Registered dietitian Erin Webley is a specialty dietitian educator with the Helen DeVos Children's Hospital Healthy Weight Center. She is our guest blogger this week.

Eating a healthy lunch refuels your child's body and will help him or her stay more focused and energized throughout the afternoon. So what's better-a school lunch or one you pack at home?

Although meals provided at schools can offer good nutrition, it can be harder for children to make healthy choices at school. For instance, many school lunches are highly processed and are pre-packaged in large serving sizes. Additionally, many a la carte items available are high in fat and sugar-laden. These are just some of the reasons why I advocate for packing your child's lunch.

A packed lunch is more likely to appeal to your child's individual tastes, be more balanced and have appropriate serving sizes as opposed to the limited options available at school. But it's important to remember that just packing a lunch itself is no guarantee that it will be better.

Always think balance when preparing meals and snacks for your child. Include foods from at least three of the food groups, making sure to always include a veggie and/or fruit. Foods like fruits, vegetables, whole grains, lowfat dairy and lean protein have vitamins and nutrients that help children feel their best. With beverages, I recommend offering water first, although low-calorie flavored water is okay sometimes, too. Low-fat milk is another good option. Always avoid pop, juice and drink boxes.

I find the best way to establish a routine of packing your child's lunch is to simply make a list of foods and meals your child likes that are also healthy so you know what to buy and prepare. Here are some good-tasting and healthy options to get you started:

• Pack one serving of whole grain crackers, 3-4 tablespoons of hummus, and sliced veggies to dip. Fruit and low-fat milk can be purchased at school and will round out this lunch.
• Pack one serving of baked tortilla chips, salsa, a quarter cup low-fat cheese, black beans and salad greens. Include a large, empty container and your child can mix all together for a yummy taco salad.
• Wrap low-fat string cheese in lean lunch meat, then cut in half. Serve with whole grain crackers and a small can of low sodium vegetable juice to drink.
• Add fruit (canned in light syrup or fresh) to low fat yogurt or cottage cheese. Add whole grain cereal or nuts for more crunch.
• If your child is tired of regular bread for sandwiches, try other whole grain varieties like pitas, flatbreads, wraps, crackers and small bagels. Be sure to go light on the mayo and add veggies whenever possible for a balanced meal.
• Make a healthy dip by mixing ranch powder into fat free sour cream or low-fat Greek yogurt.
• Fill a thermos with soup, casseroles or other stew-like leftovers. Always keep hot foods hot and cold foods cold to avoid the risk of food borne illness.

Once you have your ideas, find a variety of good, reusable containers and have been grocery shopping, you are ready to start packing. Here are some time-saving tips that will help make the process simple and quick:

• Plan ahead and start simple. In general, packing a lunch should take less than 10 minutes. Start simple with two to three menu ideas, then rotate through them for a of couple weeks. Add more recipes as you get more comfortable with the new routine.
• Involve your child in the process. Have your child pre-pack his or her napkins, silverware, or other meal items. Younger children can count out finger foods and pre-pack them in containers or plastic bags.
• Portion out a week's worth of daily servings for non-refrigerated items like crackers, dry cereal and nuts.
• Cut vegetables and store them water for the week to help them stay fresh. You can then quickly grab and pack some each morning.
• Portion out leftovers for lunch while you are serving dinner.
• Freeze leftover casseroles, soups and other foods. It then is easy to thaw them out, heat and pack them in a thermos in the morning during breakfast (make sure to heat hot foods thoroughly before packing).

One important note on portion control: As a registered dietitian, I see firsthand many children who are struggling with obesity issues, and I think it is important to know that even children who eat healthy can become obese-it is simply a matter of consuming too much food. So, please also be aware not only of the quality of the food you are serving your child, but the portion size as well.

Getting in the habit of packing healthy lunches for your may take a little time, but the rewards for you and your child will be worth it. Start with simple choices and don't be afraid to be creative.

- Erin Webley, RD

Robin Fisher is a physical therapist and a board certified clinical specialist at Helen DeVos Children's Hospital. she is this week's guest blogger.

Now that it's back-to-school time, I want you to take a moment and think about your child's backpack. Not the style or features, but how he or she carries it and how much weight your child totes. A safe backpack weight is considered 10 to 15 percent of a child's total body weight. So, if your child weighs 75 pounds, his or her backpack (and its contents) should weigh no more than 8 to 11 pounds.

