Got a Fussy Baby?

Monika Pis, PhD, CPNP

During the first couple of months of life, infants transition from living in utero to functioning independently outside of the mother’s womb.

For some babies that transition is smooth, while others are fussy and require time and small interventions to help them feel comfortable and secure while learning to adjust to the new life.

The most common causes of fussiness in young infants are colic, formula intolerance, and constipation. 

Colic
Infant colic is characterized by persistent crying in infants younger than 3 months. The average time of crying is 2-3 hours per day, but many babies cry for longer than four hours every day. Colic has been estimated to occur in 13% of infants. Parents of colicky babies report that their infants cry for 3 or more hours a day, on 3 or more days of the week. In addition, they may demand frequent feedings, be gassy, and stiffen legs and pull them up to their chest.

Although the cause of colic is unknown, there are two possibilities to consider. First, gas and abdominal pain resulting from the immaturity of the digestive system might be at play. Second, the immaturity of the nervous system may allow a susceptible infant to get overstimulated during the day, leading to fussiness at the end of the day. Have you noticed that most colicky babies fuss at night? Whatever the cause, colic bothers babies and their parents. Consider the suggestions below to soothe your colicky infant.

Remedies For Colic
- Keep stimuli to minimum: dim lights, keep noise down, etc.
- Swaddle the baby like a burrito to simulate the comfy environment of the womb
- Play classical music
- Swing your baby in a swing

Formula Intolerance
Although milk and soy allergies are rare in infants, some babies may initially have a difficult time digesting either milk- or soy-based formulas. After coming home form the hospital, you may notice your baby is fussy most of the time, passes a lot of gas, throws up a considerable amount of formula after feedings, or cries while bringing knees to the chest. During feedings, your infant may arch his/her back or move as if in discomfort. These behaviors may signal an upset stomach, abdominal pain, or heartburn, resulting from a temporary formula intolerance. Talk with your infant’s health care provider. He or she may suggest a formula change to make your child comfortable. On occasion, when fussiness is contributed to heartburn, infants are given short-term antacids to soothe their digestive system.

Constipation
Constipation is defined as passing hard, pellet-like stools, or having 3 or less stools a week. Although grunting and pushing while having a bowel movement is normal in the first couple of months of life, your infant’s stool should not be hard. If your infant produces hard stools, and it takes him/her a long time to push them out, your infant is constipate, and will be fussy sooner or later as constipation results is abdominal pain, uncomfortable gas, and painful bowel movements. (Note: chronic constipation may lead to urinary tract infections.)

To relieve your baby’s discomfort due to constipation, you may add sugar to her formula (1 teaspoon per 2 ounces). Sugar will draw water to the intestines and assist in loosening the stool. After each sugary bottle, wipe inside your infants mouth with a wet washcloth to prevent thrush. If this simple intervention does not relieve your child’s constipation, talk to his or her health care provider as soon as possible.

Plant a Kid-Friendly Vegetable Garden

Rose Straebel

The best thing about planting a vegetable garden with your kids is that they get to eat what they plant.  Teaching kids how to take a plant from seed or seedling stage to the dinner table is a great way to help them learn where food comes from.  It can also help them discover a lifelong healthy hobby. 

My dad had a small garden in our backyard when I was growing up, and now I am a gardener too.  One of my favorite childhood activities was picking cherry tomatoes off the vine with my dad and popping them directly in my mouth.  This yummy experience has stayed with me throughout my life.

You’ll need a few basics to start a garden such as good gardening soil, a sturdy container or small patch of ground, some seeds or seedlings, a watering can and a few gardening tools.  Starting small is an ideal way to keep gardening with kids fun and easy.  Container gardening using an old sandbox, window box, or flower pot is a good option.  Containers provide plenty of room for a kid-sized harvest.  Allow your kids to choose the container so the garden really feels like their own project.  Choose seeds or seedlings that are low maintenance and have short growing seasons.  Some good options are strawberries, cherry tomatoes, lettuce and radishes.

Kids are natural gardeners because they love to play in the dirt.  Let them have fun with planting the seeds and seedlings.  If you are using a container, be sure to have some extra gardening soil available to replenish the pot.  Play time could lead to having more soil around the container than in it.  If you choose to start the garden in the ground, help kids pick a spot that can accommodate a small fence.  You may want to keep rabbits and squirrels from reaping the harvest. Containers and ground plots will need a spot with lots of sunshine and not too much wind.

