed to explicit contents or bullying that have often resulted in tragic stories in the news. However, researchers in computer science have pointed out that app developers assume that parents are the main users of mobile online safety without considering the possibility (and necessity) of teens being proactive about the websites they visit and the messages they send. Teenagers who are aware of this necessity have even designed their own apps to address the need for parents and teens to work together to stay safe.

 

The article reports that the “Holy Grail” of parenting teens, according to developmental psychology, is “striking a balance between parental supervision and teen autonomy.” The American Academy of Pediatrics also supports this view, and released an online tool to help family members create a game plan together for mobile and media usage. The idea behind this plan is not to necessarily limit the activity of teens online since the internet is also a good place to find supportive communities with people who share similar interests. Instead, the goal is to encourage parents and teens to be proactive instead of being caught off guard by a problem in the future.

 

According to a statistic cited in this NPR article, currently, “only 16 percent of parents use monitoring software on their teens' mobile phones,” Parents still usually use other methods of checking up on their kids, like “friending” them on social media or directly logging into their accounts. Apps that are being developed focus mostly on restriction, with relatively little emphasis on education like teaching teens about self-monitoring or impulse control.

 

This problem presents a big opportunity for parents and app developers alike. There are more constructive ways to keep track of a teen’s online activity than snooping or restricting their usage altogether. When parents work with their students instead of restraining them, parents are showing their children that they are proactive partners who are helping them stay safer online. Apps that also focuses on developing interfaces that reflect the parent-child partnership can have potential to bridge the gap parents often feel when it comes to their teens and technology. Through a renewed outlook on teens and technology, parents can also encourage their children to keep track of their own decision-making as well.

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.

The Future of Healthcare Coverage for Children

Today we’re shifting gears a bit and talking about what the future of the Affordable Care Act (ACA) means to us and our children moving forward. Its political future has been uncertain ever since election night with no clear signals coming from the Capitol about plans to modify the landmark legislation. The “repeal and replace” rhetoric has largely been replaced with a more muted “repair Obamacare” (according to The New York Times), which doesn’t help the uncertainty we face regarding its future in our daily lives.

NPR recently published an article looking at Arizona as a case study in predicting what would happen to health insurance for children if Obamacare were to be repealed. It looked at the case of Vanessa Ramirez, a young mom of two who is an ovarian cancer survivor. She bought insurance for herself on HealthCare.gov, and her children are covered through Arizona’s KidsCare, the state’s version of the federal Children’s Health Insurance Program. Her experience of being surprised with a cancer diagnosis as an otherwise totally healthy college student is a major influence in her life and the choices she makes for her kids. 

Arizona may differ from other states in that it has one of the highest rates of uninsured children in the country and “more children enrolled in the federal marketplace than almost any other state,” according to NPR. This means that states with a high rate of children enrolled in government health insurance could be severely impacted by a repeal of the ACA. Without a solid plan in place, the number of children affected would be about 130,000 in Arizona alone. As a state, Arizona may be unique but it is not entirely unlike other states: it has a fast growing population with a significant number of people living near the poverty line.

Families like Vanessa’s will be the first to suffer if an ACA replacement does not adequately account for the hundreds of millions of dollars it will take to keep current beneficiaries on Medicaid. The ACA has brought coverage to thousands of children in Arizona in recent years. One could argue that children should be one of the most important priorities for health insurance legislation, since preventive care and annual physicals are indispensable in ensuring that children grow up healthy. Regardless of what state we live in, it is paramount that we provide health access for all children and families.
 

Medical Advice with a Grain of Salt

Today’s blog post talks about a tricky subject. A pediatrician recently wrote an article in The Upshot for the New York Times called “The Whiplash from Ever-Changing Medical Advice.” We’re constantly swamped with new findings about food, lifestyle, gadgets, or habits that could help us or harm us, according to the medical community. The author of the article, Dr. Aaron Carroll, notes that while medical researchers need to publish their work and news organizations need to report these findings, sometimes these results have a neutral effect at best. Other times, new results could actually reverse previous research that was released only a few years ago, which may confuse the general public.

 

The eternal debate about food allergies is a good example. Recently, the National Institute of Allergy and Infectious Disease recommended that we begin giving babies peanut extract or powder in their food before they are six months old, in order to reduce the odds that they develop peanut allergies. There was substantial evidence for the effectiveness of this method, especially for children who were at risk of developing these allergies.

 

Yet back in the early 2000s, the American Academy of Pediatrics warned against giving children who were at risk of developing peanut allergies any peanut-derivative products before the age of three. In hindsight, this recommendation might have actually increased the number of children with these allergies.

 

This “medical whiplash” about conflicting advice can really exhaust readers, especially parents who are trying to make healthy decisions on behalf of their children. Dr. Carroll has written articles expressing his concerns that these recommendations, “which were not supported by strong evidence, may be doing more harm than good.”


Physicians like Dr. Carroll will be the first to agree that “simple lifestyle changes may be more influential than many medical interventions.” Interventions that work for some people might not work for others, but not all medical or news organizations will definitively admit that. It’s important to keep moderation in mind as a priority, and to be receptive but critical of the plethora of medical research that comes out every day.   

The Truth About Headphones

Consumers are always looking for the latest technology even when it comes to the latest audio equipment. As of late, there has been a lot of debate about the safety of headphones and earphones, and how they affect our hearing ability. A recent New York Times article discusses what this means for children’s headphones and music listening today.

