What they found is that babies who were exclusively fed breast milk for at least three months had a lower BMI than babies who were given mainly formula. The introduction of solid food before six months didn’t seem to matter, and if a mother supplemented a little bit with formula while in the hospital, that didn’t matter as long as she established exclusive breastfeeding afterwards.
What did matter, interestingly, is how the breast milk was delivered to the baby. Mothers who exclusively fed at the breast had babies with lower BMIs than baby’s who received expressed breast milk in a bottle. Regardless of how they got the breast milk, breastfed babies had lower BMI than formula-fed babies.
What can parents do to make sure their children don’t become targets on social media or websites?
In the Raising Austin column, we’ve featured many experts in parenting or internet safety. Here are their tips:
Create a digital contract with your kids. You can get one for free for the whole family at netnanny.com. During that contract process parents would go over all the rules and restrictions for what is good behavior online.
Know what social media accounts your children are using and monitor them. One of those big rules is that kids can only have accounts that parents know about. “About 60 percent are unaware of the accounts teens have created,” says Toni Schmidt, the social media manager for Net Nanny.
Don’t rely on monitoring software to do your job for you. “The more walls we build, the more we are just creating little hackers who are just trying to get around the fence,” says Devorah Heitner, founder of the website Raising Digital Natives and the book “Screenwise: Helping Kids Thrive (and Survive) in Their Digital World.” Instead, be curious, engage in conversation about their online and social media use.
Mentor your children on the appropriate use of screens. Heitner offers this list of questions to ask your children:
Do they know people they are playing online games with? If not, you might want to set up a private server in games like Mindcraft to only invite real people they know.
Are they involved in group texts? Remind them that everyone is on those texts and can get hurt.
Are friends sharing texts with other friends about other friends? Remind them to not engage in that behavior and call it out when they see them.
Are they looking for validation based on the number of likes and comments on posts?
What will happen if they lose their phone, tablet or computer? How will they reimburse you?
Do they understand that digital money is real money? Do you have a plan on what permission they will need and how they can pay for their online purchases?
What will cause them to lose their phone, tablet or computer?
Make sure they know it’s OK to not respond to texts and social media posts right away. They don’t need to be connected all the time.
Invite them to ask you when they have a question. Google is wonderful, but it might provide information they might not understand or might be overwhelming to them.
Talk through different situations: What will you do if you see something inappropriate on your phone? What will you do if you feel a friend is not behaving well online? What will you do if a friend doesn’t understand that you can’t respond right away?
Children younger than 18 months of age: Avoid the use of any screen media except video chatting (with grandparents, for example).
Children ages 18 months to 24 months: Introduce high-quality programs or apps, but do it with your children to create a dialog about what they are seeing and how it relates to the world around them.
Children ages 2 to 5 years: Limit screen time to one hour a day of high-quality programs that you view with your children.
Children ages 6 and older, place consistent limits on time spent using media, the types of media and make sure that the use of media does not take the place of sleeping, exercise and other healthy behaviors.
Build up the parent-child relationship to prevent conflict and dangerous online use. Brooks and Lasser’s No. 1 recommendation is for parents to spend more time with their kids without technology. “The more time we spend with kids in that capacity, it feeds that part of their soul that is going to be happy, healthy, and they will have that in them that is it’s valuable to be in relationship,” Brooks says.
Have family meals at home and make that a top priority. “You have to communicate that our time together as a parent and child is more important than anything else,” says family physician, psychologist and author Leondard Sax, who wrote “The Collapse of Parenting: How We Hurt our Kids when We Treat them Like Grown-Ups.”
Take screens out of the bedroom. This includes cellphones, computers, TVs, video games. Kids are chronically sleep deprived, which leads to poor behavior and can even be the reason why kids are getting mental health diagnoses, Sax says.
Put screens in public places and limit how they are used. Even though, they might still be sneaking and text to their friends PWOMS (Parent Watching Over Shoulder) or some other acronym, they are less likely to be doing something unsafe if you could be walking by.
Remind them that what they post online stays forever. Those middle-school photos will follow them to their first job interview. Remind them of the permanent legal consequences of sending or receiving photos that could be considered child pornography. Kids can be charged with distributing child pornography even if they didn’t take the photo. And if a parent shows it to another parent or a teacher or principal, they’ve just distributed child pornography, says Bob Lotter, creator of My Mobile Watchdog, a monitoring app. They can only show it to law enforcement, Lotter says.
Make sure kids engage with real people they know. Their online friends can quickly become more important than the friends they see in person.
