How to Motivate Your Kids (Without Bribery!)

Show Them How

Want your child to eat her vegetables? Eat your vegetables. Get up and go for a walk together to show her that moving is fun. You’re the best role model your child can have. So start early. Kids begin to mimic their parents at a very young age. Resist the urge to bribe your child with food, toys, or other treats to cooperate. That teaches unhealthy habits.

Reward Them With Mom or Dad Time

Instead of bribing your child with video game or TV time (or anything where they’re just sitting), make active time together a reward. Go mini-golfing. Take a bike ride together. Or let your child plan a day full of active things they enjoy. Why this works: Kids crave your attention — especially if they have to share time with siblings. Never underestimate how much one-on-one attention means to your kids — even your teen.

Don’t Use Food as a Reward

Making sweets or junk food a prize teaches your kids to use food to fix their feelings. That can set them up for an unhealthy relationship with food. According to one study, adults who were rewarded and punished with food as kids were more likely to binge eat and diet. Withholding treats because of misbehavior — “No ice cream for you!” — isn’t good either. The forbidden food becomes more attractive.

Praise Effort, Not Just Results

Children need praise. If you want to motivate them, focus on their effort more than the end result. When your child shows you a picture he made, don’t just say it’s great. Praise him for how hard he worked on it. Note specific details. If your child is trying to learn a new sport, talk about how proud you are that he’s practicing kicks or running. Don’t focus on winning or losing a game.

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How Well Does Stroke Thrombectomy Work for Children? – Multicenter study suggests most recover with little disability

by Crystal Phend

Stent retrievers and other endovascular thrombectomy treatments appeared as safe for selected children as seen in adult trials, and also had good neurologic outcomes, in the Save ChildS Study.

Among 73 children treated at 27 centers in the U.S. and Europe, the most feared complication — symptomatic intracerebral hemorrhage — occurred in only one, for a 1.37% rate that was favorable compared with the 2.79% rate in the HERMES meta-analysis of adult trials.

No vascular complications, such as dissections or vessel rupture, were reported by Peter Sporns, MD, MHBA, of Universitätsklinikum Muenster in Germany, and colleagues in JAMA Neurology.

The only periprocedural complication was transient vasospasm on angiography in four patients (5%) that resolved without clinical sequelae. Malignant infarction followed by decompressive hemicraniectomy occurred in three children (4%). One patient with preexisting congenital heart disease died of cardiac arrest after complete recanalization.

“This study may support clinicians’ practice of off-label thrombectomy in childhood stroke in the absence of high-level evidence,” the researchers concluded.

Neurologic improvement also “showed a similar pattern as observed in the adult trials,” as median Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score improved from 14.0 at admission to 4.0 at day 7.

Median modified Rankin scale (mRS) score was 1.0 on the 6-point scale at both 6 and 24 months, with 80% having a favorable neurologic outcome (mRS ≤2) at discharge and more than 85% at the same point by 180 days.

None of the seven trials in the adult-trial meta-analysis reached much beyond 70% at 90 days on that measure.

However, an accompanying editorial expressed deep reservations about how much could be made of the findings, given the methods.

First, 24-month neurologic outcome data were missing for more than one-third of the children, “introducing the possibility of selection bias,” wrote Christine Fox, MD, of the University of California San Francisco, and Nomazulu Dlamini, MBBS, PhD, of the Hospital for Sick Children in Toronto.

“Data for earlier outcomes were more complete, but because deficits may emerge over time in children, early outcomes may not provide the full picture,” they wrote. “Cognitive and language deficits may initially go unrecognized in a toddler but become apparent as skills required for success in school grow increasingly complex.”

And using historical data from the meta-analysis for comparison “has pitfalls,” they added. “Given differences in the interpretation of outcome instruments and timing of outcome measures in the Save ChildS study compared with the HERMES trials, comparisons between these studies are of questionable value.”

Clinical trials are unlikely to be done to support the guidelines suggesting mechanical thrombectomy with stent retrievers as reasonable to consider for some patients <18 years with large-vessel occlusion, Sporns' group noted. The one trial that had started had to be abandoned for lack of recruitment. Sporns' study included all patients ages ≤18 years diagnosed with arterial ischemic stroke who underwent endovascular recanalization from 2000 through 2018 at participating centers. Most treatment was with clot retrievers (82%), while distal thromboaspiration was used in 10%, along with a smattering of other tools. All patients immediately went to the pediatric ICU after endovascular treatment. The researchers cautioned that, although all types of stroke sources were included, only seven patients had focal or bilateral cerebral arteriopathy. "Thus, an a priori selection bias of thrombectomy against children with potential inflammatory vasculopathy may be inherent to a seemingly low overall hemorrhagic risk," they wrote. "Vascular fragility and risk of hemorrhage need to be considered and weighted carefully against a potential benefit of a recanalization treatment in this specific patient population," they noted. "Underlying abnormalities are often unknown at the time of admission; therefore, the emergency decision on whether to perform thrombectomy frequently has to be made without detailed knowledge about the cause of the stroke."

