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Toying with our Children’s Health: Happy Meals, Public Health & the Obesity Epidemic

Like a great many other pediatricians and parents, I have increasingly focused my attention in recent years on the topic of children and nutrition. With an ever-increasing number of children now deemed overweight or obese, quite frankly it’s a topic that’s all but impossible to ignore. Poor nutrition and less than ideal dietary habits are posing an ever-expanding threat to our children’s (and in many cases, our own) overall health and well-being – a threat that we simply can not take lightly. As Iowa Senator Tom Harkin put it, “The childhood obesity epidemic isn’t just a catch phrase. It’s a real public health crisis.”

I, for one, don’t take it lightly. As a pediatrician and parent of three, I hope I’m not alone in considering it my parental duty to pay attention to what my children eat – not only at home, but at school and elsewhere. Sure, I strongly believe in teaching them to become independent and make wise choices, but the fact of the matter is they still need nutritional guidance. After all, I am painfully aware that when it comes to making wise food choices, they’re up against some powerful forces.

Michael O’Connor’s January 30th Omaha World Herald article, Toying with kid’s health, brings to the front page one such force. The article addresses a proposed bill (Nebraska’s Legislative bill 126) that would “prevent fast-food outlets and other restaurants from including Barbie and other prizes in kids meals unless the food meets nutrition requirements.” My concern is that people will come to the same, nutritionally dangerous conclusion as the parent whose closing argument in the article was that “fast food is supposed to be fun and entertainment.” Believe it or not, I do understand this argument. I too have found myself pressed for time at the end of a long work day, driving children around from one scheduled activity to another, and faced with pleas for the “fun and entertainment” that fast food promises to deliver. But that doesn’t change what we know about fast food and all of the other outside forces that threaten our children’s nutritional fortitude.

It probably won’t come as news to anyone when I point out that here in the United States, unhealthy foods are marketed to even the youngest of children. But the magnitude is staggering and the extent to which our children are being influenced may surprise you. I hope the following information will help you better recognize just what we are up against.

Food Fact #1: Children are not only witness to literally thousands of television food ads every year, but an overwhelming majority are for foods significantly lacking in nutritional value. With the exception of a recent (and much heralded) carrot campaign, the vast majority of ads (on the order of nearly 98% for 2 to 11 year olds and ~90% for adolescents) tout energy dense, sugary, salty and/or fatty foods.

Food Fact #2: Exposure to food-related television advertisements increases consumption. In a study that looked at the impact of television ads on children’s eating behavior, exposure to food-related ads served as powerful enough cues to increase subsequent food intake in all children studied.

Food Fact #3: Fast-food companies use toys to market their children’s meals. This fact alone isn’t a big surprise, but now remind yourself that fast food meals typically take the cake when it comes to placing at the very top of the nutritionally dangerous list. Next consider that of the reported $520 million that fast-food companies spent on marketing children’s meals in 2006, toys accounted for nearly three-quarters of this spending. In other words, the marketing of unhealthy foods to children isn’t just limited to television ads. Like it or not, it’s in your Happy Meals and comes in the form of a toy.

While I’d like to agree with the parent interviewed in Mr. O’Connor’s article, I can’t. Reality tells me that even with the best of nutritional intentions, parents are up against a lot. While it is absolutely true that parents can and should try to steer clear of fast-food, teach children to opt for healthier options when purchasing children’s meals, limit children’s television time (and with it, exposure to unhealthy food ads), and encourage daily physical activity along with plenty of fruits and vegetables, I’m not sure that parental interventions alone are going to be enough to overcome the childhood obesity epidemic that is looming large.

Originally posted on Omaha World Herald’s Live Well Nebraska

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What’s the Big Deal About Chickenpox?

I presume that many of you just received the same notification that I got in my children’s school newsletter regarding Nebraska’s new 2011-2012 School Year Immunization Law. For any parents who may have missed it: in short, the state of Nebraska will soon require all students (K-12) to have two immunizations (instead one) for Varicella (Chickenpox) unless they provide written documentation verifying prior varicella infection. In keeping with Nebraska’s current immunization laws, children won’t be allowed to attend classes in public or private school until the school has written proof of either prior chickenpox infection or the required two varicella shots.

The update in Nebraska’s Immunization Law, with its increased requirement from one to two doses of chickenpox vaccine, came as no surprise to me since I make it a point to keep current on the latest immunization recommendations. That said, I have found that parents have had many questions about the chickenpox vaccine ever since it first became available in the US over 15 years ago. I figured it might therefore be useful to address some of the questions I’m most frequently asked about chickenpox and the vaccine.

What’s the big deal about just getting chicken pox? Let me first say that I fully understand the temptation for parents to consider chickenpox a not-such-a-big-deal childhood infection. After all, it is usually mild and self-limited – known primarily for being highly contagious and causing an itchy rash, fever and maybe some accompanying fatigue. What I have found, however, is that parents are often unaware of the fact that prior to the vaccine, chickenpox was also responsible for about 11,000 hospitalizations and 100 deaths in the US every year. Young children and adults were (and still are) more likely to develop serious symptoms as chickenpox infection can lead to severe skin infection, scarring, pneumonia, and even brain damage or death. In other words, chickenpox can be a very big deal.

