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Healthy Kids
Does your child have an eating disorder?

At least 30 million people in the United States suffer from an eating disorder at some point in their lives, according to the National Institute of Mental Health. More than 2 million are children between the ages of 13-18.

"We think that up to 40 percent of girls, but also boys, will pass through phases of weird eating during middle and high school," says Dr. Pilar Bradshaw. "The real question is, 'When does it get to the point that a parent needs to be worried?'"

Identifying the signs of an eating disorder
There are three main types of eating disorders:

  • Anorexia: A person refuses to eat adequate calories out of an intense fear of becoming fat.
  • Bulimia: A person grossly overeats, often referred to as binging, and then purges the food by vomiting or using laxatives to prevent weight gain.
  • Binge eating: A person gorges on food, but without purging.

"Eating disorders are more common these days, and they are becoming more diagnosed," says pediatric nutritionist Patty Fahlstrom.

Specializing in eating disorders for more than 20 years, Patty says there are signs parents should watch for that could signal a child is developing unhealthy issues with food.

"Have their eating habits drastically changed in the last couple weeks or a month? Have they stopped eating things that they absolutely loved their entire life?"

In addition to restricting food:

  • Is your child withdrawn, irritable, depressed or acting odd?
  • Do you notice that they don't want to eat with family or go out to restaurants?
  • Do they take food to their rooms, when that's not a usual pattern for them?
  • Do they eat volumes of food and then disappear quickly after a meal?
"Eating disorders are not primarily about food," says Dr. Bradshaw. "There are complex factors, like body image and unhappiness with other parts of their life that they don't have control of, so they take control of how they're eating."

Helping a child with an eating disorder
Treatment is needed to overcome an eating disorder, not only to help restore normal weight and eating habits, but to address underlying psychological issues causing the disorder. The best results occur when eating disorders are addressed at the earliest stages.

"If you notice your child is developing unusual behaviors around food, see your pediatrician quickly," Patty says. "Because the faster we can get on top of an eating disorder, the better their chances are of full recovery."



Identifying and treating depression in kids

Teens and tweens are carrying a lot on their shoulders these days, including depression. It's estimated that about 50 percent of kids who suffer from it, go undiagnosed. Because pediatricians are often in the best position to identify kids who are struggling, the American Academy of Pediatrics is calling for every child 12 and older to be screened each year for mental health issues.

According to Lane County Public Health:
  • 1 in 3 adolescents in Lane County suffers from depression
  • 1 in 4 adolescents has contemplated suicide in the last year
  • 1 in 5 adolescents has attempted suicide in the last year
"If you think about how many children that is in this county, that's terrifying," says Dr. Pilar Bradshaw.

A pediatrician for more than 25 years, Dr. Bradshaw says it can be difficult for parents to tell the difference between what is typical adolescent moodiness and what could potentially be something more serious. So, how do you know if your teen or tween may be suffering from depression?

"First off, depression lasts. It's not like they have a good day and a bad day. Kids who are really depressed have bad day after bad day for weeks or months," she says. "But don't let it go on for months before you seek help. Your child's pediatrician is a great place to start."

Signs your child may be depressed:
  • A change in mood: your teen or tween is feeling emotional, irritable or angry.
  • Changes in patterns of behavior: they're sleeping more, sleeping less, there's a sudden a change in their friend group, or your child's appearance.
  • Your child is withdrawn: spending less time with the family, more time in their room isolated from others, not enjoying things that used to make them happy.
  • Trouble focusing or making choices; their grades suddenly drop.
"These are all signals, and it's easy to miss one, but if you're seeing a bunch of these all together, that's worth talking to your teenager and asking, 'How are you really doing these days?' And then be quiet and don't say anything; wait to see what your kid will tell you," says Dr. Bradshaw.

Diagnosing and treating depression
At Eugene Pediatric Associates, pediatricians screen adolescents for depression at each visit. It starts with asking them to fill out a questionnaire.

"And the kids might get sick of filling out the paperwork each time they come for an appointment, but we know that kids who are having big feelings will often share it in that kind of non-confrontational way where they can just write about it," Dr. Bradshaw says. "So, if you are a parent at your kid's doctor's appointment, please do not fill out that paperwork for them and do not look over their shoulder while they fill it out."