Philippines to vaccinate millions as polio virus resurfaces in 2 children

Karen Lema

MANILA (Reuters) – The Philippines recorded its second case of polio on Friday, as it prepared to vaccinate millions of children against a disease it believed to have been eradicated two decades ago.
A five-year-old boy in Laguna, south of the capital Manila, tested positive for the polio virus, the health department said, the second case this week after a three-year-old girl was confirmed to be infected on Monday in a province about 1,400 km (870 miles) away.

Health officials appealed to parents and care givers of children to take part in the government’s polio vaccination programme, which comes as the Philippines grapples to tackle twin outbreaks of dengue and measles that have killed more than 1,000 people since January, most of them children.

“The polio vaccinations happen all year round, but our coverage dropped for the past five years,” Rolando Enrique Domingo, an undersecretary of the Department of Health, told Reuters.

“We’ve learned our lesson. It is time to move on and really start vaccinating all kids and make sure we sustain this every year.”
The polio virus was detected in the sewage systems of Davao in a nearby province two months ago, and in Tondo, a rundown area of Metro Manila notorious for slum communities, Domingo said.

Afghanistan, Nigeria and Pakistan are the last three countries where the disease is endemic. The last known case in the Philippines had been in 1993, the World Health Organization says.
Immunisation coverage in the Philippines is at 70%, below the recommended rate of 95%, Domingo said, as trust in vaccines declines.
The boy who tested positive in Laguna has been discharged from hospital already, officials said on Friday. The other case was confirmed on Monday and reported on Thursday in Lanao del Sur, one of the country’s poorest provinces.

Vaccination teams will aim to administer polio drops to every child younger than five, he added.

There is no cure for polio, which invades the nervous system and can cause irreversible paralysis within hours, but it can be prevented with vaccines.

The virus spreads rapidly among children, especially in unsanitary conditions in underdeveloped or war-torn regions where healthcare access is limited.
Children nationwide are at risk as long as a single child remains infected, the United Nations agency for children, UNICEF, has said.

The Philippines has faced a challenge recently in convincing parents to vaccinate children after it scrapped a dengue immunisation programme using Sanofi’s Dengvaxia in late 2017, following its linkage to child deaths.
More than 800,000 children received the vaccine. The records of 119 dead children are being examined to determine if Dengvaxia was to blame, a panel of medical experts said in March.

The inquiry continues and Sanofi has repeatedly said its vaccine is safe.

A vaccine campaign started in August in the historic heart of Manila will be expanded to cover more than 5 million children and go nationwide next year, Health Secretary Francisco Duque said in a speech on Friday.

Doctors tell parents too late that their child is near death, survey suggests

Caroline White

Wednesday, 21 August 2019

Doctors may be telling parents too late that their child is near death, suggest the results of a small survey*, published online in the journal BMJ Supportive & Palliative Care.

National guidance is needed for doctors on how and when to give parents bad news, so that they can be properly prepared, say the researchers.

Open, accurate, and timely information about terminal illness and associated life expectancy are key tenets of high-quality palliative care. But previous research suggests that doctors often find it difficult and distressing to discuss end-of-life issues, they explain.

The researchers scrutinised a national Danish register of child deaths between 2012 and 2014 to find those who had died of a terminal illness: 402 out of 951.

A modified version of a validated questionnaire about the loss of a child was sent to the bereaved parents together with an explanatory leaflet about the nature of the study.

The questionnaire contained 122 questions designed to probe parents’ perceptions of the type and quality of communication with healthcare professionals throughout their child’s illness and imminent death.

In all, 136 mothers and 57 fathers completed the questionnaire, representing the parents of 152 children who had died of a terminal illness between 2012 and 2014 (response rate of 38%). Over half the children (56%) had died within the first year of life.

More than half the parents (59%) were told their child’s illness was terminal by a doctor. For around a third (30%) this was imparted immediately after the child’s birth.

But one in seven (15%) said they received this information in the last 24 hours of the child’s life. And around one in 10 (12%) said they weren’t told at all.

