Vaping, Cigarettes, and Teens

There has been a good deal of newspaper coverage recently on  the use of e-cigarettes, particularly the JUUL brand, which is shaped like a USB flash drive and is popular among teens. Like other e-cigarettes (also called vaping devices), these are battery powered and heat a liquid containing nicotine to produce an aerosol that is inhaled by the user.

Why the focus on JUUL? As explained by Dr. Howard A. Zucker, the New York State Health Commissioner, in a recent communication to health care providers throughout the state, this brand of e-cigarettes is almost odorless and is small enough to be used discretely almost anywhere. Students have been reported using them in school bathrooms (no surprise there) and even in classrooms and hallways. The liquid in JUUL devices is contained in a small pod, each of which may have the same amount of nicotine as a pack of cigarettes. What makes JUUL especially attractive to teens is the flavoring added to the liquid in the pods. These flavorings -- by some counts as many as 15,000 different ones, including fruit and candy flavors -- are highly appealing to young users.

What these young users don't consider is that no matter what flavor they may choose to use, each pod of liquid also contains nicotine, which is highly addictive. As Dr. Zucker notes, nicotine in any form can impair adolescent and young adult brain development, particularly those functions affecting impulse control, mood disorders, and attention and learning. Furthermore, while the vapor from the e-devices seems to be just harmless water vapor, it actually contains toxic chemicals and ultra-fine particles that enter the lungs.

Some adults have noted that all e-cigarettes can be used to help smokers quit, but evidence has shown that many adults use both regular cigarettes and e-cigarettes in different situations. There can, however, be no question at all that e-cigarettes pose a danger to young people and that parents need to be aware that they are not just a harmless fad or novelty device. They are a gateway to smoking cigarettes and they are a danger on their own.

Current data from the CDC on smoking and its effects on health is something to share with your teen. As the CDC notes, each day, more than 3,200 people younger than 18 years of age smoke their first cigarette and, each day, an estimated 2,100 youth and young adults who have been occasional smokers become daily cigarette smokers. Your pediatrician or family doctor can be a valuable resource on both the dangers of e-cigarettes and smoking and ways to help users quit.

Four Tips to Help Kids Maintain a Healthy Weight

At the Yellin Center, we devote a lot of focus to students’ minds and brains. But the health of their bodies impacts their learning, too, and childhood obesity is one of the most common health problems faced by young people today. Children who are obese are far more likely than their slimmer counterparts to grow into obese adults. They are at risk for a host of health problems as they grow older, including Type 2 diabetes, stroke, and heart attack. And obesity wreaks an emotional toll as well as a physical one: overweight children are more likely to be bullied and to suffer from poor self-esteem.

According to Dr. Chad Hayes, author of the pediatrics and parenting blog Chad Hayes M.D.  and pediatric resident physician in South Carolina, a few small changes are often all that’s needed, particularly if your child is still growing. Most overweight kids don’t need to shed pounds; rather, if they can maintain their current weight as they grow, things will balance out on their own.

Dr. Hayes reminds parents to focus on kids’ health, not on the numbers on the scale or kids’ appearance. He also offers parents the following four tips to help their kids attain, and maintain, a healthy weight:

1) Chew your calories. In other words, offer only calorie-free beverages. Juices, a common part of children’s diets, are filled with sugary, mostly empty calories and don’t curb kids’ appetites. The calories from just one serving of a sweetened beverage per day (juice, Gatorade, sweet tea, etc.) are enough to add up to a weight gain of 10 pounds per year. Hayes believes that once children are old enough to obtain adequate nutrition from solid foods, the only beverage they need is water. Sound boring? We suggest sparkling water. Or try keeping a pitcher of water filled with lemon or cucumber slices or mint leaves in the refrigerator for variety. Remember that unsweetened iced tea is calorie-free, too (although most types contain caffeine, which should be used in moderation and only for older children), and many fruit-flavored teas are available.

2) Stop bringing junk into the house. Suburban parents, we’re talking especially to you, here. Many kids in New York City can pick up their own snacks because of the freedom and autonomy offered by a pedestrian-dominated city, but the average suburban family has to drive to obtain groceries. That means parents have almost total control over whether their kids have access healthful foods or junky snacks. “If it’s not there,” says Hayes sensibly, “they won’t eat it.” Offer low-fat string cheese, fresh or dried fruit, sliced vegetables, air-popped popcorn, or raw nut mixes instead of chips and cookies (and don’t forget to keep an eye on kids’ portions).

