Health Features

Raising Them Right

Today’s parents are faced with all kinds of challenges: the growing obesity epidemic, how to harness technology appropriately, dangerous food allergies, and early exposure to everything from TV sex and violence to drugs and guns in the schools. Local experts try to help us navigate the minefields.

[growing up too fast]

Dr. Gregory Finn, Blue Fish Pediatrics:
Children are experiencing puberty earlier than in years past, but probably not as early as you think. The most recent studies show that, on average, children today go through those changes four to five months earlier than 50 years ago. The average onset age for girls is 10.5 years old, and for boys, 11.5 years old. Early puberty, also known as precocious puberty, is defined as coming on two and a half years or more early, or before the age of 8 for girls and 9 for boys.

Genetics plays a large part in determining when your child will experience puberty. There also seems to be some connection between obesity and early puberty in girls. While there’s been a lot of focus on the possible connection between hormones in our food and early puberty, at this point there is no known link between the two.

The good news is that early puberty is relatively harmless, from a medical standpoint. From a psychological one, early development can be stressful and cause children to be self-conscious. It’s important for parents to talk with their children about the normal changes they are experiencing. In rare cases where children experience puberty very early, there are medications that can slow the onset.

Dr. Lisa Ryan, BJC Medical Group, Way to Grow Pediatrics:
The secretion of estrogen in girls or testosterone in boys causes the physical characteristics associated with puberty. Precocious puberty is generally due to early maturation of the hypothalamic pituitary gonadal axis, resulting in the production of estrogen or testosterone at a younger age. Early maturation may be due to a genetic predisposition or possibly a tumor, but usually the cause is unknown. Approximately 27 percent of African American girls and 7 percent of white girls develop signs of breasts or pubic hair by age 7.

During puberty, early or not, boys will exhibit pubic hair or testicular growth. Girls will have breast development, pubic and underarm hair. However, there are cases where a girl may develop pubic hair or some breast growth without continuing to progress through the rest of puberty. Part of puberty is skeletal maturation. It’s possible if a child experiences puberty too early, he or she may not reach his or her full height.

shutterstock_181872899[too much technology?]

Priscilla Bass, Ph.D., Life Transitions Counseling:
Children today have access to the world right at their fingertips. Computer and tablet apps and games are powerful teaching tools, but it’s important to recognize the limitations of these tools and set appropriate boundaries for use. Don’t let technology limit your children.

One problem with many computer games and apps is that they are not as interactive as hands-on play. There is generally one right answer or way to win the game. This doesn’t encourage creativity or complex problem-solving skills. Unlike traditional play, computer games do not encourage kids to use their imaginations, either. Too much technology also can change the way kids learn. Kids who become accustomed to highly visual technology often are not good auditory learners and may have difficulty staying focused in the classroom.

In moderation, though, technology can be a useful supplemental tool to teach anything from colors and shapes to reading and math. Look for games and puzzles that encourage creativity and problem-solving in a fun and engaging way.

Bryan W. Sokol, Ph.D. associate professor of psychology, Saint Louis University:
Smartphones, tablets and computers are simply tools that can have both beneficial and harmful effects on their users—children or adults. Technology can be used either to promote or hinder creativity and human relationships. There is nothing inherently good or bad about it.

Determining what counts as ‘too much’ depends on where the child is in his or her development and how caregivers manage the use of technology in the household. Too often, I suspect, screen time is used to babysit the child and this can be detrimental. On the other hand, screen time, such as using FaceTime to contact a grandparent, can be beneficial in building closer relationships—all things in moderation. Tablets can be used to engage pre-schoolers in a variety of learning activities and to promote the development of different skills. Nevertheless, I would hesitate to allow children under the age of 11 or 12 to use technology unsupervised, and beyond that age I suggest setting rules for use, particularly to alert children about unsafe Internet practices.

[too young for surgery?]

Dr. Jeffrey Teckman, SLUCare/SSM Cardinal Glennon Children’s Medical Center:
Recent studies show that teens who are very obese and have also begun to suffer a complication of obesity—such as diabetes, high blood pressure, high cholesterol, elevated lipids or fatty liver damage—respond well to bariatric surgery. It can help them not only lose weight, but also reverse damage to their bodies.

