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Applying the “Kohlrabi Principle” to Practical Parenting

I recently made it out to Midtown Crossing. This was actually the first chance I had to see it since it’s completion, and I was quite impressed with the family-friendly atmosphere, the Jazz on the Green’s outdoor festivities, the whole layout, the convenient free parking, and the wide array of stores and restaurants.

As a LiveWell Nebraska blogger, I also enjoyed the opportunity to spend time at the Omaha World Herald’s booth and meet those of you who chose to stop by and say hello. As is often the case, I was asked what I thought the secret was to getting people – parents and children alike – to change their ways and live healthier, safer lives. While this is clearly a subject I spend a lot of time thinking about, I don’t presume to have the one right answer. In fact, I don’t believe that there is one, single cure-all answer to the question of how to get people to change their behaviors. But for the sake of today’s blog, I’m going to go with kohlrabi.

That’s right, kohlrabi (pronounced “cole – rah – bee”)

For those of you who have never heard of kohlrabi, much less know what it means or how to pronounce it, you have to admit that the word itself has a way of catching your attention. Try teaching your preschooler the word, or better yet – reading aloud the ever-popular Eating the Alphabet book – and you’re sure to find that children are easily intrigued with an impressively wide range of fruits and vegetables.

Okay, so reading about (and hopefully popularizing) kohlrabi, along with other fruits and vegetables, is a big step in the right direction towards better health. But better yet is when you’re able to translate linguistic & literary intrigue into dietary practice.

This noble goal brings me back to the subject of kohlrabi. Prior to three years ago, I knew nothing about it beyond the fact that it had helped round out the “K” page of Lois Ehlert’s bestselling book. Until my 8-year-old son and I came across kohlrabi at the Village Pointe farmer’s market, it had never occurred to me to actually buy or try kohlrabi (or jicama or boysenberries, for that matter).

Before deciding to buy one, we first had to ask what one was supposed to do with a kohlrabi. Not unlike an artichoke, kohlrabi can admittedly be somewhat intimidating if one doesn’t know what to do with it. Fortunately, all it takes is simply cutting off the outer “rind” and cutting up the white, crunchy interior.

Billed by wikipedia as “a low, stout cultivar of the cabbage that will grow almost anywhere,” the taste and texture are said to be “similar to those of a broccoli stem or cabbage heart, but milder and sweeter.” My kids and I think it’s better described as more like the cross between a radish and a cucumber – with the crunch of a radish, but a more mild taste. Cut it up like a carrot stick and it can be dipped in ranch dressing or hummus. Dice it up and you can sprinkle it on a salad. Google it and you’ll find that you can also season, sauté, bake, or puree it.

So back to my initial conclusion that part of the answer to getting people to live healthier lives involves kohlrabi. No, your family’s discovery of the existence of kohlrabi won’t rival Alexander Fleming’s discovery of penicillin. But I am convinced that if we all committed to applying some basic “kohlrabi principles” like those I’ve listed below to how we feed our children (and ourselves), we might all be a bit healthier for it.

  • Read all about it. It’s no secret that I’m an outspoken advocate for early literacy and reading books to kids (and babies). And there’s certainly no shortage of books with positive, healthy messages. Eating the Alphabet will get you off to a good start, but there are many, many more that stand to get your children interested in a much broader range of fruits and vegetables. Check out How Are You Peeling?, for example, and you’ll see what I mean.
  • Paint a positive picture. Books can paint a positive picture, but so can you. Rather than taking a “you have to eat your vegetables” approach, remember to put a more positive spin on it. You’ve got plenty of shapes, sizes and colors to choose from and work with as you expand your family’s palette.
  • Reach for the unknown. Given that people don’t tend to buy what they don’t know, I like to think of this as taking the kohlrabi challenge. Whether you go to a local farmer’s market or take a closer look at what the produce department in your grocery store has to offer, challenge yourself and your children to find a fruit or vegetable you’ve never had or heard of before… and then buy it.
  • Challenge yourself in the kitchen. Like I said before, I am not a kohlrabi expert. I simply asked a few questions of a friendly kohlrabi farmer and made good use of Google. Fast forward three years and our refrigerator is frequently stocked with cut-up kohlrabi, which now plays a role in helping my family meet the latest MyPlate recommendations (which include the challenge of consistently filling half the plate with fruits and vegetables).

