Is your child getting enough to drink? Tips on preventing dehydration

Image by Michal Jarmoluk, Pixabay

Summer is right around the corner and so are the activities that come with rising temperatures, including festivals and family vacations. While enjoying these activities, it’s easy for your child to be hit by dehydration. What is dehydration? Dehydration is the loss of body water greater than the replacement of it.

Hydration is essential for growing babies, toddlers, kids and adolescents. Children can become dehydrated for various reasons including spending too much time in the heat and losing too much liquid from their body from diarrhea or vomiting. If a child has a stomachache, he/she may refuse to drink enough water. That means when your children are sick, they are more vulnerable to losing water because they generally eat and drink less.

Healthy children who play sports or are active outdoors often lose more water through their skin. If these losses are not replaced, your child can become dehydrated. Here are a few tips you can use to help your child or teenager stay hydrated throughout this summer season.

  • Infants under 6 months of age: Continue to provide breast milk to your child, as this will give baby the nutrition needed. If your baby is formula feeding, check to make sure you are mixing the formula with the right amount of water. Do not provide free water unless indicated by pediatrician.
  • Infants 6 to 12 months: At this age, your child will rely on solid foods and water for hydration. If your child is eating solid foods, try to give food like cooked cereal, bananas or rice. Avoid foods with sugar such as sweetened cereal. If you feel your infant isn’t tolerating oral intake, you can give him or her an oral electrolyte solution (a solution that restores lost fluids and minerals), about 1 tablespoon every 15 to 20 minutes.
  • Toddlers/Preschoolers: Children at this age need about 16 ounces of milk and about 2 to 5 cups of water each day (16 to 40 ounces). If you feel your child isn’t tolerating oral intake, you can give him or her sips of an oral electrolyte solution, ice chips, or a popsicle. You can even make sipping fun by having your child pick out his or her own drinking cup or use crazy straws to add to the fun. As a reminder, juice should be limited to less than 4 ounces a day.
  • School-age children: Water should be the drink of choice. Your child should be drinking at least 5 cups of water (40 ounces a day). Don’t forget to provide fruits and vegetables as these have high water content and are also good sources of hydration. Fruits like watermelon or strawberries and vegetables like cucumber or celery have some of the highest water content. If your child is vomiting, start with small amounts of oral rehydration fluid (1 teaspoon every 5 minutes) and then increase gradually as tolerated by your child.
  • Teenagers: By the time your child is 13 years old, he or she should be drinking at least 8 cups or 64 ounces a day. If your adolescent is bored of drinking water, give it some flavor or color. You can infuse water with fresh fruit such as orange or mint. Avoid drinks like soda as these drinks are linked to long-term weight gain.
  • Children who play sports: Athletes should hydrate at least one hour prior to each activity, as well as during and immediately after the activity. Sports drinks that contain high sugar should be discouraged because they can lead to more water loss from the body, causing serious dehydration. The American Academy of Pediatric recommends 5 ounces of cold tap water for a child weighting 88 pounds and 9 ounces for a teen weighing 132 pounds. For comparison, 1 ounce is about two kid-sized gulps.

When to call your pediatrician

  • Your child is not making tears when he or she cries.
  • Eyes look “sunken” or if child is an infant, the soft spot on the top of the head is “sunken” or flat.
  • If vomiting is persistent and/or has blood in it.
  • Diarrhea is not improving after 24 hours and is worsening (has blood in it).
  • Your child is under 6 months of age and is extremely fussy.
  • Your child does not urinate for 8 or more hours.
  • Your child’s urine appears dark (darker than the color of apple juice).
  • Deep, rapid breathing.
  • Weak pulses.

As a reminder, washing hands can help prevent many of the illnesses that can lead to dehydration. The best way to keep your child hydrated is to provide fluids in frequent, small amounts, especially if your child is vomiting. So as that nice weather rolls in, remember to keep your children hydrated and don’t forget to treat yourself to a glass of water as well.

– Ashima Goyal, DO, is a pediatric resident (PGY-2) at Beaumont Children’s in Royal Oak, Michigan.