Once the seeds are in the ground, a daily routine of watering and checking the plants for new shoots will help stir curiosity and get kids excited about their future crop.  It’s almost a guarantee that you will see a big smile spread across your child’s face when they see the first shoot popping up from the dirt.  Keeping a daily garden journal can be a fun way to track plant growth.  Taking photos of the plants is also good way to help kids show off their gardening adventure.  

Be sure to make gardening fun for kids, not work.  Help with weeding and watering, and encourage your kids by showing them how to plant, grow and harvest.  With a little basic care, a vegetable garden can provide lots of enjoyment, memories and good eating. 

About the author: Rose Straebel is one of the team members at FreshBaby.com. 

How to Cook Gluten-Free

Elizabeth Barbone 

Elizabeth Barbone’s challenge to herself was to create easy gluten-free recipes that she could make on her busiest day.  “How to Cook Gluten-free” is her answer: a straight-forward, comprehensive guide to gluten-free cooking - a must-have resource with real solutions for real people.

Just like her previous well-loved book “Easy Gluten-free Baking”, Elizabeth’s recipes use ingredients that can be found at your local grocery store - nothing too fancy or expensive - so you can put delicious meals on the table without breaking the bank.  The recipes have been meticulously tested and perfected, so that in your hands, dishes will comw out right every time.

“How to Cook Gluten-free” is full of wholesome cooking, comforting family favorites, and easy answers for hungry families:

Essential How-to Lessons: Step-by-step photography illustrates all the basics, from how to make gluten-free substitutions and whip up the perfect gravy to elizabeth’s fail-proof recipes for gluten-free baked goods such as sandwich bread, hamburger buns, and pizza crust.

Allergy-friendly: Elizabeth has not forgotten those who suffer from non-gluten food allergies; some recipes are also soy-free and nut-free and Elizabeth has even included a guide to substituting milk, butter, eggs, corn, and cheese.

Classic, family-loved recipes will satisfy those who can’t eat gluten and those who cook for them, too:

Breakfast: Powdered Sugar Doughnut Muffins, Waffles, Quiche “Cupcakes”, Pancakes

Easy Dinners and Casseroles: Baked Meatballs, Classic Chicken Parmigiana, Creamy Macaroni and Cheese, Baked Chicken Tenders, Cornbread Chili Bake, Meatloaf Burgers, Chicken and Cheesy Biscuit Casserole

On the Lighter Side: Summer Vegetable Pasta, Oven-Roasted Shrimp, California Club Turkey Burger, Multigrain Sandwich Bread, Roasted Vegetable and CHicken Wraps, Quinoa with Spinach and Black Beans

Desserts: Rustic Pies and Cobblers, Whoopie Pies, Cheesecake Cups, Brownies, Vanilla and Chocolate Cupcakes, Peanut Butter Cookies

About the Author:

Despite being born with life-threatening food allergies, Elizabeth Barbone graduated from the Culinary Institute of America where she learned how to cook delicious meals for herself and other people with food allergies.  Today, Elizabeth develops delicious recipes for the food allergic and gluten-free communities through her site GlutenFreeBaking, a weekly column on SeriousEats, and regular television appearances.  She is also the author of “Easy Gluten-Free Baking”.  She lives in Troy, NY.

Talking with Kids About Death and Dying

Bette J. Freedson

Once, sex was the big conversation that upped the anxiety for parents. It is still a big deal, but in today’s culture death has become the topic du jour. With medical miracles and modern technology, many kids are protected from the personal experience of death and dying until they are older. At the same time, if kids listen to the news, they regularly hear about people dying in terrorist attacks, wars, and random acts of unkindness.

In addition, parents like to protect kids from pain. When it comes to talking about death, the prevailing wisdom may be, "Oh, just let them be kids, there is time enough later for them to experience these difficulties." However, kids are smart, and they will ask questions. They might surprise you by asking, "What does 'die' mean, Daddy?" Or like my granddaughter did, they might ask, "Grammy, where is your grandmother?" They might even ask you about someone you have lost that you thought they did not even know had existed.

