As the summer flies by, returning to school suddenly seems all too close and for many children, that means the stress of keeping up with homework and school responsibilities. As children get older, the expectations of them at school increase exponentially and often this is when symptoms of ADHD tend to emerge. Consider helping your child by reviewing the typical symptoms and having your child assessed by a trained professional if your child seems to be struggling to keep up. It is important not only for school performance but also for your child’s overall self esteem.

ADHD can manifest as inattention and/or hyperactive-impulsive behavior. Although some children who have ADHD tend more toward one category than the other, most children have some combination of inattention and hyperactive-impulsive behavior. Signs and symptoms of ADHD become more obvious when the child is engaged in activities that require focused mental effort.

According to the Mayo Clinic the important Signs and symptoms of inattention include:

• Often fails to pay close attention to details or makes careless mistakes in schoolwork or other activities
• Often has trouble sustaining attention during tasks or play
• Seems not to listen even when spoken to directly
• Has difficulty following through on instructions and often fails to finish schoolwork, chores or other tasks
• Often has problems organizing tasks or activities
• Avoids or dislikes tasks that require sustained mental effort, such as schoolwork or homework
• Frequently loses needed items, such as books, pencils, toys or tools
• Can be easily distracted
• Often forgetful

Signs and symptoms of hyperactive and impulsive behavior may include:
• Fidgets or squirms frequently
• Often leaves his or her seat in the classroom or in other situations when remaining seated is expected
• Often runs or climbs excessively when it’s not appropriate or, if an adolescent, might constantly feel restless
• Frequently has difficulty playing quietly
• Always seems on the go
• Talks excessively
• Blurts out the answers before questions have been completely asked
• Frequently has difficulty waiting for his or her turn
• Often interrupts or intrudes on others’ conversations or games

CAUSES:
As a parent, we tend to blame ourselves for everything that disturbs our child. But according to the latest research, the vulnerability to ADHD is more likely to be inherited than due to parenting skills.
In fact, brain scans have revealed that there appears to be less activity in the areas of the brain that control activity and attention. Furthermore, ADHD tends to run in families since about 25% of children with ADHD have at least one relative with the disorder.
Toxic exposures have also been linked to ADHD. Pregnant women who smoke are apparently at increased risk of having children with ADHD. Exposure to lead, which is found mainly in paint and pipes in older buildings, has been linked to disruptive and even violent behavior and to a short attention span. Many environmental toxins including PCBs have also been linked to an increase risk of ADHD .Other risk factors include prematurity, hyperthyroidism, and behavioral disorders.
Unfortunately, children with ADHD are at risk for academic failure and low self-esteem. They are also more prone to accidents and injuries than other children, and, as they get older, are at an increased risk of alcohol and drug abuse, anxiety and/or depression and delinquent or oppositional behavior. Learning disabilities are also common in children with ADHD. Surprisingly, gifted learners also get ADHD more often than do other children.
Some parenting tips that can help alleviate the symptoms:

• Be affectionate and patient: Compliment your child on a daily basis and focus on the positive things they have accomplished in their day to help boost their self esteem as well as their confidence.try to be patient even when they are frustratingly hyperactive and inattentive- remember that they are struggling too.
• Be appreciative: Try to have realistic expectations and accept and appreciate your child by spending quality time doing something every day that you both can enjoy together.
• Be organized and structured: Use a big calendar to mark the week’s schedule so your child can visualize the plans for the week and start to feel more in control. Put stickers on days that mark a change in the usual routine. Make sure there is a quiet place to do homework without distraction.Try to keep your child on a routine, especially after school until bedtime. It is important for your child to get enough sleep because exhaustion makes ADHD symptoms worse..

EVALUATION:
The most important pieces of information to bring with you to the evaluations are:

• symptoms that you notice both at home or at school.
• any major stresses or recent life changes.
• Your child’s typical diet
• Your child’s typical schedule including sleep schedule
• all medications, as well as any vitamins or supplements, that your child is taking.
• Any other health conditions
• When did you first notice your child’s behavior issues or other symptoms?
• Are your child’s symptoms continuous, or intermittent?
• What seems to make your child’s symptoms worse or better

Unfortunately, there is not an absolute test to diagnose ADHD, but, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM published by the American Psychiatric Association, a child must have six or more signs and symptoms from one of the two categories below (or, six or more signs and symptoms from each of the two categories).

