Wednesday, September 17, 2014

How to Avoid Back Pain Resulting in Heavy Backpacks This School Year

Heavy backpacks go hand-in-hand with the return of the school year, and parents need to know how to help their children avoid the pain.

The U.S. Consumer Product Safety Commission estimates more than 7,300 injuries a year are backpack-related.

Children’s National Health System’s Division Chief of Orthopaedic Surgery and Sports Medicine, Matthew Oetgen, MD, said about 30 percent of his patients complain about back pain caused by heavy backpacks every year.

“It’s a weird endemic issue that kids face; they carry all their books with them all the time,” Dr. Oetgen said. “Similar to lifting weights or when you run after you haven’t for a long time, your muscles hurt the next day, and it’s the same for kids. They’re doing this long, moderately intense exercise for the whole day. Muscles have no time to rest, and so, they get back pain.”

Dr. Oetgen said while there are no studies showing that carrying a heavy backpack causes structural deformity to the back, kids with chronic back pain are predisposed to becoming adults with chronic back pain.

The National Safety Council, founded in 1913 by Congress to build awareness, training, and share best practices on safety issues, has developed the following warning signs that a backpack is too heavy:

  • Change in posture when wearing a backpack
  • Struggling when putting on or taking off the backpack
  • Tingling or numbness
  • Red marks

A child’s backpack should not weigh more than 10 to 20 percent of the child’s body weight, according to the American Academy of Pediatrics (AAP).  Dr. Oetgen added that younger children and girls seem more susceptible to backpack-related pain, so parents may want lean more towards 10 percent.

“Just ask the kids if the backpack feels too heavy. Sometimes even 15 percent of the child’s body weight is too heavy for a child, and you may need to decrease the weight even more,” he said.

Dr. Oetgen also suggests children use a locker, if that option is available. Parents can also talk to their child’s teacher and ask how they can help lighten the workload.

The AAP provides some more tips to prevent back pain and injury from backpacks:

  • Always use both shoulder straps. Slinging a backpack over one shoulder can strain muscles. Wearing a backpack on one shoulder may increase curvature of the spine. 
  • Tighten the straps so that the pack is close to the body. The straps should hold the pack two inches above the waist. 
  • Organize the backpack to use all of its compartments. Pack heavier items closest to the center of the back. 
  • Bend using both knees when you bend down. Do not bend over at the waist when wearing or lifting a heavy backpack.
Learn back-strengthening exercises to build up the muscles used to carry a backpack.

Back pain among children and adolescents is very common, but if lightening the load and back exercises are not working, it may be time to see an orthopaedic specialist.

Tuesday, September 16, 2014

Spanking and Corporal Punishment: Advice for Parents

Parents may have heard about alleged child negligent or injury in the news because Minnesota Vikings star running back Adrian Peterson was indicted recently on charges of reckless or negligent injury to a child.

For perspective on this situation, we spoke with Allison Jackson, MD, PhD, Chief of the Division of Child and Adolescent Protection Center at Children’s National.

Jackson advises parents to respond in a corrective, nurturing way when disciplining their children that supports a child’s self-esteem. Appropriate discipline should begin early on, she says.

Dr. Jackson said, as a pediatrician, “We don’t recommend physical discipline. Research continues to demonstrate the negative impact of physical discipline on the health and well-being of children.”

Spanking teaches a child it’s okay to hit

“The starting point for families is that the word discipline means to teach,” she said. “We admonish our children in an effort to teach them what is acceptable and unacceptable behavior, what is safe and not safe to do. When spanking, what are you teaching?”

“By hitting your child your kids learn that it’s okay to hit. Children imitate our behavior. That’s exactly how they‘re acting out their experiences, so if you set the precedent that hitting is okay, don’t be surprised that they hit others,” Dr. Jackson said.

The child-injury charge against Peterson has sparked discussions about discipline, parenting, boundaries, and tough love. And studies show hitting children can cause long-term damage “that increase the likelihood of depression, anxiety and antisocial behavior,” according to a Washington Post report on how spanking affects brain chemistry.

Consistency Is Key

“Children need consistency and repetition,” says Dr. Jackson. “The rules have to be the same regardless of whose household they are in. And you have to provide a consistent response. You have to respond appropriately to the misbehavior. If it’s wrong at grandma’s house, it’s wrong in our house. Kids don’t learn their ABCs in one try, and they won’t learn your rules in one try, they learn by repetition.”

