But I hear from my patient families all the time that it's anything but relaxing.

The American Academy of Pediatrics recommends doctors ask parents three questions about mealtime:

1. How anxious are you about your child’s eating?

2. How would you describe what happens during mealtime?

3. What do you do when your child won’t eat?

When offered a healthy, well balanced meal with fresh fruits, vegetables, and lean proteins, kids will stop eating when they are full. Children will naturally refuse to eat when they are not hungry. We often describe these as normal appetite slumps. We can disturb children’s natural satiety cues by either forcing them to eat or by offering foods high in added sugar or salt when they won’t eat. This results in a child who will “only eat chicken nuggets.”

Parents are most successful in feeding their children more fruits and vegetables when they model healthy eating, set appropriate limits, and have a positive attitude at mealtime. “The parent determines where, when, and what the child is fed; the child determines what to eat.” ⁽¹⁾ In other words, “parents provide and kids decide”. ⁽²⁾ 

Here are some tips on eating mindfully and encouraging your kids to eat in a manner that gives them more energy and helps them avoid chronic disease. These are easy ways to change your lifestyle that don’t involve a ton of work and expensive supplements.

1.Drink more water. Kids should not drink juice or soda except on special occasions.

2.Drink milk with meals. Children from age 1-2 should be on whole milk. After the age of 2, low fat or skim milk is recommended.

3.Vitamin supplements are not needed unless your child does not drink milk. Vitamin D is essential for bone health and immune function and may play a role in prevention of chronic disease.

4.Serve 5-9 servings of fruits and vegetables daily. Encourage your children to at least take a bite of everything you serve. Remember that children will need to taste a food 10-15 times before they decide they like it. Lean protein like fish and baked chicken might be better accepted if you add ketchup as a condiment.

5.Add healthy protein likes nuts (for older children) and legumes. Peanut butter is fine for younger children and new allergy immunology guidelines suggest that early introduction of peanut may actually decrease the risk of peanut allergy.

6.Eat more meals at home. Keep staples such as eggs, whole grain pasta, pasta sauce, yogurt, carrots, frozen vegetables, chicken breasts, and fruit stocked at all times so that in a pinch you could throw together a simple meal.

7.Double your recipes and freeze 1 meal at the same time that you cook the other meal. This will save you from making a trip to a fast food restaurant when you have that go to meal in your freezer.

8.Serve only whole grain breads and pastas.

9.Avoid buying, eating, or serving processed foods (chips, cookies, cakes).

10.Avoid fried foods and fast foods.

To read more about nutrition needs of children at different ages, I highly recommend the book “Nutrition: What Every Parent Needs to Know" available on the American Academy of Pediatrics (AAP) online bookstore.

See choosemyplate.gov for more information about how your child’s plate should look at meal time.

Realize that children’s tastes will change over time. They will sometimes refuse foods they readily accepted in the past, and they will readily accept foods that they refused in the past. Involve your children in shopping and meal planning. Let them help in the kitchen! Take them to a local farmer’s market and let them choose something new for everyone to try.

Take a matter of fact and pleasant approach to meal times and ENJOY YOUR FAMILY! Create wonderful childhood memories.

References:

1. “A Practical Approach to Classifying and Managing Feeding Difficulties” Pediatrics Volume 135, number 2, February 2015

2.Nutrition: What Every Parent Needs to Know. AAP

Out of 50 states and the District of Columbia, Texas only ranked higher than Utah, South Carolina, Wyoming and Mississippi for HPV vaccination coverage, according to researchers at The University of Texas System and UT Health Northeast. HPV is the most common sexually transmitted infection and is responsible for 90 percent of cervical cancer cases as well as thousands of oral cancer cases each year.

The study found that only 39.7 percent of females and 26.5 percent of males in Texas between the ages of 13 and 17 were up-to-date with the vaccine in 2016. The national average was 43.4 percent.

“This study is particularly frustrating because a routine vaccine recommended by the CDC and other leading health organizations around the world can prevent HPV,” said Jason V. Terk, a Cook Children’s pediatrician. “A simple shot can mean the difference in life and death. Unfortunately, most Texans are not getting the importance of this message.”

The Texas System Offices of Health Affairs states that about 90 percent of men and 85 percent of women in the United States will contract HPV at some point in their lives.

By the year 2020, experts believe head and neck cancer will surpass cervical cancer as the most common cancer caused by HPV.

Across the country, the number of children who receive the HPV vaccine is very low compared to other vaccines they are scheduled to receive at the same time. This is despite the fact that meningitis and pertussis are much less common than HPV.

“One of the major problems with HPV is that it may be 20 or 30 years before a person develops cancer due to an infection that happens in the teen years,” Dr. Terk said. “Waiting until you think HPV is a risk is too late. We have to make every effort to provide our patients the HPV vaccine so we can put an end to the thousands of teens who move through Cook Children’s without ever gaining this indispensable protection.”

That’s the good news that Dr. Terk wants parents to know: HPV can be prevented.

The FDA has approved vaccines that prevent the HPV strains that are associated with cancers of the cervix and head and neck. Boys and girls can begin the vaccination process as early as age 9.

"This is a relevant issue for all parents,” Dr. Terk said. “We have a vaccine that can prevent cancer. Parents should start the vaccination process as soon as their pediatrician recommends.”

The study, published in the journal of Annals of Internal Medicine, states 11 million (one in nine) U.S. males were found to have oral HPV. The research was done between the years 2011 and 2014.

While most people with HPV don’t develop symptoms or health problems, the Centers for Disease Control and Prevention (CDC) says HPV causes 30,700 cancers in men and women, inlcuding 6,479 cancers of the back of throat, including the base of the tongue and tonsils in both men and women.

