Over the last 15 years, I have seen an increase in the number of patients I care for with constipation. I think this is easily attributed to two major changes in our society over time. The first is the amount of processed food we eat on a daily basis. The second is the decrease in physical activity due to time constraints.
Our colon, or the bowel movement maker, relies on what we eat and how we exercise to function at its peak performance. The fresher and more fiber-filled our food, the better the colon works. The job of the colon is to remove liquid from the stool to make it more formed. If you didn’t have a colon, our stool or bowel movements (BMs) would be diarrhea. So, if what enters the colon is sticky; like bread, potatoes, pasta, crackers, chips, and processed cereal, then the harder the BM will be. If what enters the colon is more liquid, as in fruit and fiber-filled veggies, then the softer the BM will be. Water also plays an important role in keeping the stool soft.
Food moves through our colon better if we exercise. The more we sit and watch TV, the less the colon wants to move. The longer BM’s stay in the colon, the harder they will become. So, the message is to get up and move to wake up the colon and move things out.
So if your children are having constipation issues, they must cut back on the starchy carbohydrates like pasta, rice and bread and increase the color in their foods with broccoli, apples, sweet potatoes, and oranges (and many, many other options). Also, turn off the TV and push them outside to play or dance or hike or bike. Drink some water along the way! Before long, the colon will be healthier and your child will be healthier too.
Dr. Katrina Hood
Summer check-up season is upon us, which means we'll be seeing lots more teenagers in the office for camp, school, and sports physicals! ã€€We MISS these teenagers, who don't tend to get sick or come into the office very often, so hooray for summer check-ups! ã€€
One topic that many teenagers have concerns about (but often won't bring up) is acne. ã€€Many families think acne is a normal, expected part of the teenage years, which can be true to some extent, but acne can have a significant impact on a teenager's life and really shouldn't be ignored if it's anything more than minor. ã€€Teenagers who suffer from acne also suffer from more depression, lower self-esteem, and sometimes long-term facial scarring. ã€€The good news is that we have lots of treatments available for acne now. ã€€Here are some things you may want to consider for your teen:
General skincare recommendations:
-- Use a gentle cleanser twice daily (Cetaphil and Dove Sensitive Skin are good examples). ã€€Avoid washcloths, and use only fingers for cleansing. ã€€Make sure the water is warm, not hot.ã€€
-- Choose facial products and make-ups that say "non-comedogenic."
-- Avoid abrasive products (exfoliators, scrub sponges, etc.). ã€€
-- Avoid astringents and toners.
-- Apply a moisturizer with sunscreen of at least SPF 30 every morning. ã€€(Keep in mind that many acne treatment products increase sun sensitivity, making this step all the more important.)
If acne is mild, over-the-counter products may be adequate:
-- Benzoyl peroxide washes and creams are effective. ã€€A concentration of 2.5% has been shown to be as adequate as higher concentrations in some studies and less likely to cause dryness. ã€€(Do remember that benzoyl peroxide bleaches towels, so be sure to pick up some white washcloths and towels at the store.)
-- Salicylic acid products can be beneficial.
-- The Proactiv skin care system is more expensive but can also be quite effective.
If acne is moderate, prescription products can help:
-- Topical retinoids, such as tretinoin (Retin-A) and adapalene (Differin), can work wonders.
-- Topical antibiotics can be effective for acne that is very pustular.
-- Oral antibiotics are sometimes used for a few months (not long-term) for more severe pustular acne.
-- Oral contraceptives can be helpful as an add-on therapy for acne in teenage girls. ã€€(We don't prescribe OCPs through our office, but we can refer to dermatologists and gynecologists who do.)
If acne is severe, is starting to scar, or isn't responding to typical treatments, then evaluation by a dermatologist is recommended:
-- Dermatologists are skilled at combining multiple acne therapies to get the best results.
-- Dermatologists can also prescribe isotretinoin (Accutane) for severe acne. ã€€Isotretinoin can be extremely effective and life-changing for teenagers who need it.
-- Above all, please don't wait until your teenager has scarring to seek out a dermatologist! ã€€The sooner, the better if acne is becoming severe!
And I'll conclude with the age-old question: ã€€does chocolate cause acne? ã€€Nope. ã€€There's no strong evidence that any particular foods are associated with acne, except perhaps for large amounts of milk -- and even that's uncertain. ã€€
Looking forward to another wonderful summer here at PAA! ã€€We can't wait to see you guys, so call to schedule that summer check-up now before it gets forgotten in the summer fun -- a new schoolyear will be upon us before we know it!
Michelle Bennett, M.D.
On my way home from work last week, I began to hear the early news stories about Enterovirus 68. There have been several Midwest states with outbreaks of this disease. As is to be expected, the next few days of my week have been filled with many reassurances to families worried that their child may be infected. As is true of the vast majority of viral illnesses, there is no easily accessible test. If we need to test, the sample must be sent to Washington, DC to the Centers for Disease Control and Prevention (CDC). Unlike some of our tests that can be performed in the office with results in minutes, the results for this test would be very delayed. The test for Enterovirus helps us identify outbreaks but does not help us with treating the patient in front of us.