However, according to a 2009 study conducted by the American Physical Therapy Association, as many as 55 percent of children in the U.S. carry backpack loads that exceed the maximum safe backpack weight. Doing so is especially dangerous to children with young, growing muscles and joints, since carrying too heavy a load can cause injury.

I often see children with neck, back or shoulder pain in my role as a physical therapist. Backpacks can sometimes be a contributing factor, especially since children wear them daily, and if worn improperly or if they carry too much weight, it can lead to postural misalignment which leads to pain. 

In addition to determining the proper weight for your child, here are some tips that will help ensure your child's backpack is safe and comfortable:

Choosing a backpack:

• Purchase a backpack with padded, wide straps. This allows your child to carry the load on more of his or her body. 
  
• Choose a backpack with a padded back. A padded back can reduce pressure on your child's back and prevent the pack's contents from digging into his or her back.
  
• Buy a backpack with a waist belt. It will help distribute some of the load to the pelvis.
  
• If you are considering a model with wheels, take care. These styles often do not fit in lockers, cannot go through snow and still need to be lifted if there are stairs or curbs to maneuver. 
  
• Make sure the backpack fits close to your child's body. Having a backpack that doesn't fit properly causes increased stress on the body. Ultimately, this will make the backpack seem like it weighs more than it actually does.   
  
• Akways make sure any backpack you choose has reflective material so your child is visible to drivers at night.

Loading a backpack:

• Weigh your child's backpack before the first day of school. Be sure to weigh it again periodically, especially as the contents may change or increase during the school year.
  
• Load the heaviest items in closest to your child's body. They will be easier to carry that way. 
  
• Make sure the weight is evenly distributed throughout the backpack. Uneven distribution can also causes stresses on your back, neck and shoulders. Strive for balance.  

Wearing a backpack:

• Always wear both straps when wearing a backpack. Wearing one strap or carrying a backpack in one hand can cause uneven stresses on the body which can lead to bad postureand back, neck and shoulder pain. 
  
• Use compression straps on the sides or bottom of the backpack. When tightened, these straps compress the contents of the backpack and stabilize the items inside.
  
• Use proper body mechanics when lifting a backpack to put on. Your child should bend down facing the backpack, lift it with his or her legs, and keep the pack close to his or her body, then put it on.  Bending over can cause undue stress on your child's back. 

A note on messenger bags: If your child wants to carry a one-strap, messenger-type bag, follow the same weight recommendations as with a backpack. Also, be sure that the shoulder strap goes across your child's body instead of it hanging down from one shoulder.  Also with one-strap bags, tell your child to regularly alternate which shoulder he or she is wearing the strap on. 

If your child is experiencing back, neck or shoulder pain, consult your physician or a physical therapist. Warning signs that your child's backpack could be causing injury include: pain when wearing the backpack; tingling or numbness in the arms; and red marks on the shoulders.

- Robin Fisher, PT, PCS, C/NDT

Nancy Kingma, MA, BSN, RN, LLP, LPC, NCC is a bereavement services coordinator at Helen DeVos Children's Hospital and director of Camp Compass. She is our guest blogger this week.

Dealing with the death of a loved one is one of the hardest things we have to face as a human being. For children, the grieving process can sometimes be even harder, since along with feeling sad, children may also be confused about death and what it means. I sometimes see well-meaning parents who have sent confusing messages to their children, such as saying a loved one has "gone to sleep" instead of saying that a person has died, in an attempt to protect them.

That is why I always advise parents and adults to tell children the truth about death in a gentle, simple manner that is appropriate for that child's age. Once the child has had time to process the news, the parent or adult should be available to answer as many questions as the child has-this will help build trust and allows the child to grieve.

Here are other ways you can assist a child who is dealing with the death of a loved one:

• Use the words "death" and "die." Words such as "passed," "lost," or "passed away" may be used in an attempt to soften the harshness of death. These words are confusing, especially to a small child who may reply, "If he is lost, let's go find him."
  
• Let the child know that feelings are okay. There are no "right" or "wrong" feelings when it comes to grief. Parents and adults can help a child to identify his or her feelings, then provide constructive ways of dealing with them. For instance, some suggestions for working through anger could be playing a game of soccer or hitting a punching bag.
  
• Share your feelings with the child. Just as we may feel the need to protect our children, they may also feel a responsibility to protect parents and adults. By sharing your feelings, you can both better cope with the grief.
  
