Read an Excerpt
The Portable PediatricianEverything You Need to Know About Your Child's Health
By Sears, William
Little, Brown and CompanyCopyright © 2011 Sears, William
All right reserved.
Four Things All Parents Must Do to Keep Their Children Healthy
In this section you will learn four important things you should do to keep your children healthy. By doing these, you can maximize the parent-pediatrician partnership:
Find Dr. Right for your child.
Get the most out of your child’s checkups and office visits.
Practice the pills-skills approach to medical care.
Follow the Dr. Sears head-to-toe guide to keeping your child healthy with good nutrition and a balanced lifestyle.
1. Find Dr. Right For Your Child: Choosing A Pediatrician
Thirty-five years ago when I (Dr. Bill) was finishing my pediatric training and was about to hang out my shingle and open a practice, one of my professors advised me that there are three qualities parents look for in a pediatrician—the three A’s: affability, ability, and availability. Picking the best pediatrician for you and your child is one of your most important long-term investments. Medical care is a partnership between parents and pediatrician. You owe it to your child to find a good partner.
Depending on the health-care needs of your child, expect to be in your pediatrician’s office at least fifteen times during the first five years of your child’s life. You might as well get the most out of it. Over my years in practice I have been grilled by many parents as they begin to search for Dr. Right for their child. Most parents do their search wisely, but some don’t. I have learned the following tips on how to search for Dr. Right from parents who have made the right match of health-care provider for themselves and their child, along with a few tricks of the trade for extracting the best from your child’s doctor. Here is a step-by-step plan, along with some insider tips on how to choose and use your child’s pediatrician.
1. Interview yourself. Before you interview prospective health-care providers, do some soul searching. What qualities do you need in your child’s doctor? Are you a new parent without a lot of experience with the usual childhood developmental quirks and the common childhood illnesses? Do you lack confidence (as some new parents do) and believe you need a pediatrician who will be very involved in your family, will help you understand normal growth and development, and will competently manage your child’s health care? Are you a worrier (as nearly all first-time parents are) who needs an empathetic listener to seriously address your concerns? Are you evaluating various parenting styles and need a doctor who will help you formulate a parenting philosophy? Or are you a veteran parent already firmly rooted in your parenting philosophy and style who simply needs a like-minded pediatrician? Does distance matter? Are you willing to drive farther for higher quality, or do you rely on public transportation and therefore need a doctor’s office close to your home or workplace and easily accessible by bus or subway?
Do you or your child have special needs? For example, if your child has a chronic illness, such as diabetes, naturally you would want to choose a pediatrician with expertise in that illness. If you are a first-time mother and are adamant about breastfeeding your baby, obviously you want to choose a breastfeeding-friendly pediatric practice. Or do you or your child have special communication needs? One of my favorite parents is blind, and I have learned so much from her about the power of mother’s intuition. I have learned to communicate by voice and touch. During an exam I guide her hands over her baby’s body to help her develop the feel for normal skin and normal muscle tone and to help her appreciate the marvels of her baby’s developing body. One time she brought her infant in for consultation about a rash, but I couldn’t see it. The next day she returned to the office with her obviously spotted child. Nancy could feel the rash the day before I could see it.
Another mother in my practice is deaf and “listens” primarily by lipreading. Initially, we had a communication problem because I did not move my lips expressively enough when I talked for her to understand me. She politely informed me that I was difficult to lip-read, which encouraged me to hone my communication skills by being more expressive with my facial language. Years ago, one of my favorite pediatric professors, Dr. Richard Van Praagh, professor of pediatrics at Harvard Medical School, gave me some valuable advice: “Surround yourself with wise and interesting parents and have the humility to learn from them.”
2. Get references. Interview friends who share your parenting philosophy. Pick out the most experienced and like-minded mothers in your neighborhood and get references about the doctors they use. Ask them specific questions: “What do you like most about Dr. Susan?” “Is Dr. Tom available when you need him?” “Does Dr. Laura give you the time you need?” “Are his partners just as good?” Pick out at least three names before continuing your search. If you are choosing a pediatrician toward the end of your pregnancy, consult your obstetrician, who likely has a feel for your specific needs. Your pediatrician should be right for you and your child.
Insider’s tip. Suppose the doctor you have chosen to be your child’s pediatrician is not taking new patients. Write a brief letter personally asking the doctor to accept your child as a new patient, and follow up the letter with a phone call. This extra effort impresses doctors that you sincerely care and it may motivate them to actually want to open the practice to you. As I tell my receptionist, “There’s always room in our practice for nice patients.”
3. Do your insurance homework. It’s disappointing to have chosen Dr. Right only to find out you have the wrong insurance. Once you have a list of prospective doctors, check your insurance plan booklet to see which are participating members. After you have narrowed down the list to a few finalists, check with these doctors’ offices to be sure they are still members of the plan and are still accepting new patients from that plan. If you absolutely want to go to a certain doctor who is not a member of your current insurance plan, check your options with your insurance carrier. The best insurance carriers offer a “point of service” (POS) option that allows you to see health-care providers outside the plan, usually for an additional charge.
4. Check out the office. Arrive early for your interview appointment and browse around the office a bit. Chat with others in the waiting room and ask what they like, or dislike, about the office and the doctor’s practice. Notice and ask the staff about how children with potentially contagious illnesses are handled. Many first-time interviewers ask whether there are separate waiting rooms for well and sick children, a question they obviously got from their childbirth class or a book written by someone who has never run a pediatric office. Most doctors who have tried separate sick and well waiting rooms found this system does not work. Nobody wants to use the “sick” waiting room. The more practical solution to minimizing the spread of illnesses is to reserve the waiting room for well children only and to usher potentially contagious children into examining rooms immediately and if possible through a separate entrance. (One comforting fact of germ spreading is that by the time many children come to the doctor’s office, they are no longer contagious.)
Besides looking around the office, find out some basic information and compare it with what you know about other offices:
What are the office hours?
Are there any evening or weekend hours?
Is there a doctor on call after hours and overnight, or is it an advice nurse?
How much are checkups and sick visits (if you don’t have insurance)?
5. Interview the office staff. Introduce yourself to the office staff. Are they friendly and accommodating? You’re likely to be having as much contact with the office staff as you will with the doctor. During doctor-shopping interviews, I love to hear new parents say, “Your staff is so helpful.” To maximize the time you have with your doctor, get as many questions answered and facts you need to know from the office staff before meeting the doctor: hospital affiliations, after-hours coverage, appointment scheduling, and anything else that is important to you.
6. Interview the doctor. Remember, the goal of your interview is to decide whether this pediatrician is the right match for your family. Try these interviewing tips:
Be brief. Since most doctors do not charge for these interviews, expect the doctor to give you about five minutes. This is usually enough to make a doctor assessment. If you or your child have many special needs and you feel you need more time, schedule a regular doctor’s appointment for a checkup rather than for an interview.
Be concise. Bring a short list of your most pressing parenting issues. If your baby is one year old, this is not the time to ramble on about future behavior worries, such as bedwetting or learning problems.
Be positive. Avoid opening the interview with an “I don’t want” list, such as “I don’t want my baby to have shots…” I remember parents who once opened their interview with “We don’t want to give our baby eyedrops, vitamin K, newborn shots, newborn blood tests, immunizations…” While it’s good to do your homework and formulate opinions about certain routine medical practices, it’s better to phrase your question positively, such as “Doctor, what is your custom about routine immunizations?” This allows you to learn the doctor’s perspective and opens the door to factors you may not have previously considered. You owe it to your child to keep an open mind. Negative openers put doctors on the defensive, as they recognize the mismatch between the parents’ desires and their professional beliefs.
Be impressive. Once, when a couple of first-time expectant parents were checking me out as a prospective doctor for their baby, they opened their interview with the impressive line: “This is a well-researched baby.” I immediately warmed to these parents because this statement impressed upon me that they had done their homework thoroughly. Both parents were in their mid thirties, well established in their careers, and were now ready to settle down and begin their parenting career and “do everything right.” These parents had carefully chosen their obstetrician and explored their birthing options, and now I was on their list of pediatric finalists. They conveyed that the choice of a pediatrician was high priority for them. Because these parents expressed that they expected a higher level of medical care, I was motivated to be a more attentive doctor to them. I always advise parents about the law of supply and demand: you will get the level of medical care that you demand. Attend the doctor interview with as many family members as possible, preferably with both parents. A new family recently moved to our area and was interviewing our practice. Grandmother came along. She sat quietly across the room while the parents grilled me. I took cues from Grandmother’s nods as to whether or not I was a Grandma-approved pediatrician.
Avoid doctor turnoffs. Remember, doctors take a lot of pride in being chosen by selective parents. Don’t reveal that you chose this practice “because I found you in the yellow pages” or “because you’re on my insurance plan.” These openers do not make good first impressions.
Be intuitive. Within a few minutes you should get a gut feeling about whether or not this doctor is Dr. Right for your family. While this may sound subjective, try to get a feel for whether the doctor really cares about kids and enjoys his or her practice. When our two sons Dr. Bob and Dr. Jim joined the Sears Family Pediatrics practice, I (Dr. Bill) advised the young Drs. Sears, “Run your practice the way you do your family. As you developed a parenting style to help you enjoy your children, develop a style of pediatric practice that you enjoy, because you’re going to be doing it for a very long time.”
Discover the doctor’s basic parenting philosophy. It’s important to pick a pediatrician who either agrees with or at least supports your basic parenting philosophy. Ask a few leading questions to get a feel for the type of parenting advice the doctor will likely give you in the coming years, such as “I’m worried I won’t succeed at breastfeeding. Is it really that important?” or “My sister used the cry-it-out method to help her baby learn to sleep well. How will I know this will work on my baby?” or “My neighbor uses spanking as a form of discipline, and they swear by it. Do you think it works on children?” While these types of questions may not really have right or wrong answers, you will get a sense if this doctor’s advice will fit well with what you feel is right for your baby.
Uncover the doctor’s basic approach to medicine. You may prefer a doctor who practices straightforward standard medicine. On the other hand, you may enjoy one who likes to think outside the box and provides some alternative approaches to treatment and prevention, or is at least open to your doing so on your own. Ask the doctor what his or her feelings are about antibiotics and other prescription medications, about adjusting your baby’s vaccination schedule to suit your preferences, and about how to treat ear infections.
Bring your child along. If you have recently moved to the area or are switching pediatric practices, take cues from your child. Watch how the doctor approaches your child and how your child reacts. Children are amazingly perceptive about their caregivers, including health-care providers.
It’s important to pick a doctor who gives you the impression of really wanting to make a difference in your life and your child’s life. Among the joys of pediatrics is watching patients grow from infancy through childhood. I (Dr. Bill) once attended the wedding of one of my patients whom I had first cared for twenty-two years earlier when he was a four-pound premature newborn. During the wedding, my mind filled with memories of Mark’s life from incubator to altar. I was so happy that Mark’s parents had chosen me as their child’s pediatrician. Most doctors go into pediatrics because they can truly make a difference in the lives of young people. When our two oldest sons, Dr. Jim and Dr. Bob, joined the Sears Family Pediatrics practice, I gave them another bit of doctorly and fatherly advice: “Jim and Bob, your success in life will be measured not by how much money you make but by how many of these little lives are better because of what you did. Be successful pediatricians.”