Originally posted on Omaha World Herald’s Live Well Nebraska

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Fighting fever phobia: The facts about fever for parents

This seems like an appropriate time to spend a few minutes focusing  on the subject of fever, in part because it’s one that effects (and therefore interests) just about every parent I know, and also because we happen to be right in the middle of cold and flu season – a time of year during which children inevitably experience far more than their fair share of fevers.  It’s also because fever phobia amongst parents is usually far more pervasive than it is warranted. That’s not to say that fever is inconsequential, but rather that we should all take the time to brush up on exactly what fever is, what it represents, when it does (or doesn’t) need to be treated, and how to do so appropriately. Fortunately,  the American Academy of Pediatrics just pulled together all of the latest expert thinking on the management of fever in children and released it in a clinical report entitled Fever and Antipyretic Use in Children.

Given the importance of the subject,  I figured it would be particularly helpful to review just what these latest fever recommendations tell us about fever.

A healthy respect for fever.  It’s important to understand that fever is not an illness, but rather a common and normal response to infection. While fevers can in some instances signify a more serious underlying infection, they are unlikely to endanger generally healthy children.

It’s a matter of degree – or is it?  According to the AAP’s report, the use of fever-reducing medications should be focused on making children more comfortable, rather than getting rid of fevers altogether. It’s certainly useful to own a thermometer and to know how to accurately measure your child’s temperature. But all too often, parents unnecessarily focus on using fever-reducing medications to fight their child’s temperature back down to normal and keep it there.

The benefits of fever. While I know it may be hard to recognize any benefits when you’re home caring for a sick child, the report reinforces that fever is actually thought to have a  beneficial effect when it comes to the body’s efforts to fight infection.

Fighting fever phobia. The most common fear that parents, caregivers and even health care providers often share is that high fevers, if left untreated, will result in seizures, brain damage, or worse. In fact there is no evidence to support this fever phobia, as there is no evidence that fever itself worsens the course of an illness or that it causes long-term neurologic complications.

Treat with care. Acetaminophen products (like Tylenol) and ibuprofen products (such as Motrin or Advil) are considered equally safe and effective for use in the treatment of fever for children 6 months of age and older. That said, it is especially important for these fever-reducing medications to be dosed accurately and given no more often than necessary or recommended (every 4-6 hours for acetaminophen and 6-8 hours for ibuprofen). As for giving them in combination or alternating them, as is often discussed, it may be effective but shouldn’t be done unless absolutely necessary since it increases the risk of making dosing errors.

Originally posted on Omaha World Herald’s Live Well Nebraska

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The Benefits of Breastfeeding

There sure has been a lot of discussion about breastfeeding in Nebraska lately, and for that I’m glad. But I have to cringe every time it’s brought to my attention that Nebraska is one of only two states without legal protection for “the practice” of breast-feeding. To put it bluntly, as a pediatrician I find this quite embarrassing. Even more than embarrassing, I find it completely baffling. As much as I try to understand the opposition to LB 197 and the right to breast-feed in public, I simply can’t.

After all, you can’t convince me it’s based on concerns about over-exposed breasts. Not in this day in age. Not when Katy Perry flaunts her assets on Sesame Street, Lady Gaga’s outfits leave little to the imagination, and everything from billboards to Superbowl ads bombard us (and worse yet, our children) with nearly bare-all images of women’s breasts. Let me also point out that there’s a huge difference between the pervasive and highly sexualized imagery our society has discouragingly come to tolerate, and breast-feeding. Quite frankly, breast-feeding shouldn’t even be discussed in the same breath. Sure, it involves the breasts, but that’s as far as the connection goes.

