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Ensuring Child Health and Safety Worldwide
- 1. 6Health and Safety Jupiterimages/Stockbyte/Thinkstock Learning Objectives After completing this module, you should be able to: ሁ Describe global health concerns and efforts that prevent childhood mortality. ሁ Identify common threats to infant, childhood, and adolescent safety. ሁ Identify common diseases of childhood and their potential consequences. ሁ Examine trends in nutrition and activity and their effects on health. Compare activity guidelines with current practice. ሁ Summarize the effects of malnutrition on development. ሁ Outline the risks to health posed by overweight and obesity. ሁ Compare and contrast three major eating disorders. Section 6.1Worldwide Early Childhood Mortality and Prevention Efforts Prologue After the end of World War II and the beginning of the baby boomer generation, Americans became more mobile, giving birth to the suburbs. As people moved, so did diseases. Screen
- 2. media, from which most children now get their information about the world, was virtually nonexistent in the 1940s. Despite its obvious benefits, screen media contribute to a sedentary lifestyle and sometimes promote other unhealthy behaviors through advertisements. Who would have thought that new technology would have such a profound effect on health, safety, and nutrition? Whereas many adults use technology and the easier access to information to stay healthy, children often become heavier and may eventually die younger because of it. Family influences are entwined in the 21st century culture, as well. Compared to the 1960s, when I was a child, more fathers in North America, Europe, and elsewhere are involved in the daily care and upbringing of their children. No doubt, part of my children’s physical, cogni- tive, and psychosocial health was influenced by the care that my wife and I provided. And that care has been influenced by socioeconomic, historical, and cultural factors. For instance, the number of single mothers has grown dramatically since the 1960s. Because single moth- ers generally have fewer social and economic resources than two-parent families, it is more difficult for them to ensure their children’s health and safety. In addition, previous generations of children were typically freer to roam their neighborhoods and engaged in random physical activity; now there is more orga- nized sports activity that includes safety standards. This module explores these health and safety issues within a contemporary context, while also examining significant historical trends.
- 3. 6.1 Worldwide Early Childhood Mortality and Prevention Efforts The United Nations established the Millennium Development Goals to reduce the unaccept- ably high under-5 mortality rate by two-thirds between 1990 and 2015 (United Nations, 2014). Because of their large populations, just five countries account for half of early child- hood deaths: India, Nigeria, Democratic Republic of the Congo, Pakistan, and China. However, worldwide, the annual rate of under-5 mortality dropped from 12.6 million to 6.6 million, a 48% decrease between 1990 and 2012. Though a vast improvement from when the Millen- nium Project began, approximately 18,000 children still die each day, or about 1 out of 20 live births. Sub-Saharan Africa continues to have the highest rates of child mortality. Due to wars, disease, and famine, 1 in 10 children do not live past their fifth birthdays in that part of the world. Although the goal of a two-thirds reduction in child mortality worldwide is likely out of reach at the moment due to lack of progress in Sub-Saharan Africa, Southern Asia, and Oceania, there is nevertheless substantial good news. For instance, during the decade from 2000 to 2009, the decline in child mortality accelerated, compared with the previous decade (Fig- ure 6.1). Gains have been made in combating poverty, increasing primary school education, addressing disease and mortality due to AIDS and malaria, and providing greater access to
- 4. clean drinking water. Among children under 5 worldwide, unsanitary conditions and lack of Critical Thinking Name one of each type of variable that con- tributes to the worldwide health and safety of children: individual, family, community, societal, and political. Section 6.1Worldwide Early Childhood Mortality and Prevention Efforts clean drinking water contribute to the 15% of deaths caused by diarrheal diseases. In com- parison, deaths due to diarrheal diseases in the United States accounted for less than 0.1% of deaths in children younger than 5 (Centers for Disease Control and Prevention [CDC], 2014a). Figure 6.1: Mortality rate for children under 5 worldwide, 1990 and 2012 ሁ Survival rates began to accelerate in 2000, continuing the substantial gains of the previous decade. Nevertheless, the goal of a two-thirds reduction in mortality of children under 5 is unlikely to be met by 2015. U n d e r-
- 12. 53 14 15 6 99 53 Source: Adapted with permission from the Millennium Development Goals Report, United Nations, 2013. Immunizations After basic needs of nutrition, warmth, and security are fulfilled, we can look to provide more advanced safety. Beginning in early infancy, immunizations provide an essential avenue for protection. In developed countries, their widespread use has made a dramatic difference in the health of infants and older children. However, a significant number of American infants and toddlers do not receive a full program of immunizations. Based on the most recent records, coverage of recommended childhood vaccinations ranged from 53% (hepatitis A) to 94% (DTaP, for diphtheria, tetanus, and pertussis). Fewer than 1% of infants and children receive no vaccines (CDC, 2013c; Wooten, Kolasa, Singleton, & Shefer, 2009). Childhood immunizations are responsible for the near elimination of diseases such as polio and measles and are the best defense against viruses (there are no cures for viruses; treat- ments focus on relief of symptoms and the reduction of
- 13. severity). As Figure 6.2 shows, since Section 6.1Worldwide Early Childhood Mortality and Prevention Efforts the widespread use of measles vaccine beginning in the 1960s, the number of cases has been reduced from three-quarters of a million to fewer than 100 in 2012 (CDC, 2014a). However, because of an unfounded fear of vaccine side effects, many parents delay the administration of childhood vaccines. Spe- cifically, as noted in Module 2, media reports in the early part of the 21st century errone- ously suggested a link between autism and the MMR (measles-mumps-rubella) vac- cine, which led to fewer vaccinations and more disease. As a result, although measles was virtually eradicated within the United States by 2000, the number of cases through July 2014 was already triple the previous year’s total cases (CDC, 2014a). By year end, the number of cases was expected to be higher than every year since 1996. Figure 6.2: Measles cases in the United States, from 1958 to the first part of 2014 ሁ Incidence of measles decreased dramatically after vaccines were distributed widely, but success sometimes breeds complacency, as indicated by temporary
- 15. a n d s ) 14.0 16.0 1958 Year 1968 1978 1988 1998 2007 2014 400.0 200.0 100.0 80.0 60.0 40.0 20.0 18.0 8.0 10.0 12.0 4.0 6.0 2.0 1.8 1.4
- 16. 1.6 1.2 1.0 0.8 0.4 0.6 0.2 0.1 0.08 0.06 0.04 0.02 0 600.0 800.0 Source: Adapted from Koo et al. (1993), Hall-Baker et al. (2010), and CDC (2014a). ©Pallava Bagla/Corbis ሁ Being vaccinated, like this child in India, is an important part of ensuring healthy development. Thanks to intensive vaccination efforts, India transitioned in less than 20 years from being the world’s most challenging polio problem to being polio-free starting in 2011. However, problem areas continue to exist elsewhere.
