Weight is one of the most personal things people carry and one of the hardest topics to talk about, especially for kids growing up and still learning who they are. When weight gain or fluctuations are out of one’s control, it can also become overwhelming and cause feelings of hopelessness. In those times, often the best action to take is to seek medical support. 

That’s exactly what Leslie Tewell did for her now 15-year-old son, Blain Tewell. Seeing Amani Terrell, M.D., Board Certified Pediatrician and Obesity Medicine Specialist with Cook Children’s Pediatrics Keller Parkway changed Blain’s life.

Obesity Medicine Care at Cook Children's - Keller Parkway

After 12 years of helping patients at Cook Children’s Pediatrics Keller Parkway, Dr. Terrell’s recent transition into obesity medicine felt natural. Year after year during routine checkups, she noticed children struggle with their weight and knew that many providers lacked the tools to truly help them. Too often, the advice was “exercise and eat healthy” and she wanted to do more. Now board-certified by the American Board of Obesity Medicine, she brings specialized expertise to every patient she sees.

“The sad reality is that 1 of every 4 children in North Texas has an obesity diagnosis,” Dr. Terrell said. “And most people don’t realize that obesity is a biological response.”

This perspective helps her patients understand their weight challenges go far beyond diet choices. Blain has been seeing Dr. Terrell for more than 10 years now and appreciates her thoughtful approach, not just focusing on one aspect of his health.

“Dr. Terrell’s consistency has been the most helpful and the way she takes time to understand me as a whole person,” Blain said.

Learning Throughout the Weight Loss Journey

Blain and Leslie have learned that weight loss takes time and that it’s important to focus on Blain’s well-being and health, not just numbers.

“I’ve learned more about making balanced choices and listening to my body,” Blain said. “My mom and I both learned the importance of patience and the encouragement I’ve needed along the way.”

Dr. Terrell has also helped Blain build his confidence and self-awareness.

“Blain is a very sweet young man,” Dr. Terrell said. “Awareness is important and with his biology and family history of health challenges, he’s at a higher risk for heart disease and type 2 diabetes. He’s now maintaining healthy lifestyle habits, and he feels a lot better and is happier with his progress.”

Paying attention to his nutrition, exercising, and learning about medication options including GLP-1 (Glucagon-Like Peptide-1) have also helped Blain.

GLP-1 is a naturally occurring hormone that helps regulate blood sugar and appetite. The medications reduce hunger, increase feeling full, and improve blood sugar control and have become common as an effective way to help patients lose weight.

Developing New Habits and Everyday Routines

Throughout the last year, Blain has been focusing on small habits that are easier to sustain -regular routines, being mindful of calories, and staying active in ways that are more manageable for him.

Having parental guidance, support and understanding makes it easier for kids to take steps and reach their goals. Leslie has tried to keep things balanced and not overwhelming. Her goal as a parent has been to support Blain and help him build lifelong habits, ensuring he feels encouraged and capable of his hopes and aspirations.

“Kids are looking for a better quality of life,” Dr. Terrell said.  “And the kids that are most successful in their goals are the ones who have their whole family involved.”

Kids often do better when their parents exercise with them, help them make healthier eating choices, and set goals together that are challenging but attainable.

Healthy Advice for Families

A lot of kids feel pressure about their weight challenges. They can even be afraid to talk with close relatives. It’s important for kids to feel safe opening up about their weight and what they are experiencing in school, and during regular daily activities.

“Take things one step at a time and focus on progress, not perfection,” Leslie said. “Most importantly, keep the focus on encouragement and overall well-being rather than pressure.”

Dr. Terrell also wants parents to understand that obesity is often a biological factor, not a result of willpower or poor parenting. She encourages parents to speak up and to share their concerns about their child’s weight with their doctor. They can even ask their doctor to speak with them in private.

“Sometimes talking about weight is triggering and we want to make sure everyone feels comfortable so we can learn about what their concerns are,” Dr. Terrell said.

Although it’s often difficult in the moment, it’s worth taking the time to have the conversation, especially when it can drastically improve a child’s health and well-being and even have a positive effect on the whole family.

Researchers leading the U.K.-based ELVIS-Kids trial found that children who were given hypertonic saline nose drops when they developed a cold had fewer sick days than those who did not use the drops. Of the 407 children ages 6 and under in the trial, 301 of them developed a cold. Of these, 150 participants received three drops of hypertonic saline per nostril at least four times daily. They experienced symptoms for an average of six days, compared to eight days for those who received standard cold care without saline drops. In addition, fewer households reported family members catching a cold, according to the study.

Saline drops and nasal rinses have long been recommended by physicians for cold symptom relief, usually in the form of isotonic saline, which has a salt concentration of 0.9%. This is similar to the natural salt content of the body. Hypertonic saline has a higher salt concentration of 2.6% or more. Both are safe and effective methods for reducing congestion by flushing and moisturizing nasal passages, according to Amy Stockhausen, M.D., a pediatrician at Cook Children’s Pediatrics Carrollton.