Recently a client of mine reported how his three-year old grandson reacted when told grandpa was going to a funeral. When grandpa answered, the "what-is-a-funeral" question by saying it was a ceremony for someone who died, the questions continued until the grandfather explained that the man had gotten very old and very sick and was no longer living.  At this point the little one broke down into sobs. Later, he revealed his fear that his grandpa would die. At 65, it could happen, but grandpa reassured that he is healthy and taking good care of himself, and that he would likely be around for quite a bit more time.

To prepare you for questions, there are some common denominators to consider, whether you are talking about the concept of death or helping a child to work through an actual loss when a family member, pet, or friend, has died.

Five Tips for Talking About Death with Kids

1. Normalizing Dying.

Take children into a garden where they can observe the natural process of the seasons. Look at the blossoms that need to be "dead-headed," and show the child how to remove them. This provides an excellent opportunity to talk about death as part of the cycle of life.

Refrain from complex or mythical explanations. Base your information on the child’s age and development. This is a topic you will revisit at varying stages of your child’s development, as a general question and as a discussion in grief.

If the death has been a suicide, the most important information is that this was not your child’s fault. Even if this is obvious to you, it may not be to a child. Refrain from saying the person was "crazy." Because kids are concrete, and this has no comfort value for them.

2. Understand the normalcy and nature of emotions related to death.

Feelings not talked about do not disappear.  If a child asks and the adult does not respond, the child may ruminate, causing feelings to surface later in behavior. Watch for signs of unresolved guilt, curiosity or stress in the children’s play or conversation. If someone close to the child has passed, the child may say something like, "I hate grandpa!" Anger is normal. Experience of death brings up a range of feelings for everyone, especially kids.

Refrain from giving explanations like, "Death is when you go to sleep forever," or, "Daddy has gone on a wonderful journey." Children are very concrete in the way they understand things. Mythical explanations can cause fears and confusion.

3. Tell the truth.

Truth enables kids to trust their adults. Just as when having the "other" conversation, tell the truth based on what the child can absorb, taking into consideration age, education level, and emotional make-up. Be alert to signs that you have said enough, and be alert to need for more.

Refrain from saying things like, "Your grandmother died because she was so good, she was wanted in heaven." This is a lovely adult belief, but too fantasy-filled for children. The child could become fearful of dying if she is told she must be a "good" girl. Refrain from deferring the death question by saying, "Go ask your father/mother/teacher," etc.

Refrain from making "heaven" sound too appealing. Although this belief may comfort you, it does not restore the loss for the child, or give an explanation that makes sense.

4. Be especially alert to guilt and fear related to a personal loss.

Especially if talking about a personal loss, children will have a range of emotions including guilt and fear. Support the child by reassuring that it is okay to have feelings, and they did not cause the death.  Often kids feel that if they had been better behaved the parent/grandparent would not have died. Assure them that it is normal to feel whatever they are feeling.

(Because it is!)

5. Keep an open attitude about your own feelings.

Especially if there has been a death in the family or extended family, children will watch how you deal with your own emotions. It is okay to express them. Refrain, however, from using kids as adult supports. They are unable to process all the nuances of emotions and issues that emerge when a close person dies. Treating children, even adolescents, as peers will create confusion for them. Refrain from substituting them for the departed adult if it is the other parent. Refrain from using children as your relief valves if the loss is a shared one. Find and use other adult supports, including professional help if you are unable to recover from your own grief.

A few suggestions and ideas for responses:

Death is a normal part of life.

Yes, eventually everyone dies, but it is likely going to be a very long time before your parent dies or you die.

You are in good health and should live for many, many years.

When a person gets very old, and/or very sick, the body cannot work anymore. If you get sick, I will take you to the doctor and the doctor is going to help make you better.

You did not make (the person) die.  You did nothing wrong.

It’s okay to say, "I do not know," or "No one really knows."

When linking dying to God or heaven, be sure to reassure with something like, "This is what we believe."

It’s okay to miss the person.

It’s okay to be sad, to cry.

Resources:

“Talking About Death/A Dialogue between Parent and Child", by Earl A. Grolllman, Beacon Press, Boston.

“Learning To Say Good-by/When A Child’s Parent Dies”, by Eda LeShan, Avon Books, New York.

BETTE J. FREEDSON Bette J. Freedson, LICSW, LCSW, CGP is a clinical social worker and a certified group psychotherapist who is dedicated to helping clients tackle life using simple, sound and effective strategies. As a Stress Expert, author and speaker, Bette makes overcoming life’s challenges easy with simple and accessible tools. Throughout her career Bette has worked with hundreds of children, parents, adults, couples, and groups to help them relieve the stress that interferes with success in life. By using her ideas and solutions, Bette's patients and pupils are able to quickly develop the skills to become directors of their own destinies.

