Health Tips - Paediatric/Teenagers

Asthma - Asthma is a disease of the lungs that involves constriction of the muscles around the small airways as well as an inflammatory response within these airways. These reactions occur in response to environmental agents like dust, smoke etc or exercise. This constriction and inflammation greatly reduces the passage through which air flows and may cause a high pitched sound known as wheezing. This gives the characteristic symptoms of chest tightness, shortness of breath and cough.

Management is aimed at dilating the airway and reducing the inflammation. This is achieved by use of inhalers or nebulisations. In addition the inflammatory aspect is treated by using a steroid medication. The steroid may be administered in an inhaled, liquid or tablet formulation. In people who have frequent attacks the steroid inhaler is used twice daily and this prevents inflammation from building up in the airways. However, if an attack occurs, then the rescue inhaler (Ventolin/Barotec) or nebulisations are used to treat the sudden onset of symptoms.

There is no cure for asthma.

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Atopic Dermatitis/Eczema - Often begins between ages 2 to 6 months. Initially a very dry, sensitive and itchy forehead, cheeks and scalp rash is noted; later spreads to trunk, creases of elbows, knees, wrists. Often a family history of asthma, allergies or eczema.

There is no cure; however, most children “grow out of it”. Steroid creams are the main treatments for eczema flare ups; in severe cases steroid ointments are used. Application of prescription strength steroid cream/ointment to the face and diaper area should be avoided, unless specifically instructed to do so.

After eczema settles, it is best to taper steroid use by applying every other day for 2 to 3 weeks before completely stopping. Oral antihistamines helps control itching. Daily bath for 15-20 minutes helps moisturize the skin. Use a mild, nondrying soap, (e.g. Dove) and avoid vigorous scrubbing, use a soft towel to pat the skin dry. A doctor recommended lubricating cream or ointment should be liberally applied to the skin within 3 minutes of bathing (and after the steroid cream/ ointment) and throughout the day as needed; this should be used every day, even when the eczema isn't flaring-up.

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Bed Wetting (Enuresis) - Enuresis is defined as the unintentional discharge of urine during sleep twice a week for at least three months during the night or day with no underlying physiological cause. At age five 7% of boys and 3% of girls are affected. Enuresis tends to run in families.

Bedwetting can sometimes be caused by a serious medical problem such as diabetes, sickle-cell anemia, epilepsy, enlarged adenoids, snoring, urinary tract infection, severe constipation or spinal cord pathology.

Enuresis can often be controlled by instituting the following techniques:

• Reminding the child to urinate before going to bed, if he or she feels the need.
• Limiting liquid intake at least two hours before bedtime.
• A special sensor can be placed in the child's pyjamas. This sensor triggers an alarm that wakes the child at the first sign of wetness. This is considered the most effective form of treatment now available.
• Encouraging and praising the child for staying dry.
• Bladder training: having your child practice holding his or her urine for longer and longer times.

Most children eventually “grow out” of this problem without treatment.

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Chickenpox - Caused by a virus: varicella-zoster It is extremely contagious, and can be spread by direct contact, droplet transmission, and airborne transmission.

When someone becomes infected, the pox usually appear 10 to 21 days later. People become contagious 1 to 2 days before outbreak. They remain contagious while uncrusted blisters are present.

Associated symptoms include fever, headache, tummy ache, or loss of appetite, for a day or two before breaking out in the rash. These symptoms last 2 to 4 days after breaking out. The blisters often appear first on the face, trunk, or scalp and spread from there. In most cases, it is enough to keep children comfortable while their own bodies fight the illness.

Oatmeal baths in lukewarm water provide a crusty, comforting coating on the skin. An oral antihistamine can help to ease the itching, as can topical lotions. Safe antiviral medicines have been developed and are most effective when started within the first 24 hours of the rash.

The outcome is generally excellent in uncomplicated cases. Encephalitis, pneumonia, and other invasive bacterial infections are serious, but are rare, complications of chickenpox.

A chickenpox vaccine is about 100% effective in preventing moderate or severe illness.

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Childhood Emergencies - How would you handle it if your child was unconscious, choking, or having a seizure?

