Halloween Treats

Trick or Treat  HalloweenHalloween can be a scary time for more reasons than the goblins and spooky ghosts. Halloween seems to kick-off the season of treats. Many parents dread Halloween due to the amount of candy that their child drags home after a long night of trick-or-treating.  This can be unwelcome, especially if any member of the family is attempting to manage their weight.  Let’s take a moment and spin this into a learning opportunity.

Trick-or-treating is a great time to teach kids about moderation. Remember, Halloween candy is no different than other sweets and desserts.  There is a growing body of research that encourages families to mark no food as forbidden. Ellyn Satter encourages parents to help their children to, “Learn to manage sweets and to keep sweets in proportion to the other food [they] eat.” Moderation can be a difficult concept to grasp, but it is a lesson worth learning. According to research, treat-deprived children often end up weighing more later in life due to hoarding forbidden foods, where as children who are permitted to enjoy treats regularly maintained a healthier weight. Additionally, authoritative food policies often encourage sneaking and hiding behaviors.

Brave parents may allow their children to manage their own stash of Halloween candy and possibly learn the hard way after a few bellyaches. Other families may wish to combine the booty and sort through it together; allowing each member to identify the candies that they “love,” “like,” and can “do without.” Most people find it beneficial to throw out the candy that they can live without and enjoy the rest 1 piece at a time as part of a meal.

It is helpful to refer to published guidelines regarding added sugar to identify a healthy way to enjoy candy. Currently, the American Heart Association recommends a certain number of grams of sugar per day based on their age and gender. For reference, there are 4 grams of sugar in every teaspoon of sugar

  • Men: 36 grams per day (9 teaspoons)
  • Women: 25 grams per day (6 teaspoons)
  • Pre-teen and Teenagers: 20-32 grams per day (5-8 teaspoons)
  • Children (4-8 years): (3 teaspoons)
  • Preschoolers (2-3 years): 16 grams per day (4 teaspoons)

In order to do your part and limit the extra sugar that enters your home, choose to hand-out the following candy alternatives:

Non-Food Alternatives:

  • Stickers
  • Glow sticks
  • Play dough
  • Rings
  • Toothpaste/Floss/Toothbrush
  • Pencil/Erasers
  • Post-it’s
  • Bubbles

Food Alternatives:

  • Sugar-free Gum
  • Granola Bars
  • Pretzels
  • Crackers
  • Trail mix

So, with moderation in mind, may the force be with you as we forge into the season of sweets!

October Recipe: Hit the Trail Mix

A healthful alternative to candy and chocolate is trail mix loaded with fiber, vitamins and minerals.

Ingredients

  • 1 Cup unsalted Nuts (Peanuts, Almonds, Walnuts, Pistachios)
  • 1 Cup dried Fruit (Raisins, Cranberries, Cherries, Berries)
  • 1 Cup unsalted Seeds (Pumpkin/Pepitas, Squash, Sunflower)
  • ½ Cup Chocolate candies (Carob chips, M&M’s, Chocolate chips)

Mix all ingredients in a bowl.

Use a ¼ cup measuring cup to distribute mixture into separate air-tight containers or bags.

 

What’s your family’s strategy for dealing with the treats of Halloween?

Halloween Treats
About Cassie Vanderwall, MS, RD, CD, CDE, CPT
Cassie Vanderwall is a registered dietitian, certified personal trainer and certified diabetes educator at the UW Health Pediatric Fitness Clinic and Pediatric Diabetes Clinic. Cassie is passionate about empowering families by equipping them with the tools they need to achieve a healthier life.

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Teens and Malls

Thin mannequins, flashing lights, the pressure to conform, and the chance to meet up with peers — both known and unknown.

Teens and the MallIt all happens at the mall, and teenagers often swarm there. Don’t take it too lightly. The mall can offer your teen an opportunity to hang out, outside of parental supervision, and yet still be in a place with rules and expectations. Successful experiences at the mall often involve deliberate preparation in shopping etiquette, public behavior and smart shopping.

Let’s back up a bit. If you have a pre-teen not yet ready to be alone at the mall, you can still prepare him or her for this eventual exciting event. Take them shopping and discuss, casually, money, marketing and the consequences of public behavior. Let them watch you as you navigate through sales, temperamental clerks and working out your budget.

As you prepare to let go of your teen at the mall, take it in steps:

  1. Go to the mall yourself and observe the happenings. Take notes and come home as you prepare to alert your teen to the mall experience. Each mall is different and brings you its own unique experiences including parking, dining and safety issues.
  2. Have your teen bring along her friends as you go shopping with her.
  3. Go to the mall together and let them go ahead. But still keep an eye on them.
  4. Go to the mall together but then actually separate. Have them call you at designated times and discuss plans and possible purchases.
  5. Finally, begin to drop her off and pick her up at a pre-arranged place and time. The duration of mall stays will depend on proven responsibility.