Instead of children being in rear-facing seats until they turn 2, the American Academy of Pediatrics is now recommending that children stay in rear-facing seats as long as possible until they meet the upper number for that seat’s height or weight limits. That means that most children will outgrow that rear-facing seat anywhere from age 2 to age 5, but there could be some kids who are older than age 5 who are still in rear-facing seats because of their size.
Why make the change?
It’s all based on analysis of trauma data from car crashes, which is the No. 1 cause of death for children age 4 and older.
Children who were in rear-facing car seats had fewer injuries and a decreased chance of death than kids in forward-facing car seats.
Why is that? Kristen Hullum, a nurse and trauma injury prevention coordinator at St. David’s Round Rock Medical Center, says that it’s all about avoiding head, neck and spine injuries. Young children have immature spines and necks and are also head-heavy, she says. The rear-facing seats prevent more movement of the head, neck and spine than forward-facing ones.
“My 5 year old is petite,” Hullum says. “I still have her rear-facing. That might have seemed pretty conservative to many people, but this justifies it,” she says of the new recommendations.
Here is the progression of where and in what your child should sit in the car:
Rear-facing infant carrier in the back seat (or convertible rear-facing car seat if it’s weight range is low enough for an infant) until the child outgrows the height or weight limit for that carrier, which is typically anywhere from 22 pounds to 35 pounds. For infant carriers, that usually happens around age 1, but it could be later.
Rear-facing car seat in the back seat until the child outgrows the height or weight limit for that seat. That could happen any time from age 2 to 5 or even later depending on the upper limits for that seat, which can be 40 to 50 pounds or even more.
Forward-facing car seat with a harnessin the back seat until the child outgrows the upper height and weight limit, which could be anywhere from 65 to 90 pounds. The forward-facing seat should be tethered to the car.
A booster seatin the back seat that raises the child up so that the car’s seat belt fits the child properly until the child is 4 foot 9 inches tall and outgrows the upper limits for that booster, usually around 100 pounds. That could happen anytime between age 8 and age 12. It’s Texas law that children younger than 8 ride in a booster seat or car seat.
In the back seat using the car’s seat belt once they have reached the upper limit of the booster seat’s height and weight limits until age 13.
In the front seat, only after age 13, but also tall enough and heavy enough to not be injured by the air bag. That’s at least 4 foot 9 inches and 100 pounds. Even though it’s hard for preteens to want to be in the back seat, it’s about safety. Airbags inflate at 200 miles an hour, Hullum says.” If that air bag hits them in their face, there’s a significant brain injury,” she says. “The air bag should be at somebody’s chest.”
There are other recommendations and guidelines that parents should know.
Get your child seat professionally installed each time you get a new one. Hospitals and county Emergency Medical Services offer car seat checks that you can sign up to attend.
When picking a car seat, the most expensive one is not necessarily the best one. They all have to pass the same federal guidelines. It’s more of a question of which one has the fanciest cup holders.
If you can’t afford a car seat, your pediatrician or any car seat check location should be able tell you how to get a free one.
Car seats do have expiration dates that are usually between six and 10 years. They wear out with use.
Once a car seat has been in an accident, it is no longer safe to use. Car insurance companies will reimburse you for the cost of the new one.
Unless you know the complete history of that car seat, do not buy or receive a used one.
If you have a truck that only has a front-seat, you can install a car seat in the passenger seat, but you have to make sure the air bag is turned off.
Rear-facing car seats could be a problem for toddlers and preschoolers who get motion sickness. If that’s the case, talk to your pediatrician about what medications or techniques they recommend.
For parents who might be thinking that their 5-year-old is never going to see the world around her if she’s still in a rear-facing seat, Hullum says, not to worry. Her 5-year-old can easily remind her if she’s passed a Chic-Fil-A.
Car seat checks
9-11 a.m. Sept. 7, Dell Children’s Medical Center, 4900 Mueller Blvd.
9 a.m. Sept. 10, CommUnity Care Clinic, 211 Comal St.
9 a.m.-noon, Sept. 13, Williamson County Emergency Medical Services, 1781 E. Old Settler Blvd, Round Rock
2-5 p.m. Sept. 13, Elgin Fire Station, 111 N. Avenue C, Elgin
9-11 a.m. Sept. 17, H-E-B Mueller, 1801 E. 51 St.
9 a.m. Sept. 19, Gus Garcia Recreation Center, 1201 E. Rundberg Lane
9 a.m.-noon Sept. 29, St. David’s Emergency Center, 601 St. David’s Loop, Leander. Free car seats will be available at this event.