3) Eat from farms. Nutrition labels can be confusing, but luckily the best foods for you tend not to have labels at all. Pick up foods that don’t come in packages, like fruits and vegetables. Hayes suggests navigating the grocery store strategically by shopping only around the perimeter, where the produce, butcher, and dairy sections tend to be located. The center aisles are home to processed food and should be avoided, especially when one shops with children who may beg for the things they see there.

4) Get moving. Banish kids to the backyard or park, if those are safe places for them to go on their own. If not, accompany them and transport yourselves on foot or bicycle if that’s a reasonable choice. Busy parents can try to coordinate with neighbors to share supervision duties or sign kids up for sports teams of all kinds; look for options like rock climbing at an indoor gym or tae kwon do if your child isn’t much of a jock. Remember that biweekly participation in a sport is not license to supersize kids’ diets, though. Hayes cautions that it’s a lot easier to eat 200 calories than it is to burn them.

Summer Sun Safety Tips for Young People

According to the Skin Cancer Foundation, just a single bad sunburn in childhood more than doubles the odds that a person will develop dangerous melanoma later in life. Sounds scary, but luckily there are lots of ways to keep your little ones’ skin safe during the summer months when burns are more likely to happen.

The Skin Cancer Foundation recommends using a wide spectrum sunscreen with an SPF of 15+ on children older than six months. (Babies younger than that should be covered up, as they’re too young for sunscreen.) Spray-on sunscreens, which should not be applied directly to kids’ faces, are excellent for squirmy toddlers. Remember that everyone is susceptible to skin cancer, no matter how dark his/her complexion, so protect all kids. And although parents often think of sun protection only before trips to the pool or all-day outdoor adventures, remember to use sunscreen before even shorter excursions outside. 

The Centers for Disease Control and Prevention - the CDC - notes that, "Unprotected skin can be damaged by the sun’s UV rays in as little as 15 minutes. Yet it can take up to 12 hours for skin to show the full effect of sun exposure. So, if your child’s skin looks “a little pink” today, it may be burned tomorrow morning. To prevent further burning, get your child out of the sun."

When kids and water mix on hot summer days, think about protecting areas that are often overlooked when applying sunscreen, like the underside of children’s chins, noses, and earlobes. Sun reflected upwards from the water can burn just as readily as sun that comes from the sky. Also, be sure to use water resistant sunscreen and to follow the directions carefully. Lots of parents forget to wait between application and swimming and don’t reapply as often as they should when water is involved.

The American Optometric Association reminds us to look beyond kids’ skin at the lake, beach, or pool. According AOA, 25% more UV rays get reflected off water and sand than are already coming from the sky. Because children’s eyes don’t filter out the sun’s rays as effectively, their retinas get blasted with three times the annual dose of UV exposure that adults’ eyes do. So, for summer fun on non-reflective surfaces, be sure to pop a hat with a brim on your little ones. And kids should wear wrap-around sunglasses when they’re on water or sand.

Got a teenager who insists that tan is cool? Help her investigate some of many the tanning lotions and sprays. They’re perfectly safe and will help her resist the temptation to bake in the sun (or worse, a tanning bed).

No matter how vigilant adults are about slathering sunscreen on their kids though, the best thing they can do is lead by example. Parents who bemoan their pale legs or sunbathe doused in baby oil are demonstrating that sun exposure is perfectly safe, and this lesson speaks louder than any carefully worded lecture about sun protection.

February is National Children's Dental Health Month

Happy National Children's Dental Health Month!

According to the American Dental Association (ADA), developing good oral care habits early can help start kids down the path to a lifetime of healthy teeth and gums. Tooth decay is the most common chronic childhood disease. Not only is it painful, but dental disease can cause kids to miss school, which negatively impacts their learning. The good news is that tooth decay is preventable!

The best way to observe Children's Dental Health Month, of course, is to encourage kids to brush twice a day for two minutes at a time. There are numerous tools available to help make sure kids brush for long enough, from simple timers to hourglasses  to this zany, light-up critter named Molar Mate.

There are lots of fun ways to help youngsters learn about their teeth and oral health, too.

