Spring 2006

Not All Calories Are Created Equal
The ones in nutrient-rich foods are best   I   An interview with Trudy Th...
Combating Childhood Obesity
      A Special Focus for HealthyKids I by David Tejeda, M.D., chair, Department of Pediatrics...
Exercise for the Mind       #                                                                       AGES 5-15

and Spirit...
Confronting African American Health
Putting kids’ needs first I An interview with Nadine Burke, M.D., MPH

     cross the ...
Disparities                                  #
                                             ALL AGES
Mending Hearts Is Strength
      of California Pacific Team
      The Pinto family’s story I by Laura Miyashita

Healthy Family Recipes
Good habits begin early I An interview with Sharon Meyer, CNC
Child-Focused Hospitals Lead Child
     Abuse Treatment and Prevention Efforts
     M       ost parents don’t want to hurt...
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Healthy Kids Summer 2006

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  1. 1. Spring 2006 Not All Calories Are Created Equal The ones in nutrient-rich foods are best I An interview with Trudy Theiss, M.S., R.D., CDE # I t’s a basic truth: If you consume more calories than you burn, you gain weight. But what, ALL AGES exactly, is a calorie? And are there any differ- ences among calories from different food sources? “Calories represent the energy-producing poten- tial in food,” says California Pacific Medical Center INSIDE: Registered Dietitian Trudy Theiss, M.S., R.D., CDE. “The energy released when your body metabolizes food fuels the 2 The Doctor Is In growth and maintenance of body tissues, the conduction of 3 Yoga and tai chi electrical nerve impulses, the work of muscles during physi- 4 Confronting health cal activity and the heat production necessary to maintain care disparities body temperature. If you take in more calories than required for those body functions, your body stores the excess as fat.” 6 California Pacific’s cardiac team mends tiny hearts Cutting down on sugar Theiss notes that some calories are “better”than others. 7 Healthy eating “Better calories”come from nutrient-rich foods that contain habits begin early lots of vitamins and minerals.“In today’s diets, sugar, which is not a nutrient-rich food, can make up a large part of the daily calorie intake,”says Theiss. To cut down on sugar in children’s diets, Theiss sug- gests limiting fruit juices, since they can contain as much sugar as sodas. “Fresh fruit is always a better choice than juice because you get fewer calories, plus more fiber and other nutrients,”she explains. Fat in your child’s diet In addition to monitoring sugar intake, parents should be concerned about the number of calories from fats. “Fats are a necessary nutrient, but excess fat calories are quickly converted into body fat,” Theiss says. continued on page 5 www.cpmc.org
  2. 2. Combating Childhood Obesity A Special Focus for HealthyKids I by David Tejeda, M.D., chair, Department of Pediatrics, and Oded Herbsman, M.D., medical director, Pediatric Inpatient Services O besity, a growing epidemic among children, is poised to pass tobacco as America’s lead- ing preventable killer. For children, the health risks program that will be unveiled later in 2006. This effort will target at-risk communities within San Francisco, providing them with convenient clinic locations, community programs, and associated with obesity are serious. At California diet and exercise classes. We will share Pacific, we are seeing an increase in many more news about this program in a health issues related to obesity, namely, future issue. a rise in childhood diabetes, sleep apnea, We hope this issue of HealthyKids gives orthopedic problems and psychiatric you some needed information and tools issues. The obesity epidemic is particu- to keep your family’s health in check! larly disturbing because overweight Please let us know of any pediatric health children often become obese adults, questions (see our “Doctor Is In” column California Pacific pedia- with problems such as diabetes, heart below), newsletter feedback or topic tricians are establishing disease and hypertension. suggestions. Our editorial contact infor- To combat the obesity epidemic mation is provided at the back of this a pediatric obesity locally, California Pacific pediatricians magazine. We look forward to hearing program that will be are establishing a pediatric obesity from you! # unveiled later in 2006. The Doctor Is In Your child’s health questions answered I by David Tejeda, M.D., chair, Department of Pediatrics My son’s verbal skills are the least transient delay in language development. Q: developed in his preschool class. I’m not sure if it’s because he is the However, it does not cause significant language delay. Reading to your child youngest in the class, or the fact that he’s daily has a positive impact on language exposed to both English and Chinese at development. # Submit Your Question home. When should I be concerned about his language development and If you have a child’s health how do I pursue an assessment? question that you want It is important to discuss your addressed in a future issue of HealthyKids, A: concerns with your child’s pedia- trician. All children should routinely e-mail it to us at: have developmental assessments, which bosquejp@sutterhealth.org, typically occur at well-child visits. Use or visit www.cpmc.org/ these visits to discuss any issues relevant pediatrics. Due to space to your child’s age. There is a wide range Reading to your child limitations, we cannot of normal language development.Your pediatrician will help determine if your daily has a positive guarantee that all ques- son’s speech is delayed. If so, referral for impact on language tions will be answered. a hearing test or further evaluation may development. be warranted. Learning two languages at the same time may be a factor in mild, 2 www.cpmc.org
