Parenting

My lovely friend Maya Adam, MD, recently launched a free online course, “Child Nutrition and Cooking,” through Coursera, a web-based platform for “massive open online courses.”

In this fun, five-week “MOOC,” participants learn about the basics of child nutrition and how to make healthy meals for children and families. Weekly lectures are broken down into bite-sized, fact-filled video cooking tutorials, with homework assignments like “Prepare a colorful vegetable dish and send us a photo.” (Warning — your meal photos will be peer-reviewed, so presentation matters.)

For Adam, a lecturer on child health and nutrition in Stanford’s Program in Human Biology, developing this course was a labor of love. “My goal is to get people to return to a simpler, healthier and more economical way of cooking,” she recently told me. “By sharing a few tips and tools with family meal preparers, I hope to inspire a lifelong celebration of easy, home-cooked meals.”

So far, more than 22,000 aspiring cooks have signed up for the course, which just began its second week. Although the tutorials can be accessed at any time, by taking the course during this active period, participants benefit from live discussions with Adam, her teaching staff and fellow cooks.

Later in the year Adam will use these videos in her Stanford Human Biology courses through a “flipped-classroom” teaching model, which blends in-classroom and online lectures together to reinforce newly learned information.

Another caveat in taking this course: Don’t watch the cooking lessons on an empty stomach. Everything looks delicious, and it could lead to overeating.

Previously: Talking to kids about junk food ads, Sugar intake, diabetes and kids: Q&A with a pediatric obesity expert, New evidence for a direct sugar-to-diabetes link, Kids don’t need “kids’ food” and Smaller plates may be a tool to curtail childhood obesity
Photo courtesy of Stanford Online Learning

Today is the final day of our Ask Stanford Med installment on autism. Questions related to treatment, diagnosis and research advancements can be submitted to Carl Feinstein, MD, director of the Stanford Autism Center at Packard Children’s Hospital, by either sending a tweet that includes the hashtag #AskSUMed or posting your question in the comments section of our previous entry. We’ll accept questions until 5 p.m. Pacific time.

And, as a reminder, Feinstein and others will be speaking next month at a day-long event geared towards parents, teachers, physicians and caregivers. The sixth annual Autism Spectrum Disorders Update will be held at the Stanford campus on June 1.

As part of efforts to promote exclusive breastfeeding, many hospitals are reducing their use of baby formula for newborns. But – as is being widely reported today – a new study published online in Pediatrics suggests that a strict no-formula approach in the early days of breastfeeding may sometimes amount to throwing the baby out with the bathwater.

The study focused on a problem that often derails moms’ early efforts to breastfeed: Early weight loss among newborns may prompt some mothers to switch from breastfeeding to formula-feeding because they worry that their babies aren’t getting enough to eat. Using a little bit of formula in a carefully controlled way may help these moms to stick with breastfeeding in the long run, the study found.

Here’s the back story: In the first three days after birth, instead of making milk, women produce small amounts of a fluid called colostrum. Colostrum is really good for babies, but there isn’t much of it, so it’s normal for babies to lose some weight before full-scale milk production begins. But if a baby loses more than five percent of his or her birth weight, doctors and moms can both get worried – especially if the mother’s milk is a bit slow to come in, or if the baby seems especially hungry or fussy.

Stanford/Packard Children’s pediatrician Janelle Aby, MD, who collaborated on the new study with a team of scientists at the University of California-San Francisco, told the San Francisco Chronicle:

In the first three days or so, the key complaint we hear is ‘I’m concerned I don’t have enough milk. I’m worried my baby is starving,’ ” said [Alby]. “Then we do daily weighs and it’s dropping and dropping, and that’s very stressful. Some moms, they get to a place where they can’t take it anymore and they give the baby formula.”

Yet giving formula at this point can derail breastfeeding completely – with a tummy full of formula, the baby may not be hungry enough to nurse. And using a bottle in the early days can cause “nipple confusion,” in which the baby finds the bottle easier to drink from and subsequently won’t take the breast.

The research team thought there might be a possible middle ground. They wondered if they could use just a little bit of judiciously delivered formula to help boost breastfeeding efforts. They taught mothers whose babies had lost at least five percent of their birth weight to supplement breastfeeding with small amounts of formula fed by syringe. The idea was to give hungry babies a little boost without feeding so much formula that they’d stop wanting to nurse. Using a syringe prevented nipple confusion. And once the moms’ milk came in, the formula supplements stopped.

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Among school-aged children in the United States an estimated one in 50 has been diagnosed with autism spectrum disorder, according to a recent survey (.pdf) from the Centers for Disease Control and Prevention. In addition to raising concerns among researchers and parents about why the number of cases has increased, the findings underscored the need to do more autism research and to provide support and services for families caring for autistic children.