Parents, Time-Outs Aren’t Just for Kids

Timeout is very effective and not just for children, according to Dr. Jackson.

“Kids can make us angry, they make us frustrated,” acknowledges Dr. Jackson, a parent herself. “But we have to understand their development and as they’re becoming mentally and physically more independent, they start to test their limits. It’s not that they’re being bad, but they‘re experimenting and we have to put the boundaries in place in a nurturing way.” Parents should take a time out themselves - take a deep breath, walk away for example.

The Child and Adolescent Protection Center treats more than 1,300 children annually from Washington, DC, and surrounding jurisdictions, and serves more than 1,800 children annually through its participation in the District of Columbia's Multidisciplinary Team on Child Abuse.

When differentiating between parenting and abuse, Dr. Jackson said she and her team look for physical and psychological damage.

Friday, September 12, 2014

Get Psyched Friday: What is the Correlation Between Weight and Mental Health?

In her latest Get Psyched Friday, psychologist Eleanor Mackey, PhD, explains how weight and mental health are related for children.

With childhood obesity affecting millions of youth across the United States, I feel it is important to discuss the relationship of weight and mental health. Often people think of “mind” and “body” as two distinct things. However, the brain is an organ in your body the same as your heart, lungs, or stomach.

Therefore, like other parts of the body, the brain can be affected negatively by excess weight. Moreover, the brain is a major contributor to how we eat and exercise, such as controlling our motivation to be healthy, our desire for food, and our impulse control. Because of all of these factors, it is important to think about the relationship between weight and mental health.

Mental Health Disorders Common in Youth with Obesity

Children with obesity are more likely than their peers to experience things like depression, anxiety, or attention difficulties. These conditions are sometimes caused by negative experiences due to being overweight. For example, many of the patients we see in our clinics at Children’s National Health System report that they have developed social anxiety as a result of feeling judged about their weight and appearance by their peers.

Others report the onset of depression due to feeling socially isolated or being teased about their weight. In turn, these experiences of depression or anxiety often make it more difficult to engage in behaviors that might improve health, such as eating well or exercising. Depression often makes motivation difficult, and kids who are concerned about others judging them may be reluctant to engage in activities like exercising in public.

Research at Children’s National Health System

Excess weight can also affect the way brains function in terms of learning, memory, and impulse control.

In our research at Children’s National, we are working to identify areas that are particularly challenging for youth with obesity and how weight loss affects mental health. This is important information needed to provide treatment to youth with obesity in order to help them be healthy and function at their best each day.

What Can Parents Do?

Given the relationship between weight and mental health, it is important for parents to consider their child’s mental health as another component of their physical well-being.

If you have concerns about potential depression, anxiety, learning problems, or other behavior or mood concerns, it is important to seek a consultation from a professional. There are many treatments available that work to help a child with mental health concerns. Parents should consider this treatment as important a component of health care as any other.

At Children’s National, the Obesity Institute IDEAL Clinic helps families prevent and manage obesity, ensuring the best chance for a healthier future. To speak with a member of the Obesity Institute, please call 202-476-7200.

Wednesday, September 10, 2014

Enterovirus D68: What Parents Need to Know

Hundreds of children in the Midwest and the South are showing symptoms of a rare respiratory illness.

According to the Centers for Disease Control and Prevention, the Enterovirus D68 causes about 10 to 15 million infections in the United States each year, and many hospitals are seeing patients this year.

What are the Symptoms of Enterovirus D68?


Symptoms are similar to those of a cold or asthma and include:
  • fever
  • wheezing
  • coughing
  • difficulty breathing

Nalini Singh, MD, an infectious disease specialist at Children’s National Health System, said children with asthma or less than 5 years old are more vulnerable to the virus. Dr. Singh said that this strain appears to prey on “weakened respiratory health.” Allergies, she said, do not appear to play a role.

Dr. Singh said this strain is usually seen in late summer or early fall. It is related to the rhinovirus and more than 70 other enteroviruses, which are responsible for the common cold. Yet this strain is very rare.

How is it Transmitted?

Transmission may occur through close contact with an infected person or by touching objects or surfaces that have the virus on them and touching your eyes, mouth, or nose.

What can Parents do?

Dr. Singh recommended hand washing and practicing good personal hygiene. There is neither a vaccine nor specific treatment for the virus other than treating the symptoms.

