Raising Healthy Children
The latest on children’s health—nutrition and healthy foods, asthma and allergies, teeth and exercise—with a comprehensive chart of age-appropriate milestones and tips. Families can join our Kentucky Living Health Club four-month challenge with ongoing support
This July, when we brought together a panel of experts on children’s health, we heard a lot of urgency from them.
Some of the most important indicators of children’s health have been worsening for decades—the number of obese children in the country has tripled since 1972.
Brian (not his real name) came into the pediatric practice as an 8-year-old weighing 250 pounds; at 12, he’s 5-feet-4 and weighs 350.
He sees an orthopedist for joint problems, a cardiologist for his high cholesterol, an endocrinologist for diabetes, a psychiatrist for depression. He takes an oral diabetes medication.
Obesity is a problem for the rest of his family as well—they spend a lot of time eating fast food in front of the television.
Brian has missed so much school from ailments and from the dread of being there—he’s made fun of for being so big—that he’s nearly a truant. He participates in no sports, or for that matter any school activities.
“He’s the saddest kid I can think of,” his doctor says. “It’s heartbreaking.”*
Poor nutrition, a core problem
Kentucky hasn’t just been following this national trend for childhood obesity—in many respects, it’s leading the way. In the 2007 KIDS COUNT report, Kentucky tied for second (with Arkansas and Georgia, behind Mississippi) for the highest percentage of obese and overweight children ages 10 to 17—37 percent. That’s more than one in three. “That’s a pretty big deal,” says Andrea Bennett, a senior policy analyst for Kentucky Youth Advocates who specializes in health issues. And she points out that the KIDS COUNT report is based on data from 2007—5-year-old information. The problem may well be worse.
Kentucky also ranks near the bottom for cases of asthma, cases of abuse and neglect, and underage cigarette smoking.
For many health professionals, simply slowing the trend would be a welcome step. “It’s taken us decades to get to where we are,” says Dr. Steve Houghland, chief medical officer for Passport Health Plan. “We want a quick solution, but there’s really not (one).
“In the next five years, if we kind of held steady, honestly that wouldn’t upset me too much.”
The concern our panel raised most consistently was the way poor nutrition harms children.
“Nutrition in the first two years is crucial in helping the brain to develop properly,” states Dr. Donna Glandon Grigsby, an associate professor of pediatrics at the University of Kentucky.
And patterns set in childhood carry on for the rest of your life. Mt. Sterling pediatrician Dr. Brandy Fouch says that studies have begun to prove that “kids who are overweight and have obesity, as even infants, are much more likely to be overweight and obese adults.” (It makes sense that would happen, she says, but until recently the research hadn’t been done to prove it.)
The adult ramifications of obesity include heart disease, hypertension, and diabetes—the diseases and conditions “that are probably the biggest killers of all of us,” Fouch says. “(They) probably have their origins in infancy.” What used to be called “adult-onset diabetes” has been renamed “Type II diabetes” because so many young people are developing it.
The nutritional mistake mentioned most often is an over-indulgence in sugary foods, especially drinks, such as popular brands of soda. And juice, which for years parents thought of as a healthy alternative to soda, is little better (and also loaded with sugar).
Sugar is the classic instance of an “empty calorie”—it fills you up, but doesn’t provide any of the nutrients such as calcium and iron that our bodies need to grow. It can cause children to be underweight as well as overweight, Fouch says, by replacing other, more healthy foods. And the caffeine in many soft drinks stresses the kidneys and heart, and dehydrates the body, lowering blood volume.
Other nutritional deficiencies doctors mentioned include too much fried food; not enough fruits and vegetables; the decline of families eating together, which leaves parents with fewer opportunities to model good food habits; and a society-wide increase in portion size.
The other side of the obesity problem is inactivity—when children aren’t burning the calories they take in.
Obesity isn’t the only reason activity’s important. Thin people need exercise, too. “Your heart’s a muscle, so exercise increases the function of your heart,” Fouch says.
A chief contributor to the decline of physical inactivity is the abundance of electronic devices children have access to. Children under age 2 shouldn’t be watching any screens, Grigsby says—that includes television, video games, and computers. And older children should restrict their “screen time” to two hours or less a day.