2. Get The Most Out Of Your Child’S Checkups And Office Visits
Now that you’ve made an informed choice about your child’s doctor, here’s how to get the most out of the professional you have so carefully chosen. Remember, medical care of your child is a partnership between parents and pediatrician. The parent’s role is to be a keen observer and accurate reporter, and the doctor’s role is to take the clues provided by the parents and arrive at the right diagnosis and plan of treatment. The more you value this partnership and the better you do your job, the better you can expect the doctors to do theirs. Mothers often confide in me, “I worry too much.” I reassure them, “It’s your job to worry. My job is to assess the situation and tell you whether or not you need to worry. In fact, I worry about mothers who don’t worry.”
Periodic checkups (also called well-baby and well-child exams) are wise preventive medicine for children and their parents. Checkups are scheduled to match developmental stages; they give parents opportunities to learn about normal childhood development and their child’s own individual developmental quirks, as well as to identify problems early so that they can intervene before these problems escalate. After thirty-five years in pediatric practice, I (Dr. Bill) have come to regard checkups as growing together. As I watch the child grow from infancy to adolescence, I also observe and counsel parents about how to expand their knowledge of their child and improve their parenting skills. I also grow in my knowledge of the whole family. Examining children when they are well gives me a frame of reference to better evaluate them when they are ill.
Over the years, I have noticed that some parents and children get more out of their checkups than others. Often I’ll finish a checkup thinking, “Wow! We really accomplished a lot in fifteen minutes!” Here are eleven tips on how you and your child can get the most out of your child’s checkups and sick visits:
1. Keep personal medical records. As your part of the partnership, keep a “what works” list, recording the advice and treatment that previously worked with your child. This is especially helpful if you have a child with a chronic illness and are changing doctors. Your new doctor will appreciate knowing this valuable part of your child’s medical history. For example, when your doctor is prescribing an antibiotic, you may volunteer, “That antibiotic gave her terrible diarrhea, but the one you prescribed last time seemed to be easier on her intestines.” Your medical records are also helpful for after-hours over-the-phone advice when your doctor, or a substitute pediatrician, may not have access to your medical records.
2. Do your homework. Before scheduling your appointment, formulate a plan, asking yourself, “What do I want to get out of the checkup?” and “What do I want my child to learn?” Write a list and prioritize your main concerns. If your concerns are minimal and your list is short, then the usual allotted time should be enough. But if you have concerns that you believe will require more time, such as behavioral or learning problems, request a “long appointment.”
3. Play doctor. Before calling your doctor for advice about whether to bring your child in, do some role-playing. Imagine you are your child’s doctor. What would you want to know about the illness? Think about when and how it began, whether it’s getting better or worse, and what home treatments you’ve tried. Do your own home checkup. A wise parent’s eyes and touch can often provide the doctor with valuable clues for a child’s diagnosis. I (Dr. Bill) tell my patients, “Our relationship is like a partnership with both of us doing our best for the benefit of your child. Your job is to be a keen observer and an accurate reporter. My job is to take what you observe and help make the right diagnosis.” The day of your child’s checkup, examine your child from head to toe. Look for unusual spots, rashes, bumps, or areas of growth that concern you. Ask your school-age child, “Are there parts of your body or any aches and pains that you would like to ask the doctor about?”
4. Book the best time. The best behavior time for examining infants and toddlers is the mornings. The worst time for tired toddlers is late afternoons. The best time for school-age children is either on a school holiday in the morning or immediately after school. Mothers often apologize for a baby’s upsetting behavior by saying, “It’s naptime.” Be sure your school-age child doesn’t miss a fun activity because of the checkup; this makes for an unfriendly patient.
Insider’s tip. Your best odds for the doctor being on time and avoiding a long wait is to pick the first appointment of the morning or the afternoon. The worst time for long appointments to discuss behavior or discipline problems is in the late afternoon when the parents, the child, and the doctor are tired.
5. Feed your child before the checkup. Feed your child before the office visit, preferably not in the office. If you bring along snacks, avoid the crumbly type so the doctor and staff do not have to clean up after your child and you don’t spend your valuable office-visit time picking up crumbs. Bring juice in nonspill cups and have office-appropriate snacks, such as yogurt and apple slices.
DR. SEARS TIP Inspect Your Insurance
Here’s a way to make points with your doctor. Before your office visit, call your insurance company and inquire: (1) Have I met my deductible? and (2) What services (e.g., immunizations and well-child visits) are covered by my policy? If you come into your doctor’s office with this information (or ask your insurance company to fax your doctor’s office a printout), you merit a sticker and perhaps a place on your doctor’s preferred-patient list. Doing your insurance homework tells your doctor that you care enough about your doctor to save the staff and the doctor time. The less paperwork the staff and the doctor have to do, the more time they have for you.
6. Be happy to be there! Consider these two scenarios at the beginning of the exam: “He’s fine, it’s just a routine checkup and here’s the required school form.” Or, “Erin and I have been looking forward to her checkup. She wants to learn more about how her body works and I have a few concerns…” Which of these two openers do you think gets the doctor enthusiastic about routine checkups?
7. Respect private time with each child. One child per checkup, please. Even though bringing two or more children for their checkups may seem like smart parental time management, this may dilute the checkup for each of your children. When you’re frazzled chasing a toddler while talking about your teen, neither child will feel special. If the luxury of separate checkups is not possible for you, bring along a friend who can care for your infant or toddler so you and your doctor can focus on the older child’s checkup. The toddler then can have a checkup before or after the older child. Private time is especially important if one of the children has a complicated and time-consuming problem. A six-year-old child may be reluctant to bring up his bedwetting in front of his four-year-old sister. The older children get, the more necessary it is to separate their checkups. If there are things you feel you want to discuss with your doctor privately before your child’s checkup, tell the nurse ahead of time so you can talk to the doctor in one room while your child is being weighed and measured in the other room. If a sensitive issue comes up during the exam, and you want some private time with the doctor, give the doctor a cue, such as: “Erin, perhaps you could go out and have the nurse check your vision.” The doctor will pick up on your cue.
8. Play show-and-tell. If you have concerns about quirky behavior your child is showing at home, in addition to describing the behavior, bring along a video recording. A parent once brought in her two-week-old infant for a checkup and was concerned about the child’s colic. To convince me (Dr. Bill) of the severity of the problem and the toll it was taking on the family, she videotaped her baby during an evening blast. When I saw how much the baby—and the parents—were hurting, I immediately gave them more time and attention than they would have gotten without this visual aid. Occasionally, a parent records our conversation during the checkups in order to play it back for the parent who wasn’t able to attend.
During one recent checkup, parents asked me about their five-year-old’s restless sleep. I asked them to videotape a few minutes of the unusual noises and restlessness they were concerned about. When I watched the tape on their return appointment I realized that their child suffered from sleep apnea and needed his tonsils removed.
I love to see parents whip out a written list of their concerns prior to a checkup. Sometimes they will hand me a copy of this list (please prioritize your concerns), which helps me be sure I’ve addressed all their concerns. A written list also helps with the doctor’s time management. If I see a particularly complicated problem on the list, such as a behavior or school issue, I may address the more immediate problems first and ask the parents to schedule a longer appointment for these more time-consuming issues.
9. Respect your child’s quirks. After you and your child have gone through a few checkups, note what works and what doesn’t. If your toddler has previously gotten spooked on the scale, ask the nurse to save the weighing and measuring until the end of the exam. One day while I (Dr. Bill) was examining a toddler, I attempted to remove her shoes. She got nervous, threw a tantrum, and the exam went downhill from there. I noted this on her chart, and the mother also made a mental note. On her next checkup, the child toddled in barefoot.
DR. SEARS TIP Thank Your Doctor
Write thank-you notes. If you have had a particularly rewarding experience at your doctor’s office or a member of the staff has gone out of his or her way to make your visit more comfortable, let the doctor know. A box of mommy-made muffins once arrived in my office to apologize for the midnight wake-up call the night before. Also, if you have had a problem, let the doctor know. Doctors have no way of evaluating their office staff unless you tell them.
10. No surprises, please. “My doctor is often in a hurry and is always running late” seems to be one of the most common parent peeves. In defense of Dr. Rush, the system of managed care has forced doctors into a “more for less” operation—seeing more patients in less time. The main reason doctors get behind schedule is that one or two routine checkups turn out to be complex problem-solving half-hour consultations. Yet the patients had scheduled only ten-minute regular checkups. If you know you don’t really have many questions and your child is basically healthy, a quick checkup will usually suffice. But if you feel you need more time to address some complex issues, the best thing to do is ask for a longer visit when you book your appointment. If you demand (politely, of course) quality and quantity time with your doctor, you’ll get it. But it is not fair to the child or the doctor to surprise the doctor toward the end of a regular checkup by mentioning, “By the way, the school thinks my child has ADD…”
11. If you and your doctor disagree. It’s important that you and your pediatrician agree on major topics of child-rearing. You want to look forward to your well-baby and well-child visits and not have to feel that you’re on the defensive. Disagreements between parents and pediatricians are usually more about parenting styles than medical care. The main example we see among parents who have transferred to our practice is that the former pediatrician does not support the chosen parenting style of the parents. For example, you may prefer the high-touch and highly responsive style of parenting called attachment parenting, which means feeding your baby on cue, carrying your baby a lot, and even sleeping close to your baby. Your pediatrician, on the other hand, may prefer a more scheduled and distant style of parenting—one that could be based on his or her own personal experience rather than any medical school training. Yes, you can respectfully disagree with your doctor if it’s a parenting-style issue. We often hear parents complain, “My doctor is very good and is very medically competent, yet we disagree on parenting styles.” Often, there is a trade-off. If your child has special needs and you are happy with your doctor’s medical care, then avoid getting into the parenting-style issue. Simply tell your doctor that you are confident about what you are doing and that it is working for you and your child. Suppose you enjoy wearing your baby in a sling for several hours a day, yet your pediatrician believes that this fosters an unhealthy dependence. While you should be open to his or her viewpoint, it’s appropriate to challenge your doctor and request reasons for your doctor’s difference of opinion. That way, your doctor learns other viewpoints and so do you. After all, you know your child best.
Eventually, the development and behavior of your child will be your best advertisement. Once your doctor sees the result of your parenting style and witnesses that what you are doing is working, he or she is likely to compliment you rather than criticize your way of parenting. Many parent-doctor relationships work quite well, even though they may start out with differences of opinion. For the relationship to thrive, there must eventually be a blending of opinions. After all, both you and your doctor share the same goal: to help your child stay happy and healthy.
