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Nutrition, Parenting, Public Health

“Less is more”: More holiday eating tips from a Stanford nutrition lecturer

"Less is more": More holiday eating tips from a Stanford nutrition lecturer

cake-buffet-58682_1280My grandmother is fortunate enough to live within an easy drive of the Shady Maple Smorgasbord, a Pennsylvania Dutch-style dining extravaganza in Lancaster County. It’s the size of a large auditorium, packed with tables and two gigantic buffet lines. It’s the biggest restaurant, serving the most food, to the most people, that I’ve ever seen.

For dinner, each day the buffet includes: “46 salad bar items, 3 soups, 8 homemade breads & rolls, 4 cheeses, 8 meats, 14 vegetables, 10 cold desserts, 3 hot desserts, 8 pies, 6 cakes, sundae bar & many beverages.” Plus the daily specials. On Tuesday, for example, there’s also: “salmon, Cajun catfish, cod, oyster stew, beef brisket, New York strip steak and baked potatoes.”  A surfeit of tastiness, abundance beyond words — mmmm, mmmm, let’s go!

Not so fast, Stanford-based dietician, Maya Adam, MD, would say. “Size matters. We can enjoy absolutely any food, as long as its consumed in moderation,” she writes in a Healthier, Happy Lives Blog post, published today by Stanford Children’s Health.

That means no King Size KitKat and no seconds at the smorgasbord dessert line, either. Try using smaller dishes, Adam suggests. Cut servings in half, eat half, save some for later or share with a friend. And pay attention to the food. No texting, TV watching or mindlessly shoveling food into your mouth. Savor each bite, Adam writes:

The truth is, when we eat real, fresh food in modest amounts (even if it’s cooked with a pat of butter and a sprinkle of salt) it doesn’t take much to leave us feeling completely satisfied.

Don’t flip out if you just can’t resist that smorgasbord. But practice moderation — that’s the real way to think big about food.

Previously: Diabetes and nutrition: Healthy holiday eating tips, red meat and disease risk, and going vegetarian, Where is the love? A discussion of nutrition, health and repairing our relationship with food and “Less is more”: Eating wisely, with delight, during the holidays 
Photo by Hans

Nutrition, Parenting, Pediatrics, Public Health

Tips on how parents with a history of eating disorders can enjoy the holidays

Tips on how parents with a history of eating disorders can enjoy the holidays

5294777976_8eb6ae86d9_zThe holiday season is often a joyful time when friends and family hit pause on their busy schedules to enjoy each other’s company. There’s also lots and lots of food involved, which can be challenging for parents with a history of eating disorders.

Recent research has found that parental eating disorders (either a past or current condition) are associated with numerous problems in child feeding, including difficulties in transitioning to solid foods and deciding which types of foods to offer and in what quantities. Studies observing the interactions of mothers with eating disorders and their young children noted greater conflict and more controlling behavior over eating, appetite, and food choices. Mothers with eating disorders often tell researchers and clinicians that their children’s troubling eating patterns are associated with their own eating habits, and shape and weight concerns  too often intervene in the decisions parents make in feeding their children.

Holiday celebrations can make these feeding relationships even more complex. Traditions of eating together with family or friends may create additional stress for parents. Additionally, family gatherings can reawaken memories of negative experiences parents may have had as children at the dinner table, adding another layer of worry and hyper-vigilance.

So what should parents with a history of eating disorders, or those concerned about their children overeating, do during the holidays? Here are some tips for having a more pleasurable and relaxing time:

  • Plan ahead: Talk to your partner about your concerns and come up with a strategy for how to cope with stressful situations around eating. Talk about what you’ll do if there is food on the table that you typically don’t eat, or if your child asks for second and third servings of foods. A rule of thumb should be to allow the child to experience a variety of food to a certain extent, as long as it doesn’t contradict any significant beliefs or preferences (such as non-kosher food).
  • Talk with your child before things get out of hand: Walk your child through the social gathering beforehand and discuss potential conflicts that may arise. The discussion should be appropriate to the child’s age. With children ages 2-3, parents could talk about the meal, mention that it will be probably very tasty, and set some limits. For instance, one could say that after dinner the child can have one or two desserts, but not more. With older children, parents should encourage autonomous eating based on the child’s regulation of hunger and satiety. This is an opportunity to discuss with children the differences between families, as well as your normal routine and special events. You should also discuss general boundaries and choices of your household.
  • Add fun activities that don’t involve food: Many celebrations and traditions revolve around food. To participate with your family in more neutral activities that are less nerve-wracking, parents should think of supplementary pastimes that all family members will enjoy. Shifting the focus away from the meal for part of the time can help parents “lower the volume” of their eating disorder when they spend time with their children.
  • Unwind: Despite being worried that loved ones will gain excessive weight during the holidays, parents should remind themselves that in a healthy-eating style, people don’t become overweight following a few specific meals. In addition, you should focus on the positive aspects of the social gathering for them and for their children – meeting family members or friends you may have not seen in a while, catching up with things you do not have time for during the year, and strengthening your relationships with your children. Before anxiety-provoking situations, parents should use any method of relaxation and stress-reduction that works for them and fits the context – have a long relaxing shower, drink a hot tea, listen to music, or stay away from the dinner table until the meal begins.

The holiday season can be a better experience for you and your family once you work through and resolve any concerns involving children’s eating.

Shiri Sadeh-Sharvit, PhD, is a psychologist and a visiting instructor at Stanford. She’s now recruiting mothers with a history of eating disorders to a parenting program study at Stanford. For more information contact shiris@stanford.edu.

Photo by Micah Elizabeth Scott

Chronic Disease, Neuroscience, Parenting, Pediatrics, Research

High blood sugar linked to reduced brain growth in children with Type 1 diabetes

High blood sugar linked to reduced brain growth in children with Type 1 diabetes

Some areas of the brain grow more slowly in children with Type 1 diabetes than those without, according to findings published this week in Diabetes. Researchers also found that children with the highest and most variable blood sugar levels had the slowest brain growth.

Glucose, the main form of sugar in our blood, is the brain’s primary fuel, and in Type 1 diabetes, the body loses the ability to produce a key hormone needed to regulate blood sugar levels. Type 1 diabetes treatment for children has often focused on making sure their glucose levels don’t get too low, since very low glucose can quickly put someone into a coma. But it’s emerging that chronically-high sugar is also bad for the brain.

The better the glucose control, the more likely that a child’s brain development will be unimpeded.

The new study, conducted at Stanford and four other universities, tracked brain structure and cognitive function in 144 young children with Type 1 diabetes and a comparison group of 72 children without diabetes over 18 months. MRI scans showed that the brains of both groups of kids were growing, but gray- and white-matter growth was slower in several areas of the brain in the diabetic children.

“These studies provide strong evidence that the developing brain is a vulnerable target for diabetes complications,” the researchers wrote. The affected brain areas have a variety of roles, including visual-spatial processing; auditory, language and object processing; executive function; spatial and working memory; and integration of information from sensory systems.

I asked two of the paper’s Stanford authors for more thoughts about what they found.

“The magnitude of the group differences in brain growth over time was surprising,” said Allan Reiss, MD, the study’s senior author. “I actually thought these differences would be more subtle — they were not.”

Past studies have found cognitive and brain-structure changes associated with diabetes in older patients, but this research stands out because the kids included were so young — at the start of the study, their ages ranged from 4 to just under 10, with an average age of 7 — and because the study had a prospective design, following children forward in time. In addition to examining brain structure, the researchers also tested the kids’ cognitive function with standard tests of IQ, learning and memory, and mood and behavior, among others. They saw no significant differences in cognitive function between the two groups, a finding Reiss said did not surprise him.