- 17. Section 6.2Safety in Later Childhood and Adolescence The same pattern has occurred for whooping cough (pertussis), a highly contagious virus that can cause serious respiratory problems. In the United States, cases of whooping cough spiked in 2012 at nearly 50,000 children, more than any year since 1955 (CDC, 2013d). Globally, it affects between 30 and 50 million children annually, resulting in about 300,000 deaths. Though older children and adults contract pertussis, as well, infants are especially vulnerable and accounted for all nine of the pertussis-related deaths in the United States in 2013 (CDC, 2014e). S E C T I O N R E V I E W Summarize the major health concerns that affect young children throughout the world. 6.2 Safety in Later Childhood and Adolescence Preventable diseases like polio and measles are a danger to millions of children, but in the United States, asthma, diabetes, poor nutritional choices, and accidents are more immedi- ate concerns. These conditions result from a complex blend of individual, family, community, societal, and political variables—main features of the ecological perspective. Because health and physical fitness remain central to development, this section explores some specific child- hood risks and ways to keep children physically safe. Homicide and Suicide Most people do not think of homicide as a leading cause of death in childhood, yet statistics
- 18. tell a different story. Tragically, homicide is the second leading cause of death for 1 year olds in the United States, accounting for over 10% of deaths in this age group. It is also the sec- ond leading cause of death among teenagers, accounting for 16% of all adolescent fatalities (CDC, 2014e). Of 1,927 homicides that were recorded, 85% were due to firearms. Homicide is particularly disturbing in the black community, where it is easily the leading cause of death among adolescents (75% more than accidents, the second leading cause). The homicide rate among black adolescents in the United States is five times greater than among the non-black population. Homicides among children and adolescents are quite different in the United States than those that occur under military regimes in Africa and some parts of Asia. Child homicide and the recruitment and enslavement of children into armies persists in countries like Central African Republic and South Sudan, where political unrest is the norm (Human Rights Watch, 2013). Children are vulnerable in other countries, as well, including notable problem areas like Syria and North Korea. Both government and opposition forces in these areas will use family neigh- borhoods, students, and schools as shields, turning children into targets. Critical Thinking How do you think issues regarding immuniza- tions differ among parents from undeveloped, rural Indonesia and middle-class families from the United States?
- 19. Section 6.2Safety in Later Childhood and Adolescence Among other adolescent subsets, suicide is more common than homicide. Overall, each year about 2% of teenagers in the United States make suicide attempts that are serious enough to require medical attention; 1,863 succeed, making suicide the third leading cause of death among teenagers (CDC, 2014c). Depression and psychosocial risk factors for suicide are explored more directly in Module 11. Unintentional Injuries (Accidents) Despite the high rates of homicide and suicide, after the risk of sudden infant death syndrome disappears, unintentional injuries (accidents) account for more deaths during early child- hood than the next 20 causes combined. Unintentional injury remains the leading cause of death throughout the rest of childhood (CDC, 2014e). Due to stricter safety standards for infants and toddlers and increased awareness through the media and educational sources, death caused by accidents continues to decline. Though nearly 1,400 children under age 5 died as a result of preventable accidents in 2010 (the year for which the most recent data are available), that number represents a 13% reduction from only 5 years earlier. Accidental deaths among older children and adolescents show significant declines as well. Parents and caregivers need to be espe-
- 20. cially vigilant as infants quickly attain more sophisticated motor skills. Without careful supervision, very young children can ingest small objects, toddle into a pool, or run into the street. School-age children have their own set of dangers as they partici- pate in more unsupervised activities. By the time children reach adolescence, suddenly there are new threats, due to both cogni- tive changes and cognitive immaturity, that often lead them toward high-risk behaviors. Racial and ethnic differences exist in prone- ness to accidents, likely because of different cultural norms. Asian American children, for instance, have a relatively low rate of accidents, perhaps due to stricter parental supervision. Factors associated with an increase in accidents and death rates in children include being a boy, spending time in daycare versus home care, and being raised in a lower socioeconomic urban area (Jaffe et al., 2011; Khamba- lia et al., 2006; Schwebel & Gaines, 2007; Sinclair, Smith, & Xiang, 2006). Differences in socio- economic status (SES) are particularly pronounced in injuries related to fires, drownings, and falls, perhaps because the lack of financial resources or education leads to deficient preven- tion efforts or a lack of safe play areas (Birken, Parkin, To, & Macarthur, 2006; Schwebel & Gaines, 2007). Outside the United States, low SES has a similarly strong positive association with burns, fires, drownings, and poisonings (Burrows, Auger, Gamache, & Hamel, 2012; Myt- ton, Towner, Powell, Pilkington, & Gray, 2012).
- 21. Road and Traffic Safety Motor vehicle accidents are the leading causes of death of children aged 2 to 5, accounting for nearly a third of all childhood fatalities within that age range (CDC, 2014e). It is estimated Purestock/Thinkstock ሁ Part of parenting includes insisting on preventive measures that reduce the negative consequences of accidents. Section 6.2Safety in Later Childhood and Adolescence that more than 70% of crash fatalities could be prevented by the proper use of seat restraints (National Highway Traffic Safety Administration, 2013). Additionally, in urban centers world- wide, more children are killed as pedestrians during the preschool years than during any other period of childhood (Wang et al., 2012). Young children do not inherently understand the difference between running after a ball in the yard and running after one in the street. The lack of judgment combined with a high level of activity may cause preschoolers to run into danger, climb to unsafe heights, and explore toxic substances. The same characteristics that make preschool and early childhood a joyful and curious time of life can also lead to dangers. In early childhood, children walk to school for the first time and begin to ride their bicycles onto busy roads. As they are
- 22. given more responsibility, they still need frequent “refresher courses” on safety. In a naturalistic study that observed 5- to 9-year-old children crossing at intersections near schools, it was found that parents modeled behavior for boys more than girls and did not actually provide explicit instruction at all. When they do, safety improves significantly (Barton, Schwebel, & Morrongiello, 2007; Morrongiello & Bartona, 2009). As hard as it is sometimes, adults also need to provide proper modeling. If parents disobey traffic signals, then their children are likely to do the same. The good news is that, among nondrivers, total traffic fatalities have been dropping (albeit unsteadily) for over a decade, including a steep 20% drop in the latest year of reporting (see Figure 6.3). Figure 6.3: Number of traffic fatalities among children 15 and younger, 1989–2011 ሁ The number of traffic fatalities involving children has declined significantly over more than 20 years. <5 years old 5–9 years old 10–15 years old F a ta li ty r a
- 24. 900 600 2004 2005 2006 2007 2008 2009 2010 2011 Source: Adapted from NHTSA, 2010, 2013. Section 6.2Safety in Later Childhood and Adolescence Skating and Cycling In 2007, skateboarding injuries caused an estimated 65,000 emergency room visits by chil- dren and adolescents, about 2,000 of them serious enough to require hospitalization. These numbers are actually an improvement from 2000, when more than 100,000 skateboard- related hospitalizations were required (Consumer Product Safety Commission, n.d.). World- wide, the use of safety equipment while skating is still not the norm. However, emergency medical treatments usually involve lower leg sprains and breaks rather than traumatic head injuries (Keilani et al., 2010; Strojek et al., 2011). Of course, when head injuries do occur, there is great potential for permanent disability. Cycling injuries account for another 207,000 emergency room visits each year among those aged 14 and under (Stranges, Uscher-Pines, & Stocks, 2012). Children will, of course, continue to engage in these activities, but as they become more actively involved in cycling and skat-