There is great joy and pride in being a pediatrician. After all, his or her name is at the top of the babysitter’s phone list when the parents go out. One of the hallmarks of a close and long-lasting doctor/patient relationship is the “remember when” reminders that we sometimes hear from patients. Once when I (Dr. Bill) was examining Jonathan, a teenager already taller than I was, his mother reminisced about the time I had to insert a tube down baby Jonathan’s windpipe to relieve his severe croup. In another instance, Dr. Bob was giving a ten-year-old girl a physical and noticed a small scar on her belly where the appendix would be, and the mom reminded him of the time he had sent her to the emergency room, certain she had appendicitis. “You were right, and the surgeon said if we had waited another hour or so it would have ruptured.” Although we often forget about many of these occurrences, parents and children sure don’t. It’s rewarding to find a pediatrician you love and to stick with him or her until your child goes off to college. That’s the kind of doctor you and your children deserve to have.
EASING EXAM ANXIETY
Exam time can be scary for little people, who may have flashbacks of the needle sticks from previous exams. Here’s how you can help everyone enjoy the checkups.
Prepare your child ahead of time. Do a pretend exam at home where you show and tell the child what the doctor may do during the checkup. Keep up a running commentary: “The doctor will count your teeth, look into your ears, pat your tummy, and listen to your heart…” If your child has a history of being less than enthusiastic about being medically examined, get him or her a play doctor kit and go through a mock exam first: “Check Mommy’s ears,” “Look at Mommy’s throat,” “Listen to my heart,” and so on. End with: “That’s what Dr. Susan will do when she examines you.” Have your child bring the doctor kit along to “examine the doctor” before his or her own exam.
Dress your child for success. Some toddlers get spooked when I (Dr. Bill) try to undress them. Dress your child for easy access, such as in a shirt that opens from the front rather than in one that needs to be pulled over the child’s head.
Read all about it. Go through a picture book about getting a checkup, such as The Berenstain Bears Go to the Doctor by Stan and Jan Berenstain, for kids four to eight.
Bribery is okay. If your child’s behavior during medical checkups has been less than ideal, entice your child by saying, “After your checkup, we’ll go for a treat”—implying that you expect him to cooperate with the doctor. If bribery offends the moralist in you, call it an “incentive.”
Be happy about the checkup yourself. Mothers are mirrors of anxiety and calmness. When I begin to examine a toddler, I notice the child usually reacts toward me the way the mother does. If the child clings to the mother, and the mother clings back adding an anxious “he won’t hurt you,” she reinforces the anxiety, and the toddler clings harder. But if the mother relaxes her grip and clicks right into a happy-to-be-here dialogue with me, often the toddler clings less to the mother. If you sense your child is anxious, greet the doctor cheerfully and carry on a happy dialogue before the exam. I watch children observing this dialogue. They feel that if I’m okay to Mommy, I must be okay. Once the child concludes I’m a mom-approved person, the exam takes on a friendlier tone.
Bring along a “friend” for the checkup. To lessen checkup anxiety, encourage your child to bring along her favorite doll or bear for a checkup, too. Pediatricians welcome these props. I often do a checkup on whatever fuzzy character is currently popular in order to win over an anxious young patient. If the doctor doesn’t take the cue, ask him if he could check the doll first. I often do a brief pretend exam on an older sibling in order to win over the younger one, or let the older child hold the stethoscope or otoscope and give him a title, such as “Dr. Johnny.” The younger child will often willingly join in this game and let me examine her.
Use the lap of security. If your child seems anxious, ask the doctor if your child could be examined on your lap instead of on the exam table. I rarely use exam tables for preschool children, who are much more secure and trusting while lounging on a parent’s lap.
3. Practice The Pills-Skills Approach To Medical Care
Pediatric care is a partnership between parents and doctor. You are your child’s “home doctor.” We will now show you how. One of the most important concepts for parents to appreciate is one we call the pills-skills model of medical care. Nowadays, many children and adults are developing a “take a pill” mind-set. Children take pills to calm them down and perk them up, bring down a fever, or help a cold. Adults take pills for the diseases we call the “highs”—high blood pressure, high blood cholesterol, and high blood sugar. Rather than make changes in their lifestyle and diet, they feel it’s easier to pop a pill. This is an unhealthy attitude that we want to change.
The pills-skills approach means the doctor is first of all the teacher, which is what the word doctor originally meant. The doctor prescribes a pill but also teaches the parents and child self-help skills that help the child’s body muster up its own internal medicine. With the pills-skills model, you go into the doctor’s office and ask the doctor not only “What can we take?” but also “What can we do?” When health-care providers see that the parents have the pills-skills mind-set, they also adopt a healthier attitude: “Here’s what I prescribe, and here’s what I advise.”
The pills-skills model, one that we will use with most illnesses in this book, is best explained by the following example:
Mrs. Smith brings her eight-year-old daughter, Suzy, into my (Dr. Bill’s) office for consultation about her chronic asthma. Suzy has been on multiple medications, and Mrs. Smith is worried about two things: the continuation of Suzy’s asthma and the possible side effects of chronic medications. After listening to these concerns, I whip out my sketch pad and draw a graph of the pills-skills model (see below). I explain to the mother that all chronic illnesses—asthma, ADD, GERD, chronic diarrhea, recurrent fevers, and all the “-itis” diseases—must follow this pills-skills model. This is, or should be, the current medical mind-set. Meanwhile, I notice Mrs. Smith’s body language: “Finally, a doctor who gets it!”
—PILLS (Example: Asthma inhalers and medications)
I go on to explain: “Our goal is to slowly wean Suzy off dependence on the medication. When and whether she will ever be completely off the medication is an unknown, but it’s likely we can at least drastically lower her dosage.” I tell her that we can teach Suzy self-help skills that, in effect, will help her body muster up its own internal medicine— medicine that is customized for her own body, and I list therapeutic things Suzy can do.
Many children have quirks—parts or systems of the body that just don’t work as well as they should. We all have them; some are more major than others. In order to deal with these quirks, make a project out of your problem, study it, and become an expert on it. Then you build your own toolbox, a set of doctor-designed skills. You carry this toolbox around. We’re going to help you build your toolbox with your own tools and show you when and how to use them. For example, if your child is on anti-inflammatory medicine, we’ll show you how to help his body make its own anti-inflammatories. If your child is on antihistamine medication, we’ll show you how to help her body make its own antihistamines. We’ll help you and your child learn to rely on skills rather than pills.
4. Follow The Dr. Sears Head-To-Toe Guide To Keeping Your Child Healthy
In this section we provide advice for using the pills-skills approach to staying healthy. When your child has a particular illness or problem associated with any of the following systems, here are practical things you can do to keep each system healthy and, when these systems do become ill, to help them heal. We give you a brief health plan for the brain, eyes, nose, heart, lungs, gut, skin, immune system, and endocrine system.
Growing a Healthy Brain
Here are some brain facts you should know:
A child’s brain grows most rapidly in the first five years, tripling in volume during the first two years and reaching 90 percent of adult growth by age five.
The brain, above all other organs, is affected—for better or worse—by nutrition.
Infants and toddlers use around 60 percent of their food energy for brain growth.
In school-age children, around 25 percent of food energy goes into brain growth and function.
For many children you can replace the term ADD (attention deficit disorder) with NDD (nutrition deficit disorder).
Nutrition and lifestyle choices dramatically affect the brain. Properly feeding your child’s mind is perhaps the most important first step to get your child off to a healthy start in life. Here are seven ways to help your child’s brain grow smart:
1. Eat smart foods
Go fish! Seafoods and/or omega-3 DHA supplements are the top smart food. (See page 34 for why seafood is good brain food.)
Blueberries. Help your children grow a berry good brain. The deep blue skin of the blueberry is full of phytonutrients called flavonoids. These are antioxidants or “phytos” (see explanation of phytos, page 34) that keep your child’s blood/brain barrier (BBB) healthy. The BBB is a thin membrane between the brain cells and the blood supply that acts like a filter, keeping harmful substances from entering the brain and healthful substances in. Blueberries also improve neurotransmitter function, or the way nerves “talk” to each other. Also, blueberries reduce inflammation to keep your child’s brain from becoming part of an iBod body (see page 35).
Greens. Not only should your children “eat blue,” they should also “eat green.” Many of the brain-health properties mentioned above for blueberries are also true for green veggies such as spinach, bok choy, collard greens, asparagus, and green, leafy lettuce like romaine and arugula.
Nuts. Go nuts with your children! Walnuts are the top brain nut because they’re the richest in omega 3s. For toddlers and preschoolers (an age when nuts can be a choking hazard), nut butters are a great choice. Most nut butters can be offered starting at age one. Peanut butter, however, should be delayed until age two in order to help prevent peanut allergies.
Smart carbs. The child’s brain is a “carbo hog”—it needs lots of sugar to function. But your child needs a right-carb diet. Two quirks make the brain particularly sensitive to carbs: first, the brain can use sugar without insulin, whereas other tissues need the hormone insulin to usher sugar into the cells for energy, and second, the brain, unlike other tissues, does not store glucose, so it needs a steady supply for brain function.
What’s a “right carb” and “wrong carb,” or “good carb” and “bad carb”? Here’s how you can explain it to your kids: “Smart carbs have two friends, protein and fiber. They never play alone. These two friends keep the carb from rushing into the brain too fast and getting it too excited. Bad carbs, or dumb carbs, have no friends. They play alone. When you eat dumb carbs the friends can’t hold the sugar back, so it rushes into the blood and brain and excites the brain too much. Smart carbs are found in nature: fruits, veggies, and whole grains. Dumb carbs are found in packages and bottles. The dumbest carbs are sweetened beverages.”
SMART FOODS VS. DUMB FOODS
It just so happens that the foods that are good for the whole body are also best for the brain.
Calcium. Calcium is an important nutrient not only for growing bones but also for growing brains. Dairy products, fortified cereals, dark green veggies, and fortified orange juice are good sources of calcium.
The Dr. Sears Smoothie. Many years ago we learned that a protein- and nutrient-rich smoothie is one of the best ways to start the day. Many of our children also join in this morning ritual. Here are the base ingredients (experiment with varying amounts to taste):
ground flaxseeds, flaxseed meal, or flax oil
frozen fruits: blueberries, strawberries, mango, papaya, pineapple, banana, kiwi
organic milk (cow or others), juice (pomegranate, carrot, other veggies)
Greek-style organic yogurt
multivitamin/multimineral protein powder
Use varying amounts of the following special add-ins according to taste:
honey (not earlier than one year of age)
whey protein powder
Pick and choose various ingredients and try some ideas of your own. Keep it simple at first so your kids won’t suspect you are trying to sneak something healthy into them. As your children get into the habit, include the healthier add-ins.
2. Eat often
Grazing is good for your child’s brain. Because the brain cannot store glucose, it relies on a steady supply of healthy sugar—not too much, not too little. Steady blood sugar means steady nerve function and mood. Nibbling on nutritious mini-meals throughout the day is more brain-friendly than eating fewer but bigger meals. Let’s delve a little deeper into the food/mood connection. The key health-food phrase to remember is stable insulin levels. Throughout your child’s body, many hormones play together like pieces in a symphony orchestra. Insulin is the master hormone, like the conductor in your child’s hormonal orchestra. When insulin is stable, the rest of your child’s body chemistry is in balance, or hormonal harmony, and the beautiful music of health occurs.