Inattention
1. Often fails to give close attention to details or makes careless mistakes in schoolwork other activities
2. Often has difficulty sustaining attention in tasks or play activities
3. Often does not seem to listen when spoken to directly
4. Often does not follow through on instructions and fails to finish schoolwork or chores (not due to oppositional behavior or failure to understand instructions)
5. Often has difficulty organizing tasks and activities
6. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort(such as schoolwork or homework)
7. Often loses things necessary for tasks or activities (for example, toys, school assignments, pencils, books)
8. Is often easily distracted
9. Is often forgetful in daily activities

Hyperactivity and impulsivity
1. Often fidgets with hands or feet or squirms in seat
2. Often leaves seat in classroom or in other situations in which remaining seated is expected
3. Often runs about or climbs excessively in situations in which it is inappropriate
4. Often has difficulty playing or engaging in leisure activities quietly
5. Is often “on the go” or often acts as if “driven by a motor”
6. Often talks excessively
7. Often blurts out answers before questions have been completed
8. Often has difficulty awaiting turn
9. Often interrupts or intrudes on others (for example, butts into conversations or games)
10. In addition to having at least six symptoms from one of the two categories, a child with ADHD:
11. Has inattentive or hyperactive-impulsive signs and symptoms that caused impairment and were present before age 7
12. Has behaviors that aren’t normal for children the same age who don’t have ADHD
13. Has symptoms for at least six months
14. Has symptoms that impair school, home life or relationships in more than one setting (such as at home and at school)

MEDICATION: Currently, stimulant drugs (psychostimulants) and the nonstimulant medication atomoxetine (Strattera) are the most commonly prescribed medications for treating ADHD.

Stimulant medications for ADHD include:

• Methylphenidate (Ritalin, Concerta, Daytrana)
• Dextroamphetamine-amphetamine (Adderall)
• Dextroamphetamine (Dexedrine)

Although it seems counter-intuitive for a stimulant medication to help a hyperactive child, stimulants balance levels of the brain’s neurotransmitters. Unfortunately they also can cause a profound decrease in appetite and subsequent weight loss that can affect your child’s overall growth.

Nonstimulant medication?Atomoxetine (Strattera) is often a useful alternative to stimulant medications if they do not work or if they cause severe side effects atomoxetine may also reduce anxiety. However, Atomoxetine has been linked to rare side effects that include liver problems. In addition, some children and adolescents taking atomoxetine seem to have an increased risk of suicidal thinking.

In order to have your child properly evaluated, the first step is to consult with your pediatrician who can then refer you to the appropriate specialist, such as psychologist, psychiatrist or pediatric neurologist. Although it is never easy to think your child may be suffering from a disorder, the sooner it is addressed, evaluated and treated, the sooner you and your child will feel better.

Haiti continues to be a tragic place to attempt to help. I traveled there this relief effort with Project Medishare and assumed that things would have improved since my first trip in late January just after the quake, but to my sad surprise it seemed that things have only continued to be so very hard for the Haitian population and their caregivers.

“I am on the first night shift for all of pediatrics and its filthy and really unpleasant facilities but the children are dying of typhoid, malaria, TB, etc. The sleeping conditions are terrible- yet the families are thus far so amazingly cheerful and smiling..It is 100 degrees by 8 am and it has been so very busy- ambulances were screaming their way in here-a boy hit by a car, another one whose skull was smashed in by a rock, three year olds that weigh 15 pounds, a child who burned his hand off…and the hospital is filled with army cots where mothers lie with their babies with no food, no showers, just little sacks of their few belongings, and they lie there all day taking care of their sick kids cheek to jowl…no movies no stickers let alone toys. The kids break would break your hearts wanting to play, giggling, wandering around trying hard to survive with so very little and so very little hope”.

Moblepediatrics.org is working hard to raise funds for food and medical supplies-trying to get them all well enough to go back to their schools and a hope of a childhood- …Please please don’t forget to give what you can to the many wonderful projects in Haiti and elsewhere. Mobilepediatric.org is partnering with many organizations across the globe to support, honor and cherish children.

As summer approaches, the joy of being outside again for long periods of time becomes possible again. Unfortunately, the risk of sun exposure returns as well. And children are particularly vulnerable.

Sun damage is caused by exposure to ultraviolet (UV) light. UV light is divided into three wavelength bands — ultraviolet A (UVA), ultraviolet B (UVB) and ultraviolet C (UVC). Only UVA and UVB rays reach the earth. Exposure to UV light accelerates the skins’s production of melanin to protect the skin’s deeper layers and creates the darker color of a “tan.” A suntan is actually your body’s way of blocking the UV rays to prevent deeper skin damage. The amount of melanin produced by any particular person in response to sun exposure varies based on their genetics so that some people are more susceptible to sunburn than others. Sun damage leads to wrinkling, freckling, hyper-pigmentation and skin cancer. Each year, more than 2 million people in the U.S. develop non-melanoma skin cancers, a more than 300 percent increase in skin cancer incidence since 1994, when rates were last estimated. Most of those cases are sun-related, according to the American Cancer Society.

Protection: What does SPF really mean?

