Practical Parenting

Children also need to exercise!

There is no shortage of information on the need for adults to maintain a healthy diet and to exercise regularly. Every news article I've ever read on maintaining good health has some reference to exercising in it. However, I have come to realize that many parents are often unaware of the critical need for them to give their children opportunities to exercise and to get their heart rates up. As a result, there are far more children who are overweight today and, in the United States for example, the obesity rate among children has quadrupled in the last few decades. 

It is important to understand that there are many benefits for children when exercise is a part of their daily routine. Some of these benefits include:

1. Exercise increases children's energy levels.

2. Exercise prevents children from becoming overweight.

3. Exercise helps children build strong bones, muscles, and joints.

4. Exercise helps children feel less stressed and it helps them sleep better at night.

Fortunately, getting children to exercise is not as difficult a process as getting adults to exercise. Children enjoy running around, jumping, climbing equipment, and just moving. Therefore, incorporating exercise into your child's day can be quite easy and fun. A simple trip to the park can do it. The following are some ways you can increase physical activity in your children's lives: 

1. Set an example. When children see you exercising, they will be more likely to want to exercise themselves.

2. Limit the amount of time they spend watching television or on the computer. Encourage them to meet with their friends and play in the backyard instead. If it cold outside, just bundle them up nicely.

3. Establish a routine so that exercise is a part of their day everyday.

4. Enroll your children in organized sports activities. Your local community center is a great place to enroll your children in soccer, swimming, and other activities.

5. Mix it up and have fun!

School is out!

It's that time of the year again! School is almost over and children will be off for over two months. At this time of the year, parents are often anxious and wonder about the kinds of things they can do with their children to engage them for such a long period of time. This is especially the case when parents work more than one job or if they are doing shift work. My best advice to all parents is to try to spend as much time with children as possible, and this can be done as you engage in your day-to-day routine work. For example, when you go shopping, take your children with you to the mall and the grocery store. Point out "nutritious foods" and ask them to find the letter "s" in the names of the stores they see at the mall. Take them to your place of worship and spend time talking about things that are important in your culture. Talk to them in your home language and realize that fluency in the first language greatly enhances children's ability to learn language skills in English.

Young children are extremely inquisitive about their world and love to ask questions. Take the time to answer their questions and model the joy of discovery for them. When you come home from work or after you pick them up from the daycare, encourage them to talk about their day and tell them about yours. To develop their sense of confidence, children need to feel valued and when you spend time talking to them, they realize how important they are.

Most of all, have fun! Children grow up very fast and these formative years are when they learn so very much about themselves, their culture, and the world around them.

And of course, read, read, read, read, read, and read! Sing songs, play silly word games, tell jokes, and read the paper together. Expose children to as much language and as much vocabulary as possible.

As always, if you have any questions or comments, please don't hesitate to share them with me.

Get Involved!

As a Kindergarten teacher, I have spoken to so many parents about the need for them to become involved in their children's learning. For many immigrant parents, "getting involved" means that they need to spend time working with their children at home. While the work they do at home is instrumental in helping children consolidate and internalize the skills they are learning at school, there are several other ways that I encourage parents to get involved. The following are some tips:

1. Ask the school principal if you can volunteer in your child's classroom. Not only will you be able to assist the teacher, but you will also have the opportunity to observe the skills your children are learning and the strategies the teacher uses to teach these skills.

2. Become a member of the school council. Before principals can made decisions that affect all students at the school (e.g., whether to have uniforms or not), the principals must consult members of the school council. By becoming involved, you can do a lot to influence the way your child's school is run.

3. Accompany your children on field trips. Teachers often ask for parent volunteers for school trips. Become involved in this way will show your children that you truly care about their education and it will help them see the continuity between the home and school.

By no means is this an exhaustive list. There are so many things you can do to become and remain involved in your children's learning. The most important thing to remember is that you can do so much to help your child have positive learning experiences at school. So get involved!

As always, if you have any questions or comments, please do not hesitate to ask.

Constipation among Children

Constipation is very common in children of all ages. Of all visits to the pediatrician, 3% are in some way  related to this complaint .25 percent of visits to a pediatric gastroenterologist are due to constipation.

Millions of prescriptions are written every year for laxatives and stool softeners.

What Causes Constipation?

