Sitting is The New Smoking: Get Up Off Your Seat!

By: Jenn Ripepi, MD, Choosy Pediatrician

You may have heard that "sitting is the new smoking" in the last few years. What is meant by this is that sitting for long periods is bad for our health in many ways. We are meant to move and do it frequently. So what does this mean for our children and their futures?

Sitting decreases our need to breathe deeply, to have our muscles contract and demand increased blood flow. That is the opposite of aerobic exercise. Aerobic exercise is the kind that improves your blood flow and helps to prevent plugged arteries. When we walk, run, swim, and bike or do other activities which get us to breathe harder and our hearts to pump faster, it helps to keep our arteries clear. When we sit we are not using our muscles and letting our blood vessels keep opened up as much as when we move. Over time, that that adds up.

Sit Up Straight

Teaching children to have good posture is important, especially in the pre-school years. Children grow at a rapid pace during their first four years of life and there is an increase in postural responses. It then regresses until adult postural reflexes are reached sometime between 7-10 years of age. So as professionals see it, the most “training”, or using correct sitting/standing positions in static posture and its dynamic reflexes occurs during the early pre-school years of life.

Our overall posture is affected by sitting for long periods. We tend to let our heads drop and that in turn leads our shoulders to hunch forward and our lower backs to curve forward. Our core muscles in our abdomen and lower back get weak. We end up with lower back problems and the whole host of other spinal problems like headaches. For our children who have developing skeletons this is a stress that may force their posture to be permanently impacted. That leads me to the next point.

Build Strong Bones

Strong bones are built not just from calcium and phosphorus but by being used. We have learned from the astronauts in space for long periods that their bone mass decreases when they are out of Earth's gravity. That led others to look at what happens here on the Earth's surface in a number of situations. People have more bone mass when they are physically working against gravity in what we refer to as weight-bearing exercise. That means walking, running, jumping, climbing---moving your body against the Earth's gravitational pull. If children are not moving, they are not building the strong bones to carry them through their lifetimes.

Muscles Matter

Muscles are meant to be used! Our bodies have been built for walking, running, climbing and jumping. If we don't use our muscles, they tend to become weak. Weak muscles can be built up but it takes a lot more work to build strong muscles when someone has not been used to using them. Ask anyone who has gone through physical therapy after an injury and a period of rest. They likely will tell you it was difficult to get started but got easier as their therapy progressed.

Get Moving!

You wouldn’t believe how often I heard in my practice as a pediatrician that kids are tired all the time! Then I'd ask what they "did" all day and they'd answer that they spent most of their time sitting! Not really "doing" anything! They were bored! Our minds need physical as well as mental stimulation. 

A few years ago I read a study about recess in schools and children's performance. Children who had recess with active free play did better in afternoon classes and with their behaviors than children who did not have that opportunity. Children are in classrooms for hours and are kept sitting for that time. They sit on the bus. They sit to do homework. Then many sit in front of a television or video games or other device when they get home. And don’t forget, when they are sitting, they should be at least practicing proper posture or they may have issues down the road.

What Can We Do As Child Advocates?

It is important to help young children learn that when their heart beats faster because they are moving, it is actually healthy and good for them. Help them identify if their heart is "resting," happy, or very happy based on sensing their heart rate. Continue to reinforce the idea of happy, healthy hearts for the entire family. Make everyone’s hearts happy in your family and engage in active movement together. 

At home, keep active not only to help your children but to help yourself. Less screen time and more active time as a family. If you and your children are watching a television show or engaging in technology of some kid, have frequent movement breaks to encourage blood flow and muscle use. 

Music is also a great tool to get our hearts beating. There are many different types of music that enable children to expand upon their listening horizons, imaginations and movements. Allow your children to listen to a variety of music and dance and sing along with them.

When you are on the go, free play outside stimulates big movements and strength and allows children to explore their surroundings. The fresh air and open spaces allow those big, deep breaths we need to keep up with our bodies' demand for oxygen. 