A similar proportion (11%) said they didn’t realise their child was going to die until the event itself. Around one in five (19%) only realised their child’s death was imminent a few hours beforehand.

Three out of four of the parents were satisfied with the information they were given by clinicians about their child’s illness. Most felt the same (80%) about their child’s treatment.

But the information given about how the child’s illness and treatment would affect their physical and mental health was judged inadequate by one in three (33%) and nearly half (48%), respectively.

A third (34%) of the parents weren’t told how to access end-of-life care, while four out of 10 (40%) didn’t know what to do in the event of an emergency.

Nearly all (98%) of them said that doctors should let parents know as soon as it was clear that all curative treatment options for their sick child had been exhausted.

Most parents (79%) felt the information about the terminal nature of their child’s illness had been provided in a timely manner. But more than four out of 10 (42%) said they were told too late that their child was about to die.

Nearly a third (31%) said they were unable to say goodbye to their child as they would have liked. And more than four out of 10 (43%) said that their child’s death had come as “a shock.”

This is a small observational study, and the distress of caring for a dying child might have affected parental recall, the researchers point out.

“Healthcare professionals are exposed to great challenges in communicating with parents about their children’s life limiting illness and imminent death, and even though [they] strive to communicate effectively with the children and their parents, several barriers on the sides of both parents and professionals, may hinder even the best of intentions,” they write.

“However, the present study clearly demonstrated that the parents’ need for information and support were not sufficiently met, and the study results may raise awareness of the importance of providing improved education and training for healthcare professionals working with children with life limiting diagnoses and their parents,” they conclude.

Not Just One Reason Kids Don’t Drink Enough Water

By Jennifer Clopton

July 29, 2019 — Kids need to drink plenty of water all year long — and especially in the summer — to stay healthy, hydrated, and active. But a recent study finds that on any given day, a staggering 20% of the children in the U.S. don’t drink a drop of water from tap or bottled sources.

“That doesn’t mean they don’t drink water on other days. But I think 1 in 5 kids not drinking any water on any given day is a bit surprising,” says the study’s author, Asher Rosinger, PhD, director of the Water, Health and Nutrition Laboratory at Pennsylvania State University in State College.

“Kids should be drinking water every day because water is the healthiest,” he says.

But for many parents, getting their children to drink water is not only a challenge, it is an almost impossible task. This lack of water can have deep impacts on children. It contributes to obesity, affects their performance in school, and can lead to other unhealthy habits.

“Our 6-year-old daughter drinks water, but with our son, who will be 2 in August, he won’t even drink a cup a day,” says Sarah Ford. “He drinks milk and half-water, half-juice, and that’s it. I’m at a loss as to how to get more water in him.”
She’s not alone, and this isn’t a problem parents can shrug away or ignore. The CDC says water consumption is a key part of keeping healthy, staying hydrated, and managing a healthy weight, and doctors say there are many health risks when children don’t get enough.
“Mild dehydration leads to symptoms like fatigue, headache, and poor endurance. Longer term, chronic lack of fluids affects the kidneys, the liver, the brain, and can lead to constipation, which can be very problematic,” explains Linda Friehling, MD, a pediatrician and assistant professor of general pediatrics at West Virginia University in Morgantown.

Julie A., who asked that we not use her last name, has seen her daughter negatively affected from not drinking enough water. “My daughter would get off the bus in kindergarten with her head hung, exhausted, saying she had a headache, and then she would usually vomit,” the mom says. “I would give her a bottle of water or Gatorade, and she would fall asleep on the couch, wake up an hour later, and be fine. No fever or other symptoms. It took me a while to realize she was simply dehydrated.”

The latest research indicates this is a real challenge for many. Rosinger’s study, published in JAMA Pediatrics in April 2019, analyzed 8,400 children and young adults in the U.S., showing everything they ate and drank in a 24-hour period. That data not only found that 20% of kids aren’t drinking water in a given day. It also showed that when kids didn’t drink water, they were more likely to drink sugar-sweetened beverages.

“Those kids that did not drink any plain water consumed almost twice as many calories as kids that consumed water. That is when they would drink more than 10% of their daily calories from sugary drinks,” Rosinger says.

The Penn State research team found that when children did that, they added 100 calories a day to their diet — increasing their risk of becoming overweight or obese.

“The association indicates that when kids drink water on a given day, their caloric intake from sugary drinks is half that of kids who don’t drink water,” Rosinger says. “So the recommendation that is very important for parents and pediatricians is that water should be the first beverage offered. If kids are consuming water, they get hydration from that instead of less healthy sources.”

