Kids’ Health Q&A

School is starting again, and I’m afraid that when left to their own devices, my kids will subsist on cafeteria corn dogs and Tater Tots. How can I make sure they’ll eat healthy meals?

William Lawrence, MD: Whenever feasible, we encourage packing a breakfast or lunch to send to school. It really gives you control over content. Most children don’t get enough fruits and vegetables in their day, so send things that are packable and won’t quickly spoil: apples, bananas, carrot sticks.

And for breakfast, try thinking beyond traditional foods like pancakes. A little bit of protein and a good carbohydrate source, like a stick of mozzarella and a piece of fruit, can make a healthy breakfast.

While packing meals is not always practical, simply knowing what’s on the school menu [check your school's Web site] can help you steer your child toward healthier options.

Depending on your child’s specific dietary needs, good everyday choices may include 1 percent milk instead of whole or chocolate milk, or opting for water instead of juice — there are a lot of concentrated calories in juice, so cutting it out can really have a good impact.

At our house, we know it’s autumn before the leaves change color because our child’s sneezing and runny nose really ramp up. Can you recommend any natural remedies for seasonal allergies?

Michael Land, MD: There is not enough strong evidence to recommend the use of herbal supplementation, acupuncture, or “special diets” for the treatment of allergic rhinitis. Some patients benefit symptomatically from nasal saline rinse, which washes out debris and pollens.

Allergy shots are considered by some to be a natural way of dealing with allergies, although they are still a medical treatment given by a doctor. These injections actually expose your body to small amounts of what you’re allergic to. By starting with tiny amounts and gradually increasing regularly, these injections slowly change your immune system to be able to tolerate larger amounts of the allergens.

The best way to get rid of the symptoms of allergic rhinitis would be to avoid the allergen that is triggering them. Reducing exposure to outdoor allergens is important when the pollen count is high.

To avoid outdoor pollens, keep the windows closed in your home and car. Also,  pollens are often emitted in the early morning hours (between 5 a.m. to 10 a.m.), so avoiding early morning outdoor activity can help extremely sensitive people.

Is it really better to “air out” a scab and keep it dry, or should you keep it covered and moist — or does it make a difference?

Martha Gagliano, MD: Airing out scabs has fallen out of favor among dermatologists. Scabs itch and kids pick at them.

We’d rather keep it covered and not let it form that thick, itchy scab. Coat the scab in an antibiotic ointment like Polysporin, then bandage it to keep it moist and not let it get crusty.

My day-care provider says my child should probably stay home if he’s got “green snot.” Does that mean he has an infection? When should I take him to the doctor, and when can he just ride it out at home?

Gagliano: That’s a myth — the color of mucus is completely irrelevant. Kids don’t blow their noses very well, so the mucous turns green.

The younger a child is, the harder it is to know how serious an illness is. Both viral and bacterial infections can make very young children quite ill, so with infants it’s best to be proactive and to follow your instincts: If your baby is listless, eating poorly, or just doesn’t look “right” to you, call your doctor.

Any fever in a baby less than one month old is worrisome, and you should call your doctor immediately.

For older children, things are a little easier. In general, viruses cause lower fevers (less than 102.5º), are accompanied by symptoms such as a runny nose, hoarseness, vomiting, or diarrhea, and improve over three or four days.

The illness is more likely to be bacterial if the fever is high, if it lasts longer than four days, of if there is specific pain (like a sore throat or an earache).

Note that antibiotics don’t work on viruses, only on bacterial infections. We have a huge problem with drug resistance because of the overuse of antibiotics, so you don’t want to  use them unless they will really do some good.

For a virus, keep your child comfortable and hydrated and wait it out. Most viruses are at their worst for three to four days, so if it lasts longer, or if the fever is 103° or higher, go to the doctor.

While we’re on the subject of fevers, is it better to let a mild fever go? If I bring down my child’s temperature with Tylenol or Motrin, for example, am I hampering the body’s ability to fight infection?

Gagliano: That’s controversial — maybe the fever’s doing some good, but maybe not. If your child is uncomfortable, treat the fever. Most kids look terrible with a fever, so they’re very difficult to assess.

