5 Tips for Developing Healthy Eating Habits in Kids

By Shonda Brown, RD, CSP, CNSC, clinical dietitian at CHOC Children’s

Kids’ food preferences are influenced in large part by their caregiver’s own food preferences, as well as the behavior they model. Too often parents want their children to eat healthy, but they either don’t offer healthy options or don’t eat healthy foods themselves.

Helping children develop healthy eating habits early in life as well as assuring adequate nutritional intake during a time of rapid growth and development is paramount in reaching and maintaining health well into adulthood. In fact, research has shown that exposing toddlers to a variety of foods and flavors increases the number of foods accepted in later childhood.  Unfortunately, less than half of children 2-17 years old meet their recommended daily intakes of vegetables, seafood and beans, and less than 20 percent of their recommended intake of whole grains, according to a 2010 study by The Healthy Eating Index, a report of the United States Department of Agriculture.  A report from the Feeding Infants and Toddlers Study showed that approximately 25 percent of children failed to eat a single serving of fruit or vegetables on the survey day and up to 85 percent of children consumed some type of sweetened beverage, dessert or salty snack. Sadly, of the vegetables consumed, french fries were the most popular.

More than one quarter of total daily calories are consumed outside the home, highlighting the need to assure meals purchased at restaurants are providing children with balanced nutrition. The National Restaurant Association introduced the Kids LiveWell program in 2011 in an effort to improve the nutritional quality of food and beverages offered on kids’ menus. Improvements over the past few years include restaurants now providing fruit and vegetables as side options instead of fries or chips, and milk or water instead of soda. However, only 9 percent of meal combinations offered at the top 50 restaurant chains meet the Kids LiveWell nutritional guidelines.

Here is what you can do to turn the tables on “kids’ food”. Incorporate the following tips to help children choose healthy foods and develop healthy eating patterns that may last a lifetime.

  1. Prepare meals together

Have your child create a new meal or snack from a few healthy ingredients. Talk about how it smells, tastes, looks and feels. Children as young as two years old can help out in the kitchen. You can have your child wash fruits and vegetables, or stir ingredients. Children are more open to trying new foods if they have opportunities to explore and learn about the food before they eat it.

  1. Make healthy foods fun

Be creative when offering new foods. You can make bugs with fruit kabobs or faces with vegetables on homemade pizza. Giving foods fun names is always a hit – like “monster brains” for cauliflower or “silly billy green beans.”

  1. Help them learn to love a variety of healthy food

Start by setting an example – a child is more likely to accept a new food if they observe parents, siblings or friends taste and enjoy the food.  Food acceptance is also related to exposure. It often takes 10-15 times before a child may accept a new food so it is important to be patient as well as persistent. Some helpful tips are

  • Offer small portions at first
  • Offer a new food with familiar foods
  • Allow your child to decide if they are going to try the new food
  • Offer praise when a child tries a new food
  1. Make mealtimes family time

Children who eat meals with their families at home have better quality diets and higher intake of fruits and vegetables. Remove any distractions such as TV or iPads from the dinner table. Allow children to make choices and serve themselves – this empowers them and gives them confidence. Enjoy time together as a family and talk about fun things that happened during the day.

  1. Make healthy choices when dining out

There are no magical foods that only kids eat. Children can be served the same foods as the rest of the family. If you are out at a restaurant, you can skip ordering from the kids menu and order a healthy option from the regular menu. The portion size will likely be more than what your child needs, so you can share between siblings or bring home leftovers. If you order from the kids menu, chose the fruit, yogurt or veggie sides instead of high calorie, low nutrient sides such as chips and french fries. Skip the sugary beverages such as soda and chose low fat milk or water instead.

Keep healthy foods available whenever you can, and maintain a relaxing and encouraging environment around mealtimes. You never know, your child may just munch on Swiss chard picked fresh from the garden, beg that you prepare scallops for dinner or think raisins and nuts are dessert.

Learn more about nutrition services at CHOC Children’s.

