Wednesday, October 22, 2014

Is Baby-Led Weaning A Safe Way to Feed Your Infant?

When a few of my new-mom friends started asking me about introducing solid foods and if I had done baby-led weaning, I gave them a blank stare. When I hear the word “weaning,” I think about transitioning a baby from breast to bottle, or formula to whole milk. But it turns out baby-led weaning is a term that describes a way to introduce solid foods to babies, and it skips the puree or mushy-food phase.

I had never heard of this concept when my daughter was an infant, and I had already begun introducing food to my son when a few friends started asking me about it. So I talked with Penny Glass, PhD, who directs the Child Development Program and is an expert on infant and child development, to get her opinion on introducing new foods to babies.

When should babies begin eating food?
“Most pediatricians say to wait until babies are 6 months,” says Dr. Glass. If a baby was born prematurely, parents should factor in their development. The main reason that babies need more than breast milk at that age is because they need more iron, says Dr. Glass.

Are there any benefits to starting babies on purees?
The idea of exposing babies to different flavors of foods and aromas is a positive one and can help whet their appetites, says Dr. Glass. And it’s typical for babies to have to try something 17 times before they like it, says Dr. Glass.

When should babies start feeding themselves?
There is no right age, but it’s really when babies have the ability to do so. Look for developed oromotor skills, like gripping, and body tone before letting babies feed, says Dr. Glass. She cautions against putting unnecessary pressure on your baby to get them to feed themselves.

“Americans in particular are very strong about wanting their babies to be independent and feeding early, but this can cause some trouble,” says Dr. Glass.

When babies are very young, they aren’t very good at feeding themselves, so they may become frustrated because they are still hungry, but are not able to eat enough. Dr. Glass suggests that parents start by offering bites from a spoon and once the baby has had a few bites, parents can let the baby “practice” on their own.

Also, as they get older, Dr. Glass says babies may decide to select certain foods or not want to try a variety, which may cause tension and frustration at the dinner table.

Is choking a concern with baby-led weaning?
Proponents of baby-led weaning say that babies’ gag reflexes prevent them from choking. But Dr. Glass says that some may have stronger responses and throw up, which causes an unpleasant experience for both the baby and caregivers. A common reaction is for parents to panic when a baby is choking, and it can create a bad cycle that leads to unpleasant mealtimes, says Dr. Glass.

Additionally, even at a young age, babies are paying attention to parents’ reactions. If a parent looks panicked, Dr. Glass says a baby can change their behavior based on a parent’s reaction.

Do you see any benefits to baby-led weaning?
“Anything that brings a parent to the table with their baby has some merit,” says Dr. Glass.  Babies learn by watching, so they watch parents chew and socialize. It’s also a great way to expose babies to new foods. Exploring new flavors and “gumming” foods is a very positive and appropriate experience.

Why is eating together so important?

Around 6-9 months of age, babies become intent on watching and learning from people, and this includes how people talk and eat. Coming to the table together is a great social and language learning opportunity.

Dr. Glass says the focus should be on keeping meals as pleasant and relaxed as possible – no matter the method parents choose to feed their children. Individual differences and cultures should be appreciated.

One tip Dr. Glass offered is one that she practiced with her own children: have breakfast together.  As her children got older, she found they were rushed in the mornings before hurrying off in several different directions. Her solution was to wake up a few minutes earlier so she could have breakfast every morning with her children.

“It’s important to make emotional contact before we rush off,” says Dr. Glass. “It’s an incredible experience for a child – and a parent – to make a connection before the day really gets started.”

Monday, October 20, 2014

Guide to Celiac Disease and Gluten-Free Diets

More than 2 million people in the United States have celiac disease, or about 1 in 133 people, according to The National Institutes of Health. It was once considered a rare childhood syndrome, but is now recognized as a common genetic disorder.

What is celiac disease?
Celiac disease is an autoimmune disease, meaning that the immune system responds inappropriately against substances or tissues normally present in the body. For people with celiac disease, the body cannot tolerate gluten, a protein found in wheat, rye, and barley. Not only can the disease cause discomfort to the child with celiac disease, but it also damages the small intestine and inhibits the absorption of nutrients from food.

What does it affect?
When children with celiac disease eat food that contains gluten, the immune system damages the small intestine’s villi, which are tiny fingerlike hairs that help to absorb nutrients from food. Without healthy villi, a child can become malnourished. If a child is left undiagnosed, damage can occur in nearly every system of the body, from skeletal to neurological.

