Special Diets & Children

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As a parent and a pediatrician, I’ve experienced that nutrition and topics related to eating generate a lot of discussions both at home and my office. Unfortunately, nutrition science is often misunderstood and victim of fads and inadequate research. While the main goal of nutrition in childhood is adequate growth, development and avoidance of nutritional deficiencies, many well-meaning parents often place their child on a special diet without discussion from a professional.

 

I have summarized three types of diets followed by a growing number of patients and their families:

 

  1. Vegan/Vegetarian:

Vegan diet avoids all animal products like eggs, dairy, meats and even honey. Vegetarian diet is mostly plant based but could include dairy and eggs. Research has shown that both vegan and vegetarian diets are safe in kids. Most kids on these diets show normal growth and sexual maturation. They tend to be leaner and shorter between ages 1 and 3 but catch up by 9-10 years of age. However, there are specific nutrients that could be missing in these diets-

  • Vitamin B 12- a supplement is needed if child is vegan. Vegetarian children who consume at least 16 oz of dairy need not worry. If mom is breastfeeding and a vegan, then her baby needs a Vit B 12 supplement.
  • Calcium- Vegan children are prone to developing calcium deficiency and need to consume foods rich in calcium e.g.: fortified cereal, soy milk, leafy vegetables, black beans and almonds.
  • Iron- This is the most common nutritional deficiency in vegan/vegetarian kids. Iron deficiency can affect the development, growth, cognitive and athletic performance of kids. Additionally, plant sources of iron are not as readily available to the body. Menstruating vegetarian girls are at highest risk of iron deficiency. Foods like white bean, green vegetables, quinoa, pumpkin seeds and cashews are good plant sources of iron but I would recommend taking an OTC iron supplement daily especially in menstruating teens.
  • Protein- While an average American diet provides 2-3 times the required protein, plant based proteins don’t always provide all the essential building blocks (amino acids). Therefore, it’s important to eat a variety of plant based proteins like lentils, black beans, nuts, chick peas, whole wheat and soy.

Benefits of a vegan/vegetarian diet:

 

Overall, plant based diets reduce the risk of chronic health diseases like hypertension, Type 2 diabetes, cancer, bad cholesterol and high BMI. As long as they are well planned, they meet all nutrient needs.

 

  1. Gluten Free:

Gluten is a type of protein found in certain grains like wheat, rye, barley, couscous, malt and brewer’s yeast. Some people have an autoimmune condition called Celiac disease or a specific wheat allergy and should stay off gluten. However, some people decide to go on a gluten free diet for perceived health benefits or a poorly understood condition called ‘non celiac gluten sensitivity.’ Gluten free diet has inherent risks like increased intake of saturated fats, sugars and is low in fiber. This can increase risk of obesity, metabolic syndrome and heart disease as an adult. Gluten free snacks are not necessarily healthy as they might have more sugar, salt and less fiber. Gluten free diet is also more expensive. At this point, we don’t recommend gluten free diet for kids unless they have a diagnosis of Celiac disease.

 

  1. Low Carbohydrate:

 

In recent years, a low carbohydrate diet (< 130 gms) has become popular with adults and adolescents. Atkins, paleo and ketogenic are all low carbohydrate diets. Just as proteins, fats and vitamins are important for kids, the right kind of carbohydrate is important for their growth and development. Complex carbohydrates like whole grains, fruits, vegetables and beans are all good sources of carbohydrates for kids. Avoid refined carbohydrates like sugar, white flour, white rice and white pasta. High fat, high protein and a very low carbohydrate diet in kids can affect their growth; cause headaches, constipation and dizziness.

 

In a nutshell, while special diets might help adults, be careful before starting a special diet for your child. A growing child’s nutritional needs could be different from yours. Please have a detailed discussion with your child’s pediatrician.

Sangeeta Elhence, M.D

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Debunking Marijuana Myths for Teens

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With the legalization and use of marijuana for medical indications there are now mixed messages as to the safety of marijuana.   These are the facts as they stand in 2016.  I have summarized an article from the Academy of Pediatrics (Swick and Jellinek) for you to share and discuss with your teens.  

Myth 1:   Marijuana is medicine

23 states allow legal sale of marijuana for medicinal purposes, but there are currently NO Food and Drug Admin – approved indications for medical marijuana.   There is modest evidence it can help muscle spasms with muscular sclerosis, nausea with chemo, and appetite in patients with AIDS.  There is no data it helps with anxiety.

 

Myth 2:  Marijuana is safe

There is robust evidence that marijuana use during youth to early 20’s causes serious and permanent effects on the developing brain.  One 2012 study showed that youth dependent on marijuana prior to 18 have a persistent 8 point drop in IQ in adulthood.  This doesn’t happen to adults.  A study in 2015 showed abnormal sizes and shapes in the brain centers affecting motivation, decision making, attention, memory and processing of emotions.  These changes occur in even light smokers and increase with frequency of use and similarly do not happen in adults.