To help parents and others in the local community better understand the growing prevalence of autism and to learn about treatments and research advancements, the Stanford Autism Center at Packard Children’s Hospital will host its sixth annual Autism Spectrum Disorders Update on June 1. The event offers an opportunity for exchange between parents, caregivers and physicians and provides an overview of the center’s clinical services and ongoing autism research at the School of Medicine.

In anticipation of the day-long symposium, we’ve asked Carl Feinstein, MD, director of the center, to respond to your questions about issues related to autism spectrum disorder and to highlight how research is transforming therapies for the condition.

At the Stanford Autism Center, Feinstein works with a multidisciplinary team to develop treatments and strategies for autism spectrum disorders. In providing care and support for individuals with autism and their families, Feinstein and colleagues identify ways of targeting the primary autism symptoms, while also paying attention to associated behavior problems that may hold a child back from school or community involvement or seriously disrupt family life.

Questions can be submitted to Feinstein by either sending a tweet that includes the hashtag #AskSUMed or posting your question in the comments section below. We’ll collect questions until Wednesday (May 15) at 5 PM Pacific Time.

When submitting questions, please abide by the following ground rules:

• Stay on topic
• Be respectful to the person answering your questions
• Be respectful to one another in submitting questions
• Do not monopolize the conversation or post the same question repeatedly
• Kindly ignore disrespectful or off topic comments
• Know that Twitter handles and/or names may be used in the responses

Feinstein will respond to a selection of the questions submitted, but not all of them, in a future entry on Scope.

Finally – and you may have already guessed this – an answer to any question submitted as part of this feature is meant to offer medical information, not medical advice. These answers are not a basis for any action or inaction, and they’re also not meant to replace the evaluation and determination of your doctor, who will address your specific medical needs and can make a diagnosis and give you the appropriate care.

Previously: New public brain-scan database opens autism research frontiers, New autism treatment shows promising results in pilot study, Autism’s effect on family income, Study shows gene mutation in brain cell channel may cause autism-like syndrome, New imaging analysis reveals distinct features of the autistic brain and Research on autism is moving in the right direction
Photo by Wellcome Images

Daily text messages may be an effective option to help children with asthma manage their symptoms and reduce doctor visits, according to recent research from the Georgia Institute of Technology.

In the study (.pdf), pediatric patients with asthma were randomly assigned to three programs: one group received text messages on alternate days, another received text messages daily and a third served as the control and did not receive any text messages. Participants ranged in age from 10 to 17 years old, owned a mobile phone and could read at the fifth grade level. The text messages asked patients questions about their symptoms and provided health information about asthma. Futurity reports:

Over four months, the intervention groups received and responded to SMS messages 87 percent of the time, and the average response time was within 22 minutes. After the study, the research team analyzed patients who had follow-up visits with their physician and found that sending at least one text message a day, whether it was a question about symptoms or about asthma in general, improved clinical outcomes.

“The results indicate that both awareness and knowledge are crucial to individuals engaging in proactive behavior to improve their condition,” [said Rosa Arriaga, PhD, who led the study].

The findings are noteworthy in light of past data showing texting is teenagers’ preferred method of communication, they get an average of 3,339 texts a month, and previous research showing they are amenable to receiving health information via text message.

Previously: CDC explores potential of using smartphones to collect public health data, Promoting healthy decisions among teens via text and Craving a cigarette but trying to quit? A supportive text message might help
Photo by Summer Skyes 11

Past research suggests that poor sleep during adolescence can have “lasting consequences” on the brain. Now a new study offers additional insights into the negative health effects of sleep deprivation on teens’ health.

In the study, researchers analyzed data collected from more than 10,000 adolescents as part of the National Comorbidity Survey Adolescent Supplement.  As MedPage Today reports, their findings show that prolonged fatigue is associated with mood and anxiety disorders among teens:

In a nationally representative sample of adolescents ages 13 to 18, 3% reported having extreme fatigue lasting at least 3 months and about half of those who did also had mood or anxiety disorders, according to Kathleen Merikangas, PhD, of the National Institute of Mental Health in Bethesda, Md., and colleagues.

Having both prolonged fatigue and a mood or anxiety disorder was associated with poorer physical and mental health and greater use of healthcare services compared with having only one of the disorders, the researchers reported online in the American Journal of Psychiatry.

“This suggests that the presence of fatigue may be used in clinical practice as an indicator of a more severe depressive or anxiety disorder,” Merikangas and colleagues wrote.

Stanford physician Michelle Primeau, MD, recently explored the topic of how teen sleep habits affect mood in a recent Stanford Center for Sleep Sciences and Medicine blog entry on the Huffington Post. In her post, she explains why teens in particular are at risk of chronic partial sleep deprivation:

Teenagers need to sleep about nine hours, and as they get older, they tend to sleep less. This is not because they need less, but because they are busier with school, jobs, extracurricular activities, and friends. Their biology also will often shift so that they tend to fall asleep later and want to sleep in later, an occurrence that may represent delayed sleep phase syndrome. This may explains why your teenager is so hard to wake up on Saturdays. But this shift to a later bedtime, both of social and biologic causes, in combination with fixed early school times, means that many teenagers are walking around sleep deprived.