- 25. ing, protective measures need to be emphasized. Head injuries in particular can have lifelong consequences. It is estimated that proper helmet use while skating and cycling can reduce catastrophic head injuries by as much as 88% and fatalities by as much as 85% (Insurance Institute for Highway Safety, 2013; Mills & Gilchrist, 2008). Drowning and Water Injuries The second most common cause of accidental death among all children 14 and younger and the leading cause among 1- and 2-year-olds is drowning (CDC, 2014e). On average, nearly two children per day drown, but more than eight times that number are injured enough that they require emergency hospital treatment (CDC, 2014f ). Children who have near-drowning expe- riences often have mild to severe brain damage, including many who end up in a permanent vegetative state. After children start walking, they are more likely to drown in swimming pools than anywhere else (Brenner, Trumble, Smith, Kessler, & Overpeck, 2001). When children drown in swim- ming pools they typically do so silently, when parents or caregivers are only a few steps away. In fact, most young drowning victims are in the care of one or both parents and are unsu- pervised for less than 5 minutes (National Center for Injury Prevention and Control, 2010). Adolescents, on the other hand, experience more danger around natural water environments like lakes and oceans (Gilchrist, Gotsch, & Ryan, 2010). They misjudge levels of risk, including ocean riptides and jumping and diving, and ignore warnings to
- 26. use life preservers in moving watercraft. More than 80% of children (and adults) who drowned in boating accidents were not taking the simple precaution of wearing a life preserver (U.S. Coast Guard, 2013). Falls Fatal injuries increase through middle childhood and then accelerate rapidly into adoles- cence. Rates of injuries and fatal accidents to boys outnumber girls by a two-to-one margin. Children have a higher rate of playground injuries in middle childhood (elementary school age) than at any other time (Phelan, Koury, Kalkwarf, & Lanphear, 2001). In response to the high injury rate from falling, schools have replaced traditional metal climbing equipment with larger playground structures (“climbers”) and hard rubber ground covers with softer materi- als. As a result, injuries among 6 to 12 year olds from falls have decreased substantially. Section 6.2Safety in Later Childhood and Adolescence F O C U S O N B E H A V I O R : S a f e t y When my son was about 18 months old, we had a number of “baby gates” installed in our house. The problem—for me—was that Max could easily climb over the 2½-foot obstacle. One day we were adamant about keeping Max out of a particular room after he woke up from a nap, so we installed an additional gate above the first one, creating a 5-foot bar- rier. Some time later, I was fortunate to turn just at the moment
- 27. Max had scaled to the very top of the “wall” and was swinging his body to the other side. He had not made a sound. Although Max was obviously capable of climbing the gates, coming back down takes quite a bit more skill for a child who is not yet 2 years old. Had I stepped out for a moment, Max would likely have landed in the hospital—or worse. Just like other circumstances that result in tragic consequences, I thought my makeshift safety device would be sufficient since I would be away for only a few moments at a time. But as with swimming pools, bath- tubs, and other situations, it takes only a moment for potential tragedy to strike. Concussions Recently, particular attention has been paid to the dangers of concussion in American foot- ball. Information, though mostly anecdotal, about the permanent brain injuries suffered by college and professional athletes has also resulted in efforts to prevent head injuries among high school athletes and younger children who play in recreational leagues. Recent minor changes to rules and equipment are intended to prevent short- and long-term brain damage, but there have been no major breakthroughs in prevention. Recognizing the scarcity of scien- tific evidence, at the end of 2013 the National Institute of Neurological Disorders and Stroke initiated a project to prevent further injuries related to concussion in high school athletes (National Institutes of Health, 2013).
- 28. Safety at Home Other than motor vehicle accidents, most unintentional injuries occur in the home. Drown- ings, burns, poisonings, and falls are largely preventable (Rimsza, Schackner, Bowen, & Mar- shall, 2002). Parents of young children need to keep sharp objects out of reach. Doors need to be secured so that children cannot wander outside. Electrical outlets can be protected with inexpensive covers. Adults also need to always turn handles of pots and pans away from the edge of the counter to prevent accidental spills and burns. Secure cabinets and child locks are available to keep chemicals and cleaning supplies out of the reach of children. It is extremely important for homeowners to look vigilantly for stored poisons and other toxic supplies in garages, bathrooms, and elsewhere, but by far the largest source of childhood poisonings is medications. Over 90,000 emergency room visits each year are due to poison- related medication exposure (excluding recreational drug use), a rate that is more than twice as high as for household products like cleansers and automobile fluids (CDC, 2014f; Schillie, Shehab, Thomas, & Budnitz, 2009). Sibling Supervision Many parents mistakenly believe that because their children can recite safety rules, they are safe. Children whose parents assume that verbal acknowledgement is the same as behavioral
- 29. Section 6.2Safety in Later Childhood and Adolescence compliance are more likely to have home injuries (Morrongiello, Ondejko, & Littlejohn, 2004). When older siblings (rather than parents) supervise younger children, more risky behaviors ensue. Parents then focus on simple rule violations (e.g., “No throwing books”) rather than on the consequences of behavior. Parents may think that their older children have supervi- sory practices similar to their own, but studies suggest that older children are more lenient. Younger children seem to be quite aware that “no parents” means getting away with behav- ior that otherwise would not be allowed (Khambalia et al., 2006; Morrongiello, MacIsaac, & Klemencic, 2007). Injury Prevention Declines in death rates attributable to accidents are probably due to the combination of increased awareness, public education about the implementation of safety products like hel- mets and seatbelts, and manufacturing improvements in the products themselves (Currie, 2008). Consistently using car seats and bike helmets and obeying traffic laws are easy ways to protect against potential injuries. Preventing traffic injuries must be a mul- tifaceted process. Keep in mind the differ- ent levels of the ecological systems model. Some designs are individual, like proper modeling and use of bike helmets by adults. Others take massive community resources and planning, like the Harlem Hospital
- 30. Injury Prevention Program. This program was implemented in 1988 to reduce the extremely high rate of accidents in a rela- tively contained area of New York. New playgrounds were built, older playgrounds were refurbished, and school and traffic education programs were implemented. A community bicycle safety initiative was developed along with a number of super- vised recreational programs for children (Durkin, Laraque, Lubman, & Barlow, 1999). This comprehensive program resulted in a 36% reduction in traffic- related injuries to school-age children and an impressive 73% decline in head trauma due to cycling accidents, demonstrat- ing the profound effect that prevention programs can have on health and safety. S E C T I O N R E V I E W List some common threats to childhood safety. What kinds of educational programs and ecological changes can be implemented to diminish such threats? Search the scientific lit- erature for at least one example. Zer05/iStock/Thinkstock ሁ Parents can take simple measures to increase child safety. Section 6.3Illnesses 6.3 Illnesses
- 31. Although illnesses can become serious, usually the biggest health concern among infants and younger children is the common cold, accounting for about 75% of all childhood illnesses (Schlesselman, 2006). Colds frequently cause secondary conditions like ear infections (otitis media), which occur with much greater frequency in infants and toddlers than in older chil- dren (Rovers, Schilder, Zielhuis, & Rosenfeld, 2004). Colds in infants can cause strain on the entire family. Parents have to sit up at night with crying children, leading to increased sleep deprivation, and it can be difficult to find a friend or relative to stay home during the day with a sick child. Doctor’s appointments and missed work add to overall discomfort and stress. Although in rare instances children experience hearing loss from untreated or frequent ear infections, for the most part children emerge from early childhood unscathed by the common cold. Children born in lower-SES families are more likely to have health problems than those born to middle- and upper-income families (Séguin, Xu, Potvin, Zunzunegui, & Frohlich, 2003). A number of associated variables contribute to this finding. Compared to children from middle- and upper-income families, lower-SES children are more likely to have health problems at birth, to have more chronic conditions like asthma and diabetes, to be hospitalized frequently, to be exposed to poorer air quality, to experience more noise and more stress, and to have parents with less education and fewer resources to understand health- related issues (Case, Lubotsky, & Paxson, 2001; Diabe-
