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.

Gadgets & Gear: Keeping Your Kids Safe Online

Are you a parent with kids still at home? Do they have easy access to the computer? Are you worried about what they see on the internet or how long they are on there; or worse yet, what damage they can do to your computer? Heck, I worry when my WIFE is on there, and she is an adult, albeit a technically-challenged adult (except when it comes to finding shoes online). Well, if you haven’t updated your computer’s operating system to Vista yet, Microsoft has given parents a huge reason to upgrade.

With Vista, Microsoft embedded parental controls that were either impossible to find or completely absent from previous editions. Now that kids can instant message their nursery-mates before they even leave the hospital after they are born, (Hey, which of those people at the window is yours? I hope mine aren’t that funny looking couple that keeps looking at me or I’ll never make it on America’s Next Top Model!) the tools are all the more needed. While not perfect, they put in a lot of powerful tools for parents to use and make it much easier.

So what kind of things does Vista let you control? You can now restrict specific websites they can view, or limit access to age-appropriate websites; you can allow or deny downloads; and also set up filters to block certain content from all sites. You can also set time limits for how long they are allowed to be on the computer by blocking off time periods that are open for use. You can also block certain games from being played. If you think it is okay for Katie to play Grand Theft Auto, but don’t want little Jimmy playing it just yet, you can set that up. You can also block other specific programs from running, like your tax software, for instance (I would hate it for little Jimmy to buy you an extended visit from the IRS).

The great thing about all these tools is that they are easy to use, easy to set up, and you can tailor the restrictions to individual accounts. This way, your account is the system administrator (with a nice strong password), and you can set up individual accounts for each of your children with age appropriate restrictions. You can also change the restrictions at any time and override restrictions instantly when the program blocks something that perhaps it shouldn’t have.

These restrictions do have limits, though, mostly with the blocked content from websites. It can be hard to judge what is offensive to everybody. I would make every image and word about Paris Hilton eradicated from view if I was writing software, but hey, that’s just me.

Overall though, it does a decent job of keeping your kids from the worst of the stuff, though some stuff can still pop up at times. If you want tight control over what your children can see, you can specify exactly which sites they can view and block all the rest.

Another great tool tied into all of these settings is a report you can receive that shows you what programs your child accesses, websites they visited and even what they TRIED to access, and how long they were on the site. George Orwell would be so proud! While stopping short of a full-on keystroke logger, this report can give you a good picture of what your child is doing on the computer when you aren’t looking over their shoulder.

Speaking of a keystroke logger, if you are really concerned about what your child is doing online or what they are ‘saying’ and to whom, these programs can tell you everything their little fingers punched into that keyboard. Hopefully your only shame from reading these logs is that you’ll find your little munchkin is a horrible speller, but if by the off chance they are the one out of those five kids that are solicited inappropriately online, you can find out early before it goes too far.

If you find all this ‘spying’ on your kids to be a little too akin to reading their diary, it is. Unfortunately, in this day and age, with instantaneous communications, you really have to be on top of these things. Now this isn’t to say that you have to do this for all of your children, which is the beauty of those individual accounts. Your teenager might be very responsible and need very little restrictions, while your elementary age children might need a little more restriction to keep them from the things they won’t, or shouldn’t, understand. All these are great options with the Vista system.

So, what should you do if you aren’t ready to completely overhaul your computer’s operating system? There are several programs out there that can do many of the things that Vista’s new controls can do. The two biggest names in parental control software, Content Watch and Net Nanny, have combined under the Net Nanny name, and their software is very highly regarded. There is also another program called CyberPatrol that is available, though it seems to be a bit more difficult to manage than either Vista controls or Net Nanny.

You can find these programs in some software stores and online at www.netnanny.com and www.cyberpatrol.com. Both of these third-party programs are geared primarily to blocking web content and tracking Instant Messaging clients. They do have some tools for controlling program access on the computer.

If you aren’t ready to get one of these third-party programs, I would encourage you to at least check out the settings that are available in your Internet Explorer. Under the “Tools” section of the toolbar, locate the Internet Options selection under that is a tab for content settings. This will allow you to at least set up some basic security measures for your child while they are online.