This is a list of some potential childhood medical emergencies:

• Difficulty breathing
• Choking on food, drink or object
• Uncontrolled bleeding
• Unresponsiveness or unconsciousness
• Blue or grey skin or lips
• Severe or persistent vomiting and diarrhea
• A seizure
• A very high fever especially if accompanied by a skin rash or neck stiffness
• Firearm wound
• Near drowning
• Suffocating
• Severe injury from a car or bike crash
• Eating or drinking something poisonous

It must be noted that preventable injuries/ emergencies are the leading cause of death and permanent disability in children. Child safety seats, bicycle helmets, poison prevention, safety caps on medicines, placing all medicines out of the reach of children, window guards and sports safety equipment are only some of the ways of preventing injuries/ emergencies.

It is important that those entrusted with looking after children (including parents) become familiar with basic CPR and other life saving techniques – e.g. Heimlich manoeuvre.

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Childhood Obesity - Here in Barbados the incidence of childhood obesity has increased significantly in the past two decades. As a general rule “fat children” will eventually become “fat adults” unless there is a concerted effort on the part of the parents, guardians, health care providers and/ or the child to curb such an eventuality.

Healthy eating habits should begin at home. Obesity can be prevented or even reversed in children by subscribing to the following:

• Don't force children to eat when they aren’t hungry
• No child should be made to clean their plate if they are already full
• Feed your child a healthy, balanced diet – no “junk food”
• A child should not be offered a fast food treat as a reward
• Fast food outings should be kept to a maximum of once per month
• Limit your child's TV watching, recreational computer access (e.g. MSN Chat) and encourage physical activity, like playing outdoors. Offer to play outdoors with your child
• Limit your purchase of sweet drinks (including juices) for the home and NEVER send these to school in your child’s lunchbox

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Cigarette smoking - is one of the most common forms of addiction in Barbados.

Nicotine, like cocaine alters brain function and chemistry, this results in chemical dependence. Therefore giving up cigarettes or other tobacco products is very difficult.

Nicotine binds to brain cells causing the release of dopamine, a brain chemical that causes the pleasure associated with smoking.

When attempting to quit, most smokers experience varying degrees of nicotine withdrawal – including nervousness, headaches, insomnia, mood swings, and poor concentration. Withdrawal symptoms last for about two to four weeks. Cravings however, last much longer, and may recur even years after quitting.

Addiction is greatest for those who start smoking during their teen years. Nearly 90 percent of adult smokers become addicted to tobacco before they reach 18-years-old.

Most persons make three or four attempts before they quit successfully. Whether quitting “cold turkey” or with the help of a smoking cessation therapy program, quitting is hard work that takes trial and error, imagination, determination, motivation and innovation. However, it can be done!

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Dengue - Flu- like viral disease spread by the bite of an infected (Aedes) mosquito. Dengue fever usually starts suddenly with a high fever, severe headache, pain behind the eyes, and muscle and joint pain. The severity of the joint pain has given dengue the name "breakbone fever." Nausea, vomiting, and loss of appetite are common. A rash may appear 3 to 4 days after the start of the fever.

The illness can last up to 10 days, but complete recovery can take as long as a month. Most dengue infections result in relatively mild illness, but rarely, some can progress to dengue hemorrhagic fever. Seek medical attention if initial flu- like symptoms worsen, or if any blood is noticed from the mouth, gums or nose or there are any signs of bruising.

There is no specific treatment for dengue. Drink lots of fluids, rest and simple paracetamol containing analgesia may help with the symptoms. Prevention centers around avoiding mosquito bites and eliminating mosquito breeding sites such as discarded tires, flower pots, old oil drums, water storage containers, etc.

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Ear Ache & Ear Infection - There are many causes of earache including trauma, infection or inflammation of the outer or middle ear, impacted wax and dental problems: - to name but a few.

The outer ear or pinna and ear canal can become inflamed and is commonly related to swimming or minor trauma such as scratching inside the ear with an object. The ear may initially be itchy with or without a discharge and then becomes painful subsequently.

The middle ear describes the eardrum and the small space behind the eardrum which is normally filled with air but can become infected and filled with fluid or mucus. Middle ear infection is common in children, but can occur at any age. The main symptoms are earache and fever but feeling unwell, vomiting and decreased hearing are also well recognised features.