When children are required to sit in school, ask the teachers how they build movement into their lessons. Ask how recess is spent during inclement weather and advocate for active play indoors in a large open space when possible, if the students cannot go outside frequently. (You may be able to let the educators know that they'll have more alert and better behaved children when they allow recess.) 

Try to observe how long children sit when you are with them. A little activity break during homework time can help their concentration. Additionally, try to avoid the command to sit still except when it is really needed (like mealtimes, religious services, haircuts, etc). As we as a society begin to relearn that we are meant to move frequently, we can let our children lead us naturally in movement. All we have to do is follow their lead!

How do you help your children stay active and moving, rather than sitting all day? 

About the Author: I have been a pediatrician for over 25 years. My husband and I have been privileged to raise 4 bright and healthy children. I have tried to gather wisdom from the families I have been blessed to meet during my journey. I believe in practical and flexible parenting to help raise healthy adults. I love to garden, hike, travel and cook and I am looking forward to hearing from Choosy followers.

Sniffles and Sneezes

By: Jenn Ripepi, MD, The Choosy Pediatrician 

It's a beautiful summer day and someone has a runny nose. How can that be? Is it a cold? Is it allergies? It is hard to know what to do about those sniffles and sneezes sometimes. Let me just give you a few little tips when wiping those runny noses.

• Viruses are the usual culprits for runny noses: They are also associated with low-grade fevers, cough, and the general blahs we get with the common cold. We can catch them any time of the year and you will typically have more than one family member with symptoms around the same time. We pick up these "bugs" from others who have been ill and they can be on surfaces in public areas. 
• Tip to steer clear of viruses: Hand washing is the best way to try to prevent these illnesses any time of the year. Check out the Choosy Kids song ‘My Hands Need Washed’ to help with hand washing!
• Don't forget to cover a cough or sneeze, get rest, and drink fluids while you have a cold. If your children are active and pretty much their typical selves when they have a cold, it's a good sign they're doing fine and no need for any other treatment. For worsening or persistent symptoms then perhaps a call or visit to your healthcare provider is warranted. 
• Unfortunately, your body may be allergic: Allergies are sometimes a bit of a challenge to figure out but the good news is that most are mild annoyances and self limited. Some are easy to detect. If you walk into a room where there is a pet and suddenly sneeze and have itchy, watery eyes when starting to pet the animal, you are likely displaying allergy symptoms. Most allergies from environmental causes make our bodies release histamine and other chemicals. These most often cause an itching reaction such as itchy, watery eyes and/or nose, hives on our skin or a scratchy throat. Many people sneeze a lot when they have allergy flares.  A tendency to allergies may be inherited, though family members may be allergic to different things or have varying severity of their symptoms. A seasonal pattern tends to occur with "hayfever" and so noting when the symptoms occur may help to solve the puzzle. If the symptoms include fever or difficulty breathing, especially if the onset is sudden and severe, professional care is urgently warranted. For mild symptoms, avoiding the cause if you know it is helpful. For more specific treatments I recommend you talk to you healthcare provider.
• It’s just in the air: Sometimes our runny noses may be caused by the environment but not necessarily be allergies. When they air is very dry and dusty, our bodies need to keep our noses moist and clean. So then we may have the need to sneeze, have watery noses or mild congestion, maybe some coughs and even watery eyes. Sometimes we have very low humidity inside our homes, especially in winter. Do you ever walk around shocking each other or having staticky hair? Well that dry air will cause our noses to make more mucus and secrete moisture. During this time, we really don't feel sick, we just have a stuffy nose. Humidifier and vaporizers can help as well as drinking lots of fluids.

Keeping runny noses under control may be challenging but most often it's minor. A part of childhood. In fact, the American Sign Language sign for ‘kids’ is a nose wipe!

Do your children tend to have cold symptoms more in the summer months than the winter months? How old were your children when you discovered an allergy? Share your stories so other parents can relate their situations. 


About the Author: I have been a pediatrician for over 25 years. My husband and I have been privileged to raise 4 bright and healthy children. I have tried to gather wisdom from the families I have been blessed to meet during my journey. I believe in practical and flexible parenting to help raise healthy adults. I love to garden, hike, travel and cook and I am looking forward to hearing from Choosy followers.