Does the chickenpox vaccine work? Yes. The chickenpox vaccine does work to prevent chickenpox, as most people who get the vaccine will not get chickenpox. In fact, a single shot is estimated to be 80 to 90 percent effective. That said, it is possible to get chickenpox after having been vaccinated. Less than an estimated 1 to 3 percent of vaccinated children each year develop a mild varicella-like syndrome involving fewer blisters, less likelihood of fever, and shorter duration of symptoms.

Can you get chickenpox from the shot? While most people who get the chickenpox vaccine don’t have any problems with it, according to the CDC’s Chickenpox Vaccine Information Statement approximately 1 in 25 may develop a mild rash up to a month after getting the vaccine. While it’s possible for people with this rash to infect others, it’s extremely rare.

Why are two chickenpox shots needed instead of just one? Like a majority of other vaccines, it has been determined that chickenpox requires a second shot in order to provide adequate immunity. It is true that when chickenpox vaccine was first introduced in the US in 1995, it was initially recommended as a single shot (between the ages of 12 and 15 months). In 2006, however, the Advisory Committee on Immunization Practices recommended adding a second dose (between the ages of 4 and 6) after outbreaks were seen in previously vaccinated school-age children.

While I understand the temptation to cringe at the thought of yet one more shot added to our children’s already immunization schedule, I would like to suggest that we remember to be grateful for the fact that we have available to us a chickenpox vaccine that is much safer than getting the disease itself.

Originally posted on Omaha World Herald’s Live Well Nebraska

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Helping Children Cope with School Shootings

My children and I took our first trip to India over the holidays, accompanying my U.S.-born husband who hadn’t been back to visit relatives in over 20 years. The trip was eye-opening. We traveled all over India – making our way through big cities and tiny villages as we visited relatives and introduced our children to a world very different from the one they know. Continue reading “Helping Children Cope with School Shootings”

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Winter, Carbon Monoxide Poisoning, and Family Safety

In an attempt to maintain my glass-half-full view of the world, I’m always relieved when I sit down to read the morning paper and come across a good tragedy-averted story interspersed amongst the doom and gloom. So believe me when I say I was particularly happy to read John Schreier’s article, Carbon monoxide sickens students. While it’s unfortunate that more than 40 UNL students recently wound up at the hospital after waking to symptoms consistent with carbon monoxide poisoning, the operative word in this description would have to be “waking.” Because the fact of the matter is that carbon monoxide is one of the leading causes of poisoning deaths in the United States. Often dubbed “the silent killer,” this toxic gas is colorless, tasteless and odorless, but has the deadly ability to disrupt the body’s use of oxygen. In other words, things could have been worse at the UNL fraternity house. Much worse. Continue reading “Winter, Carbon Monoxide Poisoning, and Family Safety”

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Preventing Carbon Monoxide Poisoning: What Every Parent Needs to Know

In an attempt to maintain my glass-half-full view of the world, I’m always relieved when I sit down to read the morning paper and come across a good tragedy-averted story interspersed amongst the doom and gloom. So believe me when I say I was particularly happy to read John Schreier’s article, Carbon monoxide sickens students. While it’s unfortunate that more than 40 UNL students recently wound up at the hospital after waking to symptoms consistent with carbon monoxide poisoning, the operative word in this description would have to be “waking.” Because the fact of the matter is that carbon monoxide is one of the leading causes of poisoning deaths in the United States. Often dubbed “the silent killer,” this toxic gas is colorless, tasteless and odorless, but has the deadly ability to disrupt the body’s use of oxygen. In other words, things could have been worse at the UNL fraternity house. Much worse.

Recognizing this, my thoughts immediately turned to the fact that this near-tragedy (with its thankfully happy ending) might momentarily grab people’s attention long enough for me to convey some very important safety information.

I certainly don’t mean to imply that no one would pay attention to information about carbon monoxide precautions except in times of tragedy. But human nature has me convinced that it’s all too easy for the out-of-sight, out-of-mind principle to take over – especially when it comes to the many hidden and/or silent dangers around the house and a not-so-subtle reminder of these dangers can go a long way towards helping focus everyone’s attention on the following simple yet potentially life-saving home safety measures.

  • Recognize the potential signs of carbon monoxide (CO) poisoning. Symptoms can admittedly be non-specific, variable and wide-ranging, but most commonly include headache, nausea, dizziness, and a general feeling of malaise that can be confused for a viral infection. See a doctor right away if everyone in the household begins to experience flu-like symptoms at the same time, especially if the symptoms seem to get better upon leaving the house.
  • Have the number to Poison Control (1-800-222-1222) posted by the phone and don’t hesitate to call it should you suspect CO poisoning.
  • Make sure to put a CO detector on each level of your home.
  • Never leave a car running in the garage, even if the garage door is open. Dangerous fumes can not only fill the garage in minutes, but also easily seep their way into the house.
  • Get household appliances that have the potential to leak carbon monoxide such as furnaces, wood stoves, fireplaces, gas water heaters, ovens, stoves and clothes dryers serviced yearly to make sure they are in good working order.
  • Refrain from using charcoal grills indoors (or in closed-in spaces) and never use a gas oven to provide heat for your home, as both can be dangerous sources of carbon monoxide gas.

