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.

Navigating the Grocery Store

By: Jennifer Ripepi, MD

Navigating the grocery store can be a real chore, especially with children in tow. As a parent who has been in your shoes, I’d like to share some tips that may help you get through the shopping process with more healthful foods and less junk in your cart.

First and foremost, I found that preparation is key to a successful venture. Review the store ads either in print or on-line. If you do your shopping the first 2 or 3 days of when the weekly specials are advertised, you are more likely to find the items that are on sale. Different stores have different days of when prices are in effect so double check what your favorite store offers. This step helps you to work within a budget and you can even begin to plan meals for the week. Cutting coupons and comparing those to the store ads may also help you to save money on the items you need. You can also check out some money saving apps for your phone. A couple that are popular are Ibotta, Checkout 51 and Saving Star.

Make a list! How many times do we finish shopping and forget some important item? Keeping a running list in your kitchen may help. As you empty one of your stock items, then you can add it to the list. Too many times, our list at home (ominously referred to as "The List") begins as soon as I get back from the store. Just another part of being in a family!

Do not go to the store while you are hungry! You WILL buy items that you don’t need just because you are eating with your eyes. Take a bottle of water with you during your shopping trip and sip that as you stroll the aisles.

Understand your store's layout. Most large grocery stores have produce first and around the outside walls are the bakery, deli, meats and seafood, dairy and perhaps the frozen foods. This is where we should spend most of our time. Selecting healthy produce with attention to season, color and freshness will help us to prepare beautiful and vitamin and mineral packed meals. Lean proteins give us the building blocks for growth and repair. Dairy and dairy-equivalents like soy products give us calcium, protein and some Vitamin D for strong bones and muscles (among other things). Frozen foods may be a reasonable alternative if fresh produce is out of season or longer storage is needed. Sometimes these foods are convenient as well, but be aware that the more processed they are, the less control you have over what you are serving to your family. Try to stick to single ingredient foods without added flavorings.

The inside of the store has some aisles a health-conscious family should avoid. Snack foods like chips, pretzels, crackers, candy and cookies and the soft drink sections are huge parts of many stores. These foods rob our health and we really do not need those in our pantries. Feel like you "have to have it"? Get the smallest size available. Or better yet, do without and look at your total at the end of your trip.

The shelves are set up for eye level shopping. Your child sitting buckled into the seat of the cart will see sweetened cereals and the items at the checkout that are there for impulse buying. Plan for letting them know that Choosy would pick something else. Perhaps even talk about being Choosy at the store beforehand. It may save you some tantrums later.

What are your grocery shopping tips? Do you engage your children in the experience and let them help out when picking out produce? Do you discuss what the foods are that they are seeing?


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.