Jason Terk, M.D., a Cook Children's pediatrician in Keller, says vaccination rates for HPV are comparatively lower than other adolescent vaccines primarily because parents don’t perceive that their teens' physicians strongly recommend it.

Across the country, the number of children who receive the HPV vaccine is very low compared to other vaccines they are scheduled to receive at the same time. This is despite the fact that meningitis and pertussis are much less common than HPV.

By the year 2020, experts believe head and neck cancer will surpass cervical cancer as the most common cancer caused by HPV.

HPV is so common, in fact, that the journal JAMA Oncology reported in January that nearly half of American men may have an HPV infection known to cause cancer. This is based on a study of 1,868 men, ages 18 to 59. Among the group, only 10.7 percent were vaccinated against HPV while 45 percent reported having genital HPV.

The recent studies show that work still needs to be done to raise awareness about the dangers of HPV and how to prevent an infection with the highly effective HPV vaccine.

“One of the major problems with HPV is that it may be 20 or 30 years before a person develops cancer due to an infection that happens in the teen years,” Dr. Terk said. “Unfortunately, waiting until HPV is contracted is not an option. We have to make every effort to provide our patients the HPV vaccine so we can put an end to the thousands of teens who move through Cook Children’s without ever gaining this indispensable protection.”

That’s the good news that Dr. Terk wants parents to know: HPV can be prevented.

The FDA has approved vaccines that prevent the HPV strains that are associated with cancers of the cervix and head and neck. Boys and girls can begin the vaccination process as early as age 9.

"Only 34 percent of adolescents in the U.S. have received the HPV vaccine series. Here in Texas, that number drops to 33 percent," said Jason Terk, M.D., a pediatrician at Cook Children’s. "This is a relevant issue for all parents. We have a vaccine that can prevent cancer. Parents should start the vaccination process as soon as their pediatrician recommends. "

Spending Thanksgiving week in Illinois, surrounded by Ashley’s family, Josh knew this would be his chance to ask her to marry him. But before they could leave, their 4-month-old daughter, Harper, had an appointment with a Cook Children’s pediatrician.

“She had been spitting up quite a bit. We thought she was a reflux baby and might need a higher dosage of medication,” said Ashley. “We had no idea our world would come crumbling down in 72 hours.”

Their appointment was with Catherine Hampton, D.O. at Cook Children’s primary care location on Keller Parkway. She suggested an ultrasound to make sure an internal blockage wasn’t the cause of Harper’s problems. Though it would delay their trip, Josh and Ashley decided not to wait and booked an appointment for the following day. Little did they know this was the best decision they could have made. The results revealed a mass on the little girl’s pelvis. After a brief round of tests, Harper was diagnosed with neuroblastoma and admitted to Cook Children’s Hematology/Oncology Center in Fort Worth.

“Everything changed so fast. We weren’t really able to process what was happening to our family,” said Josh.

Just three days after her initial appointment, Harper underwent surgery to remove the tumor. By this time, both Josh and Ashley’s families had converged on Cook Children’s. Surrounded by love and support, Harper would spend the following week fighting to get better.

“We spent Ashley’s birthday at Cook Children’s and Thanksgiving,” said Josh.

By Thanksgiving Day, Harper had made a huge improvement. She came off of her IV, had her nasogastric tube removed and was finally able to eat formula again.

But that’s not the end of the good news.

“One night, while walking around with my parents, I noticed this beautiful spot lit up with Christmas lights. That’s when I got the idea in my head,” said Josh.

On Thanksgiving night, Josh took Ashley to that spot and got down on one knee. His mother was able to capture the moment Ashley said ‘yes’.

“The picture means a lot to us. To see a Cook Children’s sign right in the middle, some people may wonder what I was thinking,” said Josh.

“It’s a good reminder for us to be able to look back on what we’ve been through,” said Ashley.

Harper is home now after a whirlwind eight days. And she’s officially cancer free.

“The future looks bright for Harper. She will have to undergo scans regularly for the next three years, but we are hopeful based on the biology of her neuroblastoma that the cancer will not come back.” said Meaghan Granger, M.D., director of the Neuroblastoma and Stem Cell Transplant program at Cook Children’s.

Dr. Granger describes Harper’s case as an excellent example of primary care from the Keller-based pediatricians who pinpointed what can be a common symptom in a newborn as abnormal. She also says this is an exemplary example of the smooth and efficient communication that occurs in an integrated medical system like Cook Children’s.

“The parents called their pediatrician with the symptoms of projectile vomiting and had an ultrasound done within 24 hours. Then, they were able to see an oncologist and had surgery within a day. All of the patient’s history, exam and imaging were immediately visible through an integrated EMR which also saved time.”

Fortunately, Harper's tumor was in a location that allowed it to be completely removed without further treatment.

In a study that was released early online from the journal Pediatrics, researchers looked at the percentage of girls aged 14-19 years were infected with the types of human papillomavirus (HPV) contained in the HPV vaccine in the years 2003-2006 and compared that to the percentage of 14-19 year old girls infected with the types of human papillomavirus (HPV) contained in the HPV vaccine in the years 2009-2012.

They found that the rate of infection in the years prior to routine vaccination in this group of girls was 11.5 percent. That percentage dropped to 4.3 percent in the years following routine recommendation of a vaccine. This is a rather remarkable finding given the relatively small numbers of girls who had received the full 3-dose series of the HPV vaccine.

It further illustrates how well this vaccine protects against such an important infection that can cause cancer in later years. This evidence of early success will likely lead to even more important measures of success with decreased numbers of women having abnormal pap smears that indicate cervical dysplasia and ultimately decreased numbers of cancers.

Imagine how much better it will be when we improve the numbers of teens getting this important vaccine!

Jason V. Terk, M.D.

