28 Days to Health

Day Zero- 5:30 am

My kids have wrecked my body! My health has definitely deteriorated since I’ve had children. I thought the time constraints of medical school and residency were a challenge. Nothing compares to motherhood. As a doctor I know that regular cardiovascular exercise and eating a low fat high fiber diet is good for me. I spend nearly every day encouraging my patients to take care of themselves. But I can honestly say I haven’t worked out consistently in years. I’m proof that being thin doesn’t mean you’re healthy. Breastfeeding has kept my weight in check although I’m terribly out of shape. I wheeze when I run around the block, the only arm curls I do is when I’m picking up my baby and lately my evening habit has been a sleeve of Oreo cookies.

As mothers we need to take care of ourselves as well. So in the spirit of National Heart Month, February will be my month to incorporate exercise and healthy eating into my life. I’ll be tracking my progress and writing about my new lifestyle. Even as I write this I’m trying to talk myself out of it! I tell myself it’s a big commitment and that I’m too busy to workout much less write about it. But I know deep down that it’s an excuse. If I’m going to get healthy it’s going to be because I just do it. I have to find a schedule that’s works for me despite the crazy busy days. Tomorrow is day number one and I still need to get ready. I will be mapping out my schedule and going to the grocery store to load up on healthy foods.

I’m on my way… I’ll let you know how it goes!

Sheila Cason, M.D., F.A.A.P.

Child Sexual Abuse

Question for Mommy MD:

Should we fear other children molesting children of the same age range?
What signs should we look for curious kids or actual kids who are causing
harm? This is a big issue bigger than most think. When our kids are
playing with other children we assume they are "safe". I am unable to find
guidelines for this. Also, please write about good information on how to deal
with actual molestation and what to tell your child. What is playing and
what is not.

It’s late and I just finished seeing my last patient of the day. She’s twelve years old and has had depression and anxiety since she was molested in second grade by her student teacher. Unfortunately this is not unusual. The American Academy of Pediatrics (http://www.aap.org/) gives the following statistic. “Some surveys say at least 1 out of 5 adult women and 1 out of 10 adult men report having been sexually abused in childhood.” Because most of the children that have been abused show no signs of abuse we need to rely on them to tell us what happened. Therefore sex education and prevention should start when children are young. Begin slowly and use terms that are simple and understandable. You need to teach them the correct names of their private parts (i.e., those areas that are covered up by a bathing suit) and that no one should be touching those areas. As they enter middle school and young adulthood you should expand their knowledge and give additional information as appropriate. It’s very important to listen to your children and make sure that you know who your child is hanging around. Drop in at your child’s caregiver without notice and make sure your children aren’t going to out-of-the-way places with adults or older children. - The offender is usually adults or older children and 8 out 10 times the victim knows them.

The following may be signs that someone is sexually abused:

1. Noticeable fear of a person or certain places;
2. Unusual or unexpected response from the child when asked if she was touched by someone;
3. Unreasonable fear of a physical exam;
4. Drawings that show sexual acts;
5. Abrupt changes in behavior, such as bedwetting or losing control of his bowels;
6. Sudden awareness of genitals and sexual acts and words;
7. Attempting to get other children to perform sexual acts. (Reference: American Academy of Pediatrics: Parenting Corner: Child Abuse: What is Child Sexual Abuse? http://www.aap.org/)

You can minimize your child’s risk and exposure to potential offenders, but you can also empower your child! Tell them it is okay to say no to an adult and that they can come and talk with you. Sex education is one of the most important conversations you will ever have with your child. If they can’t talk to you where are they going to go?

If you suspect that your child or someone else’s child has been sexually abused contact your pediatrician or another person of authority. They can refer you to a local center that specializes in investigating these cases. For more information on child sexual abuse or other forms of abuse, write to the National Committee for Prevention of Child Abuse, PO Box 2866, Chicago, IL 60690.

Sheila Cason M.D. F.A.A.P.

Drowning Prevention

I’m one of the most paranoid people I know around water. It’s why even though it’s a chilly January in Southern California my 4 year old just returned from her weekly swimming lesson. When she’s out there splashing with her teacher I’m inside the building watching her every move. I do all this because of the memory of a little boy. He was 2 years old and had fair blond hair and sweet round cheeks. I took care of him in the Pediatric Intensive Care Unit (PICU) after his parents found him at the bottom of a pool. A team of doctors, nurses and paramedics all tried to save him without success. He stayed in the PICU until all his family could come and say goodbye. My patient unfortunately was not unique. In California, Arizona, Florida and Texas drowning is the leading cause of unintentional injury and death in toddlers age 1-2 years of age. The following recommendations are taken from the American Academy of Pediatric (AAP) policy statement on drowning prevention. For full recommendations visit their website http://www.aap.org/.

1. Don’t ever leave your child alone or in the care of another young child while in bathtubs, pools, spas, or wading pools or near irrigation ditches or other open standing water. Dump water from wading pools when you are done! Other neighboring kids can wander over from next door!

2. Don’t rely on infant bath seats or supporting rings in bathtubs. Children can flip easily!!

3. Remove all water from containers, such as pails and 5-gallon buckets, immediately after use. Yes! Kids can drown in buckets! Little curious ones stick their heads in to see what’s in there and then fall in.

4. To prevent drowning in toilets, young children should not be left alone in the bathroom, and unsupervised access to the bathroom should be prevented.

5. Whenever infants and toddlers are in or around water, be it at their own home, the home of a neighbor, a party, or elsewhere, a supervising adult should be within an arm’s length providing "touch supervision."

6. The attention of the supervising adult should be focused on the child, and the adult should not be engaged in other distracting activities, such as talking on the telephone, socializing, or tending to household chores. I know of one child that nearly drowned in a Jacuzzi filled with other adults. No one saw her when she slipped in behind another person and got trapped.

