Children's Phobias

My Own Daughter suffered from a phobia of 'Throwing Up'.  It was a very difficult situation for her throughout her formative years and continues to today perhaps in a lessoned degree.  All I can offer you is empathy if you are dealing with a child suffering from a phobia.  The adivice I can offer seems simplistic but can be very difficult.  Please never dismiss her fears (at least in front of the child), and keep a calm and calming demeanor at all times when dealing with these fears.  Getting upset or flustered yourself only makes the phobia worse on the child and ultimately yourself!  On the light side I really never had to worry about my daughter becoming bulimic for sure!  Unfortunately, the exposure therapy didn't really work - how often does one really throw up during a life-time?  So that was not an option for me to work on with her.  I feared for her when she became pregnant however she lucked out and didn't have morning sickness.  However I really thought that might be my chance to help her through exposure therapy normalizing throwing up a bit!  After all who likes having the flu or throwing up anyway?

Have patience with yourself and your child.  Speak calmly when dealing with the phobia.  Never dismiss her concerns but try and minimize the fears through normalization.  Be there  to calm and support - now at 30 she generally just needs to hear my voice and her fears begin to subside.  I hope this information is helpful.

More Info?  www.addictions.net

"Come on, Marisa!" all of the fifth graders yelled from inside the big elevators. "Hurry up, don't you want to get to the top?

Marisa looked glum and thought to herself, "Of course I want to get to the top — that's why I came on this field trip." But when she glanced back at her friends, she felt jealous — how come none of them were terrified of riding in the elevator?

"I'm OK," she said as brightly as she could. "I'll take the stairs and meet you there." When she realized how many stairs that would be, Marisa wasn't too happy. But she breathed a sigh of relief knowing that she wouldn't have to take that scary elevator ride.

What's a Phobia?

A phobia (say: fo-bee-uh) is the fancy name for a fear. But a phobia isn't just any kind of fear. It's normal for kids to be afraidof things — like taking a hard test at school, passing a growling dog on the street, or hearing a huge clap of thunder.

A phobia is different because it is an extremely strong fear of a situation or thing. It is also a kind of fear that doesn't go away. Kids who have a phobia will be afraid of something every time they see or experience it. They won't just be afraid once or twice. Kids who have phobias often go out of their way to avoid the situation or thing that scares them.

That's why Marisa had to take the stairs. She has a phobia of being in closed-in spaces and was too scared to take the elevator. Sometimes, when forced to face what's scary, a kid with a phobia might get very nervous and have a panic attack.

What's a Panic Attack Like?

Panic attacks can be really scary and may make someone shake, sweat, and breathe quickly. Some people who have panic attacks might have chest pains, feel dizzy, or feel like their hearts are pounding and they can't breathe.

A panic attack can cause a kid to think something awful is going to happen, that he or she can't escape or might lose control. Some kids who have panic attacks say that when the attacks are happening, they feel like they can't think straight or that they're "going crazy."

Panic attacks only last a short time. But to somebody who is having one, they can feel much longer. Sometimes, even a kid who knows that the phobia doesn't make sense may not be able to stop the mind and body from reacting and having a panic attack.

Different Kinds of Phobias

There are many different kinds of phobias. The most common kind is a social phobia, which can make someone feel scared of being embarrassed in front of other people.

A kid with a social phobia might feel scared of talking to a teacher or a coach or might be afraid of walking in front of the whole classroom when he or she needs to go to the restroom.

A social phobia can make it nearly impossible for a kid to stand up and give a book report or even enjoy a birthday party. Although most kids might be a little afraid of giving a book report to a big group of kids or talking to a teacher, kids with a social phobia become so afraid that they can't fully enjoy life or function the way other kids do.

Sometimes people may think that a kid with a social phobia is justshy, but it isn't the same thing. A kid with a social phobia may want to go out and have lots of friends, but just can't control the fear of being with others.

Agoraphobia (say: ah-guh-ruh-fo-bee-uh) is another kind of phobia. This causes someone to worry about having a panic attack in a place where leaving would be hard or embarrassing. The fear of the panic is so strong that they often avoid places (like crowds, highways, or a busy store) where they might have a panic attack.

Marisa's fear of riding in the elevator was caused byclaustrophobia (say: klos-truh-fo-bee-uh). Claustrophobia is the fear of being in an enclosed space, like an elevator, a tunnel, or an airplane.

There are almost as many phobias as there are things and situations: arachnophobia (say: uh-rak-nuh-fo-bee-uh) is a fear of spiders, whereas ablutophobia (say: uh-bloo-tuh-fo-bee-uh) is a fear of washing yourself or taking a bath or shower.

Why Do Kids Get Phobias?

No one really knows exactly why certain kids get phobias. Some scientists think that a person's genes may have something to do with it, and that a kid who has a social phobia might have a parent with one, too. Sometimes a traumatic thing in a kid's life — like the death of a parent, dealing with a divorce, or a big move — can cause a phobia to start.

Scientists do know some things about phobias, though. They know that about 5 out of 100 people in the United States have one or more phobias. Women are slightly more likely to have phobias than men. Most social phobias start when a person is a teenager, although this and other kinds of phobias can also start when a kid is younger.

How Are Phobias Treated?

Kids who have phobias often start by seeing their doctors. In many cases, the doctor will suggest that the kid visit apsychologist, psychiatrist, or therapist. If a kid is diagnosed with a phobia, one of these specialists can help.

Some kids will take medications that help them better handle their phobias. Sometimes a kid can learn new ways of dealing with the phobia. This could include relaxation exercises that help the kid feel more in control. Part of handling the phobia may be facing it head on.