What’s a parent to do if their children struggle or downright refuse to drink water? WebMD takes a closer look at the problem — and solutions.

Why Don’t Kids Drink Water?
There isn’t just one reason that kids don’t drink water.

“It is definitely a more complex issue than you might think,” says Erica L. Kenney, ScD, an assistant professor at the Harvard T. H. Chan School of Public Health.

Some don’t like how it tastes, and others don’t know how much their bodies need it. The problem is made worse in some places by water distrust. “It should be easy to go get a drink of water when you want one because tap water should be readily available and clean, but that’s not always the case,” she says.

A study published by Kenney’s research partners in 2019 that looked at statewide initiatives between 2016 and 2018 in 24 states and the District of Columbia found that many students attend public schools in states where not all taps are tested for lead. Kenney was also lead author of a 2017 study that found that racial, ethnic, and socioeconomic disparities in water consumption are related to differences in tap water. Kenney pointed to a 2014 study that found black and Hispanic adults were more likely to say their tap water was not safe to drink, leading them to drink less of it.

“I think something similar might be going on with children,” she says. “Kids who drank more tap water had a lower risk of being poorly hydrated, and it makes sense. If you do live in a place where your tap water is safe, abundant, and cheap, it’s the quickest and easiest route to hydration.”
Melissa Mays understands the effect of water distrust on children’s drinking habits. The mother of three and activist from Flint, MI, filed a Safe Drinking Water Act lawsuit against her state government, forcing it to replace water service lines polluted by lead as a result of the city’s water crisis.

“There is a serious distrust here of water,” she says. “It is hard, especially for younger kids. This is all they know — that water is bad. You try not to teach them water is bad, but you have to teach them to be safe.”

Mays says when water distrust is an issue, finances sometimes rule your decisions. “A lot of parents will get a 2-liter of soda because it’s easier to come by and cheaper than a case of water,” she explains. “I understand that for many families, it is a hard choice. There are a lot of hard decisions.”

Access to water at schools, camps, daycares, and preschools is another big challenge. The CDC stresses the need for students to drink water at school and has materials aimed at increasing access to it. But research published in 2016 in the Journal of Adolescent Health looked at access in 59 middle and high schools in Massachusetts. It found many schools weren’t meeting state or federal policies for minimum drinking water access for students, and in some cases, school staff may not have been accurately reporting water access.

“This is something that I think adults forget about,” Kenney says. “When you become an adult and you want a drink of water, you can generally get it. As a kid though, you are in a captive school environment, and it really depends on whether or not the school makes it easy to get the water. In some cases, there are a lot of hoops kids can have to jump through, and you can easily have a scenario where kids are going through the day and can’t get enough water to satisfy their thirst.”

Parents report many problems in school settings. Some say there are logistical and time challenges for students when it comes to getting to the bathroom. Others say water isn’t offered or encouraged in the hopes of limiting diaper changes in preschool and bathroom trips, or other distractions in older grades.

“I send my kids to school with water bottles, but they aren’t allowed to just leave them on their desk or go grab whenever. Super frustrating,” Jenn Pullen says.

“When my kids started full-time preschool last year, they did not know how to use the water fountain. They just could not get the knack of it and didn’t know how to request water from a teacher. Refillable water bottles were not allowed due to possible contamination with kids swapping bottles. My kids were coming back with stomachaches and constipation,” Rosy Estrada says.

Estrada says she’s since worked with the administration at her child’s school to raise awareness of the importance of drinking water, especially on hot days, and there are now systems in place to ensure children drink enough water throughout the day.

Understanding the Problem
So how much water should kids drink? An old adage says we should all be drinking 8 glasses a day, but in reality, guidelines vary. Some scientific publications say thirst can be your guide, but the Academy of Nutrition & Dietetics says that’s not a good idea with children.
“Children that complain often of thirst may not be drinking enough, because if you experience thirst, you may already be dehydrated,” says Kristi King, a registered dietitian nutritionist and a senior dietitian at Texas Children’s Hospital in Houston. “A great indicator is making sure their urine is pale yellow and not dark yellow. You may also be able to tell by their mood. A well-hydrated child typically is energized, where if they are dehydrated, they may be sleepy, fussy, or more moody than normal.”

CHOC Children’s, a California hospital, recommends kids drink one 8-ounce cup of water a day for every year of age. For example, 2-year-olds should drink 2 cups; 8-year-olds should have 8. Kids ages 9 and older should also have 8 cups.