  3. 3. Exercise for the Mind # AGES 5-15 and Spirit, As Well As Body Yoga and tai chi offer exercise, relaxation I by Jennifer Cohen, M.D., pediatric hospitalist A s yoga and tai chi gain popularity among adults for pain management and injury prevention, many parents wonder if these activities are also appropriate for children. Yoga, which originated in India, engages participants in a series of pos- tures that promote strength, balance, flexibility and relaxation. Its regular use has been reported to improve attention deficit disorder (ADD) and asthma, as well as migraines and other pain prob- lems. Although very little research has been done on its health benefits for children, yoga is generally a safe activity that, at the very least, will help with relaxation and stress reduction. Finding a child’s yoga class Some adult yoga studios offer classes specifically for kids, while others cater exclusively to children and may include activities such as dance or art classes. Children as young as 3 may be interested in yoga; many of the postures are named for animals that children like to imitate. quiet the mind, relax the body and Yoga engages par- Before registering your child, ask to improve balance. In Chinese medicine, ticipants in a series Yoga is generally observe a class. Classes for smaller chil- tai chi is recommended to balance the of postures that dren may be geared toward having fun, body’s organ systems and restore health. promote strength, a safe activity while those for older kids and teens may Health benefits are well-documented in balance, flexibility that, at the very be quieter and more relaxing. A good adults, but again, little research has been least, will help and relaxation. teacher can engage children of all ages. done in children. Classes for children with relaxation He or she will encourage correct posi- will generally be found at martial arts tioning and offer alternatives for children studios. Look for teachers who instruct and stress who are less flexible. Children should be without criticizing and encourage a reduction. taught and reminded to respect and tune noncompetitive atmosphere. in to any pain they may feel. The lessons Yoga and tai chi are generally safe for in body awareness, as well as strength, healthy children — including those with balance and flexibility, will help children special needs — but, as with any exercise with other activities as well. program, consult your pediatrician before registering your child in a class. While the Tai chi for children research into these exercises for children Tai chi, also known as “meditation in is minimal, both clearly have advantages motion,” is an ancient form of Chinese in being noncompetitive and helping to meditation that uses a series of slow establish physical activity and mental movements, with controlled breath, to wellness habits that can last a lifetime. # www.cpmc.org 3
  4. 4. Confronting African American Health Putting kids’ needs first I An interview with Nadine Burke, M.D., MPH cross the United States, the infant mortality rate among African A _Americans is more than double the rate among the general population, according to the Centers for Disease Control and Prevention. In San Francisco, the infant mortality rate for African Americans is four times the rate of the city’s general population. To confront this astonishing disparity good job addressing the disparities and other instances of inadequate in health care delivery for the African health care coverage for San Francisco’s American community. For example, African American community, California the rate of asthma hospitalization for Dr. Burke joined California Pacific as a direct Pacific Medical Center joined forces children living in the Bayview district is result of the hospital’s involvement in the three years ago with all hospitals in roughly six to seven times that of chil- African American Health Disparity Project. the city to form the African American dren living in the Marina. One of our Health Disparity Project (AAHDP). goals is to dramatically reduce the num- regardless of the neighborhood in “Many African Americans in San ber of preventable hospitalizations.” which they live.” Francisco live in communities that have Dr. Burke joined California Pacific as One of Dr. Burke’s dream programs been marginalized,”says Nadine Burke, a direct result of the hospital’s involve- is about to become a reality when M.D., MPH, a California Pacific pedia- ment in the AAHDP. “This type of work California Pacific opens the Bayview trician with a master’s degree in public is my dream — to create programs that Child Health Center at the Arthur H. health.