Most dermatologists agree that SPF is very misleading because the numbers don’t translate logically. For example, an SPF of 30 is not twice as good as an SPF of 15- SPF of 15 blocks about 90 percent of UVB rays, and an SPF of 30 blocks about 95%. Most experts would agree that anything higher than an SPF of 30 doesn’t add much to the level of protection. So, the danger is that putting on a higher SPF may cause people to stay out in the sun longer. And SPF is not a measure of protection from UVA rays.
Unfortunately, the standards set for sunscreens still are far from perfect. For example, unlike European countries, the U.S. has no guidelines for UVA protection ( which can happen even through glass and all through the year) so consumers here have no way of judging what to do. Apparently, the FDA claims its sunscreen recommendations will be released in October 2010. But the Environmental Working Group, a non-profit organization that rates the safety and effectiveness of 1,700 sunscreen brands each year, claims that three out of five sunscreen formulas do not provide the protection promised on the label. And they report that “waterproof” and ‘sweat proof” and “all day” are simply not true.

How to protect your family: Sunscreen ingredients

1. Physical blockers:
Titanium dioxide and zinc oxide work by deflecting sunlight off skin. In high enough concentrations, (7 percent and up) they provide effective protection against both UVA and UVB rays. However, they usually leave a white film on skin, so many manufacturers use chemically engineered nanoparticles to make them invisible and there is no data to show the effect of these nanoparticles on your child’s health. Friends of the Earth, one group that has cited health and environmental concerns about nanoparticles, publishes a list of nano-free sunscreens

2. Chemical blockers:
Chemical blockers work by absorbing sunlight and vary in how much UVA and UVB protection they provide. Oxybenzone is the most common chemical blocker, but blocks only part of the UVA spectrum. Parsol 1789 is a good UVB blocker, and provides the most comprehensive UVA coverage. According to most dermatologists, Anthelios with mexoryl, a proprietary formula from LaRoche-Posay is considered to be the best sunscreen of all.

Remember these tips to prevent sun damage:

• 1. Apply sunscreen 30 minutes BEFORE going outside and reapply at least every two hours. Don’t forget that UV rays can penetrate through the clouds, so sunscreen is important even on hazy days.
• 2. Try to avoid the direct sun as much as possible between 10 a.m. and 4 p.m.
• 3. Consider Sun-Protective clothing- there are many companies that make hats, tops pants and shorts for both children and adults.
• 4. Wear sunglasses with a manufacturer’s label that says the sunglasses block 99 percent or 100 percent of all UV light. Many children’s sunglasses are not UV protective so check the label carefully, and be sure they fit close to the face or have wraparound frames to block sunlight from all angles.

I have only just begun to absorb the magnitude of the problem in Haiti on the ground, but I just want to thank everyone who did so much to support our efforts there and to respond so quickly to my requests for donations.

The medical “camp” where I worked was sponsored by Noah-New York and set up in an abandoned children’s park in the Tabarre area, about ten miles from downtown Port-au-Prince. I was one of four senior doctors ( with two surgeons and an OBGgyn) in this makeshift “camp” set up in an abandoned play park where there are tents for the doctors to sleep in at one end and the rest of the park are areas for intake, triage, non-emergent pediatrics, non emergent adults, Surgery and critical care. Surgery takes place on an old air hockey table and trauma takes place on an old restaurant table. And everyone in recovery lies on old mattresses on the floor. We ran out of sheets and blankets. The “inpatients” slept in tents, sometimes three to a single tent.

Despite generous shipments of donated medical supplies from the USA to this group of approx 10 medical professionals staffing the site round the clock,( rotating teams coming in for ten day commitments) many of the supplies had not been transported from the airport when we arrived. Fortunately, a Haitian volunteer helped us to get the supplies slowly but consistently to the camp hospital. In fact one of the largest single logistical problems was NOT a shortage of medical volunteers willing to help, but instead the distribution of supplies and transportation. The transport issues are not just about getting the supplies off the tarmac and into the sites, but also the transport of critically ill patients- the roads are jammed with traffic, there is little fuel, and ambulances sit dormant at the larger agencies.

I have never ever had to practice medicine with so little – transporting pregnant women in the back of old pick-up trucks, making diapers out of packing material, crutches from broken pieces of furniture- not to mention amputations without anesthesia. Despite the dedication of the staff and a very well organized Haitian ground crew, we were overwhelmed by the needs- and shortage of medicine and equipment.

The people have really no access to water so efforts at feeding the hungry babies and oral rehydration with Pedialyte packs felt very futile for many of the children. The mothers are trying to breastfeed their babies, but the mothers themselves have no food or water so their bodies have stopped producing breast milk and both mother and child are starving.

The many “tent cities” that have been set up, are essentially pieces of plastic draped one to the other with literally thousands of people living in the space of two city blocks. Violence, rape and disease is rampant, and the children are left unattended and starving to wander the streets. They fill the rubble-strewn city digging in the garbage along side the pigs and goats, filthy, hungry and all alone.

The number of orphans is staggering and those children with previously existing medical conditions such as cerebral palsy are being abandoned on the side of the road by parents who can’t care for them.

None of these issues come as a surprise- as with all such disasters, now that the first phase of injury is over, infection has become rampant requiring amputations for infected crush injuries.

The next phase, which we are already beginning to see is cholera and other infectious diarrhea that causes profound dehydration and spreads rapidly.