- 32. tes Public Health Resource, 2010; Evans, Bullinger, & Hygge, 1998). Given all these factors, it is not surpris- ing that children from lower-income families miss more school and experience the consequences that go along with receiving less education. Asthma Asthma is the most common chronic disease in children. It causes breathing airways to become inflamed and narrow, leading to shortness of breath, a feeling of tightness in the chest, and coughing. For unknown reasons, rates of asthma have been rising worldwide. In the United States, it is currently at its highest level ever; over 10 million children are afflicted. About 7 million children had an asthmatic episode within the previous 12 months (Akin- bami et al., 2012; Bloom, Cohen, & Freeman, 2012). Asthma causes constriction of the air- ways and induces wheezing, coughing, and shortness of breath. Fortunately, under ordinary conditions it can usually be controlled and does not inhibit physical growth and development in any noticeable way. Factors that affect severity and responsiveness to medication include tobacco smoke, air pollution and other air contaminants, respiratory infections, stress, and myriad genetic markers (National Heart, Lung and Blood Institute, 2013; Ober, Hoffjan, & Hoffjan, 2006). Research into the specific causes of asthma is generally inconclusive, though there is prob- ably a complex interaction among environmental and genetic variables (Belsky et al., 2013). For unknown reasons, it is more prevalent in wealthier countries
- 33. but leads to higher mortal- ity in developing countries. Prevalence also increases in groups that move from rural areas to more urban areas. These findings imply that some kind of environmental effect is related to industrial development. Interestingly, despite stronger environmental safeguards in the Critical Thinking Name some advantages and disadvantages of home schooling that might specifically affect children who have one of the chronic diseases mentioned in this section. Section 6.3Illnesses United States, Mexican children born in the United States have a higher prevalence of asthma than those born in Mexico (Eldeirawi et al., 2009). In general, immigrant children and adoles- cents have a lower rate of asthma than do those who are native born, a pattern that occurs in other countries, like Sweden, as well (Bråbäck, Vogt, & Hjern, 2011; Singh, Yu, & Kogan, 2013). Further variations occur within other demographic groups, as indicated in Figure 6.4. Figure 6.4: Asthma prevalence in U.S. children, 2012 ሁ Scientists have few clues to explain the wide demographic variation in asthma prevalence in those under the age of 18. P
- 37. isp an ic M ex ica n Source: Adapted from National Health Interview Survey, National Center for Health Statistics, CDC , 2013. Diabetes On average, diabetes has much more serious consequences than asthma. Diabetes refers to a group of diseases that occur when high levels of sugar in the blood are not regulated properly by the body’s normal systems. The increased incidence of diabetes in childhood is now a wor- risome trend. A long-term scientific projection foresees a near doubling of the diabetic popu- lation by the year 2050 (Boyle, Thompson, Gregg, Barker, & Williamson, 2010). There are two main kinds of diabetes. Type I diabetes occurs when the body fails to produce the hormone insulin and thus requires a daily delivery of it, usually by injection. It is a lifelong condition that puts individuals at increased risk for cardiovascular disease, kidney and nerve damage, and circulatory problems that may lead to serious infections. With proper insulin manage- ment, children can live otherwise healthy, productive lives. As Figure 6.5 shows, the rate of Type I diabetes varies significantly among racial and ethnic
- 38. groups. For unknown reasons, non-Hispanic whites have the highest rate of this type of diabetes. Section 6.3Illnesses Figure 6.5: Rates of new cases of Type I and Type II diabetes, by age and race/ethnicity ሁ Rates of Type I and Type II diabetes vary significantly as a function of age and race/ethnicity. The percentage of cases that are Type II increases substantially beginning in preadolescence. Type 1 diabetes Type 2 diabetes Rate (per 100,000 per year) 0 20 3010 40 50 All Non-Hispanic white Ages 9 & under Ages 10−19 African Americans Hispanics Asians/Paci�c
- 39. Islanders American Indians All Non-Hispanic white African Americans Hispanics Asians/Paci�c Islanders American Indians Source: Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. Atlanta, GA: U.S. Department of Health and Human Services; 2014. Retrieved from http://www.cdc.gov/ diabetes/pubs/statsreport14/national-diabetes-report-web.pdf. In this report it is figure on top of page 4. Type II diabetes was previously called adult-onset diabetes because most cases were diagnosed during adulthood. In Type II diabetes, the body does not use insulin efficiently and then compensates by overproducing it. Over several years, the compensatory mechanisms break down and medical inter- ventions to boost insulin levels are necessary. The condition can be particularly pronounced beginning in adolescence, as there is a natural process of insulin resistance during puberty (Katz et al., 2011). Regardless of when it occurs, symptoms appear somewhat slowly. Therefore monitoring and preven-
- 40. tion are key to diabetes management. By far the strongest environmental risk factors for Type II diabetes are a sedentary BSIP/SuperStock ሁ Children who have Type I diabetes eventually learn to give themselves injections. http://www.cdc.gov/diabetes/pubs/statsreport14/national- diabetes-report-web.pdf http://www.cdc.gov/diabetes/pubs/statsreport14/national- diabetes-report-web.pdf Section 6.4Nutrition and Activity lifestyle and poor nutrition that lead to overweight and obesity (Anhêa et al., 2013). And unlike Type I diabetes, Type II diabetes can be prevented and often reversed with lifestyle changes, even in teenagers (Buchanan & Xiang, 2010; Inge et al., 2009). Other Effects of Illnesses Many children suffer from more severe illnesses, like sickle cell disease or cystic fibrosis. Cys- tic fibrosis is a life-threatening genetic disease that affects an estimated 30,000 children. Usu- ally beginning by age 2 years, children develop thick, sticky mucus deposits in their lungs, which leads to impaired breathing and frequent lung infections, and results in short stature. In general, childhood diseases like these often result in greater inactivity. They ultimately affect a child’s ability to participate in the same activities as peers. Missed school days trans-
- 41. late to disadvantages in cognitive development and lost social opportunities. Participation in team sports is sometimes limited. And many children find it embarrassing to use inhalers or take medication. Side effects from medication also affect cognitive development, as sleep may be disrupted and concentration in school is affected. Following a strict diet or medical routine may cause frustration and anxiety. Further, research supports a direct link between chronic conditions like asthma and increased stress and depression (Peters & Fritz, 2010). These effects once again point to the powerful interactions among physical, cognitive, and psychosocial factors in development. S E C T I O N R E V I E W Describe the causes, treatments, and consequences of chronic diseases of childhood. 6.4 Nutrition and Activity Ordinarily, proper nutrition and daily activity are two of the most essential components for lifelong health. Due to a cultural change in these components of well-being, American children born in the 21st century are projected to be the first generation since the Ameri- can Revolution to have a life expectancy that is shorter than their parents’ (Olshansky et al., 2005). Consequences of poor eating habits and a sedentary lifestyle can lead to serious health complications in adulthood. We are beginning to see that trend now, as large-scale studies are consistently discovering that poor childhood nutrition and lack of activity are associated with a heavier adult weight, diabetes, and
- 42. cardiovascular diseases (He et al., 2014; Kaikkonen et al., 2013). This section provides further details on these important health factors. Section 6.4Nutrition and Activity Historical trends have cut in to the traditional dinner hour as stay-at-home parents are no longer the norm and children’s extracurricular activities often affect daily routines. However, planning—and preparing—dinners together can have nourishing advantages. The earlier that parents can begin a dinner routine that excludes toys, television, electronics, and other distractions, the healthier mealtime can be. That elusive “quality” time that parents strive for will become a natural outgrowth of the “quantity” time that family meals provide. Nutritional Needs The rapid growth cycles during infancy and adolescence bookend a period of slower physical growth. As most children begin to exclusively eat solid foods in their second year, many par- ents in the United States go to great lengths to ensure that their children are eating enough. But since the rate of growth begins to slow after infancy, children need less food to fuel growth. Even though height (length) increases by nearly 10 inches (25 centimeters [cm], a whopping 50%) in the first year of life, children gain, on average, just 5 inches (12.7 cm) in the second year (refer back to Figures 5.9 and 5.10).