The treatment of earache involves the use of painkillers and the elimination or treatment of the underlying cause. In the case of infection, the prescription of antibiotics may be necessary to clear the infection and avoid any further complications. The infection usually clears within a few days of the appropriate treatment.

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Eating Disorders - Eating disorders are associated with psychiatric issues that can ultimately lead to life-threatening health complications. People with eating disorders often have a distorted image of their body. An eating disorder may have a behavioural, learned, emotional, psychological, social or genetic component. Eating disorders were very uncommon in our population two decades ago. Studies have shown that persons with a history of incest or child abuse are more likely to develop eating disorders. Teenage girls and young women account for 90% of people with eating disorders. Eating disorders can lead to serious health issues including:

• Disturbances in the heart's rhythm
• Low blood pressure
• Low body temperature
• Kidney failure
• Osteoporosis
• Retarded physical growth
• Irregular periods
• Infertility
• Anaemia
• Acid reflux
• Dental problems
• Constipation
• Dehydration

Substance abuse, depression and anxiety often co-exist in people with eating disorders.

Teens and young adults, who are still developing attitudes about themselves and food, are more likely to respond to therapy. For others, eating disorders can be a lifelong battle. Get help if you suspect you or your child has an eating disorder.

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Emotional Pain - New brain scanning technologies reveal that the part of the brain that processes physical pain also processes emotional pain. The same way that some people post-injury have great difficulty overcoming chronic pain, science now reveals that up to 10% will be challenged to get over a heartbreak.

Emotional pain can take many forms – e.g.: a relationship break-up or the death of a loved one.

Physical pain warns us not to do something, for example walk on a broken ankle. Similarly emotional pain can be a warning - "don't go near that sort of man/ woman again". Sometimes emotional pain can become chronic, long outlasting its original purpose. Many with chronic emotional pain may experience bitterness and anger.

Studies have shown that there is an increased risk of dying in the six months after bereavement and it's particularly marked amongst men. Generally the bereaved are much more likely to die as a result of accidents, heart attacks and stroke.

Identifying depression in the bereaved is essential for treating those whose emotional pain can become chronic, leading to debilitating depression or even death.

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Fever in children - Fever is a response produced by the brain and in children it is quite often a reaction to either viral or bacterial illness. The increased body temperature aids the immune system to fight infection. Therefore it is the body’s natural defense mechanism in the effort to eradicate infection. Fever is defined as an oral temperature greater than 37.7°C. After your child is found to have a fever he or she may become irritable or uncomfortable and medication can be given to reduce the fever. The most common and readily available medications are Paracetamol (Aramol, Calpol) and Ibuprofen (Advil). Remember to check medication labels for dosing instructions. The child’s appetite is usually decreased, so do not force solid food but ensure that he or she is adequately hydrated, by giving extra oral fluids.

Seek medical attention is any of the following is observed:

• The fever is constant for more that 2 days
• The child appears very sleepy or floppy
• Has neck stiffness
• Is not tolerating oral fluids
• Has a seizure (fit)

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The Flu shot - The flu is an extremely contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness, even death in some instances. The best way to prevent the flu is by getting a flu vaccination (“flu shot”) each year. The flu shot an inactivated vaccine (containing killed virus) that is given with a needle, usually in the arm. October/ November is the best time to get vaccinated, however, you can still get vaccinated in December and later.

While anyone who wants to reduce their chances of getting the flu can get vaccinated. People who should receive the “flu shot” every year include: Children aged 6 months until their 5th birthday, pregnant women, persons 50 years of age and older, people of any age with certain chronic medical conditions (e.g. asthma), people who live in nursing homes and other long term care facilities, health care workers and others who care for the aforementioned. Before receiving the “flu shot” please inform your MD if you have an allergy to eggs or reacted to the “flu shot” in the past.

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Foreign Bodies in the Ear and Nose - A variety of objects (foreign bodies) may become lodged in the ear or nose.

They may commonly include things such as dried beans, small toys, and beads. Children under age five are the most likely to intentionally place foreign bodies in the ear or nose but it is not limited to this age group. The symptoms caused by these objects range from discomfort and pain, to decreased hearing, and sometimes discharge from the ear or nose.

With objects in the nose there is a risk of inhalation of the object into the airway. As simple as it may seem, foreign bodies in the airway, particularly in small children, can be life threatening due to the risk of airway obstruction and suffocation; if the child has difficulty breathing or is choking, immediate medical attention should be sought.