The Academy of Nutrition & Dietetics says parents also need to pay close attention to how much water their children drink before, during, and after physical activity, especially in hot weather. The nutrition group recommends half a cup to 2 cups of water every 15 to 20 minutes during exercise.

Keeping children properly hydrated has long been a challenge. Kenney has been doing research in this area for several years. When she and her team looked at the hydration status of children and teens in the U.S. from 2009 to 2012 for research published in the American Journal of Public Health in 2015, about half (54.5%) of more than 4,000 participants between the ages of 6 and 19 weren’t hydrated enough.

Solutions
When it comes to solutions, advocates say you have to approach a complex problem like this in many different ways. There are organizations and advocates like the National Drinking Water Alliance working to make sure all children have access to clean and safe drinking water.

“I don’t think we have enough concrete solutions,” Kenney says. “I think there needs to be more investment in improving infrastructure for kids and families. There are a lot of homes that have outdated plumbing. We need to improve access. There also needs to be an effort to help kids trust tap water and think of it as something they drink with meals.”

Friehling says there is a role for the nation’s pediatricians to play in solving this problem, too. “From a pediatric standpoint, there is much that can be done to encourage children to drink water. I start discussing it at a very early age, between 4 and 6 months — at the same time that I discuss starting solid foods,” she explains. “I recommend that parents offer plain water, in a bottle or cup, with every meal, and drink water themselves to provide a model. Babies that have been drinking water since before they can remember are less likely to reject it later on.Experts say parents can also help boost how much water their children drink. Here are several ways to try to get ahead of the problem.

Make it a habit. The best way to get your kids drinking more water is to make it a family practice, from as early an age as possible. “I think that good habits can start in infancy,” Friehling says. “Parents can make water drinking a fun part of mealtime and break time, certainly a part of family activities and an important part of physical conditioning.”

Build it into the entire day. Have a cup of water by their bed so children can drink it before they fall asleep and when they wake up. Have a cup waiting for them in the morning when they come into the kitchen and at every meal, and make sure everyone has a cup or bottle all day around the house and when you head out.

Make water the only option. If water is the only drink available, chances are greater that kids will drink it, so remove sugary drinks from your home and see if it makes a difference.
Get water from food. King says it is important to remember that some hydration can come from fruits and vegetables. “Cucumbers, watermelon, celery, lettuce, tomatoes, and strawberries are good examples,” she says.

Get creative. Play around with how you serve water, and see if that makes a difference. Try adding fruit or fruit slices like strawberries and mint, cucumbers or berries. Add a splash of fruit juice, or make slushies with water, ice, and fruit, which can make it more fun, especially for younger children.

Laura Fuentes, a mother of three who owns a health and wellness company, has written numerous blog posts on how to get kids to drink more water. She recommends serving water really cold, in a stainless steel cup if possible and with a straw, which she says children and teens enjoy. She also likes to use frozen fruit instead of ice cubes for extra flavor. She says you can buy fresh fruit and freeze it or buy it frozen for an easier, more economical option.

“I have an easy-to-open Tupperware in the freezer with chunks of pineapple and peaches, apples, berries. Not a big frozen block of fruit, but small bites the kids can reach and grab and put in. Everyone takes what they want, and instead of an ice cube, they use that,” Fuentes says.

Start small. If your child will drink only juice, cut it down by mixing it with water. Fuentes says you can also make ice cubes out of juice and drop those in a cup of water instead of serving a whole cup of juice.

Let technology help. There are apps designed to help you remember to drink throughout the day. Smartwatches and personal activity trackers can help by offering reminders to drink. You can set reminders to go off on phones or voice-based virtual assistants like Amazon’s Alexa throughout the day, too.

Look at your own habits. Last but not least, parents and caregivers should pay attention to what they’re drinking, especially in front of the kids.

“I typically tell parents, you set the example,” Fuentes says. “If you are buying flavors for your drinks or always drinking sports drinks, you may have a problem with water too, and your child is modeling that. My kids see me walk everywhere with a cup of water, so for them, drinking water throughout the day is the norm. Children will pick up the behaviors we parents set, so modeling what we wish them to do is best.”

A common skin bacterium put children with severe eczema at higher risk of food allergy

In a new study published today in the Journal of Allergy and Clinical Immunology, scientists from King’s College London have found that young children with severe eczema infected with Staphylococcus aureus (SA) bacterium, are at a higher risk of developing a food allergy.