When I advise my 3 year old patients to wear helmets on their tricycles, then I end up with 10 year old patients who wear their helmets. It’s near impossible to convince my 10 year olds to START wearing a helmet.

Why do you think so many ED doctors end up advocating for car seat safety? They see the results of horrible car accidents that could have been prevented.

That’s how I feel about obesity prevention. Far and away, poor diet and a sedentary lifestyle wreak havoc on the mental and physical health of my patients – from young to old – those with poor lifestyle choices have a decreased quality of life. They come to see me with more illnesses, more headaches and most certainly more abdominal pain.

When I start talking to my families about diet, I try to give anticipatory guidance about offering fruits and vegetables and limiting processed foods. Toddlers and young children do two things really well – they don’t eat when they are not hungry and they stop eating when they are full.

We as parents, and grandparents, mess up their satiety cues by trying to get them to eat when they are not hungry and trying to get them to keep eating when they are full. Allowing children to control the amount of food they eat leads to a long term healthy relationship with food. Parents have control over what is offered but should not try to control how much is eaten.

Along those same lines, children are naturally conditioned to be outside and to be active. We as parents mess that up by keeping them inside in front of an iPad or video game. We have control over their media time.

I think focusing on healthy behaviors rather than BMI is a positive way to talk to parents. Most parents are doing 1 or more things right in the 5-2-1-0 recommendations. Kids are motivated to follow these recommendations, but they need their parents to create an environment at home that allows them to do so. This goes along with the thinking of the Blue Zones.

I do think there is value for using BMI as a tool. I usually show growth charts to families as an objective measurement of what is happening and then we turn to talking about healthy behaviors. But I do see a flattening of BMI with improved diet/activity choices. It is also not uncommon for me to see an increase in BMI and ask what has changed, and families are usually able to say – oh yeah, he quit playing soccer, or he doesn’t have PE this year….etc.

When you look at guidelines for treatment of obesity, the first thing you must have is motivation for change. If that is not there, you really can’t go forward. What if we don’t have to motivate people to change because they have been feeding their children correctly from the beginning?

At least not yet, but both school districts are considering adopting a policy and Dallas ISD could have one by the end of the day.

That news makes Kim Mangham, M.D., a Cook Children’s pediatrician in Keller, both relieved and happy. Dr. Mangham focuses on nutrition and activity with her patient families and she believes this is a good start for area schools to get kids moving.

As early as January 2007, A Clinical Report in the Journal of Pediatrics emphasized the benefits of free play for children, “but since that time it seems we have drifted farther and farther away from this concept,” Dr. Mangham said. “Kindergarten and even preschool curriculums are emphasizing academics over social and emotional development, and kids are presenting at younger ages with anxiety and depression due to academic pressures.”

For all children, especially those with ADHD, Dr. Mangham said it is vital that they are offered unstructured free time to allow them to process the information they have learned and to get their exercise. Only then can they return to the classroom and focus.

Children have an innate need to be outside and run and play, according to Dr. Mangham. This helps them to connect socially with their peers and allows them to settle back down in the classroom and learn again.

“I hear from so many of my parents that their children do so much better with homework if they are allowed to play outside after school,” Dr. Mangham said. “Kids are so worn out by the end of the day, they need to decompress and let their brains rest before they can focus again on school work. I tell my parents that if they want well behaved children, to let them run and play outside and to burn off all of their energy. “

Why not focus on the things that are free from side effects and cost nothing? We have so much to gain, says Dr. Mangham.

Children have so much adult-directed time – in the classroom, with sports, with extracurricular activities and with chores in the home. Adults even try to interfere with free play. Children need that free time to learn to share, play nicely, make up games, follow rules, get along and just enjoy friends.

As reported in December 2015 by KERA news and a recent segment on the Today show, schools are starting to see the benefits of recess.

Cook Children’s offers Go Noodle to 18 ISDs (including public, private and charter elementary schools in Cook Children’s six-county region) and 515 schools. The 120,619 students and 4,918 teachers have logged over 35 million aggregate minutes of physical activity.

“My 12 year old daughter started sixth grade this year,” Dr. Mangham said. “Her biggest complaint is not being able to be outside all day. Their only break is the four minute transition time between classes and lunch. “She says, ‘I miss being outside and seeing the sky and the trees.’ My 8 year old son loves climbing trees. The reflection and relaxation he gets while sitting in the top of his tree is just as important as the exercise he gets while climbing.”

About the source

Kim Mangham, M.D., is a Cook Children's pediatrician at 1601 Keller Parkway in Keller, Texas. She earned her medical degree at University of Texas Southwestern Medical School in Dallas. She completed the pediatric residency program at University of Oklahoma Health Sciences Center in Oklahoma City. Her interests include breastfeeding education as well as disease and injury prevention. Dr. Mangham is board certified in pediatrics.

According to researchers at Albert Einstein College of Medicine in New York, HPV raises the chances someone will get head and neck cancer by at least sevenfold.

For their study, 96,000 people took a mouthwash test for oral HPV infection. Four years later, 132 of them developed some form of head and neck cancer. People infected with a strain called HPV-16 were between two and 22 times as likely to be in the cancer group.

"This study backs up knowledge we already have about how common HPV is and how significant its association with cancer is," said Jason Terk, M.D., a pediatrician at Cook Children's primary care location on Keller Parkway. "HPV is an infectious disease and we all need to be concerned."

By the year 2020, experts believe head and neck cancer will surpass cervical cancer as the most common cancer caused by HPV.

But there is good news. HPV can be prevented.

The FDA has approved vaccines that prevent the HPV strains that are associated with cancers of the cervix and head and neck. Boys and girls can begin the vaccination process as early as age 9. And a new version of HPV vaccine, approved earlier this year, has even more cancer protection.