Controlling the fever allows both the doctor and parent to assess how that child is doing. Also, kids get dehydrated easily; when they have a fever, they’re losing water and need more, but they often won’t drink as much, so they’re at higher risk of dehydration. My opinion is to go ahead and treat those fevers.

Size of athletes could mean future health problems

Big athletes, especially football players are sought after. A new study shows that big size, especially among football players, could mean future health problems. The study builds on past media reports suggesting that football players are twice as likely to die before age 50, compared to baseball players. The larger size of athletes that can lead to future health problems is linked to the development of cardiometabolic syndrome.

The study, presented at the 74th Annual Scientific Meeting of the American College of Gastroenterology (ACG) in San Diego is the first to explore the health risks among younger athletes for the future development of cardiometabolic syndrome.

According to study author Dr. Michael Selden, “We expect professional athletes to be in peak physical condition given the demands of their jobs and the amount of time they spend exercising heavily. However, there does not seem to be a complete protective effect of exercise, particularly among the larger athletes – football linemen. Instead, the impact of their sheer size may outweigh the positive benefits of exercise to mitigate their risk for cardiometabolic syndrome, fatty liver disease, and insulin resistance.”

The researchers collected health information in 69 current professional football linemen, and 155 professional baseball players. Included were blood pressures, fasting glucose levels, triglycerides, waist circumference, HDL (the good) cholesterol, BMI, waist-to-height ratio, insulin resistance and serum blood levels of the enzyme alanine aminotransferase that could indicate fatty liver disease.

Compared to professional baseball players, football players were found to have overall higher blood sugar levels, increased waist circumference, greater waist-to-height ratios, and increased body mass index – all of which can set the stage for the athletes to experience future health problems.

Study co-author Dr. John Helzberg, FACG says, athletes, especially football players at risk for future problems from cardiometabolic syndrome “… can undergo dietary and possibly medical interventions to reduce their risk, particularly after they stop playing when their risk would be expected to rise with increased age and presumed decreased exercise.” He also says the study challenges the notion that you can be “fat and fit”. A study published 2007 in JAMA looked at 3,683 high school football linemen – 45 percent were overweight and 9 percent of the football players fell into the category of severe obesity, showing that the next generation of big athletes could also be at risk for future health problems.

Gulf Oil Spill Effects Mental Health

For many people, the psychological effects of the oil spill in the Gulf of Mexico can be devastating and experts expect mental health issues to go on the rise. “There’s a lot of social disruption. That’s what technological disasters tend to do,” says Lawrence Palinkas, a professor of social work at the University of Southern California in Los Angeles. He will be speaking on the spill’s potential long-term effects.

Howard Osofsky, chair of the psychiatry department at Louisiana State University says, “We’re seeing indications that people are drinking more. We are also beginning to see some indication of increased domestic conflict.” He plans to present early findings about the psychological health of people in the region today.

While images of oil-soaked pelicans remind the fishermen and business the devastating effects, an even bigger challenge for the mental health workers dispatched from Louisiana to Florida to is at hand to help battle the hopelessness and despair.

The Exxon Valdez oil spill in 1989 touched off a wave of suicides, domestic violence, bankruptcies and alcoholism in Alaska that created an entire literature on the unique and confounding psychology of technological disaster.

J. Steven Picou of the University of South Alabama, the author the research on oil spill stress in Cordova, Alaska, stated, “The first suicide occurred in Cordova four years after the spill. I try to explain to people, this is a marathon, and you have to try to stick together. And you have to try to take care of yourself,” Picou said. “Don’t become obsessed with sitting in front of the television watching this wellhead just gush thousands and thousands of gallons of oil into the Gulf of Mexico every minute.”

It’s believed that the effects on the ability of people to make a living, the damage to the areas they lived in, social, economic and cultural dislocation, and even the quick money that came from working on cleanup crews disrupted communities and affected mental health, Palinkas says.

“The hurricane was an act of God. It’s a little bit easier to take. You can only be angry with God for so long,” said Elmore Rigamer, a psychiatrist who is state medical director of Catholic Charities, which is working closely with Louisiana to send counselors into seaside communities. “But this — the more we understand that this could have been prevented, and this was just a failure of corporate ethics in terms of profit, really, overriding responsibility, this makes it really difficult to take,” Rigamer said.