What is hardest to describe is the affect of these people- so hopeless- Haitians had so little to begin with, decades of living in such squalor that now there seems no way out from under the disaster and the poverty and the hunger. It is indeed a crisis with no obvious solution, and I can’t imagine how the country will ever recover- but thankfully there are many organizations across the globe that are rallying to try to support. I just worry the most about the children – a generation who has lost their childhood, with very little to hope for in the near future.
Thank you all for supporting my being there and my ongoing efforts to continue to help them.

Best
Natalie

Mobile Pediatric.org
I know how often you are asked to give of your resources, both time and money. I ask that you consider that giving to children in need is an investment in the future of our world. We welcome volunteers- we welcome anyone who can help with the plight of the millions of children who are right now losing their chance at childhood because of poverty, illness and despair. Thank you for anything you can do.

Dr Natalie Geary is a board certified pediatrician with training in developing countries and the needs of children, both ongoing and especially in crisis. Trained in medical anthropology, psychology and pediatric medicine she has devoted much of her time to the needs of impoverished children both in the USA and abroad. As a member and advisor of many relief organizations, she established mobilepediatric.org as a non-profit “clearing house” for donations for children, insuring that the generosity of others gets delivered into the correct hands. She personally oversees the delivery of goods, services and financial donations in order to bypass the often inevitable mishandling and chaos that accompanies many relief efforts. The goal is to provide relief and ultimately sustainable support for children in need.
To contact Dr Natalie Geary please email at DrGeary@mobilepediatric.org. We hope you will get involved in any way you can. Even a box of diapers is a welcome donation for many families across the globe.

As we know, Haiti, one of the poorest countries in the Western Hemisphere, was struck on Tuesday by the strongest earthquake in more than 200 years. There are reports of severe damage to homes and buildings, including a hospital that has collapsed. U.S. officials report hundreds of thousands of people dead and injured, and aid officials have described the scene as “total disaster and chaos.”

With so much uncertainty still remaining about the damage of the earthquake, this is a difficult time for many. What can we do to help?

According to Dr Paul farmer, these are the best ways to help:

DONATE. Currently, Haiti’s greatest need is financial support. The teams of doctors and other medical professionals are in need of supplies, fuel, emergency food, water, and housing for the displaced people in Port au Prince. The best way for you to help is to supply them with the means to get whatever they need to treat patients, feed people, and house the homeless.

STAY INFORMED. Sign up for email updates from Dr Paul farmer at project health ( www.pih.org) on the earthquake relief efforts

SPREAD THE WORD: Get your community involved and stay involved:

FOR THOSE IN NEED OF HELP:

• 1. The US State department

  If you are trying to contact relatives living in Haiti, the Red Cross advises to simply call repeatedly until the lines clear or contact other family members who live nearby. Or you can try the U.S. State Department’s special line for Americans seeking information about family members in Haiti: 1-888-407-4747.

  The State Department advises that some callers may receive a recording because of heavy volume of calls.

• 2. On Call International

  On Call is an organization that specializes in emergency evacuation from any point on the globe and is a member and the U.S. representative of the 26-partner International Assistance Group, a global network of independent assistance companies. For more information, visit www.oncallinternational.com. They have set up a national emergency hotline for the family and friends of travelers visiting Haiti, who might have been affected by the earthquake striking the area 15 kilometers (10 miles) west of the capital of Port-au-Prince. Anyone attempting to connect with family members or friends traveling or living in the region should call the On Call International hotline: 800-576-5172. Or, they can call On Call International collect at 603-328-1924. Callers should have as much information as possible readily available at the time of call, including tour operator name, itineraries, hotel information or cell phone numbers.

• 3. Assistance

  If you would like to provide assistance to earthquake victims, please consider contacting any of the following organizations:

  International Medical Corps

  Direct Relief International

  International Relief Teams

  Yéle Haiti (link may be down due to high volume)

  American Red Cross – you can make a $10 donation to the Red Cross by texting “HAITI” to 90999. The donation will appear on your cell phone bill. You may also contact Mat Morgan: morganmat@usa.redcross.org or 202-262-9148.

  Operation USA (link may be down due to high volume)

  CARE

  Catholic Relief Services

  World Food Programme

  World Concern

  Save the Children

  UNICEF USA

  Mercy Corps

  Operation Blessing International

  Shelterbox

  Americares

  Doctors Without Borders

  Medical Teams International

  The International Committee of the Red Cross

  The Salvation Army

  CNN also has a list of organizations to which you can donate: http://www.cnn.com/SPECIALS/2007/impact/

  …and please stay connected and stay involved.

Studies have shown that children, from elementary school to high school, get about an hour less sleep each night than they did 30 years ago, a deficiency that has the power to set their cognitive abilities back years. Because children’s brains are continuously developing until the age of 21, and because much of that development happens when they are asleep, this lost hour appears to have an exponential impact on children that it doesn’t have on adults (although adults are suffering from lack of sleep as well). It has even been theorized that many of the characteristics we normally associate with adolescence—moodiness, depression, and eating issues—are actually symptoms of chronic sleep deprivation. Sleep deprivation can lead to attention and behavioral issues in children, and it can affect their memories and their emotional well-being. Not to mention that children who sleep less are generally fatter than children who sleep more.