The top tip for keeping insulin stable is the rule of twos: Eat twice as often, half as much, and chew twice as long. This is one of the simplest and most practical of our nutri-tips, and one you will see repeated throughout this book. It is especially valuable for stabilizing moods, improving concentration and learning, and maintaining weight.
3. Eat breakfast
Feed your child a brainy breakfast. Like Grandmother said, “Breakfast is the most important meal of the day.” Studies show that children who eat a nutritious breakfast, one high in protein and with fiber-filled carbs (whole grains, fruit, yogurt, oatmeal, and eggs), get higher grades, are more attentive and behave better in class, and miss fewer school days because of illness.
READ MORE ABOUT IT
Our book The Healthiest Kid in the Neighborhood is an easy-to-read health plan for the whole family. There you will find an entire chapter on feeding the brain as well as menus for brainy breakfasts.
4. Eat “pure”
Parents, your child’s growing brain cannot handle the junk that is added to many processed foods. A simple fact of brain function is that if you put junk food into your child’s brain, you get back junk learning and junk behavior. Many chemical food additives, such as those listed under “Dumb Foods” on page 15, can damage the part of the brain cell called mitochondria, the tiny packets in the center of the cell that act like batteries to give the cell energy. Dumb foods are also called excitotoxins; they can throw neurotransmitter activity (the brain’s information processing system) out of balance. In our opinion, food additives have never been proven safe for adults, let alone the more sensitive brains of growing children. Even the Food and Drug Administration (FDA) gives them “GRAS” status, meaning “generally regarded as safe.” Do you want to put stuff in your child’s growing body and brain that is only “generally regarded as safe”?
One day a mother in our office who was holding a four-dollar cup of Starbucks coffee asked, “Is buying organic food for my children worth the extra price?” Our reply: “What’s your child’s brain worth?” You would do better to save money on much of the useless plastic stuff children get that they don’t need. Children’s growing bodies and brains are harmed by pesticides. Environmental pollutants are particularly toxic to the brain. Pesticides and other environmental pollutants are stored in fat. The brain is primarily fat. You draw the conclusion. Additionally, infants and toddlers have proportionally more body fat than do adults and are therefore more bothered by the harmful effects of pesticides. As an added perk, new studies reveal that the vitamin and mineral content of organic foods is higher.
Spending more money on better food will ultimately save you much more in medical costs. (Dr. Bob is an adviser to HappyBaby organic baby foods, promoting the importance of eating organic foods.)
Movement is one of your best brain foods for several reasons:
Movement improves blood flow to the brain. Improving blood flow to any organ, especially the brain, is like watering and fertilizing a garden. More blood means more nutrients. When you move your muscles, especially the large muscles in your arms and legs through vigorous exercise, your heart works harder to pump blood up into your brain.
Movement helps the brain grow. Exercise stimulates the release of nerve growth factors (NGF). NGF is like fertilizer to a plant. Every time your child moves, he is fertilizing one of the most important “plants” in his growing body: his brain.
Movement mellows the mind. The increase in blood flow to the brain secretes “feel good” biochemicals that have a natural calming effect.
Movement keeps insulin stable. Stable insulin means stable blood sugar, which means enough brain fuel.
DR. SEARS TIP Walk Therapy
When your child seems tense or anxious, go for a brisk walk together. This will help her brain relax and help her sit still awhile to do her homework.
6. Keep calm
By an unfortunate quirk of biology, the organ that creates the most stress, the brain, is the very one that can handle it the least. At both ends of the life span—the first five years of the growing brain and the last few decades of the aging brain—central nervous system tissue has the most trouble handling the effects of high and prolonged blood levels of stress hormones, which can actually damage brain tissue. The effect of chronic, unresolved stress on growing brains is called glucocorticoid neurotoxicity (GCN). Although this term is a mouthful, it basically means that high levels of stress hormones damage sensitive brain tissue, in addition to slowing down the ability of glucose to enter the brain cells and slowing the speed of information processing by causing a drop in the brain’s neurotransmitters. This translates into less mental energy and more unstable moods, resulting in difficulty with impulse control and focusing.
DR. SEARS TIP Laughter Is the Best Medicine
Surround your children with friends and family who perk them up rather than pull them down. As much as possible, fill your child’s mind with positive and happy thoughts. You may be happy to know that PET scans of the brain show that central nervous system pathways can actually change in response to positive and negative attitudes and thoughts. Let the refrain “Don’t worry, be happy” permeate your home. Negative thoughts are like pollution to the mind. In our homes we have found that music mellows the mind of everyone.
7. “Exercise” the brain
The “use it or lose it” biological principle applies not only to muscle but also to brain growth. A child’s brain growth is like millions of electrical wires trying to form connections. The “smart foods” listed above help insulate the wires to speed the transmission and help these wires grow branches that connect with other wires. “Dumb foods” cause the electrical wires to be frayed, and short circuits occur. But you have to do more than just provide the brain with healthy nutrition; you have to exercise your child’s mind to really maximize his intellectual development. Nothing stimulates nerve growth and connectivity better than face-to-face interaction between a parent and child. Read to your child. Play interactive and hands-on games. Tell stories and play make-believe. Laugh and sing together. Draw and color pictures. And perhaps the most important advice is to keep the television off during the first two years of life. Studies have shown that the more TV or videos young children watch, the more learning and behavioral problems they may have later on. Some supposedly stimulating infant videos have been shown to actually slow down brain development. If you must use TV as the occasional babysitter, keep it limited to thirty minutes and choose shows with music.
DR. SEARS TIP Discover Your Child’s Special Something
The earlier you can discover your child’s special intellectual talents and run with them, the more lasting effect they will have on your child’s developing brain. Think of your child’s brain as a giant file cabinet. What files do you want your child’s brain to store? The more files your child can store, the more he has in reserve to replay later in life. He can click into his cerebral DVD library and replay a scene when the situation arises. If your child has music talents, get him started early. Any time you hear that off-key or screeching sound, keep in mind that it’s building another brain pathway.
Improving Your Child’s Eye-Q
Since the retinal tissue of the eye is part of the brain, what’s good for the growing brain is also good for growing eyes. Here are four ways that you can help your child’s visual development:
1. Feed growing eyes
Like the brain, visual development is affected for better or worse by what your child eats.
Seafood is “see” food. Half of the retinal tissue is made up of DHA, the main omega-3 fat in coldwater fish such as wild salmon. Be sure your child averages at least 300 milligrams of DHA per day, preferably from coldwater seafood. An alternative would be an omega-3 DHA supplement. (See supplements, page 94.) There is a pink perk in wild salmon, called astaxanthin, that is also good eye food. It is a potent antioxidant that helps prevent wear and tear on the sensitive retinal tissue. Astaxanthin also protects the retina from the damaging effects of excessive sunlight. Think of astaxanthin as internal sunglasses for the eyes.
“Berry” good eyes. The purple pigment in berries such as blueberries is called anthocyanin, which helps the eyes adapt to changing intensities of light.
Go green. Carotenoids (nutrients that are found in vegetables, primarily green ones) also act like nature’s sunglasses. The carotenoids lutein and zeaxanthin filter the UV light, preventing damage to the sensitive tissues of the eye. The best foods for carotenoid eye sunglasses are kale, collard greens, Swiss chard, spinach, and broccoli. These greens in a salad are particularly helpful because the fats in olive oil dressing can help the carotenoids be better absorbed. Tell your children to keep their eyes on their greens.
DR. SEARS TIP Try an Eye Salad
Put all the top eye foods together, such as spinach, arugula, blueberries, walnuts, and olive oil, with a fillet of wild salmon on top. Start feeding your toddler such foods early on, and she will develop a taste for them.
2. Shade little eyes
Ever notice how fair-skinned children who go hatless and don’t wear sunglasses often have squinty eyes? That’s because over the years their eyes have tried to protect themselves from sun damage by squinting to let less light in. As a result, over time the bones of the orbit of the eyes actually look like they’re growing over the eyes as a sort of shade, leading to a permanent squint. Growing eyes are particularly sensitive to excess sunlight exposure. During the summer months we often see reddened, swollen eyes that resemble conjunctivitis. This “sun-induced conjunctivitis” is due to the reaction of the lining of the whites of the eyes to excessive sunlight. Eye specialists recommend avoiding toy sunglasses because they simply shade the eyes, which causes a baby’s pupils to enlarge and allow more damaging UV rays to reach inside the eye. Instead, use baby and child sunglasses that are labeled for UVA and UVB protection. See page 507 for more on sunglasses. Wearing a hat is also important.
3. Rest little eyes
Staring too long at a computer screen can lead to nearsightedness. Tell your children to take frequent eye breaks by simply resting their eyes when they seem tired.
4. Light little eyes
Improper lighting eventually tires out and wears out eyes. Don’t let your child zone out on a light computer screen surrounded by a dark room or read in a dim light. Be sure there is adequate ambient light around the screen.
Keeping Little Noses Clear
We cannot overemphasize the importance of good nasal hygiene. Keeping little noses clear is one of the most important and one of the simplest—yet most often overlooked—ways to keep your child healthy. Babies prefer to breathe through their noses rather than their mouths, so when their noses are clogged, it throws their whole breathing mechanism off. Also, those little nostrils are the “doors” where most germs enter the body. Here are the time-tested ways of keeping little noses clear that we use most often in our medical practice:
The Dr. Sears Clean-Nose Regimen: A “Nose Hose” and a “Steam Clean”
Remember those two phrases in the section title, as you will hear them often throughout this book. We advise parents to try all of the following techniques, select the ones that work the best, and put together their own “nose-hose” and “steam-clean” regimen:
1. Hose little noses with salt water. Make your own saltwater nose drops (one half tablespoon of salt to eight ounces of water) or buy at your local pharmacy or supermarket a prepared saltwater (saline) solution in a squirt bottle. Spritz a few drops of the solution into your child’s clogged nasal passage and gently suction out the loosened secretions using a nasal aspirator, available at your local pharmacy. Veteran nose-cleaners dub this handy gadget a “snot snatcher.” Older children can learn to blow their noses themselves. Nose hosing is becoming big business, and it’s about time, since for years this has been one of the most overlooked and most needed “medicines.” There are a variety of nasal washers that squirt water, saline solution, or a mist up into the nose under various degrees of pressure, similar to a water pick for cleaning teeth. A neti pot is another nice way to go. Our little patients call this handy snot snatcher “Aladdin’s lamp” because that’s what it looks like. For over a decade in our pediatric practice we have recommended a neti pot as the most effective way to irrigate nasal passages and drain clogged sinuses for children over eight, especially those with chronic nasal discharge and sinus infections. The directions come in the pot package. Basically, put warm salt water in the pot, tilt your child’s head to one side, and put the spout of the pot in the upright nostril. The water then flows through one nostril and out the other, meanwhile flushing the nose and pulling gunk out of the sinuses. To some children it may initially seem scary, but once they’ve tried it, after a bit of parental coaxing, and see how much better they feel and breathe, they will be willing participants.