“Because it can affect any part of the body, it often isn't thought of when people have difficulties and so it is missed for a very long time,” said Children’s National Health System John Snyder, MD, in an interview with CNN. Dr. Snyder is the Division Chief of Gastroenterology, Hepatology and Nutrition and Director of the Celiac Disease Program.

What are the symptoms?
The symptoms of celiac disease vary. Originally, researchers thought that gastrointestinal complications were the only symptom; however, because this disorder has now been found to affect the entire body, there is a wide range of symptoms.

Gastrointestinal Symptoms:
  • Diarrhea
  • Lactose Intolerance
  • Abdominal Distention
  • Change in appetite
  • Colitis – can have blood in the stool with CD
  • Constipation
  • Dyspepsia – “stomach aches”
  • Bacterial overgrowth
  • Malabsorption
  • Flatulence
Dermatologic and Mucous Membranes:
  • Dermatitis Herpetiformis
  • Eczema
  • Psoriasis
  • Vitiligo
  • Acne
  • Rosacea
  • Urticaria – hives
  • Vasculitis – inflammation of blood vessels
  • Depression – bulk of serotonin found in the intestine, not the brain
  • ADD/ADHD/Autism Spectrum Disorder (although no studies have shown a definitive link between celiac disease and ADD/ADHD/autism, many families feel their children have improved on a gluten-free diet)
  • Hypochondria
  • Inability to concentrate, “brain fog”
  • Anxiety
  • Neurosis
  • Moodiness
  • OCD – Obsessive-Compulsive Disorder
These are just a few examples of symptoms experienced by those who suffer from celiac disease. Children with celiac disease often have other autoimmune diseases too, such as:
  • Type 1 Diabetes (juvenile onset)
  • Hypothyroidism (Hashimoto’s Disease)
  • Hyperthyroidism (Grave’s Disease)
  • Secondary Hyperparathyroidism
  • Sjogren’s Syndrome – dry eyes and mouth
  • Addison’s Disease – atrophy of adrenal glands
  • Autoimmune Liver Disease
  • Dilated (congestive) Cardiomyopathy – inflammation of heart muscle
  • Alopecia Areata – patchy hair loss
  • Rheumatoid Arthritis
How is it diagnosed?
Celiac disease is first diagnosed through a blood test. The blood test is looking for high levels of antibodies, since the bodies of individuals with celiac disease attack gluten protein as a foreign substance. If the results of the test are unclear, the child would have to undergo an endoscopy, where a small biopsy of the small intestine to determine if celiac disease is present.

What is the treatment?
So, how is celiac disease treated?

The good news about this genetic disease is that it’s manageable.

“With a 100 percent gluten-free diet and 100 percent healing of intestinal villi,” said Children’s National’s Celiac Disease Program dietician Cheryl Molinatto. Molinatto helps families cope with the disease and teaches them how to remove gluten from their child’s diet.

At Children’s National, the multidisciplinary Celiac Disease Program aims to improve the way celiac disease is diagnosed and treated. A child who visits the program will meet a team of physicians, nurse practitioner, dietician, psychologist, and a community mentor. The mentor is either an individual living with celiac disease or the parent of a child with celiac disease, who can help guide the family through the process of going gluten-free and the ups and downs of celiac disease.

A dietician like Molinatto will send the child home with a Getting-Started Kit that includes a celiac disease and gluten-free handbook, a reusable shopping bag filled with gluten-free food items, a toaster, and his or mentor’s contact information.

“I teach families how to prevent cross-contamination, dine out, and school lunch safety,” she said. “I also help the family identify gluten-free foods that they’re already eating.”

There is a lot to learn when a child goes gluten-free. Gluten protein is in breads, but it’s also found in Teriyaki sauce, ground spices, lipstick, flavored yogurt, etc. Molinatto encourages caregivers and siblings to attend a child’s appointments so that the whole family is well-informed.

A gluten-free diet does not need to be difficult, as fruits, vegetables, meat, poultry, and milk are all naturally gluten-free. And as with any diet, it can be healthy or unhealthy depending on what foods are chosen.

Sign-up for Children’s National’s Celiac Disease Digest for up-to-date information and gluten-free recipes for the whole family.

Wednesday, October 15, 2014

How to Keep Your Kids Safe This Halloween

Before you join your ghosts and goblins for a night of trick-or-treating, read these tips to keep them safe in their costumes, eating candy, or walking around the neighborhood.

We spoke with Children’s National Health System’s Education, Prevention, and Outreach Coordinator Sally Wilson, BS, RN, to find out the best safety tips for Halloween.

She said a good trick to keep kids safe is to slip a piece of paper in their treat bag that identifies the child’s name and where he or she lives, in case the child is separated from the group.

