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2 Gazette Health | Summer 2014 A GAZETTE AND GAZETTE-STAR PUBLICATION

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Don’t miss The Gazette’sannual Education publication!


Unintentional drowning killed 1,027U.S. children in 2010. More childrenbetween ages 1 and 4 die of drowning

each year than of any other cause except birthdefects. (Drowning occurred most often in abathtub for those under 1 year old.)Drowning rates also vary by race; African-

American children between 5 and 14 drownat three times the rate of white children. Thisdifference is even greater—five times the rateofwhite children—in swimming pools, usual-ly the safest place for recreational swimming.Half of all patients treated for near

drowning in emergency departments requirehospitalization or transfer for further care,and many are left with permanent disabili-ties from brain injuries. Hospital care doesnot substantially change the outcomes of neardrowning, which is why prevention is critical.

Formal swimming lessons can reduce therisk of drowning by as much as 88 percent inchildren 1 to 4.Even with a lifeguard present, an adult

who can swim and knowsCPR shouldmoni-tor children in the water.Pool fences should completely separate

the house and play area from the pool, beat least 4 feet high, and have self-closing andself-latching gates that open outward, withlatches out of children’s reach.Finally, be alert for signs of drowning.

Many people don’t realize that a personwho is near drowning is almost never able toshout for help. Watch for uneven motions, asign the swimmer is getting tired. Often thebody sinks, and only the head shows abovethe water.

–CDC, NIH

As many as 1 out of 5 children experiences a mental disorder in a given year, and anestimated $247 billion is spent on treatment and management. -CDC

Nearly 1 in 5 severely obese adolescentsshows signs of abnormal kidney func-tion, according to a study presented to theNational Kidney Foundation. “Severe obesityis increasing and now affects 4 to 6 percentof U.S. children and adolescents. If untreated,obesity during adolescence is associatedwith a higher prevalence of chronic kidneydisease and other serious conditions in adult-hood,” said Beth Piraino, M.D., president of thefoundation. Lifestyle changes, such as healthyeating and increased exercise need to beginin childhood to help prevent this and otherdiseases, like diabetes, later in life, she said.

Obesity Linked toKidney Problems

Is TV Making YourBaby Cranky?Infants and toddlers whom parentscharacterized asmost fussy andhaving other self-regulation dif-ficulties also had themost mediaexposure, according to a recentstudy. It was unclear whetherthe children’s use of mediadeveloped in response to theirfussiness, or if it contributed to theself-regulation difficulties.

-American Academy of Pediatrics

Sleep Machines MayHarm HearingSleepmachines used tomask noise and pro-vide ambient sound to soothe an infant duringsleep can also contribute to babies’ hearingloss. A recent study published in the journal“Pediatrics” determined that regular expo-sure to white noise through an infant sleepmachine on a nightly basis can affect hearing,speech and language development. To pro-tect an infant’s hearing, themachine shouldbe at least 6 1/2 from the child, experts said.

-American Academy of Pediatrics

Save kids fromDROWNING

-American Ac

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Each year, approximately 2.4 millionpeople—more than half under age6—swallow or have contact with a

poisonous substance.Most poisonings occur when parents

or caregivers are home but not payingattention. The most dangerous potentialpoisons are medicines, cleaning products,antifreeze, windshield wiper fluid, pesti-cides, furniture polish, gasoline, keroseneand lamp oil.If your child is unconscious, not breath-

ing, or having convulsions or seizures dueto poison contact or ingestion, call 911or your local emergency number imme-diately. If your child has come in contactwith poison or you suspect that your childmay have swallowed a button-cell battery,

and has mild or even no symptoms, call theMaryland Poison Center at 800-222-1222.Different types andmethods of poisoning

require different, immediate treatment:

Swallowed poison: Take the item awayfrom the child and have the child spit outany remaining substance. Do not inducevomiting. Do not use ipecac syrup.Skin poison: Remove the child’s clothes

and rinse the skin with lukewarm water forat least 15 minutes.Eye poison: Flush the child’s eye by hold-

ing the eyelid open and pouring a steadystream of room-temperature water into theinner corner of the eye for 15 minutes.Poisonous fumes: Take the child outside

or into fresh air immediately. If the childhas stopped breathing, start cardiopulmo-nary resuscitation (CPR) and do not stopuntil the child breathes on his or her own,or until someone can take over.

–American Academy of Pediatrics

Teen drivers appear to be more distracted by loud conversations and horseplay than by mobile phones.-The University of North Carolina Highway Safety Research Center

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T h e H i d d e n D a n g e r o f

BULIMIA


BY KATHERINE HEERBRANDT

“The longer they have it,

it becomes ingrained and

is more difficult to treat.”

ISTOCK/GLOBALSTOCK;OPPOSITEPAGE:REPRINTEDBYPERMISSIONOFLAURAKITTLEMAN


The average age of the onset of bulimia is 20, but it can affect people much younger and older.commonCONDITIONS

After years of therapy, LauraKittleman finally acceptedthat her daughter’s deathfrom bulimia at age 26was not her fault. But shestill feels a responsibility towarn other parents about

the dangers of an eating disorder that she andher family once considered a passing phase.“We thought it was something we should

pay attention to, but we didn’t think it wouldkill her,” Kittleman said. “We thought it was astage, and it never dawned on us that this is sodangerous.”Kittleman’s daughter Jenna Katherine Miller

was a graduate student at the University ofMaryland, College Park majoring in publichealth when she died at 26 on Jan. 8, 2011.Jenna, newly married, was thrilled she wasto begin teaching a class on addiction at theuniversity the following week. She planned todevote her career to helping others with eatingdisorders because she understood the allureand the pain associated with them.Today, Jenna’s family has a website devot-

ed to her (jennakatherinemiller.com), andKittleman, of Ellicott City, has spoken togroups of young people about bulimia. Sheplans to do more.