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Parenting, Pediatrics, Pregnancy, Technology, Women's Health

Stanford alumni aim to redesign the breast pump

Stanford alumni aim to redesign the breast pump

2014-11-21 15.02.36

Three Stanford graduates have an idea that could dramatically impact the daily life of active breastfeeding women: They plan to design and build a breast pump that is discreet, intuitive, and supportive of mothers. This may sound obvious, but nothing like it currently exists. In August of this year, Cara Delzer, MBA; Gabrielle Guthrie, MFA; and Santhi Analytis, PhD, founded Moxxly, “a consumer products company designing for women.” They’re in the final stretch of their 16-week incubation with Highway 1, which helps hardware startups move from a concept to a prototype ready for production.

“We’ve talked to women, hundreds of women, who have told us things like ‘pumping makes me feel like a cow,'” shares Delzer, Moxxly’s CEO, who I interviewed in late November. So she and her colleagues are aiming to re-imagine the pumping experience.

Delzer experienced the current, poorly-imagined pumps firsthand after the recent birth of her child: “I just remember watching my husband take piece after piece out of the pump box for the first time thinking, how in the world am I going to put this together? All those pieces, and clean them? I was already overwhelmed as a new mom, but completely overwhelmed by the pump.” Once she went back to work, she found that she was spending 25 percent of her day dealing with the logistics of pumping – mentally integrating it into her schedule, worrying about having all the parts. The experience is similar for many of today’s busy, mobile moms.

Meanwhile, Guthrie was at Stanford developing her passion for designing for women, Delzer recounts. “A lot of things that have been designed for women and girls in the past have followed this ‘shrink it and pink it’ trope where you literally make it smaller and bright pink and think, ‘Oh, now the girls will buy it.’ Well, Gabrielle doesn’t buy it.” For her masters’ thesis, Guthrie interviewed working moms, and the breast pump kept coming up as something that needed to be redesigned. She spent much of her last year at Stanford working on just that. At a hackathon, she and Analytis worked together to put the new designs into practice, and Analytis, whose PhD is in mechanical engineering, was hooked on solving this problem as well.

The three women “got together, looked one another in the eyes and said, ‘Do we believe this is a problem? Do we believe we can solve it? Do we believe the time is now?’ And it was yes, yes, yes,” said Delzer. They took on the challenge despite the fact that the breast pump is an FDA-regulated medical device and they will face a lengthy review process. They invented the name “Moxxly” with the intent of conveying spunkiness and strength, and incorporated XX to signify women.

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Infectious Disease, Parenting, Pediatrics, Public Health

How one mom learned the importance of the flu shot – the hard way

How one mom learned the importance of the flu shot - the hard way

tamiflu‘Wow, I’m a pathetic sight,’ I thought as I stepped out of the bright fluorescent light onto the rainy pavement, fumbling with my half-open umbrella and crying. I was coming from Walgreens, clutching on to a crisp white paper bag containing Tamiflu and bottles of Children’s Tylenol (cherry and grape) and re-playing in my head the comments a pharmacist had just made to me. “Did they not get their flu shots?” she had asked, not unkindly, as she packaged up my loot. “Is that why your kids got sick?” Hence my (guilty and big) tears.

My two girls – ages eight and five – had indeed not gotten their flu shot. I had meant to take them in – I’m a super-organized mama who usually follows doctors’ orders to a tee, the type who carefully monitored and recorded the contents of her newborns’ diapers for weeks and who typically schedules well-child exams as close to her kids’ actual birthday as possible. And yet time slipped away from me this fall, I hadn’t taken them in (no excuses – just life), and earlier that day my oldest had tested positive for a particularly nasty type of Influenza A. Hours later we were called by the girls’ school: The little one was now sick with a high fever (and likely the flu). The doctor suggested we start her on Tamiflu, too, and hope for the best.

My guilt, as I watched my kindergartener later cry out in pain (when my husband asked what she wanted for Hanukkah, in an effort to get her mind off her sickness, she moaned, “I just want to feel better”), was practically all-consuming. How could we have not taken them in? I kept asking myself. I go every year, and I always follow the pediatrician’s recommendations about vaccines. I believe in the importance of vaccines. So what was I thinking?