How Much Sleep Do Children Need?
Sleep is probably one of the most discussed—and most argued about—aspects of child rearing. Expectant parents anticipate the worst in terms of their newborns’ sleep patterns and their own sleep deprivation. Parents of children from toddlers to teens have related horror stories of children’s bedtime battles that sometimes last for years. And parents everywhere worry that their kids are just not getting enough shuteye.

How much sleep is the right amount? That depends on the child’s age, and on the child herself. Two children of the same age who get the same number of sleep hours may react quite differently, one needing more sleep than the other. But there are certain predictable ranges you can use to guide you in judging how much sleep your child probably needs:

• From newborn to six months: Before three months of age, babies are on their own particular schedules. Their internal clocks are not yet developed. They sleep about 16 or 17 hours a day, and can sleep for anywhere from one to five hours at a time. By the time they are three months old, they sleep about five hours during the day and ten hours at night with one or two interruptions, which means they usually sleep at least six or eight hours in a row, allowing parents to finally get some sleep themselves.
• From six to twelve months: At six months, babies average about 11 hours of sleep at night, and may nap for about three hours during the day. By this time, if they wake up during the night they should be able to go back to sleep on their own.
• From one to three years: Children of this age range may start to develop separation anxiety, and put up a fight at bedtime. They need between 10 and 14 hours of sleep. Some toddlers may need daytime naps, but for others a short quiet time may be all that is needed.
• From four to six years: These children need between 10 and 12 hours of sleep per night. By the age of five, most children no longer need naps.
• From six to nine years: The average sleep requirement for this age range is about 10 hours of sleep per night. This is also a time when many kids need some quite private time with a parent, without brothers or sisters around. It may be that they have something they want to confide, or they just need a little one-on-one attention.
• From ten to twelve years: These children need between 9 and 11 hours of sleep a night, but this can vary greatly from child to child. If your preteen child is particularly irritable or hyperactive, it just might be due to sleep deprivation.
• Teenagers: Because their bodies are going through so many changes, teens usually need between nine and nine-and-a-half hours a night. They don’t usually get it, however. They stay up later at night and get up earlier. Although they often try to make up for lost sleep time on the weekends, a better idea is to try to get them to go to bed at the same time every night and wake up at the same time every morning even on Saturdays and Sundays.

How to Help Your Child Get the Sleep she Needs
Sometimes those seemingly inevitable bedtime battles are so exhausting you have no energy left to do anything but watch a tiny bit of TV and fall into bed yourself. But there are ways to make it easier for your child to get to sleep (and easier for you to get some down time as well). Here are a few suggestions:

• Don’t wait until your baby is asleep to put her to bed. Put her in her crib when she’s drowsy but still awake. This will help her learn to go back to sleep by herself if she wakes up in the night.
• If your infant wakes up crying, take a few minutes before you respond. If the crying continues, go into the room to check on him, but don’t turn on the light, don’t pick him up, or play with him. If he goes on crying, think about whether he might be hungry, need a diaper change, or if he might not be feeling well. If you do need to change a diaper or give him a bottle, do it as quickly and quietly as possible. Talk to the baby as little as possible; a few words of comfort are all that are necessary. The less stimulation he gets, the easier it will be for him to go back to sleep.
• If your toddler cries or calls out to you during the night, wait several minutes before you respond. If you do need to go into the room, don’t turn on the light and don’t stay in the room. Reassure your child that you’re there but that it’s time to go to sleep. If he calls out again, wait a longer time before responding and try speaking to him softly without entering the room again.
• Don’t give your baby or toddler a bottle to help her fall asleep. Children who fall asleep with a bottle of milk, juice, or any sweetened liquid in the mouth can suffer from a serious dental problem called “baby bottle tooth decay,” because the fluids tend to pool in the child’s mouth and can cause cavities in their front teeth.
• Probably the most valuable sleep aid you can provide is to establish a bedtime routine. Make bedtime the same time every night. As we said earlier in the stress section, children like predictability and they want to know what to expect. Set up a quiet (the operative word here being “quiet”—no games or roughhousing before bed) routine that you follow every night, such as reading a story or listening to soft music.

As an integrative pediatrician, I practice a model of healing that is based on wellness rather than disease. I am trained in both conventional and “alternative” therapies and try to utilize the best of all practices and treatments to support each child in maintaining health and wellness in all aspects of their lives.

Integrative medicine is not alternative medicine- it is a practice of medicine that literally integrates the teachings of many forms of practice, like an a la carte menu, picking and choosing the best care for each child’s circumstance. The goal is to avoid being too aggressive, allowing the body to heal itself whenever possible, but not to negate the need for biomedicine when alternatives are not appropriate. We avoid antibiotics for example, and offer nutritional support, except when antibiotics are clearly the only option. Unlike conventional western medicine, we focus on how to strengthen and supplement the natural bodily processes to heal oneself, rather than intervening only once the patient is sick.