- 43. If provided with good choices, toddlers and preschoolers are actually quite good at control- ling their nutritional intake. Many adults worry about how much children are eating, but they should focus instead on what they are eating. Anxious parents may stuff their children full of pizza, hamburgers, fried chicken nuggets, and macaroni and cheese several times a week—or even daily—because of worry about their children starving. However, if offered a number of nutritious choices at mealtime, children will learn to self- regulate. Alternatively, when the culture encourages young children to eat more than they naturally want to consume, overeat- ing behaviors are rewarded and it can set a precedent for a lifelong weight problem. Meals can consist of a number of options that are low in fat and high in fiber and include fruits and vegetables. On a daily basis, children need to consume proteins that are found in meat, soy, rice, beans, most dairy, and peanut butter. It is also important to pay particular attention to foods high in iron, including dark leafy vegetables, iron- fortified cereals, and meat and sea- food, in order to prevent fatigue associated with iron-deficiency anemia. Finally, calcium-rich foods are needed to build healthy bones and teeth. Milk and other dairy products are usually the best sources, but calcium can also be found in soy, vegetables, nuts, and some fish. F O C U S O N B E H A V I O R : W h a t ’ s f o r D i n n e r ? Is there a connection between family dinners and
- 44. overall health? Studies find that family meal times are associated with a lower chance of obesity and greater overall health (Fulkerson, Larson, Horning, & Neumark-Sztainer, 2014). Additionally, children who sit down to meals with their parents have a lower incidence of antisocial behavior and conduct problems. Family dinners and parental engagement can have a protective effect against poor grades, smoking, drinking, and drug use (The Importance of Family Dinners VI, 2010). Comstock Images/Exactostock/SuperStock Section 6.4Nutrition and Activity F O C U S O N B E H A V I O R : P r o v i d i n g H e a l t h i e r F o o d O p t i o n s Studies have demonstrated what many nutritionists have suggested for years: Children will opt for healthier breakfast foods if given a choice. In one study, researchers randomly assigned 91 children who were attending a summer camp into two groups. All were offered milk, orange juice, fresh fruit, sugar packets, and an assortment of cereals. One group had a choice of high-sugar cereals like Fruit Loops and Frosted Flakes and the other had a choice of low-sugar cereals like Cheerios and Rice Krispies (Harris et al., 2011). Although the low-sugar group used more sugar packets on their cereal, they still consumed less than half the amount of refined sugar overall, compared to
- 45. the high-sugar group. Furthermore, 54% of the low-sugar group ate fruit, compared to only 8% of the high-sugar group. Importantly, both groups rated their meals as equally enjoyable. Total calories con- sumed did not differ significantly, as the high-sugar group made up for eating less fruit by consuming larger portions of cereal. Thus, it appears that children will indeed choose healthier food options if given an alterna- tive, and that less healthy options like high-sugar cereals prevent the consumption of more nutritious food. It may seem self-evident, but research confirms that children generally follow the nutritional habits of their parents. It is the reason that comparatively more Japanese children eat fish and American children eat hamburgers. If children initially reject certain foods, adults should neither immediately rush to find substitutes nor remove those items from future menus. In an extensive survey of adolescent dietary habits, it was found that teenagers who ate more fruits and vegetables had parents who also ate more fruits and vegetables. Parents who drank more soda predicted teenagers who drank more soda and ate more fast food. Therefore, parents can have either a positive or a negative effect on their children’s eating behavior (Diamant et al., 2009). In underdeveloped countries, researchers have looked at the nutritional backgrounds of
- 46. school-age children and how cognitive, social, and emotional functioning is affected. Chil- dren who take in more nutrients are more involved with their peers, express more positive emotions, and display less anxiety, compared to peers who are poorly nourished (Barrett & Radke-Yarrow, 1985; Grantham-McGregor & Baker- Henningham, 2005; Leavitt, Tonniges, & Rogers, 2003). Well-nourished children show more curiosity, which translates directly to a keener involvement in school-related activities. In addition, they are more persistent when they become frustrated, display more self-confidence, and show more alertness and better energy, all attributes associated with better school performance. From a purely pragmatic perspective, it is fairly obvious that a full stomach affects learning. Hungry children (and adults) do not concentrate as well because they are thinking about being hungry, getting food, and eating. When there are more distractions, whether internal (hunger pains) or cognitive (thinking about the next meal), learning and concentration are compromised. As children enter elementary school, their exposure to unhealthy food choices generally grows. Schedules become denser, with homework, after-school activities, and visits to friends’ houses. Foods high in fat and sugar often become part of the daily diet. Though some parents try to be Section 6.4Nutrition and Activity
- 47. extra vigilant in restricting certain foods, there are sometimes social ramifications of forbid- ding cake and ice cream at parties and candy consumption during holidays. These nutritional issues do not necessarily have a profound impact on daily functioning. A temporary diet of cheeseburgers, pizza, and ice cream will not affect memory and concentration. As in many other areas of life, moderation is key. As is discussed in Module 12, children need to balance a burgeoning sense of autonomy and initiative with the potential for social disapproval. F O C U S O N B E H A V I O R : P r o m o t i n g H e a l t h y H a b i t s During the weeks in which mandatory state testing takes place, schoolchildren are implored to “come on time, get a good night’s sleep, and eat a good breakfast.” Many schools provide extra snacks and even have policies against assigning homework during the testing period. Schools clearly understand that good sleep and nutrition contribute to educational attainment. However, healthy sleep and nutrition are not just relevant to testing. They are emphasized during school testing for a reason. Even though standardized testing usually does not fac- tor into school grades, parents and educators can use the opportunity to reinforce the con- nection between healthy habits and educational achievement. Effect of Breakfast on Growth and Development Nutritional deficiencies on the scale found in poor African and
- 48. South American countries do not generally exist in the United States, though certainly developing children do not always receive the nutrition they need. Either because of family economics or because of family dynamics, many children go to school hungry. Although there is ample outcry about breakfast being the “most important meal of the day,” the public never really hears the science behind the rhetoric. Children who eat breakfast generally make more healthful food choices, are more likely to maintain a healthful weight, engage in more physical activity, and show substantially fewer risk factors for diabetes and other diseases (Deshmukh-Taskar, Nicklas, Radcliffe, O’Neil, & Liu, 2013). A meta-analysis (a research review that combines the results from a number of studies) on classroom learning reported a strong positive correlation between breakfast and overall academic performance (Adolphus, Lawton, & Dye, 2013). There was evidence for increased concentration, reasoning ability, problem solving, and creativity. Eating breakfast consistently was associated with better school attendance, better grades, and overall achieve- ment. Others have also found overall positive gains for children who eat breakfast, especially in the areas of problem solving, memory, complex visual organization, and overall cognitive functioning (Boschloo et al., 2012; Ellis et al., 2008). When children are reinforced for making regular, healthy food choices, they have a better chance of having positive eating habits throughout their