Now that I am done ratting out all the kids in the tri-county area, I’ve got to get to work on my own computer so I can block my wife from getting to all those shoe sites! As always if you have any questions on this or any other tech topic, feel free to write me at: jeff@healthandleisureonline.com.

Fitness: Shooting for the Stars

Rip Hamilton, Steve Yzerman, Magglio Ordonez, anyone on the Lions? Okay, so maybe Detroit is not the center of the athletic universe to people living outside of Michigan. But, rest assured millions of kids around the world have had dreams of being a professional athlete. A smaller number of those youths may actually make it to the college and/or professional level. Whether or not high level sports are in the future for today’s young athletes, they and their parents are trying to do whatever it takes to give their child an edge.

According to Associated Press writer, Jamie Stengle, “Nearly a million American youngsters, some as young as 6, rely on personal trainers to shape up, lose weight or improve in sports.” Youth personal training has grown tremendously in the last number of years due to many factors. While most kids just want to be better physically, parents want to make sure that the programs their children are doing are safe and productive. With the cuts in physical education across the country, and the sometimes dismal fitness knowledge of coaches, these are legitimate concerns.

Kids are turning to the wrong sources to learn about fitness. According to West Bloomfield based personal trainer, Gary Gonte, “many of today’s youths are your typical ‘Generation X.’ They Google everything you tell them and do not always consider the source. For example, one of my clients weighs 140 pounds and thinks he should be eating 300 grams of protein per day. I am sure he read it in a muscle magazine. I told him that magazine is for professional body builders, and he should stick with Men’s Health.”

So what can a personal trainer offer young athletes that they cannot learn from gym class, or the magazines? There is no shortage of weight lifting programs out there for kids. Everyone has done some sort of resistance training using methods that are decades old, up to “the latest and greatest” new techniques.

In terms of resistance training, a primary problem is too much information. The basic fact is that while resistance training is fairly crucial for most sports, different sports and different athletes require different methods. Let me make this clear, there is no one method that works best for everyone. A qualified trainer can help make sense out of everything out there to design a proper program for each athlete’s individual needs. The other area of concern is that weight lifting neglects many other, often more important, physical aspects of sports. These areas include power, speed, agility, quickness, flexibility, balance, injury prevention, proper diet, and mental toughness. Not to mention the need for “functional strength” vs. “Hollywood muscle.” Here are a couple of tests that most athletes should be able to do:

1) Single leg squat: balance on one leg (don’t touch anything with your hands or other leg) do a full squat on the one leg dropping your butt almost all the way to the ground (I mean just a few inches from the floor) and stand back up – still only on the one leg. Most athletes past puberty age should be able to perform at least one repetition per leg – more for the “higher level” athlete. It is always fun to see the guy who can do a standard barbell squat with tons of weight, but cannot do one of these without either falling over or hardly going down to the floor.

2) Shoulder flexibility: reach one hand behind your head, down your back; and the other hand behind your back reaching up. The two hands should be able to touch and that should be the case with the arms reversed. That 400 lb. bench press doesn’t mean much if you can’t move your arms past the front of your body.

The other side of the youth training continuum is the non-athlete child who just needs, or wants, to get in better shape. The American Obesity Association states, “30 percent of children aged 6 to 18 are overweight, and another 15 percent are obese.” According to the American Academy of Pediatrics, “kids as young as 8 can benefit from low-resistance exercise with small weights and actually grow stronger with little risk of injury.”

* This is a good time to mention that what I am talking about in this article is personal training, not athletic training. No offense to my athletic training colleagues, it’s just a different focus.*

While not all personal trainers are qualified to work with children (parents and kids should do their homework), there are those out there with the experience and knowledge that can greatly help. Especially with athletes, an evaluation of their current level of function should first be performed to design an appropriate program.