BULIMIA IS A FORM OF BINGING ON FOOD ANDpurging it through vomiting, the use of laxa-tives or overexercising, or a mix of all three.Those suffering from this illness are difficult toidentify because they often look healthy and areat a normal weight, according to dietitian DanaMagee, who works with the Empowered EatingProgram at Rebecca Bitzer & Associates inGreenbelt. Magee counsels people with eatingissues, primarily bulimia.The National Institute of Mental Health

(NIMH) reports that the average age of theonset of bulimia is 20, and that over a lifetime,0.5 percent of those with the disorder arefemale, while 0.1 percent are male. Of thoseaffected, 43 percent are receiving treatment.Hospitalization rates for eating disorders con-tinue to rise, according to NIMH, increasing18 percent between 1999 and 2006. Andcontrary to the stereotype that eating disor-ders mostly affect white, upper-middle-classfemales, the ethnic makeup of those contend-

ing with them is changing to include peoplefrom a variety of ethnic backgrounds.For women 15 to 24, eating disorders are

among the top four leading causes of life lostthrough death or disability, according to theAcademy for Eating Disorders.The majority of clients Magee sees with the

disorder are young women from ages 12 tomid-30s. Many eating disorders, she said, arefueled by times of change that produce anxiety,

such as going to high school or college, orchanging jobs.Eating disorders are a way of using food as

a coping skill, according to Sharon Peterson, atherapist and founder of the Eating DisorderNetwork of Maryland, or EDN. EDN pro-vides a list of services and resources through-out Maryland for those with eating disordersand their families. Peterson, who is a recover-ing bulimic, said people can have an eatingdisorder at any age. She has clients ranging inage from midteens to 70 years old.“The longer they have it, it becomes

ingrained and is more difficult to treat,” shesaid. “What we now know is that the disordershave to do with brain wiring. Genetics plays abig part, along with certain personality traits.”Those prone to eating disorders are usually

strong willed, see issues as black and white andhave a hard time finding middle ground. Theyare often hypersensitive, perfectionistic and com-petitive, and come from families with historiesof addiction or affect disorders such as obsessivecompulsive disorder, said Peterson.“A lot of times athletes in a sport like gym-

nastics or competitive dancing are judged bytheir weight,” Magee said. “They are often ahigh-risk group to develop eating disorders.”

KITTLEMAN SAID HER DAUGHTER WAS A CHUBBYteen who lost a lot of weight when she began aromantic relationship with an older youth at 16.She suspects that the addiction of binging andpurging began after the boy died in a car crash,and became worse when Jenna started college.“We figured out after she passed away and

we went to therapy that the drive for perfec-tionism and the bulimia started at the sametime,” Kittleman said. “Jenna did really wellin college.”The fear of gaining weight, depression and

low self-esteem are part of the disorder. Thephysical effects are more difficult to see. ToJenna’s family and friends, she looked healthy.She was a runner. She ate nutritious food, andalthough she was on the thin side, she was at areasonable weight.But looking back, Kittleman said Jenna had

had three root canals by the time she was 26.Vomiting can cause teeth erosion, cavitiesand gum disease, as well as swelling in thecheeks. Evidence that someone | continued on 17

Jenna Katherine Miller, newly mar-ried and preparing to teach a classon addiction at the University ofMaryland, College Park, died frombulimia at 26 in 2011. “We thoughtit was a stage, and it never dawnedon us that this is so dangerous,”said her mother, Laura Kittleman.She hopes that telling Jenna’s storywill help others who suffer from eat-ing disorders, as well as their fam-ily members. To learn more aboutJenna, visit the website dedicatedto her: jennakatherinemiller.com.

B r e a t h i n g E a s y

ASTHMANeed Not Stifle Your Child’s Life

BY KAREN FINUCAN CLARKSON



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While the statis-tics surround-ing childhoodasthma maybe unnerving,

the fact is that the majority ofyoungsters with this chronic dis-ease should be able to live theirlives like any other child, accord-ing to local allergists. Asthma,an ailment that affects the lungs,makes breathing difficult. Some9 million children in the U.S. areliving with the disease, accordingto a guide to asthma publishedby Children’s National MedicalCenter in Washington, D.C.More school days—14 million-

plus per year—are lost to asth-ma than to any other chronic ill-ness, and the disease is the thirdleading cause of hospitalizationamong children, according to theAsthma and Allergy Foundation ofAmerica. The average length of anasthma-related hospital stay is justover four days.While incidence of the dis-

ease is increasing every year inthe U.S., the greatest rise inasthma rates has been amongAfrican-American children, upalmost 50 percent from 2001through 2009, according to theCenters for Disease Control andPrevention. The reasons behindthe overall increase is unclear,but improved diagnosis, globalclimate change, poor air qual-ity, and the over-prescription ofantibiotics may play a role, saidRosalyn Baker, M.D., chief of theAllergy and Immunology Sectionat MedStar Southern MarylandHospital in Clinton.

ASTHMA CAN STRIKE AT ANY AGE.When it occurs in childhood, symp-toms appear in the vast major-ity of kids by age 5, according tohealthychildren.org, the websitefor the American Academy ofPediatrics. Early warning signsindicating a proclivity for asthmainclude eczemaor lower respiratoryproblems in infancy and a familyhistory of the disease.

While the cause of asthma isunknown, exposure to second-hand smoke both in utero andafter birth is, in Baker’s opinion,a contributing factor. “Smoke istoxic to the nasal passages, airwaysand lungs,” she said. “It damagesthe cilia, the microscopic hairs thatfilter what we breathe, and causesthem to malfunction. As a result,all sorts of allergens and viral infec-tions pass through. Children of par-ents who smoke have an increasedrisk for the onset of asthma.”An asthma attack, especially a

severe one that leaves a child strug-gling to breathe, can be frighteningfor both parent and child. Whenasthma is either unidentified ornot under control, the musclessurrounding the airways insidethe lungs tighten and their lin-ings become red, swollen and fullof mucus. As breathing becomesmore difficult, a child may experi-ence tightness or discomfort inthe chest, headaches, shortnessof breath, coughing, wheezing orfatigue, said Ifeyinwa Okocha,M.D., a pediatrician and allergistwith the Allergy&Asthma Centerin Greenbelt and Bowie.Diagnosing asthma in children

“can be a challenge, especiallywith toddlers and infants whocan’t tell you their symptoms,”said Baker. Spirometry, whichmeasures lung function, is a testcommonly used to diagnose asth-ma in children over 6, whose lungshave had time to develop andwho are cognitively able to followdirections. Children breathe into amouthpiece attached to a record-ing device, which assesses howmuch air they can move in andout of their lungs and at what rate.