For instance, part of Marisa's treatment might be riding on an elevator, though she might start slowly by just watching other people get on an elevator or just stepping inside with the doors open.

Depending on the kid and how severe the phobia is, treatment can take weeks, months, or longer. In the meantime, the important thing to remember is that phobias can be treated, and kids can learn to deal with them and feel more in control of their lives. 

Everybody worries. Grown-ups do it and kids do it, too. But what should you do about it? Whether your worries are big or small, you can take these 3 steps:

1. Try to figure out what you're worried about.
2. Think about ways to make the situation better.
3. Ask for help.

1. Figure it out.

Sometimes, you will know exactly what you're worried about. Other times, you might not know exactly what's bugging you. Let's say you're worried about a teacher who seems mean. But maybe what's really bothering you is that you're having trouble with math. If you get some help with math, that teacher might seem just fine.

Some problems, like family problems, are big and have a lot of parts. That can make it tough to zero in what the problem is or to pick one part of the problem to try to solve. But being able to focus on your problem — or at least part of it — is the first step to taking action. If you're having trouble figuring out what worries you, skip to Step 3 and get some help from a parent or another person you trust.

2. Think of ways to make it better.

There is almost always something you can do to help you feel less worried. Sitting there worrying is no fun and it probably won't solve your problem. But switching to an action mode can help you feel more hopeful.

Grades at school are often a top worry for kids. If that's your concern, ask yourself these questions:

• Why are grades important? What do they mean to me?
• How do I prepare for class? Do I review my notes even when there isn't a test the next day?
• Do I have a good place to do my homework?
• Have I tried different ways of studying, such as rewriting notes, using flashcards, and working with a study buddy?

If your worry is about a fight you had with a friend, you might write down all the actions you could take — from writing the friend a note to inviting him or her over for a game of basketball. Should you apologize for whatever happened between the two of you? Once you have a list of possible actions, you can select the one you think is most likely to get your friendship back on track.

But what if you can't think of anything to do to make your particular problem better? Then it's time to jump to Step 3 (it's the next step anyway) and ask someone for help.

3. Ask for help.

Worrying can make you feel lonely. When you're worried, it can help to find someone to talk to. Sometimes people say, "Why should I bother? He/she can't do anything about it." But here are two reasons to give it a shot anyway:

• You don't know for sure that no one can help until you share your feelings and let the person try to help.
• Just the act of telling someone what's bothering you can make you feel a little better. Afterward, you are no longer alone with your worries and whomever you told (parent, sister, brother, friend, counselor) is now is thinking about ways to help you.

A Final Word About Worry

Did you know worry is not all bad? If you weren't worried (at least a little) about that test, you might not study for it. And if you weren't worried about getting sunburned, you might not wear your sunscreen.

But some kids worry so much that it keeps them from doing the stuff they need and want to do. If that sounds like you, you know what to do by now: Turn to good old Step 3 and ask someone for help.

More Info?  www.addictions.net

Childhood Obesity

Childhood obesity has more than tripled in the past 30 years. The prevalence of obesity among children aged 6 to 11 years increased from 6.5% in 1980 to 19.6% in 2008. The prevalence of obesity among adolescents aged 12 to 19 years increased from 5.0% to 18.1%.Obesity is the result of caloric imbalance (too few calories expended for the amount of calories consumed) and is mediated by genetic, behavioral, and environmental factors. Childhood obesity has both immediate and long-term health impacts:

• Obese youth are more likely to have risk factors for cardiovascular disease, such as high cholesterol or high blood pressure. In a population-based sample of 5- to 17-year-olds, 70% of obese youth had at least one risk factor for cardiovascular disease.
• Children and adolescents who are obese are at greater risk for bone and joint problems, sleep apnea, and social and psychological problems such as stigmatization and poor self-esteem.
• Obese youth are more likely than youth of normal weight to become overweight or obese adults, and therefore more at risk for associated adult health problems, including heart disease, type 2 diabetes, stroke, several types of cancer, and osteoarthritis.

Healthy lifestyle habits, including healthy eating and physical activity, can lower the risk of becoming obese and developing related diseases.
Prevalence
In the past 30 years, the occurrence of overweight in children has doubled and it is now estimated that one in five children in the US is overweight. Increases in the prevalence of overweight are also being seen in younger children, including preschoolers. Prevalence of overweight is especially higher among certain populations such as Hispanic, African American and Native Americans where some studies indicate prevalence of >85th percentile of 35-40%. Also, while more children are becoming overweight, the heaviest children are getting even heavier. As a result, childhood overweight is regarded as the most common prevalent nutritional disorder of US children and adolescents, and one of the most common problems seen by pediatricians.

Consequences of Childhood Overweight
Both the short term and long term effects of overweight on health are of concern because of the negative psychological and health consequences in childhood.
Potential Negative Psychological Outcomes:

• Depressive symptoms
• Poor Body Image
• Low Self-Concept
• Risk for Eating Disorders

Negative Health Consequences:

• Insulin Resistance
• Type 2 Diabetes
• Hypertension
• High Total and LDL Cholesterol and triglyceride levels in the blood
• Low HDL Cholesterol levels in the blood
• Sleep Apnea
• Early puberty
• Orthopedic problems such as Blount's disease and slipped capital femoral epiphysis
• Non-alcoholic steatohepatitis (fatty infiltration and inflammation of the liver)

Further, obese children are more likely to be obese as adults, hence they are at increased risk for a number of diseases including: stroke, cardiovascular disease, hypertension, diabetes, and some cancers.