Parents and athletes should not feel that it is necessary to devote all of their time to working with a trainer. While some people require multiple days per week, others can benefit from working 1-2 times per month with a trainer. This does not mean that is the only time you should work out, but if you are very self motivated, a trainer only needs to get you going in the right direction. Training is often done in a group setting, but can also be individual; and can range in time and price.

Personal training can be a huge asset to a child’s physical education, and an athlete’s progress. An athlete who wants to excel to the top level needs to do what the others will not.

For more information regarding training for youths and adults, contact Bob at: bob@functional-strength-training.com or visit our website at: www.functional-strength-training.com

Ask the Doctor: August 2007

Question: My teenager has begun to ask me about plastic surgery. Is this too young of an age? – D.M., Royal Oak

Answer: Dear D.M. – Plastic surgery is much more prevalent in the adult population. Over the last 10 years, teenagers are slowly increasing their numbers in outpatient plastic surgery procedures. The reasons for this are multi-fold.

First, plastic surgery is much more acceptable not only in the adult population but also in the teenage years. It seems all of the young Hollywood stars have had some kind of plastic surgery, making patients feel it is safe, trendy and more importantly, acceptable. Second, complications are very low and recovery time much shorter and less painful. Third, plastic surgery is much more affordable than it used to be.

Teenagers in this day and age are under tremendous pressures to succeed. Those teenage years sometimes define the rest of their lives. Any edge – within reason – can help a teenager compete better, feel more confident, become more physically active and attractiveness can be an asset.

The two most common teenage surgeries are rhinoplasty and breast reductions. The nose stops growing at about the age of 16. Sometimes prominent, deviated or cosmetically unacceptable noses can be fixed at an age where the resultant outcome gives a teenager tremendous self esteem and confidence. So in this one case, a rhinoplasty is acceptable and many teenagers are eager to have the surgery.

Another example is large breasts in teenage girls. Once puberty hits, a young lady may become more self-conscious of her body as it transforms into a woman. With large breasts, they may feel more neck, back or shoulder pain. They may be athletic and now they tire more or are unable to participate in some physical activities. Then a breast reduction done in a minimally invasive way may be the answer. But patients are cautioned that the breast size will increase with weight gain or pregnancy and any surgeries may require revisions in the future.

Obesity has become a major epidemic in the teenage population. In fact a lot of parents try to use plastic surgery as a means of weight loss. This is not the answer.

Obesity brings about many problems for patients. A disproportionate body – whether it is larger breasts in males or females, redundant skin or increased fat in the body may make the patient’s self-esteem suffer. Also, being overweight may decrease physical activity levels which are needed for both weight loss and overall better health.

Unfortunately, plastic surgery is not the answer in these types of patients because the main problem (overweight) has not been treated and you are trying to fix the end results of obesity. In some cases, these patients might do better with bariatric surgeries and once the weight is controlled be eligible for reconstructive surgery.

Teenagers today are not given as much credit as they deserve. When it comes to plastic surgery education, patience and common sense, as well as listening to the complaints they have, are the best ways to deal with teenagers.

Many times, simply waiting until he or she is of legal age to consent to surgery allows the teenager time to mature, grow wiser and be more comfortable with all their decisions. However, some plastic surgery procedures are safely done in the teenage population, and balance should always be the goal.

Ayoub Sayeg, M.D. is a board-certified diplomate of the American Board of Plastic Surgery, Cosmetic and Breast Fellowship trained. He received his medical degree from the University of Toronto and served his general surgery residency at Washington Hospital Center, Washington D.C. Dr. Sayeg served his plastic surgery residency at Wayne State University in Detroit.

If you would like to submit a medical question to “Ask the Doctor”, please email your question to: askthedoc@healthandleisureonline.com

* Advice found within this article is for informational purposes only and should not replace the advice or recommendations of your physician.

Breast vs. Bottle: Is Breastfeeding Right for You?

Conflicting Information

Long before Bharati Hulbanni, 32, of Ann Arbor delivered her son, Milo, she had chosen to breastfeed him for one year. But after weeks of trying and seeking help from lactation consultants, her body would not produce milk.

As her son lost more and more weight, she finally turned to formula to give him the nourishment he so desperately needed.