 

There is increasing evidence that adolescent marijuana use can increase the occurrence of depression and anxiety.  It nearly triples the risk for schizophrenia in adulthood. 

 

Myth 3:  Marijuana has no effect on driving

The risk of being in a car accident doubled after marijuana use. 

 

Myth 4:  Marijuana has no effect on schoolwork

The “high” from marijuana typically lasts 1-3 hrs but the effect on higher-level cognitive processes can last for days.  (see Myth 2)

 

Myth 5:  Marijuana is not addictive

9% of all marijuana users will become addicted. But if you start using marijuana as a teen the rate rises to 17%, and 50% if you use daily.  The average potency of marijuana is 3 x greater than a few decades ago. 

-Kathryn Levy, M.D.

Autism: Are There Early Signs?

 

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Autism is perhaps one of the most discussed, researched, feared, misunderstood and ‘googled’ term amongst parents with young children. What makes it even more challenging, as the name autistic spectrum disorder (ASD) implies, is the array of symptoms and variations in normal child development and behavior. No one knows what causes ASD, but what we do know is that there are subtle signs or red flags, if picked early, can make a difference in the life of a child with this disorder.

Here are a few early red flags that should alert any parent there might be something different about their child’s early development:

 

  • No back and forth of smiles or facial expressions by age 6- 9 months
  • Not responding to his/her name by age 12 months
  • Not pointing to objects to show interest by age 14 months
  • Not playing ‘pretend’ games by age 18 months
  • No ‘joint attention’ or lack of reciprocity between child and caregiver by age 18 months

 

We screen all toddlers at their 18 and 24 month well care for any signs of ASD with a questionnaire called M-CHAT. If a parent feels there’s something ‘just not right’ the way their child communicates, please share it with us at any of your visits. In general,  that parental gut feel scores over any screening test done in our office. Talk to your child, watch him play, see how he communicates and engages with you. Those early subtle signs can make a big difference in the life of a child with ASD.

-Sangeeta Elhence, MD

Lessons Learnt

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Sangeeta Elhence, M.D.

As I reflect the past 20 years, both as a parent and a pediatrician, Gretchen Rubin’s quote, ‘the days are long, but the years are short,’ resonates with me. Often it’s at the stage when they’re ready to leave home, we ponder, ‘What if?’ ‘Why didn’t I?’ ‘Could I’ve done something different?’

 Learning is a life long process. My kids and patients have and will continue to guide me in my quest to become a better parent, physician and person. I’d like to share some of these experiences and lessons with parents, some of who are just stepping into this journey.

 

  1. Food becomes an issue if I make it an issue. Force-feeding doesn’t work with kids. The only thing I can control is quality and not quantity of what they eat.
  2. I’ll never win the toilet training battle. I need let them guide me and not push them to the potty just because daycare or grandma said so.
  3. I need to always think about their long term and not just short-term happiness. Just because my toddler cries for the bottle at night, I will not give it to him.
  4. Show, not tell. I will model good behavior and habits, rather than expect it.
  5. I need to socialize with their friend’s families. Their friends are as important to them as are their families.
  6. I need to set boundaries and limits when they’re still very young. Bedtime, electronic use, respect for others, personal safety, reading are non negotiable.
  7. I need to spend less time in the car, running from activity to activity and more time with them on the dining table, living room and their bedrooms.
  8. They live in our home, not a hotel. Chores and helping out at home is their responsibility, not a favor to me.
  9. Just as I’m not perfect, I can’t expect perfection from my child either
  10. If I want them to listen to me, I need to make a habit of listening to them
  11. I can give them the environment to dream but not expect them to fulfill my dreams
  12. I need to let them fall early so they can fly later. Resilience is the only way my child will succeed in future.
  13. If I’m happy and content, so will my child. Just as I want happiness for my child, my child wants the same for me. Yes, that invisible umbilical cord lasts a lifetime.

Parenting is one of the most fulfilling challenges of our lives. In some ways, it’s a spiritual experience that teaches us the virtues of patience, unconditional love, giving without expectations and compassion.

 

As Khalil Gibran said–

Your children are not your children.

They are sons and daughters of Life’s longing for itself. 

They come through you but not from you.

And though they are with you yet they belong not to you.

Guide, Not a Boss

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I am trying to delineate my new role as a parent of just teens. I have had teens before but I think I get out of practice. They are becoming their own people and making more of their own decisions right and sometimes wrong. I am now a guide, not a boss.

As you look at the data over the last decade it reminds me as a parent that my influence on my children, as they become teens, is shared. Any parent who has been displaced by their child choosing a night with their friends over any family activity knows this is true. I am sometimes second choice to a good videogame or snapchat. EEEEK

Is that a bad thing? It is a fact if nothing else. So what impact are these friends and peer groups having on my beloved kids? I know that if my kids’ friends are making good or bad decisions my children are more likely to make a similar choice. I know this applies to alcohol use, drug use and cigarette smoking. So it behooves us to know what their friends are doing.