The impact isn’t only on their physical health. “Children should be experiencing the world actively,” Grigsby says. “The evidence suggests that children learn by one-on-one interaction—their language, their vocabulary—better by talking to another person, and being talked to and read to, as opposed to watching things on TV.”
But interestingly, the first health problem for children that Grigsby mentions in our interview isn’t obesity. It’s the “amazing amount of dental caries”—tooth decay—“in young children in our state.”
A Kentucky dentist tells us this story: Holly (not her real name), a 5-year-old, came to her doctor with a mysterious fever of 103 that persisted for several nights. The doctor was puzzled—Holly showed no signs of flu or strep or other diseases that usually cause such a fever. There was some swelling in her face but, puzzlingly, no teeth.
The doctor referred her to a dentist, who performed panoramic X-rays of the whole mouth and discovered the problem: the child had teeth so badly decayed that most of them had broken off, and infection had swollen the gums so that none of the remaining teeth were visible. Nine of the girl’s 20 teeth were abscessed.
Holly’s mother cried when she heard how serious the case was. She said she’d been on a waiting list for six months to be seen by a local dentist.
The 5-year-old was put in the hospital for several days on intravenous antibiotics. A pediatric dentist extracted all but four of her teeth, which were given stainless steel caps. Those four caps were all the girl had to chew with until her 6-year molars erupted.*
How nutrition affects teeth
Tooth decay is another consequence of poor nutritional choices, especially children having too much exposure to sugary drinks. Doctors and dentists share numerous anecdotes of people putting children to bed with a bottle full of soda—a way to assure a nightlong bathing of teeth in sugary, acidic liquid that will attack the enamel of teeth. And juice or milk is hardly better in a nighttime bottle: “You’re coating your teeth with something that the bacteria are going to attack,” Grigsby says. Only water should be in a bottle a child uses to go to sleep.
The consequences of tooth decay include pain, which in turn can affect performance and attendance in school, and social embarrassment.
And they can be fatal: “There are children who die from infections that start in a tooth,” says Dr. Pamela Stein, a dentist with the public health dentistry division of the University of Kentucky’s College of Dentistry.
The frustrating but encouraging fact is that, from a public health perspective, dental care is low-hanging fruit.
“While this is the most prevalent chronic disease in childhood—much more prevalent than asthma or bronchitis or any childhood disease—it’s completely preventable,” Stein says. “And it’s not expensive to prevent it, and it’s not difficult to prevent it.”
The chief measures to take for good oral health are brushing and flossing daily, and getting adequate fluoride. Fluoride is available in the water supply (approximately 96 percent of Kentucky’s population receives its water from a fluoridated source) or from fluoride pills or fluoride varnishes, which can be applied not only by dentists but by other health professionals, including physicians and public health nurses.
It used to be that dentists recommended a child make a first office visit when all their baby teeth had come in. Now, the recommendation is to make that first visit when the first teeth erupt, around 6 months of age.
But if childhood dental problems are so easy to address, why do they persist?
One reason is a lack of access. Overall, Kentucky does better than many states when you measure the percentage of its population that lives in areas considered to be underserved by dentists. But there are pockets of the state where it can be difficult to find dental care. In the “golden triangle” formed by Louisville, Lexington, and northern Kentucky, there are seven dentists for every 10,000 people. In rural eastern and western Kentucky, there are half as many. According to the 2011 Kentucky KIDS COUNT County Data Book, the state has only 83 pediatric dentists, and not all general dentists see children patients.
Another reason might be called cultural. Kentucky has long been among the states with the highest number of toothless citizens. A 2010 report from the Centers for Disease Control showed that more than 27 percent of Kentucky seniors had all of their natural teeth extracted (only West Virginia and Tennessee ranked higher). Stein says many Kentuckians take an attitude that losing teeth is a natural part of life—the attitude that “My dad had bad teeth, so I guess I’m gonna have bad teeth.”
“There may be some genetic component (to tooth decay), but you can override that with basic oral hygiene,” Stein says.
A number of conditions create similar obstacles in other areas of children’s health. Family eating and exercise habits carry on down the generations. One thing that doesn’t necessarily pass down is culinary skills.