Contributors to Childhood Overweight

• Food Choices - diets higher in calories (including fats and simple sugars) and lower in fruits and vegetables are linked with overweight
• Physical Activity vs. Sedentary Activity - less physical activity and more time spent participating in activities such as watching tv results in less energy expenditure
• Parental Obesity - children of obese parents are more likely to be overweight themselves. There is an inherited component to childhood overweight that makes it easier for some children to become overweight than others. There are a number of single gene mutations ("genetic alterations") that are capable of causing severe childhood overweight, though these are rare. Even children with genetic risk for overweight will still only become overweight if they consume more calories than they use. Parental obesity may also reflect a family environment that promotes excess eating and insufficient activity.
• Eating Patterns - skipping meals or failure to maintain a regular eating schedule can result in increased intakes when food is eaten.
• Parenting Style - some researchers believe that excess parental control over children's eating might lead to poor self regulation of kid's energy intake.
• Diabetes during pregnancy - overweight and type 2 diabetes occur with greater frequency in the offspring of diabetic mothers (who are also more likely to be obese)
• Low Birth Weight - Low birth weight (<2500 a="a" epidemiological="epidemiological" factor="factor" font="font" for="for" g="g" in="in" is="is" overweight="overweight" risk="risk" several="several" studies.="studies.">
• Excessive weight gain during pregnancy - Several studies have shown that excessive maternal weight gain during pregancy is associated with increased birth weight and overweight later in life.
• Formula Feeding - Breast feeding is generally recommended over formula feeding. Although the exact mechanism in unknown, several long-term studies suggest that breast feeding may prevent excess weight gain as children grow.
• Parental Eating and Physical Activity Habits - Parents with poor nutritional habits and who lead sedentary lifestyles role model these behaviors for their children, thereby creating an "obesigenic" home environment.
• Demographic Factors. Certain demographic factors are associated with an increased risk of being overweight in childhood. For example, there is evidence that African-American and Hispanic children 6 to 11 years years old are more likely to be overweight than are non-Hispanic white children of the same age. Asian and Pacific Islander children of the same age were slightly less likely to be overweight.

Measuring Childhood Overweight
Childhood overweight is identified through the measurement of Body Mass Index or BMI. BMI can also be calculated using kilograms (kg) and meters (m), as well as pounds (lbs) and inches (in):

Once BMI is calculated, it can then be used to determine if a child is overweight or not, by comparing the BMI with the CDC growth charts (http://www.cdc.gov/growthcharts/) for children of the same age and sex. Children who have a BMI at or above the 95%, percentile for age and sex are considered overweight. Children with a BMI that falls between the 85%-95% are classified as at risk for overweight. To plot body mass index-for-age percentiles for boys, click here. To plot body mass index-for-age percentiles for girls, click here.
Parents whose children fall in the "at risk for overweight" category should discuss this with their pediatrician or family physician and should carefully monitor their child's growth. Parents whose children fall in the "overweight" category should make an appointment with their pediatrician or family physician to discuss whether treatment is warranted. Screening for other health risk factors (such as blood pressure or lipid profile) may be recommended by your physician. The BMI is just an initial tool in a series of examinations required to determine if your child is overweight. At no time should a child be diagnosed and labeled overweight by a parent, teacher, or other lay (non-medical) individual. Discussions concerning the child's weight should occur only after reviewing his or her condition with a medical professional.

Tips for Parents & Caregivers to Help Establish Healthy Eating Patterns with Kids

• Parents should choose what children can eat, (what foods and drinks are in the home, what foods and drinks are served at meals and snacks, what restaurants they go to, etc) but among those foods, parents should allow kids to choose whether they eat at all and how much to eat.
• Fruits and vegetables, as compared to high calorie snack foods (often high fat and high sugar), should be readily available in the home.
• Serve and eat a variety of foods from each food group.
• Use small portions - child portions are usually very small, particularly compared to adult portions. More food can always be added.
• Bake, broil, roast or grill meats instead of frying them.
• Limit use of high calorie, high fat and high sugar sauces and spreads.
• Use low-fat or nonfat and lower calorie dairy products for milk, yogurt and ice cream.
• Support participation in play, sports and other physical activity at school, church or community leagues.
• Be active as a family - Go on a walk, bike ride, swim or hike together. Limit TV time.
• Avoid eating while watching TV. TV viewers may eat too much, too fast, and are influenced by the foods and drinks that are advertised.
• Replace high-sugared drinks, espically sodas, with water and/or low fat milk.
• Limit fruit juice intake to two servings or less per day (one serving = ¾ cup) - Many parents allow their children unlimited intake of fruit juice (100%) because of the accompanying vitamins and minerals. However, children who drink too much fruit juice may be consuming excess calories.
• Encourage free play in young children and provide environments that allow children to play indoors and outdoors.
• Role model through actions healthy dietary practices, nutritional snacks, and lifestyle activities. Avoid badgering children, restrictive feeding, labeling foods as "good" or "bad," and using food as a reward.

Tips for Pediatricians & Other Health Care Professionals to Facilitate the Prevention of Childhood Overweight (from the American Academy of Pediatrics Policy Statement, August 2003).

Health Supervision Recommendations:

• Identify and track patients at risk by virtue of family history, birth weight, or socioeconomic, ethnic, cultural, or environmental factors.
• Calculate and plot BMI once a year in all children and adolescents.
• Use change in BMI to identify rate of excessive weight gain relative to linear growth.
• Encourage, support, and protect breastfeeding.
• Encourage parents and caregivers to promote healthy eating patterns by offering nutritious snacks, such as vegetables and fruits, low-fat dairy foods, and whole grains; encouraging children's autonomy in self-regulation of food intake and setting appropriate limits on choices; and modeling healthy food choices.
• Routinely promote physical activity, including unstructured play at home, in school, in child care settings, and throughout the community.
• Recommend limitation of television and video time to a maximum of 2 hours per day.
• Recognize and monitor changes in obesity-associated risk factors for adult chronic disease, such as hypertension, dyslipidemia, hyperinsulinemia, impaired glucose tolerance, and symptoms of obstructive sleep apnea syndrome.