Grandparents: A Catalyst for Dreams Come True

Monika Pis, PhD, CPNP

Research indicates that parental involvement in a child’s life has a powerful effect on a child’s development and academic achievement.  The earlier it begins, the better the outcomes.

Parents and grandparents have a tremendous impact on how their children view the world.  The adults’ involvement in the child’s world helps to create the blueprint for the rest of that child’s life.  Every moment counts, even if it is a brief one…

Here is a story of Joanna…

When 3-year-old Joanna started to draw, everybody was amazed.  She mostly drew horses, but everything she put on paper was beyond the drawing ability of most adults. Joanna grew up raised by her grandparents who quickly noticed her two interests: horses and drawing.  They made every effort to help her develop her talents.

At age 4, or so, Joanna’s grandfather signed her up for a drawing class at the local arts center.  He went with her to every lesson, and then bragged to all of the extended family how great she drew.

At age 5, Joanna started to ride ponies at local fairgrounds.  Living in a city made it difficult to accommodate her desire to ride horses during the school year, but summer time was a great opportunity for her to get away to the countryside, where she could ride freely.  When she was old enough, Joanna’s grandparents signed her up for official riding lessons and, with time, she became acutely interested in dressage (“horse ballet”).  She also started to cultivate her passion for photography.

Joanna was always quick to notice the hidden beauty of most obscure things.  Her sensitive nature helped her develop a sense of acute awareness of her surroundings. Her grandmother sat by her side for hours assisting with crayons and offering constructive criticism.  The warmth of those moments helped Joanna develop her skills of concentration that later came in handy when she trained as a dressage rider.

The precision of dressage riding helped Joanna in developing a sharp eye for detail that she finds extremely useful today in her work as a photographer. Her photography freezes the beauty of a moment that normally vanishes instantaneously. Her photo lens immortalizes what otherwise would escape in a blink of an eye. Through her work as a photographer, Joanna expresses her love for nature and the still moment.

Joanna’s accomplishments in dressage and photography came from her hard work. However, her grandparents’ love, involvement in her activities, and warm encouragements helped her develop the skills she needed to be where she is today. That is a reminder to all the parents and grandparents out there that their children’s future depends on their interest and involvement in their children’s and grandchildren’s activities. 

Parents and grandparents are catalysts for their children’s future.

To view Joanna’s work, go to: http://www.jjodkophoto.exposuremanager.com/

Childhood Constipation

Monika Pis, PhD, CPNP

Constipation, defined as hard or infrequent bowel movements (3 or less a week), is a very common phenomenon during childhood. The most likely cause is diet, although some children inherently have a slow peristalsis leading to constipation. There are many medical reasons for constipation, but I will not be addressing those in this article.

As children are transitioned from baby formula to cow’s milk, and from baby to table foods, certain feeding practices contribute to the development of constipation. Many parents think that a child should drink as much milk as formula, when actually, only 16-24 ounces of cow’s milk a day are necessary for healthy growth. While milk contains vitamins A and D, as well as calcium and fatty acids necessary for a healthy development of the brain, milk and its derivatives (cheese, yogurt, ice cream) are constipating in nature. Therefore, most children consuming large quantities of dairy products develop constipation.

Another feeding practice that leads to unhealthy elimination is catering to your child’s dietary whims. If allowed, most children would prefer to eat pizza, macaroni & cheese, noodles, chicken nuggets, and hot dogs instead of fiber-rich foods like fruits, vegetables, and beans. Processed foods high in carbohydrates lack fiber that is necessary for regularity. Therefore, diets high in carbs and low in fiber often result in hard, difficult to pass stools.

Unresolved constipation leads to chronic abdominal pain, feeling bloated, nausea, decreased appetite, heart burn, rectal bleeding from straining, urinary tract infections, vomiting, intestinal obstruction, and even bowel perforation that may result in death.

Toddlers who get constipated may become frightened of heaving another painful bowel movement. They may begin holding the stool in, which in turn causes even more constipation.

Prevent constipation in your child by serving fruits and vegetables with every meal and snack. Offer 16-24 ounces of milk daily, and limit cheese to a couple of slices a day.

