Ask a CHOC Doc: How can my athlete daughter learn vital nutrition?

Question: 

Mine is an interest. I’m looking to learn more about how my teenager, dealing with orthorexia eating disorder, can continue to play high school sports and learn vital nutrition techniques, like how to refuel the calories that have been burned. -Anonymous

Answer: 

Health care providers always support teens and families focusing on healthy nutrition choices such as a balance of fruits and vegetables, whole grains and lean proteins. Sometimes, however, a nutrition plan overly focused on the ideals of healthy eating can actually result in significant nutritional lapses with both short term and long-term consequences to your health – this is what is commonly referred to as orthorexia. Persistent fatigue, prolonged muscle aches, dizziness, mood changes, and loss of periods are all signs that your teen should be evaluated by their pediatrician as soon as possible, and with the right interventions hopefully we can prevent nutritional imbalances and medical complications.

In order for your teen to perform in their sport at their most optimal level, they need the right balance of carbohydrates, protein, and fat in addition to supportive vitamins and minerals, and adequate fluids.

  • Carbohydrates are the body’s primary fuel source and should be a significant part of all meals and snacks. All athletes need energy!
  • Protein is important for muscle growth, and repair of muscle breakdown after exercise. Athletes should consume a protein and carb snack within 30 minutes after exercise to help refuel their body’s and aid in recovery. Pairing protein and carbohydrates actually lets the body use the protein better. It is important to note that the body can only utilize 30grams of protein at any one time.
  • Fats are the body’s “reserve tank” for fuel, and are especially important in any type of endurance sport.
  • Vitamins and minerals help unlock the energy stored in food, and Calcium and vitamin D are essential for bone health.

Checking with your doctor is always important to make sure there are no early signs of an eating disorder or complications from imbalanced nutrition. Seeing a sports nutritionist can help identify the exact nutritional components your teen needs, and the best choices to meet those needs. Great websites for additional information and resources include eatright.org and scandpg.org (sports, cardiovascular, and wellness nutrition section of the Academy of Nutrition and Dietetics).

-Dr. Alexandra Roche, pediatrician specializing in adolescent medicine and Amanda Czerwin, nutritionist at CHOC Children’s

Learn more about adolescent medicine at CHOC.

A Parent’s Guide to Understanding the Teen Brain

The mind of a teenager can be at times mysterious and illusive. A pediatric neurologist, a pediatric neuropsychologist and a pediatrician who works with adolescents at CHOC Children’s offer advice for parents on how to better understand and connect with their teen.

Navigating adolescence with a still-developing brain

Adolescents’ brains are not yet fully developed during their current stage of life. Physical development can start as early as 8 years old, but the tail end of brain development doesn’t occur until closer to age 25. The more your child is exposed to new things, skills or experiences, the more connections their brain will develop.

“The brain is constantly developing through young adulthood. Just like we wouldn’t expect a baby to be able to speak or a toddler to be able to understand certain consequences, we have to have appropriate expectations for our adolescents,” says Dr. Sharief Taraman, a pediatric neurologist.

Dr. Sharief Taraman offers advice on the teen brain
Dr. Sharief Taraman, a pediatric neurologist at CHOC Children’s

This constant development can lead to experimentation and in turn, a healthy decision making process.

“On the one hand, adolescents are more apt to experiment and make poor choices because their brains are still developing, but they are also more able than adults to learn from their mistakes and alter their perspectives,” says Dr. Jonathan Romain, a pediatric neuropsychologist. “I see adolescence as a period of great potential for growth and development.”

Dr. Jonathan Romain comments on the teen brain
Dr. Jonathan Romain, a pediatric neuropsychologist at CHOC Children’s

A parent’s role in teen brain development

The consequences of teens’ actions can help them link impulsive thinking with facts. This helps the brain make these connections and wires the brain to make this link more often. Parents play a crucial role in helping teens talk through consequences and decision making.

“Part of a parents’ role during this time in their child’s life is understanding that adolescents are practicing new reasoning skills they haven’t used before,” says Dr. Alexandra Roche, a pediatrician who works with adolescents. “Having abstract thinking is one new reasoning skill they need to practice. When they are trying to make a decision, it’s helpful for parents to let them explore various consequences.”

Dr. Alexandra Roche comments on the teen brain
Dr. Alexandra Roche, a pediatrician who works with adolescents at CHOC Children’s

The primary part of the brain developing during this time is the frontal lobe. As this area develops, teens are better equipped for abstract thinking and executive functioning, such as planning their day and making decisions. The frontal lobe is also involved with connections and how we socialize with people as well.