IFASTHMAISSUSPECTED,MEDICATIONSmay be prescribed, said Okocha.“If they respond to a medicationsuch as albuterol, they probablyhave asthma.”Getting asthma under control

often requires a combination oflife style changes and medication,according to the | continued on 18

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If crying patterns change dramatically, have baby evaluated by a pediatrician.commonCONDITIONS

BY KATE MCDERMOTT

If babies could talk, they’d tell us when they arehungry, tired, have a tummy ache or need a diaperchange. But they can’t, so they cry. Crying is aninfant’s primary form of communication. But it’s

not always easy to interpret. So how can parents andcaregivers know if the crying may signal somethingserious?The first answer, of course, is to rule out all the

usual culprits. If your baby is fed, burped and dry,then it might be time to start asking other questions.Could she be overtired? Perhaps overstimulated?Generations of parents can attest to babies’ “fussy”

periods, which often occur from about dinnertimeto midnight. But just as parents will get to knowthe sound of their children’s voices once they beginto talk, they will also learn to distinguish the differ-ences among their babies’ cries. “You get used to yourchild’s response to things,” said Frederick Corder,M.D., chair of the Pediatrics Department at PrinceGeorge’s Hospital Center in Cheverly, who has been apracticing pediatrician for 34 years. “Most parents getto the point where if the crying changes, they are ableto say, ‘This is not normal for my child.’”When crying changes in its frequency or intensity,

the baby may be trying to communicate discomfortdue to digestive issues, including milk or food intoler-ance, or perhaps a sensitivity to what a breast-feedingmother is eating. “We often see that with motherswho eat a lot of spicy foods,” Corder said.Although “colic” was traditionally the catch-all

word used to describe discomfort due to intestinalgas, Corder said it has become an overused term.“Today we try to find a more specific diagnosis.”Advancements in diagnostic tests and improved feed-ing options, including new formulas as well as soyand goat milk products, are helping doctors pinpointthe cause of the intestinal discomfort and eliminate it.Thus colic no longer just defines “bad gas.”The American Academy of Pediatrics now says

“colic means simply that the child is unusually sensi-tive to stimulation or cannot ‘self-console’ or regulatehis nervous system.” That means external stimuli,including stress in the mother or the family, may alsobe a cause of unexplained crying. Because stressedmothers can lead to stressed babies, Corder said it isimportant to rule out things such as maternal depres-

sion, abuse or lack of support systems that couldaffect the baby’s caregivers and thus the baby. Whentired and stressed caregivers can take a timeout torecharge their batteries, they may find their babies willrespond to their reduced stress levels with less cryingand fussiness.If a baby’s crying patterns change dramatically, if he

exhibits a general fussiness that cannot be explained,or exhibits any signs of infection such as fever, vomit-ing or lethargy, parents should have the child evalu-ated by a pediatrician. “If you feel uncomfortableabout something that is going onwith your child, youneed to talk to your doctor,” Corder said.Sometimes, however, crying babies are just exer-

cising their power over us as master manipulators.“Women tend to ‘feel’ a baby’s cries and respond bywanting to soothe her,” he explained, while men tendto take a more pragmatic approach to crying, as in,“She’s fed, she’s dry, she’s burped. She’s fine.” Babiessoon realize that if they cry formomor grandma, theywill get picked up and cuddled, while dad or grandpamay be more inclined to let them cry and settle them-selves. “That’s why we often hear one caregiver say,‘Well, the baby doesn’t do that for me,’” Corder said,adding that despite their youth, babies “quickly learnhow to get what they want.”

l Wrap Them Up: Swaddle your infantin a favorite soft blanket to mimic theconfines of the womb.

l Go for a Ride: Take a car ride, astroller ride or a (baby) swing ride.Movement often helps rock a babyto sleep.

l Rub Gently: A gentle, caressingmassage may help calm frazzlednerves just like it does for adults.

l Music Soothes: Quiet, soft music—including a sweet lullaby sung byyou—can distract and calm a baby.Other sounds, such as white noisefrom a fan or even the rhythmicsounds of a vacuum cleaner or wash-ing machine, can help lessen tension.

l Ask for help: Babies may sensetheir caregivers’ frustration andtension. If need be, ask someoneto give you a break so that you canregain your sense of calm andtransfer that calmness to your baby.Never shake a crying baby, as doingso can cause blindness, brain dam-age, or in extreme cases, death.

-NIH, American Academy of Pediatrics,Children’s National Medical Center,

Mayo Clinic

When is it time to be concerned about your little one’s fussing?

Tips for calming babies

Crybabies

Family stresscan be a cause of

unexplainedcrying.

ISTOCKPHOTO/EMPPHOTOGRAPHY;OPPOSITEPAGE:SJUPIER/STOCKBYTE/THINKSTOCK


BY ARLENE KARIDIS

T rying to sell kids on the idea of nutritious snacking can be daunt-ing. Commercials and grocery store aisles beckon with salty,sugary and fatty temptations. To keep children on a healthytrack, local experts shared ideas for easily prepared tantalizers

and consumer tips in areas like reading labels and shopping on a budget.

What are easily-made snacks that retain nutrients?Many fresh, nutrient-packed foods last for several days in the refrig-

erator, and make easy snacks, according to Karen Vartan, a registereddietitian and nutritionist who consults in Prince George’s County andthroughout Maryland.“You can roll roast turkey deli around celery or red and green bell

pepper slices. Celery and peppers stay crisp for some time and so do snappeas. You can slice vegetable strips and place them in a bag,” she said,adding that sliced deli meat and veggies will keep for at least several days.