9 A.M. Oct. 2, Dove Springs Recreation Center, 5801 Ainez Drive
9-11 a.m. Oct. 5, Dell Children’s Medical Center, 4900 Mueller Blvd.
9 a.m. Oct. 9, CommUnity Care Clinic, 211 Comal St.
9 a.m.-noon, Oct. 11, Williamson County Emergency Medical Services, 1781 E. Old Settler Blvd., Round Rock
9-11 a.m. Oct. 15, H-E-B Mueller, 1801 E. 51 St.
9 a.m. Oct. 17, Gus Garcia Recreation Center, 1201 E. Rundberg Lane
Call 512-943-1264 to register for an appointment with St. David’s or Williamson County EMS. Call 512-324-8687 to register for an appointment in Elgin, Dell Children’s Medical Center or H-E-B. Call 512-972-7233 for CommUnity Care Clinic and recreation centers.
Dell Children’s Medical Center of Central Texas and the 10 other Ascension hospitals in Central Texas are participating in a national collaborative program to improve the care of children in emergency departments, particular those emergency rooms that are not in a children’s hospital.
The collaborative is a response to a national 2013 Emergency Medical Services for Children Program study that found that 80 percent of emergency departments were not prepared to treat children in a uniform way. That program found that 69.4 percent of the 30 million children who go to the emergency room every year are treated by emergency departments that treat fewer than 15 children a day.
That study found key areas in which emergency departments weren’t ready for children:
Children were not weighed in kilograms, which can impact the proper dosing of medication.
A full set of vital signs including blood pressure, temperature and mental illness assessment weren’t being done. Doctors were missing when children had abnormal vital signs.
Hospital systems didn’t have guidelines for when and how to transfer pediatric patients to a higher level hospital.
Disaster plans didn’t include children, who could come into an emergency department without a guardian, identification or the verbal ability to say what is wrong.
Dell Children’s already had been working on improving emergency department care at some of Ascension’s Central Texas Facilities. It added Dell Children’s-branded emergency rooms at Seton Northwest Hospital, Seton Southwest Hospital, Seton Medical Center Hays in Kyle, Seton Medical Center Williamson in Round Rock and Providence Healthcare Network in Waco.
“The real goal for us is to prepare for all hospitals to handle children,” said Dr. Sujit Iyer, assistant medical director at Dell Children’s emergency department and director of pediatric emergency department outreach.
Dr. Katherine Remick is one of the executive leads for the national Emergency Medical Service for Children Innovation and Improvement Center and the director of this collaborative, which Dell Children’s applied to be a participant.
Remick, who is also a doctor at Dell Children’s, says if her child was child choking and she lived outside of Austin, she’s not going to drive 45 minutes to Dell Children’s. She’s going to go to whatever emergency department is close and hope they are ready for her child. “Without the presence of preparedness efforts, most emergency departments are not ready for that child,” she says.
People think of preparedness in terms of disasters, she says, but what this project is about an emergency room being able to treat one child.
“Children have unique risks,” she says. “These include differences in anatomy and physiology.”
Being prepared is about training and about having the right equipment and supplies that are child-sized, but it’s also about having someone who is looking at quality control for children, Remick says. “It’s about having someone who is putting children on their radar,” she says.
To be part of the study, Iyer says, all the management of the Ascension hospitals in Central Texas had to sign off on it and be interested in improving care. Each of them also now have someone trained to be a pediatric care coordinator.
Once all the data is collected from participating hospitals around the country, the hope is that they will share best practices and note that these efforts improve outcomes in the care of children, Remick says.
The number of adolescents age 13-17 years who have completed the recommended doses in the HPV series was up 5 percentage points from 2016 to 2017. Now 49 percent had completed the series. As well, 66 percent had started the series.
The CDC notes:
In addition to a yearly flu vaccine, CDC recommends three vaccines for all preteen boys and girls:
meningococcal conjugate vaccine to protect against meningitis
The fear is that with legalization comes the idea that marijuana is safe to use and could even help women control nausea from morning sickness.
The Academy made these recommendations to its members:
Inform adolescents and women of reproductive age about the lack of definitive research. Counsel about concerns regarding potential adverse effects of THC exposure, including passive smoke, on pregnant women and fetal, infant and child development. Include marijuana when discussing the need to abstain from tobacco, alcohol and other drugs during pregnancy.
Counsel pregnant women who are using marijuana or other cannabinoid-containing products to treat a medical condition, nausea and vomiting during pregnancy — or who are identified during screening as using marijuana — about the lack of safety data and the possible adverse effects of THC on the developing fetus.
