Your Child’s Nutritional Health

From kindergarten to post-puberty, children and teens are growing rapidly. There is a delicate balance between eating enough calories and nutrients for growth and development, while getting enough physical activity to prevent weight gain and chronic disease.

KEY NUTRIENTS IN YOUR CHILD’S DIET

Calcium is found in dairy products, such as milk, cheese and other dairy products. However, calcium is more readily absorbed from plant sources such as calcium fortified soy or rice milks and orange juice, legumes, almonds along with dark green leafy vegetables such as spinach and kale. Non-dairy sources of calcium are also lower in fat and calories. Magnesium, found in whole grains, nuts and seeds, help to incorporated calcium into bone.

Iron deficiency anemia is still widespread in children. Good sources of iron include whole grains, iron-fortified cereals, legumes, green leafy vegetables and dried fruits. Consuming foods rich in vitamin C (citrus fruits, broccoli, strawberries) at the same meal as high iron foods, enhance iron absorption.

FOOD ALLERGIES

Common allergens include milk, eggs, wheat, corn, citrus, nuts and seafood. In addition, celiac disease is a digestive disease that damages the small intestine and interferes with absorption of nutrients from food. Recent findings estimate 1 in 133 people in the United States have celiac disease. Individuals with celiac disease cannot tolerate a protein called gluten, found in wheat, rye, and barley. Today, a wide variety of food exists for individuals with food allergies, along with gluten free foods to manage celiac disease.

ATTENTION DEFICIT HYPERACTIVE DISORDER

Sugar in conjunction with artificial colors, dyes and additives may exacerbate attention deficit hyperactive disorder (ADHD). Parents can usually tell when their child has been exposed to too much sugar – especially when they come home from birthday parties filled with cake, ice cream and other goodies and tend to be wound up for the rest of the day. In addition, a 12-ounce can of caffeinated soft drink consumed by a child is equivalent to the effect of four cups of coffee consumed by an adult. Limit your child’s intake of sugar. Notice if your child’s behavior improves from a more wholesome diet.

CHILDHOOD OBESITY, HIGH CHOLESTEROL AND DIABETES

Children with high fat intakes are significantly heavier than children with low fat intakes. Childhood obesity is a precursor to heart disease and diabetes. Limiting fat, especially saturated fat, in your child’s diet is the best prevention and/or management of weight, cholesterol and diabetes, which uncontrolled, can lead to health complications later in life.

WHAT IF YOUR CHILD OR TEENAGER IS ATHLETIC?

VITAMINS AND MINERALS

Since athletic individuals are consuming more oxygen through aerobic exercise, an increased amount of “free radicals” are formed from the byproduct of oxygen formation as well as breathing in air pollutants can damage growing cells. Supplementation of vitamins C, vitamin E, and beta-carotene are recommended and the dose will vary depending on age and other circumstances.

IRON

A small amount of extra iron may be needed to aid in oxygen transport through the body. Sports anemia is common, which is the breakdown of red blood cells from impact of feet on the ground during running.

ELECTROLYTES

Sodium and potassium, which are referred to as “electrolytes”, are needed for water balance and proper muscle function, which can be achieved through normal fluid intake and eating fruits and vegetables daily.

ZINC AND CALCIUM

Other important nutrients include zinc for energy metabolism, as it tends to be lost in sweat and urine. Calcium is needed for strong bones and magnesium is helpful to prevent muscle cramps.

SPORTS DRINKS

Although water is the best way to hydrate the body, sport drinks with up to 10% sugar concentration are acceptable. Too much sugar lingering in the stomach will hamper performance. Some sugar intake will help preserve the body’s carbohydrate stores, maintain blood sugar and delay fatigue. Diluted juices work just as well as sport drinks. As far as how much fluid to drink before competition, 16 to 20 ounces are recommended two hours before and eight ounces 15 to 30 minutes before. While exercising, four to six ounces every 15 to 20 minutes is recommended, especially during long-term competition. You can be down up to two quarts of body fluid without actually feeling thirsty.

PROTEIN AND FAT

Athletes do not need any more protein or fat. Too much protein may be dehydrating. In addition, a low fat diet of no more than 20% is recommended.

COULD YOUR CHILD OR TEEN HAVE AN EATING DISORDER?

Today, young girls rarely feel good about their bodies. The current emphasis on beauty and the extraordinary pressure on females to be thin in order to achieve desirability are exceptional. According to statistics, 80% of adolescent girls feel bad about their bodies, 75% feel “fat,” and up to 70% are on diets at any given time. This behavior is extending to younger and younger children every day. Studies suggest almost half of 3rd to 6th grade girls say that they want to be thinner, and that 33% have already tried to lose weight. In addition, eating disorders are increasing prevalent in males.

WHAT IS AN EATING DISORDER?