• Assist the child in finding his or her own meaningful way of saying good bye. This could be writing a letter or putting something special into the loved one's casket.

Our region is fortunate to have another resource for parents or caregivers helping children cope with death of a loved one. The resource is Camp Compass, a one-day camp for children who have experienced the death of someone significant in their life.

The annual camp is scheduled for September 25, 2010. Each year dozens of volunteers including nurses, child life specialists, social workers, therapists, physicians and teachers join together to volunteer their time to work with grieving children. The primary goal of Camp Compass is for campers, ages 5 to 15, to have fun while grieving in a safe environment. In addition to group discussions, participants benefit from a number of activities, many of which teach coping skills, such as making memory quilts or boxes and playing games.

On the morning of Camp Compass there is a two hour parents' support session conducted by a therapist or social worker. The session gives parents an opportunity to gain an understanding of grieving children and are given tools and resources to help support their children.

I'd like to share just a few sections of a letter I received from a mother whose child attended Camp Compass. I think it will give you an even better feel for how valuable the program can be:

I can't say enough to thank all of you for the amazing experience my daughter had last Saturday with all of you....She kept repeating things like: "Mom, it was SO much fun...Mom, isn't it cool that I got to pick out my own stuffed animal?!...Mom, we even got to....we talked about..." etc....In fact, I am not exaggerating when I tell you she said "Outside of Disney World, this was the most fun camp, Mom!!...I know she felt her grief was understood, "normalized" and that, for once, there were other kids like her!! Tonight she sleeps with her garden pot nightlight, made that day, and her new "teddy" chosen from many stuffed critters that greeted the children upon their arrival at camp. I am forever grateful and have already recommended next year's camp to another mom for her children who recently lost their father in a tragic car accident....

Click here if you would to register for this year's camp or learn more.

- Nancy Kingma

Diane Sinsabaugh is a Clinical Pharmacy Specialist in Pediatric Oncology/Bone Marrow Transplant at Helen DeVos Children's Hospital. She is our guest blogger this week.

When most parents find out their child has an illness requiring frequent medication, one of the last things they think about is how the medicine will taste to their child. But for many kids, concerns about the taste-sometimes even more so than the actual disease or illness-is what they think about most.

As a registered pharmacist, I've been aware of this since early in my career, and am always on the lookout for ways to educate parents and help kids who must take medicine that has a bad taste-after all, if a medicine tastes bad, children won't want to take it, or worse, may find a way to fool their parents into thinking they've taken it, when actually they haven't.

That leads me to my first and most important point: being straightforward is what is best when it comes to giving your child medicine. Therefore, one of the things I strongly recommend is to never trick a child into taking a medicine-for one, it will only work once, but for another reason, it will likely leave your child angry, distrustful, and perhaps even less secure.

What I recommend is to mask a medicine's taste and include your child in the process, so he or she can help pick flavors-this works much better than mixing medicine with mild tasting foods or in water. Any flavors that your child likes may work, but first get a sense of whether the medicine has more of a salty or sweet taste. If it is salty, choose a flavor that complements a salty taste like tomato juice, soup broth or tortilla chips. Vice versa, if it's sweet, go for a sweet masker.

I like to give maskers and chasers "themes" to help make the experience more positive for kids, and I'm sure you can come up with a few of your own. Here are a few masking ideas:

• "A Kid'll Eat the Middle": Most kids like eating the cream inside a sandwich cookie first Therefore, put the medicine inside the cream and so your child can eat it first, and follow up with the hard cookie "outsides."
• "Go Greek": Remove the pimento from a green olive, insert a pill then replace the pimento.
• "Ice Cream-less Sundae": Coat a pill with a thick chocolate, cherry, strawberry, caramel or butterscotch topping.
• Some medicines have such a strong taste, that they really can't be masked. In these cases, I recommend "chasing" them with a favorite flavor. A few suggestions:
• "Thin Mint Sans the Scout": Put the medicine in chocolate syrup and chase it with peppermint candy.
• "Reese's Re-Mixed": Put the medicine in peanut butter and chase it with chocolate.
• "S'mores Without a Campfire": Put the medicine in marshmallow cream and chase it with chocolate sauce and graham crackers.

It's important to know the perception of taste tends to be much stronger for liquids than solids. So, if the pharmacist gives you a choice between a solid tablet or a liquid formulation, choose the tablets. They will be much easier to "mask."