How can you make snacks interesting and fun?Be creative tomake snacks appealing, said Silvia Solano, a registered dieti-

tian at Laurel Regional Hospital, part of Dimensions Healthcare System.“You can make sliders with lean meats or sliced hard-boiled eggs,

then cut them in different shapes (hearts, flowers, smiley faces). You canalso make little ‘hats’ for them by cutting cucumber or carrot slices intodifferent shapes and sticking them on with a toothpick,” said Solano.Healthy snacks are all the more inviting if the kids are the ones making

them, she said.“Children can cut up slices of green and red grapes, strawberries, blueber-

ries and bananas in different shapes with a plastic knife. Then, using a pieceof whole wheat toast with peanut butter on it as the blank canvas, theycan create their own fruit landscapes, scenes or faces. You canuse low-fat cream cheese if peanut allergy is an issue.”Caitlin Wong, a registered dietitian at MedStar

Southern Maryland Hospital Center in Clinton,also has ideas for creative projects.“Kids can make ants on a log with celery,

raisins and peanut butter. Or they can plant avegetable and fruit garden and use what theygrow in their snacks. For more activities,you can visit eatright.org [and] choosemyplate.gov,” said Wong.

For more ideas on concocting fun nutritious snacks, visit eatright.org and choosemyplate.gov.children’sWELLNESS

| continued on 16

l HOW TO TEACH KIDS TO ENJOY HEALTHY NOSHING l


W hile it is true that as they age childrenneed less sleep, the fact is that many kidsare not getting enough. Adequate sleepis critical to a child’s physical, cognitive

and emotional development. “Inadequate sleep can leadto issues affecting a child’s growth and ability to learn,”said BahramRedjaee,M.D., medical director of the SleepDisorders Laboratory at MedStar Southern MarylandHospital in Clinton.By the time a child enters elementary school, “his sleep

should be consolidated, meaning he doesn’t take a nap,”Redjaee said. Grade school students need 10 to 12 hoursof shut-eye each night; teenagers require 8 to 10 hours,he said.It is not unusual for adolescents to want to hit the hay

later and wake later. With the onset of puberty comesa “shift in circadian rhythms, a one- to two-hour delayin natural sleep onset,” said Judith Anne Owens, M.D.,medical director of the Sleep Laboratory at Children’sNational Medical Center in Washington, D.C., whichhas regional outpatient centers in Laurel and UpperMarlboro. It is the presence of melatonin, a hormonesecreted by a gland at the base of the brain, that makespeople drowsy, signaling bedtime. In younger children,melatonin’s effect begins to kick in between 8 and 9 p.m.By adolescence, it is closer to 11 p.m. That can make itdifficult for teens, many of whom start school as earlyas 7:30 or 7:45 a.m. in Prince George’s County, to getenough sleep.Only about 56 percent of children inMaryland get the

recommended amount of sleep every night, according tothe 2011/12National Survey ofChildren’sHealth. That ismore than 2 percent below the national average and putsMaryland 36th among states in terms of kids getting suffi-cient sleep on a nightly basis. In the Old Line State, nearly62 percent of elementary school students but only half ofadolescents get enough sleep. More boys than girls—58versus 53 percent—report adequate nightly sleep, accord-ing to the survey.

ADEQUATE SLEEP IS ESSENTIAL FOR GROWTH. “AMONG THEhormones that get secreted when children sleep is onethat’s responsible for growth,” said Redjaee. During

children’sWELLNESS Only slightly more than half of Maryland children get the recommended amount of sleep.


Too Few ZZZZZsWhy kids in particular need the right amount of sleep

BANANASTOCK/THINKSTOCK

How much dotoddlers benefitfrom naps?See page 19.


sleep stages three and four, thedeepest and most restorative sleep,the pituitary gland releases humangrowth hormone (HGH) into thebloodstream. While missing a fewhours of sleep one night here orthere is unlikely to slow a child’sgrowth, the repeated suppressionof HGH due to inadequate sleepmay limit physical development,according to TeensHealth, a web-site of The Nemours Foundation.Insufficient sleep sets children

up for a host of health-relatedproblems, according to the CentersforDisease Control and Prevention(CDC). These include obesity, dia-betes and depression. Sleepy kidsalso are more prone to accidentsand may struggle academically,said Redjaee.

The link between obesity andsleep has become increasinglyevident, said Maria Melendres,M.D., a pediatric pulmonologistwith the Mt. Washington PediatricHospital’s Sleep Laboratory atPrince George’s Hospital Center inCheverly. “And, given the poten-tial complications from obesity,sleep issues need to be addressed.”A study in the June issue of“Pediatrics” found that “chronicsleep curtailment from infancy toschool age” was associated withhigh obesity rates by age 7.

SLEEPY KIDS ARE OFTEN HUNGRYkids, said Redjaee. A 2004 studyby researchers at Stanford Schoolof Medicine found that sleep lossresults in higher | continued on 16 1885132

Gazette Health 2014Gazette Health 2014

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Obesity is linked to lack of sleep.