The American Heart Association recommends that children older than 2 years should gradually adopt American Heart Association dietary recommendations. That means saturated fat intake should be less than 7 percent of total calories, trans fat intake should be less than 1 percent of total calories, and dietary cholesterol should be limited to no more than 300 mg daily. Children should also get the majority of calories from complex carbohydrates high in fiber.

Both children and adults should consume 14g of fiber per 1,000 calories consumed. Read the nutrition facts panel on food labels to determine how much fiber is in the food you are choosing. According to the Food and Nutrition Board of the National Academy of Sciences Research Council, the dietary fiber intake is summarized below:

Dietary Reference Intakes for Fiber
Age, then grams per day of fiber

Children
1-3 years 19
4-8 years 25

Males
9-13 years 31
14-18 years 38
19-50 years 38
51+ years 30

Females
9-13 years 26
14-18 years 26
19-50 years 25
51+ years 21

Pregnancy
<18 years 28
18+ years 28

Lactation
<18 years 29
18+ years 29

To increase fiber in your diet, follow these tips presented by The Mayo Clinic:

• Start your day with a high-fiber breakfast cereal — 5 or more grams of fiber per serving. Opt for cereals with "bran" or "fiber" in the name. Or add a few tablespoons of unprocessed wheat bran to your favorite cereal.

• Add crushed bran cereal or unprocessed wheat bran to baked products such as meatloaf, breads, muffins, casseroles, cakes and cookies. You can also use bran products as a crunchy topping for casseroles, salads or cooked vegetables.

• Switch to whole-grain breads. These breads list whole wheat, whole-wheat flour or another whole grain as the first ingredient on the label. Look for a brand with at least 2 grams of dietary fiber per serving.

• Substitute whole-grain flour for half or all of the white flour when baking bread. Whole-grain flour is heavier than white flour. In yeast breads, use a bit more yeast or let the dough rise longer. When using baking powder, increase it by 1 teaspoon for every 3 cups of whole-grain flour.

• Eat more whole grains and whole-grain products. Experiment with brown rice, barley, whole-wheat pasta and bulgur.

• Take advantage of ready-to-use vegetables. Mix chopped frozen broccoli into prepared spaghetti sauce. Snack on baby carrots.

• Eat more beans, peas and lentils. Add kidney beans to canned soup or a green salad. Or make nachos with refried black beans, baked tortilla chips and salsa.

• Eat fruit at every meal. Apples, bananas, oranges, pears and berries are good sources of fiber.

• Make snacks count. Fresh and dried fruit, raw vegetables, low-fat popcorn, and whole-grain crackers are all good choices.

Make Earth Day Everyday!

Joanna Michaels


An average American produces about 4 pounds of garbage a day. That needs to stop if we want to live in a healthy environment. Did you know than certain products, like styrofoam, never decompose? Take charge of your environment on this Earth Day. Show your children how little changes can impact their environment. Teach them respect for nature and everything that surrounds us.

RECYCLE 
About half of the U.S. population has the advantage of curbside recycling for paper, aluminum, and plastic. Others do not have such a comfort, even though they may truly want to pitch in to preserves our resources. For those who want to recycle, but have no curbside recycling in their community, and for those who would like to recycle items such as motor oil, batteries, paint, light bulbs, cleaning supplies, toys and electronics, I would like to suggest Earth911.org as a resource. Earth911 provides info on where to recycle various items in your community or in its vicinity.

SHOP WISE TO REDUCE WASTE
At the store, select products with recyclable packaging. If you have to buy a packaged item, select one with the least unrecyclable packaging. 

MAKE A COMPOST PILE
Reduce your yard waste by making a compost pile. Did you know that the leaves of just one large tree might be worth the same as $50 of plant food? It's true! Leaves are even richer in minerals than manure. Composted leaves, or humus, benefit your yard in many ways. They reduce yard waste and improve the structure of your soil. Humus improves the soil’s water-holding ability, prevents soil from drying out too rapidly, and controls evaporation. Compost acts as a good fertilizer and effectively stimulates healthy root development. It is rich in nitrogen, potassium, and phosphorus. Since it is so beneficial to your yard, why throw it out?

GO TO THE MOVIES!
Disney has released the film, Earth, today. For every ticket sold between April 22 and 28, a tree will be planted. Your ticket purchase will help replenish our quickly disappearing trees.

