September 19, 2014

CDC Says Kids Eat Too Much Salt

According to the U.S. Department of Agriculture’s dietary guidelines, children should consume no more than 2,300 mg of sodium every day. According to a new report by the CDC, they’re eating about 3,300 mg.

The risks of eating too much salt include high blood pressure, which can lead to stroke and heart disease later in life. And high-sodium foods often have a lot of calories, which undermines weight control.

American youngsters already show the effects of their salty diet. As federal officials said in a story on Reuters.com, 1 in 6 Americans 7 to 18 years old has elevated blood pressure, which is linked closely linked to a high sodium intake and obesity.

Most of the sodium kids eat comes from processed foods including pizza, sandwiches like cheeseburgers, cold cuts and cured meats, pasta with sauce, cheese, salty snacks like potato chips, chicken nuggets and patties, tacos and burritos, bread and soup.

"Most sodium is from processed and restaurant food, not the salt shaker," CDC Director Tom Frieden said in a statement. "Reducing sodium intake will help our children avoid tragic and expensive health problems."

According to the report, more than 9 in 10 U.S. kids between 6 and 18 years old eat too much sodium every day. Teenagers eat more salt than younger kids.

About 65% of their sodium consumption comes from foods purchased in stores; fast food restaurants account for about 13%. Meals provided at school represent 9% of total sodium consumption.

And if you think snacking, and food eaten outside of parental control, is the root of this evil, think again — dinner is the largest single source of sodium, accounting for nearly 40% of daily consumption.

The study involved the National Health and Nutrition Examination Survey in 2009 and 2010, and included interviews with more than 2,000 school-aged children.

Developing a taste for salty foods occurs early, so it’s important for parents to influence diet from a young age, and help their children develop a taste for less salty meals through what they buy, how they prepare it and by establishing healthful eating habits themselves.

As the researchers said, the need is to reduce sodium "across multiple foods, venues and eating occasions." In calling for processed foods with less sodium, they acknowledged that efforts in Britain to reduced total sodium consumption resulted in a 15% decline over seven years.

The CDC recommends that parents and caregivers:


  • Model healthful eating for their children by providing a diet rich in fruits and vegetables without added sodium.

  • Compare Nutrition Facts labels to choose the lowest sodium option before they buy.

  • Ask the grocery manager to provide more low sodium options for their family's favorite foods.

  • Request restaurant nutrition information to make lower sodium choices when dining out.

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April 18, 2014

Cholesterol Report Reinforces Screening Schedule for Kids

Most people don’t associate heart disease with children, and although it’s relatively rare, certain risk factors in childhood can increase a kid’s chances of developing heart and blood vessel problems as they get older. Some studies have shown that narrowing and hardening of the arteries can even begin in childhood.

Last month’s annual Scientific Session of the American College of Cardiology presented disturbing research about kids at risk for developing cardiovascular problems — approximately 1 in 3 children between the ages of 9 and 11 who received cholesterol screenings showed borderline or high results.

As summarized on ScienceDaily.com, the study was one of the largest of its kind, involving outpatient clinic visits of the Texas Children's Pediatrics Associates. It examined more than 12,700 medical records of children whose routine physical exams included screening for cholesterol.

The study’s lead researcher, Dr. Thomas Seery, a pediatric cardiologist, said "The sheer number of kids with abnormal lipid profiles provides further evidence that this is a population that needs attention and could potentially benefit from treatment. But we can only intervene if we diagnose the problem."

Seery said it’s important to identify kids with high levels of blood cholesterol/fats and to lower their blood values in order to stave off the chances of future disease.

The study showed that boys were more likely than girls to have elevated total cholesterol, low-density lipoprotein (LDL, or "bad" cholesterol) and triglycerides (blood fats), but girls had lower high-density lipoprotein (HDL, or "good" cholesterol).

No surprise that obese children were more likely to have elevated total cholesterol, LDL and triglycerides, and lower HDL than were kids who weren’t obese.