"Only 39 percent of adolescents in the U.S. have received the HPV vaccine. Here in Texas, that number drops to 33 percent," said Dr. Terk. "This is a relevant issue for all parents. We have a vaccine that can prevent cancer. Parents should start the vaccination process as soon as their pediatrician recommends. "

Some parents may feel uncomfortable talking to their children about the HPV vaccine. For those parents, here's Dr. Terk's advice:

• Explain that the vaccine protects against a very common infection that causes cancer

• · Most people (80%) will get infected with the types of HPV that can cause cancer

• · HPV vaccination equals cancer protection

• · It is best to get the vaccine at 11-12 years of age with the other adolescent vaccine; it works best at this age.

Also good to remember, research shows that youth who receive the HPV vaccine are not more likely to have sex. 

About the Source 

Jason Terk, M.D., earned his medical degree from University of Texas Medical Branch in Galveston, Texas. He completed his residency in pediatrics at Mayo Graduate School of Medicine (Mayo Clinic) in Rochester, Minnesota. His interests include public policy advocacy for children's health issues, focusing primarily on vaccines. Dr. Terk is board-certified in pediatrics.

Multiple studies suggest that walking even 20 minutes daily can decrease your risk of mortality and improve your quality of life. Read how a busy working mom finds the time to exercise, and read her perspective on the many benefits of regular exercise. Come on moms out there! You can do it! If not for yourself, then for the long term health of your family.

New year. New you!

From Alison Groom:

Being a working mom of three small kiddos is a hard job for anyone, but finding the time to be healthy and active while being a working mom of three kiddos can be a tough job in itself. For me, finding the time to do something active can be hard and I am certainly not perfect at making it a daily priority, but I do my best to do it as much as possible throughout the week.

What I have recently noticed is that my kids watch and mimic every single thing I do. The way my 3 year old talks to her baby dolls is often a reflection of how I speak to her. The same goes for what I eat and how I live my life. Statistics say that if a parent smokes cigarettes, the children in the home will likely smoke as an adult too.

This is also the same for being active. If my children learn the fundamentals of being healthy and staying active as kids, they will likely continue that throughout the adolescent years and into their adult lives. My 7 year old has started wanting to exercise with me and will often ask to run on the treadmill when we are playing in the driveway. I keep our treadmill in the garage because it keeps me from having an excuse not to run.

I am a wimp when it is cold and I do not run when it is raining, so if it is in the garage, I have zero excuses for why I cannot run on a cold or rainy day. We often go for "family walks" after dinner too. We look like a circus sometimes with my 3 year old wanting in and then out of the stroller, the two giant dogs getting tangled leashes or tripping up my 6 year old, but it is family time. It is a time that we talk about our day, we teach our kids about nature and try to find interesting new things to discover. It is also a great time to talk about being healthy and about the benefits of walking and exercising for our growing bodies. It is exercise that allows us uninterrupted time with our precious kids, which is a win win if you ask me. J

Exercising does not have to take an hour to do. I work from home, so when I put my kids down for a nap, I hustle out to the garage to run on my treadmill. It may only be a 10 minute run, or a 20 minute fast paced walk.

Sometimes, I only have time to do a couple sets of pushup and sit ups, but that is better than nothing! A walk around the block can quickly turn into two laps around the block, and then to a mile and so on. Making a conscious effort to walk faster while grocery shopping can be a simple step toward elevating your heart rate and getting your metabolism up for the day. The hardest part about working out for me, is putting on my shoes. Once they are on, I am ready to go.

Make a decision for yourself and for those precious children who ARE watching your every move to be healthy. Take twenty minutes out of your day for you to have a moment for yourself. Exercising is also a GREAT way to release your tensions and anxieties of your day. I often take a moment to run or workout just to clear my head and have a moment to do ME for a minute. That can be so hard for people to do, but it is so beneficial. I promise, if you take twenty minutes to yourself each day, you WILL be a better mother, a better wife, and a better you. Look into different methods of exercise. Reach out to friends, neighbors, or family to see if anyone is also wanting to exercise but needs someone to hold them accountable. Having a partner to walk with around the neighborhood or do a workout video with when the kids go to bed is great! It gives you some time to interact with another adult, vent about your day, and also to be held accountable to doing your workout each day. Start with baby steps and find the right workout or activity for you. If you find pleasure in what you choose, you will likely stick with it.

“Epic fail.”

A couple of years ago, this was the phrase that my teenage son used as I unsuccessfully attempted to beat him in a game we were playing. At the time, I thought to myself that it was a harsh but accurate assessment of my performance. And, I was certainly motivated to practice on my own so that the next time, things would be different.

That same phrase came to mind as I read through an alarming article of interest to physicians. The article, published in Cancer Epidemiology, Biomarkers & Prevention is titled Quality of Physician Communication about Human Papillomavirus Vaccine: Findings from a National Survey.

Bottom line: Physicians (primarily pediatricians and family physicians) do poorly in providing the Human Papillomavirus (HPV) vaccine to patients.

Another source, the most recent National Immunization Survey-Teen for the year 2014, reports another alarming trend. The survey shows the number of patients who start the shots – and also complete them – lags far behind what it should be. (The HPV vaccine is given as a series of shots.)

So, it came as no surprise to me that the first article clearly showed what I have suspected for some time and which has been hinted at by previous studies. The epic failure in providing what is essentially a cancer-prevention vaccine to the recommended population of 11-12 year old boys and girls lies not at the feet of the anti-vaccine movement or hesitant parents. Rather, the failure belongs to we physicians!