Spring clean your diet

Image by Christine Sponchia, Pixabay

Spring finally arrived! Most people are familiar with the term “spring cleaning” and typically associate it with a thorough cleanse of their home. However, “spring cleaning” can apply to overall health, too. From taking walks outside to grilling lean proteins and vegetables, there are many ways to better your lifestyle. This spring I challenge you to incorporate some of the strategies listed below into your lifestyle to help better your health and overall well-being.

  • Do a deep clean of your refrigerator and pantry. Throw out any expired food, but also try to rid your home of any “trigger” foods, like candy, cookies and chips. To prevent waste, consider giving these foods to a loved one or bringing them into work as a treat.
  • Go grocery shopping and restock! Make sure a variety of healthful food options are always available. Think fruits, vegetables, low-fat dairy, lean meats, and healthy fats like nuts and seeds.
  • Start with beverages. Try to drink 64 ounces of calorie-free fluids daily. If you don’t love plain water, try using flavoring drops like Stur Liquid Water Enhancer or infuse your water with your favorite fruits.
  • Eat every three to four hours to help keep your appetite at bay and prevent eating large portions. Eat breakfast within the first two hours of waking up and space your meals accordingly.
  • Try to have at least two servings of fruits and vegetables daily. Aim for a variety of colors and get creative. Put fruits in cereal or try salads as an easy snack.
  • Reduce fried foods. Take advantage of grilling outside, think grilled chicken, kabobs and chicken sausages. If you love fried foods, treat yourself to an air fryer to reduce calories and harmful fats.
  • Swap out your grains. Replace any “white” product like rice, bread or pasta with 100 percent whole grain or whole wheat. The fiber helps keep your gut healthy and keep you full.
  • Get moving! Enjoy the fresh, warmer air and blooming flowers by taking a walk!. Try to move for at least 30 minutes each day.

– Megan Jozefowicz, RDN, is a clinical dietitian at the Beaumont Weight Control Center in Canton.

Protect your melon

ThinkFirst about protecting your brain! A helmet can decrease the severity of a brain injury and even save your life. During a fall or crash most of the impact is absorbed by the helmet, rather than your head and brain.

  • Helmets are 87 percent effective in reducing your risk for a brain injury.
  • Always wear a certified bicycle helmet that fits and is correctly fastened.
  • Replace any helmet involved in a crash or damaged.

Fitting a bike helmet

  1. Measure your head. Select a helmet that fits snugly, then try it on. Adjust as needed with pads or the universal fit ring.
  2. Place the helmet level on your head. The front of the helmet should be one to two finger widths above your eyebrows to protect the forehead.
  3. Adjust the slide on both side straps to form a “V” directly under and slightly in front of the ears. Lock slide if possible.
  4. Center the left buckle under the chin. Make sure the helmet is level. Adjust the rear or front straps to ensure the helmet is not tilting forward or back.
  5. Buckle the chinstrap securely so that no more than one or two fingers fit between the strap and your chin. Secure all straps in the rubber ring, close to the buckle.

Helmets are for more than biking

Always wear a helmet when:

  • Riding a bicycle, motorcycle, snowmobile or all-terrain vehicle
  • Using in-line skates, a skateboard or a scooter
  • Playing a contact sport, such as football, ice hockey or lacrosse
  • Batting and running bases in baseball or softball
  • Skiing or snowboarding
  • Riding a horse

–  The Beaumont, Royal Oak ThinkFirst chapter. Learn more here.

References:
  • ThinkFirst National Injury Prevention Foundation
  • National Highway Traffic Safety Administration
  • Centers for Disease Control and Prevention

Understanding childhood trauma and Adverse Childhood Experiences

image credit: Kat Jayne, Pexels.

Childhood trauma is a growing public health crisis for children today. Research shows that traumatic childhood experiences are increasingly common. It also shows that these negative experiences have a profound impact on the function and development of children. Children exposed to parental substance abuse and domestic violence rarely have secure childhood experiences. The symptomatology tends to be complex and multi-dimensional.