The treatment is to remove the foreign body under direct visualisation, but this may be quite a challenging procedure and certain types of foreign body are difficult to see with the naked eye. Assessment by medical personnel is therefore recommended if there is any doubt whatsoever and further specialist input may be required.

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Fruit Juice Reviewed - The American Academy of Pediatrics issued a policy statement about Fruit Juice, for the full report visit aap.org. Below we summarized the findings and recommendations.

• Juice should never be given infants who are under 6 months of age.
• Do not give juice to infants in bottles or easily transportable covered cups that allow them to consume juice throughout day.
• Infants should never be given juice at bedtime.
• Daily intake of fruit juice should be limited to 4 to 6 oz/d for children 1 to 6 years old and 8 to 12 oz/d for children 7 to 18 years old
• Consumption of whole fruits is preferable to drinking of fruit juice.
• In evaluating obese children one should determine quantity of juice consumed.
• In evaluating children with chronic diarrhea, excessive flatulence, abdominal pain, and bloating, one should determine quantity of juice consumed.
• In the evaluation of dental caries, the amount and means of juice consumption should be determined.
• Primary Care MDs should discuss the consumption of fruit juice and fruit drinks and should educate parents about differences between the two.

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Gastroenteritis in Children - Gastroenteritis is a term used to describe an illness in which there is a combination of nausea, vomiting, diarrhea and abdominal pain. The majority of cases are of viral origin however bacteria and parasites may also be causative agents.

In managing these cases the level of dehydration must be determined as the child may easily be dehydrated due to fluid loss through the vomiting and diarrhea. Therefore the aim is to maintain adequate hydration and avoid dehydration. This is usually achieved by allowing the child to continue to take oral fluids but given in smaller volumes and more frequently. There are specifically formulated rehydration solutions like Pedialyte or Oral Rehydration Salts that are commercially available to replace these fluids and electrolytes.

In some cases the child may need intravenous fluids but then may either be discharged home to continue oral rehydration or be admitted to hospital if the vomiting persists and oral fluids are not tolerated. In addition medication may be prescribed to help with vomiting and abdominal pain.

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Kids and Internet Addiction - Is your child's Internet use affecting their homework, school performance, health (e.g. obesity) and relationships with family/ friends? If the answer is “yes” to any of these your child may be Internet dependant. Children can become 'hooked' on on-line activities – e.g. multi-user games, instant messaging, pornography and chat rooms.

• Compulsive Internet use may be symptomatic of other problems – e.g. depression, anger and low self-esteem. If your child demonstrates strong signs of Internet addiction, seek professional counselling.
• Examine your online habits. Remember, you are your child's most important role model.
• Don't ban the Internet. Establish rules about where your kids can go online and what they can do there - and stick to them.
• Keep your computer in an open area of your house, not in a child's bedroom.
• Encourage your child's participation in other activities - particularly physical pastimes with other children.
• Investigate software that monitors and restricts Internet use.
• If your child seems interested only in playing particular type of online games, try to encourage her or him to read books with a similar theme.

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Meningitis This is the inflammation of the membranes and fluid surrounding the brain and spinal cord; it is usually as a result of an infection. Most cases are caused by a virus, but some are caused by bacteria and fungi. Some cases can be a life-threatening emergency. Early treatment can prevent complications. The early signs and symptoms of meningitis can be mistaken for the flu. Classically the symptoms develop over a 48 hour period. Common symptoms include:

• Fever
• Severe headache
• Confusion
• Stiff neck
• Seizures
• Drowsiness
• Anorexia
• Skin rash in some cases

If meningitis is suspected seek medical attention immediately. There are certain factors that can predispose one to meningitis, such as:

• Not completing the childhood vaccine schedule
• Children less than 5
• Community living e.g. College campus dormitories
• Compromised immune system e.g. HIV
• Working closely with animals

Complications can include hearing loss, blindness, speech loss, learning disabilities and paralysis. In order to diagnose such a lumbar puncture (spinal tap) will be performed.

Treatment will be tailored based on the cause.

Specific immunization may prevent meningitis.