You don’t know if your child’s values are normal, of course, unless they’re measured. The National Heart Lung and Blood Institute guidelines recommend universal cholesterol screening of children between the ages of 9 and 11, and again between 17 and 21. That practice is endorsed by the American Academy of Pediatrics. (See our blog, “Cholesterol Tests for Kids.”)

Like all screenings, however, this one isn’t without concern for overtreatment if a result isn’t precisely within what’s considered normal. Seery’s aware of that. "There is concern by some in the medical community that children will be started on medication unnecessarily," he said. So the first line of defense against rising blood cholesterol is for youngsters to adopt a healthful diet and to exercise regularly.

Seery said that cholesterol-lowering drugs usually aren’t necessary except for 1 or 2 children in 100 who have very high cholesterol, usually because of a genetic disorder. Such problems, including inherited high cholesterol, can be detected in childhood, but might be underdiagnosed. But if blood is tested at the recommended ages, it will be found.

The universal pediatric screening guidelines were initiated at the end of 2011, during the second year of the research. So one of the study’s limitations might be that we don’t know if testing was ordered for everybody, as a matter of course, or only for select subjects chosen for their individual risk factors or family history of premature heart disease.

Other studies have demonstrated that screening based on family history alone can overlook children who have abnormally high cholesterol. So further research is needed in order to determine how many health-care providers are following the guidelines, and how consistently they do so.

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June 7, 2013

Well-Child Visits Help Keep Kids Out of the Hospital

We have been among the voices raised against the overuse and abuse of medical resources (here and here, for example), but sometimes medical attention is wholly appropriate even without symptoms or complaints.

When it comes to kids, according to a new study in the American Journal of Managed Care, regularly scheduled doctor visits even in the absence of a problem might well be wise. Young children who missed more than half of their recommended well-child visits, the study concludes, had as much as twice the risk of hospitalization compared with children who attended theirs.

Not surprising was the fact that kids with chronic conditions such as asthma and heart disease and who missed their recommended appointments had as much as three times the risk of being hospitalized as those with chronic conditions who were seen as recommended.

The study involved more than 20,000 children enrolled in Group Health Cooperative, a large health-care system in Seattle, from 1999 to 2006. The study followed the subjects from birth to age 3 1/2 or until their first hospital stay, whichever came first.

As quoted in a story on ScienceDaily.com, lead study author Dr. Jeffrey Tom, said, "Well-child visits are important because this is where children receive preventive immunizations and develop a relationship with their provider. These visits allow providers to identify health problems early and help to manage those problems so the children are less likely to end up in the hospital."

It goes without saying (although the study made it clear) that regular, preventive care for children with special needs and chronic conditions is even more important because of possible complications.

Most children in the study—3 in 4—attended at least 3 in 4 of their recommended visits. But this could be such a high percentage because Group Health coverage required no copayment for such visits. The authors acknowledge that the lack of a financial burden, even a small one, is an important incentive to maintaining a recommended medical visit schedule.

Four in 100 children in the study, and 9 in 100 of them with a chronic condition, were hospitalized. The two most common reasons for hospitalization in both groups, according to Science Daily, were pneumonia and asthma.

Children who missed more than half of their visits had as much as twice the risk of hospitalization compared with those who attended most of theirs. Children with chronic conditions who missed more than half of their visits had nearly twice to more than three times the risk of hospitalization compared with those who attended most of their visits.

During the study period, Group Health recommended nine well-child visits between birth and 3 1/2 years of age: the first at 3 to 5 days old, then at 1, 2, 4, 6, 10 and 15 months, and at 2 and 3 ½ years.

Although the study is very clear about the value of well-baby visits, a huge consideration is that the findings might not apply to all health systems. Group Health is an integrated health-care system, or one where care is well-coordinated as a person ages or a disorder progresses. Also, most of the study’s subjects attended most of their well-child visits and belong to affluent, well-educated families. Although some research studies can adjust for certain variables within the population they study, this one couldn’t adjust for income, education, race, or ethnicity.