Staphylococcus aureus (SA) is a bacterium that can be found in the nose and the skin of healthy individuals.

However, SA is more common in sufferers of eczema, especially severe eczema.

When someone has an allergy, their immune system mistakes a harmless substance (such as eggs or peanuts) as an intruder and overreacts in response. Their body produces a molecule or else antibody known as Immunoglobin E (IgE).

When IgE encounters the intruder on the skin or within the body it releases chemicals, such as histamine that cause the allergic reaction.

The team of scientists found that young children with severe eczema who are infected with SA produce more IgE against peanut, egg and milk indicating they have a food allergy to each of these.

These children were also more likely to have their egg allergy persist at the age of 5 or 6 years in comparison to children that did not have SA present.

Lead author Dr Olympia Tsilochristou from King’s College London said: “This is significant as most children with egg allergy usually outgrow this at an earlier age.

“We do not know yet the exact mechanisms that lead from eczema to food allergy however our results suggest that the bacteria Staphylococcus aureus could be an important factor contributing to this outcome.”

These results build on the earlier ones from the Learning Early About Peanut Allergy (LEAP) study which demonstrated that infants who were at a high-risk of developing peanut allergy but consumed a peanut?containing snack throughout the study were prevented from later developing a peanut allergy.

In this current study, scientists found that children with SA on their skin and/or nose were more likely to develop peanut allergy despite them being fed with peanut from early ages as part of the LEAP study protocol.

Co-author Professor du Toit said: “These findings indicate that SA may have reduced the chance of young infants gaining tolerance to peanut, even if peanut was eaten in early childhood.”

Professor Lack, who conceived and led the LEAP study, said that “SA could be considered as an additional risk factor for the development of food allergy.”

Diet Sodas May Not Help Kids Cut Calories

By Amy Norton
HealthDay Reporter

THURSDAY, May 2, 2019 (HealthDay News) — Kids who favor diet sodas over sugary ones don’t consume fewer calories over the course of a day, a new study finds.

And they average 200 more calories daily than their peers who choose water, according to the results of a survey of over 7,000 U.S. children and teens.

Experts said the findings support what’s already recommended by groups like the American Heart Association: Ideally, kids should be drinking water instead of sugar-laden beverages — or artificially sweetened ones.

“Water is best, and we should be promoting it over low-calorie sweetened beverages,” said lead researcher Allison Sylvetsky, an assistant professor at George Washington University’s School of Public Health, in Washington, D.C.

Unfortunately, a survey published just last week suggests this could be an uphill battle. On any given day, one in five American youngsters don’t drink any water at all, the Penn State researchers found.

That said, the latest results — published May 2 in the journal Pediatric Obesity — do not prove that reduced-calorie drinks are bad.

The findings come from a one-time survey, Sylvetsky said, so there are unanswered questions. For example, kids drinking low-cal beverages might have switched from sugary varieties, and were actually consuming fewer calories than they used to. In that case, the beverages would be a positive influence.

Julie Stefanski, a registered dietitian who was not involved in the study, made another point.

“It’s possible that the children who are drinking low-calorie beverages are already individuals who prefer a larger quantity of food, and parents were trying to make changes to reduce their overall calorie intake,” said Stefanski, who is a spokesperson for the Academy of Nutrition and Dietetics.

However, she noted, there is evidence that beverages can sway food choices.

“In some studies in adults, it’s been found that artificial sweeteners caused a craving for more sweet foods,” Stefanski said. “This isn’t an automatic association, but if your taste buds are wired to always expect a sweet sensation, plain water might help to decrease that craving for sweets.”

In the survey, the teens were asked to recall what they’d eaten and had to drink the previous day.

Kids who’d had at least 4 ounces of water, and little to no sugary or artificially sweetened drinks, were considered water consumers.

On average, those kids had the lowest calorie intake for the day, and consumed the least amount of sugar and added sugar. In comparison, their peers who had low-calorie sweet drinks — at least 4 ounces for the day — consumed 200 more calories, on average.

That put them on par with kids who’d had sugar-sweetened drinks. (Any beverage dubbed sugar-free, diet, light, low-calorie or no-calorie was categorized as a low-calorie sweetened drink.)

On the other hand, kids who drank diet beverages were doing better in some ways, the study found. They consumed less daily sugar for the day — including added sugars — than those who drank sugar-sweetened beverages.

So the fact that their calorie intake was the same is not necessarily a bad thing, according to Sylvetsky — if those calories came from nutritious foods.

“We weren’t able to look at overall diet quality,” she said. “We’d like to do that in a future study.”