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Migraine - Recent studies have proven that a combination drugs taken within an hour after the start of a migraine is effective in relieving symptoms. This combination includes the drugs sumatriptan and naproxen sodium.

It is well known that most migraine suffers put off treatment. This lost window of opportunity can essentially turn the initially treatable migraine into a refractive headache. The recent study unequivocally proves that treating a migraine at the first sign of pain increases the likelihood of relief.

The study involved well over 1,000 patients who frequently suffered with migraine headaches. Half of the participants (of the study) were given the sumatriptan/naproxen drug within an hour after migraine pain started and while the pain was still mild. The other half was given a placebo (false drug). Neither group were aware of what they actually received.

The study showed that the migraine suffers who received the combination of sumatriptan/ naproxen were more likely to be relieved of their headaches, nausea, light and noise sensitivity, or other symptoms when compared to those who received the placebo.

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Near-Drowning - is the term for survival after suffocation caused by submersion in water or another fluid. A reduced concentration of oxygen in the blood is common to all near-drownings.

The signs and symptoms of near-drowning can differ from person to person. Breathing may have stopped, or the victim may be gasping for breath. Bluish skin/ lips (cyanosis), coughing, and frothy pink sputum are often observed. Rapid breathing, a rapid heart rate and a low-grade fever are common. Conscious victims may appear confused, lethargic, or irritable.

Treatment begins with removing the victim from the water and performing cardiopulmonary resuscitation (CPR). Have someone call an ambulance. Once emergency medical help has arrived on the scene, oxygen is administered. If the victim's breathing has stopped or is otherwise impaired, a tube is inserted into the windpipe to maintain the airway. The victim is also checked for head, neck, and other injuries, and fluids are given intravenously. The victim is then transported to an emergency department. Hospital admission for further observation and treatment is a must for patients who do not appear to recover fully in the emergency department.

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Post Exposure HIV Prophylaxis - Scientific data demonstrate that if anti-HIV treatment (i.e. antiretroviral therapy) is initiated within 24 -72 hours after significant exposure to HIV (e.g. sexual, injection-drug-use and other substantial non-occupational HIV exposure) and continued for 28 days reduces the likelihood of transmission of the HIV virus.

Centre for Disease Control (CDC) recommends:

• The prompt initiation of a specific cocktail of antiretroviral therapy when persons seek care within 72 hours after exposure, the source is known to be HIV infected, and the exposure event presents a substantial risk for transmission.
• When HIV status of source is not known and the patient seeks care within 72 hours after exposure, CDC does not recommend for or against initiating antiretroviral therapy but encourages clinicians and patients to weigh risks vs. benefits on a case-by-case basis.
• When transmission risk is negligible or when patients seek care > 72 hours after a substantial exposure, antiretroviral therapy is not recommended however, clinicians might consider prescribing antiretroviral therapy for patients who seek care  >72 hours after a substantial exposure if, in their judgment, the diminished potential benefit of antiretroviral therapy outweighs the potential risk for adverse events from antiretroviral medications.

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Protect your child from common burns

• Never drink hot (e.g. coffee, tea, cocoa) when you are holding a baby. The baby will reach for it, spill it, and probably get burned.
• Use the back burners of a stove and keep panhandles turned toward the back of the stove.
• After your child can walk, keep hot liquids and appliances away from the edge of a table, counter, or stove.
• Always test the temperature of bath water before your child gets into the tub.
• Give up smoking, or at least carefully dispose of used cigarettes. Cigarettes are a common cause of fires in homes.
• Keep cigarette lighters away from children. Even a 2-year-old child can ignite one by inverting it and pushing it across the floor.
• Install smoke detectors in your home. Check them monthly. Smoke detectors senses smoke long before your nose can.
• Rehearse and have a fire drill.
• Before you place a child less than 1 year old in a car seat, check the seat's temperature. Hot straps or buckles can cause second-degree burns.

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Protecting Yourself from Sexually Transmitted Diseases (STDs) - STDs include AIDS, chlamydia, gonorrhea, genital herpes, genital warts, and syphilis. These are passed through sexual contact with an infected partner.

