sports nutrition pitfalls

Childhood obesity is a widespread problem in America.  Obesity is becoming a normal part of American culture.  Just this week there have been two publications, one national and one local, addressing this issue.  The CDC now projects that 42% of Americans could be obese by 2030 and that multiple strategies will be needed to prevent this.  The latest CDC data found 17% of US children obese, which is at least triple the rate of one generation ago. Meanwhile, the Wichita Eagle carried an article yesterday about nutrition for kids active in sports.  I liked most of what this article had to say, but was disappointed at the photos in the article which featured sports drink and juice as part of a healthy diet for athletic children.

Many concerned parents of overweight and obese children try to increase their healthy habits by getting their child involved in athletics.  This is a great idea. However, there are several pitfalls for well-meaning parents.  The worst offender is the "snack and drink sign-up sheet".  If getting your child on a soccer team means downing a Gatorade during game play (310 calories in 12 oz), and eating a Quaker chocolate chip granola bar as an after-game treat (100 calories), then your child just ate more than double the amount of calories burned during their soccer game (about 150 calories for a 30-45 minute game).  This is obviously a problem. It's a cultural problem.  Why would the local YMCA encourage this habit by providing copies of the snack and drink sign-up sheet for volunteer coaches?  Why do we as a society of parents allow the snack and drink sign-up sheet system?  Why can't our kids just drink water like we did when we were children?

A second pitfall is allowing a child to eat more if they become more physically active.  It's true that kids may feel hungrier if they are more active, but parents have to recognize that an overweight child should not increase their already too high daily calories if they become physically more active.  That can undo all the good you are striving to help your child accomplish.  

If you are struggling with finding ways to get your child to a healthy BMI, it can help to visit your pediatrician and/or a dietician, who might offer a step-wise approach and check on growth at regular intervals to gauge your progress. But it also might help to be the brave parent who suggests at the next practice that your kids' team be a "water bottle" team, and not a "snack and drink sign-up sheet" team.  

I like my teeth. I just used them a little while ago at Picasso Pizza in Delano... yum.

Last month two of my little patients underwent general anesthesia in an operating room to have dental work done on their teeth!  One had a dental abscess, and the other had 7 rotten baby teeth.  Both of these children have behavioral problems and developmental delays which make it difficult to brush their teeth.  Their parents try --but even with special toothbrushes, there is only so much they can accomplish.  

Two other toddlers showed signs of early decay that I noticed during their well-child check-ups-- white chalky areas of discoloration on the top front baby teeth near the gum line. Their parents were surprised because "but we help her brush her teeth!" However, our culture of toddler snacking on goldfish cracker and sippy cups of juice must have outweighed their brushing efforts.  

I can't help but wonder which of my patients would not have these problems if Wichita had a fluoridated water supply.  Statistics from other communities show that the incidence of dental decay decreases by 25% with water fluoridation.  Fluoride is a mineral that already exists in Wichita water supplies, but at a concentration of less than what is needed to prevent dental decay.  If we could just increase the fluoride in our water slightly from our natural mineral content of 3 parts per million to 7 parts per million, this would be enough to save many of the children in our community from dental disease.  

Water fluoridation is a safe and preventative measure that is supported by every single large reputable group of public health and medical authorities:  the CDC, the WHO, the AAP, the AAFP, the ADA, . . . 

It's time the citizens of Wichita stood up for a safe and proven public health measure which would benefit EVERYONE, from infants to elderly citizens of all income groups.  For more information on the subject, see the website www.ilikemyteeth.org

It's always about the poop!

As soon as a baby is born, the parents know to worry about the poop! But it doesn't seem to stop once your child is older-- one of the top reasons for toddler visits to the pediatrician is constipation problems. 

Constipation is the passage of infrequent hard large or small pebble-like stools.  If your child has struggled with severe constipation since birth, they may have a serious condition that requires specialty evaluation and care.  Most toddlers, though, are constipated because of several factors:    1.) the physics involved in having a normal little toddler body,  2.) diet, and 3.) activity level.