“The oil spill in the Gulf carries with it a very significant risk of PTSD and major depression, as well as other psychiatric disorders,” says psychiatrist Dr. Keith Ablow, author of Living the Truth. “The Exxon Valdez spill was a one-time shock, and that alone caused tremendous suffering on a psychological level. I fear that this event, with its protracted course, could prove far more toxic.”

Meanwhile, psychiatrists, counselor and social workers will be just as important to the Gulf Coast’s recovery as the recovery workers and engineers.

NYC Unveils Citywide Health Goals

Mayor Michael R. Bloomberg and New York City Health Commissioner Thomas Farley today unveiled New York City’s ambitious new health policy – Take Care New York 2012 – outlining the City’s plan to improve the health of New Yorkers by targeting 10 leading causes of preventable sickness and death, including lung cancer, heart disease and HIV. Take Care New York 2012 follows the success of Take Care New York, and is part of the City’s overall strategic health agenda, which was launched in 2004.

Take Care New York identified 10 steps New Yorkers could take to live longer and healthier lives, and set citywide goals for 2008. Through the efforts of more than 400 City and community partners, Take Care New York helped to increase the number of New Yorkers with a regular primary care provider, decrease smoking rates across the city, increase the proportion of adults over age 50 getting checked for colorectal cancer, and decrease intimate-partner homicide. The Mayor and Dr. Farley were joined at the City University of New York’s Graduate Center by Deputy Mayor for Health and Human Services Linda I. Gibbs, Department of Transportation (DOT) Commissioner Janette Sadik-Khan and Housing Preservation and Development (HPD) Commissioner Rafael E. Cestero, as well as Citizens’ Committee for Children Executive Director Jennifer March-Joly.

“The entire nation is focused on the health care debate in Washington right now, and one positive thing to come out of it so far is the attention it’s brought to prevention and the importance of high-quality primary care,” said Mayor Bloomberg. “Those are exactly the areas that we have been focusing on in New York City, and the single best measure of our overall success is that between 2001 and 2006 life expectancy for New Yorkers increased by 50 percent more than it did in the U.S. as a whole. We’ve made some impressive progress over the past four years, but there’s a lot more to do, so we’re setting even more ambitious goals for the next four years.”

“Much progress has been made since Take Care New York began in 2004,” said Health Commissioner Farley. “Today we know more about the behaviors and conditions that affect public health and how different interventions can improve outcomes, and decrease illness. While New Yorkers are healthier today than they were in 2004, challenges remain. Injuries, illnesses and deaths from preventable causes persist, and some New York City neighborhoods have higher rates of sickness than others. Working together on the plans set out by Take Care New York 2012, we can make New York City an even better place to live.”

“The Bloomberg administration is a leader when it comes to creative collaboration and prevention as tools to address some of our City’s most intractable challenges like poverty, homelessness and public health disparities,” said Deputy Mayor for Health and Human Services Linda I. Gibbs. “We are thankful to the many partners who are helping us to create a healthier New York City for all.”

Take Care New York 2012 differs from its predecessor because not only does it include what can be done by individuals, but it also provides ways in which community organizations, businesses, health care providers and government agencies can improve the city’s health. The 2012 policy also adds a new focus on children, acknowledging their unique health needs as well as the opportunity to promote life-long healthy behaviors. It emphasizes closing the health gap among New Yorkers of different races, ethnicities and income levels, and it addresses neighborhood conditions such as safe housing and access to nutritious, affordable foods.

The new policy uses a three-pronged approach that includes: 1) developing laws and regulations to improve environmental, economic and social conditions that affect health (2) emphasizing high-quality preventive health care with expanded access and (3) raising New Yorkers’ awareness of the best ways to improve their own health and the wellness of their communities. Here are the new plan’s 10 priorities for the city: (1) Promote quality health care for all; (2) Be tobacco free; (3) Promote physical activity and healthy eating; (4) Be heart healthy; (5) Stop the spread of HIV and other sexually transmitted infections; (6) Recognize and treat depression; (7) Reduce risky alcohol use and drug dependence; (8) Prevent and detect cancer; (9) Raise healthy children; and (10) Make all neighborhoods healthy places. The full action plan is available online at www.nyc.gov/health/tcny.