In addition, teens and tweens should have some one-on-one time with their doctor, so consider stepping out of the room for a bit. Encourage your child to be honest with their physician, and remind them that their doctor is there to help them.

Treating the whole child
Doctor Bradshaw recognized early on that caring for children's mental well-being is a critical part of their overall health. As a result, in 2014, she integrated Thrive Behavioral Health into her pediatric practice. Mental health specialists, including therapists, counselors, case managers, a child psychologist and a child psychiatrist, are on-site to offer immediate help and support to families who need it.

For more information about Thrive Behavioral Health, click here.

Is my child getting the proper nutrition?

When it comes to children's nutritional needs, parents often have questions: How many calories should my child be consuming? Is he or she getting enough calcium and iron? Are they eating too much fat?

A child's nutritional needs and caloric intake fluctuate depending on their age and their stage of development. Here are some general guidelines, but always talk with your pediatrician if you have questions or concerns.

Newborns and infants rely mainly on breast milk or formula for the first six months of their lives until solids foods are introduced. Breast milk or formula provides almost everything babies need nutritionally with the exception of vitamin D. It's recommended that babies receive a daily vitamin D supplement.

Toddlers and preschoolers
The toddler and preschool years are an active time in a child's life when changes are happening physically and developmentally. However, it's important for parents to know that toddlers grow fairly slowly.

"The total number of calories your child requires per pound of bodyweight is significantly less than what they required as babies," says Dr. Pilar Bradshaw.

Encourage more calcium and fiber-rich foods like fruits and vegetables in your child's diet and do not focus on restricting fats.

"Your child's brain has millions of nerve cells and each one needs to be coated in healthy fat," says Dr. Bradshaw. "So, if your child is eating a low-fat diet, it can adversely affect their brain development, especially when they're under the age of 2."

Toddlers and preschoolers grow in spurts and their appetites come and go in the same way. They may eat well one day and hardly anything the next. Be patient with your little one and avoid food battles.

"Just put food in front of them that's healthy and let them decide what they're going to eat," Dr. Bradshaw says. "And know that a normal toddler eats a decent meal every couple of days and otherwise just grazes."

Once your child reaches school-age, their bodies need carbs (sugars), fats and sodium, but they should be consumed in moderation. It's common for children at this age to begin to question where their food comes from and suddenly decide to become vegetarian.

"That's a big conversation and you do have to be thoughtful about it," says pediatric nutritionist Patty Fahlstrom. "Before allowing your child to become vegetarian, talk with your pediatrician to make sure that you have a nutritional plan that still gives them adequate protein."

To help build healthy eating habits in your kids, Patty encourages parents to involve children in planning and preparing family meals. They're more likely to eat healthier if they have a hand in that process.

"Whether it's grocery shopping, making a grocery list, making choices in the store based on cost or where the food comes from—there are so many opportunities to talk with your kids about food and eating well that will help instill good values in them," she says.

Your children's nutritional needs remain rather consistent from preschool until adolescence. Once they hit adolescence, however, the majority of your child's bone mass develops—approximately 45 percent—so they will need more calcium. In addition, the number of nutrient-rich calories they need also grows. As they experience puberty, girls need more iron, while boys need slightly more protein.

"I tell all parents, 'If you're not sure what kind of nutrition your children are getting, give them vitamins,'" says Dr. Bradshaw. "A multivitamin with minerals and iron can really cover a bunch of gaps in their diet."

Don't forget about water
Water makes up more than half of children's weight, so it's important to make sure kids age one year and older are drinking water throughout the day, not just when they're thirsty. Fruits and veggies are also good sources of water. Babies generally do not need water during their first year of life. And don't forget: children need to drink more water when they are ill or outdoors in hot weather.

How many calories should my child be eating?
Your child's body needs calories for energy. The recommended daily caloric intake for kids is based on their level of activity, as well as their age and gender.

Making time for family meals
As kids get older, families tend to get busier, but it's important to make time for a sit-down family meal at least a couple of days a week.

"Self-esteem is an important reason to sit around the breakfast or dinner table and talk," Patty says. "Multiple studies show that communication skills, self-esteem, as well as family bonding and connectivity are all significantly improved when families take the time to eat together."


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