Originally posted on Omaha World Herald’s Live Well Nebraska

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Helping Children Cope: What Parents Can Do In the Wake of Another School Shooting

My children and I took our first trip to India over the holidays, accompanying my U.S.-born husband who hadn’t been back to visit relatives in over 20 years. The trip was eye-opening. We traveled all over India – making our way through big cities and tiny villages as we visited relatives and introduced our children to a world very different from the one they know.

On the sixteen-and-a-half hour flight back from Delhi to Chicago, my husband and I discussed how we sincerely hoped that the 3-week experience would help shape how our children see the world. We wanted them to never take for granted what they’ve got in the relative safety and security of their lives in Omaha.

Arriving back in the U.S. early Thursday morning, I dutifully called my mother to let her know that we had made it back safe and sound. Even though I’m now in my 40’s with a family of my own, my mother all but sits by the phone waiting for me to call and let her know that I’m okay. It was she who first told me what had happened at Millard South High School. I quickly thought about whether I knew anyone involved. I then selfishly reflected on how fortunate I was that my own three children – all Millard students – were out of harms way and with me at the time of the school shooting. No – my oldest won’t start high school until next year and she won’t be at Millard South, but I was nevertheless grateful that she and her brothers didn’t even have to experience the ensuing lockdown that I’m told had Millard students under desks and in the dark until the threat had passed.

And then I couldn’t help but turn my thoughts to the actual events of the day and what it must have been like to have been there. To be the parent of a Millard South student on the first day of school after the holiday break. To be the principal or the assistant principal. And yes – even, what it must be like to be the parents of the student responsible for the devastation.

I’m sure many of you must have reacted the same way. The reason I’m so sure is that in a certain sense, I’ve dealt with this sort of tragedy before. Not at Columbine (although my family did move to that area only shortly after the country’s worst high school massacre), or at any of the handful of other school shootings that have taken place over the past several years. My experience in helping parents (including myself) cope with this sort of threat to our children’s (and our own) sense of safety dates back to 2001.

You see, at the time of the reported terrorist attacks that destroyed the World Trade Center towers, a section of the Pentagon, and thousands of lives, I was the pediatrician responsible for content creation at a prominent national parenting media company. With a sincere desire to do anything I could to help parents in the wake of the attack, I sat down and wrote an article on the morning of September 11th entitled Helping Your Children Cope with the News of Reported Terrorist Attacks.

As I sat down this morning to figure out what I should write about the Millard South shooting that would be of any help or comfort, my September 11th article kept coming to mind. While the advice I offered back then was in response to a tragic event of unprecedented and enormous proportions, the sad fact is that in the minds of children, violence is violence regardless of the scope.

At it’s core, the following advice adapted from what I first wrote in 2001 applies every bit as well to violence in 2011, and will hopefully provide parents with several things they can do to comfort their children and help them make some sense out of senseless tragedy.

Personal safety. Any time senseless tragedy occurs, it’s important to offer immediate reassurance in any way possible – starting with the reassurance that your own family and friends are okay.

Routine. I have always believed that a predictable routine and consistency are important in helping children feel safe in their world. Never is this truer than in the context of tragedy. When our core sense of security is shaken, maintaining regular routines such as going to school and work may seem disrespectful, insignificant or difficult, but they give children (and adults) back some sense of structure and security.

Details and distance. One of the most striking aspects of the aftermath of September 11th was the intense media coverage. Without officially counting, I must have literally seen the planes crash into the twin towers a thousand times. The fact of the matter is that its human nature to watch. While I was on the other side of the world the day of the Millard South shooting, I’m sure that the coverage was (understandably) intense. As a parent, it’s especially important to also understand, however, that young children who repeatedly witness the news coverage of a shocking event are likely to be left feeling frightened and confused and may even feel like they’re re-living the experience. In this day and age of 24 hour media coverage, this is as good a time as any to turn off the television, at least when young children are around.

Someone is in charge. One of the fundamental aspects of raising children who feel safe and secure in their world is providing them with a sense that there are people in authority making sure that everyone is going to be safe. While a school shooting inevitably threatens our own parental sense of security, it’s helpful to focus your child’s attention (and your own) on what is being done to keep your child safe. Despite last Wednesday’s shooting, school remains one of the safest places your child can be.

Perspective. Despite the fact that I provide parenting advice for a living, I have yet to figure out how to explain the need to maintain perspective without seeming to minimize the tragedy for those involved. While its important for all of us who weren’t directly related to or involved in the school shooting at Millard South to remind ourselves that the overwhelming majority of schools across the country are safe (just as we had to remind ourselves on September 11th, 2001 that almost all planes and buildings were still completely safe), I can’t bring myself to say it without acknowledging that this provides no solace to students, friends, colleagues and family of Assistant Principal Vicki Kaspar. I only wish there was something more I could say that would help.

Originally posted on Omaha World Herald’s Live Well Nebraska