Commissioners Sadik-Khan and Cestero both emphasized new opportunities for collaboration to improve neighborhood conditions that contribute to disease and sickness. Dr. March-Joly talked about the importance of a community-wide approach to ensuring that the city’s children live free of preventable illnesses such as obesity and Type 2 diabetes – diseases once thought to be restricted to adults.

“New York City is a walking town, and we’re designing our streets to make walking as safe and enjoyable as possible for all New Yorkers,” said Transportation Commissioner Janette Sadik-Khan. “You don’t need a gym membership to get the exercise you need. These days, we’re biking here too, with 200 new bike-lane miles to ride on. Here in New York, it’s easy to build fitness into your daily routine, and through Take Care New York 2012, we’re going to make it even easier.”

“Healthy lifestyles start in stable neighborhoods,” said HPD Commissioner Rafael E. Cestero. “Take Care New York 2012 offers a unique and comprehensive plan that will build on our successes in improving the living environments of hardworking New Yorkers, regardless of income, throughout the city. By investing in neighborhoods and creating high quality, affordable homes, we are doing more than providing a place to live – we are helping to create a safe environment where these initiatives have the opportunity to succeed.”

“New York City is becoming a better and healthier place to raise children, thanks in large part to the efforts of Mayor Bloomberg, the City’s Health Department, and the partnering City agencies and organizations gathered here today,” said Citizens’ Committee for Children Executive Director Jennifer March-Joly. “We are very pleased that Take Care New York 2012 includes a strong focus on children and youth – as they are the future of our city.”

To help achieve the new goals, the Health Department is working collaboratively with City agencies on key action steps. For example, to help promote physical activity across the city, the Health Department is working with the New York City Departments of Design and Construction, Transportation and City Planning on improving pedestrian and bicycle safety, creating more green and active recreation spaces, and developing street designs and public buildings that are better adapted to walking, bicycling and everyday stair use.

To help make all neighborhoods healthy places to live, the Health Department is working with the New York City Department of Housing Preservation and Development to enforce regulations designed to prevent home hazards such as rodents and other pests, improperly installed window guards, lead paint, and missing smoke and carbon monoxide detectors.

Below are some of the specific actions the Health Department is pursuing to achieve the plan’s goals:

To promote quality health care for all, the Health Department is increasing the use of electronic health records to advance the quality of clinical services.

To stop the spread of HIV and other sexually transmitted infections, the Health Department is improving access to HIV testing and condoms, and working to promote safer sexual behavior.

To reduce risky alcohol use and dependence, the Health Department is advocating for policies that reduce underage drinking and heavy drinking among youths and adults.

To improve heart health, the Health Department is collaborating with food industry leaders on a voluntary plan to reduce salt in processed foods.

To make New York City tobacco free, the Health Department is working to reduce the availability and social acceptance of tobacco and limit exposure to second-hand smoke. The Department is also expanding access to, and use of, smoking cessation services.

To measure the effectiveness of these action steps, the Health Department will monitor a set of indicators within each of the plan’s 10 priority areas. These include:

Reduce – by 17 percent – the rate at which New Yorkers are hospitalized for preventable causes.
Cut the smoking rate among New York City adults by 29 percent.

Lower the proportion of New York City adults who drink one or more sugar-sweetened beverages each day by 20 percent.

Reduce premature deaths from major cardiovascular disease by 20 percent.

Increase – by 17 percent – the proportion of men who have sex with men (MSM) who report using a condom whenever they have anal sex.

Reduce – by 5 percent – the proportion of psychologically distressed adults who do not receive treatment.

Reduce – by 19 percent – the rate at which New Yorkers are hospitalized for problems attributable to alcohol.
Increase – by 30 percent – the proportion of New Yorkers 50 and older who have had a colonoscopy in the past 10 years.

Reduce the city’s teenage pregnancy rate by 16 percent.

Reduce, by 13 percent, the gap in housing quality between low-income and high-income neighborhoods.

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