Provider

KVH Contributor*

Dr. Elise Herman
KVH Pediatrics

We seem to hear a lot more about food allergy lately – and for good reason. Food allergy is more common in kids than adults, the prevalence of it is increasing, and 8% of all kids under the age of 6 have food allergies. Understanding food allergy and the newest recommendations about peanut allergy is important for parents and anyone interacting with children.

A food allergy is an abnormal immune response of the body to a particular food. You must be exposed to a certain food at least once (either by eating directly or via breast milk) in order to have an allergic reaction. An allergic reaction occurs when the immune system’s IgE antibodies react with the food, which releases histamines. These histamines cause the signs and symptoms of food allergy that range from mild to life threatening.

90% of all food allergies are caused by the following foods: milk, eggs, wheat, soy, tree nuts (walnuts, almonds, etc.), peanuts, fish, and shellfish. In children, eggs, milk and peanuts are the most common causes of food allergy. Severe reactions are usually caused by peanuts, tree nuts and seafood. Children often outgrow their allergies; 80-90% of milk, egg, wheat and soy allergies resolve by age 5 years. Allergies to peanuts, tree nuts and seafood are more likely to persist. Approximately only 1 in 5 children will outgrow their peanut allergy.

An allergic reaction to a food usually occurs within minutes to hours of eating it. In addition to hives and wheezing, a child may also have itching, swelling of lips/ tongue, shortness of breath, stomach pain, lowered blood pressure, vomiting, diarrhea and/or anaphylaxis (a severe shock-like reaction). Testing for food allergy is only done if there is a strong suspicion of allergy; an abnormal test does not always mean the child is truly allergic. Testing may include blood tests or a skin prick test.

Treatment for food allergies most importantly means avoiding that food (and similar foods) – not easy in today’s world of processed foods that may contain many ingredients. Even a tiny amount of the offending food can trigger a reaction. Epinephrine is the only treatment for severe allergic reactions and comes in the form of an auto-injector called Epi-Pen. Allergy specialists typically do allergy testing and decide if a child should have an Epi-Pen. It is crucial that anyone who will have contact with a child who has a severe food allergy is aware of this and has access to (and knows how to use) an Epi-Pen.

There has recently been exciting news about peanut allergy, which affects 2% of all children. Previously the recommendation was to wait until at least age 1 year for peanut products but it has been shown that earlier introduction actually decreases a child’s risk of peanut allergy. New guidelines from the National Institute of Allergy and Infectious Diseases state that for those children at highest risk – those with severe eczema and/or egg allergy – blood testing should be done by age 4-6 months, and if abnormal the child should see an allergist.

For children who have mild to moderate eczema, peanut products may be introduced and given regularly starting at age 6 months. If the infant has no eczema or food allergy, peanut products may be introduced “freely” into the diet and given regularly with other foods at age 4-6 months (ideally solids are begun at 6 months for breast-fed infants). It is important to remember that peanut products may be a choking hazard. A small amount of smooth peanut butter blended into other foods such as applesauce or oatmeal is ideal. If a rash or any sign of allergy occurs, a doctor should be contacted.

*Opinions expressed by KVH Contributors are their own. Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.

KVH Contributor*

Dr. Elise Herman
KVH Pediatrics

Childhood obesity is truly an epidemic. In the past 30 years, the percentage of American kids who are overweight has tripled to 17%, or about 1 in 5 children. Additionally, the very heaviest children are even bigger than previously. Adults also have an increasing rate of obesity, but it is especially sad to see kids now dealing with what used to be adult-only health issues due to obesity: Type 2 diabetes, high blood pressure, high cholesterol and lipid levels, fatty liver, sleep apnea and joint problems. Obese children are more likely to grow up to be obese adults, with increased risk of stroke, heart disease, high blood pressure and diabetes.

The emotional and psychological side of obesity is significant as well. These children have greater occurrence of depression, low self-esteem, poor body image and eating disorders. Overweight kids are also more likely to be bullied, compounding their distress.

There is no single cause of childhood obesity, but there are know factors that contribute, including the child’s diet. Diets higher in fats and simple sugars and lower in fruits and vegetables are linked to obesity. Drinking sweetened liquids such as soda and juice can count for lots of extra calories with minimal nutrition. Even diluted juice can give a child extra calories and sugar they do not need and is not recommended on a regular basis. Milk, although a good source of calcium and protein, should be limited to 16 ounces per day.