DR. SEARS TIP Sit Up for Nose Hosing
Instead of laying Baby on her back, which she will find threatening, sit her upright on your lap while doing the “nose hose.”
2. “Steam clean” the airways. Make a home steam bath by turning on a hot shower in the bathroom with the door closed. Fifteen minutes of concentrated steam while your baby is nursing or playing will help keep her nose clear. Facial steamers are also very useful. These are not only the best way to steam clean the nasal passages and sinuses but can also be the most fun, or at least they are marketed as such. First, get your child used to seeing you use the facial steamer, even if you don’t have a medical reason to use it. Many women use a facial steamer for home facials. After using the facial steamer, let your child see you cheerfully boast, “Oh, it makes my face feel so good.” Let your child try it. Sit her on the couch in front of the TV. Put the steamer on the table in front of her and prop it up with a few books so the child can comfortably sit on the couch and bend over with her face in the steamer, while at the same time keeping her eyes riveted on the TV to distract her from what’s going on in her nose.
3. Vaporizers are very good. Children’s noses and central heating are not a match. When the heat goes on, so should a vaporizer. Besides humidifying the air and the breathing passages, warm-mist vaporizers have a double benefit: steam sterilizes the water, and when the steam condenses, it releases heat to the bedroom, allowing you to turn off or turn down the drying central heat. Steam can pose a burn hazard, so be sure to keep the vaporizer and cords out of reach of infants and toddlers. Try for a relative humidity of around 50 percent in your child’s bedroom. (An inexpensive humidity-measuring device, called a hygrometer, is available at hardware stores.) Excessive humidity in a bedroom can foster allergens and mold growth, while low humidity dries out the skin, especially during the winter months.
Raising a Healthy Heart
While you may think of cardiovascular disease as an adult problem, that’s no longer necessarily so. The Bogalusa Heart Study, a famous study of 14,000 children ages five to seventeen, revealed that around half of the overweight children in the study already had signs of early cardiovascular disease, or what we call the “highs”—high cholesterol, high blood triglyceride levels, and high blood pressure. Autopsy studies have shown fatty streaks and early signs of coronary artery disease even in preschool-age children. Because nowadays many children eat too much of the wrong foods and sit too much, they are growing up with early cases of “heart overload.” Studies show that children with elevated cholesterol are three times more likely to have high cholesterol, high blood sugar, and high blood pressure levels as adults. Even though heart disease strikes in adulthood, it begins in childhood.
The two best preventive medicines for cardiovascular disease and raising healthy hearts are
Eating a heart-friendly diet (see Go Fish! page 34; Smart Foods, page 15; and anti-inflammatory foods, page 36).
Why Movement Grows a Healthy Heart
Growing bodies are only as healthy as the blood vessels that supply them. A fun health exercise is to take a trip through a fictitious blood vessel with your children. Here’s how we explain it to our curious older patients (you can simplify this description for children under ten):
You may think that your blood vessels are like rubber hoses. The heart pumps blood in one end of the hose, and it comes out the other end of lots of little hoses to nourish all the tissues.
There is a lot more to the cardiovascular system than a bunch of hoses. One of the newest and most exciting discoveries is that the endothelium (the lining of the blood vessels) is the largest endocrine organ of the body. The billions of cells that line your arteries don’t just sit there—they do something. When you exercise, the blood flows faster across the surface of your blood vessels like traffic across a highway after rush hour ends.
Special glands inside the lining of your blood vessels function like a giant pharmacy within your body. When the blood flows fast across these glands, these little medicine bottles open up and release custom-made medicine into your bloodstream according to your body’s needs. These glands especially make medicines to lower the highs—high blood pressure, high cholesterol, and high blood sugar—the three main causes of cardiovascular disease.
Movement helps the lining of your blood vessels repair itself, just as the maintenance crew of a highway repairs the wear and tear of lots of traffic. If your blood vessels get rusty, they build up clots and gradually shut off the blood supply. Then your organs can’t grow and function right. When you exercise a lot, the maintenance crew inside your blood vessels repairs them and keeps them open so you get lots of blood to your brain, your heart, your muscles, and all over your body to help you learn, grow, and play well.
But if you just sit around and eat junk food all day, the inside of your blood vessels get’s rough like Velcro instead of smooth like Teflon. This is what happened to Uncle Johnny [or whoever in your family has had a heart attack]. He didn’t take care of his blood vessels, so they clogged up and his heart stopped working right.
DR. SEARS TIP Check Your Child’s Cholesterol
According to the American Academy of Pediatrics, routine cholesterol testing is not necessary until puberty. But you should have your child’s cholesterol checked in the preschool years if
you or your parents have a history of cardiovascular disease or developed cardiovascular disease before turning fifty-five.
you have a family history of hyper-cholesterolemia, a metabolic quirk in cholesterol metabolism that leads to fatty deposits in the skin and arteries, even at an early age.
Five Ways to Cut Your Child’s Cholesterol
1. Move! Exercise raises good cholesterol (HDL) and may reduce the so-called bad cholesterol (LDL). Exercise is one of the most effective cholesterol-lowering “drugs” and doesn’t have unpleasant side effects.
2. Graze! Grazers (eating frequent mini-meals throughout the day) tend to have lower cholesterol than gorgers (eating three big meals a day). (See why grazing is good for you, page 37; and the rule of twos, page 97).
3. Stay lean! Trimming excess body fat trims excess cholesterol.
4. Eat a right-fat diet, not necessarily a low-fat diet. (See Fats, page 94.)
5. Eat cholesterol-lowering foods. The following foods have been shown to help lower cholesterol:
fiber-filled foods, such as bran, prunes, and legumes
New insights have revealed that cholesterol may not be the main cardiovascular culprit that it’s made out to be. Growing kids need some cholesterol. In fact, breast milk, the gold standard of infant nutrition, is a medium-cholesterol diet. Certainly, do not put your child on a low-cholesterol diet unless your doctor advises you to.
Growing Healthy Little Lungs
The quality of air your children breathe affects how healthy they are. The two most important lung-health tips are: breathe healthy air and grow healthy respiratory passages.
Help Your Children Breathe Clean Air
Just as you take special care to help your children ingest clean food, do your best to help them inhale clean air. Little breaths add up. For example, you’re doing carpool and there is a bus or a big truck ahead of you spewing out polluted exhaust. The light goes on in your head: “I can’t let my children breathe this.” So you pass the truck, take an alternative route, or roll up the windows. Avoid daycare and preschools that are downwind from pollution, such as near freeway interchanges. Make a list of all the daily changes you can make to help your children breathe clean air. If your child has allergies, use an air purifier, especially in the child’s bedroom. (See Allergy-Proof Your Home, page 154.)
NO SMOKING AROUND CHILDREN, PLEASE!
Everyone knows that smoking is hazardous to children’s health, but here’s a reminder:
Suppose you’re about to take your child into a room when you notice a sign that reads: Warning! This room contains poisonous gases, containing more than 4,000 chemicals, some of which have been linked to cancer, asthma, lung damage, and Sudden Infant Death Syndrome (SIDS). You certainly wouldn’t take your child in there, would you? Yet that’s exactly what happens when you take your child into a room frequented by smokers. Even sitting in “non-smoking” areas of restaurants, while helpful, is not enough. Having a non-smoking area is like chlorinating half a swimming pool. Pollutants travel through the air. If a restaurant allows smoking anywhere, don’t patronize it. It’s not family-friendly. The risk of just about every disease you don’t want your children to get goes up in proportion to the amount of cigarette smoke they’re around.
Children of smoking parents have over twice as many doctors’ visits because of respiratory infections. Here’s why: Your child’s breathing passages are lined with tiny filaments called cilia that wave back and forth like sea plants under the ocean and function to clear mucus from the airway passages. When a germ, irritant, or pollutant gets into the airway, these cilia, and the mucus around them, act like a miniature conveyor belt to move the harmful stuff up into the airway where the child can cough or sneeze it out. Smoke paralyzes these cilia, so the conveyor belt stops and the mucus and germs clog and infect the lungs. (See Smoking, page 482.)
DON’T ALLOW SMOKING AROUND CHILDREN!
Humidify Your Child’s Air
As a guide for the winter, turn the heat down and put the hot-steam vaporizer on. During naptime and nighttime run a vaporizer in Baby’s bedroom. The dry winter air of central heating can thicken nasal and bronchial secretions, further compromising Baby’s tiny airways. Also, like water in a stagnant pond, mucus that sits too long gets infected. Besides adding nasal-friendly humidity to dry winter air, as we’ve already mentioned, a vaporizer acts as a healthy and stable heat source at night. A word of caution: Vaporizers can pose a burn hazard. Be sure you keep them, and the cords, out of reaching distance of little hands.
Breathe to Relax!
You’ve probably heard Grandmother say “Take a deep breath.” Grandmother was physiologically correct. Deep, relaxed breathing mellows stress by turning on the part of the nervous system that relaxes you and turning down the part of the nervous system that revs you up. Deep, slow, relaxed breathing lowers the levels of circulating stress hormones. The younger your child learns this very simple mood mellower, the better.
Helping Your Child Enjoy Good Gut Health
Intestinal upsets rank second to respiratory problems as the reason for pediatrician visits. Although you may think of the intestines as simply being a long tube that helps food get from the mouth to the bloodstream, there is a lot more going on. Next to the brain, the intestines have the richest supply of nerves; hence the name gut brain. The intestines are the most important part of your child’s immune system. The healthier the intestines, the healthier the immune system. Here are seven things your child can do to grow healthy intestines:
1. Graze. Perhaps the simplest yet scientifically proven home remedy for intestinal health is Dr. Sears rule of twos:
Eat twice as often.
Eat half as much.
Chew twice as long.
This simple way of eating allows more digestion to occur at the upper end of the digestive tract while the lower end is healing. (See page 37.)
2. Eat healthy. See the nutrition tips on page 420 (Traffic-Light Eating). The healthier the food that goes into the intestines, the better they perform.
3. Eat smaller bites. Children love to stuff food in their mouths, which encourages not only overeating but indigestion. Give your child a small fork and cut the food into smaller bites.
DR. SEARS TIP The Sipping Solution for a Healthier Gut
A fruit, yogurt, and ground flaxseed smoothie (see recipe, page 15) is a recommendation we make frequently in our medical practice. The sipping solution is good for just about every intestinal ailment or pain in the gut. Blending the food increases absorption, decreases heartburn, and decreases constipation. Since the blender does much of the digestion, the gut has to work less and there is less undigested food to reach the colon. The fiber is also very friendly to the gut.
4. Play chew-chew. Hurried children wolf down their food. The more work that can be done in the mouth, the less wear and tear at the other end of the digestive system. Mom’s mealtime advice to “chew your food” is biochemically correct. Digestion begins in the mouth. Chewing breaks up the fibers that hold the food together. Digestive enzymes target chewed-up food particles. Chewing stimulates saliva, which lubricates the esophagus for smoother passage and also protects the lining of the esophagus against the irritating effects of stomach acids. Saliva is rich in enzymes that pre-digest food. Another reason why saliva is dubbed the body’s own “health juice” is that it contains a substance called epidermal growth factor, which helps repair inflamed intestinal tissue. This may explain why animals lick their wounds. Play the chew-chew game. Encourage your child to chew each bite at least ten times.