Finding a New Pediatrician: 5 Things to Look for During Your Doctor Search

By: Christine Cox, The Choosy Mommy

There are many reasons why parents choose to find a new Pediatrician. Most of the time your search starts when you find out you are pregnant and need to select who your child will see for the next 18 years for medical care. Sometimes it is because you just don’t mesh well with the doctor you chose and you are opting to look for another provider. But in my case, it is because my Pediatrician is retiring. Now it is time to start my search all over again and I’d like to share with you how I am going about this process.

I didn’t start seeing my current Pediatrician until this past year. I had horrible previous experiences at another office with various doctors and was just not happy with the customer service side of care (ex: waiting over an hour for an appointment is just not fun with a toddler). I asked my local mom friends who they see and I was recommended to give my current doctor a try. Her office is literally 5 minutes from my house, I love how she always came into the room with a smile, answered all of my questions, and the big thing was that Capri instantly liked her. She even pretends to be this doctor when she plays doctor’s office at home. Plus, she has been seeing Cam since he was born too, which as you may remember, he was premature so we saw our doctor more often than normal and she helped me through a lot with him.

But now I have to find a new doctor and I am sad. There are others within the group that I am going to give a try since I love that it is so close to home. The list below is what I will be using to determine if the new doctor(s) we see will be our go-to Pediatrician or if I have to go to a whole new practice:

1. Male versus Female: Capri has always seen a female doctor. It was kind of by chance to be honest, but I feel like anytime she has to see a male doctor due to the female not being available when we were, she did worse at her appointment. This might make a big difference in how your child acts during a checkup too!
2. Wait Times: I understand that doctor’s offices get backed up, but there is no reason for me to wait over an hour for a simple checkup, even worse if my child is sick and miserable. At my current Pediatrician’s office, I have never waited longer than 2 minutes to be seen. That is quite unheard of so I am hoping that our next doctor doesn’t make me wait long or I’ll be moving on.
3. Happiness During Our Appointment: Listen, I know that people have bad days, but if someone is a grump every time I see them and just does not seem to enjoy working with kids, then I am not going to expose my child to that environment. My doctor needs to come in the room smiling, happy to see my child. Or if children are sick, the doctor needs to show sympathy for their illness. Kids react to the moods of others.
4. Answers All of My Questions: I am not one who asks a ton of questions, but if I do, I want the doctor to answer them and not be rushing out of the room because my 15 minutes are up. I am paying them for my appointment, so if I have questions related to my child’s health, then I expect them to be answered right then and there.
5. Has Longevity with the Group: I want my kids to build a relationship with their Pediatrician. I like that they will know who they are going to see when they are sick or just for a checkup, and not see this  person as a stranger to be feared. It is so much easier when I can remind them how great the last visit with the doctor was and that they don’t have to be scared.

Additionally, check out this website from healthychildren.org that shares information on how to find the names of qualified pediatricians and more interview questions.

Have you ever had to make a doctor switch? What tips can you share with me to make my search easier?


About the Author: Christine Cox is the blog master for Choosy Kids. She has always had a passion for writing and is honored to contribute her work to this blog. Most of her writing inspiration comes from her daughter, Capri, who is fun-loving and full of energy, and newborn son Cam. Click here to learn more about Christine.

Welcome the Sandman

By: Jennifer Ripepi, MD

Sleep is really important, isn't it? Many of us have been sleep deprived for various reasons and lengths of time in our lives. We know how much better we feel when we've had a good night's sleep or a refreshing nap. Let's look at some ways to welcome the sandman into our homes to help our families have a sleep inducing environment for overall better health. I'll just touch on three factors that I recommend to my patients to help them to sleep better at night. These are tips I wish I knew when our children were young. I felt like between them not sleeping and frequently getting phone calls during the night, I never got enough rest. You can bet I'm catching up now!