- 49. lifetimes. In contrast, as children get older, more of them skip breakfast as they begin to make more independent choices. Between adolescence and adulthood, mean number of days eating breakfast drops about 25% (Nie- meier, Raynor, Lloyd-Richardson, Rogers, & Wing, 2006). All racial and ethnic groups show similar average declines, and more girls skip breakfast than boys. Once again, it appears that Section 6.4Nutrition and Activity routines formed in adolescence have an effect on later eating habits, as a decrease in the breakfast habit is consistently associated with weight gain and health risk factors in adoles- cence and early adulthood (Jääskeläinen et al., 2013; Shafiee et al., 2013). Activity Another essential component of the health equation concerns activity. According to both evo- lutionary insight and contemporary research, the importance of daily physical activity cannot be underemphasized. Yet, like nutrition, there has been a cultural shift in habits recently. The World Health Organization (2010a) and the CDC (2008) continue to reaffirm that school- age children should accumulate at least 60 minutes of physical activity each day. Yet despite numerous public campaigns to support physical fitness (e.g., Michele Obama’s “Let’s Move”), part of the continuing trend in weight gain is due to a more sedentary lifestyle among chil-
- 50. dren. Meanwhile, hours of physical education in school have been decreasing in the United States and elsewhere (e.g., Swaminathan, Selvam, Thomas, Kurpad, & Vaz, 2011). In the United States, standards for physical activity in school are often ignored, replaced by testing and accountability mea- sures that are inherent in the push to improve academic test scores. One example is found in California, which is frequently held up as a model for health and fitness. The most recent California education standards allow for an average of just 20 minutes of daily physical activity in grades 1–6 and 40 minutes per day in grades 7–12. The de-emphasis on physical move- ment is especially evident in kindergarten and school district- sponsored preschools, where no minimum standards cur- rently exist (California State Board of Education, 2005/2010). Further, when physical education is included in an elemen- tary curriculum, it is often devoid of the unstructured play that researchers say is crucial for cognitive enhancement, physical health, and psychosocial development (Pellegrini, 2005; Ramstetter, Murray, & Garner, 2010). Instead, it usu- ally includes formulaic standards like California’s 58 first- grade physical education goals and the 41 goals that Califor- nia’s sixth-grade teachers are expected to meet. California is not alone. In one nationwide sample, over 30% of kindergarteners did not have recess time (Pellegrini, 2005). In Arizona, as a response to a lack of physical activity in general, elementary schools can now “consider” providing a recess period. But if they do, it “shall consist of structured physical activity outside or inside the classroom” (Azleg.gov, 2011; emphasis added). S E C T I O N R E V I E W
- 51. How have nutrition and exercise among children changed in recent years? What are the potential health effects of these changes? Omgimages/iStock/Thinkstock ሁ When parents model healthy lifestyles, their children are more likely to follow suit. Section 6.5Malnutrition 6.5 Malnutrition In much of the world, activity is less of a concern because getting sufficient nutrition is a daily struggle. When nutrition intake is deficient either because of not enough food or not enough specific nutrients, it is called malnutrition. Without proper nutrients, malnutrition leads to physical, cognitive, and social consequences (Anjos et al., 2013). About one-third of the world’s children suffer from undernourishment before they reach age 5; in some African and southern Asian countries, the proportion is considerably higher (Patwari, 2013; United Nations Development Programme, 2013). Though poverty certainly contributes to under- nourishment in the United States, there is not the widespread serious malnutrition that is evident in war-torn countries like Afghanistan and severely impoverished areas in countries as diverse as India and Fiji. Due to undernutrition, about 165 million children around the
- 52. world suffer from stunted growth (stunting) and 3 million childhood deaths occur before the age of 5, representing 45% of all deaths in that age range. Stunting as a marker for malnutrition is associated with poorer motor skills and arrested mental development (McDonald et al., 2013). Maternal malnutri- tion during pregnancy often leads to insufficient fetal growth, which causes another 800,000 neonatal deaths (Black et al., 2013; Katz et al., 2013). The good news is that these kinds of consequences have declined recently due to interventions that specifically target areas where undernutrition is widespread. Marasmus and Kwashiorkor It is estimated that up to 16% of children worldwide suf- fer malnutrition that results in two specific life- threatening nutritional diseases. When children have a severe pro- tein deficiency because they have not consumed enough calories in general, their bodies waste away in a condition called marasmus. It is most common among children dur- ing their first year. Marasmus is caused by starvation, when there is insufficient breast milk (usually due to malnutri- tion in the mother), or formula and food are unavailable. Children become extremely thin and fragile, and their weak bodies are at higher risk for disease. Kwashiorkor is a condition caused by insufficient protein intake, even in children who sometimes maintain a mini- mal calorie intake. When children eat only starchy foods that lack protein, the body begins to break down its own reserves. A distended stomach is the hallmark of kwashior- kor and is often seen in photos of starving African children. It also causes severe swelling in the feet, loss of teeth and hair, immunity problems, and a multitude of other compli-
- 53. cations. Kwashiorkor most often occurs after the age of one, when children are weaned from the breast and alternative protein sources are not available. Therefore, in areas where malnutrition is common, the World Health Organization (2013) and the United Nations Development Programme (2013) recommend that mothers of infants at risk for malnutrition continue breastfeeding until their children are at least 2 years old. Burger/Phanie/SuperStock ሁ This young child shows the tissue wasting associated with marasmus. Section 6.6Overweight and Obesity in Childhood Lasting Consequences of Malnutrition and Undernutrition Children who survive nutritional diseases suffer lasting damage to the body and brain (Müller & Krawinkel, 2005). The effects of malnutrition on brain development are cumulative, affect- ing later attention and learning ability, overall intelligence, and motor coordination. Dramatic evidence of the effects of malnutrition is provided by studies of mothers during times of war that were also marked by famine. For instance, during the World War II Siege of Leningrad beginning in 1941, German troops cut off the food supply to the city for nearly 2½ years. During and after this period, fewer children were born, and those who were had a higher incidence of prematurity and low birth weight (Antonov, 1947).