Explain that even where marijuana is legal, pregnant women can be subject to child welfare investigations if they have a positive marijuana screen result.
Note that data are insufficient to assess the effects on infants who are exposed to maternal marijuana while breastfeeding. Inform women of the potential risk of exposure during lactation and encourage them to abstain from using any marijuana products while breastfeeding.
Encourage women who never have used marijuana to remain abstinent while pregnant and breastfeeding.
Work with state/local health departments if legalization of marijuana has occurred or is being considered to help with constructive, nonpunitive policy and education for families.
That vaccine was recommended by the Centers for Disease Control and Prevention’s Advisory Committee on Immunication Practices in 2015 for people age 16 to 23.
What researchers found was that only 51 percent of pediatricians mentioned the vaccine to patients in this age range and only 31 percent of family practice doctors mentioned it. The good news was that when doctors talked about it, 91 percent of them recommended it to their patients. Doctors were more likely to recommend it when there was a disease outbreak or incident of the disease locally.
Diphtheria/Tetanus/Pertussis: four or five doses depending on which version your kid got.
Polio: four or three doses
Measles, Mumps and Rubella: two doses
Hepatitis B: three doses
Varicella: two doses
Hepatitus A: two doses
All of the above, plus
Diphtheria/Tetanus/Pertussis: three doses of the primary series plus a booster within the last five years
Meningococcal: one dose
Eighth- throught 12-graders
All of the above, but if the diptheria/tetanus/pertussis shot has not been given in the last 10 years, a booster is needed.
The Centers for Disease Control and Prevention also recommends these vaccines for the 11-year-old or 12-year-old check up:
Human papillomavirus (HPV) vaccine helps protect against HPV infections that cause cancer. For kids age 9-14, it’s two doses, one six months to a year after the first. For kids 15 or older, it’s three doses, the second one to two months after the first; the third, six months after the first.
Quadrivalent meningococcal conjugate vaccine
Quadrivalent meningococcal conjugate vaccine protects against some of the bacteria that can cause infections of the lining of the brain and spinal cord (meningitis) and bloodstream infections (bacteremia or septicemia). These illnesses can be very serious, even fatal. It recommends one dose at 11.
Tdap vaccine provides a booster to continue protection from childhood against three serious diseases: tetanus, diphtheria, and pertussis (also called whooping cough).
Preteens and teens should get a flu vaccine every year, by the end of October if possible. It is very important for preteens and teens with chronic health conditions like asthma or diabetes to get the flu shot, but the flu can be serious for even healthy kids.
We asked Dr. John Kuo, the chair of the department of neurosurgery at Dell Medical School and the surgical director of the Mulva Clinic for Neurosciences, about this form of brain cancer and the advances in treatments that have been made.
It’s a very rare cancer, Kuo says, even though it’s been in the news recently because of McCain’s diagnosis and the diagnoses and deaths of Bo Biden, Vice President Joe Biden’s son, and Sen. Teddy Kennedy.
Cancers that originate in the brain affect only about 7 or 8 people out of 100,000. We don’t know what causes glioblastoma, though. It’s not linked to known outside factors like smoking, and it’s not genetic, Kuo says.
Unlike other cancers in the brain that originate somewhere else, glioblastoma begins in the brain in support cells called astrocytes (they look like stars). Astrocytes support and surround neurons. Glioblastoma infiltrates the brain, Kuo says.
In other cancers, you can cut out the tumor and a margin of healthy cells around it. In glioblastoma, “you can’t do that in the brain safely,” Kuo says. “The nature (of glioblastoma) is the cells left behind are likely embedded and invaded in the brain. That’s why it’s incurable.”
Typically, doctors will try to surgically remove as much as they can do safely. Sometimes, depending on where it is in the brain, they might not be able to remove much.
Then patients get radiation to the remaining cavity and the surrounding region.
Then they get a new chemotherapy in the form of a pill that was show in 2005 to make a difference in the survival rates for six to 12 months. Doing all three — surgery, radiation and chemotherapy — gave people a 5 percent survival rate in the first five years.
Now, an innovative treatment developed in Israel has extended that from 5 percent to 13 percent when added to those three, Kuo says. It’s called tumor treating fields. Doctors place grids on a shaved scalp and using electricity and magnetic fields, they disrupt cells as the cells are dividing. Using tumor treating fields now has FDA approval.
With glioblastoma, Kuo says, the younger the patient is the better treatment tends to work.
The median length of survival once diagnosed is about 15 to 18 months, Kuo says, which means that half the people will live that long, half will not.