I also think that anyone who opposes protecting the rights of women to breast-feed in public is missing the hugely important fact that promoting breast-feeding is one of the single best ways we know to improve the health and well-being of babies (and their mothers). It’s no coincidence that the U.S. Surgeon General, Dr. Regina Benjamin, recently  launched a nationwide campaign to encourage breastfeeding by removing barriers that discourage it. I applaud well-respected pediatricians Dr. Laura Wilwerding (the American Academy of Pediatrics’ breast feeding coordinator for Nebraska) and Dr. Tom Tonniges (former Associate Director at the American Academy of Pediatrics and now Medical Director at Boys Town) for their recent and ongoing efforts to insure that Nebraskans don’t lose sight of just how important breastfeeding is.

I join them in closely watching what’s happening with LB 197 and hoping Nebraska will soon catch up with the rest of the country in better supporting every new mom’s noble efforts to successfully breast-feed her baby –in the hospital, at home, and yes…even in public.

On that note, I figured it would be most compelling to leave you with a few simple but powerful reminders of just why breast-feeding and LB 197 are so important.

  • Breast milk contains infection-fighting antibodies that provide babies with protection against everything from diarrhea and the common cold to ear infections and pneumonia
  • Breastfed babies are less likely to have asthma
  • Babies who are breastfed for at least six months are less likely to become obese
  • Breastfeeding reduces the risk of Sudden Infant Death Syndrome (SIDS)
  • Moms who breastfeed not only return to their pre-pregnancy weight faster, but experience less postpartum bleeding and are at reduced risk of breast and ovarian cancer.

Obstacles such as lack of support, instruction, and accommodation to breastfeed at work and in public all contribute to the fact that while 75% of moms in the U.S. start breastfeeding, only 43% are still doing so at the end of six months (and only 13% exclusively, as recommended by the American Academy of Pediatrics).

Originally posted on Omaha World Herald’s Live Well Nebraska

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An alternative to Valentine’s Day chocolate: reasons to dance your heart out!

Valentine’s Day is undeniably all about love and sweethearts. It’s also defined by the heartfelt gifts of chocolates, sweets and (candy) hearts so plentiful this time of year. Now it’s not that I think we need to do away with all of these sweet gifts in lieu of a more heart-healthy approach to Valentine’s Day. But it has occurred to me that this holiday could mean so much more when it comes to finding ways for our loved ones to have happy hearts.

To get you one step closer to achieving this goal, I’d like to suggest that you, your kids, and your sweetheart all get up and dance. That’s right…dance! There are several reasons why you and your family should put your best foot forward and get up and start dancing.

It’s Fun. Regardless of age, who doesn’t like putting on some music and just letting loose? The good news is that regular physical activity throughout the day (which could easily include dancing), improves sleep, reduces stress, and overall makes people feel better about themselves. So just break out those dancing shoes (and your toddler’s skid-free socks and tutus) and start dancing. For some added fun – grab your video camera and capture the moment(s). No rules, just fun.

It’s Exercise. I imagine you don’t need me to tell you that we’re in the middle of a nationwide childhood (and adult) obesity epidemic. The beauty of dancing is that it’s not work, it doesn’t require committing to regular trips to the gym, and it doesn’t cost a thing to break a sweat. Yet don’t let this lack of requirements deceive you into thinking it’s not exercise. In fact, First Lady Michelle Obama’s national Let’s Move! Campaign actively promotes the need for kids to get 60 minutes of moderate to vigorous active play every day. After all, when they (and you) simply get moving (or dancing!), it all adds up to building and keeping healthy bones, muscles and joints and achieving a healthy body weight.

It’s Quality Family Time. Whether you opt for a daddy-daughter dance, a dance contest, or a more freestyle approach to your family’s dancing, it all adds up to the potential for quality family time. With the hectic pace of parenthood and often over-scheduled childhood that defines the times, I would argue that protected quality time with the family – at the dinner table, during conversations with your child in the car, and when sharing fun family activities like dancing together – is invaluable.