Costume Safety

“One of the basics is to make sure your child’s costume isn’t too long, so he or she doesn’t trip and fall,” Wilson said.

Here’s a checklist of costume safety from Safe Kids Worldwide:
  • Avoid masks or head gear that blocks vision, long costumes or awkward shoes that could cause a fall, and loose or non-fire-resistant material that could ignite near a candle.
  • Use hypoallergenic makeup for face painting instead of masks that could block vision. Don't apply makeup too close to the eyes. 
  • Make sure swords and other accessories are made of cardboard or other flexible materials. 
  • Mark costumes and accessories with reflective tape and provide flashlights.

Candy Safety

Wilson says that parents should not let children eat candy while trick-or-treating, until you have time to check it.

 “Make sure your child eats dinner before they go,” she said. “And only eat commercially approved treats, unless you know the neighbor personally.”

Here are some other candy safety tips from Safe Kids:
  • An adult should check sweets for signs of tampering before children are allowed to eat them.
  • Remind children to only eat treats in original and unopened wrappers.
  • Throw away candies if wrappers are faded, have holes or tears, or signs of re-wrapping. When in doubt, throw it out!

Pedestrian Safety

Wilson is passionate about promoting pedestrian safety and since Halloween encourages walking from house to house, she has many tips on this subject.

She stressed that children younger than 12 years old should always be accompanied by an adult. Children should also be careful when crossing the street, and only cross at corners.

“When I had done some research on this, one of the significant issues is that adults drink and drive and that’s an issue for children,” she said. “Because kids get excited, dart around, and get hit. We need to encourage children to use their safety rules.”

According to Safe Kids, children are more than twice as likely to be hit by a car and killed on Halloween than on any other day of the year.

Kids should also be mindful of cars in driveways. It becomes darker earlier in the fall and kids can be more difficult to see when a car is backing out of a driveway.

“Most people don’t do this, but parents need to discuss the route of trick-or-treaters, know who they’re going with, and only travel in familiar areas,” she added. “And don’t go into a stranger’s home, particularly ones that are not well lit. Establish the route and a return time.”

Below are more tips from Safe Kids on walking safety.
  • Cross the street at corners using crosswalks and traffic signals.
  • Children younger than age 12 should cross streets at night with an adult.
  • Walk on sidewalks or paths. If there are no sidewalks, walk facing traffic as far to the left as possible.
  • Have kids carry glow sticks or flashlights for added visibility to drivers.
  • If older kids are trick-or-treating without adult supervision, parents should make sure they go in a group and stick to a predetermined route with good lighting.
Have a safe and fun Halloween!

Tuesday, October 14, 2014

How to Keep Young Athletes Safe While Playing Sports

Nonprofit advocacy group Safe Kids Worldwide, an affiliate of Children’s National Health System, recently released a study of youth sports injuries.

The group surveyed 1,000 young athletes, 1,005 coaches, and 1,000 parents, finding that 90 percent of the athletes reported being hurt while playing a sport. While most of the reported injuries were minor such as bumps and bruises, 37 percent of the injuries involved sprains or strains, 24 percent dehydration, 13 percent broken bones, 12 percent concussions or head injuries, and 4 percent a torn ligament injury, according to the report.

Founded in 1988, Safe Kids Worldwide is a global network of organizations dedicated to preventing unintentional injury.

With sports starting up for schools across the country, fall is a good time to get the word out about sports safety. Suzanne Jaffe Walters, MD, a Children’s National orthopaedic surgeon who specializes in sports medicine, discussed sports-related injuries and the culture of youth sports.

Dr. Walters said the most common injuries (acute and overuse) she treats include anterior cruciate ligament, or ACL, tears; meniscus tear, a common knee injury; shoulder dislocations; ankle sprains; and Osgood-Schlatter disease, an inflammation of the bumpy part of the upper shinbone called the anterior tibial tubercle.

Citing the American Academy of Orthopaedic Surgeons, Dr. Walters offered the following tips for engaging in sports:
  • Be physically fit 
  • Know and abide by the rules of the sport
  • Wear appropriate protective gear
  • Know how to correctly use athletic equipment
  • Warm up before playing 
  • Stay hydrated
  • Avoid playing when very tired or in pain
Dr. Walters noted that some young athletes continue to play even if they’re hurt because they do not want to feel humiliated if they leave the game, and also desire to keep up with their teammates. Additionally, she said they’re afraid that stepping away from the game adversely affects their position on the team, or that they’re letting down the coach and their parents.

“Also, a lot of kids are having fun and don’t want to stop,” she said, adding that what drives many to stay in the game is “a desire to win.”