Constipation is mostly functional. This means it is not due to any medication or anatomic abnormalities .Ninety percent of the causes of constipation come under this category

.

· Immature system: In some infants, constipation can be due to an immature system,improper relaxation of the rectal muscles.

· Some breast fed infants can go without a bowel movement for several days. However it is important to look for signs such as

 Distension of the tummy

  Persistent vomiting especially

 Inconsolable crying

If any of these are seen then it is important to contact your primary care provider or visit the emergency room. It is important to rule out obstruction of the intestines, ileus, Mal-rotation, Volvulus.

 

 Fiber: Lack of fiber can also cause constipation later on in life. Once the child has been constipated for more than a few days, the retained stool can fill up the Large intestine (the colon) and cause it to stretch. This overstretched intestine then does not work efficiently to expel stool.

 
Then constipation becomes a behavioral issue. The bowel movements are hard and painful .Most of the times children withhold their stools due to fear of pain. (Withholding Behavior)

In some children, constipation can begin when

· there are changes in the diet

· the time of toilet training

 Following travel, or after a viral illness.

· Older children can begin withholding the stool .Even if they have an urge to use the bathroom. They may be afraid to use public toilets. School or summer camps, with facilities that are not so clean, are common causes of stool withholding in this age group.

There are some causes that may be due to a problem with the muscles of the stomach, anatomic abnormalities, endocrine problems, drugs. These causes are not so common.

Hence it become extremely important to talk to you primary care provider with regard to the consistency of the stools, when and at what age did your child start having hard stools. It is also important to know if your child had difficulty passing the first stool. This may not be functional and may need to be further looked into.

When does constipation become a problem?

 

· If your child has Hard painful stools that are difficult to pass

· If your child consistently skips days without having normal

  Bowel movements

· If your child has symptoms such as constipation stomach pain, poor appetite, and  crankiness

· If you see bright blood in the stool or on the toilet paper after wiping. This hard stool can tear the lining of the anus which is also called a fissure. These fissures are very painful and bleed.

· If your child has Problems with passing the stool in the underclothes. Most of the times  the child is not aware of this soiling. The child does not feel the urge to have a bowel movement and has an accident. These stool accidents are often mistaken as diarrhea.

· Pain-abdominal or rectal

· Daytime or night time urinary incontinence and recurrent attacks of a urinary tract infection

In most cases there is no need for testing prior to treatment for constipation. However sometimes the doctor may need to do an X-ray of the tummy or perform other tests to asses the degree of stool or rule out other causes of constipation.

How do you treat constipation?

The goal of treatment is soft, regular stools. Positive results requires time and patience

Diet rich in fiber and fluids are important in the treatment of constipation. Fiber such as fruits, vegetables, whole grain breads, cereals.

Many a time’s behavior modification becomes extremely important. It is often helpful to start a bowel training routine where the child sits on the toilet for 5 – 10 minutes after every meal or before the evening bath. It is important to do this consistently in order to encourage good behavior habits. After every successful bowel movement a reward such as a sticker may be given that reinforced this positive behavior.

A few children may require an initial “clean-out” to help empty the colon of the large amount of stool. This typically entails the use of laxatives by mouth or even suppositories or enemas for a short period of time.

Please feel free to post any comments or questions

Preserving Your Home Language

Hello all,

As a kindergarten teacher, parents often approach me with concerns about their children's language skills in English. This is especially the case for parents who have recently arrived from another country, and who struggle with the English language. These parents will often say that they are trying to speak to their children in English as much as possible to help them learn the language. Many stop using their home language with their children completely. While it is important to introduce children to the English language and to communicate with them in English, it is absolutely critical for parents to continue using their home language. The research clearly indicates the many advantages of bilingualism (and multilingualism) on children's ability to learn English. These studies have shown that when children are fluent in their home language(s), many important language skills (e.g., phonemic awareness, vocabulary, higher order thinking skills, etc.) transfer over and help them learn the English language much more quickly and much more efficiently. 

In addition to helping children learn English, fluency in the home language is essential in helping children preserve their cultural identity. Moreover, as children grow older, their home language helps them to continue to communicate with family members who may not speak English (e.g., grandparents). This is so very important because if children lose their first language, they may potentially risk their relationships with family members. And while it is natural for children to communicate in English once they begin school, parents should still encourage them to use their home language as much as possible. For younger children, it is a great idea for parents to enroll them in classes where they have the opportunity to learn how to read and write in their home language.