 

According to a 2015 report, half of 8- to 12-year-olds in the U.S.listen to music daily, as do nearly two-thirds of teenagers. Unfortunately for them, Dr. Papsin, the otolaryngologist interviewed in the article, said “Headphone manufacturers aren’t interested in the health of your child’s ears.” Products are advertised to be noise-cancelling, “safe for young ears,” or provide “100 percent safe listening.” However, recent studies of the kinds of earphones on the market found that some of them were so unsafe that they damaged ears within minutes of producing loud music.

 

In a study to determine the relative rankings of the many kinds of earphones and earbuds available to children, researchers used two types of sounds. They used a recently released pop song and compared it to “pink noise” (usually used to test the output levels of equipment, according to the article), and found that playing the chosen pop song at maximum volume made it more likely for headphones to exceed healthy decibel levels than they did playing pink noise.

 

This means that music that adolescents prefer to play generally produce loud sound at high volume, and is impacting boys and girls alike. The gap in hearing loss rates between boys and girls is decreasing, with the rate of girls’ hearing damage catching up to that of boys. Experts agree that no headphone can replace the most effective means of controlling damage, which is adult supervision. Some practical advice from pediatricians include: “If a parent is an arm’s length away, a child wearing headphones should still be able to hear when asked a question.” In other words, according to Dr. Jim Battey, the director of the National Institute on Deafness and Other Communication Disorders, “if they can’t hear you, ‘that level of noise is unsafe and potentially damaging.’”

Forming New Year's Resolutions to Keep

Happy New Year! Many of us want to start off on the right track in the new year by making resolutions. These resolutions aren’t limited to adults; kids can make them too along with their parents and siblings! Resolutions don’t have to be notoriously difficult to keep either.

 

Many families may strive to eat healthier and get more exercise. Dr. Thomas McIerny, the former president of the American Academy of Pediatrics (AAP), pointed out the importance of these goals - they improve health and they establish healthy habits that will stay with children throughout their lives..

 

Check out the AAP’s tips for parents and kids to help you formulate healthy resolutions this year. Let’s break them down and take a look:

 

Eating:

  • Focus on developing healthy attitudes about food and where it comes from by avoiding a “clean your plate” mentality that discourages conversation about food.

  • Establish a “regular routine” of meals and snacks, and always eat meals at the table. As mentioned in our previous blog post, children who eat with family tend to experience a diverse range of foods and avoid overeating.

  • We also talked about picky eaters who can pose as a challenge to parents. But we should keep two truths in mind: when a child rejects a certain food, it’s always a good idea to try again later; parents also remain their children’s best role models.

Play:

  • Anything can become physical activity such as a walk around the neighborhood, or going out to the yard. Take advantage of this as a group.

  • Limit screen time for children. Each day brings new research that further proves that devices can distract from good sleep or ruin concentration. Televisions, phones, and video games are all ubiquitous in our daily lives, but we can take steps to limit their influence in our lives.

  • Encourage your children to participate in sports and dance teams that can introduce them to new friends while also providing physical activity.

 

Here are some tips from Stanford University’s Children’s Hospital on how to achieve these goals:

  • Make small goals: these are easier to keep, so it won’t be as discouraging if you fail to meet a very ambitious goal about a habit that takes time to develop. Establishing one activity to do each week is a great start.

  • Have roles and a buddy system: Family members can remind each other about their goals and help each other stay on track. Encourage kids to be active participants in choosing their next goal.

  • Have a rewards system: Small, non-food rewards can accumulate to bigger awards, which kids can choose for themselves (e.g. a trip to the beach or playing a favorite game).

  • Practice simple journaling: It can build awareness, according to Cindy Zedeck, director of the Pediatric Weight Control Program at Lucile Packard Children’s Hospital Stanford. Journaling can help you think about the choices you’ve made that day.

Understanding Food Allergies

We hear a lot about diverse kinds of food allergies, and whether or not they are getting more common as a whole. However, a new report published by the National Academy of Sciences says insufficient data or research methodologies make the number of people in the U.S. who actually have food allergies difficult to determine. Also, despite the general agreement among many health experts that food allergies have increased over time (and not just due to better methods of diagnosis), it remains difficult to confirm this with data.

 

According to an NPR report on this announcement, an important reason for the difficulty in getting these numbers is that it is challenging for parents to recognize and diagnose their children’s allergies. Food allergies and other conditions, like lactose intolerance, sometimes have “[overlapping] symptoms,” as explained by Dr. Virginia Stallings, a nutrition pediatrician at the Children’s Hospital of Philadelphia, for the NPR article. The difference is that food allergies can potentially be dangerous, while lactose intolerance, while very uncomfortable, does not pose an immediate danger to the person.

 

The more severe symptoms of food allergies - some examples given in the NPR report include difficulty breathing and swollen lips - should receive immediate medical attention. However, since symptoms are often milder than these, and since there is no single blood test or other procedure that precisely points out a food that a child can be allergic to, it is best to rely on expert advice to navigate the path to finding out a child’s allergy.

 

Some experts have noted that parents have their children unnecessarily avoid a food for fear of an allergy. According to a pediatric food allergy program director interviewed in the article, a common “gold standard” test that they use to diagnose a food allergy, the “oral test challenge,” is surprisingly obvious. Patients [literally] eat small portions of foods they might be allergic to, and if they start having an allergic reaction, the medical supervisor stops the test and administers treatment. Such a method might be perplexing to parents who are looking for more sophisticated science in identifying their children’s allergies, but more research is needed to develop these methods.

 

Children also sometimes outgrow their allergies, and can be determined allergy-free with the same kinds of tests. In the meantime, parents and teachers can do more to learn about children’s food allergies in case an emergency happens at home or at school when there are no nurses around. According to the article, school nurses are usually the only ones trained to administer potentially life-saving epinephrine shots in many schools. The National Academy of Sciences suggests that more school officials be trained to react to food-allergy related emergencies.