Later that evening, after the kids (following much negotiation and crying) agreed to take their “yucky”-tasting Tamiflu and had finally gotten to sleep, I took to Facebook, where friends and acquaintances sweetly tried to cheer me up and came to my defense. The girls might have gotten sick even if they had gotten a flu shot, some suggested. (Although: This year’s vaccine offers protection from this particular strain.) They could have had a reaction from the shot itself, someone pointed out. (Yet: My kids have never experienced side-effects from being vaccinated.) The pharmacist was just trying to fill a quota for flu shots or make you feel bad, one old college friend suggested. (But: The pharmacist actually wasn’t being pushy or judgmental with her question; she seemed more curious than anything.)

The bottom line is that I messed up and didn’t come through in protecting my kids this time around. It was a hard pill to swallow. But what comforted me in the end was the thought that my daughters’ illness is temporary and in the grand scheme of things, not all that bad. I am blessed for my children’s overall good health (I know many parents have to face far, far worse things than the flu), and I am blessed to have the resources that enable us to see a good doctor and purchase not-inexpensive antivirals.

The experience, also, reminded me of some valuable lessons. A parent – or anyone, really – should never take good health for granted. And one should never become complacent about disease and illness prevention.

I’m fairly confident this is the last year my girls will ever go without a flu shot.

Previously: Side effects of childhood vaccines are extremely rare, new study finds, The earlier the better: Study makes vaccination recommendations for next flu pandemic, Working to create a universal flu vaccine, Ask Stanford Med: Answers to your questions about seasonal influenza and European experts debunk six myths about flu shot
Photo by kanonn

Behavioral Science, Health and Fitness, Nutrition, Parenting

"Less is more”: Eating wisely, with delight, during the holidays

"Less is more": Eating wisely, with delight, during the holidays

309295507_10531bb128_zSome multi-culture families celebrate their heritage by adding more holidays, writes Maya Adam, MD, a Stanford lecturer who operates the nonprofit Just Cook for Kids. “For our family, with its unusual set of Indian, German and Jewish South African roots, this season seems particularly out of control because we celebrate all of these holidays, one after another. And if we’re not careful, we can easily end up suffering from a severe case of sugar shock.”

Sugar shock, or rather, avoiding sugar shock is the topic of Adam’s blog post on the Healthier, Happy Lives Blog, published by Stanford Children’s Health.

For me, the whole moderation thing is a particularly daunting challenge. Either yes or no seems much simpler. Eat lots or say “no thanks” — none of this healthy balance baloney for me.

But with three simple guidelines, Adam makes moderation seem possible, even doable. Numero uno: Offer healthy alternatives. If potato chips are accompanied by fresh veggies and hummus, it’s much easier to go for the veggies. Dos: Model good behavior for your kiddos. As Adam writes: “When kids see that their parents are able to enjoy a small treat on occasion — and then stop — they learn a great lesson: Less is more.”

And for the third tasty pointer, I’ll let you check that out for yourself. Mmmm, mmmm, it’s a good one.

As Adam writes: “Holidays should be happy times — and sharing food with the people we love is a big part of that happiness.” Bon appetit!

Previously: A physician realizes that she had “officially joined our nation of fellow sugar addicts”, Eat well, be well and enjoy (a little) candy and Pediatrics group issues new recommendations for building strong bones in kids
Photo by Laura

Parenting, Pediatrics, Stanford News, Technology

Using texting to boost preschool reading skills

Using texting to boost preschool reading skills

Stanford researchers find promising results from program that uses text messages, like this one, to support parents in helping their children learn to read.

A new program that sends weekly texts to parents to  remind them to engage in simple activities to boost their preschooler’s literacy skills appears to help children read. The program, called READY4K! and developed at the Stanford School of Education by education professor Susanna Loeb, PhD, and graduate student Benjamin York and tested at preschools at the San Francisco Unified School District, underwent an 8-month pilot conducted in 2013-2014. In a release describing the pilot program, Loeb described the challenges faced by parents:

The barrier to some of these positive parenting practices isn’t knowledge or desire, but it’s the crazy, busy lives… It’s difficult to have the time or focus to make all these choices as parents, and we’re helping parents do what they know they should do and what they want to do.