Advocacy Recommendations:

• Help parents, teachers, coaches, and others who influence youth to discuss health habits, not body habitus, as part of their efforts to control overweight.
• Enlist policy makers from local, state, and national organizations and schools to support a healthful lifestyle for all children, including proper diet and adequate opportunity for regular physical activity.
• Encourage organizations that are responsible for health care and health care financing to provide coverage for effective obesity prevention and treatment strategies.
• Encourage public and private sources to direct funding toward research into effective strategies to prevent overweight and to maximize limited family and community resources to achieve healthful outcomes for youth.
• Support and advocate for social marketing intended to promote healthful food choices and increased physical activity.

References:

American Academy of Pediatrics. Prevention of Pediatric Overweight and Obesity: American Academy of Pediatrics Policy Statement; Organizational Principles to Guide and Define the Child Health System and/or Improve the Health of All Children; Committee on Nutrition. Pediatrics. 2003;112:424-430
Banis HT, Varni JW, Wallander JL, Korsch BM, Jay SM, Adler R, Garcia-Temple E, & Negrete V. Psychological and social adjustment of obese children and their families. Child: Care, Health, and Development. 1998;14,157-173.
Barker M. Birthweight and body fat distribution in adolescent girls. Arch Dis Child 1997; 77(5): 381-383.
Barlow SE, & Dietz WH. Obesity evaluation and treatment: Expert Committee recommendations. Pediatrics, 1998; 102(3): URL:http://www.pediatrics.org/cgi/content/full/102/3/e29.
Bouchard C and Perusse L. Heredity and body fat. Annual Review of Nutrition, 1988;8:259-77.
Dietz WH. Childhood Weight affects adult morbidity and morality. J Nutr, 1998;128 (2):411S-414S.
Ebbeling CB, Pawlak DB, Ludwig DS. Childhood obesity: public health crisis, common sense cure. Lancet 2002, 360:473-82.
Gortmaker SL, Must A, Sobol AM, Peterson K, Colditz GA, Dietz WH. Television viewing as a cause of increasing obesity among children in the United States, 1986-1990. Arch Pediatr Adolesc Med. 1996;150(4):356-62.
Satter E. How to Get Your Kid to Eat...But Not Too Much. Bull Publishing Company, 1987.
Haas JS. Lee LB. Kaplan CP. Sonneborn D. Phillips KA. Liang SY. The association of race, socioeconomic status, and health insurance status with the prevalence of overweight among children and adolescents. American Journal of Public Health. 93(12):2105-10, 2003
Johnson SL, Birch LL. Parents' and children's adiposity and eating style. Pediatrics, 1994;94:653-661.
Kinnunen TI, Luoto R, Gissler M, Hemminki E. Pregancy weight gain from 1960s to 2000 n Finland. Int J Obes 2003; 27:1572-77.
Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, et al. CDC growth charts: United States. Advance data from vital and health statistics; no 314. Hyattsville, Maryland: National Center for Health Statistics. 2000.
Malina RM, Katmarzyk PT, Beunen G. Birth weight and its relationship to size attained and relative fat distribution at 7 to 12 years of age. Obesity Research 1996; 4(4): 385-390.
Obarzanek E, Schreiber GB, Crawford PB, Goldman SR, Barrier PM, Frederick MM, & Lakatos E. Energy intake and physical activity in relation to indexes of body fat: The NHLBI Growth and Health Study. Am J Clin Nutr, 1994;60:15-22.
Sallis JF. Epidemiology of physical activity and fitness and adolescents. Critical Reviews in Food Science and Nutrition, 1993;33:403-408.
Shapiro C, Sutija VG, Bush J. Effect of maternal weight gain on infant birth weight. J Perinat Med 2000; 28:428-31.
Troiano RP and Flegal KM. Overweight children and adolescents: Descroption, epidemiology, and demographics. Pediatrics, 1998;101(3):497-504.

Childhood Overweight

by L. Bellows and J. Roach¹ (05/09)

Quick Facts...

• Overweight children have an increased risk of being overweight as adults.
• Genetics, behavior, and family environment play a role in childhood overweight.
• Childhood overweight increases the risk for certain medical and psychological conditions.
• Encourage overweight children to be active, decrease screen time, and develop healthful eating habits.

The prevalence of overweight children in the United States has increased dramatically in recent years. Recent reports have reached epidemic levels, with approximately 16 percent of children, 2 to 19 years old, classified as overweight.² Colorado fares slightly better with close to 14 percent of children considered overweight; however, the same increasing trend seen nationally is occurring in Colorado as well.³ Excess weight has both immediate and long-term consequences and the current issue demands serious attention.

Definitions

Body Mass Index (BMI) is a measure of weight adjusted for height used to determine weight categories. Due to children’s changing body compositions over time and the different growth rates of boys and girls, BMI for children is age and gender specific. BMI for age is determined using gender-specific growth charts that place a child in a percentile relative to weight and height. Weight categories are determined based on these percentiles and are defined as:

Underweight < 5th percentile
Normal 5th to < 85th percentile
At risk of overweight 85th to <95th br="br" percentile="percentile">Overweight 95th percentile and above

The terms obese and overweight are often used interchangeably, although the terms at risk of overweight and overweight are preferred to reference children whose excess body weight poses medical risks.