And of course there is no absolute cause-and-effect conclusion that missing well-child visits increases the chances of hospitalization. But it’s pretty clear that there’s an important association. In addition to well-baby visits providing the opportunity for preventive care, Science Daily notes that parents who miss well-child visits are probably less likely to manage their kids' illnesses and follow treatment regimens, which could result in higher rates of hospitalization for the children.

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June 7, 2012

For Kids, More Screen Time Equals Less Fitness

Are you sitting down? A study of teenagers showed that sedentary behavior increased as they aged, and at the expense of physical activity. The culprit is the allure of an electronic screen.

As interpreted by the American College of Sports Medicine, (ACSM) cardiorespiratory fitness (CRF) levels could improve in childhood if kids spent less time in front of a screen. The study was published in the official journal of the ACSM, Medicine & Science in Sports & Exercise.

Researchers assessed more than 2,000 children ages 11 to 13 in their relationship between sedentary time spent in front of a screen and changes in CRF. Boys and girls living in a single city in England were studied. Intervals of screen time were broken into segments of 10-19, 20-29 and more than 30 minutes.

As the children grew older, they generally grew more sedentary. By the time they were 16, on average, they spent 121 percent more time sitting in front of a screen for longer than 30 minutes than at the beginning of the study.

Those who reported more screen time were able to complete fewer running laps. The association was strongest for the children who started with mid-to-high CRF levels, and was independent of physical activity levels.

It isn’t exactly rocket science to conclude that the popularity of electronic media can be a threat to cardiovascular development, whether you’re playing “Call of Duty: Modern Warfare,” updating your Facebook page or texting your homework assignments to your bff. And that if sedentary habits of kids become the sedentary habits of adults, that’s an invitation to all the disorders that can reflect poor cardio fitness—heart disease, diabetes and obesity.

“[S] pending too much time sitting is hazardous to children’s health,” the study’s lead author said. To co-opt the words of Romantic-era poet William Wordsworth, “The Child is father of the Man.”

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May 24, 2012

Kids Join the High Blood Pressure Club

Childhood is generally the time when we begin establishing the bad habits—eating poorly, overeating, being sedentary—that later come back to haunt us in the form of diabetes, heart disease and a higher risk of cancer.

But the American Academy of Pediatrics (AAP) has determined that for youngsters, it’s almost never too early to be screened for high blood pressure.

A large—no pun intended—-part of the concern is that one-third of children and teenagers are overweight or obese. The forecast is grim—as much as half the population, researchers say, could be obese by 2030.

As noted above, obesity invites myriad health problems, including high blood pressure. According to a story on NPR, pediatricians are seeing the roots of these diseases in kids as young as 3.

Diagnosing hypertension (or high blood pressure) in kids is more complicated than for adults. The numbers rendered when the nurse applies the cuff to an adult arm are pretty clear—if they’re higher than 140 over 90, you’re at risk. But those values vary for children according to their age, gender and height.

So doctors must not only measure a child’s blood pressure, but compare it to standards of normalcy for children with the same traits as the patient. What’s normal for an 8-year-old girl isn’t what’s normal for a 15-year-old boy.

Sometimes pediatricians neglect to measure their patients’ blood pressure. The NPR story noted that among children eventually diagnosed with high blood pressure, only about 1 in 4 had it recorded in his or her chart. As a parent, you should insist on this simple, painless procedure.

And even if the notation is made, if the doctor fails to consult the varying standards, a high reading might not be recognized. So after the reading is taken on your child, ask what is deemed normal for a kid like yours. Don’t accept a response such as “he’s fine,” or “there’s nothing to worry about here.” Get the values and ask how they will change as your child grows. This not only reinforces your participation in your children’s care, it models how they should manage their health care as adults.

The risk of not diagnosing high blood pressure early is setting up a child for premature problems. We recently reported about the wisdom of testing children for high cholesterol for the same reasons. People as young as 20 or 30 can suffer a stroke that results from hypertension that might have been recognized sooner.

One estimate counts 2,000 children and teens among people who suffer strokes every year as a result of high blood pressure.