In an ideal world, your child’s mind, body and spirit will be in balance, and any medications, treatments or interventions will reflect the needs of the whole child. Children are particularly responsive to integrative care because they are fundamentally healthy and strong, their immune systems ( after 6 weeks of age) are generally robust, and they are forever growing and getting stronger if we feed them well, nurture them well and protect them from toxins and stress.

However, Integrative care counts on parents: because it is all about prevention, good nutrition and healthy living styles. A child is so vulnerable to his home environment and parental practices. A parent who believes in good nutrition, healthy habits and a healthy home gives their child a “passport” to a healthier future.

Integrative pediatricians work with the whole family-to look for patterns of behavior that effect health, patterns of behavior that effect mood, family paradigms that work and don’t work. We examine a child not only from the perspective of acute disease but also from the perspective of his mood, his schedule, his family life, his school environment and his temperament. We look at the roots of illness from all these perspectives and search for care plans that respect all the facets of each child’s life.

According to Dr Weil, a pioneer in the field of integrative medicine, and others in the field, there are several basic principles of integrative medicine, especially integrative pediatrics.

• 1. Prevention is better than later cure- western medicine has always been action oriented- do something now- rather than educate, watch and wait. Certainly there are times when intervention is life-saving and critical, but often if the focus had been on simple prevention( good nutrition, good hygiene, mental health stability) disease could have been avoided.
• 2. Each human being is unique, and their response to illness and stress is therefore unique: Children are all different: even siblings respond to stressors, medical or emotional, in different ways. Illness triggers each child uniquely, so the medications or treatments offered must be individualized.
• 3. There must be a commitment to draw from conventional and alternative therapies in order to customize the care of each patient: A good doctor will draw on the wisdom of many different established practices, such as Ayurveda, Chinese medicine, herbal medicine and homeopathy and with that understanding pick and choose what will work best for the child within the context of conventional medicine.
• 4. The human body, especially as a child, is inherently programmed to heal itself: Your child’s immune system, unless she has an underlying disease, is innately set up to fight illness. Conventional care often disregards this, filling your child with medications that actually suppress the body’s own ability to fight disease.
• 5. Do no harm and do not order tests that will not alter treatment: There is a place for prudent use of laboratories and radiology, but not as a replacement for common sense and good listening.
• 6. Children are not small adults- their bodies require thoughtful care: the challenge of pediatric medicine and integrative pediatrics is to approach and treat each child within the context of their growth and developmental stage. We must look not only at the short-term consequences of an illness and treatment plan, but also the long term effects and the long-term goals.
• 7. Health care is a partnership between physician and parents: as parents you are and must be your child’s biggest advocate. This means you must speak up to your doctor- you know your child best of all, and you spend more time with him than a 15 minute doctor visit for strep throat. Be sure to bring a list of questions to your child’s doctor and be sure that your relationship with your child’s doctor is a partnership in her care.

According to national surveys, the number of children who are overweight in America has increased dramatically, especially since 1980. Some statistics say that over 25% of children and adolescents are at risk or already are overweight. While some people like to believe it is a genetic problem, that would not explain the dramatic rise over the past 20 years because our genetics just haven’t changed that much. Yes, genetics are a risk factor, but not nearly as strong a risk factor as poor nutrition and poor eating habits.

For most American kids, they are on the go and busy from the minute they wake up until they “crash” at bedtime. Despite afterschool soccer, running around in the playground and PE classes, friends, and homework, there is very little “down time” for kids, and unfortunately that down time is often spent in front of the TV.

So why are American kids getting progressively more and more overweight?

Well the answer is complicated by many factors: Obviously nutrition plays a major role. But studies have also shown that the more time kids watch TV ( and eat because every other ad is for a snack food) the heavier they are- and that is because they really are not getting the exercise they need along with the nutrition they deserve.

Remember, no amount of healthy eating can keep a child from gaining too much weight without also having daily exercise. Exercise can improve concentration, reduce anxiety and depression, build strength, increase their immunity and improve their sleep- that’s just right now! Down the road it can reduce the risk of diabetes, heart disease, bone decay and even some types of cancer. So, read on about nutrition but remember to incorporate daily exercise!

Obesity, or being overweight is simply that your body takes in more caloric energy than it uses. American children eat too much of the wrong thing and are not using it all up.

Being overweight is usually defined by your child’s doctor in terms of his growth curve- is his height matching his weight on the percentile curves. But as of the last ten years, a more sensitive way to assess weight is called the BMI or body mass index which is a measure of the body-mass index- essentially how much mass is on your child’s bones. Obviously this is an imperfect system because there are more variables to BMI in children, whose actual percentages of fat mass may vary by race, stage of development, height and sexual maturity. Talk to your child’s pediatrician about his BMI not just his weight.