Eating disorders are extreme expressions of psychological issues experienced by both boys and girls. They include anorexia nervosa, bulimia nervosa, binge eating and compulsive overeating. Anorexia nervosa is characterized by an irrational fear of body fat and weight gain, which contributes to drastic weight loss and refusal to maintain a height and age appropriate weight. With bulimia nervosa, cycles of binge eating and purging take place. Binge eating disorder or compulsive eating involves impulsive overeating with isolated fasts and recurrent diets.

WHAT ARE THE WARNING SIGNS OF ANOREXIA AND RELATED EATING DISORDERS?

Aside from extreme weight changes, behavioral signs that something is wrong are:

• Isolation

• Range of emotions from angry outbursts to no affect

• Procrastination

• Trouble in school

• Perfectionism

• Compulsive habits

• Omitting significant food groups at meals

• Change in sleep habits

• Loss of interest in formerly fun activities.

An eating disorder is a medical illness like any other disease, and will not go away without attention. If you suspect that your child has an eating disorder, it is important that you work with a team of professionals including your physician, psychotherapist, registered dietitian, and if necessary, a psychiatrist. This team of professionals’ can help you understand the impact of stress on your child and the rest of the family, teach healthy communication skills, and help you to assist your children to grow and individuate.

It is not so much what you say to your child, to convince them to eat healthier and have healthy food behaviors, but your own behavior that you model for your child rules. If you emulate healthy nutrition and lifestyle choices, your children will follow.

No Bones About It

With Walid Khaled Yassir, MD

It is no longer surprising news that the obesity epidemic, which is crippling adult Americans, has now reached children and adolescents. Over the past 20 years, the Centers for Disease Control reports that the proportion of overweight children ages six through 11 has more than doubled and the rate for adolescents ages 12 through 19 has tripled.

There are a number of factors at place, which have contributed to the rise in childhood obesity. No single factor is solely to blame. Instead, childhood obesity is the result of a combination of leading a sedentary lifestyle, the availability of processed, packaged and high-fat foods, socioeconomic status, heredity, environmental factors and underlying metabolic or hormonal conditions.

The health consequences associated with those who are overweight or obese seems to grow every day as new research gleans important insight into how carrying extra body weight predisposes the individual to host of medical and mental conditions and illnesses. The medical community is seeing that the same diseases that are associated with obesity in adults are now being observed in children. Diabetes, early signs of heart disease and weight-induced orthopedic conditions are being diagnosed in children, some as young as 6 years old.

Even though these factors paint a grim picture of the health of our children, for Walid Khaled Yassir, MD, a pediatric orthopedic surgeon, he encounters the faces behind the statistics and research every day at Children’s Hospital of Michigan in Detroit. For the past decade, Detroit has continued to rank as one of the nation’s top cities with the highest rates of residents who are overweight or obese.

“Children’s Hospital serves the population that is so vulnerable to the obesity epidemic,” says Dr. Yassir.

Because of this, it makes his work that much more important for the health of southeast Michigan’s youth.

In his practice, Dr. Yassir treats two orthopedic conditions in children that are directly linked to carrying excess weight: Blount’s Disease and Slipped Capital Femoral Epiphysis.

Blount’s Disease affects the inner part of the tibia, just below the knee. This area fails to develop normally and causes angulation of the bone. With too much weight on the growth plate of the bone, which is the area where the bone grows, the cells won’t form and essentially shut down so that all bone growth is stopped.  The effects are severe arthritis of the knee and physical changes in the leg that resemble bow legs.

Those who are predisposed to this condition are adolescents who are bow-legged to begin with and who are also overweight. The progression of Blount’s Disease can be halted if it is caught early and if the child controls his or her obestiy through lifestyle changes. Surgery is required in cases where the condition has progressed but the disease has the potential to resurface when the child is older if they continue to remain overweight, says Dr. Yassir.

Slipped Capitol Femoral Epiphysis (SCFE) is a bit more serious. It is marked by a hip problem that starts if the growing end of the femur or thigh bone slips from the ball of the hip joint. An analogy commonly used to describe this condition is that it can be like a scoop of ice cream slipping off the top of a cone. Pain and stiffness are two side effects that make the problem worse because often the child is in too much pain or too immobile to exercise. The lack of physical activity adds to the overweight problem creating a vicious cycle, says. Dr. Yassir.  The most serious complications of SCFE are avascular necrosis, which is a lack of blood flow to the bone and arthritis.

Two surgical procedures can be done too correct SCFE. The most common treatment is called “in-situ fixation” which uses a single screw to hold the bone in place. A more involved surgery that carries more serious risk factors is also done in certain advanced cases.

In both Blount’s Disease and SCFE, the disease can be prevented with proper weight management.

Dr. Yassir suggests two actions parents can take to ensure that their children lead healthy lives so that their bone development can occur uninterrupted.

“First, you must start early. At a young age, start teaching your child not only about making healthy food choices but about lifestyle behaviors as well. Kids today should spend equal amounts of time indoors as they do outdoors,” he says.