1. Bedrooms should be dark. We are adapted to be active during the day and let our massive brains sleep and recover at night. Our eyes are very sensitive to light but our world now is full of light. Many people have even brought more light into their bedrooms with TVs, computers, phones, and electronic tablets which all emit light that stimulates the primitive parts of our brains to perceive that it's still daytime. When our brains think this, we produce less melatonin (our sleep-inducing hormone). This may cause you to have trouble falling asleep or staying asleep. Even when your eyes are closed you can sense light through your eyelids. Choosing to keep electronics off and lights dimmed for the hour before bed will help your brain produce melatonin.
2. People also sleep better when bedrooms are cooler. Again, night is generally cooler than day on our Earth. We have been outside for most of our time as humans. It is only recently that we have been able to control our indoor climates. Even just a few degrees cooler is better for sleep. Choose to turn down the thermostat (if you can) and even think about cracking a window open a bit if it's safe for you. That fresh air may just be the ticket to improve sleep.
3. Quiet. Silence is golden when it comes to helping our brains to fall asleep. I want to revisit the idea that we have changed our environment significantly. Our bodies developed into our present amazing form while we were living out in the wild. We needed quiet in order to be roused if there was any disturbance in the area which could be harmful to us or our families. Our modern brains still need that quiet both to respond immediately to danger and to rest and recover from our daytime tasks. Again, keeping electronics out of the bedroom and keeping sounds to a minimum can help.

You can also check out Choosy's song, Choosy Says Let's Rest, from the Choosy Kids CD "Our Special Time". It is a very calming song that can help children focus on resting. Scroll down after clicking the link to hear a sample!

If sleep is a problem for you or your family, I encourage you to try keeping your evening a little darker, a little quieter and calmer, and maybe a little cooler for about two to three weeks. Maybe it won't be a miracle cure but maybe it can help at least a bit.

What helps you fall asleep at night? How about your children?

About the Author: I have been a pediatrician for over 25 years. My husband and I have been privileged to raise 4 bright and healthy children. I have tried to gather wisdom from the families I have been blessed to meet during my journey. I believe in practical and flexible parenting to help raise healthy adults. I love to garden, hike, travel and cook and I am looking forward to hearing from Choosy followers.

To Supplement or Not to Supplement

By: Heather Dyson

Many parents come to me worried that their child is not getting all of the nutrients they need for proper growth and good health, especially if their child is a “picky” eater. There are a number of different vitamins and supplements available for kids in fun shapes and tasty flavors. But parents often wonder, “Is it worth it? Does my child really need it?”

Requirements for supplementation vary depending on the child’s age. Both breastfed and formula fed infants meet most of their nutritional needs. Once your child transitions to solid foods, it is important to offer a well-balanced diet, including plenty of fruits, vegetables and whole grains, which will go a long way to helping them meet their nutritional needs. Even “picky eaters” often get enough vitamins and minerals, but a children’s multivitamin might not be a bad idea if you are worried your child does not eat enough variety. Just be sure to choose one that is made specifically for children, such as L'il Critters or Flintstones brands.

It is recommended that exclusively breastfed infants be supplemented with 1 mg/kg iron at about 4-6 months when it is believed that baby’s iron stores become depleted. Breastmilk does not contain iron in amounts that are recommended for infants. However, many feel that since breastmilk is a complete food for infants, supplementation is not necessary, especially if baby is starting solid foods. There are many foods that will provide iron for babies, including meats, eggs, dry beans (such as pinto, garbanzo, kidney, etc.) and fortified whole grain cereals. Formula is fortified with iron so supplementing is not necessary for formula fed babies.

Another vitamin that is often recommended for infants and children is Vitamin D. We get most of our Vitamin D from the sun, however in the fall through spring months we cannot get enough sun to make the Vitamin D we need. Also, the sunscreen we use to protect our skin from harmful rays also blocks the rays we need to make the vitamin. Infants can be supplemented with 400 IU of vitamin D per day and children over the age of 2 with up to 800 IU per day. Be sure to buy a children’s version as Vitamin D supplements are sold in many different dosages. Enfamil’s Vitamin D drops are a good and safe choice.