There are five factors most commonly attributed to risk of obesity in kids.

• 1. Time in front of the TV or computer or DVD

  There is, as I mentioned, a direct correlation between television viewing and obesity, and the more time your child watches TV the worse it gets.

• 2.Exposure to snack and junk food in advertisements and social functions

  Although children’s television, especially for preschoolers, has become much more developmentally savvy, the ads that sponsor these shoes are still selling junk food and plastic toys. There is a food advert every 3-5 minutes on cartoon channels, and the grocery stores place these food often at eye level of the child with favorite cartoon characters like Dora to make them recognizable

• 3. Juice boxes and other high calorie drinks- as a pediatrician I hear how often kids are given Gatorade or other juices for dinner- these drinks are NOT nutritious and your child only needs a sports drink if he is dehydrated after intense sports ( toddler ballet does not qualify). There is never a reason for juice especially without dilution. Water water water.
• 4. Very important- . Lack of family meal times- parents are less likely than ever to sit with their child and have a meal- so the child is unsupervised and often eating on the run between activities. Parents are very busy these days, and the food marketers make it easy to just toss a kid a junky snack or happy meal rather than sit and enjoy mealtime together.

That said, isn’t our culture too obsessed with weight? Don’t we all hear all the time about eating disorders of another nature ( anorexia and bulimia)?. Yes, our culture is obsessed with weight, but we have a country that has a serious obesity problem compared with other countries. Why? At least part of the reason is that there is so so much food available, snack foods for sale on every corner. And in part because junk food is so much less expensive than organic and fresh food, in part because food stamps buys you coke and chips instead of organic, in part because school meals (which are a growing source of food for many many children) are poorly balanced and in part because, compared to Europe and Asia, our “serving size” is massive. When was the last time you saw an “ all you can eat” advert in Europe?

The burden of being overweight is not only medical but psychological. From a medical point of view, it is linked to the alarming rise in Type 2 diabetes in children, as well as metabolic syndrome. These problems are life-long. Heart disease/atherosclerosis, long thought to be a problem of the middle aged and elderly, is now understood to have its orgins much much earlier in life- as early as 9 or 10. Other risks include colon cancer and gallbladder disease, and breast cancer.

What to do if your child is overweight?

First and formost, engage your pediatrician to help- the parents should NOT be the police on this alone. Check with her doctor to be sure it is not a medically treatable condition such as thyroid underfunction, and that it is not the sign of an emotional eating disorder. Review with the doctor the average daily meals, your child’s exercise habits, and your family’s overall nutrition. Remember that the only way this will work is if the whole family participates.

Some important suggestions if your child is overweight:

• 1. Confirm with the doctor that he/she truly is overweight, and not that you are unnecessarily concerned for other reasons such as appearance and your own issues with food.
• 2. DO NOT make your child “ diet”. We never talk to kids about losing weight, just about GROWING INTO the weight they already are. Of course this is more difficult if they have already gone thru puberty. But for most children weight should be “maintained” as they grow up in height- not calorie restriction to actually lose significant weight. This requires great patience on the part of BOTH parents, but in the end will be the safest way for your child to learn to manage food and weight.
• 3. Be willing to make changes for the whole family, even if only one child is overweight. Do not single that child out or make him feel ashamed. These children are already potentially teased at school, see images in the media of the models and supermen- they need to feel safe at home.
• 4. Do NOT make it a topic of open family discussion- especially at the dinner table or around the food itself. Let the pediatrician help guide the conversations and then do not discuss it at home, especially in front of normal weight siblings. Do not allow grandparents to voice their opinions at the table either!
• 5. Cut back on sedentary time like TV and computer and get more active as a family- bike instead of drive, walk instead of drive, go to the park rather than the movies when you have family outings. Encourage a family sport to do all together on weekends.
• 6. Make high quality foods available without making him feel deprived. Bring healthy snacks when you pick your child up from school ( like the EAT RIGHT boxes available in gluten free and for ages 3 and under and 3 and over). Stock the fridge with easy to grab snacks like cut up fruit, carrot sticks, quinoa bars.
• 7. Reduce serving sizes and do “portion control” without making a big statement about it- and check with your child’s school to see how many servings they provide to each child that asks- it is often very hard to change the menu at schools but you can at least point out that the servings are too big- and that much of the food is going to the waste-or the waist!!

The World Health Organization (WHO) has raised the pandemic alert level to Phase 6 in response to the global spread of the H1N1 (swine flu) virus. This reflects that the virus has spread to other parts of the world, but it does not mean that the virus has changed or become more severe. However, a bit of a panic has occurred since the outbreak of the H1N1 flu and parents are eager to find out about the vaccine and whether it is important for their children to receive it. The truth is that the H1N1 flu is not so terrible now but the fear is that it will mutate and create more severe disease in the fall. AS a result of this concern, the government is working hard to create a vaccine- and pushing it through testing faster than is usual for a human vaccine. So is it safe?