And now for my timely and heart-warming news. As many of you may already know, in addition to being a pediatrician, I also own an educational childcare center – Primrose School of Legacy – located in West Omaha. As one of over 200 franchised centers across the country, I am particularly proud to share with you that from February 1st through March 19th, all your heart-felt family dancing can be for a very worthy cause! That’s because Primrose Schools is hosting the 2nd Annual National Family Dance-off Contest. This fun family-oriented dance-contest is open to all families and benefits the Children’s Miracle Network Hospitals. By simply uploading a 30-second video of your family’s most creative, unique, or amusing dance moves at www.FamilyDanceoff.com and/or making sure that you and everyone you know votes each day for your favorite Omaha video, you could be one of 14 weekly contest winners who receive a flip video camera and up to $5000, while also winning Children’s Hospital and Medical Center a chance at receiving a $15,000, $20,000, or even $30,000 donation from Primrose Schools!

Simply put, I want to see Omaha families and children getting healthy by eating healthier, getting up and moving, and dancing. And through March 19th, I more specifically hope you all will be dancing to win, not only for yourselves, but for Omaha’s Children’s Hospital and Medical Center. I guarantee you it will do your body, your family, and your heart some good!

Originally posted on Omaha World Herald’s Live Well Nebraska

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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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I have to say, it’s a good thing I have the opportunity to talk to lots of parents on a regular basis, if for no other reason than because I’m able to reassure myself that I’m not the only parent having conversations like this one:

Me:     “You can’t wear shorts today.”

Child who shall go nameless: “Why not?”

Me:     “It’s winter, and it’s too cold outside for shorts.”

Child (still wearing shorts):    “So?! I’m not cold.”

Me:     “It’s not just a little cold. It’s frigid outside. As in snow temperature. As in it’s sub-zero wind chill and like the arctic tundra outside. Now go change!”

Child (still not changing):        “But mom, WHY?!”

Me:     “Because I give people parenting advice for a living, and if you don’t, you’ll make me look bad, so end of discussion – go change!”

I have to admit that there’s some irony to me telling my children to change into long pants or go put on a winter coat. After all, I grew up in the Midwest and I was actually known all throughout college for not wearing a coat – even when walking outdoors between classes during winters spent at the University of Michigan. In fact, last winter I passed a college friend on the streets of NYC who I hadn’t seen in almost a decade. He later told me that the only reason he hadn’t stopped me to say hello was because I was wearing a coat, so he figured it couldn’t possibly be me!

Okay, so now I’ve owned up to my own history of dressing inappropriately for the cold weather. But that doesn’t change anything when it comes to the parenting advice I’m about to share with you. The fact of the matter is that cold weather (like what we get here in Nebraska) can be dangerous, young children are especially susceptible to the cold, and it’s our duty as parents to insure our children’s health and safety in warm and cold weather alike. While it’s not actually true (except in more extreme instances) that being cold makes you “catch a cold,” there are definitely instances such as hypothermia and frostbite that most certainly can result from being inappropriately dressed for the weather.

With this in mind, the following information, excerpted from the American Academy of Pediatrics’ Winter Safety Tips, will hopefully help you better determine which cold-weather clothing battles are worth fighting. Don’t let it deter you if your children try to give you the cold shoulder after you lay down the law. Instead of resorting to “because I said so,” you too can feel free to justify your “request” that your child go put his shorts away until at least March (if not May) by simply saying, “Because Dr. Laura and the American Academy of Pediatrics say so!”

  • Dress infants and children warmly for outdoor activities. Several thin layers will keep them dry and warm. Don’t forget warm boots, gloves or mittens, and a hat
  • The rule of thumb for older babies and young children is to dress them in one more layer of clothing than an adult would wear in the same conditions
  • Hypothermia develops when a child’s temperature falls below normal due to colder temperatures. It often happens when a youngster is playing outdoors in extremely cold weather without wearing proper clothing or when clothes get wet. It can occur more quickly in children than in adults
  • Frostbite happens when the skin and outer tissues become frozen. This condition tends to happen on extremities like the fingers, toes, ears and nose. They may become pale, gray and blistered. At the same time, the child may complain that his/her skin burns or has become numb.