“San Francisco’s health care help ensure all San Francisco children Coleman Medical Center on 3rd Street. providers have historically not done a have the opportunity to grow up healthy, This center will offer such medical Get Your Kids to Log Off “Screen time” cuts into physical pastimes T elevision and video games have deprived children of outside play for years. Now that most homes have a personal computer and # about a third of kids ages 8 to 18 have one in their room, health experts have raised concerns about safety and inactivity. AGES 5-15 Going “online”can expose young- Children and teens should sters to predators or cause them to get at least 60 minutes a day of physical waste hours in chat rooms. In addition, activity, according to the 2005 dietary rising “screen time”can cost kids the guidelines from the U.S. Department with your children by walking with exercise they need to keep fit. of Agriculture and the Department of your kids a few nights a week after “Activity levels are waning, due to Health and Human Services. supper, for instance. Consider shutting changes in [school] curricula, computer off the weekend cartoons to do a family technology and community resources,” How can you help? activity like bike riding, hiking or says Carl Foster, Ph.D., president of the A lot of doctors say you should take swimming. American College of Sports Medicine. TVs and PCs out of kids’ rooms and “While your children may complain “As a result, our kids are getting fatter limit screen time to less than two in the short term, they will be healthier and may be the first generation not to hours a day. They also say you should and better developed people for having have a longer life expectancy than their encourage more exercise. This is a ter- a little less electronic input,”says Dr. parents.” rific opportunity to spend quality time Foster, a professor of sports science at 4 www.cpmc.org
  5. 5. Disparities # ALL AGES Not All Calories continued from page 1 Parents should be selective about the type of fats their children consume, and limit saturated and trans-fats as much services as vaccinations, well-child as possible. Remember, the lower the fat exams and urgent-care visits, along with content, the bigger portion you get for follow-up and continuous care for long- the same number of calories.” term health problems. Families can also Consumption of calorie-dense foods get referrals to medical specialists for and lack of adequate exercise are directly problems ranging from diabetes to related to the increasing rate of obesity asthma. To contact the Bayview Child among children and teens in the United Health Center, call 415-600-2460. States, Theiss notes. Monitoring your Trudy Theiss, M.S., “We want to ensure that children get Nadine Burke, M.D., children’s diets to make sure they aren’t R.D., CDE the specialized care they need so that MPH, pediatrician, taking in too many calories and encour- they don’t end up in the emergency room,”notes Dr. Burke, who will staff California Pacific Medical Center aging children to get plenty of exercise are key to preventing childhood obesity. # “ In today’s diets, the facility along with other California sugar, which is Pacific health care professionals. The Center will accept all forms of “ We want to not a nutrient-rich insurance and help families enroll in var- food, can make ious city, state and federal medical cover- ensure that up a large part of age programs.“Children in San Francisco children get the the daily calorie are universally insured through programs specialized care such as Healthy Kids,” Dr. Burke explains. intake. they need. “Parents often aren’t aware of the resources available to them. We are ” ” committed to helping families protect the health of their children.” # Tips for Staying Healthy To Learn More To help develop healthy eating patterns in children, Theiss offers several recommendations: “We Can!” (National Heart, Lung, Be aware of what your children are eating at home and school. and Blood Institute): Limit consumption of sodas and processed or “fast” foods. http://wecan.nhlbi.nih.gov Offer healthy choices of foods with low calorie density, and PC-Turnoff Organization: Children and allow children to decide how much or whether to eat. www.pcturnoff.org Never force a child to “clean your plate.” teens should American College of Sports Medicine: Limit fat consumption to about 30 percent of total caloric intake. get at least www.acsm.org Avoid being overly restrictive about which foods children eat 60 minutes a day National Coalition for Promoting — the sense that some foods are “forbidden” may lead to Physical Activity: www.ncppa.org of physical unhealthy eating behaviors. President’s Council on Physical activity. Encourage children to eat foods that are high in water and Fitness and Sports: www.fitness.gov fiber content, both of which help make them feel full longer. Dietary guidelines from the U.S. Try to have relaxed family meals and encourage children to Department of eat more slowly and recognize when they are full. the University of Wisconsin–LaCrosse. Agriculture and the “The key is to create something else Make sure your children get plenty of exercise. Department of for them to do outside without being Health and Human For more guidance in developing a healthy diet for your children, overbearing about it or orchestrating the Services Theiss suggests consulting the Web site for the USDA’s food pyra- play. You may need to band together mid, www.mypyramid.gov, or an authoritative book such as Child with other parents and organize an after- of Mine, by registered dietitian and social worker Ellyn Satter. “If, school program to provide a safe venue. in spite of your best efforts, you notice your child is gaining too But kids, being kids, are plenty smart enough to think up fun things to do.”# much weight, be sure to consult your pediatrician,” she adds. www.cpmc.org 5