DONATE UNWANTED ITEMS
While spring-cleaning your house, you might find a number of unwanted items. Don’t throw them out! Instead, donate them to the Salvation Army, Purple Heart, soup kitchen, or a local shelter. 

MAKE A PROJECT
The best way to stimulate your children’s imagination is to engage them in a fun project that requires using items you already have. Items you can use for projects include old buttons, paper plates, egg cartons, and ice cream sticks. Use your imagination and have some fun! 

JOANNA MICHAELS Joanna has been a middle school science teacher for 8 years. She emphasizes ways to live an environmental friendly lifestyle in her classroom on a daily basis. For two years before she began teaching, Joanna lived "off the grid" with her husband and son. She says those two years were the hardest of her life, but also the most memorable and enjoyable. She hopes to return to that lifestyle after she receives her doctorate.

Eating Disorders:What Families Need to Know

Kyla Boyse, R.N.

What do I need to know about eating disorders?

Most importantly, you should know that eating disorders require medical attention.

The two best-known types of eating disorders are anorexia nervosa and bulimia nervosa. They can occur separately or together in the same person. A person who has an eating disorder is not always skinny. Some people with eating disorders are even overweight. Binge eating disorder is another kind of eating disorder.

Can men and boys have eating disorders?

Eating disorders most often affect girls and women, but boys and men can also have an eating disorder. One out of every four pre-teen kids with anorexia is a boy. Binge eating disorder affects females and males about equally.

What is anorexia nervosa?

To be diagnosed with anorexia, a person would:

• Be 15% below their ideal weight

• Have an intense fear of being fat, even though they are underweight

• Have a distorted view of their body or deny that their low weight is a problem

• Have amenorrhea (missing at least 3 periods in a row)

• May or may not also binge and purge

Anorexia usually affects teens, and mostly girls. An estimated 1% of white females have anorexia nervosa. It is more common among people in higher income groups, and in groups that value thinness (like athletes, ballet dancers and models). It usually starts around ages 13-14 or ages 17-18.

What is bulimia?

To receive a diagnosis of bulimia nervosa, a person would:

• Binge eat (eat more food all at once than most people would normally eat in the same setting )

• Feel a lack of control during binge eating

• Purge the food by making themselves vomit, fasting (not eating for 24 hours), exercising excessively (for more than an hour), or abusing diet pills, laxatives, enemas, or diuretics (water pills)

• Binge and purge regularly over a period of time

• Have a self-image based mostly on their body shape and weight instead of other traits

People with bulimia may be anywhere from underweight, to normal weight, to overweight. It is estimated that as much as 3% of college-aged women have bulimia.

What is binge eating disorder?

Binge eating disorder is diagnosed when a person:

• Continues to binge eat over time (eating more food all at once than most people would eat in the same setting)

• Feels a lack of control during binge eating

• Eats fast during binges

• Overeats to the point of discomfort

• Eats a lot when not hungry

• Eats alone out of shame

• Feels disgusted with themselves, depressed or very guilty after overeating

• Is worried about their binge eating

Binge eating disorder does not include the purging consistent with anorexia and bulimia. It may be the most common eating disorder. About 40% of obese people may have this problem.

• for more information: http://win.niddk.nih.gov/publications/binge.htm

What causes eating disorders?

We don’t know for sure. Many factors working together may lead to eating disorders. Dieting is a risk factor, with the greatest risk to severe dieters. Around two-thirds of new cases of eating disorder are in girls and women who have dieted.

Is an eating disorder dangerous to my child’s health?

Eating disorders can cause many dangerous medical and mental illnesses.

Is it dangerous to use medications to lose weight?

The products a person might use to lose weight can be very unsafe. The regular use ofdiuretics (water pills), laxatives, and weight loss pills can cause life-threatening problems. And they don’t even work that well for weight loss. Using syrup of ipecac to cause vomiting can also lead to severe illness or death.

Should I worry if my child is on a diet to lose weight?

Most kids and teens do not need a restrictive diet. Limiting eating to control weight not only doesn’t work, but in fact, dieting promotes weight gain in tweens and teens. Reading dieting advice in magazines may lead to later unhealthy weight loss behavior in girls.

How can I tell whether my child has a healthy weight?

If you are concerned about your child’s weight, you should take them to see their doctor. There are some different measurements the doctor may take.