5. Eat slowly. Take time to dine. Eating slowly gives the upper end of the digestive tract more time to do its work, and it also discourages overeating. Ask your child questions between bites and encourage him to talk. Children who eat too fast don’t give the stomach time to signal the brain, “Enough, already. I’m full.”
6. Serve smaller portions. A child’s tummy is the size of her fist. Next time you serve a heaping plateful of pasta, put it next to your child’s fist and notice the mismatch. Put a fistful of food at a time on the plate and refill as desired. Even better, let your child serve herself. Studies show that kids tend to self-serve smaller portions than others serve them.
DR. SEARS TIP Smaller Portions, Happier Gut, Leaner Child
When children are served smaller portions, take smaller bites, chew longer, and eat slowly, they tend to eat just the right amount and seldom overeat and become overweight.
7. Probiotics: Put the best “bugs” in your kid’s bowels. You may not realize this fact, but your child’s largest immune organ is the gut, so it stands to reason that the better you feed your child’s intestinal system, the better his immune system works. Also, a medical truism at all ages is: “You’re only as healthy as your colon.” One of the best “medicines” for colon health is putting the right bacteria in your bowels.
Let’s begin with Colon Health 101. Billions of bacteria normally reside in your large intestine. And, in return for a warm place to live, they do good things for the gut. These “bowel bugs,” as we like to call them, are also called intestinal flora, because they are the fertile soil that contributes to colon health and to the health of the whole body. Besides the healthful bacteria residing in your colon, harmful bacteria also get in from the food supply. Most of these harmful bacteria (those that cause intestinal upsets such as diarrhea or gastroenteritis) are killed by the stomach acids, but some do get into the colon. The way to keep the colon healthy is to help the good bacteria outnumber the harmful “bugs.” The healthful bacteria are also known as probiotics because they support good health.
Here are the good things that probiotics do for your gut:
Boost intestinal immunity. The gastrointestinal tract is the body’s largest immune organ. Probiotics enhance the immune barrier of the gut lining. They help increase the immunoglobulin IgA and the thickness of intestinal mucus, which acts like a protective paint to keep harmful bacteria from getting through. Probiotics compete with the bad bacteria, thereby discouraging their growth and harmful effects.
Promote a healthy gut environment. Probiotics produce lactic acid, which creates a more acidic environment in the gut, and this favors the growth of good bacteria and discourages the growth of harmful bacteria. Keeping the intestinal environment slightly acidic is especially necessary if you are taking antacids for heartburn.
Reduce intestinal allergies. Probiotics promote anti-allergic processes by stimulating the production of growth factors that suppress the allergic response and generally increase food tolerance by the intestinal lining. These growth factors are helpful in reducing the severity of conditions such as gastroenteritis, colitis, and inflammatory bowel disease (IBD).
Produce healthful nutrients. Probiotics ferment some of the fiber in food to form short-chain fatty acids (SCFAs), which nourish the cells lining the colon, stimulate healing of these cells, and reduce the likelihood of colon cancer. These short-chain fatty acids are also absorbed into the bloodstream and travel to the liver where they lessen the liver’s production of cholesterol. These SCFAs also inhibit the growth of yeast and harmful bacteria in the gut.
You may also have heard the term prebiotics, which, like fiber, are indigestible carbohydrates that feed the probiotics. Think of prebiotics as food for the good bowel “bugs.” When you eat probiotics and prebiotics, you essentially are feeding your immune system to help it work better.
Suggested gut food. Here are our recommendations for prebiotics and probiotics to nourish your intestinal health:
Eat yogurt. Yogurt and other fermented dairy products such as kefir are the main dietary source of probiotics. The two most familiar bowel “bugs” that are added to yogurt during the culturing process are Lactobacillus bulgaricus and Lactobacillus acidophilus. Be sure to use organic yogurt.
Eat prebiotics. Foods that contain prebiotics often list the carbohydrate/fiber combination fructooligosaccharides (FOS) on the label. Another cue word is inulin, a prebiotic that is an important ingredient in many healthy foods, such as Stonyfield Farm yogurts. Foods that contain natural prebiotics include whole grains, fruits, and vegetables (such as onions, garlic, leeks, and artichokes). You will commonly see healthier foods such as HappyBaby organic baby foods, promoted as “containing prebiotics and/or probiotics.”
Take probiotic supplements. Besides suggesting yogurt at least several days a week, your doctor may advise you to give your child a probiotic supplement. There are many different species of probiotic supplements. The most commonly known one is called acidophilus, but there isn’t necessarily any one that’s particularly better than another. They come in liquid, powder, capsule, or pearl form and can be mixed into any cool food or drink. Follow the dosing instructions on the package. If no infant dosing is given, it is usually safe to give half of the child’s dose to an infant two months and older.
What science says. Hundreds of scientific studies show that probiotics have many health benefits. The species most commonly used in medical studies has been Lactobacillus GG (LGG), although most other species of probiotics probably yield many of the same benefits, including the following:
Daycare children given LGG had fewer respiratory infections and fewer absences due to illness.
In children with diarrheal illnesses, LGG cut the duration of the diarrhea in half.
Hospitalized children had 80 percent less chance of acquiring acute diarrhea in the hospital if they received LGG as prevention.
Probiotics have been shown to improve eczema.
The Lactobacillus reuteri species has been shown to reduce infant colic.
Children who were given LGG had a 47 percent lower risk of dental cavities compared with the unsupplemented group.
DR. SEARS TIP Give Probiotics with Antibiotics
In our pediatric practice we routinely prescribe a probiotic to be given during antibiotic courses and for at least two weeks following treatment. Antibiotics kill not only the germs that are causing the infection but also the healthful germs that normally reside in the gut, which is one reason that children routinely get diarrhea after taking antibiotics. Giving probiotics replenishes the healthful bacteria that were harmed by the antibiotics.
Keeping Your Child’s Skin Healthy
That soft, smooth, adorable baby skin we all love to see and feel also gets rashy and itchy. Skin irritations are one of the top causes of night waking and one of the most frequent reasons for consulting the doctor. First, let’s learn Skin 101:
The skin is the largest organ in the body, so it’s important to care for it. Certain unique features of infant skin make it more prone to rashes:
The epidermis (outer skin) is the surface layer of the skin. It’s about as thick as a piece of paper, but it’s composed of very tough material called keratin, which acts like a protective shield. The outer layer of the cells of the skin are continually rubbed or sloughed off and then replace themselves every few weeks. So, in effect, your child gets a new surface coat of skin about every month. The surface layer of baby skin is thinner because it hasn’t been exposed to years of conditioning by wear and tear and environmental exposure. Because it is thinner, it is more sensitive to irritation, such as scratches and friction rubs. When this thinner protective barrier is damaged, baby skin becomes prone to infection and rashes.
Not only is the outer layer of Baby’s skin thinner and less protective, the underlying skin (the dermis) contains fewer melanin-producing cells, making it more prone to sunburn. (Melanin is the pigment that colors the skin and helps protect it against ultraviolet [UV] radiation from the sun.) As skin is exposed to sunlight, these cells churn out more melanin to darken the skin and help shield it from UV damage.
The dermis contains a lot of materials that support skin health, including fibrous structures made of proteins called collagen and elastin that act like a spongy web to give the skin a strong padding. Unlike the weaker fibers of an adult’s thinning and sagging skin, these fibers in baby skin are like springs in a mattress and give the skin a bouncy feel.
The dermis is rich in sebaceous glands that secrete an oil called sebum. Sebum travels up the natural passageway of each hair shaft and secretes a thin, oily film on the surface of the skin. Throughout the dermis are jelly-like materials that act like sponges to absorb water so the skin has its own internal, natural moisturizers. Sweat glands are coiled throughout the dermis and worm their way to the surface of the skin, and sweat cools the skin by evaporation.
New insights into skin function and health have shown that many of the skin changes and irritation can be prevented, or at least lessened, by controlling two things: what you put onto the skin and what you put into the skin.
DR. SEARS TIP Teach Proper Hand Washing
Children share germs from hand to hand or nose to hands. Teach them to wash their hands thoroughly throughout the day before eating, after using the bathroom, and after they’ve sneezed into their own hands. Teach them to use soap and warm water and to scrub their hands thoroughly, including the backs of their hands, between fingers, and under fingernails. Teach them to wash their hands for as long as it takes to sing the ABC song twice, which takes around twenty seconds.
To keep your infant’s or child’s skin from becoming dry, flaky, and prone to rashes, try these general tips:
1. Moisturize your child’s skin. Moisturizers contribute to healthy skin in two ways: they act as a seal to slow the loss of water from the skin and keep it from drying out, and they help bring up water from the lower layers of the skin. Moisturizers contain barrier agents, such as petrolatum, that seal in the moisture. They also contain substances called humectants that hydrate the skin from beneath by attracting water to the surface of the skin. Think of using moisturizers as dressing your child’s skin in protective layers. This is especially important during the dry winter months. Dry air and sensitive skin are a recipe for a rashy winter, particularly if your child’s skin is prone to eczema or allergic dermatitis. Once you turn the heat on, expect skin irritations to go up. The low humidity of central heating dries the skin. Dry skin gets flaky and itchy. The child scratches the itchy skin, further irritating the rash, and the cycle continues.
2. Seal in moisture and nutrients. We recommend what we call the soak-and-seal method. After giving your child a bath, gently blot the skin with a towel, then leave a thin layer of water to soak into the skin. Apply moisturizing cream, ointment, or oil to the skin to seal in the moisture.
3. Vaporize bedroom air. Put a vaporizer in your child’s bedroom. As we’ve said, vaporizers increase the humidity in the bedroom and help prevent winter skin from drying out. A relative humidity in your child’s bedroom of around 50 percent is ideal.
4. Water growing skin. Water is the primary component of skin and the underlying tissues. Dehydrated skin is more prone to get itchy and rashy, and, the more irritated the skin, the more prone it is to dehydration. Be sure your child drinks at least an ounce of fluid per pound of body weight per day.
5. Feed growing skin. The skin is greatly affected, for better or worse, by nutrition. Because both the skin and brain tissue develop from the same root cell, foods that are good for the brain are also good for the skin. Feed these foods for keeping skin healthy:
Go fish! Seafood is the top skin food. We have been prescribing omega 3s for skin problems since 1999, with amazing results. Most skin irritations are due to inflammation, and omega 3s are the top anti-inflammatory food (see Keep Your Child from Having an iBod, page 35). “Oiling” your baby’s skin not only decreases drying, but speeds healing from eczema or rashy illnesses. Since omega-3 fats are one of the top nutrients for healthy skin, be sure your child gets an average of 300 milligrams of DHA a day, either in the form of an omega-3 supplement or by eating around four ounces of coldwater fish, such as salmon, three times a week.
Go nuts! Bet you never realized that a peanut butter or almond butter sandwich could be great for the skin. The healthy fats, protein, vitamins, and minerals in nuts are nutrients for the skin.