Originally posted on Omaha World Herald’s Live Well Nebraska

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Giving Thanks: Things the Whole Family Can be Thankful For

I bought my turkey this past weekend. Not only did I buy it, but I even took a moment to think about how thankful I am for it. Sure I’m thankful because I love turkey, but also simply because I am fortunate enough to be able to afford a turkey. As a parent, I know full well that taking a simple weekend task like grocery shopping and turning it into a shared reflection on what our family has to be thankful for is likely to lead to some eye-rolling from my tween- and teenage children.

But the fact of the matter is that there’s no better time than the present (i.e. Thanksgiving week) to take a few moments – whether waiting in line at the grocery store or gathered with family and friends around the Thanksgiving table – and reflect on those things in your life for which you’re truly thankful. While trips to Disneyland, ipods, and the latest greatest toddler toys will understandably spring to mind first, I suggest you challenge your children, and yourself, to dig deeper. As a pediatrician and parent, I figured I’d get you started by sharing some of my own, all-too often taken for granted things to be thankful for.

Breathing through your nose. Spoken like a true pediatrician, right? But years of tending to snotty nose colds (my own, my children’s, and others’) has taught me that it’s hard to take time to stop and smell the roses if you can’t breath through your nose. You may think I’m kidding, but I’m not. Just think how many times your child’s (or your own) stuffy nose cold has kept you up at night and caused you misery. Instead of being frustrated by the annual average 6-10 colds that kids catch each year and the fact that we still don’t have a cure for the common cold, I suggest that we all remember to be grateful for each day that we wake up healthy.

Shots. I figure while we’re on the subject of waking up healthy, I’d take this opportunity to give my thanks to modern medicine and all of the medical pioneers that have given us vaccines. No, I’m not a huge fan of needles, and neither are my children. But I have such a healthy respect for the dreadful diseases we are now able to prevent by simply making sure that our children’s (and our own) immunizations are up-to-date that I count each and every shot a blessing, needles and all.

Car Seats. As someone who had 3 kids in just over 3 years – the youngest of whom only just outgrew the need for a car seat at age 10 – I am certainly aware of the parental challenges inherent in the purchasing, installing, and juggling of car seats, especially during holiday travel season. Yet despite having spent every day of the past 10 years overseeing the use of numerous seats of my own, I’m exceedingly grateful for the fact that car seats even exist, much less that they are so incredibly effective in protecting kids from harm. With nothing more important than my children’s health and safety, car seats (and all those who contribute to making sure that children are secured safely) deserve my thanks.

Cell Phones. Yes, I do have tween- and teenage children of my own. And yes, I do face the daily parental challenge posed by a world now dominated by texting tots and teens and threatened by everything from cyberbullying to sexting. But having just returned from a mobile health summit in Washington DC, I am now very, very grateful for cell phones. World thought leaders the likes of Bill Gates, Director of the National Institutes of Health Francis Collins, and the president of the Rockefeller Foundation joined over 2500 attendees from around the world who all share the belief that cell phone technology is the tool by which we will be able to reach the world’s poorest and provide them with access to better health.

Here in the United States, innovative programs like text4baby are making use of the ubiquitous nature of cell phones to put valuable health information and access to local resources right at the fingertips of pregnant women and new moms.

While I will absolutely not be thankful for any cell phones that make their way to my family’s Thanksgiving table, I will nevertheless be grateful that they exist, not just to make my life easier, but improve the health and well-being of those less fortunate than me.

Originally posted on Omaha World Herald’s Live Well Nebraska

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The Great American Smokeout: Why We Need to Clear the Air…for Our Children’s Sake

I am pleased to note that November 18th is the 35th anniversary of the American Cancer Society’s Great American Smokeout. That said, I have to admit that the existence of this day also makes me a bit sad. Sad because people still smoke. Sad because even those who don’t – including children – are nevertheless at risk. And most of all, sad because smoking is both deadly and powerfully addictive.