“They’re learning that if A happens, then B or C is going to happen after that. Parents get frustrated at how adolescents handle peer relationships and how extreme their feelings can be, but these may happen because those connections are being formulated. Talking through consequences helps good connections to form,” says Dr. Taraman. “Decision making takes practice. If you want to play guitar, you take lessons and practice, and it makes you better. If you only take one guitar lesson, you’re not going to learn how to play. Decision making is the same thing; it takes practice and it is never too early to start teaching our kids how to make good decisions.”

How to teach decision-making skills to your teen in an interactive way

Remember that you are a role model for your teen’s behavior. When it’s time to make a big decision, show them how to make a matrix, weigh the criteria of what is important to you and them, and teach the decision making process in an interactive way.

Modeling reasoning behavior with your teen will affect how they explore and understand downstream consequences, says Dr. Roche.

“If they approach you and want permission to do something, have them do research via respectable sources and find out what’s appropriate for their age. Involve them in the decision making process. That’s how you can give them good tools instead of just deciding things for them,” says Dr. Taraman.

Talking to your kids is essential in the digital age. It’s common for teens to want to be on their smartphone around-the-clock, but that can spur an extreme fear of missing out. Figuring out how to turn off both the devices and the need to be constantly plugged in is important.

“Try setting technology-free zones or times in your home, such as the dinner table. Take turns going around the table and sharing the highlight of your day. It can spark conversations about other things that happened during your day and how you dealt with them. Teens can learn by example,” says Taraman.

Your teen’s friends also play a crucial role in their development, but peer pressure is not always a bad thing.

“Peer pressure can be positive in many cases, like trying a new sport or joining a new club at school. Experimentation is the way adolescents learn how to interact with their environment and peers,” says Dr. Roche. “Kids should be curious and try different activities.”  Helping them plan ahead for unexpected events, such as being offered drugs or alcohol, can help your teen make the right choice when it counts.

How to calm an overly emotional teen

When teens are overly emotional and fixating on a problem they feel is the end of the world, there are several things parents can do to calm them down so they can start talking through their emotions.

“It’s very common for teens to be very dramatic. Whatever is happening in their world can seem like it’s the most important thing that has ever happened to them,” says Dr. Roche. “Help them identify the emotion they are feeling, and what is making them angry or excited, for example. Identifying the root cause of the emotion and then connecting that back to how that affects their decision making is important.”

Dr. Romain encourages parents to give their teen some space but remind them that you are available to listen.

“Not every problem needs a solution. Sometimes they just need someone to listen to them in a safe space. Encouraging journaling can also be a productive way of getting thoughts and feelings out,” he says.

Listen first and then expand on their statement.

“If they express hurt or disappointment, try to get them to more openly explain why something hurt their feelings,” says Dr. Roche. “Did they misinterpret a conversation?”

Allowing them to solve their own problems teaches independence and prepares them for adulthood.

“If you fix all their problems for them as a teen, then when they go off to college they won’t know how to deal with problems. We don’t just give them a driver’s license and tell them to hit the road. First they drive under supervision of a parent or guardian, and then they gradually gain more independence and responsibility,” says Dr. Taraman.

The power of positive reinforcement

Remind teens that they are resilient and competent. They may have trouble remembering past times they have overcome obstacles.

“Positive reinforcement helps encourage certain behaviors you’d like your teen to model,” says Dr. Taraman. “If they want to go to their friend’s house after school and they ask if that’s ok, say “no problem, thank you for asking.” And if they instead tell you they are going, say “Don’t you need to ask permission first?”

Positive reinforcement will also help them develop strong self-esteem. As they develop their identity, encourage your child to reflect on successes as well as challenges.

“During adolescence kids are coming up with self-identify, personal morals and ethics. This all relates to self-esteem. Comparing yourself to others is common but it can also set unwieldy expectations. Identify their unique strengths (for instance music, but not math) and focus on encouraging them to pursue those,” says Dr. Roche.

When to seek help for your teen

Adolescents are prone to addictive behaviors. If they use certain chemicals such as drugs and alcohol, it can hard wire their brain in a certain way. If they are experiencing anxiety or depression and it is not acknowledged and treated, they are more likely to experience those into adulthood.

“It is important to keep an eye out for symptoms of depression and anxiety that extend beyond normal grief and loss. Check in with your child periodically and be aware of changes in behavior pattern. Persistent irritability, sadness, disrupted sleep, and lack of interest and isolation are some things to look out for that likely warrant a check-in with a counselor or psychologist,” says Dr. Romain.

A few days of emotional outbursts might just be a normal sign of adolescence, but if they are persistently practicing abnormal behavior, it may be a sign to seek additional help. Remind your child that you are there for them, says Dr. Taraman, but also empower your teenager to explore the resources available to them, with or without their parents’ help. Suicide hotlines (1-800-Suicide) or adolescent clinics can help them obtain resources without the help of their parents.

“Because adolescents have so many obvious physical changes, it’s easy to forget the cognitive changes going on in this phase. It’s the most exciting change for kids but can be very frustrating for parents,” says Dr. Roche. “Remember to enjoy the experience of watching your kid develop into an adult.”





Learn more about Adolescent Medicine




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How New Tobacco Laws Affect Your Teen

Roche, Alexandra

By Dr. Alexandra Roche, CHOC Children’s pediatrician

Under recent legislation, California has raised the age of legal sale and use of tobacco products from 18 to 21 years of age, effective June 9 (with an exemption for military personnel). Other important changes to the current laws include aligning e-cigarette location use with that of regular cigarettes: schools K-12, restaurants, hospitals and work-places must be completely tobacco-free, and that includes e-cigarettes.

Already, California has some of the strictest tobacco regulations in the country, and one of the lowest rates of tobacco use (13 percent) among adults. However, nationwide over 40 million people smoke regularly, and tobacco accounts for one in five deaths every year. Nine out of 10 smokers started smoking before the age of 18. This is a crucial time for adolescent brain development, and the adolescent brain is particularly vulnerable to the addictive effects of nicotine. Every day, our teens are bombarded with advertisements highlighting the ‘cool’ factor of e-cigs and vaping; these images can easily be found in magazines, on the internet, on billboards, and in movies.

While traditional cigarette use by teens has decreased – a drop from 4.5 percent to 2.3 percent between 2011 and 2015- , statistics on e-cigarette use are quite sobering. In the same time period, e-cigarette use among teens jumped from 1.5 percent to 16 percent! Even more unsettling, 5.3 percent of middle schoolers are using e-cigarettes on a regular basis. Adolescents and pre-teens are easily persuaded by catchy advertising; with e-cigarette devices sold in a variety of rainbow colors and intriguing flavors such as gummy bear, juicy peach, and chocolate, it is easy to see why teens might be interested in these products, but the long term health effects can be devastating. While the new California regulations do not directly tackle advertising, they take a tremendous leap forward in limiting the access of these products to our youth.

Parents can also help their children make smart choices by modeling good behavior. If you smoke yourself, consider quitting. If you are using e-cigarettes as a way to cut back on your personal tobacco use, be sure to let your children know the harmful effects of nicotine and why you are trying to quit. Limit the use of these products when with your children, and be sure to store the liquids far away from young children’s inquisitive hands! You can seek help for yourself, or your child or teen, by speaking with your physician or calling 1-800-QUIT-NOW.

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Warning Signs of Eating Disorders

Parents encourage their children to develop healthy eating habits, but extreme changes in a child’s behavior or attitude towards food could be a warning sign of an eating disorder.

In this episode of CHOC Radio, Dr. Wayne Nguyen, director of psychiatry at CHOC Children’s, and Dr. Alexandra Roche, a pediatrician in CHOC’s Eating Disorder Clinic, discuss:

  • Warning signs of eating disorders
  • What to do if you suspect a family member or friend has an eating disorder
  • How CHOC Children’s multidisciplinary team approach to treating eating disorders benefits CHOC patients and their families
  • How CHOC’s Mental Health Initiative will further support adolescents who are struggling with an eating disorder

Hear more from Dr. Nguyen and Dr. Roche in this podcast.

If you have concerns regarding your child’s eating habits and/or weight, talk to your pediatrician. Ask about the possibility of an eating disorder, and request a referral to a psychologist. CHOC partners with a number of organizations to make sure all our patients’ and families’ needs are met.

CHOC Radio theme music by Pat Jacobs.

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  • Talk Openly To Your Kids About Bullying
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Be a Good Car Passenger

Be a good car passengerIt’s bad enough for a young driver to be distracted by talking on the phone, texting, or messing with the car stereo while driving. But having loud, rowdy passengers further endangers everyone in the vehicle ­­– and on the road.

Passengers can be a distraction to a young, inexperienced driver and their presence increases the risk for an accident. They share a responsibility for keeping everyone safe, says Dr. Alexandra Roche, a CHOC Children’s pediatrician.

Being a good passenger means limiting loud conversations and excessive movement as not to spook or distract the driver, Dr. Roche says. Don’t encourage drivers to move faster or race another car.

“If friends are talking, then the music should not be on,” Dr. Roche says.

Parents should talk to their teens about their behavior as passengers, and remind their teens that if they feel uncomfortable as a passenger, they should call their parents.

Dr. Roche noted other factors that can impair someone’s driving ability:

  • Driving under the influence of alcohol or drugs, including prescription drugs and over-the-counter cold medicines
  • Cigarettes (the smoke and ash can be an irritant and someone could get burned)
  • Fatigue

“Becoming a good driver takes years of experience, so build up slowly,” Dr. Roche says. “Help your teens to remember all the risks associated with driving. It’s always better to be safe than sorry.”

To learn more about teens and driving safety, please go to choc.org/health.