The article describes findings from an online survey sent to 2368 pediatricians and family physicians in 2014. The 776 respondents self-reported their own performance on strength of four criteria: Endorsement (how strongly they recommend the vaccine); timeliness (whether they recommend it at 11-12 years of age, which is the most beneficial age); consistency (recommending it routinely vs using a risk-based approach); and urgency (whether they recommend the patient receive the vaccination that day). More than a quarter stated they did not strongly endorse the HPV vaccine, and a similar number reported that they did not recommend it be given at 11-12 years of age. Amazingly, 59 percent said they used a risk-based approach versus a routine approach to recommending the HPV vaccine, and only half of the respondents recommended giving the vaccine then and there, while the doctor discussed the HPV vaccine with the patient and parent. And these results represent a best-case scenario because respondents would be unlikely to paint an unflattering picture of their own performance.

Clearly, we have a major problem with physicians struggling with their own discomfort in talking about the HPV vaccine and who erroneously believe parents do not value it. Physicians who can’t communicate the importance of this cancer-preventing vaccine in turn fail to recommend it, which is so important to protect our patients. We are at risk of being the generation of pediatricians and family physicians who collectively failed to protect our patients from a preventable cause of cancer. Only we physicians can fix what it wrong with us: Only we can reverse this epic failure!

Limiting how much Halloween candy your kids eat isn't as tricky as it seems. Stop them from getting too much sugar with these tips:

1. Eat a healthy meal. Kids who fill up before going trick-or-treating or to a Halloween party are less likely to eat too much candy.

2. Remember you're in charge of setting limits. "I let my kids eat a few favorite pieces on Halloween night and then save the rest for later," said Kim Mangham, M.D., a pediatrician with Cook Cook Children's. "After a week of enjoying a few pieces of candy each day, we throw it away or freeze it."

3. Offer healthier treats. Hand out pieces of dark chocolate and small bags of popcorn, or avoid food altogether and give away small toys, pencils, erasers or stickers.

4. Focus on making memories. "Halloween is a fun, magical time," Dr. Mangham said. "Focus on costumes and decorations and play Halloween-themed games and spooky music rather than making it about the candy."

About the author

Kim Mangham, M.D., is a Cook Children's pediatrician at 1601 Keller Parkway in Keller, Texas. She earned her medical degree at University of Texas Southwestern Medical School in Dallas. She completed the pediatric residency program at University of Oklahoma Health Sciences Center in Oklahoma City. Her interests include breastfeeding education as well as disease and injury prevention. Dr. Mangham is board certified in pediatrics.

The incidence of anxiety and depression in pediatrics is due in part to overscheduled children and families. Here are some suggestions on how to slow down and find some down time with your family.

1. Gardening: My children’s happiest moments have been picking tomatoes and digging out potatoes in their grandparent’s garden. In describing her experiences in the garden, their grandmother, Jean Mangham writes “I love to get outside to feel the sun, smell the dirt and hear the birds sing. My garden provides me with a place to see the miracle of life. Put a small seed into the dirt and with just a little nurturing, you produce a fruit or a flower. Gardening also provides me with a great sense of pride, and how important that is to pass along to my grandchildren.”
2. Kathleen Wayland, a music teacher, writes, “Relaxation is a learned behavior. A child’s day, even one spent at home, can be very stimulating, offering a little, unstructured quiet time. Having some quiet time with your child provides an opportunity for you to model relaxation for your child and let them know they can relax, even when it’s not naptime or bedtime. This is also a wonderful opportunity for some bonding time to deepen your connection with your child. Holding, rocking, singing and cuddling are all ways to have a quiet, bonding time that will relax both of you. Children need time to be stimulated and engaged, and they also need time to be at leisure. This down time is physically necessary for the brain to process the learning that occurs during structured activities and interaction.”
3. One of my yoga instructors once said, “If you can breathe, you can do yoga.” The practice of yoga and meditation promotes physical and mental wellness. Heidi McGall, a trained yoga instructor teaches kids relaxation: “I have kids close their eyes and imagine a balloon in a big empty blue sky. Imagine anything that is bothering them – schoolwork, family life, things that are nagging them. Imagine tying all those troubles to the balloon. Then they set the balloon free. It floats off into the blue sky out of their vision and they are left with the perfect blue cloudless sky. Then take a big inhale and exhale and open their eyes.”
4. Take your children outside. Being near trees and under a blue sky are inherently relaxing. Go for a walk, take a bike ride, plan a camping trip. Read the book, “Last Child in the Woods” by Richard Louvs. He describes why being in nature is important for children. He lists nature activities for kids and families. Have you and your kids seen the movie The Lorax? You should. It is a thoughtful look at the value of nature in the lives of our children.

And to quote another wise sage, “Life moves pretty fast. If you don't stop and look around once in a while, you could miss it.” – Ferris Bueller.

Karen Evans, M.D., a pediatrician with Cook Children’s in Keller, says setting New Year’s resolutions is a healthy tradition no matter what your age and should ultimately be a family affair.

“Everyone in the family should create one or two resolutions focused on working toward a more healthy lifestyle,” Dr. Evans said. “Choose goals that will be attainable for the family as a whole.”

Starting the new year off by adopting a healthier lifestyle can be difficult. Dr. Evans suggests defining basic goals that can be realistically achieved and give the motivation needed to sustain permanent lifestyle changes.

Basic resolutions for the entire family may include:

• Eating meals at the table as a family at least four times a week.
• Preparing more meals at home.
• Limiting fast food and takeout.
• Packing lunches for school and work.
• Planting a garden.
• Going for a family bike ride, walk, swim or hike two times a week.

About the source

Karen Evans, M.D., is a Cook Children's pediatrician in Keller. Dr. Evans earned her medical degree from University of Texas Medical Branch, Galveston, Texas. She completed her internship, residency and became the Chief Resident of Pediatrics at the Louisiana State University Health Science Center, New Orleans, Louisiana. She is board certified and a member of the American Academy of Pediatrics. Dr. Evans' professional interests include childhood obesity and expanding health care access to underserved children.