Use the mall to reiterate some of the good values that you already have instilled in your teens. Let them use the mall to exhibit good public behavior. Teaching them proper shopping etiquette (put merchandise back in its original locations; wait in line patiently; smile and be polite to clerks) can only help your teen with their public social skills. Chances are they’ll be steps ahead in other displays of public behavior too.

We have to mention shoplifting. While your adolescent may not plan to shoplift, he or she can fall into this act to impress friends, especially due to the “dare” factor. Your teens should know how to remove themselves from a suspect group.

Teach your teen about shopping and marketing gimmicks. Thirty percent of what? – the original price. Should she buy it just because it is on sale? Does that fit into the budget?

Finally and really important, try to prepare your teens, especially females, for the inevitable conflicts they might feel as they visit the mall. Their clothes size is different than their peers and is changing; that is ok! They don’t feel right about how young women are being portrayed- that is ok and good! They don’t look like the glistening bodies or rail-thin mannequins- that is ok. Maybe they can’t buy the expensive jeans that their friends can; that is ok. Arm them with preparation to be confident in themselves and own their own choices and self-esteem.

Teens and Malls
About Caroline R. Paul, MD
Dr. Caroline R. Paul is a pediatrician at UW Health West Clinic.

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Let’s talk about…

Teenage girl and physicianA recent study conducted in New Jersey and Pennsylvania looked at electronic documentation and notes from pediatric visits and showed pediatricians had only documented a sexual history for one out of five teenagers.  The authors of the study also found very low rates of recommended testing for sexually transmitted infections in teenage patients, a finding concerning given that half of all chlamydia and gonorrhea cases occur in people between the ages of 15 and 24.

So why aren’t some pediatricians talking about sex?

There several reasons to consider.   Time constraints on visits make in-depth history taking difficult and put pressure on providers to limit the questions that they are able to ask.  Some also believe that some pediatricians just are not that comfortable asking or assume that they’ll know what kids are at risk, though studies show that 47 percent of U.S. high school students have ever had sexual intercourse.  Lastly, because there are laws and ethics that protect the conversation between adolescents and their providers (except when there are reports of abuse or concern for imminent self-harm to the patient’s self or to others), some providers may chose not to document fully the conversations that they have with adolescents, even if they are asking the questions.

Many might wonder how important it is for a pediatrician to ask an adolescent about their relationships and sexual activity, but this is a critical part of providing the appropriate counseling, testing, and education to support health.  Here’s the deal:

Let’s talk about… much more than sex.  Though it’s often labeled a “sexual history,” the conversations between a provider and an adolescent encompass much more than that, ranging from safety and relationships at home and at school or work to diet, body image, drug and alcohol use, and mood.  The “sexual history” is just part of the interaction, and even that conversation covers a number of different topics.  Often, providers will start by talking about attraction, puberty, and healthy relationships at younger ages.  As teens get older, discussions are guided by the patient’s experiences and include anticipatory guidance and education to help teens be as safe and healthy in their relationships as possible, including delaying sex if they’re not ready.  We also screen for violence or abuse in relationships and open up a safe space for victims of sexual assault.

Families play an enormous role in education around all of these topics, and an open relationship that encourages straightforward discussion with lots of room for questions can be a teen’s best resource.   A pediatrician that asks these important questions can add to that by being another trusted adult with access to the latest up-to-date information and tools for screening and prevention of sexually transmitted infections and pregnancy.

Let’s talk about…
About Brittany Allen, MD
Dr. Allen is a pediatrician at UW Health University Station. Her special interests include preventive pediatric care, adolescent health and care of LGBT and transgender youth.

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Educational and Social Opportunities for All Children

Katie and Benny

Katie and Benny

When I was in preschool my best friend was a boy in my class named Benny. He had spina bifida and used a wheelchair, which I was very jealous of and thought was super cool.  When I turned four I invited him to my birthday party. Benny arrived, and as soon as his parents left our house,  he screamed and cried. His parents had shared with my parents that this was the first time he had been invited to someone’s house and the first time he had been to a birthday party. His parents waited for a while on the porch to make sure he would settle in and have a good time, which he definitely did.  Benny and I were very fortunate to attend a preschool which was able to accommodate special healthcare needs children.  I was able to have a wonderful friendship with Benny, and Benny was able to engage in normal childhood activities.

As a pediatric resident in the children’s hospital I frequently see children with special healthcare needs (any child with medical needs above that of an average, healthy child). 15.5% of children in WI have special healthcare needs, and I wonder if they have the same early education opportunities as my friend Benny did.  Are children with special needs welcome at day cares, preschools, and other childcare venues? Are environments created where they have the same opportunities to interact with their peers and make friends?