“The younger baby boomers didn’t necessarily learn to cook, and they didn’t teach their children, who are the parents of the children today,” says Debra Cotterill of the UK Cooperative Extension Service. “So the majority of the parents today can’t teach their kids to cook because they don’t know themselves.”
And sometimes there are quirks in the ways we treat young children and food. “These kids, the grandparents think it’s cute to give ’em gravy, because we want ’em to be chunky,” pediatrician Fouch says.
“We need to change our mindset as to how we feed our children in infancy and early childhood so as to make healthier adults.” Young children “will eat till they’re full and then stop,” says Cotterill. “If they’re hungry, they’ll eat—there’s no need for us to be pushing food at them all the time.”
Kids love to cook
Cotterill pins some hopes on young people learning basic cooking skills and, as a result, making healthier food choices. It doesn’t have to be a casserole that spends an hour in the oven: “You can sauté a few vegetables—they taste delicious; and they have more control over their diet.” And she points out that children are more likely to try a new food if they’ve had a hand in making it.
The Extension Service has a series of nationally recognized nutrition education programs for every age level, available to be offered by county Extension agents across the state.
LEAP, for pre-kindergarten age through third grade, promotes literacy, physical activity, and healthy eating. For example, children will read a book about a vegetable or fruit and then taste that item. It also introduces gardening.
Superstar Chef, for fourth-graders and up, teaches cooking skills. Cotterill mentions a summer enrichment camp for gifted and talented students in Maysville where these cooking classes filled up before robotics or law.
The Kentucky Farm to School curriculum is a new program for high school students that views them as burgeoning food consumers, starting to make their own food decisions and purchases. It not only emphasizes a healthy diet, but also helps them connect it not only to their health but also to the community, making them aware of where their food comes from, “giving them back some of their cultural heritage,” says Jacqueline Walters of the Cooperative Extension.
UK Extension Service shows that more than 216,000 children in grades K-12 participated in a nutrition program in 2011.
Health literacy—in particular improving how healthcare providers communicate with patients and with others—is a major focus in medical education these days. The University of Kentucky, for example, has an innovative program that reaches across nine of the university’s colleges, including not only health sciences programs but also social work, law, and communications. (It also emphasizes teaching students in all those professions to learn to communicate with each other.)
The greatest resources for children’s health, however, are the two fundamental parts of the equation—kids and their parents.
“Kids get this,” says Jan Winter, founder and executive director of the Kentucky Children’s Health and Fitness Fund, which distributes four Fit4Fun Readers a year to every public elementary school child in the state. “Kids want to be healthy. Kids love playing outside. Kids love gardening. Kids love cooking food.”
Winter’s readers encourage critical thinking skills, to set a basis for good decision-making, and encourage kids to be leaders in their families. She mentions how children love to have rules and to hold others accountable for them, for example, holding a parent to a commitment to stop smoking.
But children being leaders in their families doesn’t mean they take control. “Parenting is setting a good example, and creating the environment where the child can succeed in a healthy way,” Winter says. “We know that children are far more likely to make healthy choices when they’ve been involved in the buying and cooking and serving processes. Children love doing things with their families.”
She recalls a “good rule of thumb” she heard from the pediatrician and author T. Berry Brazelton about the eternal struggle between parents and children over what children get to eat: the parent decides when and what, and the child decides how and how much. In other words, the parent sets mealtimes and chooses the food, but lets the child decide what to do with it.
“So if you’ve got a 3-year-old who wants to mix it all together,” Winter says, “that’s their personal food choice, but you’ve decided what to put on the plate.” It’s important, she says, for the parent to be the decision-maker about health.
It’s also important for parents to be role models. “You’re far more likely to adopt your parents’ values when you actually see them in play,” Winter says.
That’s been the experience of some of the members of the Kentucky Living Health Club—the private Facebook group we led last winter in which members set health goals and used the social network to support each other.
Jennifer Tidwell of Hillview in Bullitt County wrote, “Since joining this group my children have started drinking only water and eating raw veggies! Yes, I said it, eating vegetables! They often choose healthy snacks now instead of other sweet items.”