- 54. Similar results were found in 1944–1945 Holland, when the country was subjected to a blockade by the Germans. Like the consequences in Leningrad, there were increased numbers of miscarriages, stillbirths (babies born dead), and birth abnormalities (Stein, Susser, Saenger, & Marolla, 1975). S E C T I O N R E V I E W Describe two specific nutritional diseases and the different ways that inadequate nutrition affects the developing child. 6.6 Overweight and Obesity in Childhood In addition to the clear evidence that malnutrition leads to deficits in physical, cognitive, social, and emotional functioning, there are also problems associated with eating too much food. Obesity is defined as a body weight that is 20% higher than normal for a particular height. For consistency in research and for medical purposes, the body mass index (BMI) is calculated as a ratio of weight to height and standardizes the terms overweight (BMI of 25–29.9) and obesity (BMI of 30 or more). The number of children in the United States who are overweight is approximately double the rate of obesity at any one age. Overall, about 17% of children and adolescents in the United States are obese; rates are even higher among children from lower-income families (CDC, 2014g). The proportion of preschoolers and school-age children who are obese has about tri- pled since 1980. Though the rate for preschoolers has been dropping recently, among school-
- 55. age children, it is the highest ever, at 19%. Additionally, the rate among girls has dropped or remained steady in recent years, while the rate among all boys continues to rise (Ogden, Carroll, Kit, & Flegal, 2012). Research strongly suggests that, probably due to early nutrition and activity habits, young chil- dren who are overweight are particularly susceptible to obesity during adulthood (Thomp- son & Bentley, 2013). One study compared BMI at seven different periods for more than 1,000 children aged 2 to 12. When children were obese before the age of 5, they were more than five times as likely to be overweight at 12 years old than those who were not obese in early childhood (Nader et al., 2006). About half of obese 6 year olds will become obese adults; the proportion rises to 70–80% for obese adolescents (Guo, Wei, Chumlea, & Roche, 2002). As a Section 6.6Overweight and Obesity in Childhood consequence, childhood obesity is associated with multiple health problems later, including a host of cardiovascular diseases and pulmonary, endocrine, and even orthopedic problems as extra weight puts added strain on bones and systems related to movement (Barlow et al., 2007; Inge et al., 2013). Behaviorally, being overweight is associated with delayed motor development beginning in infancy (Slining, Adair, Goldman, Borja, & Bentley, 2010).
- 56. This finding is not surprising since extra weight limits mobility for anybody. Remember that, in infancy, motor develop- ment is intimately connected to brain development, exacerbating long-term effects of being overweight. Causes The rise in obesity rates among children, from less than 5% in the 1960s to nearly 20% today, cannot be attributed to genetics because human genetics do not change in such a short period. There is no doubt that biology and genetics influence body type and how people react to cer- tain foods (e.g., craving a particular kind of taste). But with few exceptions, obesity occurs because of an imbalance between caloric intake and energy usage. In rare cases, a genetic component is identified. Prader-Willi syndrome, for instance, is a specific genetic disorder. It is characterized by feeding difficulties during infancy that soon change to a preoccupation with food and overeating. However, this syndrome is rare, occurring in only 1 out of every 25,000 births (Chen, Visootsak, Dills, & Braham, 2007). Prevention Intervention programs to reduce childhood obesity can be successful. Parental education and involvement remain key components, but programs designed specifically for at-risk elemen- tary school children have also enjoyed success (American Academy of Pediatrics, 2007; Topp et al., 2009). Healthy habits can be gained with a simple after- school education and fitness program. In one study, 63 children aged 5 to 10 years
- 57. participated in a 14-week interven- tion program. The children had 90 minutes of physical conditioning twice a week; an addi- tional 90-minute session was divided equally into physical play and nutrition education. After the intervention period, significant gains in fitness and nutrition were attained. Gains were sustained without parental involvement, even when there was less-than-ideal participation among the children. More general programs have also been successful. Among a group of 8- to 12-year-old children, a program of education and physical conditioning was instrumental in lowering BMI and increasing physical activity over only a 12-week period. Importantly, children who participated in this after-school program appeared to maintain the changes a number of months later (Crabtree, Moore, Jacks, Cerrito, & Topp, 2010) S E C T I O N R E V I E W Distinguish between overweight and obesity in research and summarize how they contrib- ute to children’s health. Section 6.7Eating Disorders 6.7 Eating Disorders Adolescence complicates the issue of overweight and obesity, since teenagers ordinarily need to increase their caloric intake to keep up with accelerated growth. But adolescents are also becoming increasingly aware of body image. For some, that increased focus can lead to psy-
- 58. chological eating disorders. Survey data show that eating disorders affect 4% of adolescents, but only 0.2% suffer impairment that causes extreme personal distress. Those who suffer from eating disorders have a distorted view of what is considered normal and may not recog- nize their own distress (Merikangas et al., 2010). Anorexia Nervosa Anorexia nervosa is a severe body-image disorder in which individuals refuse to eat because of an obsession to maintain an unrealistically thin body. Anorexia is much more common in girls than boys. It has been reported that there may be as many as nine times more girls as boys who are affected, but recent studies show the gap closing (Hudson, Hiripi, Pope, & Kes- sler, 2007; Swanson, Crow, Le Grange, Swendsen, & Merikangas, 2011). Anorexia often begins during early adolescence and can be difficult to treat. It has been reported that up to 10% of anorexics die within 10 years and as many as 20% die within 20 years, usually from heart or other complications related to tissue starvation. Though anorexia has the highest mortality rate of any mental disorder, a major national survey found the average duration among those who recovered was only 1.7 years, so recovery is not necessarily out of reach (Attia, 2010; Hudson et al., 2007). Bulimia Nervosa Whereas anorexia nervosa is characterized by forced starvation, bulimia nervosa involves bingeing, consuming large quantities of food, and then purging though vomiting or the use
- 59. of laxatives, enemas, or diuretics. Bulimics may cycle through bingeing and purging sev- eral times each day. Though the weight of someone with bulimia can remain fairly stable, serious complications are just under the surface. Because of the frequent contact with stomach acid due to vomiting, there is usually damage to the throat and teeth, and scarring of the mouth. Gastric reflux is common. Like anorexia, bulimia is most often diagnosed in wealthier Caucasian girls, but the frequently cited lower prevalence in some other groups has been challenged recently (DeLeel et al., 2009; Swanson et al., 2011; Walcott, Pratt & Patel, 2003). Sociocultural variables, including messages from peers and the media, familial influences, low self-esteem, and biological factors have all been suggested as agents of influence in anorexia nervosa and bulimia nervosa (e.g., Polivy & Herman, 2002; Wade et al., 2008). Certainly cul- ture must have a large impact on these eating disorders, since they are found almost exclu- sively in areas that hold up thinness as the ideal body type (Harrison & Hefner, 2006). For instance, prevalence is higher in the United States than in any other country; these disorders are virtually nonexistent in Asia, except among the upper classes in Japan and Hong Kong, which are strongly influenced by Western culture (Makino, Hashizume, Tsuboi, Yasushi, & Dennerstein, 2006). Though some general environmental, cognitive, and biological factors appear to be prerequisite to eating disorders, research that supports any one theory does not
- 60. exist (Attia, 2010). Consequently, treatment is also multifaceted, incorporating a combination of behavioral, cognitive, and family treatment. Section 6.7Eating Disorders F O C U S O N B E H A V I O R : W a r n i n g S i g n s o f a n E a t i n g D i s o r d e r • Sudden, dramatic weight loss • Distorted view of “normal” weight and body image • Obsession with weight, calories, cooking, recipes, or the fat content of foods • Ritualistic behaviors—eating only in one place, eating only one kind of food at a time, chewing for a prescribed period • Dieting despite less-than-ideal weight • Harshly self-critical • Fear of gaining weight • Purging after meals (and secretive, regular trips to the restroom at mealtimes) • Frequent use of diet pills, laxatives, or diuretics • Lying about eating (faking illness or pretending to have eaten already)
- 61. • Frequent strenuous exercise • Swollen salivary glands (disproportionately large cheeks) • Depression Prolonged starvation: • Brittle bones and hair • Lanugo—soft, fine hair on the face and body • Organ system failure Binge Eating Disorder Unlike anorexia and bulimia, binge eating disorder does not involve harmful compensatory behaviors like excessive exercise, purging, and periodic self- starvation. Therefore, those with binge eating disorder are usually overweight. Binge eating disorder is marked by rapidly eat- ing unusually large amounts of food several times per week, leading to physical discomfort. Individuals typically feel shame when they overeat, which leads them to binge while alone. As in the adult population, binge eating disorder among adolescents is the most common kind of eating disorder. It affects between 1.6% and 3.0% of the U.S. teenage population (Stice, Marti, & Rohde, 2013; Swanson et al., 2011). Little is known about the causes of binge eating disorder, though researchers have suggested it is associated with depression or is caused by differences in brain chemicals and hormones (e.g., Gadalla & Piran, 2008).