Ways to reduce your risk of getting a STD:

• Know your sexual partner(s) and limit their number—Your partner’s sexual history is just as important as your own. Remember, you can't tell if someone has an STD just by looking at them.
• Using a latex condom every time you have vaginal, oral, or anal sex decreases the chances of infection. But remember, even condoms are not 100% effective.
• Avoid risky sex practices—Sexual acts that tear or break the skin carry a higher risk of STDs. Even small cuts that do not bleed let germs pass back and forth. Anal sex poses a high risk because tissues in the rectum break easily. Body fluids also can carry STDs.
• Have regular physical exams. Ask you physician to test for STDs if you think you've been exposed. Regular tests help find STDs early, when treatment can be most effective.
• Get immunized—Vaccinations are available that will help prevent hepatitis B and HPV.

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Protect your skin from the sun- The sun's rays contain two ultraviolet (UV) rays that can damage our skin – A and B. UVA primarily causes premature aging, wrinkles, and tanning, while UVB causes sunburns. Both UV rays can cause a range of skin cancers.

Here are some ways to protect our skin from the ravages of the sun’s UV rays:

• Generously apply and reapply every two hours water-resistant sunscreen with a Sun Protection Factor (SPF) of at least 15 that provides broad-spectrum protection from both UVA and UVB rays to all exposed skin.
• Wear protective clothing, such as a long-sleeved shirt, long pants, a wide-brimmed hat and sunglasses, where possible.
• Seek shade when appropriate, remembering that the sun's rays are the strongest between 10 a.m. and 4 p.m.
• Use extra caution near water and sand as they reflect the damaging UV rays of the sun which can increase your chance of sunburn.
• Check your entire skin around your birthday. If you notice anything changing, growing, or bleeding on your skin, see your GP or a dermatologist. Skin cancer is very treatable when caught early.

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Roaccutane Side Effects - Roaccutane (isotretinoin) by mouth reduces production of the skin’s natural oil (sebum). It is reserved for the treatment of SEVERE ACNE that has not improved with standard treatment – e.g. topical medicines, contraceptive pill (for females) and oral antibiotics. Here in Barbados it is sometimes prescribed for mild cases of acne. IT MUST BE NOTED:

• You should never give this medicine to another person.
• Do not donate blood during treatment, and for at least four weeks after stopping treatment
• It can cause major birth defects if taken during pregnancy.
• May cause depression, anxiety, mood changes and rarely suicide attempts.
• Avoid exposing skin to intense sunlight while taking.
• Avoid waxing while taking, and for at least six months after stopping, as waxing could cause stripping of the skin’s top layer.
• Decreased night vision has been reported.
• Your liver function, blood lipids (fats) and blood sugar must be closely monitored because all of these biochemical parameters can be affected.
• Severe bloody diarrhea can occur.

Anyone being prescribed this medicine should ask the prescribing doctor if all the alternatives acne treatment modalities have been exhausted.

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Sleep Position for Young Infants - Healthy infants should sleep on their backs the first 6 months of life. This reduces the risk of Sudden Infant Death Syndrome (SIDS). SIDS is the sudden unexplained death of a healthy infant. Worldwide thousands of babies die yearly from SIDS, typically while sleeping.

Sleeping on its stomach increases the pressure on a baby’s jaw bone which in turn causes the upper airway to become narrower. Also the baby’s nose and mouth is more likely to be compressed while sleeping on its stomach. Babies who sleep on their stomach have a 3 to 9 times greater risk of SIDS when compared to babies who sleep on their back while babies who sleep on their side have twice the risk.

Your baby’s day-care nursery or babysitter should be asked to place your baby on his/ her back to sleep.

Your health care provider may advise you to place your baby on its stomach in rare cases where there are complications from spitting up or in instances where there is a birth defect that interferes with breathing. Any baby who must sleep on his stomach should be placed on a firm surface.

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Some (Noisy) Toys may affect your child's hearing - In a 2006 study it showed that 14 out of 15 noisy toys tested produced noise levels above the recommended safety limit of 85dB..

The most dangerous toys were found to be toy guns. A mechanical toy machine gun, a plastic Tommy gun, and a cap gun were tested and all were found to have noise levels that exceed recommended limits. These guns have the potential to cause serious damage to your child’s hearing and could cause irreversible hearing loss.

How a child plays with a toy can strongly influence the risk to his or her hearing. If a child consistently holds the gun too close to his or her ear or plays with the toy for too long it can adversely affect the child’s hearing.