Consequences of Childhood Overweight

Overweight children and adolescents are at increased risk for several health complications. During their youth, for example, they are more likely to exhibit risk factors for cardiovascular disease (CVD) including high blood pressure, high cholesterol, dyslipidemia, and type 2 diabetes compared with normal weight individuals.⁴ Additional health complications associated with overweight children include sleep apnea, asthma, and liver damage.⁴⁴⁴ This study also concluded that if overweight begins before 8 years of age, obesity in adulthood is likely to be more severe. Finally, childhood overweight has psychological and emotional consequences. Overweight children are at an increased risk of teasing and bullying, low self-esteem, and poor body image. Further, overweight children and adolescents are more likely to become obese adults. For example, one study found that approximately 80 percent of children who were overweight at 10 to 15 years old were obese at 25. Another study found that 25 percent of obese adults were overweight as children.

Contributors of Childhood Overweight

There is not one single cause of childhood overweight, rather it is a complex interaction of many variables. Contributing factors include genetics, behavior, environment, and certain socio-demographics.
Genetics. Certain genetic characteristics may increase an individual’s susceptibility to excess body weight, however, there are likely to be many genes involved and a strong interaction between genetics and environment that influences the degree of excess body weight.⁵ It has been shown that overweight tends to run in families suggesting a genetic link. In some cases, parental obesity is a stronger predictor of childhood overweight than the child’s weight status alone.⁵
Behavior. Weight gain occurs as a result of energy imbalance, specifically when a child consumes more calories than the child uses. Several behaviors can contribute to weight gain including nutrition, physical activity, and sedentary behaviors.

• Nutrition - An increase in availability and consumption of high-calorie convenience foods and beverages, more meals eaten away from home, fewer family meals, and greater portion sizes all may contribute to childhood overweight. Further, many children’s diets do not meet nutrition guidelines. For example, only 8 percent of children in Colorado ate vegetables three or more times per day as recommended by the U.S. Department of Agriculture.^{3, 6}
• Physical Activity - Decreased opportunities and participation in physical activity is another behavior that contributes to overweight children. Being physically active not only has positive effects on body weight, but also on blood pressure and bone strength.⁷ It also has been shown that physically active children are more likely to remain physically active into adolescence and adulthood.⁷ Children may spend less time being physically active during school as well as at home. School physical education programs have decreased and children are walking to school and doing household chores less frequently.
• Screen Time - While physical activity levels have decreased, sedentary behaviors, such as watching television, playing on the computer and with video games have increased. One study found that time spent watching television, videos, DVDs, and movies averaged slightly over three hours per day among children 8 to 18 years old.⁶ Several studies have found a positive association between time spent watching television and prevalence of overweight in children. Sedentary behavior, and specifically television viewing, may replace time children spend in physical activities, contribute to increased calorie consumption through excessive snacking and eating meals in front of the television, influence children to choose high-calorie, low-nutrient foods through exposure to food advertisements, and decrease children’s metabolic rate.⁶

Environment. There are a variety of environmental factors that can potentially contribute to childhood overweight, including home, childcare settings, school, and the community. The school and community settings are other environments where children learn about eating and physical activity habits. It is becoming increasingly important for all children to have access to healthful food choices and safe physical activity opportunities. Advocating for innovative school nutrition and physical activity programs as well as ensuring that there are well-lit sidewalks, bike paths, and parks in the community can all help to shift towards a more healthful environment for our children.
Socio-Demographics. Certain ethnic minority and socioeconomic populations have increased rates of childhood overweight.⁸ Low-income families face numerous barriers including food insecurity, lack of safe places for physical activity, and lack of consistent access to healthful food choices, especially fruits and vegetables.⁵ Recent reports also indicate racial disparities, with the greatest prevalence among Mexican American boys and African American non-Hispanic girls.² With both sexes combined, roughly 21 percent of both Mexican Americans and African American non-Hispanics are overweight compared to close to 15 percent for white non-Hispanic.²

Promoting Healthy Habits and a Healthy Weight

Lifestyles and behaviors are established early in life; therefore, a focus on healthful behaviors is vital to promoting healthy weight. The primary goals of overcoming childhood overweight should be healthful eating and increased activity. It is important for children to consume enough calories to support normal growth and development without promoting excessive weight gain. The home, childcare setting, school, and community are all integral to a more healthful environment for our children.
Parents, caregivers, teachers, and community members can promote healthy nutrition and physical activity habits and a healthy weight among children by:
Encouraging Healthy Eating Habits

• Serve a wide variety of foods, including fruits, vegetables, whole grains, and low-fat dairy products. Provide children with a variety of foods to ensure they get all the nutrients they need for proper growth and development.
• Know how much food kids need. Keep portion sizes in check to help children maintain their sense of self-regulation –and to know when they are hungry and when they are full.
• Be a good role model for kids by eating together. Eating meals as a family has been shown to increase fruit and vegetable consumption and decrease the amount of junk foods and sugar-sweetened beverages.
• Visit USDA’s MyPyramid website (www.mypyramid.gov) for information and tips for eating healthfully.⁶

Promoting Physical Activity

• Aim for children to accumulate a minimum of 60 minutes of moderate-to-vigorous physical activity each day. Activity bouts can be all at once or in several bouts spread throughout the day.
• Increase opportunities for children to engage in physical activity throughout the day. Incorporating daily recess and physical education into the school day will help ensure that children are getting the recommended 60 minutes of physical activity each day.
• Be a good role model. Engage in activity with children.
• Limit screen and television time to less than two hours per day. Keep televisions and video games out of children’s bedrooms to help them limit the amount of screen time.
• Visit the National Institutes of Health’s WeCan™ (Ways to Enhance Children’s Activity and Nutrition) website (www.wecan.org) for ideas on increasing physical activity, decreasing screen time, and improving food choices among children.⁹