Finally, our societies are becoming more and more global and our world is more connected now than it has ever been. Giving children the benefit of learning and mastering several languages (including their own) will enable them to thrive in this society.

Let's Talk! Let's Talk! Let's Talk!

Hello all,

As adults, we do not realize the critical importance of talking with children and, as a result, we spend most of our time talking to children (e.g., telling them what to do). Having conversations with children helps them develop their vocabulary, it helps them learn the rules and conventions of our language, and it presents them with a great opportunity to ask questions and to learn many new things. In addition, by initiating conversations with children when they are young, they become comfortable talking to you and it becomes easier for them to talk to you when they are older about serious issues (e.g., bullying at school).

There are many simple ways to engage in conversations with young children. These conversations can be centered around books that you read together, events you attend, or even around a question the child may ask. You can also initiate conversations when you play with your children. For example, if your child is building with blocks, you can have a conversation about what the blocks represent and make up a story together about the structure the child may be building.

During the early years, children's language skills grow very quickly. They learn the words they hear and the words that are spoken to them. By the time children are three, they have a vocabulary of nearly 1,000 words. So how do you initiate conversations with your children? You may find the following tips helpful:

• Children love to ask questions. Build your conversations around these questions and ask your own.
• Talk about what your child is doing and what you're doing. Ask questions that extend their thinking such as, for example,"what kind of picture are you drawing?" or "what do you think will happen next in the story?" and "what is your favourite part of the story?"
• Practice taking turns in conversations.
• Read with your children. Involve them in the reading. If they are still too young to read, do a "picture walk" with them and have them tell the story looking at the pictures and using their own words.
• Continue to have conversations with your children in your first langauge. Research has shown than language skills transfer over when children learn another language.

Remember, it is largely through conversations with more experienced adults that children come to learn about the world outside their own personal experiences. So continue to have fun conversing with your children. As always, if you have any questions or comments, don't hesitate to share them with me.

Irritable bowel syndrome

Have you ever had these tummy aches ----that everyone has dismissed as a pain of convenience. My own mother always thought it was my most played excuse to stay out of school.

Finally after going through a series of tests and half a dozen doctors i finallly had a diagnosis-irritable bowel syndrome.

So what is irritable bowel syndrome and how common is it?

It is chronic disorder that can cause abdominal pain ,bloating and abnormal bowel movements. About 15-20% of school aged children . Children with irritable bowel syndrome complain of bloating,abnormal bowel movements. They complain of constipation alternating with diarrhea. The abdominal pain is diffuse, occurs any time of the day. It may be non -existent for weeks  and then on a warm sunny morn when you have the whole day planned out the pain may recur.

What causes IBS?

Although the exact cause is not known, It is postulated that some chemicals secreted by the intestines  or brain, may cause the intestine  to be more sensitive to triggers like stretching of the intestine .

How is it Diagnosed?

A careful history of how of the site onset and character of the pain may help distinguish it from more serious problems. It is also quite possible that the doctor may obtain some tests. The reason for these tests is to look for signs of any serious disease. These screening tests may initially include blood and stool tests. The results of screening tests often guide the doctor in deciding whether further tests are needed .Often times a referral to pediatric gastroentrologist shall be made.

If any of the tests come back abnormal-then definitely its not Irritable bowel syndrome . Further testing like endoscopies or imaging studies such as CT scans and upper Gi series may be required.

It is also recommended to watch out for these red flags:

Weight loss

diarrhea with blood

Joint pains and rashes

Pain that is not easily controled and is different form the usual

The primary care doctor needs to be informed. Depending upon the case a visit to the Emergency may also be necessary.

So does your child have IBS ?

Does your child have pain in the tummy that has been present for weeks-

• Gets relieved with defecation
• Is often associated with a change in the frequency of stool.
• Onset is associated with constipation alternating with diarrhea.