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Keeping Kids Active This Summer

By Michael Molina, MPH, Community Educator at CHOC Children’s

Children and adolescents should meet a minimum of 60 minutes of physical activity every day. The full 60 minutes doesn’t have to be all at once- you can break it down in smaller sessions such as 15-20 minutes. Being active is an essential part a child’s growth and development, and keeping them healthy. Incorporate these easy tips into your family’s summer plans to make sure everyone gets the physical activity they need and deserve.

Be active with your children

Be a role model for your kids. Children are more likely to stay active when they are having fun with their parents. Using words like “play time” or “fun time” makes it more exciting and appealing than “exercise” or “working out.” Tap into activities or sports that they are interested in, such as walking the dog, playing catch, soccer, riding a bike, or an obstacle course in your backyard.

Parents should encourage physical activities for the whole family, and time together should concentrate on 3 areas:

  • Endurance (increase heart rate)- Run away from the person who’s “it” or balloon tag
  • Strength (using our muscles)-Try crossing the monkey bars. No need for weights for this one; use your body weight for pull-ups, pushups, and sit-ups at the playground
  • Flexibility (stretching our muscles)- Fun yoga poses or something as simple as bending down to tie their shoes

Limit screen time for the entire family

Children should not exceed more than two hours of screen time each day. Screen time is considered watching TV, playing video games, or using the computer, tablet or smartphones.

Children are more likely to eat foods that are high in fat, sugar and sodium during long periods of screen time that surpass their serving size.

Screen time means time away from being active. Long term consequences of being physically inactive increase one’s risk of diabetes, high blood pressure and heart disease.

Join a summer camp or program

Look for your city’s summer camps or programs, or join your local Boys and Girls Club.

Ask what types of activities  these summer programs provide for your child and if they are age appropriate. Also try to find ways that you can be involved with the summer program.

Drink plenty of water

Provide water as a source of rehydration, not fruit drinks. Many fruit drinks are advertised as “healthy” drinks because they have images of real fruit on the packages when really it is made with a small percent of real fruit.

Water is a great source of hydration and it is calorie-free.  Try adding slices of real fruit in the water for more flavor.

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Avoid heatstroke with these sun safety tips

Heatstroke can happen when body temperature rises to dangerous levels and it isn’t able to cool itself quickly enough. On average nationwide, 37 children die in hot cars every year from heat-related incidents. Nearly every state has experienced a child vehicular heatstroke death.

Community educators at CHOC Children’s recommend the following tips for avoiding heatstroke:

  • Never leave your child alone in the car, for any amount of time. In California it’s against the law to leave any child under age of six alone in a vehicle without a person who is at least 12 years old.
  • Teach kids not to play in cars, and kept your car locked so they can’t get in on their own.
  • Create reminders for yourself not to forget your child in the backseat of your car. Leave an important item in the backseat near your child, like a wallet or cellphone that is needed at your final destination.
  • If you notice a child alone in a car, call 911.

Parents can retain these tips by remembering to ACTAvoid leaving your child alone in the car. Create reminders, such as one that ensures you dropped your child off at daycare that morning. Take action- if you see a child alone in a car, calling 911 could mean saving their life.

Heatstroke symptoms include dizziness, disorientation, agitation, confusion, sluggishness, hot and dry skin that is flushed but not sweaty, loss of consciousness, rapid heartbeat and hallucinations. These symptoms can progress to seizures, organ failure or death if not immediately treated.

If a child is experiencing heatstroke, there are several things you can do while medical assistance arrives. Take the child to a cool place, remove as much of their clothing as possible, and apply cold packs or ice to areas with large blood vessels (neck, groin, armpits) to accelerate the cooling process.

Learn more safety information from CHOC’s community education department.