The Calorie Control Council, which represents the low-calorie food industry, said the study has too many unknowns to draw conclusions.

“These results do not challenge the existing evidence that [low-calorie sweetened beverages] are one of many helpful tools in weight management and overall calorie reduction,” the group said in a statement.

The study did not prove a cause-and-effect link, other diet and lifestyle factors weren’t measured, and self-reported results can be biased, the council explained.

Stefanski said it’s always important to consider a child’s overall diet when deciding whether beverage “swaps” are needed.

But, she stressed, “parents should definitely steer clear of foods or drinks with a lot of added sugar.”

If your child turns her nose up at water, Stefanski said, there are ways to “jazz it up” — like adding lemon, or slices of strawberry or cucumber.

“Younger kids can help to cut up the fruit or vegetables and create their own fancy color combos,” she suggested.

Inactive Lifestyle Begins as Early as Age 7: Study

By Robert Preidt

HealthDay Reporter

MONDAY, April 15, 2019 (HealthDay News) — Kids can start becoming couch potatoes as early as age 7, a new study reveals.

A review of 27 studies published between 2004 and 2018 in different countries found high rates of decreasing physical activity among children and teens.

While many teens quit playing sports, overall activity starts to decline during early school years among kids who were once active, said study author Irinja Lounassalo. She’s a doctoral student in sport and health sciences at the University of Jyvaskyla in Finland.

So, “being physically active in childhood and adolescence may be of high importance since it can postpone the time of becoming inactive later on,” Lounassalo said.

While the percentage of inactive people increases with age, certain groups actually increase their activity levels in adulthood and old age.

“In the future, special attention should be paid to these individuals who increase their physical activity, because it is important to understand how potential lifelong inactivity could be turned into activity,” Lounassalo said.

Among children and teens, parental support for an active lifestyle helped increase activity. For teens, less time in front of the television was associated with regular activity.

For adults, quitting smoking brought increased activity. And among older adults, regular activity was associated with a lack of chronic illnesses, a lower death rate and good physical functioning.

“Since physical activity behavior stabilizes with age and inactivity is more persistent behavior than activity, interventions should be targeted at children early in life before their habits become stable,” Lounassalo said.

Parents can help by supporting physical activity in the schools and extracurricular sports clubs for kids, she said.

“Building publicly available sport facilities and safe bicycling and walkways might help in increasing opportunities for being active regardless of age, nationality, gender or educational level,” Lounassalo said.

The study was recently published in the journal BMC Public Health.

After-School Programs Can Ease Kids’ ADHD

By Sonya Collins

Kids with ADHD often struggle just to stay on task or behave in school. So the idea of taking on more activities after school might feel like you’re asking for trouble. But new research shows that after-school programs could relieve some troubles for kids with this condition.

“These activities have potential benefits for kids with ADHD and should be part of the holistic strategies that we offer,” says Nicole Brown, MD, a pediatrician at Children’s Hospital at Montefiore in New York City. Brown co-led a study on this subject with Yonit Lax, MD, a pediatrician at Maimonides Medical Center in New York City.

Brown and Lax pulled data from the 2016 National Survey on Children’s Health, a questionnaire for parents of children ages 5 to 17. Parents of 4,185 children reported that their child had ADHD and answered questions about how severe it was. Kids who did after-school activities were more likely to have only mild — versus moderate to severe — ADHD symptoms. These children were less likely than others who have ADHD to have missed more than 7 days of school in the last 12 months.

The researchers can’t say for sure whether after-school programs ease symptoms or whether kids with already mild symptoms are more likely to enroll in such programs. But they see clear benefits to enrollment. “When children are in after-school activities,” says Lax, “they’re less likely to be sitting and watching TV for several hours a day and more likely to be engaging both their mind and their body.” That results in better mental and physical health for everyone.

After-school programs can also build friendships and confidence. These perks could ease the school-related anxiety and stress that often come with ADHD, “which is very strongly linked with refusal to go to school,” says Brown.

Treating ADHD isn’t just about prescription medications and behavioral therapy. “We need to think about multimodal strategies that can also help with symptoms, and after-school programs are pretty low-cost and associated with great outcomes,” she says.
Four Tips

After-school activities are just one lifestyle change that could help improve symptoms for a child with ADHD. Brown and Lax offer more tips:

  • Limit screen time: Keep the use of tablets, computers, phones, and TVs to less than 2 hours per day.
  • Go outside: Don’t let your child spend all their downtime in the same indoor space. “Get them out into different settings, such as parks or the backyard, to avoid stagnant time in the same environment for extended periods,” says Lax.
  • Get fit: Help your child get as close to national physical activity guidelines as possible. The CDC recommends 60 minutes of mostly aerobic activity per day.
  • Stick to a schedule: “Structure is very important, no matter what the activity, so try to have your child do the same things at the same time every day,” says Brown.