But unlike many adults, children don’t necessarily require medication to control hypertension. Simple lifestyle changes generally bring positive change in their health profile. As usual, reducing high-fat foods and high-sugar drinks, and increasing activity make a big difference. And, because kids have higher metabolism, they’re better at losing weight.

Most high blood pressure in children is found during routine medical exams. According to the AAP, these symptoms also can indicate hypertension:


  • headache;

  • dizziness;

  • shortness of breath;

  • visual disturbances;

  • fatigue.

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April 19, 2012

Children Whose Hearts Stop

Happily for most parents, heart trouble is pretty well off their child-care radar. When a child succumbs to cardiac arrest, often it’s a shock and a surprise.

But by some estimates, according to a recent story on MedPage Today, there might be warning signs in as many as half of all cases of sudden cardiac arrest in children. Awareness by clinicians of these signs and a thorough understand of family history by both parents and pediatricians can prevent sudden cardiac arrest in youngsters, says the American Academy of Pediatrics in the journal Pediatrics.

A primary point in the academy’s statement was that some symptoms of cardiac problems in children commonly are associated with other, less dire disorders. Pediatricians must remain not only vigilant in observing them, but open-minded about their cause because pediatric sudden cardiac arrest can be lethal within minutes if it goes unrecognized and untreated.

Approximately 2,000 such deaths are estimated to occur annually in the United States.

Symptoms can include chest pain, dizziness, exercise-induced syncope (temporary loss of consciousness) and dyspnea (difficult or labored breathing). Any or several of these symptoms might have been disregarded by the patient and family, the article notes.

A detailed family history that yields knowledge of a sudden, unexplained death of a young relative also warrants scrutiny of any child exhibiting symptoms of what can easily be ascribed to getting tackled on a Pop Warner football game, or too many rides on the Tilt-a-Whirl.

The most common underlying causes of sudden cardiac arrest among children are:


  • structural or functional disorders such as hypertrophic cardiomyopathy, a heart defect in which the muscle wall is so strong that it can’t relax enough to allow sufficient blood flow;

  • coronary artery anomalies, or congenitally malformed heart vessels;

  • primary cardiac electrical disorders, when the heart’s electrical system malfunctions.


An afflicted child most frequently experiences ventricular tachyarrhythmia, which is an abnormal heart rhythm that is rapid and regular. It originates in the lower chamber, or ventricle, of the heart. Sometimes arrhythmias are of short duration, and resemble seizures.

If a doctor or parent believes a child is having a seizure, he or she probably will be referred to a neurologist. If the real problem, however, is heart-related, the delayed diagnosis can be disastrous.

Similarly, if a child experiences breathing trouble, someone might believe he or she has a respiratory problem, and send to a pulmonary specialist.

If your child has experienced any of the symptoms above, was diagnosed and treated for a problem other than a heart issue and has not responded, see a pediatric cardiologist immediately.

The academy advises use of these risk-assessment tools, which haven’t been validated or assessed for sensitivity or specificity; nevertheless, experts emphasize that if any of the following have occurred, the patient should get a cardiac assessment as soon as possible:


  • a history of fainting or having a seizure, especially during exercise;

  • past episodes of chest pain or shortness of breath with exercise; and/or

  • a family member with unexpected sudden death or a condition such as hypertrophic cardiomyopathy or Brugada syndrome (a certain kind of heart rhythm disorder heart rhythm disorder characterized by a specific abnormal heartbeat and detected by an electrocardiogram test).


Although heart screenings have long been overused, in the case of young athletes, the academy advised against following earlier American Heart Association guidelines that did not endorse widespread use of ECG tests. (The AHA rightfully cited the possibility of false-positive and false-negative results, additional cost and associated problems.) The academy advised screening young athletes before they participate in sports.

The academy also recommended that automated external defibrillators be widely available in schools, as well as cardiopulmonary resuscitation training of staff and others. Parents should determine if these tools are present in their child’s school, and lobby for them if they are not.

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