Children will enjoy doing the experiments provided in a fun card pack from Renaissance Dental. These simple activities will help them learn about the importance of flossing, the powers of fluoride, and more, all in a hands-on way.

For game-lovers, the ADA has put together an activity pack of word searches, connect-the-dots pictures, coloring pages, and more. Online gamers will find plenty to do on Colgate's Kids World page. There are plenty of free games to choose from for children as young as two and as old as nine.

The temptations of Valentine's Day candy mid-month will put kids' dental hygiene habits to the test. Make sure they're ready to take a bite out of tooth decay with healthy practices!

Youth Tobacco Use

The dangers of tobacco use are well documented and widely understood. A recent article in PLoS Medicine adds just one more data point to the argument against cigarette smoking: in Asia, where smoking is more widespread than in the United States, approximately two million premature deaths in recent years can be attributed to cigarette use. Victims generally died of cancer, cardiovascular disease, or respiratory disease. Men who had a history of smoking were nearly twice as likely to die from cancer as men who had never smoked and were fifty percent more likely to die from respiratory diseases.

According to the Center for Disease Control , cigarette use among youth in the United States has seen encouraging declines in recent years. It is particularly important to track rates of tobacco use among young people because nearly all adult smokers begin using tobacco during their youths. CDC surveys show that nine of out ten adult smokers began using cigarettes by the time they were 18 years old, and 99% of smokers had begun smoking by age 26.

Cigarette smoking among youth declined between 2000 and 2011, which is certainly a positive trend. However, the use of electronic cigarettes, a product whose advisability is hotly debated among health care professionals, and which are often manufactured in China without oversight as to safety issues, doubled between 2011 and 2012. During that same period, hookah use among high school-aged youth increased as well. In 2012, the most recent year for which data were available, 6.7% of middle school students and 23.3% of high school students used tobacco products.

Declines in cigarette use are certainly good news, but the risks that accompany tobacco use are frightening enough that parents, teachers, and mentors must continue to work with physicians to ensure that teens understand them. Resources are available through the Surgeon General, including conversation cards for parents and doctors to guide talks with young people about tobacco. Adults can also help by reporting sales of tobacco to underage customers, which is illegal in every state; consumers who witness an illegal tobacco sale in New York, which includes sale of tobacco products and electronic cigarettes to minors or sale of loose cigarettes, should call 1-800-458-1158.

Photo credit: Wlodi via Flickr CC

Physical Fitness is Good for Kids’ Bodies and Brains

In case you haven’t heard, exercise is really good for you. Study after study has associated physical fitness with a multitude of health benefits like improved ventilation in asthma patients, lower risk of cancer for both men and women, lowered rates of coronary heart disease, and reduced risk of dementia in senior citizens. Kids who build healthy habits at a young age tend to maintain them, so many health experts recommend that children engage in physical activity while they’re young so that they’ll grow into fit adults.

But a recent study suggests that active kids aren't just physically healthier; they learn better, too. It’s been established that exercise before a test leads to better test scores, and researchers have also uncovered a link between overall fitness and higher achievement scores. Most recently, a study at the University of Illinois at Urbana-Champaign found that fit kids outperformed their less healthy peers on a difficult memorization task.

Although the benefits of exercise may be obvious to parents, persuading kids to set down the iPad and get their pulses racing can be tricky. Participation in sports, martial arts and dance classes, and horseback riding lessons can be fun ways to get kids moving. But for some over-scheduled families, adding extra commitments isn't an option. Here, then, are a few ideas to get kids moving that can be integrated into day-to-day family life:

Make Screen Time Active

We advocate limiting screen time, but some small changes can make the time your child does spend in front of the tube or the computer a little more healthful. Ask your child to stand while working with a laptop or tablet (place the device on the kitchen counter if a tabletop is too short). Even better, dare them to stand on one foot! While watching TV, designate commercial breaks as movement periods and challenge kids to do crunches, leg lifts, push-ups, sit-ups, or wall sits until the program starts again. A little friendly competition between siblings or buddies will add an extra element of fun. During programs, encourage kids to sit on stability balls that will engage their core muscles as they balance and work their leg muscles when they bounce.

A Furry Friend in Need

Express your concern that the family dog isn't getting enough exercise and task your child with taking it for frequent walks or starting games of fetch or keep-away.