Teresa Igo of Hopkinsville found a similar effect working with her 10-year-old daughter: “My daughter has started eating some of the things I make, like my spinach and egg white omelet, and she likes to go run with me.” She says that on a recent trip, when they stopped at a Waffle House, the girl told her she wished she could have one of her mom’s omelets instead.
*These true stories were shared with us by Kentucky pediatricians and dentists on the condition that we not identify them or their patients.
20 Top Children’s Health Tips
1 The greatest resource for children’s health is the parent and child relationship.
2 Nutrition in the first two years is crucial in helping your infant’s brain to develop properly. Patterns set in childhood carry on for the rest of your life.
3 Kids love to cook. They are much more likely to choose healthy foods if you involve them in the buying, cooking, and serving processes.
4 Use the MyPlate food icon to ensure children receive the right balance of foods at each meal. Half your plate should be fruits and vegetables, one-fourth grains, and one-fourth protein. More information is available online at ChooseMyPlate.gov.
5 Kids want to be healthy; kids love playing outside; kids love gardening; kids love cooking food.
6 Parenting is setting a good example, and creating the environment where the child can succeed in a healthy way.
7 Limit fried foods, especially take-out, and opt for more fruits and vegetables, baked or grilled meats, and increase whole grains.
8 Use the Drink Pyramid mantra: Water whenever. Milk with meals. Juice just once. Pop at parties.
9 Have children drink water; get them off of sugar-filled soft drinks and limit juice to once a day.
10 Do not put babies to bed with a bottle of soda, milk, or juice; only water if you must.
11 Children should see a dentist as soon as their first teeth erupt, around 6 months, or by age 1; they should see a dentist at least twice yearly.
12 Children learn by one-on-one interaction—their language, their vocabulary—better by talking to another person, being talked to and read to, as opposed to watching things on TV.
13 Children under age 2 should not have any “screen time”—no watching television, video games, or computers. Over age 2, limit to two hours or less a day.
14 Make sure your child is getting at least one hour of moderate physical activity daily.
15 Healthy teeth and good oral health depend on brushing and flossing daily, and getting adequate fluoride by drinking water (not bottled water).
16 Replace your child’s toothbrush every three to four months. Store the brush in an upright, uncovered position to allow it to air-dry.
17 Asthma is often aggravated by being overweight; avoid secondhand smoke exposure, and consult an allergy and asthma specialist, especially if using a rescue inhaler more than twice a week.
18 Crying is normal in young babies and is also usually a daily part of toddlerhood. Most children do not gain the ability to stop crying on demand until at least 4 years of age or even older.
19 Use care when deciding who watches your child. Never leave a young child with an abusive partner. Caring for a baby or young child is hard work! It requires patience, self-control, and a basic understanding of the child’s needs.
20 If you suspect child abuse (such as bruising or burn marks), contact the Kentucky Child Protection Hotline at (877)KYSAFE1/(877) 597-2331.
DO YOU HAVE A PICKY EATER?
Jan Winter of the Kentucky Children’s Health and Fitness Fund passes along this simple, tested method of introducing a picky eater to healthier foods:
“It’s called repetitive presentation: you just put the carrots on the plate, night after night after night.” (The time span is roughly two weeks with the same food.)
“But the key to it is, no emotional response from the parent as to whether the child eats it or not. If it becomes a power struggle, you’re done.
“Loads of solid science shows this works almost 80-90 percent of the time, especially if the adults are also eating the food.
“Not enough parents understand that it is possible” to get their children to try new foods.
Also try to involve your children in preparing the food. As noted earlier, children who are involved in cooking or preparing the food will more likely eat it.
KENTUCKY LIVING HEALTH CLUB
Join the Kentucky Living Health Club
Does your child need to learn a healthier lifestyle?
You Could Win a Wii Console, Wii Fit Balance Board Bundle, and other games
Up to a $500 value
Must register by December 7, 2012
Join the Kentucky Living Health Club for your child, let us know what changes you’d like them to work on, and what steps you will help them take to achieve that goal. Last year’s KL Health Club was very successful and many members made lifelong health changes. We bet you’ll improve your health right along with your child!
HOW LONG IS MY COMMITMENT? Four months—that’s right, it’s a four-month commitment to better the health for your child, lasting until March 31, but just think of the payoff!
