Goodbye, whole milk

A new policy statement from the American Academy of Pediatrics, published in July 2008, calls for almost all children to consume low-fat rather than whole milk to reduce their long-term risk of cardiovascular disease.

Reduced-fat milk is preferred for all children starting at age 2. For babies younger than this, starting at age 1 year reduced-fat milk should be used if there are any risk factors: obesity or risk for obesity, or a strong family history of heart disease or increased cholesterol. Since just about every child growing up in the developed world is at risk for obesity, the guideline seems to apply to just about everyone.

The guideline doesn’t distinguish between low fat (2%), skim (0%), or other varieties of reduced-fat milk. I have been advocating skim milk for all children starting at age 2, and will now also suggest low fat (2%) milk starting at age 1 for all babies. The only exception would be in children who are truly underweight, who could benefit from the extra calories of whole milk.

The policy statement also covers new information about screening for cardiovascular risk by measuring cholesterol in children starting at age 2 who are at risk. You’ll be hearing more about this soon as these guidelines are distributed and discussed, but you heard it here first!

Podcast!

It’s a new frontier for the blog: a podcast! I recently recorded an interview as a guest with Dr. Rich Sagall, the editor of Pediatrics for Parents. I’ve been a regular contributor to this journal for a few years. It’s a well-researched and reliable publication about children’s health issues for parents. In the podcast, we discuss things about patients that have caused us grief as doctors, along with tips and tricks about how to get the most out of doctor visits. The material is similar to some of the secrets covered in my first book. Check it out!

To listen to the podcast, go to this page and click on episode 58. You may see other podcasts that interest you further down on the page. There are a few others that feature me on a variety of topics. If you’d like, you can also reach this podcast or subscribe to the series via iTunes. Search for “Pediatrics for Parents.”

Let me know if you like the podcast format. They’re pretty simple to set up, and though I don’t have a jingle yet I could whip one up and start recording my voice more regularly if there’s interest. I promise I won’t sing!

Hair chewing solution

DM asked, “My 23 month old daughter has always enjoyed putting hair in her mouth. Lately, however. she has realized her own hair is long enough to suck on and she is pulling it out. This morning, she got about 15 hairs in one big chunk. It really does not seem to be a nervous type habit - she is happier than ever and a very calm little one. Any suggestions on how to get her to stop?”

I don’t want to sound glib, but I have a quick solution for you. Get her a cute, short haircut. Keep it short for 6 months or a year, then consider growing it out again. In the meantime, you can encourage her to snuggle with a soft lovie or rub a toy bunny’s nose when she gets bored or anxious.

Sleep habits broken

Beverly posted: “Our four year old daughter is having trouble sleeping. Until a few weeks ago, she usually slept very well and only occasionally needed us after she went to sleep, unassisted, at 7:30pm until she woke at 6:30 the next morning. Now she is hysterical if we leave her before she falls asleep. She wakes ups frequently throughout the night and runs screaming from her room in search of us. We put her back to bed repeatedly, but eventually we let her fall asleep with us where she sleeps quite soundly for the rest of the night. Do we continue to put her back in her room despite her crying? Do we let her get through this phase and sleep with us until she’s ready to sleep alone again? Here’s a bit of additional info: She sleeps with two lamps on. She doesn’t nap during the day. She doesn’t receive much refined sugar. She doesn’t watch any TV - and gets a moderate amount of exercise. Her only outstanding medical condition is eczema.”

My first thought is: what happened a few weeks ago when her whole night routine changed? I would guess that a four-year-old would be pretty set in her ways, and some sort of medical or social change would be needed to upset her so much. It might not be something that would seem like a big deal to an adult, but think more from her point of view. Is she no longer spending time with her friends at school? Did Grandma move away? Are there workmen in the house? Did she see a scary movie (this includes just about any Disney production)? Or an episode of the local news—which is often much scarier than anything else on TV? If there was a specific factor that disrupted her routine, you’ll probably need to address that directly.

You mentioned she has eczema—if it’s been acting up, and she’s itchy, that will definitely disrupt sleep.

If there really doesn’t seem to be anything else going on, you’ll need to gradually withdraw your snuggly support at bedtime.

Better safe than sorry? Vaccinate!!

Katie posted, “While most doctors agree that vaccinations are necessary, there has been a lot of talk about spacing them out. I.E. the more necessary or severe diseases first or not giving “group” shots such as MMR, but doing one at a time spaced out. How do you feel about this? Is it possibly a ‘better safe than sorry’ approach worth entertaining?”

If you’d rather be safe than sorry, the best thing to do is get your child vaccinated, and encourage every parent in your community to do the same. If all of our child remain fully vaccinated, we’ll maintain the great protection against these diseases that we’re all taking for granted now. But as soon as a sizable number of children go unvaccinated, the diseases will return.

Who needs more vitamin D?

A question from Allison: “I just read that 40% of children are thought to be vitamin D deficient. How can we figure out if our child falls into that 40%? Should we give vitamin D supplements just in case? What should we do to make sure they stay vitamin D healthy?”

The honest, insider answer to these excellent questions is: we don’t know. We don’t know how much vitamin D a child ought to ingest every day, and we don’t even know what the “normal” blood levels of vitamin D should be!

Car sickness cures

Beth asked, “Do you have any advice on how to deal with and/or prevent car sickness?”

Many children are prone to motion sickness in the car. This often runs in families, and usually starts in the preschool years, about age three or so. There are many good strategies than can help—try these, and see which works best.

Flu vaccines for all children

Max asked, “What are your thoughts on the new guidelines suggesting that all kids from 6 months to 18 years get flu vaccine every year? And what about non-needle flu vaccines?”

Influenza continues to be a significant cause of death and misery in the United States, and the new strategy of immunizing all children, if implemented, should dramatically reduce the burden of influenza for everyone.

There are about 30-40,000 deaths each year from influenza, and almost all of these are in the elderly. The current strategy calls for immunizing older adults, but that doesn’t work very well. We know that in people older than 70, influenza vaccinations are not very effective. And by 80, they don’t work at all. Although it’s become a yearly ritual for older people get their flu vaccines each year, in truth from a public health point of view this is probably not helping very much.

What to do with a Strawberry Hemangioma

My two month old daughter has a strawberry hemangioma that’s getting bigger. The pediatrician says I don’t need to do anything. Is that right?

I can’t say for certain without seeing it, but most of the time strawberry hemagiomas can be safely watched until they go away on their own.

Food Fights Fixed: How to have a successful family meal

Eating together as a family has tremendous health benefits. Kids who regularly eat with their families do better in school, watch less television, and are less likely to struggle with obesity. They also tend to get more exercise and eat a more healthful diet, including more vegetables and fewer processed foods.

But a healthy, relaxing family meal may not come easily. Parents say the kids just won’t eat what they’re served, and get whiney and surly. Mom inevitably heads back to the kitchen to make something separate for every child, and the nice relaxing family meal becomes a frustrating experience that no one enjoys. Needless to say, those vegetables sit untouched on their plates.