Always speak to your pediatrician or a Registered Dietitian before supplementing your child or if you are concerned about your child meeting his or her nutritional needs.

About the Author: Heather Dyson is a Licensed and Registered Dietitian who currently focuses on counseling patients with a variety of health situations, and in ages ranging from infancy to elderly. Click here to learn more about Heather.

HELLP Syndrome: Knowing About It Could Save Lives

By: Christine Cox, The Choosy Mommy

On Monday, May 25, 2015, which happened to be Memorial Day, my husband and I welcomed baby #2, Cam, into our family. Much to our surprise, Cam arrived 7 weeks early at 33 weeks and 3 days gestational. As a second time mommy, I thought I had a lot of things figured out, but I learned so much from my premature peanut. Our experience was unlike my other pregnancy and delivery. My situation was rare and I hope that another mother, or even father, can learn something from my story.

The Thursday before Cam was born, I was in pain starting in the very early hours of the morning. My stomach just hurt. It was hard to describe the pain but it wasn’t contractions. I guess you could say the pain was a constant cramping feeling. That progressed to my back hurting to the point of feeling like I could not walk. I knew something was wrong so I promptly called my OB and went in for a checkup.

My blood pressure was a bit elevated but we figured it was just due to me stressing out. I had a bit of protein spilling into my urine, but it wasn’t enough to be concerned about at that time. The baby’s heart tones were fine according to the Doppler, but just to be sure, I was sent to the hospital for a non-stress test.

The non-stress test also showed that the baby was fine, and my blood pressure had declined by the time I got to the hospital and was hooked up to an IV. However, at that time the doctors were more concerned about my cervix changing than anything else. After an hour or so of monitoring, they thought I may have dilated a bit and since the hospital did not have the highest level of NICU that we would need at 32 weeks I had to be transported to another hospital.

I was hooked up and monitored at the new hospital for another hour. After nothing changed, they gave me some pain medicine and a steroid to help develop the baby’s lungs faster in case we did end up delivering early, and sent me home. I felt fine until Sunday evening.

My toddler and I spent most of Sunday in the pool. It was one of the first really nice weekends of the summer so we took full advantage of the weather. But by dinner time, I started to feel achy again. Not exactly the same pain that I had on Thursday, but similar. The stomach pain intensified (still not a contraction feeling) and I could not get comfortable. Plus my shoulder hurt, but I chalked that up to being in the pool all day and kind of ignored it.

The only time I felt fine was when I was soaking in a hot bath. At one point I did end up throwing up but I also didn’t really think much of that either since I was getting upset. But after taking 4 baths, I finally said to my husband that something isn’t right and we have to go to the hospital again (and by this time it was midnight!)

We dropped our toddler off at grandma’s house and went back to the first hospital. They did a blood test to find out that I had something that I have never heard of before---HELLP syndrome. I was told that we would have to deliver my baby ASAP. Yet again, I was transported to the second hospital since we were still too early in my pregnancy for the first hospital’s NICU.

This syndrome is rare which is why I felt it was important to share my story. According to WebMD, HELLP syndrome is a life-threatening liver disorder thought to be a type of severe preeclampsia. It is characterized by Hemolysis (destruction of red blood cells), Elevated Liver enzymes (which indicate liver damage), and Low Platelet count.

HELLP syndrome often occurs without warning and can be difficult to recognize. A lot of women believe they just have flu-like symptoms and ignore the pain and signs. It can occur without the signs of preeclampsia (which are usually a large increase in blood pressure and protein in the urine – like I had). WebMD states that symptoms of HELLP syndrome include:

• Headache.
• Vision problems.
• Pain in the upper right abdomen (liver).
• Shoulder, neck, and other upper body pain (this pain also originates in the liver).
• Fatigue.
• Nausea and vomiting.
• Seizure.

What you need to remember most from this is that HELLP syndrome can be life-threatening for both the mother and her unborn baby. A woman with symptoms of HELLP syndrome requires emergency medical treatment, hence why I was told we had to deliver ASAP, because it is the only known way to reverse the syndrome.