“If you start to feel fatigue and you’re starting to have pain and it’s not going away, you need to take yourself out of the game,” she said.

With injury prevention, it is important to have parents, coaches, and players all aware of every athlete’s individual limits and make sure that no one is surpassing that through extra-long gameplay and practice while hurt.

She also cautioned against young athletes about playing against children who are older or bigger than they are. Often, that is “when smaller players tend to get hurt,” she said, adding that “playing peers of similar size and similar skill levels” the athlete is “less likely to be injured.”

Monday, October 13, 2014

Pediatrician: Sofas are ‘extremely hazardous sleep surfaces for infants’

Parents and caregivers need to be aware of the dangers of infants sleeping on sofas, says Rachel Moon, MD, a pediatrician and SIDS researcher at Children’s National Health System.

In a study published online Monday in the November 2014 issue of the journal Pediatrics, Dr. Moon and other researchers found a strong association between sleeping on sofas and infant deaths.

“Too many people simply don’t know the risks of having infants sleep on sofas,” Dr. Moon said.

Dr. Moon and other researchers studied information supplied by 24 states from 2004 through 2012 to the National Center for the Review and Prevention of Child Deaths Case Reporting System database. They found that of more than 9,000 sleep-related infant deaths, about 1,000 occurred on sofas. About 72 percent of the deaths involved babies aged 0 to 3 months.

Some studies have shown that, compared to other surfaces, sleeping on a sofa places a baby at a 49 to 67 percent increased risk for death, says Dr. Moon, who is also Associate Chief of the Division of General Pediatrics and Community Health for Children’s National and professor of pediatrics at the George Washington University School of Medicine and Health Sciences.

“Soft bedding, sleeping somewhere other than in a crib, (e.g. sofa), surface sharing (when an infant is sleeping on the same surface as another person), and bumper pads contribute to an unsafe sleep environment,” the report stated.

Sleeping on a couch raises the risk of suffocation and entrapment in the cushions.

“I don’t think most parents know that the sofa is a dangerous place,” Dr. Moon said. “They see it as a logical place to put the baby. If they are in the living room, and doing other things such as watching TV, or talking to other people, it feels like it makes sense for them to put the baby right there. In other instances, parents may come home from work, and they want to snuggle with the baby, put the baby on the couch, or have the infant on top of them. Then they fall asleep and the baby rolls off the parent’s chest and gets stuck between the parent and the sofa.”

Their study found that infants who died on sofas were likely to be found on their sides. The side position puts infants at risk for suffocation when the baby’s face is against a cushion or person.

Sudden infant death syndrome (SIDS) is the leading cause of infant mortality after the first 30 days of life in the U.S., with the rate of 53.9 percent of deaths per 100,000 live births.

For more tips on how to reduce the risk of SIDS for babies and information on other SIDS studies led by Dr. Moon, visit our SIDS Resource page.

Friday, October 10, 2014

Get Psyched Friday: The Importance of Early Identification and Treatment for Behavioral Health

In her latest Get Psyched Friday, psychologist Eleanor Mackey, PhD, discusses the importance of early identification and treatment for behavior health.

Recently, I’ve had a number of parents ask questions about when they should be concerned about a child’s behavior or mood. Children are, by nature, unpredictable, inflexible, moody, and often difficult to reason with. There is a wide variation in personality traits, too, so “normal” is a big category. However, a significant percentage of children experience mental illness – about 1 in 5 – at some point in their childhood. I always wonder how many of these cases could be avoided if parents were encouraged to address minor difficulties early on in order to prevent bigger problems from occurring down the road.

Getting ahead of behavioral health difficulties

The importance of early identification and treatment cannot be overstated. I have seen many children at Children’s National Health System come in for treatment before other parents, teachers, or family members thought there was a real “problem.” These are the kids who thrive in treatment and may avoid developing more significant issues in the future. Often these children have a particular difficulty, like being fearful, having trouble controlling their emotions, or having trouble getting enough sleep, that has begun to interfere with their (and their family’s) health and happiness.

So, how do you know when to bring your child in to consult with a professional?

The easy answer is whenever a child’s behavior or mood is making you or them unhappy or is negatively affecting life at home or at school. It cannot hurt to consult with a professional to determine if treatment may help.

How to identify and help inflexible children

A recent example that came up in a discussion with a parent was the question of inflexibility. For example, parents sometimes describe the inability to put their kids in weather-appropriate coats because the new and different coat can cause a huge meltdown. Other parents have told me how their inflexible child cannot pay attention to the first part of any class because it takes a long time just to adjust to the new topic.