The program enrolled 440 parents, half of whom got literacy building tips by text and the other half got placebo announcements about the district. Parents who received literacy tips were more likely to engage in literacy activities such as reading to their children, reviewing rhyming words and playing word puzzles. Moreover, the authors note in a report that the preschool-age children scored higher on literacy assessment tests at the end of the pilot program than those whose parents had not gotten weekly texts. In the release, a representative of SFUSD notes:

I believe that all families want to be involved in their child’s learning, but many feel they don’t have the time or perceive that supporting their child’s learning might be labor intensive or something that the teacher is better at. The texting program offered some simple nuggets around literacy strategies and validated that families do want to be involved, if given information that is easy to receive and useful.

The READY4K! program was developed with accessibility and scalability in mind. York and Loeb carefully parsed early childhood literacy standards from the state into text-size bites, with the aim that they would be helpful and not add another layer of stress to the already busy parents’ lives.

SFUSD has expanded the program this year to all preschool and kindergarten parents. Loeb and York have heard from other interested school districts and have also added early math skills into the weekly texts.

Previously: Reading, book sharing less common in immigrant families, Stanford study finds, Researcher shows how preschoolers are, quite literally, little scientists and This is your 4-year-old on cartoons
Photo by L.A. Cicero/Stanford News Service

Obesity, Parenting, Pediatrics, Research

Study shows that toddlers benefit from rules about eating habits

Study shows that toddlers benefit from rules about eating habits

toddler_eatingA recent study from pediatrics researchers at the University at Buffalo suggests that toddlers who are faced with parental rules about what to eat develop better eating habits later in their childhood, regardless of the self-restraint they demonstrate. The connection between self-restraint and eating habits has been studied widely in adults and adolescents, but this research is among the first to investigate it in very young children.

The findings suggest that self-restraint in two year-olds doesn’t itself lead to healthier habits by the time the child is four; it must be combined with parental rules about eating. Neha Sharma, a co-author of the paper, explained the significance when presenting the research at ObesityWeek 2014 in Boston, as quoted in a University of Buffalo news release:

It is amazing to see that a parental rule about which types of food a child can and cannot eat could have such a great impact on child eating habits. Without these boundaries set by caregivers, the benefits of high self-regulation on weight gain and childhood obesity could be diminished. This illustrates just how important parental involvement is in influencing child eating habits.

Seventeen percent of American children age 2-19 are obese, as are nearly 35 percent of adults, according to the Center for Disease Control and Prevention. Obesity is well-known as a pressing public health issue, and children who are obese are much less likely to attain healthy weights as adults.

Furthermore, a study published this week in Pediatrics suggests that obese youth are very likely to become obese teens, contrary to a popular idea that overweight adolescents have “baby fat” that will disappear with puberty. Researchers found that a child’s weight at age 11 is a good indicator of his or her weight at age 16: 83 percent of obese fifth-graders remained obese, and 87 percent of normal-weight fifth graders remained at a normal weight five years later.

By setting guidelines and rules for toddlers, parents and caretakers can play a key role in guiding society’s very youngest members towards healthy eating habits with life-long impacts.

Previously: No bribery necessary: Children eat more vegetables when they understand how food affects their bodies, Examining why instilling healthy eating and exercise habits in children may not prevent obesity later in life and How to combat childhood obesity? Try everything
Photo by David Goehring

Chronic Disease, Obesity, Parenting, Pediatrics

Getting a handle on screen time: tips for parents

Getting a handle on screen time: tips for parents

child watches TV

Most parents know that they should keep screen time to a minimum, but how much is too much? Moreover, with the advent of many educational apps for tablets and smartphones, it’s easy as a parent to get confused about managing their childrens’ use of televisions, computers and tablets. Watching “Frozen” for the hundredth time is clearly entertainment, but what about playing with a Dora the Explorer app that teaches vocabulary? Should that count against a child’s screen time “budget?”