Second, Dr. Yassir recommends that parents must control what kinds of food their children eat and how much they eat. Too much of the wrong kinds of foods will result in an overweight child and the potential for years, or even decades of medical complications if these lessons are not taught and learned early.

If you are concerned about your child’s health, talk to your family doctor about creating a nutrition and exercise plan that your entire family can participate in.

Walid Khaled Yassir, MD is a board certified pediatric orthopedic surgeon at DMC Children’s Hospital.  He is a graduate of SUNY Health Sciences Center at Brooklyn College of Medicine and completed his Fellowship at Children’s Hospital of San Diego.  He is a member of the American Board of Orthopedic Surgery and specializes in Pediatric Orthopedics.

Fighting the Battle of Childhood Obesity

by Heidi Press

When family challenges and overeating created health issues for 12-year-old Kylee Gallero of Waterford, her family decided it was time to take action. They signed up for Shapedown.

Phil (dad), 48, Lori (mom), 40, and Kylee joined the University of California-developed weight loss program through the Community Programs department of St. Joseph Mercy Oakland (SJMO) in Pontiac. Based on family involvement, Shapedown is aimed at ending childhood and adolescent obesity through a curriculum that emphasizes healthy eating, exercise and communication. By-products of the 10-week program include increased self-esteem, decreased depression, improved diet and exercise habits and weight management knowledge.

For the Galleros, enrollment in the program came in the nick of time. Phil had suffered failure of one kidney and a heart attack. Mom, Lori, who works midnights was “sleeping on everything I ate.” Daughter Kylee had developed high blood pressure and diabetes.

With Gallero’s illnesses already causing stress, the family also had experienced deaths of family members in recent months, including Lori’s father, with whom 12-year-old Kylee was particularly close. She was so broken up when he died, she started eating for comfort and “that’s when I started gaining weight.” “We were so stressed out with things that happened to us, we just started eating,” Lori explains. Thanks to Shapedown, the Galleros learned how to deal with death and other life challenges.

They learned about Shapedown at SJMO, when Phil was being treated for his heart attack. The hospital connected them with a nutritionist who directed them to Shapedown. The Galleros attend the program at the North Oakland YMCA in Auburn Hills.

Currently, five families are participating, but there’s room for eight in each session. The program costs $500 per family, and each member receives a workbook in which he/she can keep track of the foods intake, exercise and communications activities. And it is loaded with information.

The program doesn’t offer a diet, just a plan to make healthy choices when it comes to food. In one class, the Galleros learned how to make healthy sandwich wraps and season and prepare food. They also learned how to scale down proportions. Each used to eat a bowl of ice cream; now it’s just a cup.

According to the Centers for Disease Control and Prevention (CDC), about 17 percent of children and adolescents ages 2-19 are overweight. In Michigan, 12 percent are overweight, and 15 percent are at risk for becoming overweight. This extra weight can lead to all kinds of health issues, the Michigan Department of Community Health reports, including cardiovascular disease, Type 2 diabetes, some types of cancer as well as social and emotional difficulties.

Since enrolling in the program, the Galleros say their communications skills have increased. “If anything is bothering us, we now talk to each other, rather than holding it in,” Lori says. “The program made us more aware of each other,” she adds. “We’re supporting each other.”

They also learned how to relax with breathing exercises accompanied by mellow music.

In the exercise track, the program provides the children and teens with Theraballs, Therabands and water bottles. Other recommended exercises include walking, swimming, Rollerblading, bike riding and ball exercises.

Each of the Galleros has experienced some results from the program after only a couple of sessions. Phil says it has helped with his recovery. Lori finds that it boosts her self-confidence in addition to motivating the family to get moving. And, their daughter Kylee says that her “pants are getting bigger, which I’m happy about.” She also likes the fun element, and that “you’re not going through this alone.”

Phil says he likes the program because it gives him the tools to help him eat right and “ideas for exercise that won’t put stress or strain on you.”

SJMO’s program is directed by Julie Esparsa, coordinator for weight management programs. Classes are taught by licensed professionals, including an exercise physiologist; nutritionist; and social worker.

According to Esparsa, Shapedown was started in response to the increase in childhood obesity, especially in Pontiac, which is served by SJMO. The program is supported by donors and SJMO’s Community Benefit mission. Scholarships are available.

The Galleros like the supportive nature of the program. “We interact with other families,” Lori says. Since joining the program, the Galleros have met other families with whom they are planning to stay in touch.

For Phil, Lori and Kylee, Shapedown was a great find. “This program is the best way to go,” says Gallero. “It works. If you follow the program and do the exercises, you actually lose the weight.”

Heidi Press is the public relations specialist for Trinity Health’s St. Joseph Mercy Oakland in Pontiac, MI. She holds a Bachelors of Arts degree from Wayne State University in English and Journalism.  She has an extensive background in the communications field.