Sleep, while critical to a child’shealth, does not always comeeasily. Sleep hygiene, which con-sists of habits and environmentalfactors, lays the groundwork forrestorative rest, allowing childrento awaken refreshed. “Havinga bedtime routine is imperativeand will help prevent a lot ofissues,” said Bahram Redjaee,M.D., medical director of theSleep Disorders Laboratory atMedStar Southern MarylandHospital in Clinton. “If your childhas trouble falling or stayingasleep, take a look at his sleephygiene before panicking andjumping into a sleep study.”

l Establish regular sleep andwake times and avoid lettingchildren stray from those timesby more than an hour, even onweekends.

l Eliminate naps during the day.l Encourage exercise early inthe day; avoid strenuous physi-cal exertion before bedtime.

l Ensure adequate exposure tonatural light during the day.

l Avoid caffeinated food anddrink—chocolate, soda,coffee, tea—in the afternoonand evening.

l Refrain from eating largemeals or heavy, spicy orsugary foods before bedtime.

l Discourage the use of TVs,computers and smartphoneswithin an hour of bedtime, aslight signals the brain to stayawake and the associatedactivities can be stimulating.

l Remember that a bed is aplace to sleep, not watch TV,play board games, wrestle withsiblings or read.

l Create a sleep-conduciveenvironment that is cool, quietand dark.

l Take a warm bath. Not only isit relaxing, but the mild dropin a child’s body temperaturewhen he emerges from the tubsignals his body that it is timefor bed.

l Wear loose-fitting, comfortablepajamas.

l Steer clear of conversationsthat might be emotionallyupsetting before bedtime.

l Maintain a consistent bedtimeroutine and follow a predictablesequence of events, such astaking a bath, brushing teeth,reading a story and beingtucked in by a parent.

Sources: Bahram Redjaee, M.D.; Centersfor Disease Control and Prevention;National Sleep Foundation; Seattle

Children’s Hospital Pediatric ResearchFoundation; TeensHealth/The Nemours

Foundation; University of MarylandMedical Center

HELPING THEM NOD OFF

TurnThatDOWN!

‘‘IfI know what song is playing from yourheadphones and I’m 2 feet away from you,it’s too loud. If I have to shout in orderfor you to hear me when you’re listening

to music, that’s a red flag,” said LisaM. Nelson, an audiolo-gist and founder ofHearing Professionals inLaurel andBowie.With teen hearing loss on the rise, many health care profes-sionals are pointing to the improper use of personal technolo-gy as a possible cause. It’s not that iPods,MP3players, earbudsand headphones are inherently bad, but that kids are crankingup the volume and listening for extendedperiods, traumatizingtheir ears. Nelson pointed to European research showing that,at an acceptable volume, the use of personal listening devices“should be limited to four hours a week, an exposure limit thetypical teenager or young commuter far exceeds.” >>


L i s t e n U p


Are DigitalMusic Devices

Ruining Kids’ Hearing?

ISTOCKPHOTO/GPRENTICE


NEARLY 1 IN 5 ADOLESCENTS AGES 12 TO 19has some degree of hearing loss, according toa 2010 study in the “Journal of the AmericanMedical Association.” That’s a roughly 30percent increase over an 18-year period. Whilethe researchers did not single out digital audiodevices as the cause, they uncovered a sig-nificant increase in high-frequency hearing loss,which is associated with exposure to loud noise.They also highlighted an Australian study thatlinked the use of “personal stereo devices”with a 70-percent increased risk in hearing lossamong children.“Every generation has its own albatross, so to

speak,” saidKathyMellott, an audiologistwhosepractices include Audiology Unlimited in UpperMarlboro and College Park Hearing Servicesin College Park. “The field of audiology camefrom World War II, with exposure to new guns,vehicles and ships. Then came rock ‘n’ roll con-certs….Today there are all these devices.”“Prolonged exposure to loud noises causes

hearing loss and the effect is cumulative andirreversible,” said Estelle S. Yoo, M.D., an oto-laryngologist with the Center for Ear, Noseand Throat at Doctors Community Hospital inLanham. “We’re all progressively losing hearingover time and the greater the exposure—in bothdecibel level and duration—the faster the loss.”Repeated exposure to loud noise destroys the

tiny hair cells in the inner ear, reducing one’sability to hear high-pitched sounds, according tohealthychildren.org, the American Academy ofPediatrics’ website.Lower frequencies, which include human

speech, eventually become affected as nerve fibersdegenerate. “Once the nerves are shot, there’s nogoing back,” said Nelson. “There are no drugsor surgery that will restore your hearing to whatit once was.”

DAMAGE BEGINS EARLIER THAN MOST PEOPLErealize, said Yoo, who recommended that par-ents pay attention to the Sight & HearingAssociation’s (SHA) annual Noisy Toys List.Some of the toys on the list, which are madeby well-known manufacturers and designed forchildren as young as 6 months, “may have thepotential of causing enough noise that can resultin hearing loss in less than 15 minutes,” accord-ing to the SHA.Sound volume is measured in decibels (db). A

whisper is around 30 db; the typical conversationtakes place at about 60 db; a lawn mower putsout about 90 db; and a rock concert averages110 db, according to Yoo. The typical rock con-

cert or earphones played at 110 db can damagea child’s hearing in half an hour, according tohealthychildren.org.While no exposure guidelines exist specifi-

cally for children, said Nelson, the NationalInstitute for Occupational Safety and Health(NIOSH) has recommended that noise on thejob remain below a level equivalent to 85 db foreight hours. For every 3 db increase in volume,the amount of exposure time should be halved,according to NIOSH.

CHILDRENMAY EXPERIENCEA FEWORNOSYMPTOMSbefore hearing loss sets in. But, “if your child feelslike there is cotton in his ears, senses a fullnessor has ringing, it’s time to rest and retreat,” saidNelson. A visit to the pediatrician also may bein order.Preventing noise-induced hearing loss in chil-

dren requires action on several fronts. Beginby talking to your teen, Yoo suggested. Turnsout most parents don’t. A study earlier thisyear in “JAMAOtolaryngology—Head&NeckSurgery” found that 96.3 percent of parentsbelieved their teen was either not or only slightlyat risk of developing hearing problems fromnoise. As a result, fewer than a third of parentssaid they had talked to their teen about the haz-ards associated with excessive noise.Teens need to understand how loud is too

loud, said Yoo.While parents can provide exam-ples, there are apps—many of them free—foriOS and Android phones that allow adolescentsto measure decibel levels in the environment todetermine when hearing protection is warranted.“Empower your child to take control of his

health and hearing,” said Yoo. “Help him under-stand why it’s important to protect his hearing”and give him the tools to do so.Chief among those tools is noise-canceling

headphones. “They are better and, yes, you pay

for that,” said Mellott. “Because they cut downon competing sounds, you can enjoy your musicwithout having to turn up the volume.”To set the volume, “I advise my teenage

patients to go to a quiet room,” said Yoo.Once set, “that’s where the volume shouldstay, even if they’re in a public space with noisearound them.”Raising the volume to compete with a lawn-

mower or vacuum cleaner may result in danger-ously high decibel levels.Many websites, including healthychildren.org,

recommend what’s known as the 60/60 rule. Setthe volume at 60 percent of the maximum andlimit listening to 60 minutes per day.Take advantage of built-in volume controls.