Before considering surgery, teens (and adults) should try to lose excess weight through diet and exercise. Simple things like walking 30 minutes per day and reducing intake of simple sugars, high fructose corn syrup and trans fats can reverse diabetes and lead to significant weight loss. But if previous attempts to lose weight have failed, bariatric surgery is worth consideration.

It’s important to pay attention to the patient’s mental state prior to and after surgery. At Cardinal Glennon, we have a team of people, including psychologists, medical doctors and a nutritionist, who address conditions like depression and anxiety and also look for ways to help patients make healthy lifestyle changes. Close follow-up care is also important to ensure patients meet their nutritional needs.

Dr. Lisa Hawver, Mercy Bariatric Center:
Bariatric surgery for anyone, no matter their age, is a lifetime commitment to having healthy behaviors. Surgery is not a magic wand; patients have to work hard to achieve and maintain their health goals. The ideal candidate for weight-loss surgery is someone who has the desire and ability to lose weight. It cannot be a decision a wife makes for her husband or a parent for a child.

Bariatric surgery is rarely done in teenagers, due to several factors. First, the patient may not have a good grasp of the necessary lifestyle changes. Second, bariatric surgery can lead to changes in how the body absorbs vitamins and minerals, which may disrupt bone growth. A team approach must be used to assist patients in being successful.

When deciding which type of surgery to pursue, patients and their surgeons need to weigh the risks and benefits of the procedure, as well as the patient’s desired outcome. Sleeve gastrectomy and gastric banding work by restricting intake. Gastric bypass restricts intake and also changes absorption, meaning some people may have problems getting the necessary vitamins and minerals.

[teaching gratitude]

Gratitude is one of the most important lessons parents can teach their children. “Instilling habits of gratitude not only make children more empathetic, which increases their capacity to be a good family member, friend and citizen, but it also shapes their brain to be wired toward focusing on what’s good,” says Rachel Hasper, a licensed professional counselor at Rachel Hasper Therapy in Webster Groves. “While toddlers and young children are naturally self-centered, you can help them relate to the world and people around them and develop an attitude of thankfulness by modeling thankfulness yourself in your words, actions and attitude.”

Simple things like teaching manners and expressing appreciation for the people in your life can help your children learn gratitude. Hasper notes. It’s also important to focus on the things you have rather than what you don’t have. “Volunteer and service work is another way to show children empathy and open up dialogue about all the things to be grateful for,” she says.

Teaching patience through delayed gratification can help instill gratitude. “In a time where life is filled with conveniences, technology is immediate and we can have most things on demand, we are shaping ourselves to be more impatient,” Hasper says. “Rather than buying your child the toy he wants right away, ask him for ideas on how he can earn it. Then let him work for it. It will mean much more to him.”

[preventing peanut allergies in utero ]

With peanut allergies on the rise, it’s no surprise that expecting mothers are looking for ways to prevent food allergies in utero. According to Dr. Hasma Subramanian, an allergist and immunologist with Signature Medical Group, primary allergy prevention is always the ultimate goal. In a 2012 study published in the Journal of Allergy and Clinical Immunology, researchers looked at whether avoiding peanuts and other nuts during pregnancy and breastfeeding would prevent subsequent allergies in children. According to Subramanian, the study was inconclusive, and there currently is no recommendation for expecting and nursing mothers to avoid nuts. “I tell pregnant patients to eat a healthy, balanced diet and not to try new diets during pregnancy,” Subramanian says. “You don’t want to unnecessarily remove a healthy food from a pregnant woman’s body. You have to think about the overall diet. For example, is she vegetarian or kosher? Peanuts are a good source of protein.”

Subramanian recommends waiting until the baby is 4 to 6 month old to introduce complementary foods; shellfish, peanuts and tree nuts (the most common allergic foods) should be added last. This is especially important if there is a family history of allergies. “Siblings of children with nut allergies have a 7 percent risk of also having a nut allergy,” he says.