While there are some local resources, the need is much greater than can be met by the available services. Families of children with special healthcare needs have a very difficult time finding childcare, and for those who do, sometimes their children are asked to leave because their needs are too great. Childcare centers do not always have the resources and support required to provide the necessary care for children with special needs. In addition, early education programs that do have the ability to do so aren’t able to enroll all of the eligible children.  It is important that families and healthcare providers be aware of what is available, but more importantly we need to know what is still lacking and work to fill those voids.  Benny’s life was positively impacted by being able to get the services that he needed.  We should work hard to ensure that every child with special healthcare needs has that same opportunity.

A few of the local resources are:

  • Head Start  provides need based early education and childcare
  • The southern regional center for children and youth with special healthcare needs at the Waisman Center helps connect families to resources
  • United Cerebral Palsy of Greater Dane County provides services and connects families with outside resources
  • 4-C  provides resources and referrals to childcare and facilitates free play groups for children and parents
  •  Gio’s Garden provides respite care for children with developmental or physical delays
  • Center for Families provides respite and crisis child care
Educational and Social Opportunities for All Children
About Katie Rebedew, MD
Dr. Rebedew is a pediatric resident at the University of Wisconsin Pediatric Residency Program.

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Contraception: What’s Best for Teens?

ss_160528112_teen_girlsTeen pregnancy is a public health concern, and it’s totally preventable. True, not having sex is the best way to prevent pregnancy. However according to the most recent CDC Youth Risk Behavior Survey (YRBS), over 64% of teens have had sex by the time they graduate high school, so we need to suck it up and talk about the next best way to prevent pregnancy: contraception. Last week, the American Academy of Pediatrics released an updated statement asserting that the best contraception for teens is Nexplanon (implant in the arm that lasts 3 years) and the intrauterine device (device placed in the uterus during a pelvic exam and lasts 3 years-10 years, depending on the type). Together, these contraceptives are called Long Acting Reversible Contraceptives (LARCs).  These are the most effective pregnancy prevention for a number of reasons.

For one, LARCs take the responsibility of adherence off the teen’s shoulders.  All forms of contraception work best when taken appropriately. For example, birth control pills should be taken at the same time every day (I’m going to repeat that. At the same time every day.  NOT “in the mornings during school days and at nights during the weekend, and oops, I forgot to take Friday’s pill so I’m going to take 2 on Saturday.”)  There are similar scenarios for the patch, ring, and injection; trust me, I hear them at least once a day from my patients.  This is why most sources list 2 effectiveness statistics for each method: one is for PERFECT use (as in, taking the medications exactly how they are prescribed down to the T) and another for typical use (how most well-meaning people take meds).  For the implant and IUD, once they’re in, they’re in.  There is no difference between perfect use and typical use. Even when looking at perfect use for those other contraceptives, LARCs still have a higher effectiveness rate.

The duration of LARCs (3 years for the implant, 3-10 years for the IUD) is perfect for females going through transitions like starting college or graduating from college and starting a job.  Sometimes there are issues that can make obtaining the other contraceptives more difficult (access to pharmacy to pick up the prescription, access to clinic to get the shot, finding a provider in the area that takes her insurance, transportation, etc).  Although having a LARC does not mean that the female should stop getting annual check-ups, at least she can rest easy that she is at low risk of getting pregnant during these transition periods.

Also, LARCS are also great for period control.  There are many reasons that periods need medical treatment, including being too heavy or long, too painful, or not often enough.  Hormone fluctuations during the menstrual cycle can be responsible for seizures, severe mood changes, skin changes, etc.  There are many medical conditions in which hormonal medication is a mainstay of treatment, including Polycystic Ovarian Syndrome and Endometriosis. In my clinic, I do the procedures for implants and IUDs as much for menstrual management as I do for contraception.

Don’t get me wrong – I am a big fan of whatever the teen chooses to prevent pregnancy, be it the birth control pill, patch, ring, shot or LARC. (Besides the “withdrawal method.”  I’m not a fan of that. I have lots of patients with babies due to that method of “birth control.”)  I just want each teen to know ALL her options and make sure she is choosing the right one for herself (and LARCs are a great option for everyone).   I also want each teen to know that nothing is 100% effective at preventing pregnancy besides abstinence; and no hormonal contraceptive method prevents sexually transmitted infections so condoms are always encouraged for dual protection.

Stay tuned for future blog posts describing each of these contraceptives in more detail.  In the meantime, let me know your thoughts in the comment section below.

Contraception: What’s Best for Teens?
About Paula Cody, MD, MPH
Dr. Paula Cody is fellowship trained in adolescent medicine and is a pediatrician at the UW Health John Stephenson Teenage and Young Adult Clinic.

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