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.

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.