While 5 or 13 percent survival rate in five years, might not sound like a lot, Kuo is seeing improvements in everything related to glioblastoma. Surgeons are able to do better surgery, more safely using microscopes, GPS mapping and fluorescence to see where the cancerous cells are. They also have better radiation techniques, new chemotherapies and innovations like tumor treating fields.
He also believes that eventually immunotherapy treatments that look at the biology of that person’s specific cancer cells will be applied to glioblastoma. “I hold a lot of promise and hope that research will help us beat this,” Kuo says.
“People think very dismally of this and pancreatic cancer,” Kuo says. “There’s a lot of research going on in this and that carries over to other cancers. We’re really hoping to make dents in this in quality and length of survival. There’s hope.”
The Centers for Disease Control and Prevention released its 2018 Breastfeeding Report Card. How is the U.S. and Texas doing when it comes to reaching the Healthy People 2020 goals that were established in 2010 by this committee that has representatives from the U.S. Department of Health and Human Services, the U.S. Department of Agriculture and U.S. Department of Education.
In many areas, we’re meeting those goals. 83.2 percent of infants in the U.S. have been breastfed at least once. (the goal was 81.9 percent). We’ve also more than met the proportion of infants who are breastfed at a year (35.9 percent are); and the percentage at three months (46.9 percent are). The six-month mark we didn’t quite hit the mark in infants who are breast fed (57.6 percent vs. the goal of 60.6 percent) or those that are exclusively breastfed at that time (24.9 percent vs. the goal of 25.5 percent). We also didn’t do as well as hoped in the percentage of infants given formula before 2 days old (17.2 percent instead of 14.2 percent).
What can you do to encourage a new mom to breastfeed?
Make sure she checks out what kind of support she’ll receive at her hospital when it comes to lactation consulting. Hint: It’s usually 3 a.m. when you need a consultant. Babies feed just great from 9 a.m. to 5 p.m.
She can also ask the hospital what percentage of their infants are given formula vs. babies that are exclusively breastfed while there.
Feed her. Bring her healthy meals and plenty of water.
Offer to take care of her other child, help around the house or hold the baby while she takes a nap.
If she’s a work colleague, link her to another mom who has been pumping at work, who can help her make the transition back to work easier.
“We’re recommending that doctors write a prescription for play, because it’s so important,” said pediatrician Michael Yogman, the lead author of the report in a press release. “Play with parents and peers is fundamentally important for developing a suite of 21st century skills, including social, emotional, language and cognitive skills, all needed by the next generation in an economically competitive world that requires collaboration and innovation. The benefits of play cannot really be overstated in terms of mitigating stress, improving academic skills and helping to build the safe, stable and nurturing relationships that buffer against toxic stress and build social-emotional resilience.”
What the study and others like it note is that children are playing less.
Here are some stats this study offers:
Children’s playtime has decreased by 25 percent from 1981 to 1997, and we bet that if someone did a current study, it would be even less.
About 30 percent of kindergarten children don’t have recess and instead have more academic lessons, says research from Advances in Life Course Research.
In a study of 8,950 preschool children and parents, only 51 percent of those children went outside to walk or play once a day with a parent.
Part of what has happened is that academics have replaced play at a very young age, and parents don’t know how to play with their children or they are fearful about safety concerns to let their children play.
It enhances brain structure and function and promotes that executive function, the study says
When kids play, stress is reduced and kids learn to regulate their stress. One of the things the study found was that preschool children who were anxious about going to school were twice as relieved of their stress when they were able to play with their teacher of fellow students for 15 minutes instead of listening to a story. Kids with disruptive behaviors were also less stressed and disruptive when a teacher played with them one-on-one.
Children who played as preschoolers had a better advantage when it came to paying attention and behaving appropriately in the classroom.
Of course, the study also looked at play in rats and changes in the brain structure of the rats who played and the rats who weren’t allowed to play. “Rats that were raised in experimental toy-filled cages had bigger brains and thicker cerebral cortices and completed mazes more quickly.”
And in kids, the study notes that “Children who were in active play for 1 hour per day were better able to think creatively and multitask.”
Play also helps our children be physically active, be socially aware, learn self-regulation skills, language development, imagination and more.
So, parents, get out there and play with your children. Yes, you can put the phone down and they can put down that tablet or gaming device. Also, make sure that your child’s school still has elements of play such as outdoor time or recess.
Zach Theatre is starting a new class for parents and young children to play together called Wee Play. It will be showcased at the open house on Saturday at it’s 1510 Toomey Road location and on Sept. 1 at its 12129 RM 620 N. location.