References

²Ogden, C. L., Carroll, M. D., & Flegal, K. M. (2008). High body mass index for age among US children and adolescents, 2003-2006. JAMA, 299(20), 2401-2405.
³Colorado Department of Public Health and Environment, Colorado Physical Activity and Nutrition program. (2006). Overweight, Physical Activity and Nutrition Among Colorado Children and Youth: A Data Resource. Retrieved February 27, 2009 from http://www.cdphe.state.co.us/pp/COPAN/olderadult/childfactsheet04.pdf
⁴Centers for Disease Control and Prevention. (2009). Overweight and Obesity. Consequences. Retrieved February 27, 2009 from http://www.cdc.gov/NCCDPHP/DNPA/obesity/childhood/consequences.htm
⁵American Academy of Pediatrics. (2003). Policy statement. Prevention of pediatric overweight and obesity. Pediatrics, 112(2), 424-430.
⁶United States Department of Agriculture. (2009). MyPyramid: Steps to a Healthier You. Retrieved February 27, 2009 from http://www.mypyramid.gov
⁷Centers for Disease Control and Prevention. (2009). Overweight and Obesity. Contributing Factors. Retrieved February 27, 2009 from http://www.cdc.gov/obesity/childhood/causes.html
⁸Institute of Medicine. (2004). Childhood Obesity in the United States: Facts and Figures. Retrieved February 27, 2009 from http://www.iom.edu/Object.File/Master/22/606/FINALfactsandfigures2.pdf
⁹National Heart, Lung, and Blood Institute. (2009). WeCan! Ways to Enhance Children’s Activity and Nutrition. Retrieved February 27, 2009 from http://www.wecan.org

How Lying Works - Basics - Signs - How to Tell

When you're young, there's one lesson that gets hammered into you more often than others: Tell the truth. Tell the truth, you're told, and everything will be OK. Then why does Mom call her boss claiming to be sick when she's not, and why does Dad say Mom's dress doesn't make her look fat? The lesson didn't stick for them when they were little, and it didn't stick with you or me, either.
Lying isn't a sign of moral depravity (except when it is). Lying is a sign of cognitive advancement. It requires a fertile and high-functioning brain to take something as simple as the truth and twist it, palming off the deception on someone else with the earnestness of a choirboy.
The problem with the truth is that it doesn't always serve our purposes, further our careers or keep us out of trouble. When you can take the route made of imagination, best-case scenarios and wish fulfillment, you'd be nuts not to take a deceitful stroll toward your goals, right?
­Younger children believe that they're always being watched, and that Mom (or some other authority figure) knows all. For this reason, they're initially more inclined to tell the truth. As they get a little older, they begin experimenting with lies: The dog is blue, my shirt is made of copper, the cookie told me so. For the very young, lying is a series of cause-and-effect experiments. When does a lie work? What kind of lie? What is a believable lie? Is the jig ever up, or should I keep lying until the truth is just a vague memory for all parties?
­Around age 2 or 3, children realize that they're not under constant observation by an all-knowing, all-seeing Eye of Truth. A typical 4-year-old stretches the truth once every two hours, while 6-year-olds will tell a whopper every 90 minutes [source: Bronson]. They're applying their earlier lie studies toward the general goals of all truth-stretchers: gaining advantage, staying out of trouble and "bigging" themselves up in the eyes of others. As children become older, they become more skilled at deception. And they never really stop. Continue reading to learn the truth, or something like it, about lying.


The Basics of Lies
The ability to lie is a cognitive accomplishment. While we look down on the practice from a moral and ethical point of view, lying isn't normally done without a pretty good motive. Lies are told for some of the following reasons:

• To conceal misdeeds and stay out of trouble. Wrongdoings often can't be undone, and it's rare that owning up to a misdeed will result in a positive outcome (at least in the short term). ­These lies are told to avoid responsibility and repercussions.

• To preserve reputation. A recovering drug addict may lie about time spent in a treatment facility, especially to a potential employer or romantic prospect. A lie like this is told to avoid shame or embarrassment.

• To avoid hurting someone's feelings. Children learn early on to be polite, not to point out physical flaws, and to say "thank you" even after they receive something they don't like. These "white lies" are distinguished from other types because they carry no ill will or bad intentions.

• To increase stature and reputation. Some lies are told without any obvious external stimulus, such as a demand for an answer to a specific question. This type of lie is often narcissistic in nature, told to make the liar seem more accomplished, skilled or gifted as a means of gaining favor in the eyes of others.

• To manipulate. These lies aren't evasive or defensive, but rather aggressive and malicious in nature. Such lies are told to gain wealth, love, favor or other assets by damaging another's reputation or spreading harmful untruths.

• To control information. As opposed to airing a falsehood, indirect lying is withholding or concealing important facts. This is often seen as a more acceptable form of lying, since a person doesn't actively construct lies, but only sits tightly on the truth. A missing piece of information can completely alter the understanding of an event, leading American courts to demand not only the truth, but "the whole truth."

Lies are told -- in some form or fashion -- by just about everybody. Some personality types, however, are more likely to lie than others:

• Pathological liars are generally sociopathic, lack a clear sense of right and wrong and show an absence of remorse when harming others. Sociopaths tell some of the best lies, since they don't feel bad about doing so and don't show signs of guilt or worry. Sociopaths lie for self-gain, and their lies veer heavily toward manipulation.

• Compulsive liars lie as the first option, even when there's no reason or advantage for doing so. Childhood experiences, such as living in an abusive environment where lying might be necessary for survival or emotional well-being, are often responsible for compulsive lying.

• Narcissists lie to gain undeserved glory and esteem in the eyes of others.

• Borderline personalities experience wild mood swings and out-of-control behaviors, like drug abuse, gambling or promiscuous sex. This type may tell lies in an effort to deal with the fallout from these behaviors.