7. If a home has a residential swimming pool, it should be surrounded by a fence that prevents direct access to the pool from the house. Rigid, motorized pool covers, pool alarms, and other protective devices, which may offer some protection if used appropriately and consistently, are not a substitute for 4-sided fencing. Make sure the gate is self latching. It doesn’t help to have a fence and a gate if it’s not closed. One child I knew nearly drowned because her sibling opened the gate and left it open by accident.

8. Sign your child up for swimming lessons! AAP recommends waiting for formal swimming lessons until after their fourth birthday. However, because some children develop skills more quickly than others, not all children will be ready to learn to swim at exactly the same age. The decision must be individualized.

9. Learn CPR and keep a telephone and equipment approved by the US Coast Guard (e.g., life preservers, life jackets, shepherd’s crook) at poolside. To find where you can take CPR classes contact your local American Red Cross center.

10. Teach your child never to dive or jump in unknown water. Find out the depth of the water first.

Sheila Cason MD, FAAP

Ask and Discuss Questions in the Medrounds Pediatric and Parenting Forum

Discussion Forum

I spend a lot of time talking and listening. It’s my profession! As a pediatrician I was trained to listen, ask questions, do a physical exam and mold all the information into diagnosis. I can’t help but give advice particularly if I feel something will harm a child. My children’s friends all hear my opinion on helmets and bike riding. I practice medicine every day because I love it. I love my patients- they make me laugh and smile. I love my patient’s families. I am inspired and awed by them. I love my colleagues. I love discussing cases and determining the best care for the children. All these people make me a better doctor and a better mom. I have dedicated my life to other parents’ children as well as my own. Often my two worlds collide. You can see that my pediatric advice is often peppered with my own experiences as a mother. I started my column because I knew there would be people that needed the advice. But I am also interested in hearing what you all think! Medrounds.org has started discussion forums that will facilitate the exchange of information. I welcome everyone to log on and participate!


Sheila Cason MD, FAAP

Junk Food

I told a parent today that her daughter needed to stop eating Hot Cheetos and you know what she said? Oh! I didn’t know that Hot Cheetos were bad for her! Hmm…I thought. Doesn’t everyone know junk food is bad for you! Maybe not. So I’m telling you… Junk food is bad for you! It offers no nutritional value and yet loads our kids with extra calories. This puts them at risk for obesity and later health complications.

If you haven’t seen the movie “Super Size Me” by Morgan Spurlock then put it on your must watch list. I highly recommend it. It’s an eye opening look into what eating fast food exclusively for an entire month will do to your health! I have had to curtail the fast food myself when my two year started eating only the french fries. At one point I was actually cajoling her to eat the greasy hamburger as well! Ideally you want to offer a child treats in a moderate manner. Give fast food no more than one time a month. Children need to eat mostly fresh fruits, vegetables, lean meats, low fat dairy and whole grains. Give juices moderately. And rarely give processed snacks. If high fructose corn syrup is in the first 10 ingredients then don’t eat it! One exception is children under two years of age do not need a low fat diet. They need the calories for their growth and development.

Whatever your child’s weight is you need to watch what they are eating. Don’t think only about reducing calories but think of their overall health. Fill your house with nutritious foods. I see a lot of people look at their child and say, “See? I told you no more eating junk food”. But unless they are older, they have no other access to food except the food you provide for them. Be a good role model and eat healthy yourself. And don’t forget to indulge in the occasional treat. As long as we are moving in the right direction then we’re doing well.


Dr. Sheila Cason

Bonding With Your Baby

Have you seen a baby being fed with its bottle propped? Do you think we don’t hold our babies enough? What effect does this have on our young? One reader recently wrote in asking these very questions.

We know that touch and subsequent bonding is essential to the wellbeing and development of the child. James W. Prescott, PhD, an American developmental psychologist, proposed that the origins of violence in society were related to the lack of mother child bonding. He said "The easiest and quickest way to induce depression and alienation in an infant or child is not to touch it, hold it, or carry it on your body." Harry Harlow also did extensive studies looking at the relationship between affection and development. His most famous study was of Rhesus monkeys, between 1963 and 1968. He placed the monkeys into two groups. The first group was offered a choice between two mothers, a terrycloth mother without food and a wire mother that provided a baby bottle containing milk. The second group also had a choice between two mothers, a terrycloth mother that provided food and a wire mother with no food. Interestingly the researchers found that the monkeys clung to the terry cloth mothers regardless of whether she had food or not. The only times the monkeys went to the wire mother was when she had food. The terrycloth mother provided something more important than food: contact comfort. Harlow concluded that affection and emotional connection is integral to mother child relationships. He later went on to do studies that showed the complete psychological deterioration of monkeys who were kept in social isolation.

Unfortunately we see this in real life when we observe babies who prior to adoption are kept at orphanages with a high caregiver to child ratio. The child never has the opportunity to bond with another person and therefore develops disorders of attachment. This disorder significantly impairs their ability to relate to other human beings for the rest of their lives!

The good news is that we can continue to bond and increase our well-being by touching and being touched! Oxytocin is a hormone secreted by the posterior pituitary gland mainly in response to touch. Most people know of this hormone as a female hormone because it increases dramatically in labor and breastfeeding. But both men and women secrete oxytocin. It is known to lower blood pressure and other stress related responses and it has been called the calm and connection hormone. So remember to hug your baby or hug your pet or get a massage! All this will increase your oxytocin and help with calmness. Hug your older child too! Even teenagers need to know their parents are there and care for them. And please don’t bottle prop! If your life is so busy that you can’t hold your baby while you feed them you just might be too busy!


Dr. Sheila Cason