Get Out Together

Take a walk after dinner whenever possible. Use weekends to do something outdoors together; it’s a great way to combine family time and fitness time. Go for a hike, take a walk in the park, or strap on helmets for a bike ride. Parents who like the idea of longer bike rides don’t need to leave their little ones behind; look into a trail-a-bike, a device that uses a child-sized seat and wheel that turns any adult bike into a tandem.

Stairmaster

Only going up a flight or two? Skip the elevator and lead your kids up the stairs.

Take Measure


Really committed to getting your kids to move? Hand out small, inexpensive pedometers and compare everyone’s steps at the end of the day. The desire to beat his older brother’s total may just get your child to go the extra mile.


Play Time

Kids love interactive games like Simon Says, Mother May I, Follow the Leader, or the Mirror Game*. When you play, throw in physical challenges like crab walks, jumping jacks, frog hops, etc.

Clean Living


Assign kids chores like washing windows, sweeping, washing the car, raking leaves, gardening, or anything else you can think of that will get them moving.



Golden Oldies

Introduce your kids to old, favorite schoolyard games like jump rope and hopscotch. Brownie points for successfully navigating a game of double-dutch!

Three Words

Impromptu Dance Party!





*To play the Mirror Game, partners face each other. One is the actor and one is the mirror, and when the actor moves the mirror must copy the movements exactly. Partners should switch roles at some point so that each one has a chance to be both the mirror and the actor.


Photo credits:U.S. Dept. of Agriculture; espensorvik; vastateparksstaff; glutnix; Pink Sherbert Photography; mastermaq.

August Health Observances

Two month-long reminders about children's health take place in August, both intended to coincide with the start of the school year.

National Immunization Awareness Month

First, this month marks the annual National Immunization Awareness Month, and the American Academy of Pediatrics (AAP) reminds parents that "August is an ideal time to make sure everyone is up-to-date on vaccines before heading back to school and to plan ahead to receive flu vaccines." The AAP notes that some parents have concerns or questions about immunizations, and their website includes information on every aspect of immunization from school vaccination requirements in all 50 states to vaccine safety. They recognize the importance of getting accurate information about immunizations and note that the "AAP Immunization Web site was assessed by the World Health Organization (WHO) and passed their credibility and good information criteria."

Children's Vision and Learning Month

Ano Lobb

August is also Children’s Vision and Learning Month. As the New Jersey Society of Optometric Physicians states, "Children with undiagnosed, untreated vision problems ... can experience trouble focusing between a book or electronic device and the blackboard, or controlling or coordinating eye movements. In today’s digital classroom, a student must see well to not only keep up but to excel." We could not agree more -- and it is because of these important connections between eyesight and learning that vision screening is a routine component of a comprehensive educational evaluation at The Yellin Center. Further, we believe that regular exams with a pediatric ophthalmologist (a medical doctor who specializes in the eye issues of children) should be a part of your child's medical care.


Here's to a healthy start of school for all!

ChopChop: Healthy Cooking with Kids

The bad news: Child obesity is on the rise, our diets include increasing amounts of processed food, and it seems that more and more kids aren’t getting the nutrients they need. According to the Mayo Clinic, kids with unhealthy eating habits are likely to continue those habits into adulthood, putting them at risk for a host of dangerous health problems.

The good news: Children and even teenagers tend to listen to their parents about nutrition (really!) and tend to follow their lead. According to experts, family cooking sessions are great opportunities to talk about nutrition, encourage kids to try new things (even picky eaters are more likely to dig in when they've had a hand in the preparation of unfamiliar foods), and, of course, have fun.

For parents interested in cooking with their children, ChopChop is an invaluable resource. The mission of the organization is to inspire kids to cook real food, and their products give kids the know-how to do just that. ChopChop produces a cookbook (containing “more than 100 super yummy crazy fun totally doable recipes”) and a quarterly magazine in Spanish or English. Each issue of ChopChop includes inexpensive, kid-friendly, healthy recipes, fun food facts, games and puzzles, and interviews with admirable public figures who are committed to healthy lifestyles. Recipes are accompanied by clear, step-by-step instructions – all of which begin with the mandate that kids wash their hands and clean the counter.