Trial investigators suggest the higher salt concentration of a hypertonic solution helps to increase the production of hypochlorous acid within the cells lining the nose. In turn, the hypochlorous acid helps to suppress viral replication, leading to fewer sick days and faster relief of symptoms. Dr. Stockhausen says this is a good theory for why it works, but other mechanisms could be at play. 

“I think that they are taking the body's natural physiologic mechanisms and assuming that that's what's going on, but it’s not clear to me from the article itself that we know that for certain, but it makes some sense,” Dr. Stockhausen said.

Even so, she says, the results are promising.

“This particular study gives us some interesting insight that what we've been recommending for symptomatic treatment may actually make you better faster,” she said. “That's pretty exciting if they can actually show that that's true.”

Both hypertonic and isotonic saline drops are safe, inexpensive and can be purchased over-the-counter. Dr. Stockhausen recommends isotonic saline drops to her patients for symptom relief with any upper respiratory virus that causes congestion and runny nose. With its higher salt concentration, hypertonic saline may sting or cause some discomfort to the lining of the nasal passages. Dr. Stockhausen recommends dropping down to isotonic saline if you experience discomfort with a hypertonic solution.

She also cautions parents about applying too much force when using a saline spray or mist.

“If you are forcibly pushing salt water into the nose, you can end up causing some pressure injury to the eustachian tubes or the back of the nose. So you have to be careful that it’s under low pressure,” she said.

Parents should also be careful about making their own saline solution at home. Using iodized salt from the baking shelf is not recommended as it can irritate the nose, and tap water should never be put into the nose. It contains chemicals and bacteria that can damage the inside of the mucous membranes and cause serious harm. Always use distilled water when mixing a saline nasal rinse.

In addition to saline drops, Dr. Stockhausen offers these tips for relieving cold symptoms:

• Moist air in the form of a steamy bathroom or a humidifier next to the bed helps keep mucus thin and wet, so it’s easier to expel. You can add Vicks to the steam or vaporizer if you choose. 
• Honey has natural mucus reducers and anti-inflammatories that help break up mucus in the throat and quiet coughs naturally without side effects. Give a spoonful of honey as often as needed to children over 12 months of age. It can also be given in warm liquids such as tea or apple juice. It should not be used in infants under 12 months.
• If your child is old enough to gargle, warm salt water gargles can help with throat symptoms.
• Use over-the-counter pain and fever medications like acetaminophen or ibuprofen as needed if your child's symptoms are causing discomfort or changes in their eating/drinking and sleeping patterns.
• Encourage fluids to stay hydrated, and get lots of rest to allow the immune system as much energy as possible for fighting off the illness.
• Over-the-counter cough and cold multi-symptom remedies for children are generally not recommended. They are often ineffective, can cause multiple side effects like elevated blood pressure and irritability, and can excessively dry up mucus making it difficult to expel. Additionally, data is limited on their safety, especially in young children.

Now I know that the reason that no one got whooping cough when I was younger was due to a vaccine that I received called DTP. We now give a slightly different version of the vaccine called DTaP. Children are supposed to received DTaP at 2, 4, 6, 12-18 months, and 4 years of age. They then get a booster dose of a related vaccine called TDaP at 11 and a second TDaP booster in adulthood (recently added to the recommendations).

Whooping cough, which is also known as pertussis, has been on the rise all over the country for several years now. I see it in our clinic in Mansfield and throughout the area. There are various theories as to why it is coming back. Some theories center around the idea that people’s immunity toward pertussis wears off as they get older. Others deal with the issue of people who do not vaccinate themselves or their children. Still more center on possible mutations in the illness itself. Whatever the cause, what we do know is that it is here and causing problems.

Whooping cough can be very dangerous for children, especially if they are under age 1, but many parents don’t realize that their children have it until they have been sick for at least a couple of weeks. At the beginning, it can look like a simple cold. The typical story is that the child has been sick for 2 weeks or more and is having “coughing spasms” that can cause them to “lose their breath,” vomit, or even pass out. Regular cough medicine hasn’t helped (not to mention it isn’t recommended in children). Parents have typically tried all of the regular tricks like honey, humidifiers, vapor rubs, etc.

Under age 1, however, children don’t necessarily cough. Instead of coughing, infants may simply not breathe, which is called apnea. Since that is a very dangerous and silent problem that can kill, we must do our best to protect infants from even catching pertussis – which is where vaccination comes back into play. All people in the same household as an infant, including adults, should have a current pertussis vaccination.

Unfortunately, pertussis doesn’t have a simple, quick test like strep or flu does. In our office in Mansfield, we do have a test that we can take the sample in the office, though, which isn’t typical of many clinics. The result from the test is usually available in about 3 days. Pertussis can be treated with an antibiotic, but only if it is caught early. Once past the early phase, a person must simply recover from it, and that can take up to 3 months, even if there are no complications from the infection.

Vaccination is not a 100 percent guarantee that children will not get the whooping cough, however, it has been shown to greatly reduce their chances of getting it, and if they do get it, their case will likely be less severe than if they were not vaccinated. There are also children who cannot receive the DTaP vaccine for various reasons, some of whom have serious health problems. We all need to do the best we can to protect ourselves and our neighbors from this disease, which is making quite the comeback in our community.