A natural response

Children learn to regulate their behavior by anticipating their caregivers’ responses to them. A caregiver’s response encourages that child to develop an attachment to the caregiver and the environment. Attachments can be both secure and insecure, resulting in a child’s ability to form and engage in relationships for the rest of his or her life. Children’s attachments also impact their ability to regulate their own emotions and senses, as well as adapt to their environment.

Children who experience developmental trauma are often stuck in the “primitive brain,” which is responsible for automatic body functions (breathing, heart rate, and temperature control) and protects us by switching us to survival mode. Survival mode requires an immediate response (fight, flight or freeze) to all possible harmful stimuli. Children who are stuck in their primitive brain due to Adverse Childhood Experiences (ACE) will respond with one of the survival responses and will require co-regulation. These children will require co-regulation much longer than their typically developing counterparts.

Also, children who experience developmental trauma cultivate coping strategies that aid in ensuring safety. However once the child is removed from the unsafe environment, those coping strategies become unhealthy. They inhibit healthy growth and the development of daily life skills that are important for managing impulses, problem solving, and learning and developing higher level thinking and planning skills. These skills take place in higher levels of the brain that are often “offline” and inaccessible due to the quick response of the primitive brain. This limits the ability for information to pass into the higher levels responsible for attachment, relationships, learning, thinking and language. Often these children are misdiagnosed and misunderstood by professionals, friends and family. These misdiagnoses and misunderstandings tend to reinforce the already disorganized patterns of attachment and regulation.

Trauma at an early age

Many professionals and individuals who aren’t educated in the effects of early childhood trauma believe if the child experiences the trauma as an infant or toddler, then the child doesn’t remember the trauma and therefore won’t be affected by it. However that is not the case.

Because language hasn’t developed at that young of an age, memories of the trauma aren’t stored in language, so the child cannot necessarily describe or recall the event in words. Instead it is stored “physically” in sensations and sensory memories.

Infant brains function mainly in the brainstem, the primitive brain, therefore their experience of trauma is held in primitive responses (heart rate, temperature, respiration rate). The child’s sensory system develops with limited ability to effectively filter sensory input due to its over or under response for survival. As a result, the child grows up re-living the trauma through natural body functions, without the ability to put words to the trauma. The child also has difficulty telling the difference between danger or natural body responses to safe experiences that cause activation of the automatic brainstem (aka primitive brain).

Trauma in infancy causes disturbances to the sensory system, which often brings the children challenges in making sense of the world through their senses, including knowing how much pressure their body is exerting, differentiating differed textures, and understanding where their or her head and body are in space (balance and coordination). It also makes it difficult for the child to manage his or her own emotions and regulate responses. Often there may be an increase in anxiety and depression, with the child expressing this through behavioral issues and anger outbursts.

Treatment is available

Beaumont’s Trauma Regulation Treatment team uses a multidisciplinary approach within a medical model for children who have experienced abuse, neglect, peri- and post-natal substance exposure, invasive medical treatments, and/or exposure to community trauma. Our goal is to provide education and support to aid parents and caregivers in understanding the impacts of trauma on their children. Our team is composed of an occupational therapist, a behavioral health therapist, and a physical therapist who work closely to address underlying issues caused from trauma exposure. This interdisciplinary approach supports a combination of bottom-up (occupational and physical therapy) and top-down (behavioral health) treatment to calm the response of the child’s primitive brain and encourage increased access to the relationship and executive functioning parts of the brain. This lets the child develop use of all parts of the brain for neurological growth and development while addressing attachment, regulation, sensory motor challenges, and natural processing of trauma experiences. Our treatment approach values the efforts and inclusion of the caregiver into the treatment team to provide education and resources, empowering the caregiver’s efforts to better support their children through daily growth and development.

Resources

The information above is derived from pioneers in the areas of trauma and child trauma: Bessel van der Kolk M.D. and the National Child Traumatic Stress Network, Bruce Perry M.D. Ph.D and the Child Trauma Academy, and Vincent Felitti M.D. and his work with the Adverse Childhood Experience (ACE) study.

For more information on childhood trauma and treatment options refer to:

– Sara Gariepy, MS OTRL, CATP and Kristin Rosales, MSW, CATP are with the Beaumont Center for Children’s Rehabilitation team in Macomb.

What is the ketogenic diet?

keto diet foods

A ketogenic diet is a low-carbohydrate, moderate-protein, and high-fat diet that results in ketosis. Ketosis is a process your body uses when you consume low amounts of carbohydrates.

Carbohydrate and fat are two main energy sources for your body. However, your brain cannot use fat directly for energy, so your liver needs to convert fat into molecules called ketones. Ketones can be used by your body and brain for energy. This can help with weight loss because your body can use your fat for energy if calories are restricted. In normal circumstances, ketosis is a safe metabolic state but in some cases, ketosis can be a symptom of an underlying condition, such as diabetes.

What can you eat on the ketogenic diet?

  • Fatty cuts of meat, such as New York strip, T-bone and ribeye steak, pork belly, lamb chops, chicken thighs.
  • Whole eggs.
  • Full-fat dairy, including cheeses, yogurt, sour cream.
  • Non-starchy vegetables like broccoli, Brussels sprouts, cabbage, cauliflower, celery, leafy greens, cucumber, eggplant, onion, etc.
  • Vegetable oils, such as olive oil, canola oil, coconut oil, sunflower oil, butter, coconut oil, palm oil, avocado oil.

What to avoid on the ketogenic diet?

  • Grains, such as wheat, oats, barley, rice, and quinoa.
  • Most fruit, such as bananas, apples, pineapple, cantaloupe, figs, and all other fruit high in carbohydrate.
  • Starchy vegetables, such as potatoes, pumpkin, acorn squash, butternut squash, corn.
  • Legumes and beans.
  • Carbohydrate-dense food/beverages, such as donuts, deserts, juices, sodas, candy, chocolate bars, beer.

It may help:

  • Epilepsy. The ketogenic diet has been clinically shown to treat seizures.
  • Weight loss. The ketogenic diet may result in quick weight loss, but is not medically advised due to the list of cons below.
  • Type 2 diabetes. The diet is low in carbohydrates and may help with blood glucose control.
  • Cancer. There is growing research suggesting that tumor cells can burn glucose more effectively for energy, therefore starving tumor cells of glucose can inhibit growth.

It may cause:

  • Nutrient deficiencies. Since food groups such as grains and fruit are restricted from the diet, nutrient deficiencies can result, such as fiber, B vitamins, magnesium, and zinc.
  • Keto flu. Reduced intake of carbohydrates can lead to symptoms such as fatigue, headaches, hunger, irritability, constipation, and brain fog.
  • Gut health. Fiber is food for probiotics in the gastrointestinal track. A low-carbohydrate diet is typically low in fiber, which means there is poor probiotic support for growth.
  • Adherence. Long term low-carbohydrate and high-fat eating can be difficult to follow for some because this type of eating pattern isn’t very practical.

– Ruslan Shkaradyuk is a dietetic intern with Beaumont Health. The Beaumont Weight Control Center offers cooking classes to kids in the community. View a list of upcoming classes here.