Other symptoms that may or not be present:

• Abnormal stool form
• Abnormal stool passage(straining,urgency or incomplete evacuation)
• Passage of mucus
• Bloating or feeling of abdominal distension

Treatment

Physicians know that stress and anxiety do not cause the problem. But they do aggravate it. So things that could be done and are under our control are:

• Establish a good relationship with a physician
• Eat more fiber
• Avoid fatty foods. Fatty foods may aggravate symptoms in children with IBS
• Medications: such s antispasmodics can temporarily relieve symptoms
• in cases where there is a tendency to be more constipated-laxatives may be used. Diarrhea may also be an issue that can be relived by the use of anti-diarrheal medications
• Reduce stress .Relaxation and behavioral techniques are always helpful.
• The most important thing is to understand your child and his needs.

What do i anticipate in the future?

Irritable bowel syndrome may have negative effects on the child’s physical and psychological state. The pain may interfere with school attendance, participation in sports and other extra-curricular activities. Infrequently, it may affect appetite and sleep

Fortunately, the diagnosis of functional abdominal pain has a good prognosis. Half of these children getting better on their own .

Please feel free to post your comments or ask any questions.

Ritu Walia

Spit ups

                                      My baby is a happy spitter

In our practice 50 percent of the mothers complain that their babies won't keep their formula down. They cry and most of the times are fussy. Most often these babies also have problems with adequate weight gain and various other problems that may get the parents worried. The spitting up or Gastro esophageal Reflux (GERD) GER occurs often in normal infants. Most infants with GER are happy and healthy even though they spit up or vomit. Spitting up tends to peak at 4 months and most infants stop spitting up by 12 months.                                                                                                 

When is it necessary to treat Gerd?

As long as the baby is gaining weight and is growing well, and has no other medical condition there is no need to treat this condition .However if if you see any of these following signs - It is important to involve your primary care provider.

·         If you see Vomiting associated with

            Blood

           Green or yellow fluid

            Poor weight gain

·         Inconsolable or Severe Crying and Irritability

·         Persistent Food Refusal

     Poor growth or failure to thrive 

·         Breathing Problems

       Difficulty breathing

      Repeat bouts of pneumonia

           Breathing stops

            Turning blue

            Chronic cough

           Wheezing

What tests may be ordered by you doctor?

Depending how severe the reflux is the following may be ordered:

1.  Test for a blood in stool

2. To look for anemia

3. Upper gi series-a type of x-ray to study the baby’s food pipe and the tummy.

4. Ph probe - A test to measure how often stomach contents wash up into the food pipe

However if the baby (0-24 months old) is gaining weight certain conservative measures can be employed;

Smaller frequent feedings should be given.

Frequent burping during feedings.

Avoid using an infant seat after feeds, this may encourage reflux

Changing the formula to a more basic form like nutramigen, allocare ,neocare.

Thickening of the feeds with rice cereal. Prior to this it is advisable to consult your primary care provider.

Role of Medications

If necessary medications may be provided. Two types of medications may be used one that reduces the stomach acid. Another type that shall prevent food from the stomach to go into the food pipe (esophagus). This again should be discussed with your primary care provider

Reflux may occur in older children and adolescents-which may at times require a more extensive work up. However this can also be modified with a conservative approach like

·         To have smaller more frequent meals.

·         Avoid eating 2-3 hrs prior to bed time.

·         Elevating the head of the bed to thirty degrees.

·         Avoiding choclate, carbonated drinks, spicy food and caffeine.

·         Avoiding large meals prior to exercising.

·         Loosing weight if over weight.

·         Avoid exposure to tobacco.

When do you get worried?

If any of the above mentioned worrisome signs are seen along with

·         Sensation of food coming to the back of your throat

·         Discomfort or pain in the stomach and chest

·         Swallowing problems such as

·         Pain while swallowing

·         Discomfort while swallowing

·         Sensation of food getting stuck in the chest

·         Breathing problems along with hoarseness of your voice

Diagnostic testing and treatment

Other than the above mentioned tests  An endoscopy may become necessary depending on the Patient. If the child has been taking acid suppression drugs for more than two months without any relief in the heart burn an upper endoscopy may be required. This allows the Doctor to look directly at the Childs food pie and stomach to check for any abnormality.

Generally acid suppressing drugs may be necessary if symptoms persist even after changes to the lifestyle are made.

Prior to making any of these life style changes it is important to discuss it with your primary care provider. Please feel free to post any comments or questions.