• Histrionic personalities desperately crave love and attention and will tell lies that, though not accurate, may reflect the emotional truth of the situation. "I'm so sick I could die," and "If you leave me, I'll kill myself," are two examples of lies told by this type [source: Goleman].

Signs of Deception

There is no single telltale sign of lying, but rather a constellation of possible signs that may "leak" from the liar during the act. We'll discuss both verbal and nonverbal signs of lying in this section.
First, we'll examine some nonverbal signs of lying. One sign that escapes most people is the flashing of a microexpression. Microexpressions are superquick expressions that cross over people's faces against their will and without their awareness. These provide a true look at their honest feelings about a matter. While most people aren't looking for such clues, a good many of us detect them without knowing what just happened. The information we glean -- detecting a millisecond-long look of anger in the middle of a smile -- is often chalked up to intuition or a "gut feeling." If your "gut" is telling you something isn't quite right with a person, you very well may have detected a microexpression on that person's face that doesn't mesh with what he or she is saying.
Another nonverbal sign of lying is a forced smile, which generally involves only the muscles of the mouth and not the rest of the face. A sign of deception is a smile or other gesture -- such as nodding "yes" during a denial -- that contradicts what is being said. When we normally interact, both speech and body language happen naturally, without specific thought. When we lie, however, not only must we appraise the truth, construct a plausible lie and then verbalize it, we must also decide which body gestures best match the lie, or rather best represent the telling of the truth. All of this thought leads to mis-matching words and body language.
Someone who's lying may feel attacked and get in a defensive position. He or she might turn away from the questioner, cross his or her arms or even move farther away. Liars may noticeably fidget, especially during a pause in the conversation.
There are other nonverbal cues that many people think are surefire signs of lying but aren't, such as increased blinking, scratching the face or nose, or placing a hand over the mouth while speaking. These signs are only good indicators when they represent a change in the person's normal behavior (that is, the behavior immediately preceding the suspected lie). Maybe the guy who's blinking a lot has an eyelash in his eye, and the girl covering her mouth is just self-conscious; however, if the person doesn't blink often during the first three statements and blinks like crazy and scratches his or her neck while giving the fourth statement, then that statement warrants closer examination.
Someone telling a lie will also leak verbal clues that point to dishonesty. Since he or she has to invent an answer, a lie-teller will often spend more time searching for the right word in the course of telling a story. The person might take too long to provide an answer or get words mixed up. To get extra time to think, a liar won't use contractions (opting for "cannot" instead of "can't") and may also repeat questions ("Where was I last night?" or "You want to know what I was doing yesterday?").
Since they have to create an alternate reality apart from the truth, liars have difficulty knowing how much of the new story to tell and will often include unnecessary details.

How to Tell If Someone is Lying

If you were accused of murder, you'd be under enormous pressure to lie if you were guilty. The stakes are high, and that kind of pressure can lead to physical cues that will give you away. A person serving a life sentence for murder, however, would feel virtually no pressure when lying about the murder because he or she is already in prison -- there won't be any further consequences for lying. In this case, it's the verbal details, and not body language, that will likely be his or her undoing.
Here's how you separate the liars from the truth-tellers:

• Establish the baseline. Liars may look you directly in the eye, and truth-tellers may be fidgety and seem evasive, so don't look for one trait or the other. First, establish the person's behaviors, mood and mannerisms for that particular point in time, before the questioning begins. Is the person relaxed or nervous? Angry? Distracted? Notice how much eye contact and blinking is going on. Does the person touch his or her hands or face when speaking?

• Look for deviations from the baseline. The key to detecting lies is to look for deviations from an established pattern of behavior. If a person normally makes no eye contact and blinks like crazy but stares straight through you when answering a particular question, there's your red flag. Look for slight pauses before answers -- this is the amount of time it takes their brain to fabricate data. The liar may act offended at being questioned at all but suddenly quite affable when the lie is being told, or vice versa.

• Listen. Sometimes, there will be no body language or visual cues that accompany a lie. You have to rely on the verbal information you receive. Do the facts add up? Is the person telling you lots of information that is unrelated to the question? If someone provides lots of details, ask more questions. These details might be their undoing. After getting into the nitty-gritty of the details, bounce the questioning back to the overall time frame or arc of the story. Now, refocus on a small detail. Does the story still fit together? Is the person having to create new details to explain why other details aren't fitting well into the arc of the story?

• Pause. For most people, lying -- and the circumstance that necessitates the telling of a lie -- is stressful. If you're questioning somebody, pause between one of his or her answers and your next question. Pauses are slightly uncomfortable for most people in a social interaction, and much more so for a person who is trying to pass off a lie. This pause may seem like a torturous eternity to a liar. Look for fidgeting, defensive posturing and microexpressions.

• Change the subject. The best news a liar can receive is that the lie is over. When the person believes the topic of conversation has changed, he or she may be visibly relieved. A nervous person may loosen up; an agitated person may smile. This tactic also allows you to continue studying for deviations from the baseline or to look for a return to the baseline.

 Tom Scheve

Rise In Children Under 12 Developing Eating Disorders

Rate of Eating Disorders in Kids Keeps Rising

MONDAY, Nov. 29 (HealthDay News) -- Eating disorders have risen steadily in children and teens over the last few decades, with some of the sharpest increases occurring in boys and minority youths, according to a new report.

In one startling statistic cited in the report, an analysis by the Agency for Healthcare Research and Quality found that hospitalizations for eating disorders jumped by 119 percent between 1999 and 2006 for kids younger than 12.