My family and I LOVE, LOVE, LOVE the state fair. We go every year and get our corn dog and our roasted corn. We see the dog show, and we watch the acrobats. The sights and sounds are the same as they were 20 plus years ago, and I hope to make the same happy memories for my own kids.

How do we enjoy the fair without compromising the healthy lifestyle that we enjoy? Here are some tips from our staff members and from the nutrition department at Cook Children’s.

1. Start your day off with a healthy well balanced meal at home. Do not show up hungry!
2. Bring waters and healthy snacks with you (nuts and dried fruit travel well). This will also help your ticketbook!
3. Allow your child to pick one treat.
4. If he or she (or you) can’t decide – pick a few treats to share – 1 or 2 bites of a fried Oreo^® is probably enough to satisfy even the worst sweet tooth.
5. Pick healthy alternatives to the fried foods: the roasted corn (a must), smoked turkey leg, fruit kabobs, and chicken kabobs.
6. The fairgrounds are huge! Walk a lot. Walk off those calories that you consume!

Special occasions like The State Fair of Texas include traditional foods to be enjoyed together. Remember that there are always healthy alternatives, and that the quality family time is the most important part of these magical moments.

I order a kid’s meal for my son at a seafood restaurant in Galveston, Texas. I tell the waiter to hold the fries. He gets a very odd look on his face and replies “But they come free with the meal." My response. “I understand that, but we don’t want them.”  

There is good evidence that meals eaten at home are healthier. One way we can improve the nutrition choices we make when we eat out is to avoid the pitfall of accepting the free choices that come with a meal and worse – encouraging our kids to finish them. 

I know I’ve had the experience of wanting only the sandwich at a restaurant, yet ordering the entire meal is actually cheaper. This comes with chips or fries and a drink that I don’t even really want, yet I end up picking a soft drink instead of a water because it is “free,” and also eating the chips that I didn’t plan to order.

I heard a news clip on the radio the other day about all inclusive restaurants and how many calories we tend to consume on these trips. I think we definitely get caught trying to get our money’s worth at all you can eat buffets. 

The excess calories consumed and the subsequent health consequences for ourselves and for our children can be quite costly in terms of our overall health. So the next time we try to find the best value in our meals while eating out – it might be in saying no to the free extras.

About the author

Kim Mangham, M.D., is a Cook Children's pediatrician at 1601 Keller Parkway in Keller, Texas. She earned her medical degree at University of Texas Southwestern Medical School in Dallas. She completed the pediatric residency program at University of Oklahoma Health Sciences Center in Oklahoma City. Her interests include breastfeeding education as well as disease and injury prevention. Dr. Mangham is board certified in pediatrics.

If you are having even the slightest trouble, questions or concerns regarding your child’s safety in the car, certified child passenger safety technicians are able to help or even double check your work.

For those of you in the Tarrant County area, you can call Safe Kids Tarrant County, led by Cook Children’s, at 682-885-2634.  Also visit this site for a quick car seat checklist with the top 5 things to do to check your seat. 

1. When can my child change from rear-facing to forward-facing?

The American Academy of Pediatrics (AAP) recommends children ride rear-facing until at least 2 years old or until they reach the maximum height and weight for their seat. Keeping children in a rear-facing position better protects their heads, necks, and backs. Seats will indicate on the side labels what the rear-facing weight/height limit is and you can also check the manual of the seat. Parents often worry about the safety of a child’s legs when the child is growing taller and is still rear-facing.  Studies show that a child’s legs are actually injured less often when a child is rear-facing.  Both of my children were in the 90+ percentiles for height at age 2 and both remained rear-facing past 2 years old.

2. When can my child use a booster seat instead of a harness forward-facing seat?

The AAP recommends children ride in car seats with a harness until at least 4 years old, however they should continue to use a 5-point harness up to the highest weight or height allowed by the manufacturer of the seat.  Moving from a 5-point harness to a booster seat is a step down in safety, so a child should remain in the harness seat as long as possible.

3. When does my child no longer need to use a booster seat?

Texas law requires children to remain in booster seats until at least age 8, unless the child reaches a height of 4 feet, 9 inches before age 8 (which is extremely uncommon). 

Recommendations state a child should remain in a booster seat until at least age 8 or until the seat belt fits correctly. Most children are 9 years or older before they reach 4 feet, 9 inches, which is when the seat belt will usually fit them correctly without the booster seat. You can use the “Safety Belt Fit Test” to help you determine if your child is ready to use the seat belt alone without a booster seat:

1. Have your child sit all the way back on the vehicle seat.  Do the knees bend at the front edge of the seat?  If no, then your child should stay in a booster seat.  If yes, then go to No. 2.
2. Buckle the seat belt.  Does the lap belt lie on the upper legs or hips (not the stomach)?  If no, then your child should stay in a booster seat. If yes, then go to No. 3.
3. Does the shoulder belt rest on the shoulder or outer collar bone (not the neck)?  [Note- Never put the shoulder belt under a child’s arm or behind a child’s back.]  If no, then your child should stay in a booster seat.  If yes, then go to No. 4.
4. Can your child maintain the correct seating position for as long as you are in the car without slouching or moving positions causing the belt to move improperly to the neck or stomach?  If no, then your child should stay in a booster seat.  If yes, and you answered yes to all 4 questions, then your child is ready to use a seat belt without a booster seat.

4. When can my child sit in the front seat?

Children should not ride in the front seat until age 13. The safest place for a child in the car (or any person for that matter) is the back seat, particularly since the most common crash is a frontal crash.  Air bags deploy with such force that they can cause severe head and neck injuries to a child.