The experts advise that you should not allow your child to hold noisy toys too close to their ear and don't let them play with them for more than an hour a day.

If you suspect your child might have a hearing problem please carry him or her to your Primary Care Provider.

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Sweet Drinks and Obesity - In Barbados the consumption of sweet drinks has risen over the past 15 to 20 years. Sweet drinks by definition includes Coke, Pepsi, Sprite, 7-Up, Busta, Fanta, Plus, Lucozade, Kool-Aid, all Fruit Juices, sports drinks and many concentrates. In North America there are studies that have linked the consumption of such, in children and adults, to obesity.

As a general rule you should NEVER drink your calories. Fruit juice (even 100 percent juice) and the other drinks mentioned above, contain a lot of calories. They do not fill you up and provide little or no nutritional benefit.

Interesting factoids………….

Drinking just one 12-ounce can/bottle of sweet drink/juice every day for a year is equal to 55,000 calories or 15 pounds a year. Many people think of juice as an essential part of a child’s/adult’s diet. However, juice isn’t as healthy as people think. It’s much healthier to eat the fruit rather than drink the juice.

For the children who are overweight, the basic recommendation is no sweet drinks including juice.

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Top ten vegetables/fruits - You should always aim to eat the most nutritious vegetables and fruit available whenever possible. The beneficial effects are derived from the high concentrations of phytochemicals and antioxidants found in vegetables and fruit.

The evidence shows that phytochemicals found in vegetables and fruits can significantly reduce the risk of cancer, probably due to the polyphenol antioxidant and anti-inflammatory effects. In general antioxidants have been shown to play a major role in reducing the risks of strokes and cardiovascular disease.

When compared to other vegetables broccoli has been shown to hold the top spot as the most nutritious by virtue of the fact that is has the highest concentration of phytochemicals when compared to other vegetables.

The 9 runners-up to broccoli were spinach, yellow onions, red peppers, carrots, cabbage, potatoes, lettuce, celery, and cucumbers. Studies have shown that red peppers actually have the highest levels of antioxidants.

In rating the most nutritious fruit cranberries came in first – with the most phytochemicals and antioxidants – this was followed by apples, red grapes, strawberries, peaches, lemons, pears, bananas, oranges, grapefruit and pineapple

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Teenage Depression Teenagers that are depressed commonly have the following symptoms:

• Irritable or angry mood –They are often grumpy, hostile, easily frustrated, or prone to angry outbursts.
• Unexplained aches and pains - Frequently they complain about physical ailments such as non-specific headaches or stomach aches.
• Extreme sensitivity to criticism – They are plagued by feelings of worthlessness, making them extremely vulnerable to criticism, rejection, and failure.
• Withdrawing from some, but not all people - Teens with depression may socialize less than before, pull away from their parents, keep up at least some friendships or start hanging out with a different crowd.

The consequence of untreated teenage depression includes:

• A drop in school grades
• Violence
• Suicide
• Running away from home
• Internet addiction
• Anorexia
• Substance abuse
• Self injury
• Bulimia
• Low self-esteem
• Reckless behaviour
• Binge eating

The first thing you should do if you suspect depression is to talk to your teen about it in a loving and non-judgmental way. Encourage your child to open up about what he or she is going through.

Just remember once you identify any of depression’s warning signs, seek professional help.

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US Task Force Recommends Obesity Screening for Children, Adolescents - The US Preventive Services Task Force has recently recommended that clinicians screen children aged 6 to 18 years for obesity and develop interventional programs in order to improve their weight status.

Before arriving at their conclusion the task force reviewed 20 clinical trials of behavioural and pharmacologic interventions for obesity and found comprehensive, moderate- to high-intensity programs are effective at helping children improve their Body Mass Index (BMI) – NB: The BMI is an index that is calculated based on one’s weight relative to one’s height.

The proposed program includes a three pronged approach: (1) Counselling for weight loss or healthy diet; (2) counselling for physical activity or a physical activity program; and (3) behavioural management techniques such as goal setting and self monitoring.

In order to reduce the incidence of obesity here in Barbados we should consider routinely measuring all children at least once per year, between the ages of 6 and 18, for height and weight, from which BMI is calculated, This would allow us to intervene in a timely manner if a child is found to have a BMI over the acceptable limits.

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