The H1N1 flu vaccine is due to be available in October, probably in both a nasal spray and a shot. This will be a separate vaccine from the regular seasonal flu vaccine.

The best advice I can give at this time is to watch and wait. Although some people have already been injected with the new vaccine, the details of the vaccine are not yet readily available. For example, what ingredients go into this new vaccine? Will it contain Thimerasol or Mercury? What are the side effects of the vaccine, short-term and long-term? In the 1970s when a swine flu vaccine was developed, there was a significant rise in Guillain-Barre reactions (GBS: temporary muscle weakness and/or paralysis).

For patients in my practice, this is the advice I am giving: keep in close touch with your pediatrician, especially as we approach the flu season next fall. Read the newspaper reports about the clinical trials of the vaccine with a grain of salt- the media has really created a panic where there needn’t be one as yet. More people die of the “regular flu” than swine flu- having had swine flu myself this spring I can tell you it is no fun, but with rest, fluids and good care, most otherwise healthy people can get through it just fine. I definitely suggest waiting at least until the second round of safety trials are done, to see if there are GBS reactions. If the studies prove the vaccine to be safe, then perhaps I will recommend. But those results wont be available until November.

The bigger concern is whether the government will make the vaccine mandatory. Mandatory is very different than required. As you all know, schools require vaccines for your child unless you sign a particular waiver. Mandatory is very different- it means that you wont have a choice at all.

The latest American Academy of Pediatrics report (www.aap.org) does not seem to believe it will be mandatory. However, some news reports from the government seem to say otherwise. That said, there will only be approximately 120 million doses, so the priority will be for those at highest risk of suffering a severe case of the H1N1 flu (or those most likely to spread it to others): Pregnant women, health care workers, and children 6 months and older. Parents and anyone caring for infants, anyone with high-risk medical conditions (such as heart, lung, or immune diseases), and young adults ages 19-24.

Best advice: keep in touch with your child’s doctor and practice good health hygiene.

The CDC recommends:

• Cover your nose and mouth with a tissue when you cough or sneeze.
• If you don’t have a tissue, cough or sneeze into your upper sleeve, not your hands
• Put used tissues in the trash.
• Clean your hands after coughing or sneezing. Wash with soap and water, or with alcohol-based hand cleaner.
• Avoid touching your eyes, nose and mouth.
• If you get sick, stay home from work or school, and limit your contact with others to keep from infecting them. People should stay home at least 24 hours after they are free of fever (100°F), or signs of a fever without the use of fever-reducing medications.

People cannot get swine flu from pork or pork products.

And, as always, be sure your child is eating well and sleeping well to maintain a strong immune system.

Dear Healthcare Professional:

I am writing to inform you that, in consultation with the U.S. Food and Drug Administration (FDA), McNeil Consumer Healthcare is voluntarily initiating a recall of certain lots of Children’s and Infants’ TYLENOL® products that were manufactured between April 2008 and June 2008. The full list of recalled product lots is below.

The company has implemented this recall because examination of bulk raw material detected that one of the inactive ingredients did not meet internal testing requirements. Specifically, the gram-negative bacteria Burkholderia cepacia (B. cepacia) was detected. The portion of raw material in which the bacteria was found was isolated and was not used in the production of any finished product. However, it was decided, as a precaution, to recall all product that utilized any of the raw material manufactured at the same time as the raw material that tested positive for the bacteria. Please note: No bacteria has been detected in finished product and the finished product has met all specifications.

A review of the relevant published scientific literature regarding B. cepacia indicates that while ingestion of contaminated pharmaceutical product is not known to be a route of transmission of B. cepacia infection, infection has been reported following the use of contaminated pharmaceutical products such as mouthwashes and nasal sprays. Adverse health consequence of B. cepacia infections could be potentially severe especially in high-risk patients, such as those with underlying pulmonary disease, cystic fibrosis or compromised immune systems.

McNeil has conducted an assessment of post-marketing safety surveillance data and did not identify any safety signals or batch-related safety concerns for Infants’ and Children’s TYLENOL® products over the time period, starting with the introduction of these batches, in or around April 2008.

McNeil is advising parents and caregivers who have administered affected product to their child or infant and have concerns to contact their healthcare providers. Parents and caregivers can find the lot numbers on the bottom of the box containing the product and also on the sticker that surrounds the product bottle. If your patients determine that they have affected product, they can contact our Customer Care Center at
1-800-962-5357 and we will send them a coupon for a new bottle.

If you have any questions, please call our Medical Affairs Department at 1-800-962-5357 (available Monday-Friday 8 a.m. to 8 p.m. Eastern Time).

Sincerely,
Edwin Kuffner
Edwin K. Kuffner, MD
Vice President, Medical Affairs
McNeil Consumer Healthcare

McNeil Consumer Healthcare
7050 Camp Hill Road
Fort Washington, PA 19034, USA

©McNEIL-PPC, Inc. 2009