  6. 6. Mending Hearts Is Strength of California Pacific Team The Pinto family’s story I by Laura Miyashita fter having a healthy second pregnancy and Charlie Pinto with A delivering a beautiful baby boy one year ago, San Francisco residents Sarah and John Pinto couldn’t mom Sarah (right) and Pediatric Cardiologist Nikola have been happier.“My delivery was a piece of cake Tede, M.D., nearly and our son, Charlie, was perfect,” remembers Sarah. one year following Within hours, though, Charlie’s life was at risk. his heart surgery. “Charlie was in the Well-Baby Nursery when we were informed that he looked the most minimally invasive procedures blue,” Sarah remembers. “They took him possible,”notes Dr. Black. to the NICU for tests, where doctors During Charlie’s surgery, Dr. Black used determined he had a closed valve in his exceptionally small incisions and micro- heart. Charlie was given a drug called scopic cameras to magnify and illuminate prostaglandin to keep open a communi- the area surrounding Charlie’s heart. Then, cation between his pulmonary artery and Dr. Black used Charlie’s own tissue to aorta. Without that drug, no blood could create a new valve. Because of Charlie’s # get into the lungs, and the oxygen young age, a portion of his initial defect level in his circulatory system was left to promote growth. After his heart could not sustain life. INFANTS developed further, Dr. Black used the same California Pacific Medical incisions nine months later to completely Center Pediatric Cardiologist Nikola close the hole in Charlie’s heart, leaving Tede, M.D. was one of the physicians him with normal circulation. who immediately attended to Charlie in the NICU.“Charlie had a murmur that Minimally invasive surgery sounded louder than the normal transi- used for heart repairs tional murmur of a newborn,”recalls Dr. “Every child’s condition is different,” Michael Black, M.D., Tede.“After performing an echocardio- Dr. Black continues.“Because we have For more information chief, Division of gram [cardiac ultrasound], we quickly such a highly skilled cardiac team, as Pediatric Heart confirmed Charlie had pulmonary atresia well as the most leading-edge technolo- Surgery California Pacific Medical with an intact septum.” gies available, we are able to think cre- Center is a regional leader in pediatric cardiovascular Heart disease prevalent in newborns atively to develop unique strategies that exceed treatment expectations.” “ Because we care. To find out more “Most people don’t realize how Charlie’s parents are extremely prevalent heart disease is in newborns,” happy with the care Charlie received at have such a about our pediatric ser- vices, visit our Web site at Dr. Tede continues.“Up to 1 percent of California Pacific.“We never thought of highly skilled all babies will have some form of con- our situation as a tragedy,”says John. cardiac team, www.cpmc.org/pediatrics genital heart defect, and most of these “Drs. Tede and Black were very positive or call our Specialty we are able to problems become apparent very shortly about our options and were so willing Referral Line at after birth.” to talk to us at length.”Sarah agrees, think creatively. Shortly after his diagnosis, two-day- “There’s always hope, and the medical 888-637-2762. old Charlie Pinto underwent surgery advancements now are amazing.”Even ” with Michael Black, M.D., chief of better, though, is Charlie’s recovery. Now California Pacific’s Division of Pediatric 1 year old, Charlie is a charming little boy Heart Surgery.“A newborn baby’s heart who is developing well and keeping his is so incredibly tiny that we have to use parents busy chasing after him! # 6 www.cpmc.org
  7. 7. Healthy Family Recipes Good habits begin early I An interview with Sharon Meyer, CNC #ALL AGES etting children to eat a healthy diet with a G good balance of nutrients isn’t always easy. There is hope, however, for every parent who has had to contend with a picky eater who refuses to touch those “icky”green beans. “Introducing children to a wide vari- Involving your kids ety of foods at an early age helps develop in cooking enables healthy eating habits that will continue you to educate your through the years,”says Sharon Meyer, children as to where CNC, a certified nutritionist at California various foods come Pacific Medical Center’s Institute for “ Introducing Health & Healing. “One way to do that is to involve your kids in cooking. They from and what con- stitutes a healthy children to a wide will be proud of the dishes they create meal. variety of foods and excited to eat them. It also enables you to educate your children as to where at an early age various foods come from and what con- helps develop stitutes a healthy meal.” healthy eating For children, a healthy diet encom- habits that will passes more than just three meals a day. “It’s better for children to eat smaller continue through meals, with healthy snacks between in addition to dairy sources of calcium. the years. meals,” Meyer says. Meyer offers