While all kids can be relatively inflexible, if this trait doesn’t affect the day-to-day and just means that your child wears certain clothes on particular days of the week or you pack the same lunch every day, this might not be a problem. However, over time, it may get in the way of important activities or health.

Just like other traits, you can learn new ways of thinking and acting, but they have to be taught. This is what behavioral health professionals are trained to do and also to help parents look for signs that these traits or behaviors are becoming a greater cause for concern. Professionals can also help reassure parents and teachers about what is normal, and that is often invaluable for a parent’s peace of mind.

Behavioral health is essential to a child’s overall health

Lastly, parents often ask me if they risk stigmatizing or labeling their child by bringing them in to see a mental health professional. I don’t think that is the case at all and provides a great opportunity to teach new generations that brain health is the same as physical health and should be treated with the same respect.

You can tell your child you are taking them to someone who can teach them how to feel better when certain things happen. Sometimes psychologists are billed to kids as “feelings doctors” who can help when feelings get hurt.

If you show your child you are not afraid or embarrassed to help them when something is wrong with any part of their body or that it is important to be proactive about health to prevent problems, you are doing them a great service that will enable them to care for their own health needs throughout their lives.

At Children’s National, the Division of Psychology and Behavioral Health treats every patient as a unique individual. To make an appointment, call 202-476-4717.

Related links:

Wednesday, October 8, 2014

Research Suggests Bullying is a Risk Factor in Adolescent Suicide

According to a study published by JAMA Pediatrics, bullied teens are twice as likely to consider suicide and nearly two-and-a-half times as likely to actually attempt suicide. In addition, the study found that teens who were cyberbullied were more than three times as likely to contemplate suicide as other kids.

October is National Bullying Prevention Month and in observance, we spoke  with Adelaide Robb, MD, Chief of the Division of Psychology and Behavioral Health, about the study’s findings and how bullying can play a contributing role in adolescent suicide.

Implications of Bullying

Bullying makes a child feel hopeless, helpless, and hated, which can lead to low self-esteem, depression, or post-traumatic stress disorder (PTSD), according to Dr. Robb.

In response to the study, Dr. Robb said, “It’s not just bullying.” She noted that bullying is just one of many potential contributors that can lead to suicide. Other risk factors include depression, bipolar disorder, psychiatric disorders, physical abuse, drug and alcohol abuse, LBGT, or a prior suicide attempt.

Bullying is no longer just a problem that arises at recess or on the school bus. With advances in technology, kids can bully others through devices and equipment such as cell phones, computers, and tablets as well as communication channels like social media sites, apps, text messages, chat, and websites.

Traditional Bullying vs. Cyberbullying

While previous studies reported that traditional bullying and cyberbullying were equally harmful, this study found that cyberbullying increased the risk of suicide in children.

Cyberbullying can intensify a teen’s vulnerability because it allows peers to post negative messages anonymously and can also quickly reach a wider audience, Dr. Robb explained. While a teen may be able to delete inappropriate messages, texts, or photos, the content is stored online, which could result in a victim reliving these previous demeaning experiences.

Last fall, 12-year-old Rebecca Sedwick jumped to her death at an abandoned concrete plant after two teenage girls were accused of bullying her online, despite her switching schools. The stalking charges against the two teenage girls were later dropped.

Signs and Symptoms

Increased awareness of bullying is important and can help parents intervene before it escalates further. Dr. Robb lists several common signs of bullying that parents should be aware of, including:

  • Sudden changes in friends
  • Changes in eating or sleeping habits
  • Declining grades, loss of interest in schoolwork
  • Unexplainable injuries
  • Lost or destroyed possessions
  • Self-destructive behavior
For more information on the signs a child is being bullied or bullying others, visit

Furthermore, parents should be aware of the signs of suicide in teens such as giving away possessions, not wanting to be around family, hopelessness, and a lack of future-oriented thinking. The National Suicide Prevention Lifeline lists additional warning signs and how to get help.

What Can Parents and Teachers Do?

Parents, caregivers, and teachers in the community can help prevent and stop bullying. It’s never too early to start – bullying can begin as early as kindergarten and suicidal thoughts could start as early as first grade, according to Dr. Robb.

Dr. Robb recommends parents check in with kids often to keep the lines of communication open, talk to them about bullying, and monitor their online activity, including social media accounts and apps.

Additionally, parents and teachers need to enforce zero-tolerance policies addressing bullying at home and school, Dr. Robb said. These policies should set clear expectations that fighting among siblings and classmates will not be tolerated.

She emphasized that parents should “make sure kids are getting treatment for the mental health issues associated with bullying.”

Related links: