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Applied Behavior Analysis

September 20, 2017 by  
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by Monica Lee, MD

 

“Point to red” is a common refrain I hear daily. My son says it out of the blue several times a day. He is probably thinking about one of his Applied Behavior Analysis (ABA) therapy sessions he gets at home six times a week. A therapist will sit with him at the dining room table and repeatedly ask him to point to red and reward him with a treat when he does. They will continue this until he masters the task at 80 percent in two consecutive sessions. Ever since he started 15 hours or more of therapy a week, he has been making huge improvements each month. I kick myself for not starting this therapy sooner. His Behavior Interventionists (BIs) work tirelessly with him every day to help improve his joint attention, speech, and social skills. ABA is a growing field where there are just not enough workers to fill the need. BIs are entry-level workers who receive several weeks of training and then usually independently work with children with autism. They get paid just above minimum wage and are subject to often rough treatment from their subjects, who often kick, bite, and scratch when frustrated.

I have no excuse for not starting ABA that first year after my son was diagnosed. I was still in shock and too depressed to read anything educational. I couldn’t even get through the Regional Center’s parent training program. Because of his declining skills, we tried speech therapy right around the time he was two years old. He made no progress after a month of weekly sessions there. And all the speech therapist could say to us was how much he was likely to have autism. A few months after that, we started ABA for three hours a week; it was not enough. We wanted to keep him at the same day care since we had such a difficult time getting him child care, but the day care declined to let an ABA therapist work with him there.

Finally, I moved and we needed different child care anyway. We tried a neurotypical preschool, but he didn’t do well there, so we finally had to get a nanny. That is when he really started to improve. We were then able to get at least 15 hours of ABA a week in a consistent and peaceful environment. He was finally potty trained when he was five and a half, and he even started answering questions with “yes” and “no,” which was something I never thought he would be able to do. He is now able to name relatives in photos. We also found an amazing speech therapist who works with him twice a week. And just two days ago, he finally greeted me excitedly at the door with, “Mommy, Mommy, Mommy.” This was something he had never done before and hasn’t replicated since, but it gives me so much hope. He is almost six years old, and I hope with the help of ABA and speech therapy, this will be the year he will start calling me “Mommy” consistently.

Here are some tips if you suspect your child might have autism:

  1. Get a diagnosis from your pediatrician, pediatric neurologist, developmental pediatrician, or psychologist ASAP.
  2. Have your pediatrician then refer your child for ABA therapy, speech therapy, and occupational therapy. Most health insurance carriers in California will cover this. If not, switch to one that does or move to a state that does.
  3. If you live in California, your Regional Center will cover costs for therapy not covered by your insurance carrier.
  4. During a child’s first five years, his or her brain is most “plastic,” or flexible and able to change and make neural connections based on what the child experiences. This means that the earlier an autistic child receives therapy and the more hours of therapy he or she receives, the more likely you will see progress. Studies show that if children get 40 hours or more of early therapy for two or more years, they have a much higher chance of having a normal IQ.*

About the Author: Monica Lee, MD, is a mom of one son and an ob-gyn in the LA Metro area.

*Lovaas OI, “Behavioral Treatment and Normal Educational and Intellectual Functioning in Young Autistic Children,” Journal of Consulting and Clinical Psychology 55, no. 1 (Feb 1987): 3–9.

A Promising New Drug for Autism!

August 17, 2017 by  
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by Monica Lee, MD

 

When I walk through the door, I am usually greeted by my son sitting next to his therapist. She will prompt him to say, “Hi ___.” He usually ends up saying, “Hi Brenda, please” (his nanny’s name). He is five, almost six. You might find this a bit peculiar, but I am used to it. You see, having a child on the spectrum means you have to be okay with your son never calling you mommy. On the outside, I remain cool and calm since I have no other children and have never been called mommy, so you know, it’s not like I’m really missing anything. Inside, of course, is another matter. I would pay a lot of money to hear my son call me mommy on his own.

Through the years we have heard of many different alternative therapies for autism including GABA, cannabis oil, and Vayarin, but all the studies relating to them were unsubstantiated and the safety could not be proven. So when I heard about suramin, my heart did a little leap and is still pitter-pattering. The article I read was in The Economist, a well-respected journal, and it seems the drug has already been used in the past to help people with African sleeping sickness and river blindness. Researchers reported some amazing results in the autistic boys taking the drug, including one boy speaking a full sentence for the first time in 12 years! Another boy, who is five years old, started smiling and actually said to his mom, “I just don’t know why I’m so happy.” And on top of that, it has been shown to be effective in a small randomized controlled trial, the gold standard of clinical trials! After reading the article, I immediately sent it to different friends who might be interested in such developments, aka other MD parents of kids on the spectrum, and they were as excited as I was. My son’s dad was just as excited and wanted him to try it right away.

Being the doctor that I am, I delved deeper into suramin and found out that the research is being conducted at UC San Diego, which is within driving distance of Los Angeles, where we live! However, when I looked up the trial in the database at ClinicalTrials.gov, I learned that the lead researcher, Dr. Robert Naviaux, is not recruiting at this time for new subjects. Wikipedia says I can potentially get the drug from the CDC (Centers for Disease Control and Prevention), but this gives me pause because the drug needs to be given intravenously and also I wouldn’t want to dose the medicine and monitor my son myself. This whole journey has made me wonder how far I will go to see my son act normally. How amazing is this idea of hope based on a single article I read online. Now I will be sitting at the edge of my seat waiting for larger phase 3 clinical trials of this drug to demonstrate safety and efficacy.

Here are some tips if you start getting excited about a potential treatment for your child:
1. Consult first with your pediatrician. The doctor may have first-hand knowledge and access to many more databases and sources of information than you do.
2. Make sure that the treatment is safe. Confirm that it is FDA approved and has gone through phase 3 clinical trials at least or has been used for other purposes and safety has been demonstrated.
3. Call into question the sources proclaiming efficacy of the herb, treatment, or remedy. Does the source tend to gain financially if you buy what they’re advocating? Is it government regulated? Does the source have a good reputation or is it nonprofit?
4. Check ClinicalTrials.gov to see what trials are being conducted in your area and if they are recruiting new subjects.
5. Remember that we all want to see our children get better, and we want to keep them safe too!

About the author:  Monica Lee, MD, is a mom of one son and an ob-gyn in the LA metro area.

How the Movie Buck Changed Me as a Parent

July 31, 2017 by  
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by Monica Lee, MD

I get really frustrated with my son. He is five and has autism, and it has been really difficult for the last three years. He was diagnosed when he was two years old when he started to lose words. A friend noticed and sent us a long e-mail about how he needed to be tested. At first we were taken aback, but we knew she was right. It took us several months to make sure he didn’t have hearing problems. We got him ear tubes and sedated him for a complicated hearing test. Then we had him see a neurologist and a psychologist. But we still couldn’t believe our son had autism. So nine months after the first diagnosis, we finally saw a more “traditional” pediatric neurologist than the first “maverick” one and got basically the same diagnosis.

At least that helped explain why he never asked for anything with words, but would pull our hands to what he wanted. But what hurt the most was when he was stubborn and didn’t want to do something that we thought was necessary, like brush his teeth or get into his car seat when we had to go somewhere. He didn’t have the words to tell us why. When he was younger, we just kind of made him do our bidding. I remember when we would have to hold him still to brush his teeth. Or the time when, unbeknownst to us, he put a piece of foam in his ear and, weeks later, I could smell something rotting. We had to straitjacket him for the doctor to remove it.

A friend made me watch a movie one day, and it changed my perspective on getting the behaviors I wanted. The movie was Buck. It is a documentary based on the real-life horse whisperer. It is about a man who was severely abused as a child and who used that knowledge to help people train horses. He uses only gentle persuasion and never a hard hand. He gently tugs the reins to help guide the horse to his bidding. Anytime he sees a violent and fearful horse, he recognizes that the horse has been abused. The friend who showed me the movie is a golf instructor, and he uses the same principles as a guide in his life and with his clients on a daily basis. After watching this film two years ago, I have let go of my frustrations and tried to use only gentleness and reasoning when dealing with my son. I think it has brought us closer together. Now when I want him to do something, I whisper gently in his ear and am patient if he doesn’t want to do things the first, second, or third time I ask him. The trick is to make him understand that it won’t hurt, and that it is good for him and might actually be fun. He is less frustrated, and so am I.

My son now gets intensive applied behavioral analysis therapy six days a week, and he is showing improvement on his monthly evaluations. The therapists use the same positive reinforcement principles I’ve learned to guide behavior changes because science shows that they produce longer-lasting change than negative reinforcement does.

I think that this principle of positive reinforcement can be used to improve any child’s behavior, including those without learning or behavioral challenges. Some ideas of positive reinforcement include:

  1. Giving a reward for A’s on a report card.
  2. A hug and a kiss for any kind act they might perform, such as sharing toys.
  3. Taking a child to a homeless shelter to give to those in need so that they understand the intrinsic feeling of good that comes from charitable giving.
  4. A monetary reward for chores they might do around the house.

There are so many ways, can you think of others?

About the Author: Monica Lee, MD, is a mom to a 5-year-old son and ob-gyn practicing in the LA Metro area.

 

Fall’s Beautiful Sunlight

October 30, 2016 by  
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by Mommy MD Guide Ayala Laufer-Cahana, MD

vegHave you noticed fall’s beautiful sunlight filtering through the trees? Take it as a reminder to be kind to yourself this season.

As colder weather sets in, immerse your body in vegetables and fruits throughout the day, so it’s teeming with antioxidants, plant-based nutrients and more.

Here are a few ideas:

  • Try Meatless Monday
  • Try vegetarian before 6: Eat fruit & veggies, whole grain and unprocessed until dinner, eat as you normally would in the evening
  • Shift your meat-to-plant ratio in favor of plants

My Magic Spice — coming soon — will help make your plant-based dishes sing and dance. Stay tuned to be the first to receive a free sample.

In the meantime, here are a few plant-based recipes, with love, from my kitchen.

Bests,

Dr. Ayala

Why are we painting our pumpkins teal?

October 17, 2016 by  
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By Mommy MD Guide Jeannette Gonzalez Simon, DO

teal-pumpkinHalloween is a great time of year.  Kids get so excited about dressing in their costumes, going to a Halloween party, marching in their school Halloween parade and eating Halloween candy.  But what about the kids who can’t eat Halloween candy.  What about them?  Many kids have to abstain from trick-or-treating because they cannot eat the candy safely.  It can be for a variety of reasons.  They may suffer from celiac disease, diabetes, a nut allergy, other food allergies and intolerances or they may need to follow a special diet. Why should these children not be able to enjoy the festivities?

For many years, some parents kept their children from this celebrating this tradition to protect them from a possible anaphylactic reaction or severe allergic reaction.  Then the campaign called #THETEALPUMPKINPROJECT started.

Last year, I saw a few Teal pumpkins painted in my neighborhood.  It piqued everyone’s curiosity. Many just thought “oh how pretty.”  But what is the purpose?  In 2014 the Food Allergy Research & Education (FARE)  launched a national campaign called the Teal Pumpkin Project™.  The Teal Pumpkin Project raises awareness of food allergies and promotes inclusion of all trick-or-treaters throughout the Halloween season.  This nationwide movement offers an alternative for kids with food allergies, as well as other children for whom candy is not an option. It keeps Halloween a fun, positive experience for all!

It seems a daunting task at first.  Many say, “I don’t want to be the house not giving out candy or chocolate, the kids will hate us and egg our front door!”  In reality there are many really cool fun non-food items that you can hand out.  Kids would love to get glow sticks or glow bracelets.  They will undoubtedly put them on immediately and use them the rest of the night.  Bouncy balls, stickers, tattoos are all great options.  You can find a list of recommended non-gift treats here at FARE’s website.

To let the neighborhood now that you are participating in this event you can paint your pumpkin teal and also put up one of the FAREs downloadable signs on your window or front door. And YES, you can still give out candy if you choose too.

For a Successful School Year: Get Enough Fluids

September 21, 2016 by  
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by Mommy MD Guide Ayala Laufer-Cahana, MD

Is the water bottle your constant companion, or are you the type that trusts we can do just fine in between hydration opportunities? Does hydration status really matter all that much?

Clearly, dehydration is an unhealthy, dangerous state. Even mild dehydration – loss of just 2 percent of body weight in water – makes us less alert, affects our well-being, and of course makes us feel thirsty. But going without water for just a few hours hasn’t been studied much up until now.

4 HOURS WITHOUT WATER

A new study, led by David Benton, in the American Journal of Clinical Nutrition, recruited 101 undergraduate students, aged 18-30 years, and put them in a warm (86 °F, 30 °C) room for 4 hours, during which they performed cognitive tests.

Half the students got a 5oz drink of water 90 and 180 minutes into the experiment.

The students were not aware that what was tested was the effect of hydration on cognition – they were told that the experiment was about the effects of heat. The tests, which were repeated 3 times throughout the 4-hour study, included memory recall quizzes — in which the students were given lists of words, and asked to recall as many as they could remember immediately after, and then again 20 minutes later — attention tests and subjective mood scores.

Students that didn’t drink water forgot more words in both the immediate and delayed memory recall test, and had poorer attention scores. The students who got some water also reported less anxiety at the end of the test.

The 26 men and 24 women who had no water for 4 hours lost on average 0.72 percent body weight, but at 90 minutes into the experiment the participants lost just 0.22 percent body weight, which is very little. Nevertheless, memory was already affected.

IS YOUR KID DRINKING ENOUGH WATER AT SCHOOL?

This experiment suggests that even small changes in hydration can make a difference. Mood and alertness are the first to be affected when our body needs food and drink, and while mild changes in body fluids certainly don’t put us in danger of dropping blood pressure or shutting off our kidneys, proper hydration can help a student to perform at his best. Kids also lose a larger proportion of their water due to their smaller size and higher activity levels. The authors cite a few studies that prove that as a first-grader, a drink can help you think, and that 7-9 year olds that got an additional drinkperformed better on visual attention tasks.

As the school year starts, giving kids access to good drinking water, and reminding them to take that drink is a really simple way to make sure studying’s a little bit easier and happier. Hydration affects mood and if we can buy a little peace of mind with a glass of water lets do it.

By federal law, free drinking water has to be available to students during school meals. In between, kids should have access to plain water throughput the day, but policies change state-to-state and district-to-district.

Does your school have functioning water fountains? Unfortunately, due to old pipessome school fountains have been found to dispense water with unsafe lead levels.

So, as the school and academic year commence, encourage kids to pay attention to hydration, check that they have access to water that has been tested, and set an example by drinking enough yourself.

To a happy and healthy school year!

Dr. Ayala

Signs Your Child May Need “Sleep Training” {aka Parent Training}

August 14, 2016 by  
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by Mommy MD Guide Nilong Parikh Vyas, MD, MPH

Signs Your Child May Need Sleep Training: A Pediatrician’s Tale

Having a baby was one of the most wonderful, emotionally satisfying and beautiful things that has ever happened to me. After the initial exhilaration wore off and we finally got to take our bundle of joy home, it suddenly hit us: now what do we do? The reality was that – as amazing as it all was – I had no idea what to do. Combine that with the exhaustion from lack of sleep and, well, it was a bit overwhelming. Then came all the well intended advice from friends and family…

“You will be so exhausted but because you love your baby so much, you’ll somehow get through it.”

“You will want to hold that baby in your arms all day, everyday, and never put him down,”

“It’s the best thing that has ever happened to you so just deal with all the hard stuff!”

“You can sleep, shower and eat – when the baby sleeps.”

Granted, some of those things turned out to be true, but for me it was hard. Really, REALLY hard. I was not just physically exhausted but emotionally as well. I loved this baby; I really wanted this baby. I wanted to spend every waking moment with this baby, but wait … did I really? I was beyond tired, and it proved to be much more difficult than I expected. I thought that I was well-qualified for motherhood because I had loved (and was good at) all my baby-sitting jobs growing up. Moreover, I was a trained pediatrician. But I quickly realized that neither the universe nor pediatric residency prepared me for the hardest job of them all: motherhood.

My bundle of joy was 4 months old, super cranky and so was the rest of my family. He was cranky when I held him and even crankier when I put him down. He would fall asleep in my arms, but as soon as I would put him down, he would wake up, cry, and the process would start all over again. I would get him to sleep, walk out of the room, the floorboards would creak and he would be up again. Repeat. Repeat. Repeat. They say that the definition of insanity is doing the same thing over and over and expecting different results.

I had to do something for the sake of my child and my own sanity…

The Solution: Sleep Training (aka Parent Training)

The one common thread through all the books I read on the topic of sleep was that I needed to follow my baby’s cues and let him guide me (instead of the other way around). I had to figure out what he was trying to tell me that I couldn’t hear, couldn’t judge or wasn’t listening to properly. As I watched him more closely, I noticed a pattern emerging. I monitored his sleep cues, as well as his hunger cues, trying my best not to confuse the two. I noticed that when I followed his sleepy cues, he would sleep. When I followed his hunger cues (and fed him only when I saw those), he ate better, which led him to sleep better, which led him to be happier. A less cranky baby led to a less cranky mommy. Common sense, right? But oh so hard to decipher when you’re in the thick of infant sleep deprivation, adjusting to motherhood and possibly returning to work on top of it all.

As I made this change, my son’s sleep cycles and feeding cycles became more predictable and so did my own life. Granted, I had many friends and family that told me they were “anti-schedule.” They said things like, “let the baby decide when he’s hungry and sleepy, and do not put him on a schedule. Let him sleep when he wants to and feed when he wants to.” Was putting him on a “schedule” going against nature and doing something wrong for my baby?

I soon realized that I was indeed following nature (my baby’s cues), and a schedule was emerging on its own, with only a minimal amount of input from me. This wasn’t MY schedule; it was my baby’s schedule. Then, I knew with confidence that I was doing the right thing. Not only did I notice a palpable increase in both mine and my baby’s overall happiness, I also noticed significant jumps in his development. I had the baby that everyone noted “you are so lucky to have such a sweet, happy and alert baby. He is so easy but wait until you have the next one!” Well, guess what? I did have that next one, and I put the same principles into play. And what do you know? I got really lucky. TWICE!!

Note to all: luck had nothing to do with it!

So What Is Involved With Sleep Training?

Many people think that sleep training is harmful to your child, that it involves leaving your child to cry for hours on end and that it’s akin to cruel and unusual punishment. What terrible parent would have a baby just to torment that child into fitting into their lifestyle and schedule? NO ONE!!

Sleep training is not the best term. It should more appropriately be called sleep adjustment, sleep tolerance, sleep associations, or my personal favorite: Parent Training. Just call it anything BUT sleep training. Parent training means that you are training yourself, as a parent, to learn what the baby is trying to tell you. In fact, you don’t have to do any of the hard work: just figure out your baby’s cues, and they will lead you. If you do that, the rest is easy and falls into place. It’s a matter of assessing his/her needs and putting in the necessary steps to fulfill those needs. In the process, he learns to soothe himself. You have to establish routine and consistency, and everyone can at least agree that a child needs that to grow and meet their milestones to reach their full potential.

If a child is not well-rested, it can lead to numerous problems throughout his lifetime. In the short term, sleep deprived children can be slow to meet developmental milestones. Of course kids will ultimately learn to walk, talk, read and write, but it’s more likely to happen readily and without much challenge if the child has had adequate sleep. A well-rested child is emotionally stable, more capable of dealing with the world around her and more willingly redirected. Lastly,a well-rested child yields a well-rested adult, which in turn allows you to be at your best when interacting with your child.

So how do you know if your family may benefit from parent training?

What Are the Symptoms of Sleep Deprivation?

  • Your child usually cries when you put them down to sleep
  • You have to lay with your baby for them to fall asleep
  • Your child falls asleep every time they are in the car
  • She is difficult to soothe and put to sleep
  • She is a perpetual ‘catnapper’
  • Multiple things have to be done to get her to sleep including continuous rocking, feeding, bouncing, walking, etc
  • Your child will fall asleep when you are holding her and wake moments after she is put down, even when you thought she was ‘fast asleep’
  • She cries even when you are rocking her
  • She takes longer and longer to fall asleep in your arms. This is mostly because children get distrustful when they fall asleep one place and wake up in another. Imagine if you fell asleep on the sofa and ended up in your bed – it would be very confusing for you! For the child, falling asleep in your arms then waking in their crib is more than a little disconcerting
  • If your child has been deemed ‘very active, hyper, can’t stop, always on the go, and doesn’t need much sleep’. Hint: ALL children need sleep and plenty of it

If you said yes to any of the above statements, it’s likely that your child suffers from sleep deprivation. It is one thing if you want to go to sleep with your child at 7:00 pm and want to lay with them in their bed, but if you are doing it because you have to – because it’s the only way they will get to sleep – then it’s a problem.

Every new parent wants to rock their child and have them fall asleep on their chest; that is the most precious feeling in the world. It is an entirely different story when that HAS to be the norm, rather than it being a special occasion. Everyone in the household needs good, quality sleep. Period. End of story. And it’s not great if it only happens occasionally; it NEEDS to happen Every.Single.Night!

If you rock or nurse your child to sleep and they stay asleep through the night, then there is no need to change a thing. If your child is happy, and you are happy, I’m happy. A lot of moms say “my baby only wakes up, feeds and goes right back to sleep, we don’t have any sleep problems at all.” That may be okay for you, and it seems to be okay for the baby. But while she is feeding, her brain is working, telling the organs to start working. The stomach is working, the gut is working … the pancreas, liver and kidneys, all working to process that meal she has in the middle of the night. That means her body is not resting, her organs are not regenerating and healing themselves as they are required to do during sleep. And even though mothers say they are sleeping through their infants nursing all night, there is a part of your brain that is awake throughout the process because you need to know at all times where you are in relation to your baby and where your baby is in relation to you. You are not going into a deep slumber as you should to regenerate yourself. But again, if you are happy and your baby is happy, I’m happy. I am mainly advising that if you wish for your child to sleep through the night and it’s developmentally safe and appropriate, it is indeed possible.

Preventing the Sleep Deprived Child

To prevent a sleep deprived child, parents and caregivers should follow these guidelines:

  • DO put your child to sleep following her natural sleep cues
  • DO put her to sleep drowsy but awake
  • DO maintain consistency and sense of routine as children thrive and depend on this
  • DO what feels right for you and your family and DO trust your gut
  • DO NOT let your baby fall asleep in one place and then move her somewhere else
  • DO NOT turn on TV or engage her at night if she wakes up
  • DO NOT think that this is just a phase and they will eventually become good sleepers. Remember, good sleepers as infants make good sleepers as adults
  • EVERY CHILD CAN AND SHOULD SLEEP WELL

The Ikea Effect of Cooking

August 6, 2016 by  
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by Mommy MD Guide Ayala Laufer-Cahana, MDIKEA

You’re never too young — or too old — to start cooking; Standing on a stool my kids barely reached the faucet when they started. Our first kitchen adventure involved making a good green salad, and included the basics of how to wash and dry lettuce, and the simple principles of mixing a good salad dressing. The second lesson’s product was a nice bowl of lightly salted edamame in their shell, which my kids still think of as “addictive food.”

We didn’t get into brownies and cupcakes until much later. I figured that creating a dish makes its creator treasure it, and why waste a lesson of love on brownies, which any kid’s bound to fancy anyway.

In his book The Upside of Irrationality Dan Ariely, professor of behavioral economics, devotes a chapter to the well know phenomenon of falling in love with the things we make, and the irrational value we attribute to the objects we had a more intimate relationship with. Ariely titles the chapter “the IKEA effect”— the Swedish maker’s assemble-it-yourself shelf Ariely labored over for hours somehow has a special place in his heart, and Ariely investigates why it’s so.

Through a series of experiments, involving the creation of origami animals, Lego patterns, and real-life examples of successful and unsuccessful businesses, Ariely comes to several conclusions regarding the evident connection between labor and love:

  • Putting effort into an object changes how we feel about it — we value the things we labor over• The harder we work on something, the more we love it
  • We’re so invested in the things we labored over, and value them so much, that we assume others share our (biased) overvaluation of our creation
  • Although working hard on a task makes us love it more, not completing the task is a deal breaker. We have no attachment to tasks we failed at or failed to complete.

Interestingly, Ariely also shows that both people and animals would rather earn their keep and work for their food. Even mice seem not to value free meals, at least not on a regular basis.

KIDS IN THE KITCHEN

The lessons above are valuable and applicable to many aspects of life: I think “the IKEA effect” chapter (the whole book in fact) has lessons for any employer or employee seeking greater work productivity and satisfaction, and for any parent contemplating showing photos of his kids to a stranger (no, he doesn’t think your kids are the cutest — he couldn’t care less).

But back to kids in the kitchen. Learning how to cook is a valuable life skill that will not only enable kids to eat healthier — no matter what you make at home it will usually be healthier than the bought version — but can also be a great tool in directing their preferences toward those foods you’d like them to eat more of, namely, fruits and veggies.

Ariely’s lesson also made me think of the importance of giving kids a task they can complete. Being responsible for just one small step in a complicated dish would result in much less creator’s pride than being able to claim the creation from start to finish as your work. So selecting recipes that are of just the right technical difficulty — challenging, but not too hard for a kid to complete — is the name of the game.

As time went by we moved to things like potato gnocchi from scratch. I wasn’t sure my kids would be able to create dumplings that hold up in the boiling water on their first try — I had many less than stellar attempts at this dish before I sort of mastered it — but beginners luck, or maybe I can take some credit as the instructor, theirs turned out incredible and light-as-a-clouds.

Ariely wrote nothing about clean-up — it doesn’t, unfortunately, reward one the way cooking and serving your handiwork does. For cleanup to be pleasurable the best tricks, I think, are joint effort and/or some good music.

I’d love to hear about your adventures in the kitchen —  as a kid or with them.

Dr. Ayala

“Learning how to cook is a valuable life skill that will enable kids to eat healthier”

The Downside of Gluten-freeing Your Kids

July 18, 2016 by  
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by Mommy MD Guide Ayala Laufer-Cahana, MD

Gluten FreeThe gluten-free food industry has seen tremendous growth, and while celiac disease – which requires lifelong complete avoidance of gluten – is also on the rise, consumers who do not have celiac or any other medical reason to avoid gluten are the main engine propelling the gluten-free boom.

Why do they do this, and is this a healthy trend?

Norelle Reilly, gastroenterologist and director of the Celiac Disease Center at Columbia University Medical Center, in a commentary in the Journal of Pediatrics, cites a 2015 survey of 1500 American adults. “No reason” is the most common reason for going gluten free – 35 percent of those surveyed explained their choice just so. 26 percent choose gluten-free food because they think it’s a healthier option, and 19 percent perceive it as better for digestive health.

If gluten-free foods are indeed a healthy trend, the fact that 20 percent of Americans are seeking them for no medical reason might be a good thing. If, on the other hand, gluten free carries risk, this fad might be an expensive gamble.

THE RISK OF GLUTEN FREE

For people who do not have celiac, wheat allergy, or non-celiac gluten sensitivity, there is no data to support the notion that gluten free is healthy, states Dr. Reilly. In fact, packaged gluten-free food often contains more sugar and fat, and has higher caloric density. Contrary to what people believe, going gluten free without medical supervision can lead to packing extra weight, to insulin resistance, and to vitamin deficiencies, since gluten-free foods are not fortified the way wheat is.

And then there’s arsenic. Gluten-free diets often rely heavily on rice, and rice quite often, contains arsenic, which comes from the soil. The amounts are small, and probably not a problem if one eats a varied diet, but on a gluten-free diet rice becomes the predominant grain, and that can be especially problematic for babies and pregnant women.

A gluten-free diet, just like many other exclusion diets, comes with a quality of life price tag. And these specialty foods often cost more and are sold at a premium.

And since in kids there are only two indications for excluding gluten from the diet: celiac disease and wheat allergy (non-celiac gluten sensitivity has not been described in kids), putting kids on this diet carries risk with no apparent benefits. There is no support to the misconception that gluten is toxic, and no evidence that gluten-free diets treat a myriad of afflictions such as autism, arthritis or obesity.

Dr. Reilly concludes:

“Patients self-prescribing a GFD (gluten-free diet) should be counseled as to the possible financial, social, and nutritional consequences of unnecessary implementation.”

The food industry uses the health halo of the gluten-free health claim to better sell. It’s really important to emphasize that just like one knows that foods that are peanut free are not generally healthier, gluten-free foods are not a panacea; avoiding gluten isn’t a recipe for health for those of us who don’t have a sensitivity or autoimmunity that involves gluten.

Dr. Ayala

“There is no support to the misconception that gluten is toxic, and no evidence that gluten-free diets treat a myriad of afflictions such as autism, arthritis or obesity.”

 

5 Immunologist’s Tips for Building Your Child’s Immunity

October 27, 2014 by  
Filed under Uncategorized

Girl blowing her nose --- Image by © Royalty-Free/Corbisby Mommy MD Guide Sonal R Patel, MD

I often get asked “How can I build my child’s Immunity?”  Here are some suggestions:

1. It starts with a great diet.

You are what you eat! There may be something to the old saying. Healthy things in everyday foods — from yogurt to walnuts — may help boost a kid’s natural defenses. So whether you’re arming your kid for cold and flu season or just aiming for good, year-round health, immune-boosting foods may help.

Foods that may Boost Immunity

  • Yogurt contains helpful germs called probiotics. You may already know that these organisms live in your gut and can improve the way your body uses food. But they’re also important in helping your body fight sickness. What type of yogurt should you get? Look for brands that say they contain live cultures. Just stay away from artificially added sugars, colors, etc.
  • Walnuts. Walnuts have healthy omega-3 fatty acids, which are good for you in lots of ways. Experts believe that omega-3s help your body fight illness. Walnuts are easy to sprinkle into a snack mix or on cereal. This is an especially great way to get natural omegas for vegetarians.
  • Fruits and veggies. To help your immune system, some experts suggests aiming for ones that are high in vitamin C, like citrus fruits, strawberries, bell peppers, broccoli, and sweet potatoes.

Sugar has been shown in many clinical trials to actually suppress immunity. To keep kids well, limit their overall intake of additives, sugar, and find out which foods are allergens. Focus on plenty of fresh veggies, whole fruits, nuts, seeds, legumes, and eggs.

2. Maintain your child’s microbiota!

Probiotics are the friendly helpful bacteria that naturally occur in our guts. They protect our digestive tracts, help us to digest food, and shield us from invading bacteria and viruses. When this bacterial balance becomes disrupted in children, we can see changes in a child’s ability to fend off infections. So eat food that have probiotics like yogurt and avoid unnecessary antibiotic use. Urging your pediatrician to write a prescription for an antibiotic whenever your child has a cold, flu, or sore throat is a bad idea. Antibiotics treat only illnesses caused by bacteria, but the majority of childhood illnesses are caused by viruses. Studies show, however, that many pediatricians prescribe antibiotics somewhat reluctantly at the urging of parents who mistakenly think it can’t hurt. In fact, it can. Strains of antibiotic-resistant bacteria have flourished as a result, and a simple ear infection is more difficult to cure if it’s caused by stubborn bacteria that don’t respond to standard treatment.

3. Help calm their stress and anxiety.

In today’s fast-paced world, parents are overstressed, children are over-scheduled, and everyone suffers. Children’s bodies have the same response to stress that adults’ do — their cortisol and adrenaline rises. When this elevation in stress hormones is sustained, their immune systems’ response is lowered. It’s important for children to have lots of down time, time for creative play, and simply times of rest.

4. Make sure they’re getting enough good sleep.

Most children are not getting the required amount of sleep. Depending on age, children need between 10 and 14 hours of sleep per night.

5. Remember that fever helps fight infection and infections develop your immunity

Although many parents panic at the first sign of a rise in temperature on the thermometer, it’s important to recognize that fever is only a sign of and not an illness itself. Fever is your child’s body’s natural response to an infection, and without it her body isn’t as effective at fighting the illness. Minor illnesses are part of life, and not every infection can be prevented or treated. When you do have an infection, your immune system builds immunity and memory to that particular virus or bacteria.

 

  • All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.

 

 

 

 

 

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The information on MommyMDGuides.com is not intended to replace the diagnosis, treatment, and services of a physician. Always consult your physician or child care expert if you have any questions concerning your family's health. For severe or life-threatening conditions, seek immediate medical attention.