- 62. Because psychological eating disorders have great cultural variance, and because they typi- cally begin during adolescence, once again the issues of nature versus nurture and continuous versus discontinuous development are apparent. It is likely that biological changes influence thinking, personality, and emotional development, which causes teens to be more vulnerable to eating disorders. These kinds of factors related to cognition are the focus of the next two modules. Summary and Resources S E C T I O N R E V I E W Name and distinguish characteristics of the three most common eating disorders. Wrapping Up and Moving On Throughout the world, great variation exists in threats to childhood health. Whereas disease and malnutrition affect substantial numbers of children in underdeveloped countries, unin- tentional injuries are the biggest concern elsewhere. Other health concerns have arisen as new technology and changed cultural attitudes have shifted eating patterns and overall activ- ity levels. Individuals generally eat more food that is high in fat and calories and low in nutri- tion than in previous generations. In tandem with lower levels of physical activity, including time for physical education in school, there is now an epidemic of overweight and obese chil-
- 63. dren. Food and eating are also involved in three primary eating disorders, which first appear most commonly during adolescence. Summary and Resources • Concentrated efforts have contributed to a drop in worldwide child mortality, but millions of children still die from preventable diseases. • Homicide and suicide are often overlooked health dangers that have a significant effect on the adolescent population. There are specific warning signs for suicide, but homicide seems to be a more entrenched problem, even affecting a significant num- ber of preadolescent children. • The prevalence of homicide and suicide are highly dependent on demographic char- acteristics. Lower-income minorities in the United States have a comparatively high homicide rate. • In developed countries like the United States, accidents kill more children overall than any other cause. In addition to pedestrian and automobile accidents, children are at risk for drowning, other water injuries, and poisonings. Safety and prevention efforts significantly decrease mortality rates. • Though a cold is the most common childhood illness, millions of children have asthma and diabetes, often contributing to cognitive and psychosocial problems.
- 64. • Healthy exercise and activity are necessary complements to good nutrition. Parents and schools need to prioritize this essential part of development. • Children clearly benefit from better nutrition and positive eating habits that can be established in childhood. Some parents are overly concerned with their children who are fussy eaters, whereas others may not be modeling appropriate eating hab- its. Adults may inadvertently model the potential for lifelong negative consequences, including obesity. • Appropriate physical movement should be a daily, habit- forming activity. Recent trends show a continued de-emphasis on this essential component of health. • Partly because of available social programs, life- threatening malnutrition is rare in the United States. However, marasmus and kwashiorkor are serious problems in less-developed countries. Summary and Resources • Whereas some children develop health problems by eating too much, others develop anorexia nervosa and bulimia nervosa, which are characterized by not enough nutri- tion. Though these eating disorders are together the most fatal
- 65. mental disorders, evidence indicates that they can often be relatively short term. Key Terms anorexia nervosa An eating and body image disorder characterized by self-starvation. asthma The most common chronic dis- ease in children. Causes breathing airways to become inflamed and narrow, leading to shortness of breath, a feeling of tightness in the chest, and coughing. binge eating disorder An eating disorder marked by rapidly eating unusually large amounts of food several times per week, leading to physical discomfort. body mass index (BMI) A number calcu- lated as a ratio of weight to height, which provides a standard to indicate underweight, normal weight, overweight, or obesity. bulimia nervosa A disorder of weight con- trol characterized by cycles of bingeing and purging. diabetes A chronic disease that occurs when high levels of sugar in the blood are not regulated properly by the body’s systems. kwashiorkor A consequence of malnutri- tion caused by insufficient protein intake.
- 66. Characterized by a distended stomach and other swelling. malnutrition A condition that results from insufficient intake of nutrients from food. marasmus A condition of malnutrition that is characterized by wasting. meta-analysis An extensive research review that combines the results from a number of studies. obesity Body weight that is 20% higher than normal for a particular height, defined by a body mass index score of 30 or more. whooping cough (pertussis) A virus that causes respiratory problems. Web Resources See links below for additional information on topics discussed in the chapter. Asthma http://www.nhlbi.nih.gov/health/dci/Diseases/Asthma/Asthma_ WhatIs.html Baby Boomers http://www.bbhq.com/whatsabm.htm Body Mass Index (BMI) http://apps.nccd.cdc.gov/dnpabmi/
- 67. Calcium-Rich Foods http://www.iof bonehealth.org/patients-public/about- osteoporosis/prevention/nutri- tion/calcium-rich-foods.html http://www.nhlbi.nih.gov/health/dci/Diseases/Asthma/Asthma_ WhatIs.html http://www.bbhq.com/whatsabm.htm http://apps.nccd.cdc.gov/dnpabmi/ http://www.iofbonehealth.org/patients-public/about- osteoporosis/prevention/nutrition/calcium-rich-foods.html http://www.iofbonehealth.org/patients-public/about- osteoporosis/prevention/nutrition/calcium-rich-foods.html Summary and Resources Central African Republic http://www.newworldencyclopedia.org/entry/Central_African_R epublic China https://www.cia.gov/library/publications/the-world- factbook/geos/ch.html Democratic Republic of the Congo http://www.newworldencyclopedia.org/entry/Congo Depression http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001941
- 68. Diabetes http://www.diabetes.org/ Ear Infections http://www.nidcd.nih.gov/health/hearing/earinfections Foods High in Iron http://www.buzzle.com/articles/iron-rich-foods-list-of-foods- high-in-iron.html Gastric Reflux http://my.clevelandclinic.org/disorders/gastroesophageal_ref lux_gerd/hic_ gastroesophogeal_ref lux_disease_gerd.aspx India http://www.newworldencyclopedia.org/entry/India Insulin http://www.endocrineweb.com/conditions/diabetes/diabetes- what-insulin Let’s Move http://www.letsmove.gov Measles http://www.emedicinehealth.com/measles/article_em.htm