HOW DOES IT WORK? You and your child will register online, providing his or her health goal and at least three action steps for achieving that goal. Create one overall family goal or each child can create a goal and action steps.
The first 200 children who register will receive our free Starter Kit (one per family). The Starter Kit will contain information and tools to help your child on the journey over the next four months.
You’ll also receive detailed instructions for joining the KL Health Club on Facebook, which is a private online area for other readers joining the KL Health Club for the same purpose. This club will not be visible to any other Facebook users, nor is it searchable. It is completely private. You will be encouraged to post or send us updates at least monthly.
WHAT INFO WILL BE PROVIDED? Kentucky Living magazine personnel and some of the healthcare professionals mentioned in this feature will join us online. The purpose of the club is not for healthcare advice, but for information to help your child achieve their goal and to get support from other children and parents like yourselves.
A variety of content posted online will help you set goals to cultivate a healthy family. “Cultivating the Authentic You” is a weekly lesson, for women or men, provided by exercise physiologist and certified wellness coach Lisa Capehart, that empowers you to stick to behavior changes. You will learn to work on yourself from the “inside out” and to create a deep vision for your family by discovering what’s important to you. By teaching parents how to work through their own issues concerning physical activity, healthy eating, and self-care, they will learn how to model healthy habits in order to help children understand this worthwhile lifetime goal.
We will update the progress of KL Health Club members monthly in Kentucky Living magazine. In June 2013, a follow-up story will feature successes and how you did it!
THE PAYOFF? The most important payoff, of course, is the improved health of your family! But if you stick to your goals and actively participate in the KL Health Club until the end of your four-month commitment on March 31, you will be registered for a grand prize random drawing for a Wii Console, Wii Fit Balance Board Bundle, and other games, up to a $500 value.
WHO CAN JOIN? Adults age 18 or older, so please register on behalf of your child or children. Although anyone can join the KL Health Club, employees and immediate family members of the Kentucky Association of Electric Cooperatives, Kentucky Living, and Kentucky’s electric cooperatives are ineligible for the prize drawing.
HOW DO I JOIN? Go to KL Health Club to register online no later than December 7.
• Include this information: your child’s name and age, your name, address, phone number, the e-mail address you wish to use to access the KL Health Club on Facebook, and the name of your electric co-op if applicable.
We recommend you always consult your physician before starting a new exercise program or making any changes affecting your health.
THE ASTHMA AND ALLERGY CONNECTION
In the most recent KIDS COUNT survey, 2007, Kentucky was among five states that ranked at the top for their percentage of children 18 and under affected by asthma.
Being at the top sounds bad enough, but the percentage is shocking—12 percent, or a little less than one in every eight children, is affected by asthma.
In the last 20 to 30 years, the prevalence of all allergic diseases has at least doubled, according to Dr. Doug Tzanetos, a Lexington-based allergist. That includes allergic asthma (about two-thirds of asthma cases have an allergic basis), but also food allergies, allergic eczema, and allergic rhinitis (so-called hay fever).
Asthma, the most serious of these diseases, is often aggravated by obesity and overweight status in children and adults, explains Tzanetos. For example, patients who are obese or overweight often need their asthma rescue medication more frequently and require higher doses of inhaled steroids to control their asthma.
“Asthma is aggravated by, and asthma exacerbations or attacks are often triggered by, secondhand smoke exposure,” says Tzanetos. “Smoke exposure makes a child nearly twice as likely to develop respiratory infections, which are common triggers of asthma attacks and often result in ER visits or the need for oral steroids. The earlier in life the exposure occurs, the more severe are these results.”
If a child needs their rescue inhaler more than twice a week, Tzanetos says, he or she may benefit from consulting an allergy and asthma specialist. Tzanetos says he sees many patients who use their rescue inhalers several times a day (and have done so for years), even when there are better treatment options available for persistent asthma, such as inhaled steroids.
While some patients and physicians are leery of steroids, Tzanetos says, the inhaled dose is much smaller than an oral one—a year’s worth of inhaled steroids is roughly the same exposure as five days of oral steroids (frequently prescribed after an asthma attack).
PREVENTING CHILD ABUSE
(Note: this information was not included in all magazine versions.)