“Some headphones and devices have volumelimits,” saidYoo. “With the iPod, Apple providessoftware that lets you set themaximumvolume.”There also is an iPod option that allows parentsto create a password without which the volumesetting cannot be changed.Insist your child wear ear protection when

mowing the lawn or undertaking activitieswhere the noise will exceed the NIOSH recom-mendations. That includes band or orchestrarehearsals, “especially if the room is reverber-ant,” said Mellott. “My contention is you needgoggles for chemistry, mouth guards for sports,and ear protection for music. If your child playsan instrument, there are earplugs that preservetonal quality.”Because adolescents often view themselves as

invincible, hearing protection can be a tough sellfor parents. Hearing, however, can be believing.Several websites offer simulators that allowteens to step into the shoes of those with hearingproblems. The Starkey simulator [starkey.com/hearing-loss-simulator] demonstrates with bothtext and sound how certain consonants—suchas T, F and S in mild cases—become more dif-ficult to discern as hearing loss progresses. Thesimulator is available as an app for $1.99 at theiTunes store. Play It By Ear, a free hearing-losssimulator, is found there as well. Websites forthe Hear the World Foundation and Centersfor Disease Control and Prevention also offerhearing-loss simulators.While teen hearing loss is on the rise, it is

not inevitable. Education in combination withthe proper use of personal listening devices andlimits on the amount of time teens can plug inwill, agree experts, go a longway to ensuring thatthey can hear the rustling of leaves, the song of asparrow and the voices of loved ones for decadesto come.

The typical rock concert can begin to damage hearing within half an hour.children’sWELLNESS

“ONCE THE NERVES

ARE SHOT, THERE’S

NO GOING BACK.There are no drugs orsurgery that will restoreyour hearing to what

it once was.”

-Lisa M. Nelson


What are some healthy snacks forlunchboxes?Dana Magee, a registered dietitian at

Rebecca Bitzer & Associates in Greenbelt, sug-gested making your own trail mixes, and alsohas interesting ideas for fruits and vegetables.“You can make trail mix with nuts, choco-

late chips, popcorn and pretzels, and store itin snack bags for easy grab-and-go,” she said.“Apple slices with nut butter or caramel

are also good lunchbox snacks. Cut the appleahead of time and squeeze lemon juice on it tokeep it from browning.”Masha Fox-Rabinovich, a registered dieti-

tian at Washington Adventist Hospital inTakoma Park, offered ideas for healthy sal-ads and wraps that store well in lunchboxes.“Make tuna salad with olive oil instead ofmayonnaise and chopped veggies mixed in(such as diced cucumber, green onion, celery,etc.) served with 100-percent whole graincrackers or pita bread.“You can make chicken veggie lettuce

wraps. Take diced chicken, chopped veggiesand a spoonful of hummus and wrap them ina lettuce leaf. Add a cup of fruit and yogurt toenjoy on the side,” said Fox-Rabinovich.

How can you make healthy snacks on abudget?Vartan suggested buying in bulk rather

than in individual portions and offered ideasfor making the most of what’s already inyour house. “You can buy cereals that arehigh in protein and fiber and fairly low insugar. You might throw in shredded wheat,oatmeal squares and Cheerios. You can alsoadd grapes and whole almonds.”“With ripe bananas, rather than have to

throw them out in a day, freeze them wholeand peeled, and slide a Popsicle stick throughthem,” she said.

What should you look for on the label?First, be aware that a long list of ingredients

is a clue that the food is likely processed andmay be high in sodium, sugar and fillers. Lookfor snacks lowest in these ingredients, saidMagee of Rebecca Bitzer & Associates.“Try to keep sodium in snacks to under 300

milligrams [.3 grams].When it comes to grano-la bars, know that many are more like glorifiedcandy bars and are lacking fiber and protein. Isuggest under 10 grams of sugar for a granolabar. I do like KIND bars and Kashi bars, whichare satisfying and balanced,” she said.

What are healthy alternatives for kids witha sweet tooth?“The most satisfying snacks combine

foods from more than one food group, so forsweetness, try apple slices with peanut but-ter, yogurt and fresh strawberries, grapes andstring cheese,” said Valorie Anlage, M.D., apediatrician at Primary Pediatrics in Laurel andBowie. “Avoid sweet liquids such as juice, lem-onade, and fruit punch—these drinks containway too much sugar and will only add to thatsweet tooth.”

What are healthy alternatives to fatty,salty snacks?Anlage suggested fresh veggies provide the

crunch without the fat and salt. Nuts are goodfor texture, as well. “Carrots or celery dippedin hummus would be a good choice. For olderkids, nuts are a great snack, providing proteinand healthy fats. If you like to cook, try mak-ing eggplant fries or kale chips,” she said.