1.) the toddler body:  Toddlers have a bigger belly than older children. Their belly sticks out because extra room is needed to store the important large organs of the body—the liver, spleen, kidneys, and intestines.  As toddlers grow, their whole torso grows as well, making more room for the organs in the belly.  By about age 5-6 years old, most kids have a flatter belly and stronger abdominal muscles.  This makes it easier to have a bowel movement.  Therefore, mild constipation problems will often resolve at about kindergarden age. 

2.) the toddler diet:  Some toddlers drink a lot of milk.  Too much milk can be constipating.  Limiting your toddler’s milk intake to no more than 12 – 16 oz of milk daily (2-3 child sized glasses) is helpful in improving constipation.  Sometimes, changing from cow’s milk to soy milk will improve constipation immensely .  Keep in mind, though, that it is important to limit any type of milk intake to less than 20 oz per day for a toddler.  Otherwise, they will not eat the other healthy foods that their body needs. Many toddlers are "picky" eaters, and prefer processed carbs (Goldfish crackers, anyone?) and processed meats  and cheeses. Eating a healthy diet full of fruits and veggies (at least 5 servings daily) and whole grains (oatmeal is a great breakfast for toddlers!) will have a big impact, too, in improving constipation.  While in general juice is not good for children, it can be helpful in relieving constipation in toddlers if given once daily, at one sitting, with a meal (and it helps to water it down - one part juice plus one part water). 

3.)  Toddler activity:  Make sure your toddler has the opportunity to have physically active playtime for more than one hour per day.  This type of exercise helps in developing abdominal muscles and keeps the body moving the food in the right direction.

Sometimes children need medication to help relieve constipation.  Usually it is best not to give a medicine that stimulates the bowels to move, like Maalox or senna.  The medicines that work best are fiber substitutes.   Fiber substitutes are not habit forming, and work naturally to keep more water in the gut so that the stool stays softer.  


Fiber substitutes are available over the counter as Benefiber or Miralax.  Usually 1 to 2 teaspoonsful, dissolved into a 6- 8 oz glass of liquid, once daily, will do the trick.   These fiber supplements are odorless, textureless, and tasteless.  Your child won’t even know they are drinking it!  The amount given can be tapered down or up by the parent as needed to get the desired outcome of one soft stool daily.  


Plan to always give the fiber substitute at the same time each day, dissolved in milk, water, or watered-down juice, with the meal that your child usually eats the best.  Then, when the meal is over, your child may feel their gut moving and have the urge to use the toilet.  You can encourage developing a regular bowel habit by establishing the routine of sitting on the toilet and reading a book after the meal that your child drinks the medicine. This will give your toddler time to sit, relax, and let nature take it's course.  Soon, your child may be one of those “regular” kids who poops in the toilet after dinner every night. 

Good Luck!

February 29: "Leap" into allergy season!

Spring allergy season is arriving!  March in Wichita usually is the start of the allergy season, with itchy eyes, runny or stuffy noses, sneezing, dark under-eye circles, itchy skin, and for some kids, asthma flare-ups. Kids who are known to suffer from spring time allergies in Wichita typically need to start their allergy medications in the middle of February.  We have had such a mild winter that I'm expecting Wichita's pollen counts to explode anytime now. . .

Do you feel unsure if your child might have allergies, or is it just cold symptoms?  It is often hard to tell in young children.  A few good points to make:  children less than 2 years very rarely have seasonal allergies.  Allergies never cause fever, and never cause muscle aches and pains.  If you are concerned that your child may have allergy symptoms, and if they are severe enough that sleep is disrupted or your child is expressing their annoyance at these symptoms, see your child's doctor to discuss the best treatment plan.   