Hulbanni felt pressure to breastfeed based on the media’s and society’s lauding of the benefits of breastfeeding. It was very damaging to her as she wrestled with caring for her newborn infant.

“It was bad enough that my baby was crying all the time and losing weight after he was born, but the added guilt of not being able to breastfeed and not for lack of trying was too much for me. No wonder post partum depression is so rampant,” says Hulbanni.

Even though it ultimately comes down to a personal choice, women are exposed to conflicting messages and information passed to them through the medical profession, the workplace and society.

For instance, The American Academy of Pediatrics, a strong breastfeeding advocate, recommends exclusive breastfeeding for the infant’s first six months, but only twelve states have passed laws that protect the woman’s right to breastfeed in the workplace. Michigan is not one of these twelve.

The United States Breastfeeding Committee cites that 70% of moms with children under the age of three are also full-time workers. For these women, the adequacy, or inadequacy, of the workplace accommodations to offer the flexibility and privacy to pump and store breast milk during the workday quickly drives the woman’s decision. This has a dramatic affect on women’s choices.

According to the Centers for Disease Control and Prevention and the National Immunization Survey, 70% of babies are breastfed at birth, but by the age of six months that number drops to thirty-six percent. As the child gets older, this number falls off even more with only 17% of one-year-old children being nursed.

Taya Hamilton, 35, of Huntington Woods, maintained her nursing schedule by pumping during work for all three of her children.

“Pumping was easy for me because I was able to use the conference room which offered me privacy. I became an expert at multi-tasking as I pumped both breasts simultaneously while using my hand to answer the phone,” says Hamilton.

Hamilton considered her act of pumping breast milk a gift she was providing to her children while she toiled away at work. For moms who would like to breastfeed after returning to work, it is wise to discuss the practicalities with their employer before they take maternity leave.

Unexpected Benefits

Despite logistical concerns, breastfeeding does offer many benefits. According to The American Academy of Pediatrics, breastfed infants have reduced incidence of ear infections and bacterial meningitis. Other studies also indicate that breastfeeding may protect against sudden infant death syndrome (SIDS), diabetes, asthma and obesity. Breastfeeding also provides benefits to the mother such as reducing her risk of ovarian cancer and possibly reducing her risk of osteoporosis or hip fractures. It also helps the mother rid herself of some of the excess baby weight since breastfeeding burns 500 calories or more each day. The environment gets a green boost, too, with less formula bottles and cans to discard.

Breast milk is also inexpensive, much less likely to cause allergies, convenient, and the antibodies that are passed to the baby boost children’s immune system and ward off some infections.

The advantages of formula are also many. It allows the new father as well as other family members to share in the feeding process while giving mom a break. Bottle-fed babies tend to eat less frequently since formula takes longer to digest and you know how much your baby is eating with each feeding. Finally, for many moms, formula is an attractive option because it gives her more freedom and flexibility as she resumes her pre-pregnancy routine.

Deciding Early

One thing to keep in mind is that this decision should not be postponed until you are holding your newborn in your arms. It is very difficult to begin feeding your infant formula and then switch to nursing since the ability of breast to lactate weakens without stimulation.

“We’re seeing more parents coming in for prenatal consultations. It’s here where we can openly discuss the advantages and challenges of breastfeeding and prepare the mother to nurse,” says Dr. Nancy Mannisto, a pediatrician in Huntington Woods.

Mannisto adheres to the recommendations put forth by the American Academy of Pediatrics and encourages the mothers she sees in her practice to breastfeed.

Talking with your spouse, other mothers and your doctor throughout your pregnancy will help guide you along as you consider which option makes the most sense for you and your child. Whatever decision you make, take comfort in knowing that your baby’s nutritional and emotional needs will be met whether you choose to breastfeed or formula-feed.

10 Ways to Prepare You & Your Child for Surgery

With Nancy Strzyzewski, RN

Surgery can be frightening for almost anyone, let alone a child. So, if the time comes that your child needs surgery, how do you prepare him? Can you prepare him? Are you prepared?