How do you empower kids to adopt healthysnacking habits?Dietitian Vartan recommended teaching

children to become educated consumers.“Parents should take kids to the snack

aisle at the store and [parent and child] canmake decisions together. Encourage them tocompare nutrition labels’ ingredients, andto help you find manufacturers who put outhealthy products.“Let them help put away groceries and

engage them in conversations on what is onthe label. Give them the power to educate you.For instance, encourage them to challenge youwith questions like, ‘How much salt is in thiscan of soup?’” she said.Empowering kids also means leading by

example, according to Patricia N. White, a reg-istered dietitian and president/CEO ofNutritionand Your Temple, LLC in Upper Marlboro.“A good way to increase children’s desire for

healthier snacks is for parents to demonstrategreat enthusiasm about quality food ingre-dients used to make nutritious snacks,” shesaid. “Explain to children the good nutrientsin these products will help their bodies growstronger.”She also encouraged parents to make snacks

with their children. “One project you canenjoy together is cutting bananas, mangos,apples and oranges into animal shapes anddecorating them with raisins or dried cranber-ries for color.”

levels of a hormone that triggers appetite,reduced levels of a hormone that tells yourbody it’s full and an increased body mass index.The resulting cycle is a vicious one, accordingto Redjaee, as obesity can lead to more severeissues, such as obstructive sleep apnea. Childrenwith sleep apnea stop breathing for brief periodsmany times each night. With their sleep inter-rupted over and over, they rarely awaken feelingrested and refreshed. Sleep apnea can be treatedthrough lifestyle changes and the use of a CPAP

machine, which applies continuous positive air-way pressure through a mask worn by the childwhile he sleeps.Sleepy kids may have trouble in school. “It’s

difficult to concentrate and you don’t have thesame mental acuity when you’re tired,” saidRedjaee. Because sleep may “help consolidatewhat we learned during the day and put it intoour memories,” insufficient sleep may inhibit theimprinting of information or events.Although somewhat counterintuitive, sleepy

kids may be hyperactive kids, Redjaee said.When tired, children and adults may behave dif-

ferently. Adults may become sluggish while chil-dren will overcompensate by speeding up. As aresult, “kids can be misdiagnosed with attentiondeficit hyperactivity disorder when what theyreally have is a sleep issue,” he said.Because sleep is key to overall health, parents

should pay attention to signs that their child isnot getting a good night’s rest. If that is the case,“speak to your pediatrician. He may be able topiece out things in your child’s sleep schedule orsleep habits that can be fixed,” said Melendres.And, if not, “he can request a sleep study, whichmay uncover other medical problems.”

SLEEP, from 13

SNACKS, from 11

ISTOCKPHOTO/FIOLIK

A


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Hours of Operation:Monday – Friday8:30am - 5:00pm

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• We also provide Adult Care and Prenatal Care

is purging can also be seen inbruises on the hands from stick-ing fingers down the throat.Forced vomiting creates an

irritated throat and esophagus,and can lead to ulcers and con-stipation. Because the body isnot receiving enough nutrients,it hangs on the food it is get-ting, slowing the metabolism andmaking it harder to lose weightin the future. Bulimia also weak-ens the muscles, including theheart, because the body is losingso much fluid and minerals suchas potassium, sodium and mag-nesium, said Magee.“When Jenna was losing

weight, we worried that she wasthrowing up, and listened forit. I had noticed that a lot offood was missing, but we neverthought to look online for infor-mation,” Kittleman said. “Wejust thought if she starts lookingemaciated, we will have to dosomething. We didn’t have anyidea that it could kill her.”In July 2011, Jenna ended up

in the hospital after passing out.Her heart was shocked twice tokeep her alive. Doctors askedif she had a heart condition.Eventually, an ICU doctor askedif Jenna had an eating disorder,as tests had uncovered a lackof potassium and magnesium,both essential for keeping theheart beating. She was put intoa medically-induced coma whiledoctors worked to reduce herfever and fill her up with themissing minerals.“After that, her secret was

out,” Kittleman said. “That washard for her, that everyone knew.”Jenna quit binging and purg-

ing, but replaced it with drinkingalcohol, and ended up at a rehabfacility in Florida. But when shestopped drinking, the bulimiacame back. It had such a hold onher, Kittleman said. She lookedforward to binging and purgingas a way of relieving stress at theend of a tough week.“She was definitely hooked on

bulimia. After she died, I went to

therapy, trying to stop blamingmyself…finally you realize you areegotistical to think you have con-trol over life and death,” she said.

TREATING BULIMIA IS EASIER WHENa person has just begun bing-ing and purging. Both Mageeand Peterson said that treat-ment is a group effort: the fam-ily, a therapist, a nutritionist,support groups and possiblyantidepressants. The only FDA-approved medication for buli-mia is Prozac or its genericequivalent, according to theAcademy for Eating Disorders.“We do the nutrition side,”

Magee said. “Treatment reallyfocuses on self-care … knowingyour triggers and seeing how foodis affecting your life choices.”Meal logging and journaling

are part of the treatment plan.Magee and her associates use aphone application calledRecoveryRecord that allows clients to texttheir dietitians, log foods and getimmediate feedback.Other ways they can take

care of themselves are to man-age stress, get enough sleep, stayhydrated, and have an eatingplan they can stick to, in spite ofthe stressors their lives present.Some clients are going to have

to be mindful of the potential toslip back into bad habits, whileothers are able to just walk awayfrom it, said Peterson.“It’s a lot ofwork,” saidMagee.

“There’s no way to sugarcoat it.”

BULIMIA, from 7“We just thought if

she starts looking

emaciated, we will

have to do something.

WE DIDN’T HAVE

ANY IDEA THAT

IT COULD KILL

HER.”

-Laura Kittleman


allergists. Identifying and remov-ing—to the degree possible—those things that trigger an asth-ma attack are important. If, forexample, a smoker can’t quit ora pet must remain, then movingthe activity or the animal outsideis the best option, according tothe Children’s National MedicalCenter guide. Improving indoorair quality by cleaning ducts andregularly changing HVAC filters ishelpful. And, while a clean homecan go a long way toward reduc-ing triggers, sweeping, vacuuming,dusting, painting and spraying forinsects should not be done in thepresence of an asthmatic child.Most children with asthma

need bothmaintenance and rescuemedications, said Baker. Takenregularly to prevent inflamma-tion of the airways, maintenancemedications may be prescribed aspills, inhalers or injections. Rescuemedications—designed to haltan asthma attack—are deliveredthrough an inhaler directly to thelungs. It’s important that children“learn the proper inhaler tech-nique from a physician or phar-macist, otherwise the medicationwill not deposit into the lungs,”she said.