• Weight and height can be compared and plotted on a growth chart.

• Body mass index (BMI) is a good screening number that points toward how much body fat a person has. This number comes from a formula using height and weight numbers. It is a little difficult to compute by hand. You can use the link above to read about children’s BMI, calculate your child’s BMI on the web calculator, and find out their percentile rank.

◦ What does percentile mean? A body mass index (BMI) below the 5th percentile for the child’s age and sex is a sign of underweight. This would mean that 5% of children the same age and sex have a lower BMI than your child. A BMI around the 50th percentile is about average. A BMI above the 95th percentile is a sign of overweight. This would mean that 95% of kids the same age and sex have a lower BMI than your child. Your child would be in the top 5% highest BMIs.

◦ One drawback to BMI is that it does not take into account frame size (either small or large) or high muscle development (like with bodybuilding). A person with a large frame or big muscles may have a high BMI but low body fat. A person with a small frame may have a healthy amount of body fat, but have a very low BMI.

◦ Be sure to use measurements from the doctor’s office when calculating BMI. A small error in height or weight can cause a big error in the BMI result.

◦ Kidshealth.org has a BMI calculator that allows you to plot trends in BMI over time on a chart. (Follow the “instructions for entering more than one set of measurements.”) Then you can see if your child is gaining or losing body fat. Call your child’s doctor if you have concerns.

How can I tell if my child might have an eating disorder?

Look for these behaviors, signs and symptoms:

• Eating tiny portions or refusing to eat

• Intense fear of being fat

• Distorted body image

• Strenuous exercising (for more than an hour)

• Hoarding and hiding food

• Eating in secret

• Disappearing after eating—often to the bathroom

• Large changes in weight, both up and down

• Social withdrawal

• Depression

• Irritability

• Hiding weight loss by wearing bulky clothes

• Little concern over extreme weight loss

• Stomach cramps

• Menstrual irregularities—missing periods

• Dizziness

• Feeling cold all the time

• Sleep problems

• Cuts and calluses across the top of finger joints (from sticking finger down throat to cause vomiting)

• Dry skin

• Puffy face

• Fine hair on body

• Thinning of hair on head, dry and brittle hair

• Cavities, or discoloration of teeth, from vomiting

• Muscle weakness

• Yellow skin

• Cold, mottled hands and feet or swelling of feet

If your child has some of these signs, you should bring them to the doctor right away. Your doctor can rule out diseases that can appear to be eating disorders. If an eating disorder is not treated, it can become life threatening.

How can I help my child?

• In a calm and caring way, tell your child what you saw or heard. Use "I” statements and let him or her know you are concerned. For example, "I'm worried about you because you haven't eaten lunch this week.”

• Listen carefully to what your child says. Teens with eating disorders might feel ashamed or afraid. They may think that life doesn't matter. Feeling out of control is also common.

• What if they get mad or deny it? It is very common for kids with problems to say that there is nothing wrong. Tell them you want to help. You may need to approach them several times.

• Find out the first steps to getting help for a child or family member if you suspect they have an eating disorder.

• Parents should be aware of their child’s Internet use. There are many pro-eating disorder Web sites, and even YouTube has videos that promote eating disorders. These sites often use the terms “pro-ana” (for anorexia) and “pro-mia” (for bulimia).
  

• How are eating disorders treated? How can I get my child started in treatment?

The first goal in treating severe anorexia is to improve your child’s nutrition and eating habits. Then, the goals will focus on learning about nutrition and normal eating patterns, improving self-esteem, relating to others, interacting with family, and treating medical and other psychological problems.

What is Body Dysmorphic Disorder (BDD)?

Your child may have Body Dysmorphic Disorder (BDD). Having BDD means thinking about what you look like much more than normal. It also involves thinking too much about real or imagined defects in how you look. It is a kind of distorted thinking. It affects males and females about equally.

If you think your child has BDD or body image problems, you should talk to your child’s doctor. Your child’s health care provider can refer you to someone who can help. It’s best to see someone with expertise in treating BDD. It’s also helpful to see someone who treats obsessive-compulsive disorder (OCD), since OCD and BDD often overlap.

What can we do to help prevent these problems?

You may feel you want to protect your child from the hurt of being teased about their weight. Unfortunately, focusing on your child's body may do more harm than good. Your child may begin to value themselves solely on what they look like. They may feel they have to look a certain way to gain approval and acceptance. Do not stress what your child looks like. Instead, put the focus on your child’s inner qualities.