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Examining the Causes of Gynecomastia

By Dr. Ashley Cowan, pediatric resident at CHOC Children’s

Gynecomastia is breast tissue that forms in males.  Males can also have excess adipose (fat cells) tissues in this same region, but gynecomastia is different. Typically, the formation of this breast tissue is caused by an imbalance of estrogen and androgens in the body, which is very common in the early stages of puberty. While it may or may not be noticeable to others, this tissue often will feel like a firm bump, and is sometimes tender. Commonly it occurs on both sides of the chest, but it may also appear on only one side.

This condition is surprisingly common. Up to two-thirds of boys actually develop gynecomastia during puberty, and it’s considered a normal part of adolescent development. For the majority of males it is temporary, usually lasting anywhere from six-12 months. There are three times in a male’s life when breast tissue may form:

  • As a newborn- 60-90 percent of male babies have gynecomastia from exposure to the mother’s estrogen.
  • During puberty- it might develop during early puberty, but usually resolves on its own.
  • Later in life- elderly men often develop breast tissue as the result of a decrease in testosterone levels.

There are some medications that can cause gynecomastia including gabapentin, an anti-epileptic medication; metoclopramide, prescribed for stomach and esophageal problems; ulcer and acid reflux medications like ranitidine or omeprazole, and some antipsychotic medications such as risperidone. In fact, over 300 medications have potentially been associated with the development of breast tissue, usually reversible when the medication is discontinued. Herbal or ‘natural’ medications that contain estrogen also can lead to gynecomastia. Steroids, alcohol, heroin and heavy marijuana use also can stimulate the development of breast tissue.

There are a few rare syndromes and other causes for breast tissue development, which is why it is important to discuss the presence of breast tissue with your primary care provider.  These causes can include:

  • Hyperthyroidism or renal and liver disease. These can affect the balance of hormones in the body.
  • Certain tumors that produce estrogen.
  • Some genetic syndromes that may also lead to altered estrogen and testosterone levels.

If your child has breast tissue development between the ages of 3 months and before puberty has started, if the breast tissue that developed is larger than 4 cm, or if it occurs after puberty has completed, consult your child’s pediatrician. Be sure to let your doctor know if you notice discharge or liquid coming from the nipples or if the breast tissue is not resolving.  Your provider will help determine if any additional testing is needed.

The majority of patients have physiologic (normal) and temporary causes of gynecomastia. Typically, this breast tissue will resolve on its own and no intervention is needed. It can take from a few months up to two years to resolve completely. The breast tissue itself is not harmful and surgery should only be considered for those with significant distress for cosmetic reasons.

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Does My Child Have a Sleep Disorder?

Healthy sleep is critical for children and teens. Sleep disorders, such as problems falling asleep and sleep apnea, affect your child’s ability to get the sleep needed for good growth, development and overall health. Even infants may have sleep disorders. However, a pediatric sleep disorder can be treated with the help of a sleep specialist.

In this episode of CHOC Radio, Dr. Neal Nakra, a pediatric pulmonologist and sleep specialist, and Dr. Marni Nagel, a psychologist, discuss:

  • The difference between medical and behavioral sleep problems and how to recognize them
  • When it may necessary to see a sleep specialist
  • How many hours of sleep your child needs
  • How sleep problems can affect health
  • The importance of sleep for teens and school start times

Hear more from CHOC experts in this podcast.

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How to Treat Poison Oak this Summer

Contrary to a common misconception, poison oak is a different nuisance than its counterpart, poison ivy. In southern California and throughout the West Coast, outdoor explorers can expect to find poison oak in wooded, brushy areas. In the northeast, you will find poison ivy, and in the southeast, poison sumac.

The best way to avoid poison oak is to stay on a path when outdoors this summer, since poison oak can be hidden in brushy areas. Wear long pants and socks, and avoid off-roading, advises Dr. Katherine Roberts, a CHOC Children’s pediatrician.