5. Do car seats and booster seats expire?

Yes, all car seats and booster seats expire. Usually they last about six years, but be sure to check for an expiration date on the seat label.

For more information:

• Car safety
• Is your child's car seat safe?
• FREE car seat checks
• Never leave your child alone in a car
• Look and lock
• Spot the tot
• From the car seat to the driver's seat
• Resources

About the author

Nicole Wineriter, M.D., is a Cook Children's pediatrician at the Heritage Trace Clinic. She is a Fellow with the American Academy of Pediatrics and a member of Safe Kids Tarrant County, led by Cook Children's, and a certified child passenger safety technician. 

The summer is coming to an end and so is our time blogging about reducing our household media time. To finish up the series, I thought I would interview the kids and ask them what they thought about our summer experiment. The answers are very real and brutally honest. .

What was the best part of our screen free experiment this summer?

Max, age 11.5 years – “Hanging out with my friends at the pool more.”

Morgan, age 10 years – “In Michigan, it was like fun because we weren’t always on the screen and stuff, and we had more things to do with the world.”

Matthew, age 6 years – “Nothing at all.”

What was the worst part of being screen free?

Maxwell – “I couldn’t catch up on all the things I was missing on my games and less time playing with my friends (online).”

Morgan – “When I wanted the electronics because there was literally nothing to do, you wouldn’t let me have them, and that really annoyed me.”

Matthew – “I couldn’t play with anybody (online).”

What can we learn from our screen free summer?

Maxwell – “I learned that I play with my friends more online than I do in real life during the summer, not during the school year, but during the summer.”

Morgan – “Video games aren’t the answer to happiness.There are other things you can do besides electronics.”

Matt – “It (the computer) will make you mad if you watch it too long.”

Would you do this screen free experiment again?

Maxwell  - “No.”

Morgan - “I don’t know, maybe, if we go to Michigan, or a different state.”

Matthew – “Um, no.”

What should our family work on next?

Maxwell – “Playing more sports. That would be so much easier.”

Morgan – “Manners. Our family should work on being nicer to each other (siblings fighting). Being more serious about the screen free thing because we still played it a lot.”

Matthew – “Clean the house.”

The answers made me pause and think that while we actually had some pretty great screen free moments this summer, we still have some work to do (and we need to clean the house).

I am so incredibly grateful to Dr. Mangham and to Cook Children’s for this unusual summer experiment! Although we were not “screen free” and did not manage to “go dark” very often, being asked to write about our efforts really opened my eyes to just how much time we do spend on the screen, how much we depend on it and just how capable we are of living without it. We are a family that is “off” more than we are “on” now, and will continue to strive to use it less and less every day.

Thanks so much everyone!

Previous media free stories:

• 'TV head' - Could you unplug?
• Going media free - part 1
• Breaking it to the crew - part 2
• 'Operation Unplug' - part 3
• We far from nailed it - part 4
• Screen free for 20 days - part 5

About the author

Aubrey Conklin, moved to Texas from Michigan via Chicago almost 10 years ago. She’s been married for 14 years and is the  mom to three kids ages 11,10 and 6. A huge sports fan who not only loves all things Detroit sports but spends her own free time playing soccer, volleyball and softball. Aubrey is a part time preschool teacher as well, a volunteer for her kid's school. 

I had this amazing, Mom of the Year type plan where our family would reduce our use of electronics to 1 hour a day and provide the kids an opportunity to EARN up to another hour of screen time per day by doing various chores around the house. Awesome plan right? Right.

I was trying to figure out how I was going to humorously chronicles all of our FAILS this first week of Operation UnPlug (thank you to my sweet friend DeeDee for the name). But I truly am a glass half full gal, so despite our family not being able to hit a home run with plan A, we had some big family wins. Even though we did not exactly follow the plan, we had a good week.

Some highlights from week 1

No one died. The kids swore they would die without constant electronic entertainment. They totally didn't.

We did use electronics a little less every day. Look, tracking kids' minutes (times three kids) proved to be a major pain from the word go. MAJOR.PAIN. It proved very quickly to be time consuming and complicated. But,having a general sense of how much time we are on and off electronics is admittedly helpful. We ditched the strict minute tracking and did a more informal tracking (That is us in a nutshell - informal). We were successful in making sure we were off more than we were on and that each day we were off even more than the day before.

We invented new family lingo. Our family now has our own terminology. Phrases like “going dark,” “screen free,” “fun break” and “screen amnesty” are all part of our daily conversation now. I am not sure what “Screen Amnesty” means in real life, but for us, it is unlimited screen time that is not earned and has no consequences. Fun Fact - “screen amnesty” was invented by my husband ... FOUR HOURS INTO THE FIRST DAY OF OPERATION UNPLUG! FOUR HOURS! Honestly, I thought about calling Cook Children’s and telling them they had the WRONG family after we started throwing around “screen amnesty” so early into this project.

We were so productive!!! I hate to even admit just how much cleaning we knocked out the first few days of this experiment. It was awesome. I had the kids work on their rooms, the cool thing was they would find toys they had not paid any attention to in quite some time. They would stop and play and I was OK with that. Take your time kids. All the time you need. And now that I am not consumed with crushing my old high school buddies that I haven’t seen in 20 years at Words With Friends, I do find myself spending a little more time on my own personal to-do list. Go figure.

The dog lost weight. Ok, I may be reaching here, but I am trying to focus on everything that went RIGHT this week. By unplugging, we did more cool things as a family like take the dog for long walks and she lost an eighth of a pound. Hey, a loss is a loss

Did we turn into The Waltons week 1? Oh good gravy, not even close. Did we become aware that things in our home need to change and we are in need of daily unplugging? Totally. We will keep working on it and we will keep you posted!