Eat colorful! The more colorful the fruit and veggies, the more they contribute to skin health. Phytonutrients (“phytos” for short) are antioxidants (aka “anti-rust”), and they help keep the skin from becoming inflamed. Keeping high levels of phytos in your child’s skin helps keep the “-itis” out.
DR. SEARS TIP A Word for Kids
We tell our little patients, “To keep your skin from looking like a fish, eat fish!”
6. Avoid powders. We discourage sprinkling babies with powders for three reasons: Powders tend to cake in skin folds, such as the groin, and actually aggravate the rash; they do absolutely nothing for Baby’s skin; and, if applied too liberally, they can be inhaled and irritate Baby’s sensitive respiratory passages.
7. Clothe sensitive skin. Infants with any type of dermatitis are often sensitive to wool and synthetic materials. Use soft, breathable, cotton clothing, as well as cotton sheets and blankets. Wash new clothing before use to remove any possibly irritating chemical residues.
8. Protect growing skin. That adorable baby skin is also prone to sunburn. Avoiding sunburn in infancy and childhood helps prevent skin cancer from developing later. Dermatologists believe that repeated sunburn in childhood can increase the risk of skin cancer in adulthood. Be especially sun protective if you have a fair-skinned, blue-eyed, freckled child who is particularly sun sensitive. Don’t let sunscreen give you a false sense of security and allow your child to spend excessive time in the sun unprotected. Be sun-savvy to help your child grow healthy skin. Try these sun protection tips:
During the sunnier months, let your baby and child enjoy the healthy outdoors at the least sunny times of the day, usually before 10 a.m. and after 3 p.m. Avoid the peak hours of the day when sunrays are most intense.
Put Baby in a wide-brimmed hat.
To protect Baby from reflected rays off the sand at the beach, use an appropriately positioned umbrella.
Put your child in tight-weaved fabric shirts specially designed to screen out a lot of the sun’s rays.
Apply lip balm or moisturizer with SPF to sun-exposed lips.
Use a sunscreen with an SPF between 15 and 30 that blocks out both UVA and UVB radiation, and, if your child is going to be swimming, make sure it’s waterproof. Sunblock potions that contain vitamins C and E are helpful.
Dab a test dose on a small area of Baby’s forearm to be sure the skin is not sensitive to the sunscreen.
Apply sunblock immediately before sun exposure, but apply sunscreen thirty minutes before exposure to give it time to work into the skin and exert its sun-protective effects. Reapply every couple hours.
Sun Protection 101
Understand the difference between sunscreens and sunblocks. Sunblocks are simply a physical barrier to the ultraviolet sunrays—both UVA and UVB sunrays. These are usually made from zinc oxide or titanium oxide and resemble diaper rash cream. Sunscreens work their way into the skin and absorb the sunrays before they can do their damage. Many of them contain the active ingredient PABA (para-aminobenzoic acid), which blocks UVB radiation, but the occasional child may have a skin sensitivity to PABA. The SPF in sunscreen stands for sun protection factor. An SPF of 15 will block 95 percent of the radiation; an SPF of 30 will block about 97 percent. Usually an SPF between 15 and 30 is sufficient.
For babies, we prefer sunblocks instead of sunscreens. Sunblocks are okay for infants under six months because the potentially irritating chemicals are not absorbed by the skin. Because sunscreen chemicals are absorbed, parents are advised to avoid them for babies under six months. Even though sunscreen hasn’t been proven harmful to infants, it hasn’t been studied enough to be proven safe at that age.
Although it’s important to be sun-savvy, don’t let the fear of skin cancer deprive your child of the health benefits of sunshine. Children need vitamin D for general health, especially for strong bones, healthy skin, and a healthy immune system, and sunshine triggers vitamin D production in the body. If your child is exposed to a lot of sun during the warmer months, enough vitamin D may be stored in her body fat to tide her over during the winter months of less sun exposure. Expose your child to at least fifteen minutes of direct sunlight without sunblock on the hands, arms, and legs at least several times a week for as many months of sunshine as you can. (See vitamin D supplementation, page 34.)
SOAP SENSE FOR BABIES
Soap helps suspend oils and other stuff that collects on the skin so that they can be more easily washed off, yet too much soap applied in places that don’t need it can both dry out and irritate the skin. Here’s the skinny on soap cleaning your baby’s skin:
Use soap only on grungy areas that are caked with secretions, such as on the groin, in the skin folds of the neck, and on any other areas that obviously need it. Use soap sparingly on the face.
Some babies’ skin is more soap-sensitive than others’. If your baby is prone to eczema or any type of dermatitis, use soap sparingly or not at all on the most irritated areas.
Do the soap test. Apply a dab of soap on the forearm to be sure your baby is not sensitive to it. The more additives, the more likely your baby is to be sensitive to that particular soap.
Use soap that contains built-in moisturizing creams.
Rinse soap off thoroughly and gently pat dry instead of rubbing the skin.
Limit soap time on the skin. Wash off as soon as possible and rinse well.
Mothers often feel that too much unnecessary soap and other fragrances camouflage a baby’s naturally appealing scents.
Boosting Your Child’s Immune System
As your child enters child-care settings or preschool, he will be exposed to an increasing variety of germs. Boosting the immune system is like planting a “doctor” within your child. Here’s how:
1. Have Your Child Vaccinated
Vaccinations stimulate your child’s own immune system to produce antibodies against germs that cause serious childhood illnesses. (See page 43 for discussion of individual vaccines and the recommended schedule.)
2. Breastfeed for as Long as Possible
Consider breastfeeding your baby’s first and most important immunization. New research has proven what mothers have long suspected: The longer babies are breastfed, the healthier and smarter they are. Here’s why:
Breastfed babies are smarter. Studies of breastfed babies have shown that they tend to have a higher IQ. The reason for this intellectual advantage is that, in addition to the increased touch and maternal interaction, breastfed babies get more smart fats such as docosahexaenoic acid (DHA), from mother’s milk. DHA is the prime structural component in the insulation that lines nerves, enabling messages to travel faster and more efficiently through the nervous system.
Breastfed babies are healthier. Research has shown that every system in your child’s growing body is likely to be healthier if breastfed: visual development, lung function (such as preventing asthma), cardiovascular health, intestinal health, and the immune system. The incidence of just about every illness you don’t want your child to get—including diabetes, cancer, and cardiovascular disease—is lower in breastfed babies.
LEARN MORE ABOUT IT
Read The Breastfeeding Book by Martha Sears (Little, Brown, 2000). Martha is a nurse and a lactation consultant, and has logged nineteen years of breastfeeding eight children.
Breastfed babies are leaner. With the number one medical problem currently being the epidemic of obesity-related illnesses, breastfeeding is good preventive medicine. Long-term studies have shown that breastfed babies tend to grow up to be leaner children, and leanness is associated with increased health and well-being. As you will later learn in our section on Obesity, page 417, lean does not equate with being skinny, but rather means having the right amount of body fat for the child’s individual body type.
3. Feed Your Child’s Immune System
As we were preparing to write this book, we discussed why some children in our practice are healthier than others. We came to the conclusion that kids who eat healthier are healthier. We have noticed a group of mothers in our practice we call “pure moms,” or what some might call “health-food nuts.” These mothers seldom let a morsel of junk food enter their homes or the mouths of their children. We all notice that we don’t need to see these children as often in the preschool years because they are sick less often than those who regularly ate junk food. When these “pure children” get sick, they recover sooner because their immune systems work better.
When these “pure children” go to school, we notice we don’t see them as often for the D’s—ADD, learning disabilities, and mood disorders. Not only are their growing bodies healthier, but so are their brains.
Consider foods your family’s own farmacy. Here is our pick of the top “health foods,” those that have been proven to boost a child’s immunity:
Fruits and vegetables. Feed your family phytonutrients (“phytos” for short), which are immune-boosting substances found in fruits and vegetables. Phytos are the germ-fighting nutrients that give fruits and vegetables their color. Besides fighting germs, these phytos act as natural anti-inflammatories, meaning they help slow down the wear and tear on the tissues and help organs repair themselves. In general, the deeper the color, the better the “medicine.” Foods that are rich in color—such as blueberries, bell peppers, spinach, papaya, and strawberries—are examples of top phyto foods.
Vitamin D supplementation. New studies have revealed a concerning fact: Most Americans are deficient in vitamin D. We have tested numerous kids in our practice during the writing of this book, and most were low. Vitamin D is a substance that plays an important role in many body functions and ensures a healthy immune system. For a boost up to a proper level, a child must take higher-than-normal daily doses for six months or longer. Ask your pediatrician about having your child tested and treated if her vitamin D level is low. You can also discuss treating presumptively for several months without testing, as it is fairly safe to assume most children are low. For more information on the health benefits of vitamin D and correcting deficiency, visit www.VitaminDCouncil.org.
Go fish! Seafood is the top health food, especially for growing children. Let’s go head-to-toe to see why the phrase “a salmon a day can keep the doctor away” has scientific merit.
Eat seafood, be smart. Seafood is your top brain food. Your child’s brain grows more in the first five years than at any other time in life. Feed it well. The omega-3 fats in seafood form the structural component of cell membranes and myelin (the fatty layer of tissue that covers nerves, like the insulation of electrical wires), increasing the speed and efficiency of nerve messages. In light of recent studies, omega-3 DHA is now recommended for children with behavioral and mood disorders, as well as for those with attention and learning problems.
Eat seafood, see better. Seafood is “see food.” Half of the retinal tissue of the eye is made up of DHA, the same omega-3 seafood fat that is good for brain tissue.
Eat seafood, have a healthy heart. One of the biggest medical breakthroughs in the prevention of cardiovascular disease in the past decade is the discovery that cultures where people eat the most fish have a much lower incidence of cardiovascular disease.
Eat seafood, have a healthy repair system. Omega 3s are anti-inflammatories. The arteries throughout your child’s heart, body, and brain are constantly bombarded with high-pressure pounding on the sensitive lining of blood vessels. With time this rough arterial lining attracts buildup of debris called fatty deposits or plaque. Alarmingly, recent studies have found that cardiovascular disease is occurring at a younger age. Many teens are now found to have fatty deposits on their arteries. Here’s how omega 3s help. Your child’s immune system perceives that the arteries are like a road in need of repair and sends out a repair crew to fix the damage. Omega-3 oils feed the maintenance crew—the body’s immune system, which repairs the lining of the bloodstream that can be damaged by the wear and tear.
Eat seafood, have less cancer. Studies show that people who have higher levels of omega 3s in their blood have fewer intestinal cancers.
Eat seafood, prevent diabetes. In addition to acting as anti-inflammatories, omega 3s help steady blood sugar and lower the risk of diabetes.
Eat seafood, have healthier skin. As you will learn in the section on eczema, omega 3s are one of the best natural medicines for keeping skin smooth. (See Eczema, page 297.)
Consider omega 3s your child’s best anti-inflammatory against all the “-itis” illnesses such as bronchitis, arthritis, colitis, dermatitis, otitis, and gingivitis.