11 health concerns to discuss with your teen

doctor talking with mom and teen

Photo credit: Rhoda Baer, Wikimedia Commons

  1. Nutrition. As teens become more independent, their eating habits frequently change for the worse. Family dinners are replaced by pizza with friends or fast food between extracurricular activities. At the same time, increased social pressures can result in body image issues and eating disorders.
    What parents can do: Continue to stress the importance of fueling your body with good food, stock the refrigerator with healthy options, and model good eating habits. If the teen no longer drinks milk, introduce calcium and vitamin D supplements to strengthen their bones during this time of growth.
  2. Sleep. Teens are sleeping less and less. Between extracurricular activities, school, friends, and electronics, sleep becomes a teen’s last priority. Sleep is very important however and teens need nine hours of sleep a night on average. Not getting that amount is associated with everything from poor school performance to obesity to depression.
    What parents can do: Emphasize regular bedtimes, restrict phone use at night, limit activities, and talk to your schools about later start times.
  3. Exercise. There are kids who struggle with both too much and too little. Athletes who specialize in single sports at a young age suffer from overuse injuries and burnout. Kids who don’t have opportunities for regular exercise struggle with obesity.
    What parents can do: Encourage a goal of at least one hour of aerobic activity every day. For athletes, emphasizing cross-training and breaks can help with injuries.
  4. Vaping. E-cigarette use has been rising exponentially in teens over the past several years. Now, about 1/5 teens have used them! The chemicals in the vapor are toxic, but more importantly, the nicotine in e-cigarettes is highly addictive. It makes it much more likely that they will go on to use cigarettes. It also affects the developing teen brain.
    What parents can do: Talk to your teens early about the dangers of e-cigarettes. For more information on vaping and adolescents, check out this article.
  5. Marijuana. As many states are beginning to legalize marijuana, we are seeing increasing use in teens. They view it as the “safe and natural” drug since it is legal. However, marijuana has significant negative effects on the developing teen brain. It is not safe for kids to use! In addition, many teens are using their e-cigarettes to vape marijuana.
    What parents can do: As with vaping, talk to your teens early about the dangers of marijuana.
  6. Alcohol.Thirty percent of high school students drink so this is a topic you can’t skip. Of particular concern is that many teens are drinking hard alcohol rather than beer and they are much more likely to binge drink. This is particularly concerning because they are much more likely get alcohol poisoning; teens need to understand that drinking strong liquor quickly can be very dangerous. 
    What parents can do: Start discussing this important topic early and consciously model responsible behavior. Timing is crucial as you don’t want to bring it up for the first time as the teen is walking out the door to go to a party. Use a news story, movie or TV show to bring it up in a relaxed atmosphere like dinner. Luckily, teens now are generally much smarter about drinking and driving, but that is still something that should be discussed with every teenager before they get he or she gets a driver’s license.
  7. Acne. Acne is one of the most stressful parts of being a teen. So much of a teen’s identity revolves around his or her appearance. Luckily, there are many options for acne treatment now; they don’t need to suffer through it.
    What parents can do: Let your teen know that acne is not a hygiene issue and that over-scrubbing his or her face can actually make it worse. If over-the-counter medications don’t work, talk to your pediatrician.
  8. Sex. The “birds and the bees” talk is one of the big milestones that your child is growing up. Although it is awkward (for both the parent and the kid), it is critical for your teen to get accurate information from you rather than inaccurate information from friends.
    What parents can do: Giving your teens a book to read beforehand (or together) is a good way to start the conversation. Being open-minded and non-judgmental will go a long way to keeping the lines of communication open between you and your teen for years to come.
  9. Hygiene. Hygiene can be another awkward conversation but is vital to discuss. Some kids figure this out on their own; others need some guidance.
    What parents can do: Let teens know that the changes in their body make it important for them to care for themselves differently. They need to shower every day, use deodorant and wash their clothes regularly.
  10. Bullying. No matter how many educational sessions teens have, after-school movies they watch, rules that guide them, bullying continues to be a big problem. And now with social media, bullies have a whole new and particularly vicious way of tormenting their peers.
    What parents can do: Open the door to conversation by bringing up stories that you hear. Keep a watch out for signs that your teen is being bullied and get help early if you suspect bullying. Beaumont Health’s anti-bullying program, NoBLE, has resources.
  11. Mental health. Many mental health disorders such as depression, anxiety, and schizophrenia present during adolescence.
    What parents can do: Talk with your teen about mental health, especially if there is a family history. Like with bullying, look for signs such as mood swings, change in activity or sleep or appetite, loss interest in friends or activities, or substance abuse. Don’t assume these changes are “normal teen behaviors.”

Many of these topics don’t need a formal, sit-down discussion. In fact, those can make your teen uncomfortable and less likely to hear what you are saying. My favorite way to bring up many of these topics with my teens is in the car using a situation I had heard about. For example, when we were travelling near a college campus, I commented on all the vape shops I saw and mentioned that I was worried about e-cigarette use. My then-12-year-old son reassured me that e-cigarettes were perfectly safe – just water vapor – and that one of his friends got one for Christmas. What?! But that opened the door for conversation and I got a chance to have a really good discussion about vaping.