Poison oak causes a contact dermatitis that is spread onto the skin from the plant oils. A rash and itchy irritation are common side effects of a poison oak exposure. These plants cause a delayed reaction, so symptoms may appear anywhere from a few hours to a few days later, potentially creating confusion on their cause. The itching may last for a few days, and the rash may be apparent for up to two weeks. Unfortunately, while nothing will make the  red weepy rash go away faster, says Roberts, but topical calamine lotion may provide relief from the intense itching, which can last for a few days. Hydrocortisone cream may also alleviate symptoms, and can be used in conjunction with topical calamine lotion, she adds. For severe cases, oral antihistamines can help. Consult your pediatrician on specific questions related to any medication regimen.

If you think you have been exposed to poison oak, it is important to thoroughly wash anything that may be have been exposed to the plant oils which can spread to the skin if touched again:

  • Wash yourself and the clothes you were wearing at the time of exposure
  • Use soapy water to wash down your shoes, including laces
  • Wash or wipe down coat

It’s important for parents to remember that poison oak dermatitis, although inconvenient, is not contagious, so there is no reason to keep kids home from school if they have poison oak.

If the affected area becomes puffy, painful or at-home remedies do not alleviate itching, consult your pediatrician, as those may be signs of a skin infection. Topical or oral antibiotics may be prescribed. In rare cases, oral steroids may be needed.

Learn more safety tips to protect your family this summer.

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U.S. News Names CHOC One of the Nation’s Best Children’s Hospitals

From treating the most complicated cases of epilepsy and repairing complex urological conditions, to curing cancer and saving premature lives, CHOC Children’s physicians and staff are committed to delivering the highest levels of safe, quality care. That commitment has earned CHOC its most recent accolade:  inclusion on the coveted U.S. News & World Report’s Best Children’s Hospitals rankings.   CHOC ranked in eight specialties: cancer, neonatology, neurology/neurosurgery, pulmonology, orthopedics, gastroenterology and GI surgery, diabetes and endocrinology, and urology, which earned a “top 25” spot.

U.S. news

According to U.S. News, the Best Children’s Hospitals rankings are intended to help parents determine where to get the best medical care for their children. The rankings highlight the top 50 U.S. pediatric facilities in 10 specialties, from cancer to urology. Of the 183 participating medical centers, only 78 hospitals ranked in at least one specialty. For its list, U.S. News relies on extensive clinical and operational data, including survival rates, clinic and procedure volume, infection control measures and outcomes, which can be viewed at http://health.usnews.com/best-hospitals/pediatric-rankings. An annual survey of pediatric specialists accounts for 15 percent of participants’ final scores.

“The Best Children’s Hospitals highlight the pediatric centers that offer exceptional care for the kids who need the most help,” says U.S. News Health Rankings Editor Avery Comarow. “Day in and day out, they offer state-of-the-art medical care.”

Dr. James Cappon, chief quality and patient safety officer at CHOC, points to the survey as an invaluable tool for him and his colleagues to evaluate programs and services, determining best practices, and making plans for the immediate and long-term future.

“CHOC is certainly honored to be recognized once again by U.S. News. But our dedication to serving the best interests of the children and families in our community is what truly drives us to pursue excellence in everything we do. Our scores, especially in the areas of patient-and-family-centered care, commitment to best practices, infection prevention, breadth and scope of specialists and services, and health information technology, for example, reflect our culture of providing the very best care to our patients,” explains Dr. Cappon. To hear more about CHOC’s commitment to patient safety and quality care—and what parents need to know— listen to this podcast.

CHOC’s culture of excellence has it earned it numerous accolades, including being named, multiple times, a Leapfrog Top Hospital. Additional recent honors include the gold-level CAPE Award from the California Council of Excellence; Magnet designation for nursing; gold-level Beacon Award for Excellence, a distinction earned twice by CHOC’s pediatric intensive care unit team; “Most Wired Hospital”; and The Advisory Board Company’s 2016 Workplace Transformation Award and Workplace of the Year Award. Inspiring the best in her team, CHOC’s President and CEO Kimberly Chavalas Cripe was recently named a winner of the EY Entrepreneur of the Year Award in the “Community Contributions” category.