Previously: Can sleep help prevent sports injuries in teens?, Study shows link between lack of sleep and obesity in teen boys, Study shows lack of sleep during adolescence may have “lasting consequences” on the brain, Teens and sleep: A Q&A, Sleep deprivation may increase young adults’ risk of mental distress, obesity, Districts pushing back bells for the sake of teens’ sleep and Lack of sleep may be harmful to a teen’s well-being
Photo by lunchtimemama

Getting through medical school and raising a child are two activities that on their own can each be challenging – not to mention exhausting. But what’s it like to do them simultaneously? In a candid piece on Mothers in Medicine (a blog that I consider a must-read for doctor-moms), a writer shares the less-positive aspect of her juggle:

I judge myself constantly. If I were not a medical student mom, I could have given my child a more even-keel life filled with playgroups, museum activities, more reading and less TV. Should I be doing those things despite needing to study and handle school and fatigue? Should I have done more anyway? Maybe sucked it up, because darn it – medical school moms are supposed to be smart and manage the house and family? Having it all and doing it all, right?

Now I’m looking backwards. I am less than two weeks from graduation as I write this, and I still judge myself for decisions I made in medical school. We did survive the away rotations despite living in a 350-sq ft apartment for one of them. We survived each of the Step exams and third year. We even survived a crazy interview season that involved many flights, and I matched somewhere that is perfect for my family. However, did I do enough of the right things to balance out the wrong ones? Should I just be thankful Sesame Street and Super Why! have taught my toddler all his letters and numbers? (Thanks PBS!) I don’t really know, but I console myself that he is a loving, sweet toddler who seems to somehow really love me…

My daughters spent their first few days of life in the neonatal intensive care unit, and I won’t soon forget padding down the long hospital hallways, decked out in my flimsy gown and fluffy blue slippers, every two hours to go visit and feed them. As emotional as this time was for me and my husband, I recognize it would have been even more so if I wasn’t able to see my baby - which is why I think a new program at a Los Angeles hospital is so cool. Called BabyTime, the Cedars-Sinai program uses iPads to connect parents with their premature or ill newborns.

readwrite’s Brian S. Hall reported yesterday:

Mothers who are confined to recovery rooms following delivery, typically because of a cesarean section or other complications, often can’t see their newborns in the intensive care unit for 2-3 days. “With BabyTime, the new mother can now see their baby in about 2-3 hours,” Yvonne Kidder, a clinical nurse in the hospital’s Neonatal Intensive Care Unit (NICU), told me:

“BabyTime’s been wonderful. For mothers, to see their baby, this absolutely lessens their anxiety. For the fathers, who can become overwhelmed with all the information they are receiving, BabyTime bridges the gap and allows for a direct line between mother and caregivers.”

Previously: The emotional struggles of parents of preemies

Yesterday evening, Rebecca Rialon Berry, PhD, a child psychologist from Lucile Packard Children’s Hospital, participated in a San Jose Mercury News live chat covering topics such as how to recognize that a child has experienced a traumatic event and how to help teens manage their online presence.

A transcript of the chat is now available on the newspaper’s website. During the chat, Berry discussed the issue of empowering teens to be proactive in preventing, or notifying adults about, harmful online or in-person interactions. Below is her exchange with reporter Katy Murphy:

Murphy: Even if a child isn’t being bullied or bullying others, he or she might see it happening — online or in person. What effect do these harmful interactions have on bystanders, and what do you recommend that teens do if they see harmful images or messages shared?

Berry: Bystanders can have a very helpful role in preventing or stopping cyber bullying. Encourage youth who see online activity that might appear to be cyber bullying to print out the message, post, tweet, or email and share this with an adult … Adults can respond to receiving such messages by validating the teen’s openness to speak up and with encouragement to the teen to continue communicating about online activities that he/she does not feel is productive or healthy.

The full chat is worth taking a moment to read.

Previously: Packard Children’s Hospital psychologist to discuss helping children coping with trauma, Talking to children about school shootings and Talking to little ones about 9/11

As the ongoing investigation into the tragic death of California high-school student Audrie Pott has become national news, many parents are wondering how to help their children and teens cope in equally traumatic situations. In an effort to answer parents’ questions, Rebecca Rialon Berry, PhD, a child psychologist from Lucile Packard Children’s Hospital, will participate in a San Jose Mercury News live chat.

The chat begins today at 5:30 pm Pacific time and will cover topics ranging from how to recognize a child has experienced a traumatic event to how to help manage students’ social networking presence.

Previously: Talking to children about school shootings and Talking to little ones about 9/11
Photo by Troy Benson Photography