Pay attention to the messages you send your child about appearance and weight. Do you constantly diet, and talk about “good foods” and “bad foods?” Do you make negative comments about your own body in front of your child? Make your home a place to learn healthy attitudes about food and body image. Stop the dieting, and instead focus on eating and serving healthy foods. Make sure your family eats breakfast, and share family mealsas often as possible.

It may also help to discourage your daughter from reading many women’s fashion magazines and from seeking out other media that portray underweight women as being glamorous. Discuss media images of “ideal bodies” with your children. Teach your kids to be media literate, which will help protect them from harmful messages about food, eating, and body size from TV, music videos, magazines, and ads.

What are some recommended books?

• How to Get Your Kid to Eat…But Not Too Much, by Ellyn Satter. 
This is a book all parents should read, whether their children have eating problems or not. It applies to kids from birth through the teen years. The advice in this book can help you help your child to develop a healthy relationship with food.

• I'm, Like, So Fat: Helping Your Teen Make Healthy Choices about Eating and Exercise in a Weight-Obsessed World, by Dianne Neumark-Sztainer.

• Eating With Your Anorexic: How My Child Recovered Through Family-Based Treatment and Yours Can Too, by Laura Collins.

• Help Your Teenager Beat An Eating Disorder, by James Lock and Daniel LeGrange.

• Gaining: The Truth About Life After Eating Disorders, by Aimee Liu.

• When Dieting Becomes Dangerous: A Guide to Understanding and Treating Anorexia and Bulimia, by Deborah Michel and Susan Willard.

• It's Not About Food: Change Your Mind, Change Your Life; End Your Obsession with Food and Weight, by Carol Emery Normandi.

Organizations and information/support websites:

• The National Eating Disorders Association is the largest not-for-profit organization in the United States working to prevent eating disorders, eliminate body dissatisfaction, and provide treatment referrals to those suffering from anorexia, bulimia and binge eating disorder and those concerned with body image, eating and weight issues. Their Web site offers information about eating disorders and body image; referrals to treatment centers, doctors, therapists, and support groups; opportunities to get involved in prevention efforts; prevention programs for all ages; and educational materials. Call 1-206 382-3587 for more information. Call the Toll-Free Information and Referral HelpLine at 1-800-931-2237.

• The National Association of Anorexia Nervosa and Associated Disorders(ANAD) http://www.anad.org/ has an international network of support groups, offers referrals to health care professionals, publishes a newsletter, and will mail information packets customized to individual needs upon request. They work to educate the public, promote research projects, and fight insurance discrimination and dangerous advertising. Their national hotline (847-831-3438) can give you a listing of support groups and referrals in your area.

• Maudsley Parents is a site for parents of eating disordered children. The site offers information on eating disorders and family-based treatment, family stories of recovery, supportive parent-to-parent advice, and treatment information for families that opt for family-based Maudsley treatment.

• The Something Fishy Website on Eating Disorders has lots of resources of all kinds, including information and online support. (Scales are for Fish!)

• The Academy for Eating Disorders is a global organization for professionals from all fields who are committed to leadership in eating disorders research, education, treatment and prevention. Phone 703-556-9222.

• Overeaters Anonymous is a twelve-step program offering support for recovering from compulsive overeating. Phone 505-891-2664.

• About-Face focuses on the impact mass media have on the physical, mental and emotional well being of women and girls. They challenge our culture's overemphasis on physical appearance and encourage critical thinking about the media. Phone 1-415-436-0212.

• The Vegetarian Resource Group (VRG) educates the public on vegetarianism, health, nutrition, and more.

• The American Dietetic Association has information on good nutrition, sensible eating habits. Phone: 1-800-877-1600, ext. 5000 (for publications).

• The Weight-control Information Network provides the general public, health professionals, the media, and Congress with up-to-date, science-based information on weight control, obesity, physical activity, and related nutritional issues. Phone: (202) 828-1025 or 1-877-946-4627.

• The Council on Size and Weight Discrimination, Inc. provides information on eating disorders, "sizism," the non-dieting movement, and size discrimination. Phone: (914) 679-1209.

References

Reprinted with permission from http://www.med.umich.edu/yourchild/topics/eatdis.htm

Reviewed by David Rosen, MD, MPH.