The thought of having surgery can bring on feelings of anxiety, fear, anger, confusion – and that is just for the parents! Now imagine the signals your child is receiving when she sees mom and dad expressing these emotions.

According to Nancy Strzyzewski, RN, a nurse clinician in surgical services education, children pick up on the emotions of their parents during these stressful times. “The better the parent is prepared, the better the child will do. If the parent is anxious and nervous, the child will know that. Your child knows exactly what you’re feeling and you need to be aware as a parent,” says Strzyzewski.

A good starting point to preparing for your child’s surgery is to familiarize yourself with the hospital, facilities and personnel. “I encourage parents to go to the hospital, get familiar with the area; take a test drive. It’s important to know where your going to park, where the entrance is, and where registration is located. If you are anxious, your child will pick up on your anxiety,” says Strzyzewski. “The size of the hospital can be intimidating. Your child will sense you’re more relaxed if you are prepared, and your child will be more relaxed as a result.”

It is also recommended that parents take the time to meet some of the caregivers prior to showing up to the hospital the day of surgery. This way, parents can establish some trust for the people who are going to have direct care of their child pre and post-op. “I’m in awe of the amount of trust that parents put in us,” says Strzyzewski. “Visit the nurses who are taking care of your child.”

So, what else should you know about preparing your child? Here is some advice:

1. The day of surgery bring something of comfort for your child..special toy, blanket

2. Do not allow your child to eat or drink per the physicians instructions the day of, and prior to, surgery. It is so important to the child’s safety.

3. Bring extra underwear. Most kids feel more comfortable in their own underwear (rather than the hospitals paper ones); bring extra pairs in case of any “accidents.”

4. Be flexible for the day. If your child is in the middle of changing habits (bottle to cups; removing pacifier; potty training, etc.), allow your child to regress if they want for the day.

5. Don’t be embarrassed. Your child may throw tantrums the day of surgery. Remember, they are stressed out, afraid and anxious. Tantrums are expected.

6. Talk to your child about the surgery at an age-appropriate time. Do not wait the day of, or the day before, to tell him/her. Recommendations are: preschool, 1-2 days; Adolescents: 7-10 days so they have time to process the information.

7. Ask your child what is their biggest fear/worry. What do they think is going to happen? That will give you a key as to what to talk to your child about beforehand.

8. Give your child some control. Your child does not have control for that day. Give them some reasonable control on what they want to wear to the hospital, items they may want to take, etc. Make your child feel like he/she has some control of the day’s events.

9. Relax. It is going to be a long day, and the best way to calm your child is to be relaxed yourself.

10. Be patient. Remember that everyone involved has your child’s care and safety in mind.

“Children regress when they are stressed out. We know it is the worst day of their life, and we don’t expect them to be perfect. They may have a tantrum or two. We expect that. They are just trying to cope,” says Strzyzewski. “Parents need to look at this as just one day. It is not going to be a reflection on their child for the long run. The goal is to make it work for the child.”

Get Your Children’s Eyes Checked

By Barbara Kuczynski, MD of Advanced Ophthalmology Associates

Many parents believe that if their child has a problem seeing, the child will complain about blurred vision or the eyes will turn inward or outward. However, there is usually no indication that the child is having difficulty seeing. Many parents do not realize that their child is having problems until the child fails a school screening or a vision check at the pediatrician’s. In some cases, this may be too late.

In reality, unlike adults, children do not usually complain about blurry vision. This happens mainly because the child does not recognize the deficit. There is no discomfort so the child is unaware of the decreased vision, especially if the other eye sees normally. Even when both eyes have poor vision, the child will not complain because what he or she sees is “normal” and therefore, do not perceive things as “blurry.”

In the majority of children, glasses correct the problem. In others, patching, or even drops, may be necessary. A common misconception is that patching improves eye muscle strength; this is not true. Patching, or drops, is used to try to improve the vision in the weaker seeing-eye. By blocking the better seeing-eye, this forces the child to use the weaker eye.