More Sleepless Nights for Toddlers With Autism

by Elizabeth Hlavinka, Staff Writer, MedPage Today

Children with autism spectrum disorder (ASD) were more than twice as likely to have problems sleeping than those without neurodevelopmental disorders, according to a community-based case-control study.

In a sample of nearly 2,000 children ages 2 to 5 years, those with ASD had significantly higher odds of sleep troubles — such as night waking and bedtime resistance — than kids in the general population (adjusted OR 2.37, 95% CI 1.75-3.22), reported Ann Reynolds, MD, of the University of Colorado School of Medicine, and colleagues.

Children with ASD were also more than twice as likely as children with other developmental delays and disorders to have problems sleeping (adjusted OR 2.12, 95% CI 1.57-2.87), they wrote in Pediatrics.

“For all children, lack of sleep can cause increased hyperactivity, inattention, and irritability, but for kids with ASD, poor sleep has been associated with more repetitive behaviors and self injury and so that has an impact on the quality of life for the child,” Reynolds told MedPage Today in an interview in which a media relations representative was present.

Although this study did not examine the cause of this increased risk for sleep disturbances, it’s possible that multiple contributing factors could predispose children with ASD to sleep problems, including obstructive sleep apnea, attention-deficit hyperactivity disorder (ADHD), or behavioral disturbances that interfere with sleep, Reynolds and colleagues noted.

Catherine Lord, PhD, of the David Geffen School of Medicine at UCLA, who wrote an accompanying commentary, said that although the same strategies and medications that improve childhood sleep are typically helpful in children with ASD, certain treatments like sleep training can take longer to change autistic children’s sleep patterns.

“Although medication used for sleep have been shown to be safe and have similar effects in kids with autism, there’s always variation and there will be more variation in kids with autism than in other populations,” Lord told MedPage Today.

Lord stressed the importance of pediatricians and healthcare providers working with parents of children with ASD to develop plans for improving sleep disturbances, particularly because a lack of sleep could further exacerbate their condition.

Reynolds and her team examined data from the Study to Explore Early Development (SEED) study, noting that all children included in this analysis were born from September 2003 to August 2006, completed a developmental evaluation, and had a caregiver interview and a completed Children’s Sleep Habits Questionnaire. Three groups of children were included in the study — those with a research classification of ASD, children with other developmental delays and disorders, and children from the general population.

Notably, a higher score on the 33-item Children’s Sleep Habits Questionnaire indicates more sleep issues, but researchers used two cut-offs for this study. While a total score of 41 differentiates a clinical sample of children with sleep problems, the authors said, they also used a total score cutoff of 48 for a more conservative estimate.

Data was adjusted for mothers’ education, race or ethnicity, and family income, as well as children’s sex, enrollment age, cognitive scores, and prior genetic or neurological diagnoses.

Of the 1,987 children included, those with ASD were more likely to be boys and have lower cognitive scores, and were less likely to have high-income families and non-Hispanic white mothers with a college degree.

Using the standard total score cutoff of 41, the results were “attenuated, but similar” as the more conservative total score cutoff. There were higher odds of sleep problems among children with ASD versus the children in the general population (adjusted OR 1.75, 95% CI 1.27-2.42) and versus children with other developmental delays and disorders (adjusted OR 1.45, 95% CI 1.05-2.00).

There was no difference in sleep patterns observed between children with ASD and children with other developmental delays and disorders in addition to ASD at either cutoff, Reynolds and colleagues noted.

Using the more conservative sleep score cut-off, 47% of parents reported sleep problems in their children with ASD compared to 29% of children with other developmental delays and disorders, and 25% of children in the general population, the authors noted.

Limitations to the data mainly involve limits to the Children’s Sleep Habits Questionnaire. Because it is a parent-completed questionnaire, there is no objective measure of sleep and no clinical assessment of sleep problems, the authors said, meaning “determining the exact prevalence of sleep problems” on the basis of the questionnaire “may be problematic.” In addition, the questionnaire was not designed to make a sleep order diagnosis or address the severity of sleep problems, nor has it been validated for use in young children (ages <4 ) or children with ASD as well, they noted.