The fact of the matter is that despite decades of clear messages about the risk of cigarette smoking, there’s still more than enough smoke to go around. So much so that the FDA has now decided to resort to more drastic, scare-tactic measures, since high taxes and an ever-present surgeon general’s warning that “Smoking causes lung cancer, heart disease, emphysema, and may complicate pregnancy” hasn’t sufficed. Soon, fully half of each entire cigarette pack will be required to show grim images of what smoking actually does to you, with images of diseased lungs, toe tags and body bags up for consideration.

As a pediatrician, of course, my focus is on helping insure that all babies are born healthy; that all children are raised in environments that are nurturing, healthy and safe; and whenever humanly possible, keeping kids from trying out risky behaviors for themselves. Unfortunately, smoking puts children in the direct line of fire on all three fronts.

While getting people to stop smoking (or not to start in the first place) can be admittedly challenging, it is my sincere hope that it’s possible. Whenever anyone is faced with having to change a habit or behavior because it’s “good for them” – whether it has to do with losing weight, exercising more, improving one’s diet, or quitting smoking – they first have to want to change. I hope that a closer look at some compelling dangers our children face from cigarette smoke will provide added motivation to help clear the air of cigarette smoke once and for all.

  • Babies are at risk, even before they are born. According to the March of Dimes, expectant mothers who smoke are at greater risk for pregnancy complications including bleeding, serious problems with the placenta, and even stillbirth. Babies born to mothers who smoke are at greater risk for being born prematurely, being low birthweight, having birth defects such as cleft lip/palate, and a whole list of other serious health problems.
  • Sudden Infant Death (SIDS). According to the American Academy of Pediatrics, maternal smoking during pregnancy has emerged as a major risk factor in almost every study of SIDS and several studies also suggest that smoke in an infant’s environment after birth poses an added risk.
  • Breathing problems and increased infections. The EPA estimates that as many as 300,000 children under 18 months of age get bronchitis or pneumonia resulting in thousands of hospitalizations each year just from exposure to secondhand smoke….and this is only the tip of the cigarette iceberg. Children who are exposed to cigarette smoke also get more ear infections, and breathing problems include everything from coughing, wheezing, bronchitis and pneumonia to an increased risk of developing asthma, or more frequent and severe asthma attacks for those kids who already have asthma.
  • Smoke lingers. Smoking in a different room or away from your child may lessen the exposure a bit, but not enough to protect them. No amount of exposure is safe. Even when cigarette smoke is delivered secondhand, the end result is still dangerous exposure.
  • Glorified images of cigarette smoking are influencing our children. Most parents are unaware of the fact that despite all the known dangers of smoking, a CDC report reveals that more than half of PG-13 movies in 2009 still contained images of tobacco use. While you may be understandably tempted to say “so what?” this statistic becomes far more frightening when partnered up with the CDC’s statement that “exposure to onscreen smoking in movies increases the probability that youths will start smoking.” In fact, there are pediatricians who consider images of smoking in movies “the single biggest media risk to young people.” Yet Hollywood still allows for paid placement of cigarettes in movies. For anyone still tempted to blow off the impact that smoking in the movies has on children, I suggest you find out more at Smoke Free Movies.
  • Teens are still being tempted. When it comes to protecting kids from the dangers of cigarette smoke, we’re up against some very powerful forces: The addictive nature of tobacco makes it very difficult to quit once someone starts, and the continued portrayal of cigarettes as sexy and powerful in everything from celebrity magazines to movies serves as a powerful lure for our children. It’s no wonder that an estimated 20 percent of high schoolers smoke, and 4000 US teens each day still opt to gain firsthand experience of cigarettes’ harmful effects by trying out smoking for the first time.

Like elsewhere around the country, the good news is that if you want to quit, there are people, organizations and resources right here in Nebraska that are ready, willing and able to help you – from a free confidential Nebraska Tobacco Quitline (800-784-8669) to online support at QuitNow.ne.gov.

Whether you decide to take the first step for yourself, or for your children, you can start by joining Tobacco Free Nebraska, the American Cancer Society and Nebraska’s Department of Health and Human Services’ efforts as part of Thursday’s Great American Smokeout.