The most depressing health threat to Kentucky’s children is child abuse. The following tips to combat it come from the Partnership to Eliminate Child Abuse.
• Crying is normal in young babies and is also usually a daily part of toddlerhood. Most children do not gain the ability to stop crying on demand until at least 4 years of age or even older—depending on the reason the child began to cry.
• Remember, it is normal to feel frustrated when a baby or young child cries—but NO ONE should EVER shake or harm a baby or young child.
• If you are feeling frustrated or angry, take a break. It’s okay to leave the baby in a crib or other safe place while you take a moment to regroup.
• If you are caring for a child, keep a list of phone numbers on hand that you can call for support. This can include friends, family, neighbors, members of the faith community, mental health, or other healthcare providers.
• Use care when deciding who can watch your child. If you don’t have total and complete trust in the person, then don’t trust him or her with your child. Brand new relationships, intimate partner violence, or a boyfriend who is mean to pets or swears at mom or child are warning signs not to leave the child with that person.
• Caring for a baby or young child is hard work! It requires patience, self-control, a basic understanding of the child’s needs, and some specific skills. Make sure that anyone who cares for your child is PREPARED to watch your child and WANTS to watch your child.
• The American Academy of Pediatrics does not recommend spanking or other physical discipline at any age. Research has shown that its effectiveness wears off over time, and the risk of inadvertently causing an injury far outweighs any potential benefits. Research also tells us that children who are spanked or physically disciplined have a higher rate of aggressive behavior toward adults and other children.
• One way to help support families in your community: If you have experience and skill in caring for babies or young children, offer to provide a few hours of childcare to friends or family in need of a break.
• Substance abuse is commonly associated with child physical abuse. Caregivers of babies and young children should be clear-headed and able to make sound decisions.
• Intimate partner violence is often associated with child physical abuse. If your partner has hit, kicked, shoved, or threatened you with physical violence—he/she should NOT be caring for your child.
• Bruising is an important warning sign for child abuse for infants and children. For a nonmobile infant, bruising of ANY KIND is not normal. For a child of any age, bruising to the ears, neck, torso, buttocks, or genitals should raise concerns. If you see this kind of bruising, seek immediate medical attention for your infant or child.
• Burns on a young baby or child, such as those caused by cigarettes or immersion in hot water, also are warning signs for child abuse. If you see burns on a young baby or child, seek immediate medical attention.
• Many abusive events in toddlers occur in response to toilet training accidents. Most children are not fully potty-trained until after 3 years of age, and even after that accidents are common. Having unrealistic expectations for a toddler can increase frustration for the caregiver.
FOR MORE INFO, help, and resources on child abuse, contact Prevent Child Abuse Kentucky at (859) 225-8879, (800) CHILDREN/(800) 244-5373, or go online to www.pcaky.org.
IF YOU SUSPECT CHILD ABUSE contact the state or national hotline 24 hours a day. Call the Kentucky Child Protection Hotline at (877) KYSAFE1/(877) 597-2331. Or call the Childhelp National Child Abuse Hotline at (800) 4-A-CHILD/(800) 422-4453.
KENTUCKY LIVING CHILD DEVELOPMENT & HEALTH CHART
Using input from all of our health experts, we put together a comprehensive chart that provides guidelines parents should follow as their children grow, along with a few of the signposts to look for, from infants saying "Mama" and "Dada" to teenagers worrying about their body images. Download a copy of this Child Development & Health Chart.
KEYWORD EXCLUSIVE: MORE ON CHILDREN'S HEALTH
To read additional online stories, go to “children’s health”.
Access to healthcare
Learn more about the barriers to children’s healthcare—including literacy, convenient hours, and physician and community access—and ideas for overcoming these barriers.
Preventing Child Abuse
Not all magazine versions include the section on “Preventing Child Abuse” but it is online. If you suspect child abuse, contact the state or national hotline 24 hours a day. Call the Kentucky Child Protection Hotline at (877) KYSAFE1/(877) 597-2331. Or call the Childhelp National Child Abuse Hotline at (800) 4-A-CHILD/(800) 422-4453.
Allergies and the environment
Learn why a large family or living on a farm around animals might be good for your allergies.