In a small number of cases, when vision is not improved with glasses or patching, the condition is called amblyopia. This is more commonly known as “lazy eye.” Each eye sends a slightly different visual image to the brain. Normally, the images are similar enough to allow them to be combined into a single image. If the images are too different from one another, the brain cannot combine them resulting in double vision.

Young children are able to avoid double vision by suppressing the image from one eye. The suppressed eye loses its ability to see clearly. In these cases, the vision loss may be mild, such as 20/25, or as severe as 20/400 (barely seeing the eye chart). The vision loss may become permanent if it is not corrected by 8-9 years of age.

Children should have their eyes tested by the time they enter preschool, around age 5. This is especially true if there is a family history of wearing glasses, eye muscle problems, or amblyopia. The earlier the child is diagnosed with the vision impairment the greater the likelihood the vision can be improved.

Of course, there are some conditions that occur that do not allow for the full correction of vision. These are rare, but do exist. These include: congenital cataracts, muscle misalignment, glaucoma, infections, and tumors, all of which require close follow-up.

A vision check for children should become part of the yearly physical exam. A more thorough exam should be done by the time the child enters school to try to avoid permanent vision loss.

Dr. Barbara Kuczynski is board certified in ophthalmology. She has been in practice 13 years, specializing in diseases of the eyes. She received her medical degree from Wayne State University, and completed her residency in Ophthalmology at William Beaumont Hospital. She is affiliated with Beaumont Hospital and Crittenton Hospital. She speaks both Polish and Spanish.

Immunizations are Important for Children’s Health

By Mike Williams, MD

When applicable, medical care today should focus on prevention of disease. A prime example of preventative medicine is vaccination against illness. Many new vaccines have been developed and released to the general public in the last few years while others have been modified and improved. These vaccines are directed toward both pediatric and adult populations and provide the recipients with an excellent opportunity to maintain their health and well-being.

A review of the most current vaccine recommendations should be undertaken with your physician at every routine physical examination to assure you are aware of any significant changes and to get caught up with any immunization deficiencies.

Adacel is a new version of the tetanus shot. As with previous versions, this vaccine boosts immunity against Clostridium tetani and Cornybacterium diphtheriae, two toxin producing bacteria that cause neuromuscular dysfunction and severe respiratory infections, respectively. The improved vaccine also contains antigenic material that will enhance the recipient’s immunity against Bordetella pertussis, the cause of whooping cough.

Many adults were vaccinated against pertussis as children but have suffered waning immunity due to the lack of a well-tolerated adult vaccine. Although the cough induced by this infection is usually mild in an adult, it can be severe and even fatal to an infant or small child. This is an important breakthrough in prevention as the affected infant is usually exposed to this illness by close contact with an adult. Enhancing the immunity of the adult population should help reduce the cases in both adults and children alike.

Menactra is an immunization designed to reduce the incidence of meningitis caused by Neisseria meningitidis. This form of meningitis, an infection of the lining of the brain and spinal cord, is often rapidly progressive resulting in death in approximately 10 percent of the cases. Further, survivors have a 10-20 percent chance of significant neurologic disability or hearing loss. Obviously, this is a very serious disease and prevention is vital. Vaccination of an individual is indicated as early as eleven years of age and seems to be extremely effective at reducing the incidence of disease.

Gardasil is a new vaccine that helps to reduce the risk of cervical cancer by as much as 75 percent and genital warts by as much as 90 percent in women. Human Papilloma Virus (HPV) is the etiologic agent of this condition and can be combated with this three dose series which may be started at the age of nine years and completed over a six month time frame. This is hopefully the first of many vaccines which will target cancer prevention.

Rotateq is an improved version of Rotashield, vaccines responsible for reducing the risk of severe vomiting, diarrhea and subsequent dehydration caused by rotavirus infection. Most unprotected children will experience this gastrointestinal illness by the age of five years, with the most severe cases occurring in children between the ages of six and twenty-four months of age. This illness accounts for over 50,000 hospital admissions per year in the United States. Unfortunately, it also causes over 500,000 deaths per year worldwide, especially in those areas where access to healthcare is limited.