Good luck! The teen years are both wonderful and terrifying, but before you know it, they will be gone and you will miss them.

– Rita Patel, MD, MPH, is the associate director of the pediatric residency program at Beaumont Children’s Hospital. She is also an associate professor at OUWB School of Medicine.

Keeping children’s hearts healthy

boy getting a Beaumont Student Heart Check

Sudden Cardiac Arrest (SCA) is not something many parents think about in the long list of worries when it comes to their teenager’s health. We make sure our kids have their required sports physicals, and we pay attention to the required concussion education each school year. What parents don’t know is that SCA is the leading cause of death in student athletes. Did you know we lose one student athlete every three days in our country to SCA? Here are some things we can do as parents to make sure our children’s hearts are healthy and that their schools are prepared should a cardiac event happen on campus.

Learn CPR and how to use an AED

CPR has been around since the early 1900s and has helped save millions of lives. In 2008 the American Heart Association released a statement recommending bystanders who witness a sudden collapse should first call 911, ask someone to get an AED (automated external defibrillator) if available, and start high-quality chest compressions pushing hard and fast in the middle of the chest at 100 to 120 compressions per minute.

High-quality chest compressions replaced the recommendation to do mouth-to-mouth to break the hesitation people felt about breathing for a stranger. AEDs are becoming more common in the community. They don’t require extensive training to operate, and once turned on, it walks you through the steps to use it with an automated voice. Effective CPR provided by a bystander in the first few minutes of cardiac arrest can increase the chances of survival by two or three times.

Make sure your child’s school is heart safe         

Michigan law states that each school must have a Cardiac Emergency Response Plan and have staff identified to respond to a cardiac emergency. Although schools are not required by law to have an AED, or enough AEDs for their campus, there are many charity groups who provide AEDs to schools free of charge. Michigan also has a designation for schools that have taken additional steps to ensure they are prepared to respond appropriately to a sudden cardiac emergency on campus called the HEARTsafe School Award. This award recognizes schools that have a trained cardiac emergency response team, clearly identified AEDs, a certain percentage of staff and coaches who are certified in CPR, and requires that the school conduct an AED drill each year to practice the response time. If your school is not a HEARTsafe school and they are interested in becoming one, we can help.

Sports physicals and symptoms are important to pay attention to

Have you ever cruised through filling out that sports physical form, not really reading the health-related questions regarding family history and previous symptoms your child might have? It is important for your child’s physician to have all the information requested to evaluate your child’s health for the upcoming sports season. Let your physician know about any close family members with heart conditions or any who have died unexpectedly at a young age. Take symptoms your teen reports during sports seriously such as unusual shortness of breath, heart palpitations, chest pain, fainting/collapsing, or seizures during or after exercise. With all the information, your physician can refer for cardiac testing if indicated.

Bring your teen to a Beaumont Student Heart Check

The Beaumont Student Heart Check program offers a free community screening program at local high schools across metro Detroit four to six times a year, and a regular clinic screening program at the Ernst Cardiovascular Center in Royal Oak for a small fee of $25. This program is open to any student between 13 and 18 years old. Students receive a blood pressure check, cardiac history and physical, EKG, and a “quick look” echocardiogram (ultrasound of the heart) with Beaumont staff and cardiologists. Students also receive education on hands-only CPR and how to use an AED.

Since 2007 the program has screened 17,492 student athletes. Of those, 1,797 could continue sports but were recommended to see their physician, 207 were recommended to stop sports until they followed up with a cardiologist for several congenital heart conditions and abnormalities, and nine were found to have hypertrophic cardiomyopathy, the leading cause of death for young athletes. To find an upcoming SHC screening, visit beaumont.org/student-heart-check.

– Jennifer Shea, Student Heart Check Manager, Beaumont Heart & Vascular Services