The CDC recommends protecting yourself and others from the virus by:
  • Washing hands frequently especially after using the bathroom or changing diapers
  • Avoiding close contact with people who are sick
  • Cleaning frequently touched surfaces

What Should I do if I Think my Child has Enterovirus D68?

Dr. Singh says that if a child has the virus, the illness can escalate quickly. If your child has the symptoms listed above and you suspect your child may have the virus, contact your pediatrician right away.

For more information, watch Dr. Singh's interview with ABC7.

Monday, September 8, 2014

How to Pack a Healthy and Tasty Lunch for Kids

Packing a healthy lunch for kids that they will actually enjoy can seem like a dauntless task. Children’s National dietitian Erika Davies highlights the trouble with balancing what kids want to eat with what is actually nutritious as the obstacle to getting kids to eat healthier.

“Parents who pack lunches should use the MyPlate method,” she advises. The MyPlate method, developed by United States Department of Agriculture, uses each of the five main food groups- grains, protein, fruits, vegetables, and dairy- as a building block for each meal.

The American Academy of Pediatrics (AAP) recommends parents ensure their kids are getting adequate amounts of calcium, fiber, protein, and carbohydrates. If your child is vegetarian, he or she can get protein from rice, beans, eggs, tofu and peanut butter. The AAP also recommends subbing in water or reduced fat milk for juice, as too much sugar-filled juice can lead to obesity and tooth decay.

What are some tricks to make lunch fun?

The American Heart Association also provides several lunch tips that can satisfy even the pickiest of eaters:

  • Sandwich substitutions:
    • Use 100 percent whole wheat instead of white bread, or go half and half to add more fiber to your child’s diet.
    • Try an “inside out sandwich”- wrap sandwich meat and vegetables with lettuce, instead of bread.
    • Kids get bored easily, so switch things up by packing last night’s leftovers instead of a sandwich, or put smaller amounts of a variety of foods in separate containers, bento-style. This is more visually appealing to kids.
    • Use whole grain tortillas, pitas
    • Instead of jams and jellies, make a peanut butter sandwich with banana and strawberry slices.
    • Replace mayo with mashed avocado, hummus, or Greek yogurt.
  • Finger foods/Dunking: kids love dipping and dunking food, so try packing carrot, celery, and bell pepper slices to dip into hummus or salsa, or apple and pear slices to dip into peanut butter.

To get kids to try something new, introduce bite-sized portions of new foods: kids are less likely to be overwhelmed and more likely to be curious. Most importantly, make sure to get kids involved. If they help with packing the lunch, they are more likely to eat it as well as be mindful about the ingredients involved. Have them help you make fruit cups, trail mix, or personalized mini pizzas.

How can I keep my child healthy if they buy lunch at school?

While it’s easy for parents to regulate and be aware of what their kids are eating at home, school is another story. For parents who worry their kids are reaching for cakes and chips in the cafeteria, Davies says that while the nutrition standards for school lunches are getting better, “some school districts also allow parents to place limits on what their kids can purchase in the cafeteria.”

With these tips, parents can ensure kids are getting all the energy and nutrition they need for the rest of the school day.

Wednesday, September 3, 2014

What is Cholesterol?

Reading a food label can give parents a lot of information about a product, but sometimes it can make choices more confusing. For example, what is cholesterol and how much of it are kids allowed to have?

We enlisted Children’s National Health System dietician, Angela Boadu, RD, LDN/LD, for some advice to guide us through this question.

“Cholesterol is basically fat in your body. You need a certain amount of cholesterol to have energy, keep your cells healthy, keep growing, and protect your organs,” Boadu said. “But too much is bad.”

So, we don’t want to have too much cholesterol, but there’s also good and bad cholesterol.

HDL vs. LDL:
  • HDL or high-density lipoproteins is known as good cholesterol. This cholesterol carries excess cholesterol away from the arteries and to the liver. Additionally, HDL gives us energy, protects our organs, and supports cell growth.
    • Where we get it:
    • Monounsaturated fat: vegetable oils, avocados, nuts, and seeds
    • Polyunsaturated fat: soybean oil, safflower oil, fatty fish like salmon or mackerel
  • LDL or low-density lipoproteins are bad cholesterol, if there is too much of this in the blood stream, it can build up on the artery walls that lead to the heart and brain. The buildup is called plaque, which can reduce the blood flowing to the brain and the heart.
    • Where we get it:
    • Trans fat: fast food items, store-bought items, baked goods, pastries, donuts
    • Saturated fat: fatty beef, lamb, poultry with skin, butter, cream, cheese, full fat dairy products
  • How much should children have?