So once again, I am back to helping my concerned patients and families with how to know what to look for in their own child. The answer is fairly straightforward and applies across the board to all children. A common cold, or a virus like Enterovirus, has the potential to sicken anyone severely. So, what does a parent or a caregiver look for specifically? First, you need to pay attention to the child's breathing. Is the child breathing fast, heavy or with difficulty? If the answer is yes then seek medical attention. If the child is not experiencing breathing issues then the second symptom to look at is their color. If the child ever looks blue, then this is an emergency and call 911. If they are pink, then that is normal. Hydration is the third aspect you should monitor. A sick child will often experience a decreased appetite and may not eat and drink as they normally would. While a decreased appetite for food is okay, a sick child still needs to drink. To evaluate hydration, check if the child has continued to urinate and if the mouth looks wet inside. Any concern with hydration should be addressed with your pediatrician.
So the take home message is that whether the virus of the day is Enterovirus, Influenza or the common cold, watch for signs of distress with breathing, color change, hydration or any combination of the three. Always call your physician with questions or concerns
Booster Seats: 9 Important Things to Know
Are you confused about whether your child needs a booster seat? If so, you're not alone -- and your child is probably not helping by trying to convince you that every other child his age is already out of the booster! Here's the information you need to know to keep your not-so-little-one safe:
1. Children can transition to a booster when they are at least 4 years of age AND at least 40 pounds.
2. ã€€Why do children need boosters? ã€€
Here's a schematic showing your child's body in a crash with just a seatbelt and no booster:
Here's the schematic of your child in a crash in a booster:
Yep. It makes a BIG difference. Children in booster seats are 45% less likely to be injured in a crash than children just wearing seatbelts.
3. ã€€Booster seats come in two forms: high-back and backless (combination seats can transition between the two). High-back boosters offer several added elements of protection. They keep sleeping children more safely positioned and more comfortable. They provide an extra layer of protection at the child's back and neck. And in one study, they offered 50% better protection in side impacts.ã€€
4. ã€€High-back boosters that include five-point harnessing offer the best protection. Watch this video (http://www.youtube.com/watch?v=V2kO8AxKbrM) to see the difference in a crash test.
5. ã€€Most families will need to invest in a couple different booster seats:
-- For your main vehicles, I recommend the Britax Frontier 90: It's a high-back booster that allows for five-point harnessing until 90lbs and general booster use until 120lbs, and it's specifically designed with side-impact protection. ã€€
-- This is another, less expensive option: Britax Parkway SGL Belt-Positioning Booster Seat.
-- Or this one: Cosco Juvenile Pronto Belt Positioning Booster Car Seat.
-- For portability (traveling on short trips with friends or family members, for example), this is a good one to keep on hand: Harmony Carpooler Backless Booster Seat.
-- For riding in taxis while traveling, I love the Bubble Bum. It's an inflatable booster that rolls up and can fit in a medium handbag or backpack.
-- Of note, here are two seats were specifically "not recommended" by the Insurance Institute for Highway Safety's 2013 ratings: Safely 1st All-In-One and Safety 1st Alpha Omega Elite. Avoid these.
6. ã€€Don't forget that carseats and booster seats have expiration dates. Just like anything plastic, they can lose some of their strength with time. Look for the sticker on the seat to see if an expiration date is printed. If not, assume that the seat should be replaced 5 years after purchase.ã€€
7. ã€€Children should remain in boosters until they are 57 inches tall and can meet all five of these requirements when buckled in using the regular lap and shoulder belt:
-- Does the child sit all the way back against the auto seat?
-- Do the child's knees bend comfortably at the edge of the auto seat?
-- Does the belt cross the shoulder between the neck and arm?
-- Is the lap belt as low as possible, touching the thighs?
-- Can the child stay seated like this for the whole trip?
Over 50% of 10-year-olds still need booster seats!
8. ã€€Once a child is ready to be out of the booster, she should still sit in the backseat of the car until at least age 13. (This is a recommendation based on musculoskeletal development, not size.)
9. ã€€Is your child complaining about being in a booster? Blame it on us, parents! We're happy to take the fall for you on this one!
Want more information? The Car Seat Lady's website is an awesome resource: www.thecarseatlady.com. Safe Kids is another great site: www. safekids.org.
Drive safely, everyone!
As we head in to the Holiday Season, I encourage you to pause and reflect on what it means to be a parent. I recently read a quote of an unknown author, "The days are long, but the years are fast." My interpretation of this as a parent (and a Pediatrician) is that we often get bogged down in the daily "stuff" -- laundry, kid transportation, cleaning, doctor visits, etc -- that our days become so long. I find myself looking forward to bedtime after a full day at the office followed by all the evening chores and kid activities. But here I am with a child ready to graduate from high school and I can't believe I had roughly 6500 days of "stuff" with her, but only 18 very short years. I try often, but not often enough, to just watch her as she studies or competes in her sport. Just watching seems to make the time slow down. I think this satisfies "the living in the moment mantra" we hear so often these days or the "mindfulness mantra." Take time to just watch your kids, whether they are 8 months or 18 years, your day may feel more fulfilled and you will experience a richer 18 years knowing you "watched" your child grow up.
Katrina Hood, MD
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