At the same time as severe cases of anorexia and bulimia have risen, so too have "partial-syndrome" eating disorders -- young people who have some, but not all, of the symptoms of an eating disorder. Athletes, including gymnasts and wrestlers, and performers, including dancers and models, may be particularly at risk, according to the report.

"We are seeing a lot more eating disorders than we used to and we are seeing it in people we didn't associate with eating disorders in the past -- a lot of boys, little kids, people of color and those with lower socioeconomic backgrounds," said report author Dr. David Rosen, a professor of pediatrics, internal medicine and psychiatry at University of Michigan. "The stereotype [patient] is of an affluent white girl of a certain age. We wanted people to understand eating disorders are equal-opportunity disorders."

The report is published in the December issue of Pediatrics.

While an estimated 0.5 percent of adolescent girls in the United States have anorexia and about 1 to 2 percent have bulimia, experts estimate that between 0.8 to 14 percent of Americans generally have at least some of the physical and psychological symptoms of an eating disorder, according to the report.

Boys now represent about 5 to 10 percent of those with eating disorders, although some research suggests that number may be even higher, said Lisa Lilenfeld, incoming president of the Eating Disorders Coalition for Research, Policy and Action in Washington, D.C.

Most studies that have been focused on prevalence were based on patients in treatment centers, who tended to be white females, Lilenfeld said. "That does not represent all of those who are suffering," she said. "It's hard to say if eating disorders are on the rise in males, or if we're just doing a better job of detecting it."

Rosen and his colleagues pored over more than 200 recent studies on eating disorders. While much is unknown about what triggers these conditions, experts now understand it takes more than media images of very thin women, although that's not to say those don't play a role, Rosen said.

Like other mental health problems and addictions, ranging from depression to anxiety disorder to alcoholism, family and twin studies have shown that eating disorders can run in families, indicating there's a strong genetic component, Rosen said.

"We used to think eating disorders were the consequences of bad family dynamics, that the media caused eating disorders or that individuals who had certain personality traits got eating disorders," Rosen said. "All of those can play a role, but it's just not that simple. All young women are exposed to the same media influences, but only a small percentage of them develop eating disorders. So what is different about those 1 percent that develop an eating disorder compared to the 99 percent who don't?"

At the same time as eating disorders have risen, the obesity epidemic has also exploded. Concerns about overweight and obese children have prompted some physicians to counsel their young patients about nutrition. That's an approach that can backfire when not handled correctly, however.

"There are lots of kids in my practice who say their eating disorder started when their family doctor told them, 'You could stand to lose a few pounds,'" Rosen said. "As physicians, we need to make sure our conversations are not inadvertently hurtful or impact their self esteem."

For people who are genetically vulnerable, dieting itself is a risk factor for eating disorders, while strict dieting is even a bigger risk, Lilenfeld said.

Parents and pediatricians should look for signs of eating disorders, including a child whose progress on growth charts suddenly changes, very restrictive eating, compulsive overexercising, making concerning statements about body image, vomiting, disappearing after meals or use of laxatives and diet pills.

Eating disorders, especially anorexia, can have long-term consequences for health, including leading to early osteoporosis and death.

"We know the sooner they get some evidence-based treatments, the better the outcome," Lilenfeld said.

"The good news is eating disorders can be 'cured' -- that is to say, the person isn't merely keeping the condition at bay but can actually get over it," Rosen said. With treatment and maturity, many kids move beyond the eating disorder.

"The conventional wisdom is eating disorders are incurable. You have them for life, you never get better and the best you can hope for is to keep it under control like alcoholism," Rosen said. "That's not the reality, particular for children and teenagers with eating disorders. The majority of children and adolescents get all better."

More information

The U.S. National Institute of Mental Health has more on eating disorders.


SOURCES: David Rosen, M.D., M.P.H., professor, pediatrics, internal medicine and psychiatry, University of Michigan, Ann Arbor, Mich.; Lisa Lilenfeld, Ph.D., incoming president, Eating Disorders Coalition for Research, Policy and Action, Washington, D.C.; December 2010, Pediatrics

5 Things NOT To Do If Your Child Has Eating Disorder

Don't ask your daughter how you can help; she doesn't know or she would tell you. It also communicates that you are just as baffled as she is. Just like with any other issue, she is looking to you for help and direction so find someone who knows what to do and ask them.

2. As you learn the eating disorder lingo, like eating disorder abbreviation is ED, ana is an abbreviation for anorexia, or mia is another word for bulimia; don't over use them. It's almost like these words are a badge of honor and if you use them condescendingly or loosely, your daughter will begin to dismiss you. Some girls don't like the abbreviations at all and it will irritate them greatly if you utilize the lingo with them. Sometimes it is best to ask if you can use these words in discussion or if there are other words she would rather you use to refer to the eating disorder.

3. Try not to over-discuss things. What I mean by this is ask your question or state your concern and wait for a response. Parents often believe if I can just ask the right question or ask it in the right way I will get a response. This often frustrates your child when she is already having difficulty putting words to her thoughts and feelings. Stay away from 20 questions and err on the side of brevity. She will appreciate it and will feel more open to future discussions if she knows she will not be badgered with questions.

4. Don't expect her initially to be able to verbalize how this happened. She won't have an answer and this will add to the guilt she already feels. She may appear on the surface to only feel angry and oppositional about food, but underneath there is a ton of guilt for being a burden and disappointing you.

5. Don't require things of her that she is uncomfortable with in the early stages. Some examples might be forcing her to go to a swimming party when she is so self-conscious in a bathing suit; requiring her to go to a sleepover when they are serving breakfast the next morning. It is okay to offer to pick her up before breakfast if that will help her stay connected with friends. Be flexible early on and know her recovery is a process. It will get easier again as she progresses.