the following snack Children also require plenty of cal- ideas and a recipe to help ensure a ” Sharon Meyer, CNC, cium, but it doesn’t have to come from milk. “Studies have shown that absorp- healthy diet. certified nutritionist, tion of the calcium in cow’s milk is Snack ideas: California Pacific inferior to that of calcium from plant Trail mix: pecans, walnuts, almonds, Medical Center sources,” Meyer notes. She recommends cashews, soy nuts, raisins, dried cran- Institute for Health leafy green vegetables, cooked beans berries. Note: Avoid giving nuts and & Healing and peas, nuts, seeds and whole grains, raisins to toddlers under 2, and supervise older toddlers when they eat these foods, as they can present a choking hazard. Tuna or Salmon Salad Wraps Plain yogurt with 1 teaspoon honey and fresh or thawed frozen fruit (if 1 can tuna or salmon not lactose intolerant). Note: Do not 1 /4 cup minced green onions give honey to children under age 1. 1 celery stalk, chopped String cheese 1 tsp. lemon juice Hummus with carrots, steamed broc- coli, red peppers or jicama 1 tbsp. olive oil Sweet potato chips: 1 tbsp. chopped fresh parsley — Slice sweet potatoes thinly. 1 /4 tbsp. Dijon mustard — Lay on a baking sheet; sprinkle To Learn More salt and pepper with olive oil, salt and pepper. 2 whole-wheat tortillas — Bake at 375 degrees until crisp. Visit www.cpmc.org/ Mix all ingredients in a bowl. Spoon the mixture onto the tortillas — Serve plain or with hummus or pediatrics for more and wrap. guacamole. nutritious recipes. Fruit # www.cpmc.org 7
  8. 8. Child-Focused Hospitals Lead Child Abuse Treatment and Prevention Efforts M ost parents don’t want to hurt their children support groups and other resources to guide parents through the stresses of intentionally. But the stress of an infant who raising children. won’t stop crying or the daily struggles of caring for Worried that a child you know or see in a public place is being maltreated? To Learn More a child with special needs can overwhelm even the Child-focused hospitals and medical most loving parents. Whether you are struggling to providers can help connect you to an California Pacific Medical appropriate community resource where Center is an associate build positive discipline skills or have seen another you can anonymously report your member of NACHRI. parent or caretaker abuse a child but don’t know concerns. For more information Some parents worry that if their what to do, your children’s medical provider can help. children are injured accidentally, not on this organization Nearly 3 million cases of suspected through abuse, they will be suspected of and its efforts to prevent abuse and neglect are reported in the child abuse if they bring them to a hos- and treat child abuse United States each year. The National pital. That’s why child-focused hospitals and neglect, visit Association for Children’s Hospitals and are working together to weave a seam- www.childrenshospitals.net Related Institutions (NACHRI) and its less, timely and effective system of and select “Child members, such as California Pacific abuse response that helps protect inno- Medical Center, are leaders in providing cent parents and provides necessary Advocacy.” California medical care to abused and neglected medical care and emotional healing to Pacific Medical Center children. They teach coping skills to deal the nation’s most vulnerable children. offers a Postpartum with the frustration and anger that every Working with hospital leaders, Depression Support parent feels at one time or another while pediatricians and allied organizations, Group through Newborn child-rearing. Hospitals dedicated to the NACHRI developed a guide to the Connections. Call care of children and their families also establishment, development and provide parenting classes, fact sheets, enhancement of child abuse services 415-600-BABY for details. within child-focused hospitals. These To view other resources, NACHRI guidelines are helping the community visit www.cpmc.org or National Association of Children’s of child-focused hospitals provide the ask your child’s health Hospitals and Related Institutions highest level of quality care possible to care provider. www.childrenshospitals.net abused and neglected children. # www.cpmc.org Articles in this newsletter are written by professional journalists or physicians who strive to present reliable, up-to-date information. But no publication can replace the care and advice of medical professionals, and readers are cautioned to seek such help for personal problems. ©2006 StayWell Custom Communications, 780 Township Line Road, Yardley, PA 19067, 267-685-2800. Some images in this publication may be provided by ©2006 PhotoDisc, Inc. All models used for illustrative purposes only. Some illustrations in this publication may be provided by ©2006 The StayWell Company; all rights reserved. (206) For Q&A contributions Non-Profit or to opt out of this Organization mailing, please contact U.S. Postage California Pacific Medical Center John Bosque at Department of Pediatrics PAID bosquejp@sutterhealth.org Permit No. 1741 P.O. Box 7999 San Francisco, CA or 415-600-2991. San Francisco, California 94120-7999 Editorial Team Jennifer Cohen, M.D. Oded Herbsman, M.D. Return Service Requested Steve Martel, M.D. Laura Miyashita Tim Nicholls, M.D. David Tejeda, M.D. Contributing Writer Susie Caragol