Common Little League and Softball Injuries in Children

Overuse injuries can plague athletes of all ages and sizes, and youth softball and baseball competitors are no exception, a CHOC Children’s sports medicine specialist says. Two of the most common injuries that affect youth competing in either of these sports are commonly referred to as ‘Little League Shoulder’ and ‘Little League Elbow,’ says Dr. Jonathan Minor, a CHOC pediatrician who specializes in sports injuries, injury prevention, and concussion management.

Dr. Jonathon Minor

‘Little League shoulder’ is a fracture of the growth plate in the shoulder. A warning sign is often pain that comes with throwing, without any preexisting injury. ‘Little League elbow’ is a small growth plate injury on the inside part of the elbow. Many will eventually hear or feel a ‘pop’ on the inside of the elbow, which often is a small piece of bone being pulled away from the elbow, at which time you should seek medical evaluation urgently, says Minor.

With either injury, pain tends to be gradual. Initially the shoulder or elbow may feel sore after games for players in heavy throwing positions such as pitchers, catchers or outfielders. For example, for pitchers, the shoulder or elbow may feel sore after pitching, but often after one to two weeks of continued throwing, they may experience pain during the game as well.

“Forty percent of the speed of the ball comes from the arm and shoulder, and the rest comes from the core, legs and hips,” says Minor. “Proper form is essential to preventing injuries. This also means that having strong lower body and core muscles, not just a strong upper body, is imperative. Working with a throwing mechanics coach can be very helpful at utilizing each of these different muscle groups.”

Other preventative measures include adhering to the sporting organization’s rules for pitch counts and rest requirements between pitching appearances. Athletes also should not be allowed to switch from one heavy-throwing position to another during the game, such as playing catcher after pitching for several innings. Remind your child to do a proper warm-up and cool down before and after practices and games. Consider loosening up arm muscles with a heating pad prior to practice, as tight muscles are more prone to injury.

Athletes at this age are developing their skills as well as their sense of competitiveness, but that doesn’t mean they should be playing through the pain, he adds.

Leagues often encourage players to recognize when and where their pain occurs. Consult a physical therapist or athletic trainer initially, and if basic treatments like rest, ice, and basic medication such as ibuprofen, are not helping, ask your pediatrician about a referral to a sports medicine specialist.

Since a major contributing factor to these all-too-common injuries include throwing mechanics, Minor often recommends athletes work with a physical therapy program that has experience with athletes in their chosen sport, in order to work on proper form.

Recommendations for treatment are made on a case-by-case basis says Minor, but may include rest, X-rays or other imaging, or changing positions in the game to a position less strenuous to their injury.

Since these pains are often gradual, they may get more severe as the season progresses. As playoffs commence, athletes may fear that speaking up about an injury could prevent them from participating, or result in other consequences. Encourage your young athlete to be honest about how they’re feeling, since identifying an injury and seeking treatment sooner rather than later, can allow them to return to competition earlier.

“Southern California is such a great place to live- the weather is very conducive to playing baseball and softball for twelve months out of the year. But every athlete, especially ones who throw often, should have a few months off per year to prevent overuse injuries. Try playing another sport that doesn’t involve throwing, or focus on conditioning work, particularly hips, legs and core that all too often get neglected during the season,” says Minor.

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Concussion Program Prescribes At-Home Exercises

Athletes and other adolescents with mild to severe concussions who experience symptoms such as dizziness, feeling unbalanced on their feet, blurred vision or trouble focusing on objects, may be good candidates for at-home visual and vestibular exercises recently designed by experts of the CHOC Children’s concussion program.

“Concussions are like puzzles, and every one is a little bit different,” says Dr. Jonathan Minor, a CHOC sports medicine specialist. “As many as fifty percent of concussed athletes may experience these symptoms and could benefit from these exercises that may get them back on the field or back in the classroom sooner.”

concussion exercises
Dr. Jonathan Minor models one of several at-home exercises recently designed by experts of the CHOC Children’s concussion program.