ONCE THE ASTHMA IS UNDER CONTROL,children generally “follow upwith their physician every 3 to 4months,” said Baker. “We want tosee how they are doing throughoutthe year as the seasons change,especially if the asthma is allergyrelated, and make adjustments tothe medication.”The need for medication adjust-

ments and potential for asthmaattacks often can be identifiedthrough the child’s use of a peakflow meter at home. “It’s a greateducation tool,” said Baker, “andhelps us pick up on problemsbefore the symptoms occur.” Thepeak flow meter, a handheld devicethat a child blows into daily, func-tions as a traffic light. “If results arein the green zone, it means yourasthma’s well controlled; the yellowzone serves as a warning; and red

means go to urgent care or the ER,”said Baker.A physician’s directions about

what to do when certain symptomsarise or peak flow readings changeshould be part of a child’s asthmaaction plan. “Your child’s schoolnurse, classroom teacher and coachshould all have a copy of the plan,”said Baker. Sample asthma actionplans can be found on the web-sites of the National Heart Lungand Blood Institute and AmericanLung Association. School nursesalso should have a rescue inhalerfor your child.Keeping symptoms under con-

trol, through both monitoringand medication adherence, allowsa child to participate in activitieswithout fear of an attack. Whileexercise can be a trigger for someyoung asthmatics, daily physicalactivity is nonetheless encouraged,said Okocha. “For some children,we may recommend a prophylac-tic—a few puffs of the albuterolinhaler—before engaging in car-diovascular activity,” she said. “It’simportant for children with asthmato stay healthy, which includesexercising and eating right.”

“When kids have difficulty run-ning or exercising and routinelyhave to stop to catch their breath,they may choose more sedate activ-ities, such as video games,” saidBaker. “That leads to childhoodobesity, and the heavier a child is,the worse his asthma becomes. It’sa vicious cycle,” one parents shouldstrive to avoid by making sure theirchild is taking his medication andthat it is having the desired effect.

WHILE THERE IS NO CURE FORasthma, some children do experi-ence a decrease in symptoms intheir late teens or adulthood. “With

increased lung volume and capac-ity, some people can come off ofmedications, as long as they stillmonitor,” said Baker.For those whose symptoms

continue, enhanced and alterna-tive treatments may be availablein the future. “Medications haveimproved dramatically over thepast 20 years,” said Baker, “andresearch continues.” Last year,the American Lung Association’sAsthma Clinical Research Centersbegan recruiting patients for a studyexploring whether a device usedto treat sleep apnea could reduceasthma symptoms. BronchialThermoplasty, which delivers lowheat to the smooth muscle of theairways, is now being used—though only on adults—to controlasthma symptoms.In themeantime, young asthmat-

ics are urged to take their condi-tion seriously. Through monitor-ing, medication, lifestyle changesand regular physician visits, asthmagenerally can be held in check. “Itis a chronic disease, for which thereis no cure,” said Baker. “But withproper diagnosis and treatment, itcan be effectively controlled.”

ASTHMA, from 9

“For some children,we may recommenda prophylactic—a few puffs of thealbuterol inhaler—before engagingin cardiovascular

activity. ”

-Ifeyinwa Okocha, M.D.

ISTOCKPHOTO/LS

OPHOTO


CHILD:ISTOCKPHOTO/POCO_BW;ALARMCLOCK:BURKE/TRIOLO

PRODUCTIONS/STOCKBYTE/THINKSTOCK

Naps Help Little Ones Learn

Afternoon naps canenhance memory andsupport learning inpreschoolers, accord-

ing to a study released late lastyear. The finding hints thatmaking time for naps in theclassroom might be helpfulduring early childhood.Although plenty of stud-

ies have shown that over-night sleep and brief naps canboost learning and memory inadults, the effects of nappingon toddlers hadn’t been close-ly examined. To learn more,National Institutes of Health(NIH)-funded scientists playeda memory game with 40 pre-schoolers. In the morning, thechildren learned where nine or12 cartoon images were locatedon a grid. Then the childreneither took an afternoon nap(about 1 hour and 15 minutes)or were gently kept awake.After nap time, the children

were tested to see how wellthey could remember the loca-tions of the cartoon images. Thescientists found that childrencould recall 10 percent more ofthe items’ locations when theynapped than when they’d beenkept awake. Children who’dnapped had similar success inremembering items’ locationseven the next morning. Theresearchers also found that thebenefits of napping were great-est for the children who regu-larly took naps.To explore how memories

might be stored in the brain, theteam measured the brain waves

of 14 additional childrenduring naps. The research-ers noticed a link betweendistinct bursts of brainactivity during napping anda child’s performance onmemory tests. These burstsof activity might representthe strengthening of memo-ries, the scientists suggested.“We hope these results

will be used by policymakersand center directors to makeeducated decisions regard-ing nap opportunities in theclassrooms,” said the study’slead researcher, Dr. RebeccaSpencer at the University ofMassachusetts Amherst.Babies typically sleep

about 16 hours a day, andyoung children need at least10 hours of sleep, while teen-agers need at least nine hours,said Dr. Michael Twery, asleep expert at NIH.“We’ve learned that sleep

before learning helps pre-pare your brain for initialformation of memories,”said Dr. Matthew Walker,a sleep scientist at theUniversity of California,Berkeley. “And then, sleepafter learning is essential tohelp save and cement thatnew information into thearchitecture of the brain,meaning that you’re lesslikely to forget it.”

–NIH News in Health, withexcerpts from the articles“Sleep On It” and “TheBenefits of Slumber”

From the Experts Young children need at least 10 hours of sleep a day.

’d’dnnnnnsnsnsnsheheheheththeeeatat--u-u-u-u-

ieiesssththeeevevesss

afafhehehehenenenenearararmemememelililili

–N–N–N–Nexexexex“S“S“S“SBeBeBeBe

After nap time, children couldrecall 10 percent more of itemsthey’d been shown beforesleeping than when they’d

been kept awake.


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