Ritu Walia

Reading = Learning

Hello all,
Reading is a fun activity that you can engage in with your child at any time of the day. It is a great way to spend some time together and to really get your child interested in reading.

When children are very young, you will be doing most of the reading and your children will enjoy listening to you. Remember to choose books from a variety of genres and topics. Choose books that have rhyming words in them (Dr. Seuss books are a good choice for this). My personal favourite authors include Robert Munsch and Eric Carle. Also, I always encourage parents to have their own library of books at home that children can choose from. Your local public library is also a great place to get books from. You may also consider speaking to the children's librarian to get some ideas of authors that children enjoy.

While reading is a good way to wrap up the day or to just have fun, there is a lot you can do to support your child's learning. The following are some basic strategies you can use when reading to your child:

1. Read the title of the book. Talk about why the title is important and emphasize that it sets the stage for the story that follows.

2. As you read each page of the story, go on a letter hunt with your child. Ask them to find the letter "a" or the letters that makes the "sh" sound.

3. Have the children predict what will happen next. Talk about whether the prediction was accurate or not. Emphasize that predictions need to be logical and that it is important to use information from the story (the context) and information they can draw from (their own experiences, knowledge, etc.) to make these predictions.

4. At the end of the story, have your child retell the story in his or her own words. Model how this is done for the child, and use words like "first," "next," "then," "after" to guide their retelling of the story.

By no means is this an exhaustive list of the kinds of things you can do when reading to your children, and this list is only meant to provide you with a general guideline to use when reading to your child. Be sure to talk to your child's teacher about what you can do at home to support your child's developing skill and interest in reading.

As always, if you have any questions or comments, please feel free to share them with me.  Until next time, keep reading!

Infant health and Nutrition

Hello! My name is Ritu Batra Walia. I am pursuing a career in pediatric gastroenterology. Pediatric gastroenterology specializes in the care of children with chronic abdominal pain, diarrhea, constipation, vomiting, bleeding from the GI tract, inflammatory bowel disease, liver diseases, diseases of the pancreas, poor weight gain and nutritional problems

With this blog I would like to discuss day to day complaints that drive a mother to the pediatrician’s office. I would be discussing issues on growth, nutrition and disorders related to digestive diseases.

I wonder how many mothers have complaints that their new born baby does not stop crying. The baby is miserable and is too fussy. This leads us to a discussion on infantile colic---.

What is infantile colic?

Colic is defined as crying and extreme irritability in infants. The fits of inconsolable crying tend to occur in the evening, but many infants do not follow a predictable pattern. The crying and fussiness can last for

hours at a stretch, followed by other periods when the baby acts and seems perfectly normal.

How common is infantile colic?

Colic is very common, affecting 1 in 4 newborns. The reason for the irritability is not totally clear but includes an immaturity of the baby’s nervous system, sleeping disruption, hypersensitivity to the environment and sensory overload. However it is important that the parents discuss this pattern with the pediatrician in order to rule out other causes that may need immediate medical attention.

What are the symptoms of infantile colic?

The baby will start crying at the top of their lungs, as if in apparent pain, turning red in the face, kicking the legs, arching, and passing gas. Sometimes, feedings will temporarily stop the screaming, only to resume when the nipple is taken or pushed away. Colicky infants continue to gain weight and grow normally.

Just remember a rule of threes:

Begins at three weeks of age

Lasts upto three hours

Occurs at least three days in a week

Lasts unto three months.

How do I treat my baby?

There is no specific treatment, Often; the baby’s formula is changed to one that is more basic. Some mothers will modify their own diet, removing gas forming foods or dairy products. If acid reflux is suspected, antacids can be tried and continued if they clearly help. In most cases massaging the baby’s tummy, swaddling or soothing music may help.

Above all the prognosis is very good and by three months of age the baby is more comfortable and this exhausting phase passes.

There is very conflicting data on over the counter medications. It is important to speak with your primary care provider prior to using any herbal or over the counter medications to your baby.

This is a tough phase for the parents. I am sure they loose allot of sleep during this time. It’s good to have some family support during this time.

As beautiful as mother hood may be ---it comes with a lot of sleepless nights, unconditonal love and sacrifice. These mothers also need some time for themselves and a little bit of tender love and care.

My next blog shall focus on something that we all suffer from----heart burn .Especially in infants.

Please feel free to share your questions and comments with me.