The convenient and self-explanatory exercises are ones that athletes and students can perform at home, but should only be started under the guidance of a concussion specialist, after an appropriate evaluation, and as part of an overall post-concussion treatment plan. These exercises are intended to enhance and improve a patient’s recovery from a concussion.

“Patients should be aware that beginning these exercises may stimulate some symptoms for a short period of time, such as trouble focusing, dizziness, nausea or headaches. But after just a few days of daily exercises, they may find that they can tolerate each exercise for a longer period of time,” says Minor, who is a lifetime athlete himself.

“We encourage our patients to only perform these exercises for the duration tolerated, rather than endure and push through worsening symptoms initially. Seeing a difference quickly with improved tolerance resonates especially with athletes, who are used to training and then seeing improved results.”

Download your copy of the vestibular/balance exercises and the visual concussion home exercises.

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Get Up and Grill!

By Amanda Czerwin, RD, CLEC, clinical dietitian at CHOC Children’s

Summer is here! And you know what that means- it’s time to get outside and start firing up the grill. Barbequing is a great way to bring your family and friends together and cook up a nutritious meal at the same time. Here are a few tips for your next grilling adventure in order to make a safe and tasty meal.

Before throwing your foods over the fire, make sure your grill is clean and ready to go. Consider using alternative products that may be safer for your environment. Then light up your barbeque and allow it to thoroughly heat up before cooking to kill any lingering bacteria.

Now comes the difficult task of deciding what to cook up! There are plenty of ways to get creative and try something different besides the typical hot dogs and hamburgers. If you’re looking to cook meat, then try choosing some leaner options such as chicken, fish, ground turkey or lean pork chops. It’s important to also avoid charring your meat as much as possible to prevent any carcinogenic compounds from forming. According to the Academy of Nutrition and Dietetics, one of the best ways to prevent this is by trimming any extra fat and skin off your meats before cooking. When fat drippings fall off meats, it can cause flames to flare up, causing extra charring. It’s also recommended to cook your foods over a longer period of time, at lower temperatures to avoid charring. You can also turn your food over frequently while cooking and scrape off any charred areas.

Brighten up your grill with colorful vegetables to add more flavor and nutrition to your meals. Put together delicious vegetable kabobs with veggies like zucchini, onions, cherry tomatoes, mushrooms and bell peppers. And who said burger patties had to be made out of meat? Switch it up one night and try grilling a black bean burger or making your own veggie patties using your favorite finely chopped vegetables.

You can even grill fruits too! Grill fresh pineapples slices and add them to a turkey burger or grill a colorful fruit kabob and add it to a fresh salad. Fresh grilled peaches or bananas added to angel food cake, low-fat ice cream, or whipped cream can also make a tasty treat.

Try cooking up this recipe at your next barbeque!

Quinoa Black Bean Burgers:

Ingredients

  • 1 (15 ounce) can black beans, rinsed and drained
  • 1/4 cup quinoa
  • 1/2 cup water
  • 1/2 cup bread crumbs
  • 1/4 cup minced yellow bell pepper
  • 2 tablespoons minced onion
  • 1 large clove garlic, minced
  • 1 1/2 teaspoons ground cumin
  • 1/2 teaspoon salt
  • 1 teaspoon hot pepper sauce (such as Frank’s RedHot Sauce)
  • 1 egg
  • 3 tablespoons olive oil

Directions

  1. Bring the quinoa and water to a boil in a saucepan. Reduce heat to medium-low, cover, and simmer until the quinoa is tender and the water has been absorbed, about 15 to 20 minutes.
  2. Roughly mash the black beans with a fork leaving some whole black beans in a paste-like mixture.
  3. Mix the quinoa, bread crumbs, bell pepper, onion, garlic, cumin, salt, hot pepper sauce, and egg into the black beans using your hands.
  4. Form the black bean mixture into 5 patties.
  5. Heat the olive oil in a large skillet.
  6. Cook the patties in the hot oil until heated through, 2 to 3 minutes per side.

Recipe via www.allrecipes.com

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