On the other hand, studies remind us that our attitudes have power. If we don’t sanction alcohol our children are less likely to try it, and they are significantly less likely to binge drink if they know we are not ok with it.   I have to make clear that we don’t approve of smoking and drug use, and if hopefully siblings have not used these substances our kids are safer and their choices are better.

I have to stay connected. I have to know my kids friends and, if possible, their friends’ parents. I have to listen. My daughters may not talk about their feelings at length, but they may occasionally comment on what is going on with their friends. They are less likely to share again if I am terribly judgemental about their friends actions. Or, if I get all preachy about it. I have to remember that my best impact may be as a sounding board to their impressions and letting them process and evaluate what they are seeing without my interpretation or input. It is not like they have not heard these things from me before.

I need to set an expectation that I get to monitor their electronic/internet world. Not to criticize it, but to keep a dialogue and educate them about crazy things that happen online.

I will continue to set boundaries that will surely be challenged and discussed for their logic and necessity.

It is time to have only teenagers.   Time for them to stretch and interpret their own world. I love them so much I could bust. But my new mantra must be: I am a guide, not a boss.

-Kathryn Levy, M.D.

Beware of the Unvaccinated

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(Image: cdc.gov)

Be aware that those around you who have chosen not to vaccinate are also exposing you to preventable disease. 

As an example, 9 people who had recently visited Disneyland (California) have confirmed cases of the measles.   Seven of the patients were from California and 2 were from Utah.  Of the 7 Calif. cases 6 were unvaccinated. 

Measles had been eliminated in the US population some 15 years ago due to aggressive vaccination efforts.  Any new cases are generally due to an unimmunized international visitor which then results in spread though our unvaccinated or under vaccinated population.

Symptoms of the measles initially are cough, fever, nasal discharge and conjunctivitis (red eyes).  A few days later a rash appears on the face and upper body then spreads downward.  Infected persons are contagious and will spread the infection before the rash appears making it difficult to avoid. 

Protect yourself; make sure your measles and other vaccines are up to date. 

 -Glen Ogden, M.D.

Is Your Child a Smartphone Addict?

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 (Image: http://www.morguefile.com/archive/display/908841)

With growing number of teens showing signs of depression, anxiety, poor attention span, sleeps disturbance, aggression, poor school performance and social withdrawal—symptoms we often see in kids addicted to drugs and alcohol—one can’t help wonder if one of the greatest innovations of this century, the smartphone has added to these maladies. Gaming and internet addiction are well known disorders to psychiatrists. Do we need to add smartphone addiction to this list? A recent study in South Korea, where use of smartphones in teens is rampant, confirms our fears.

Is there a way we can prevent our children from going down this slippery slope? As parents, we need to have an honest discussion with our kids regarding the risks with overuse of smartphones.

Here is a list of things to watch out for:

 

  1. Does your teen have the urge to respond to every notification/message on the smartphone immediately?
  2. Does your teen constantly check the screen of their smartphone even if it doesn’t ring or vibrate?
  3. Does your teen ignore the real world in favor of what’s happening on the screen?
  4. Does your teen get restless or anxious when away from their smartphone? This is a sign of serious addiction—signs we see in drug addicts.
  5. Is your teen always tired, irritable and distracted when you interact with them?

 

Addiction of any kind hurts our physical and emotional health. As parents, isn’t it our responsibility to limit their exposure to something potentially addicting and harmful? Your child might revolt or get upset with you, but in the long run will thank you for being proactive.

Sangeeta Elhence, M.D.

The Flu Mismatch

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(Image: cdc.gov)

You’ve all heard it on the news. This year’s flu vaccine is a mismatch with the circulating strain of flu virus in the community. The predominant strain that scientists call the H3N2 (Influenza A) has stumped us by ‘drifting’ just a little—a common way the virus mutates itself to avoid our smart immune systems and flu vaccines. The flu virus epitomizes nature’s survival of the fittest rule very effectively. Over the years, our scientists have done a great job guessing what flu virus strain they should include in the flu vaccine. However, every so often, the virus manages to fool all of us through minor ‘drifts’ and major ‘shifts’ in its genetic makeup.

Fortunately, a drift as we’ve seen in this year’s strain is not all bad news. Our quadrivalent flu vaccine (effective against 4 strains of flu) offers cross protection against this mutated strain and even if it can’t prevent the flu, it can minimize the severity of illness and reduce the risk of hospitalization and death from flu.

 

So, please don’t lose faith in this year’s flu vaccine. A little protection is better than no protection. Also, don’t forget there are three more flu strains out there that haven’t created havoc yet—hope the vaccine will keep these in check this season.

-Sangeeta Elhence, M.D.