At 11:38 a.m., my son was delivered by cesarean due to him being breach. Born at a whopping 4 pounds, 14 ounces, Cam was breathing on his own and crying!

Cam spent 13 days in the NICU so he could grow and learn things outside of the womb that babies who remain inside the womb normally do (I’ll tell you about this in another blog). This was the most stressful 13 days my husband and I have had. In fact, my husband, a U.S. Marine, said that he would rather go back to Iraq than go through the 13 days in the NICU again!

Now a little more than 3 months old, Cam weighs in around 9 pounds, 7 ounces, He is a happy, healthy baby. My family and I are doing fine now and I haven’t had any further issues since delivery.

My story is important to read because it teaches expectant mothers, and fathers for that matter, to not ignore the signs your body is trying to tell you. Your body is a well-oiled machine but when something is wrong, it starts giving you signs to do something about it. Don’t ignore your body and get the help needed ASAP!

Have you heard of HELLP syndrome prior to reading this post? Do you have a rare pregnancy/delivery story that you’d like to share?

About the Author: Christine Cox is the blog master and The Choosy Mommy for Choosy Kids. She has always had a passion for writing and is honored to contribute her work to this blog. Most of her writing inspiration comes from her daughter, Capri, who is fun-loving and full of energy, and newborn son Cam. Click here to learn more about Christine.

The Powers of a Purple Cape: The Choosy Story

By: Christine Cox, The Choosy Mommy

Super heroes come in all shapes, sizes, colors, genders, so on and so forth. They have different sources of power and types of weapons. And for many of our heroes, a cape is part of their costume, and they too come in a wide array of colors and designs.

Did you ever think about the powers of a super hero’s cape? Some capes help heroes fly and others shield them from villains. But the cape that I specifically want to tell you about is worn by a super hero who is green and has antennae and fur! You may have never heard of this super hero before, but believe me when I say that this super hero’s powers help us all, especially when it comes to health, brushing your teeth and eating fruits and veggies!

Choosy is our super hero’s name and Choosy means Choose Healthy Options Often and Start Young. It is really up to you to decide if Choosy is a boy or a girl, or really what “life form” Choosy is. When interviewing children, we have learned that sometimes Choosy is referred to as a bug or an alien. Some children think Choosy is probably a boy because of the red backwards hat upon its head and others (usually little girls) think Choosy is a girl because of the purple hair. Regardless, what we do know is that Choosy harnesses a special power – the purple cape.

Choosy’s cape symbolizes empowerment. The power of making healthy choices even though unhealthy options are available everywhere. When children make healthy decisions about physical activity, nutrition, and dental habits, they are overcoming massive media marketing and sometimes even family preferences. Choosy is a messenger and a motivator and the cape empowers young children to be champions of choice ---- the healthy choice.

Choosy is a health hero. Do you know of other health heroes? Not since Popeye has there been a health-hero for children. Research has demonstrated that children’s characters are profoundly influential – like the super heroes you were thinking of earlier! Choosy can help promote healthy habits in your family, agency, classroom, clinic or community, which is really a super power! Choosy’s uniqueness includes health messages and reminders embedded in lively music. When used consistently, health messages paired with the image of Choosy can become familiar and favored.

Choosy is my toddler’s super hero. She always points out what Choosy would say if we made an unhealthy choice or is positive in stating that Choosy would be happy that we are brushing our teeth. Day care, pre-school and even kindergarten teachers love to use Choosy in their classroom, and physicians and dentists love to show off how strong Choosy’s muscles and teeth are in the office.

Super heroes are around us everywhere. What we need to remember is that it doesn’t matter what they look like but rather what their super powers harness.

Check out more about Choosy on our Facebook, Twitter and Pinterest and view videos of Choosy dancing on our YouTube page!

About the Author: Christine Cox is the blog master and The Choosy Mommy for Choosy Kids. She has always had a passion for writing and is honored to contribute her work to this blog. Most of her writing inspiration comes from her daughter, Capri, who is fun-loving and full of energy, and newborn son Cam. Click here to learn more about Christine.