Spring time allergy treatment plans for children may include:

Medications:  

• An over-the-counter, long-acting antihistamine medication (such as Zyrtec, Claritin, or the generic equivalents) taken every night. 
• A prescription nose spray (such as Flonase or Nasonex) made of a low-potency liquid steroid that is squirted one spray into each nostril once or twice daily.  A benefit of using a nose spray for spring allergies is that it helps control both runny/congested noses PLUS it relieves itchy eyes.  
• Singulair is another prescription medication that is used in controlling allergies.  It is not often helpful in controlling allergies if used alone, but when combined with an antihistamine medication, it can be very effective.  
• For itchy, watery eyes, sometimes a prescription antihistamine eye drop such as Patanol can provide great relief.
• Kids with asthma may require a daily "maintenance" medication during these allergy months, or if they are already on a daily medication for asthma control, they may need to increase their medication dosage temporarily.  

Non-medicine tips:

• Make sure your child bathes or showers every night and washes their hair.  This washes off any pollen that has stuck to their skin and hair over the course of the day.
• For kids with dry, rash-prone skin or eczema, make sure they are moisturizing their skin nightly after baths with a thick, "greasy" moisturizer, such as Vaseline, Eucarin, Aquephor, or generic equivalents.
• Wash clothes every day, and wash jackets and sweaters often.
• Keep windows in the house closed.
• Take shoes off at the door.  Not wearing shoes in the house will decrease pollen tracking onto floors, rugs, and carpets.  
• Don't forget housekeeping :)  Dust, vacuum, and mop more frequently to keep settled dust and pollen in the home to a minimum.  Wash your child's bedding at least once weekly and wash curtains or remove them.  
• Use a cool mist humidifier in the bedroom if the air is dry to help prevent dry sore throat from night-time mouth breathing.  

Should your child see an allergy specialist? 

Finally, if your child has severe allergy symptoms that are not well controlled despite using multiple medications, or if allergy symptoms are becoming more severe over the years, your may want your child to see an allergist.  An allergist may recommend treatment with allergy immunotherapy (allergy shots).  Allergy shots can decrease your child's allergy symptoms, and may make them go away entirely.  This can decrease your child's risk of developing asthma, or reduce asthma flare-ups if your child already has asthma.  Allergy shots are usually done about once weekly, with a much smaller needle than is used in an immunization, and are very well tolerated by children.  

Spring break is fast approaching, too!  If you have allergy sufferers in your family and are planning on a spring break trip, just leaving Wichita may relieve your allergy symptoms for the duration of your time away.  :)

Lullaby and Goodnight

At an infant and toddler well-child check-ups, I love to talk to parents about their child's sleep.  Sleep is SO important to the current and future health of a child, and all too often, sleep is compromised due to lifestyle issues we have as parents. Young children thrive on consistent schedules, and the linchpin of this schedule is bedtime.  This fall there was an important study published which showed that lack of adequate night-time sleep in a child less than 5 years old is associated with an almost 2-fold increase in their risk of being obese.  Before that, there was a study that showed a link between ADHD symptoms and young school-aged kids who did not get enough night-time sleep.   So, what is a good bedtime schedule for your child?  Visit one of my favorite children's health websites-- healthychildren.org, or kidshealth.org to find out.  But first, put your child to bed :)

Kids Cereal: More sugar than a Twinkie?!

Cereal with milk used to be a healthy, fast breakfast for school children.  More and more, though, cereals are part of the "junk group", as my kids call it.  Many cereals marketed to children have more sugar than store-bought desserts!  I encourage all parents to read the labels of breakfast cereals before buying.  Look for a cereal with 10 g of sugar or less, and at least 2 g of fiber.  For some good suggestions and lists of the "best" and "worst" breakfast cereals, see the environmental working groups report on sugar in children's cereal.  

Check us out in the newspaper!

There's a nice article about Redbud Pediatrics in today's Wichita Eagle, on page 3 of the Business section, by Joe Stumpe.  You can also find it online here.  Thank you Joe Stumpe for a great feature article!