Previous media free stories:

• 'TV head' - Could you unplug?
• Going media free - part 1
• Breaking it to the crew - part 2

I had just agreed to write about how our family is going to drastically reduce their screen time over the summer. Now to break it to the kids. I was actually a little nervous about their reactions. After all, I had created three media junkies.

We were at the eye doctor. I was watching all three kids play on their handheld devices. My original plan was to have a big family meeting after dinner and explain the plan. But instead, in the waiting room I simply blurted out, “We are going to go almost totally screen free for the rest of the summer.” I was waiting for the big wails and sobs and yells of protests, but I don’t think they believed me. They sort of chuckled and looked back down at their games. I explained that I had been asked to write about the experience on a regular basis, and we were really going down to one hour a day. Oh buddy. That got their attention.

My middle girl, Morgan, 10 years old, said, “You know, that might be fun, we may learn something.” 

That was about it as far as the family taking it well.

Our youngest, Matthew, 6 years, said, “I don’t want to.”

Our oldest boy, Max, 11 years, said, “What? Wait, what? When? For just this weekend? Are you sure? Mom, this is not going to work. Can I pay for extra time? Can we start in September? What are we gonna DO all summer if we can’t play games?” 

You get the drift, Max is not happy. Like at all. This line of questioning went on for hours. I think I saw him actually go through some of the stages of grief to be honest, especially the denial and bargaining part. Poor guy.

I told the kids my plan is to allow them one hour a day with the option to earn an additional hour a day by doing certain chores and tasks. I figure we can set it up together. Maybe a family trip to Hobby Lobby to buy a fancy chore chart, stickers. You know, all that cool stuff I see on Pinterest, but never actually do.

I decided to give the kids 24 hours to mentally prepare. The two youngest ones want to start now. My oldest, not so much. I know there are going to be special circumstances that may result in the kids getting additional time (I bet Max will be the first to point ALL of them out) and I am not totally sure how this is going to go. I have to admit, I have gone from being completely freaked out by the idea to actually a little curious how our summer is going to change now that we will be a lot less distracted. 

Previous media free stories:

• 'TV head' - Could you unplug?
• Going media free - part 1

Aubrey Conklin, moved to Texas from Michigan via Chicago almost 10 years ago. She’s been married for 14 years and is the  mom to three kids ages 11,10 and 6.  A huge sports fan who not only loves all things Detroit sports but spends her own free time playing soccer, volleyball and softball.  Aubrey is a part time preschool teacher as well, a volunteer for her kid's school. 

We moved into a new home about three weeks ago. Amid the chaos of boxes and a not quite finished remodel job, I hear the laughter of my kids upstairs. I head up to check on them and realize they are “playing nicely.”  What is interesting is that we have had no access to TV for three weeks. Could there be a connection between my kids getting along and no TV?  What are the results of being unplugged?

The American Academy of Pediatrics recommends no TV for kids under 2 and less than 2 hours per day of media time for kids older than 2 years of age. Why? Because too much media is associated with aggression, inattention, anxiety, depression, sleep problems and obesity in our kids.

We call it TV head at my house. It is a lazy Saturday morning. The kids lounge in front of the TV for a few hours watching a movie. The next thing I know there is fighting, yelling and disagreement between my children. My son never quite recovers the rest of the day. He is a little “fuzzy headed” and a little grumpy.

Many of my patients have found harmony at home by decreasing media time. My parents have returned with true amazement at the difference in their kids once they have unplugged, especially in the evenings. They have reported healthier and happier kids. A number of my families have decided to unplug for the summer, which in all honesty, is probably the hardest time to do so, especially when it is hot outside and not much to do inside. Enter Mrs. Aubrey Conklin, one of the most fun and down to earth moms I have ever met.  I discussed the benefits of decreased media with her at the recent well-child exams for her three children. She is open minded enough to try it, and kind enough to let us join her on this journey.

Watch for Aubrey’s blogs this summer. She will be reporting in on how she and her family are doing cutting back on screen time.

"My mom used to say, 'When God closes a door, He always opens a window.' I have found that to be true many times in my life. My life as a pediatrician is a result of crawling through an open window when the door I thought I was supposed to walk through was closed to me."

Jason Terk, M.D., Keller, Keller Parkway

"Florinda Peak, the most amazing Mommy in the world, to 5 year old Dr Sandra Peak who did not want to practice reading… 'You have to learn how to read…because when you do the whole world opens up to you!'”

Sandra Peak, M.D., Lewisville

"The best advice my mother ever gave me was to give to others without expecting anything in return. (She also told me to never go outside with wet hair because I’d catch a cold, but medical school later disproved that. Sorry mom.)"

Diane Arnaout, M.D., Willow Park

"The best advice my mother ever gave me was, “never miss the chance to use a perfectly good bathroom” when you are out of the house."

Audrey Rogers, M.D., Fort Worth, Forest Park

Nicole Wineriter, M.D., Keller, HeritageTrace

"My mom told me to respect (be nice) to the nurses because they can either make or break your day."

Samuel Sheng, M.D., Arlington Neighborhood Clinic

"Encourage others. She always wrote notes to people for accomplishments, during sad times and just because."

Justin Smith, M.D., Lewisville

And finally, our favorite advice ...

"Marry Joan."

Tom Rogers, M.D., Forest Park. Dr. Rogers and his wife Joan have been married 59 years and today, she is a proud mother. "Joan worked to pay my way through medical school, gave me two great kids who are both pediatricians, and has allowed me to work without having to pay attention to small things like finances, maintenance of our house and yardwork. I couldn't be where I am today without her," Dr. Rogers said.

Happy Mother's Day from all of us at Cook Children's ...