Rotateq prevents about 75 percent of rotavirus infections completely and nearly 98 percent of severe infections that would otherwise require hospitalization and intravenous fluids. A type of bowel obstruction called intussusception which was possibly linked to Rotashield has not been associated with Rotateq.

Multiple other routine vaccines as well as those recommended for global travel are available through your primary care physician’s office or your local health department. As with any medical decision, you should educate yourself regarding potential benefits and side effects of any medical treatment including immunizations. Your physician will be able to answer most questions and concerns you may have with the support of valid medical literature.

Mike Williams, MD is board certified in Internal Medicine and Pediatrics. He received his medical degree from Wayne State University Medical School, and completed his residency in Internal Medicine/ Pediatrics at The Ohio State University. Dr. Williams has been in practice for 16 years, and is affiliated with Beaumont Hospital.

Teach Your Child About Stranger Danger

With Deborah Neidbala, RN

As your child heads back to school, it is a great time to talk about “Stranger Danger.” Although you may have covered this topic with your child before, it is important to continually reinforce the importance of safety at the beginning of the school year, and periodically throughout the year.

If your child walks to school, you should walk the route with your child a few days before school, according to Deborah Niedbala, RN, of DMC Children’s Hospital. “Take a look at how far they have to walk and look for safe houses,” says Neidbala. “Young children should not be walking by themselves.” Niedbala recommends the following precautions that you can take to keep your child safe:

1. Tell your child to never go with a stranger, even if they ask the child for help to find a puppy, kitty, directions, etc. Make sure your child knows that adults do not ask children for help; they ask other adults.

2. Identify a stranger as anyone that has never been to mommy and daddy’s house to visit, or for dinner. This will eliminate even people that may be familiar to the children, but not close to mom and dad.

3. Create a password with your children that never changes. By having a password, or code word, a stranger cannot claim to pick up your child at the direction of the parents. If the person does not know the password, then the child knows to move away quickly and call for help.

4. Teach your child which adults are safe to approach, such as policemen/firemen, or security personnel. Also, tell your child if they are in a crowd of people, to ask a woman with other children for help. “Moms know how to help lost children,” says Niedbala.

5. If someone tries to grab your child – teach your child to grab a tree, hold on to their bike, or drop to the ground, spread their arms and legs wide and yell, “Help! Not my mommy, or not my daddy!” It is more difficult to carry someone who is spread out than curled-up in a ball.

6. Never get into a stranger’s car. If you get in the car, try to get out as soon as possible. If you are put in a trunk, try to kick out the brake lights, or tail lights from the inside. Newer models of cars have trunk releases within them, and talk to your child (age appropriately) about the trunk release.

There are many other precautions you can take to improve your child’s safety when they are away from you. Some of these can even branch out into educating your child on what actions to take if a dangerous situation arises at school.

Other situations may arise when you are on a family trip. For instance, if the family is headed to a crowded event such as a fair, amusement park, concert, always make sure that your child has all of your contact information in their backpack, cell phone or lunch box. This way they always have a way to get in touch with you.

Niedbala also recommends that parents take advantage of identity kits. Many community police departments will occasionally offer these programs where you can have your child fingerprinted, take hair samples, DNA swabs and photos. This is great for kids of any age. This way you are prepared in the event something does happen.

By simply taking the offensive now through educating your child, you can hopefully prevent a dangerous situation in the future.

Deborah Niebdala, RN is coordinator of the Trauma and Burn unit at DMC Children’s Hospital. She coordinates and creates community education programs on a variety of safety topics for children.

Helping Your Children Cope With Your Divorce

With Eric Herman, MA, LLP

Statistically more homes are being led by single-parent families. Due to the high rates of divorce in the United States, many children are growing up in a single-family home. Children learn to adapt to their new surroundings; however, there are generally emotional scars that can be expected as a result of a divorce.

You may notice that your child has a change in their personality, their security or their behavior. Some children may regress in their learning at school, or potty training. Depending on the age of your child, a variety of negative symptoms may arise. It is therefore very important to know how to provide the best environment possible as you and your spouse part ways.