Even non-subscribers can access ChopChop’s collection of recipes on their website where fare is divided into five categories: breakfast, lunch, dinner, dessert, and snacks. It’s difficult to imagine anybody not finding something to suit his or her tastes among delicious, hugely diverse options like chicken soup, panzanella, Parmesan yogurt dip with carrots, toshikoshi soba, sunshine smoothies, chai tea, German pancakes…hungry yet? The website, cookbook, and magazine are colorful, accessible, and appealing. Information is conveyed in simple language and accompanied by vivid pictures of food, and of kids in the midst of cooking up a storm.

ChopChop doesn't post calorie counts or nutritional content, or demonize any individual foods, though their content is reviewed by a team of medical and nutritional advisors. One of ChopChop’s most valuable lessons can be learned simply by scrolling through the appealing pictures of the dishes they recommend: healthy eating can, and should, be fun, adventurous, and delicious.

Bon Appetit!

Backpack Awareness

Today is Backpack Awareness Day, an annual event created by the American Occupational Therapy Association (AOTA) to highlight problems students face when carrying backpacks that are too heavy or which are improperly worn.

According the the AOTA, 55% of American students carry backpacks that are heavier than the recommended safe weight of ten percent of their body weight. That means that a 100 pound child should carry a pack that weighs no more than ten pounds. Also important is how a pack is worn. The AOTA recommends that the height of the backpack should extend from approximately 2 inches below the shoulder blades to waist level or slightly above the waist. They also recommended that the backpack should always be worn on both shoulders so the weight is evenly distributed.

Even though these suggestions seem pretty basic and easy to follow, studies have made clear that they are often ignored, to the detriment of children's health. The AOTA reports that a 2007 study found more than 2,000 backpack injuries requiring medical treatment that year and that another study found more than 64 percent of 11-15 year old students reported back pain related to heavy backpacks.

One solution recommended by the Occupational Therapists group is to hold a backpack weigh-in at school, so that students can be made aware of how much they are carrying around. Their website includes permission forms for schools to use to obtain parental consent for this program. They also provide an information sheet for families with tips on how to pack a backpack to avoid injury.

It's not just children who can be injured by carrying bags that are too heavy or carried in the wrong way. If you carry a heavy briefcase or tote you might want to review some guidelines to help avoid doing damage to your own back and shoulders!

August is National Immunization Awareness Month

Although New York City's public schools don't begin classes until September 6 this year, many schools across the country have already opened. It's a good time to make sure your child's immunizations are up to date, especially since August is National Immunization Awareness Month.

The American Academy of Pediatrics has a section on their website directed at parents that looks at what immunizations are needed for different age groups and considers questions parents may have about the safety of vaccinations.

All 50 states require that students be immunized and will not permit children without immunizations to attend school, although there are exemptions available for medical and religious reasons (which vary from state to state). Check out the requirements in your state for immunizations and speak with your child's pediatrician to make sure that your child also receives non-mandatory vaccines, such as a flu shot, when appropriate.

The Centers for Disease Control has created a list of childhood diseases that can be prevented by vaccination. Parents who question why their child needs to be vaccinated should find this important reading.

Photo: AKZOphoto / Creative Commons

Health Benefits of Dogs and Dirt

A study of almost 400 infants in Finland has demonstrated the positive impact of early exposure to dogs on the health of the children. The study, just published by the journal Pediatrics, found that children with dogs at home had fewer repiratory or ear infections and needed fewer courses of antibiotics than children who had no exposure to dogs.

Further, the study determined that the greatest positive impact occurred when children were exposed to dogs that spent a significant part of their day outside of the house. The authors note that this might be due to the increased amount of dirt brought into the home by dogs who spend much of their time outdoors. They state, "In other words, less dirt is brought indoors by dogs who live mainly indoors". The study noted some positive impact for exposure to cats, but not as significant as that for dogs.

Another recent study, this one using mice, looked at the impact of a germ free environment and found a negative correlation between such an environment and tolerance of cells to conditions such as asthma and inflammatory bowel disease. The authors conclude that early exposure to microbes is critical for building tolerance to later disease exposure. 

Parents who are concerned about having pets around young children and keeping their kids away from dirt should be heartened to learn that both dogs and dirt can be beneficial to their childrens' health.

Photo by Aaron E. Silvers via Flickr/Creative Commons