The Lucile Packard Children’s Hospital Stanford blog, Healthier, Happier Lives, had a post earlier this week that offers concrete tips from Thomas Robinson, MD, MPH, director of Packard’s Center for Healthy Weight. Robinson notes that educational screen time doesn’t need to count toward entertainment screen time, which he recommends keeping to less than an hour a day. But he cautions that parents should distinguish between real educational programs and entertainment disguised as education.

He also says that it’s easier to get kids to follow screen-time rules if parents are judicious about their own screen use (this includes time in front of a computer or with a smart phone, as well as TV time). One of the key reasons to turn off the TV (and other screens) is to avoid bad habits associated with screen time like eating high-fat, high-sugar snacks, especially while in front of a TV or computer. Another is simply to get kids to move more and be more active.

The bottom line? Robinson says:

More than anything else, just having family rules about how much, what, when, where, and with whom is the most important step in making screen time and technology work for your family, instead of against it.

Previously: Examining the effects of family time, screen time and parenting styles on child behavior, Childhood obesity expert to parents: Reduce your child’s screen time and Study: Too much TV, computer could hurt kids’ mental health
Photo by Vidmir Raic

Autism, Behavioral Science, Parenting, Pediatrics, Research, Stanford News

Study validates oxytocin levels in blood and suggests oxytocin may be a biomarker of anxiety

Study validates oxytocin levels in blood and suggests oxytocin may be a biomarker of anxiety

Karen Parker Oxytocin, sometimes dubbed “the love hormone,” can be tricky to study in humans. To conduct research on the connection between oxytocin and emotion, scientists want to assess the hormone’s levels in the brain. But sampling cerebrospinal fluid, the liquid bathing the brain, requires an invasive technique called a lumbar puncture. Measuring blood oxytocin is much easier, but some researchers have questioned whether blood oxytocin levels truly reflect what’s happening in the brain.

A new Stanford study simplifies the problem: It is the first research in children, and some of the first in any age group of humans, to indicate that blood and CSF oxytocin levels track together. The research also found a correlation between low-oxytocin and high-anxiety levels in children, adding to findings from animal studies and adult humans that have documented this oxytocin-anxiety link. The paper appears today in Molecular Psychiatry.

The findings raise the possibility that oxytocin could be considered as a therapeutic target across a variety of psychiatric disorders

The researchers recruited 27 volunteers from among a group of patients who needed lumbar puncture for medical reasons. The volunteers agreed to have oxytocin levels measured in their blood and CSF, and the parents of 10 children in the study answered questions about their children’s anxiety levels. From our press releaseabout the research:

“So many psychiatric disorders involve disruptions to social functioning,” said the study’s senior author, Karen Parker, PhD, assistant professor of psychiatry and behavioral sciences. “This study helps scientifically validate the use of measuring oxytocin in the blood, and suggests that oxytocin may be a biomarker of anxiety. It raises the possibility that oxytocin could be considered as a therapeutic target across a variety of psychiatric disorders.”

Parker’s team is now conducting studies of possible therapeutic uses of oxytocin in children with autism. They recently published a paper demonstrating that autism is not a disease of oxytocin deficiency per se; instead, oxytocin levels in kids with autism fall across a broad range. The findings hint at a future in which patients’ oxytocin levels could be used to guide treatment for autism or other psychiatric or developmental disorders. As Dean Carson, PhD, the lead author of the new study, explained:

“Our belief is that there are oxytocin responders and nonresponders,” Carson said, adding that the team is now testing this hypothesis.

…“Being able to have objective measures of psychiatric illness really will enhance early diagnosis and measures of treatment outcomes,” Carson said.

Previously: Stanford research clarifies biology of oxytocin in autism, “Love hormone” may mediate wider range of relationships than previously thought and Study shows oxytocin may boost happiness among women
Photo of Karen Parker by Norbert von der Groeben

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