Boadu said the daily recommended amount of monounsaturated fat and polyunsaturated fat is 25 and 35 percent of a child’s daily calories, respectively, while trans fat and saturated fat should be avoided.

What are healthy alternatives?

“It’s really just a matter of convenience. It’s about preparation. Make sure you have low fat options in the house. Choose lean meats. Get low fat, fat free, milk cheese and yogurt – same with ice cream, or do sherbet instead,” Boadu said.

Boadu also suggested removing the skin from poultry and baking food instead of frying it.

Other low cholesterol tips:
  • Eat salmon or mackerel at least two times a week to help eliminate higher fat from meat
  • Limit fast food
  • Keep frozen fruits and vegetables in the house
  • Serve veggies simply
    • Don't make broccoli and cheese, just broccoli
  • Choose plant oils over butter or margarine: use only 1 to 2 tablespoons, enough to sauté or pan-sear
  • Choose low fat dressing or mayo, an even better choice would be olive oil
“Choose low fat, instead of fat-free, foods because most of the time fat free foods replace the fat with sugar, and too much sugar is not a good thing,” Boadu said.

Ask your child’s pediatrician for more tips on eating healthy and staying healthy.

Friday, August 29, 2014

What is Binge Eating Disorder?

Binge eating disorder (BED) is defined as an eating disorder marked by the frequent consumption of unusually large amounts of food, according to American Academy of Pediatrics.

It was officially classified as a formal diagnosis in 2013, making it the latest identified eating disorder. BED differs from bingeing and purging in that the individual takes no actions to prevent weight gain, consequently many suffering from BED are often overweight or obese.

BED differs from other eating disorders in that it appears to be an “equal opportunity” disorder, affecting men almost as much as women, with no discrimination against race. It is also more common than both anorexia nervosa and bulimia nervosa, affecting one in every 35 adults in the United States, according to the National Association of Anorexia Nervosa and Associated Disorders.

While many people are guilty of stress eating or taking second helpings of dessert when full, for those with BED, this becomes a regular pattern says Children’s National Health System nutritionist Megan Barna. Eating is no longer simply to satisfy hunger, rather, it is used as a means of escape to distract from scary or stressful problems, feelings, or situations.

“Actual eating behaviors are symptoms of more profound underlying factors, such as depression, anxiety, or having experienced a trauma,” Barna explains. She said food is used as a tool for rebelling, rewarding oneself, or easing anxiety or loneliness.

“A binge is indicated by a complete loss of control followed by feelings of shame,” Barna says, “binge eating disorder is marked by multiple recurring episodes.”

Individuals suffering from BED often feel deep embarrassment and humiliation about gorging, but are unable to resist the compulsion to binge. This vicious cycle of bingeing can lead to even greater feelings of hopelessness and despair.

Signs and Symptoms

Children’s National psychologist Eleanor Mackey, PhD, describes potential warning signs for parents concerned their child is suffering from BED:

  • Watch for evidence that secretive eating is occurring, marked by hidden wrappers or plates and missing containers of food
  • Look out for increased stress and anxiety levels in children, along with isolative behaviors
“Often binge eating is associated with anxiety or depression or functions as a coping method for stress. If you are concerned that these other issues are going on and see evidence of secret eating or significant weight gain, binge eating may be a potential problem,” Mackey said.

Mackey notes that approaching a child who appears to have symptoms of BED can be very difficult. She advises, “Without ‘accusing’ your child of anything, note the signs that you’ve seen without even mentioning food, your concern, and your ability and willingness to seek help.” For example:

“‘I have noticed that you have seemed stressed and unhappy recently. I am concerned for you and want to help.’”


Most individuals diagnosed with BED are treated with traditional eating disorder approaches, such as improvement of self-esteem and body image, and determining underlying psychological problems, such as depression and anxiety in individual psychotherapy. Treatment also includes group therapy and nutrition counseling, as well as targeting obesity, high blood pressure, and high cholesterol often associated with binge eating, said Barna.

Children’s National is currently working on a new program to aid individuals with BED.