According to Eric Herman, MA, LLP, a psychologist at DMC Children’s Hospital of Detroit, children experience the same disappointment as parents when divorce happens. “It’s a breakdown and failure of what people were hoping for in their family,” says Herman about divorce. “It’s the death of a past reality, and things won’t be the same.”

Tension, anxiety and anger within a household between the divorcing parents can directly affect the children. “The main thing for parents is to keep the best interest of the kids on the top of the list. Parents get so preoccupied about their own feelings and forget about the kids,” says Herman. “Sometimes that means taking care of yourself so your own issues don’t affect the kids.”

Communication is very important during this time, according to Herman. In fact, if parents can share age-appropriate communications with their children, it can make a difference in their coping skills. “Reassure your kids that this is an adult parental decision and that mom loves you, and dad loves you and it’s not your fault,” says Herman. “Honesty will calm the anxiety. A lot of worry comes from secrets. Kids can tell something is going on, so communicate effectively.”

The most common feeling kids experience when their parents are divorcing is blame. A child will think of things they have done, and believe that their actions may have led to mom and dad’s fights and divorce.

“Kids blame themselves. They think ‘if I’m good, mom and dad will stay together.’ They hear arguments going on about them and don’t realize the arguments are about parenting oftentimes and not the child personally,” shares Herman.

Older kids may have different approaches to their parents’ divorce. Because adolescents and teens are more aware, they may actually blame one, or both of the parents. In these situations, parents need to be extra cautious about their discussions or arguments within the household. Harmon recommends the following tips for parents:

• Do not speak poorly about the other parent to the children

• Don’t argue about the issues in front of the children

• Be honest with your children on an age-appropriate basis

• Don’t let the children be in the middle of your arguments

• Don’t use the children as a weapon, messenger, or spy against the other parent

Once the divorce is final, it continues to be important for parents to put the kids first. There are several mistakes that parents make, that Herman warns, can be very detrimental to their well-being. He suggests parents do not do the following:

DON’T

– Ask your children what mom or dad’s new boyfriend/girlfriend is like?

– Direct your child to give a message to the other parent

– Don’t withhold visitation

– Don’t allow your children to manipulate you against the other parent

– Don’t have a long custody battle

DO

– Share your own hurt feelings with your child, kids need to know their parents are hurt by the situation, too

– Understand kids need mom and dad in their life

– Communicate and agree with your ex-spouse the rules in both households so there is consistency in discipline

– Work out a visitation schedule that fits the children’s needs, not the parents’

– Keep as much stability as possible (don’t move from the home, school, friends and parents all at the same time)

Depending on the age of the child, or children, there may be a variety of ways they may respond to the divorce, says Herman. Some kids may:

• Begin having behavioral problems at home and/or school

• Suddenly present with poor grades

• Exhibit anger or anxiety

• Experience illnesses such as headaches, stomach aches

When these situations occur, Herman recommends parents seek out the many resources available for their children. “You can utilize resources such as support groups, therapists, and school counselors,” says Herman. “They often will group kids with others their own age and it helps them see that their feelings are valid.”

Parents often feel that divorce will solve their problems, but that is not true, says Herman. “Parenting issues do not change following a divorce,” says Herman. “Sometimes things get worse because parents feel guilty and begin to compete for the child’s affections. They try to ‘out-do’ the other parent with things such as vacations, toys and presents.”

Finally, when it comes to custody, parents must determine what is best for the kids and their schedules. Joint custody may not always be the best for the kids. Often, kids need stability and shuffling them back and forth within the same week can be overwhelming.

“Sometimes a fresh start can be negative for kids,” says Herman. “As long as there is a stable home environment and the communication is good, you can work through shared custody, but remember that the kids do need stability.”

Eric Herman is a clinical psychologist, on staff at DMC Children’s Hospital of Michigan in the Psychiatry/ Psychology department He specializes in working with children/adolescenst and their families on a wide variety of psychiatric and behavioral problems, including situations of divorce. Herman completed his undergraduate and graduate work at Wayne State University.

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