Originally posted on Omaha World Herald’s Live Well Nebraska

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Coughs, Kids & Vaccines: Why parents are the key to silencing the sounds of pertussis!

You really don’t have to listen very hard to hear the sounds of the season – the rustling of fall leaves, the weekend cheers of husker fans, and lawnmowers out for one last run before being swapped out for snow blowers. But if you ask me, the most noticeable sounds this time of year are all of the coughs, sniffles and sneezes that predictably make their annual show of force during cold and flu season. For parents and pediatricians alike, these are familiar sounds that we learn to live with and treat as needed. This year, however, we are hearing a lot more than usual about another sound – a sound for which we should all be listening carefully: the sound of pertussis.

Perhaps you’ve heard of pertussis – also commonly referred to as whooping cough – from your pediatrician. Some of you may remember reading about it each time you received the standard set of vaccine information sheets describing each of your child’s scheduled immunizations, since the DTaP (the “P” part referring to pertussis) vaccine is routinely given.

Chances are that if you’ve been following the national news lately, however, you may have also heard that there’s a pertussis outbreak in California. In the world of infectious diseases, let me assure you that California isn’t very far away from Nebraska, and this outbreak is not just another news story about an isolated incident hundreds of miles away. The spread of pertussis in California is, in fact, proving to be the worst outbreak in 60 years, having already claimed the lives of 10 infants under the age of 3 months. If that’s not a reason to stop and take notice, I don’t know what is.

The fact of the matter is that pertussis is caused by one of the most contagious bacteria we know. The infection can start out seeming like a common cold, but over the course of a couple of weeks manifests itself as an escalating cough which then turns into coughing episodes sometimes severe enough to result in vomiting or the characteristic “whoop” sound that represents the dramatic effort to draw air back into the lungs.

While adults typically experience weeks (if not months) of a cough that just won’t go away, they don’t often “whoop” like kids do. Neither do babies under 6 months of age – a fact that increases their risk of life-threatening illness or death at a time when they can’t yet be vaccinated (under 2 months) or haven’t developed full immunity (under 6 months of age). Unable to draw air back into their lungs, babies may gasp, gag, or simply stop breathing altogether – making them the most vulnerable at a time when they are also the most at risk.

As someone committed to helping insure the health and well-being of all children, I’ve therefore pulled together some very important facts about whooping cough, who is at risk, and what each of us can do to prevent the spread of pertussis in hopes that we protect all of Nebraska’s children and adults against a sound you never want to hear at any time of the year….the sound of a young child with pertussis.

Make sure your child is up to date on his/her shots. DTap is recommended at 2, 4, 6 and 15-18 months, and again at 4-6 years. The best time to get your child protected against pertussis is the first day your child becomes eligible for each recommended immunization.

Get your adult tetanus booster. Immunity to whooping cough doesn’t last forever. Any adult (or teen) who doesn’t remember getting a pertussis booster shot, or hasn’t had one since they were immunized as a child needs to get vaccinated. The fact of the matter is that babies too young to be protected by the vaccine rely solely on all of us to not expose them. Sadly, an estimated 3 out of every 4 babies with life-threatening pertussis infection got it from a loved one. Prevent this from happening by rolling up your own sleeves, getting an adult booster shot, and doing your part to limit the spread of pertussis.

Be on the lookout for pertussis and contact your doctor or your child’s pediatrician with any concerns. It’s all too easy to mistake pertussis for the common cold at the outset of the infection, and while people are contagious for up to a month, antibiotics are of little benefit after the first week or so. Half of babies with whooping cough end up needing to be hospitalized.

Listen to the sound of pertussis. If my blog hasn’t already convinced you, or you simply want more information, watch my recent pertussis-focused CNN interview with Kiran Chetry on American Morning, go to www.soundsofpertussis.com and let Jeff Gordon of NASCAR fame convince you, or simply listen to what a baby with pertussis sounds like .

Now let’s all commit to doing everything we possibly can to silence the sounds of pertussis.

Originally posted on Omaha World Herald’s Live Well Nebraska