Snacking can be a major source of calories for American kids, as snacks are increasingly processed and high calorie. Some kids snack almost continuously and can take in more than a quarter of their daily calories in this way; this is especially true in 2-6 year olds. Having regular family meals with minimal snacking decreases the risk of childhood obesity.

Genetics may play a role as well, although the bigger issue may be the environment—high calorie snacks, inadequate exercise and lack of regular family meals probably contribute more than actual genetics.

Exercise helps kids maintain a healthy weight by not only burning calories but also by keeping them busy and elevating their mood. Like adults, kids may eat out of boredom or for emotional reasons; exercise works against this. Due to computer, TV, personal electronic devices and video games, however, kids are more sedentary than ever. Limiting the usage of electronics and encouraging kids to get at least 1 hour of exercise a day (with most of this being aerobic exercise) is important.

A surprising contributor to childhood and adult obesity is lack of sleep. This may be due to hormonal alterations, less regular meals and poorer food choices when sleep-deprived. It is recommended that kindergartners get 10-12 hours of sleep a night, with the amount decreasing as kids get older, with the goal for the teen to be 9-10 hours per night.

So what’s a parent to do? Like many issues, setting a good example is important. Regular family meals, minimal snacking of healthy foods such as fruits and vegetables, routine exercise (ideally outside to elevate the mood and keep us away from the kitchen!) and regulated use of technology all help. The goal should also be a healthy lifestyle and healthy habits, not a number on the scale or the desire to be thin, as this could backfire and predispose to an eating disorder. Have fun with your family as you enjoy regular meals together as well as getting out and being active, and preventing childhood obesity will be a natural healthy side effect!

*Opinions expressed by KVH Contributors are their own. Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.

KVH Contributor*

Dr. Elise Herman
KVH Pediatrics

There are lots of parenting books and websites out there, but in trying to keep it simple, here are some tips on how to raise a great kid:

Talk and sing to your baby while you hold, feed or play with him; eye contact and face to face interaction promotes brain development.

Start books early with your baby and read to her every day – make it part of the bedtime routine.  If you speak a second language at home, read books in that language, too.

Get outside with your child every day (unless absolutely too cold, icy, etc.) – good for kids and adults!  Getting outside is healthy exercise and good for us emotionally as well.

Start family meals with your child as soon as she starts eating solids (4-6 months) and continue through adolescence. Family meals promote healthy eating, connection with each other and have been shown to decrease risky behaviors in teens.

No screens (other than looking at photos or doing video chat such as Skype, though even this should be limited) until 2 years. Avoid fast moving content such as cartoons and stimulating videos, which has been shown to lead to trouble paying attention later in life. Slow moving content such as Mister Rogers/Daniel Tiger makes more sense to kids. Avoid YouTube especially if you are not watching with your child since you do not know what will be ‘recommended’ for him to ‘watch next’.

Put your phone or other devices away when with your child. We adults miss out on valuable interactions with our kids when we are distracted by technology. We are sending a clear message to them that they are not as important as the phone, etc. And of course our kids want to imitate us and be on a phone, too – not what we want to encourage!

Establish routines for meals, naps and bedtime. We all thrive with a predictable routine.

Play with your child – really play!  Channel your inner child, pretend, be silly, play dress-up, play tag. Let your child lead and encourage unstructured play with her peers; the adults can be nearby but not directing/controlling what happens. Play has been called “the work of childhood” because it is so important to kids.

Praise good behavior right at the time you see it.  Ignore the little things he does “wrong” but be consistent if there is a real problem – hitting, disrespect, etc.  Spanking is not effective discipline but having a “time-out”, taking away privileges and natural consequences (for example if a child throws food off the high chair tray and he has been told not to, meal time is over) are.  Stay calm; yelling is scary and bewildering to kids.

Chores make kids feel valued and also encourage a sense of family responsibility. Kids learn how good it feels to help out and to be counted on.  When they (eventually!) leave home, we want them to have the skills to be independent adults. Yes, that means scrubbing the toilet!

Wait until your child is at least 14 years old to have a cell phone (Microsoft CEO Bill Gates’ recommendation!), and many experts suggest a flip phone (no Internet) for at least one year to see if the child is responsible enough for a ‘smart phone’. Better yet, ask why she ‘needs’ a smart phone. Given the risks of social media (anxiety, depression) and the negative effect on reading, getting outside, family time, etc. it is reasonable to avoid the smart phone until much older.  Your child may not be happy, but is a parent’s job to do what is best for the child, not to make him happy.

Elise Herman, MD, is the mother of 2 terrific kids who are by no means perfect!

Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.