HEALTH FOODS FOR A HEALTHY FAMILY
Here are the foods that boost the immune system the most:
4. Keep Your Child from Having an iBod
We coined the term iBod (or inflamed body) to describe a child who is prone to the “-itis” illnesses. In fact, inflammation has been the buzzword in adult medicine for the past decade and is now becoming equally important in childhood illnesses. Inflammation simply means that the body’s immune system and repair system have gotten out of balance. When the immune system is in balance, the body’s inflammatory or repair system works. Cuts, scratches, and wounds heal. Your child’s immune system is like a road-repair maintenance crew. When the immune-system repair crew is healthy, the body’s wear and tear on the tissues is mended. When the repair crew isn’t healthy, the repair work doesn’t get done, resulting in an “-itis” illness. The inflamed tissues lining the body’s cavities such as joints (arthritis), intestines (colitis), breathing passages (bronchitis), ears (otitis), gums (gingivitis), and skin (dermatitis) are all the result of the inflammatory response causing the child to be an iBod. To prevent and treat childhood “-itis” illnesses, here are five things to do:
1) Encourage exercise. Exercise perks up the immune system by stimulating the body to produce more infection-fighting substances. Exercise perks up the mind. We think of anxiety and depression as adult mental problems, but, not surprisingly, mood disorders are occurring more frequently and at younger ages in children. Exercise is not only healthy for growing bodies; it’s also good for the mind. Exercise increases blood flow to the brain, which increases “feel-good” and “think-right” neurochemicals.
Exercise reduces inflammation in three ways. Movement stabilizes insulin, and the more stable the blood insulin, the more stable the blood sugar. Stable blood sugar promotes a balanced immune system. Exercise burns fat. Leanness balances the immune system. Finally, exercise stimulates the body to produce its own anti-inflammatory medicines.
2) Help your child stay lean. A phrase that we use to counsel overweight children in our practice is “reduce your waist.” Once upon a time it was thought that excess abdominal fat was simply a nuisance. New studies have shown that excess abdominal fat spews out chemicals into the body that can cause all the “-itis” illnesses. These are known as pro-inflammatory chemicals. (See the Dr. Sears L.E.A.N. Kids Program, page 417, for an understanding of how being overfat can make kids oversick.)
3) Feed your family phytos. Phytonutrients (phytos) are the immune-boosting stuff that gives fruits and veggies their deep color. In fact, the deeper the color, the stronger the phytos.
4) Give your family an oil change. Feed your child more omega-3 oils (which are anti-inflammatory) and fewer omega-6 oils (which are pro-inflammatory). Oils and foods that are anti-inflammatory (promote a balanced immune system) include fish oil, flaxseed oil, olive oil, fruits and vegetables, chili peppers, coldwater fish (especially wild salmon), whole grains, nuts, and spices (such as cinnamon, ginger, and turmeric). Pro-inflammatory foods that promote an imbalance of the immune system include animal fats, corn oil, partially hydrogenated oils, vegetable oils (such as sunflower, safflower, and soybean oil), and high-fructose corn syrup. We call anti-inflammatory foods “healing foods” and pro-inflammatory foods “hurting foods.”
HEALING FOODS VS. HURTING FOODS
Some foods boost your child’s immune system; others hurt it.
5) Encourage grazing on frequent mini-meals. Grazing keeps insulin and blood sugar stable, which keeps the body in balance. One of the best eating-pattern changes you can make for maintaining optimal weight and promoting a healthy immune system is to follow Dr. Bill’s rule of twos: Eat twice as often, half as much, and chew twice as long.
5. Boosting the Immune System During an Illness
Besides the everyday immune-building tips we offer you in this section, there are several ways to give your child an added boost during an illness. These tips can help to resolve a variety of illnesses more quickly and lessen the need for antibiotic treatments. They are generally not recommended until six months of age (not because they may cause any harm to younger infants, but because they haven’t been adequately researched yet).
Vitamin C. This antioxidant can help fight off viruses and bacteria. It comes in liquid, powder, chewable, and capsule forms (chewable forms can damage tooth enamel, so follow them with tooth brushing). Start treatment at the first sign of illness and continue until your child is well, following these doses:
six months to two years—150 milligrams once or twice daily
two years to five years—250 milligrams once or twice daily
six years to eleven years—500 milligrams once or twice daily
twelve years and older—1,000 milligrams once or twice daily
Echinacea. In proper doses, this herb can give the immune system a nice boost against infections. A recent study attempted to prove it ineffective. However, infant doses were used for this adult study, so no wonder it didn’t work. Echinacea comes in infant drops, chewables, or capsules. Here is our suggested dosing at the first signs of illness:
infants six months to two years—250 milligrams three times daily for two days, then 125 milligrams three times daily until well
two years to five years—500 milligrams three times daily for two days, then 250 milligrams three times daily until well
six years to eleven years—1,000 milligrams three times daily for two days, then 500 milligrams three times daily until well
twelve years and older—2,000 milligrams three times daily for two days, then 1,000 milligrams three times daily until well
Zinc. This mineral has some useful immune-boosting properties. Follow these suggested doses:
six months to two years—10 milligrams once or twice daily
two years to five years—15 milligrams once or twice daily
six years to eleven years—20 milligrams once or twice daily
twelve years and older—25 milligrams once or twice daily
Herbal remedies. Various herbal supplements are available that help boost the immune system. In our practice we’ve found that Sinupret (an herbal blend made in Germany) works well to support sinus and respiratory health and the immune system. Visit www.SinupretForKids.com for more information.
Minimize sugar, maximize fruits and veggies. What your child eats can have an immediate effect on the immune system. Take extra care to feed your child well during any illness.
Frequent illnesses. If your child seems to catch more than his fair share of illnesses, try giving the above supplements on a daily basis at half our suggested doses, even when he is well. Note: when using echinacea on an ongoing basis, take a two-week break every eight weeks to retain its effectiveness on the immune system.
Balancing Your Child’s Endocrine System
One of the most important keys to health is to put your child’s body and brain in hormonal harmony. Hormones are chemical messengers that travel throughout the body telling the organs how to work together optimally. They work best when they are just at the right levels—not too much and not too little. For example, hormones tell the child when he is hungry and when he has eaten enough. Hormones also tell him when he’s tired and it’s time to go to bed and when it’s time to wake up. The body is often described as a “chemical soup.” If hormones and other biochemicals are in the right balance, the body is healthy and happy. One of the reasons kids are getting sicker, sadder, and fatter is that growing bodies are out of biochemical balance more than ever before. The health program you are now learning is designed to keep your child’s hormones in biochemical balance.
Think of your child’s endocrine system as a symphony orchestra and all the hormones, such as growth hormone and thyroid hormone, as instruments in this orchestra. Insulin, appropriately called the “health hormone,” is like the master conductor of your child’s hormone orchestra. When blood insulin levels are optimal, the rest of the body and brain chemistry are in balance, or hormonal harmony, and the beautiful music of health results. One of the most important goals in keeping your child healthy is to promote hormonal harmony by keeping blood insulin levels stable. The four magic words that promote hormonal harmony are movement, grazing, happiness, and leanness.
While there are hundreds of hormones trying to work in harmony throughout your child’s body, let’s divide them into two groups: grow-right hormones and feel-right hormones. Growth hormone, for example, helps the cells recharge and grow by instructing them how to use nutrients in food for energy; it builds muscle by telling the muscle cells to take up the amino acids from the foods that enter the blood and assemble them together as muscle-building proteins; and it tells fat cells to release some of their stored fat for energy when the other cells need that fuel to grow. Sleep and exercise are powerful stimulators of growth hormone. Insulin is also a grow-right hormone because, as we said before, it is the master conductor of the hormonal harmony orchestra.
Think-right hormones, like serotonin and endorphins, keep the thoughts in balance. Too much of these hormones and the child can become anxious or silly; too little and the child can become sad and depressed. The body and brain get used to the right level of these mood-managing hormones, all of which are regulated by the four magic words movement, grazing, happiness, and leanness.
Move. Movement is one of the healthiest things your child can do to keep the levels of insulin and blood sugar stable. Remember, when insulin is stable the whole body is more likely to be in biochemical balance. For parents who want to understand how exercise promotes stable insulin, let’s go inside one of the cells of your child’s body. On the cells there are tiny “doors” called receptor sites. These doors let just the right amount of fuel, such as sugar, into the cells to provide energy. Insulin is like the doorman for these cells: it opens the door to let just the right amount of fuel into the cells—not too much, not too little. Increased blood flow past these receptor sites during exercise increases “insulin sensitivity,” meaning it makes the doors more efficient to let the right amount of fuel in. When every cell in the body works more efficiently, overall health results. Movement also keeps the happy hormones of the brain more stable. This is why recent studies have shown that vigorous exercise helps children with learning and mood disorders by stabilizing their neurochemicals.
Graze on “grow” foods. Grazing on good foods (see Healthy Munching, page 422) stabilizes insulin levels. Nibbling on nutritious mini-meals throughout the day is more brain-hormone-friendly than eating fewer big meals because, unlike other organs of the body, the brain cannot store glucose. It relies on a steady supply of glucose—just the right amount. Steady blood sugar results in steady brain neurotransmitter function so that the child can learn and behave well. In addition, insulin and the stress hormone cortisol are interrelated. Grazing keeps insulin stable, which helps to keep stress hormones stable. When stress hormones are out of balance, the immune system is also out of balance, which makes the child more prone to illnesses. In short, grazing stabilizes insulin, and stable insulin leads to hormonal harmony. (See benefits of grazing, page 37.)
Think happy thoughts. New studies have shown that the thoughts that go into your brain can keep the mood-producing hormones in balance. If your child thinks more positive thoughts, the happy hormones are higher. If your child thinks predominantly negative thoughts, the happy hormones are lower. This isn’t something you can really teach children to do. You have to model it for them. Be a positive parent. Frequent encouragement and praise will build up a child’s confidence and self-esteem. Criticism and impatience will not. An uplifting mood and everyday interaction with your child can help keep the hormones in a positive balance.
Live lean. Part of your home health-maintenance program is to keep your child lean. Lean does not mean skinny, but rather just the right amount of body fat for one’s body type. Your doctor can help you assess your child’s body balance at checkups. Excess body fat, especially around the middle, causes hormonal disharmony, especially with insulin. Excess body fat causes the cells to become increasingly resistant to the effects of insulin, leading to conditions called insulin resistance or Type-2 diabetes— which are becoming more prevalent in children at younger ages. This is why leanness is one of the most important health words you can teach your child. Here’s a list of illnesses whose incidence goes way up proportional to the excess fat your child lugs around:
attention deficit disorder (ADD)
gastroesophageal reflux disease (GERD)
YOUR HOME HEALTH-MAINTENANCE PLAN CHECKLIST
Here is a summary of the home “medicines” that you have learned about in Part I of this book. This plan helps you to provide basic medical care for your child at home. If you have checked “no,” try to take steps that enable you to check “yes” in every column:
Excerpted from The Portable Pediatrician by Sears, William Copyright © 2011 by Sears, William. Excerpted by permission.
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