I also have just a few final thoughts I'd like to leave you with regarding young children:

• Very young children are often extremely motivated to learn how to swallow capsules to avoid a bad taste. Kids can practice swallowing using mini-sized M&M's or "Nerds."
• "Pill glide" is a fruit-flavored spray you may want to try, which helps make swallowing tablets and capsules easier.

Even if your child does not need medicine now, chances are at some point, he or she will, so I hope you keep these tips in mind for when that comes. Your child is sure to thank you for it.

- Diane Sinsabaugh, RPh

Kids and Body Image

Dr. Cadieux is a child psychologist and this week's guest blogger.

 Media portrayals of unrealistic or unhealthy body images, sometimes through use of computer technology to make a model look thinner or improve "flaws" is bombarding our children with ideas of how their bodies should be.

Children and adolescents definitely pick up on these messages. Kids of all ages and sizes can adopt a negative body image and believe they must strive to make their bodies "perfect." It's also important to recognize that increasingly more and more boys are having issues with body image. And, of course, peer pressure continues to plays a significant role in how your child views his or her body.

I'm going to share some good news in a moment, but for now, here are some sobering statistics:

• Half of all girls and a third of all boys use unhealthy weight management strategies
• 81% of 10-year-olds report that they are afraid of being fat
• 46% of 9-11 year olds are "sometimes" or "very often" on diets

But, before you become too discouraged, consider this: as a parent, you hold an enormous influence over your child, and therefore, your own attitude towards weight and body image will likely be the greatest influence on your child's beliefs about these topics. You can make a difference. That's important to remember.

That said, we all know most children don't want to be told what to do-and they usually listen best when we think they aren't listening. That's why, instead of lecturing your child, one of the best ways to help your child maintain a positive body image is to be aware of what you say about yourself. If you're a mother, do you sometimes make negative remarks about your own body and say you look or feel fat or need to lose weight?  If you do (and 80% of all women report that they are dissatisfied with their bodies, so it's likely you've got company), just keep in mind that your child is more likely to take on a negative view of his or her own body, too.

Of course, I also hope it goes without saying that any negative comment a parent makes about his or her child's body, or other people's bodies, can have a negative impact on the child. So, even if a child is overweight, a parent should never use negative comments to try to "help" the child to lose weight.

Here are some ways you can encourage a positive body image in your child:

• Be accepting of your own and others' bodies
•  Pursue your own individual and social activities, try new things and encourage your child to do the same
• Offer positive comments to your child about their characteristics, abilities, efforts
• Focus on effort and improvement in yourself and child, not perfection
•  Pick up a magazine, and talk about and challenge messages being sent through the advertisements
•  Eat healthy, and limit, but do not eliminate low-nutrient "junk" foods
•  Be physically active with your child

Remember: Your attitudes and behaviors are probably the biggest factor in how your child will view his or her own body. Make sure your child knows that while maintaining your health is important, body shape or size does not determine happiness, self-worth or success. When you send your child these positive messages, everyone wins.

- Dr. Cadieux

Morgan Cole, PharmD, is the pharmacy manager at Helen DeVos Children's Hospital. He is our guest blogger this week.

Giving kids medicine safely can be a complicated task. It's possible to give your child medicine safely and prevent dangerous reactions with knowledge and double-checking.

Using medications safely means knowing when they are necessary, as well as when they are not. Always check with the doctor or pharmacist if you are unsure whether medication is necessary.

In many cases, supportive treatments may be the best bet for a quick recovery, especially with cases of the flu or the common cold. Getting enough rest will allow the body to heal, and plenty of clear liquids will help your child avoid dehydration from body fluids lost through vomiting, diarrhea, perspiration and nasal secretions.

To ensure the safe use of prescription or over-the-counter (OTC) medicines, discuss your child's allergy symptoms with your doctor and pharmacist. Once treatment has been established, you should know:

• The name and purpose of the medication
• How much, how often and for how long the medicine should be taken
• How the medicine should be administered
• Whether the medicine be taken with or without food
• How the medicine should be stored
• How long the medicine can safely be stored before it needs to be thrown away
• Common side effects or reactions
• What happens if your child misses a dose

Dosages of prescription and OTC medicines depend on a child's weight so make sure the doctor and pharmacist have current information about your child. Too little medication can be ineffective and too much can be harmful.

Sometimes medicine should be given on an as-needed basis. OTC drugs that relieve symptoms such as aches, pains or fever should only be taken as recommended. We do not recommend OTC cough and cold medicines such as phenylephrine, pseudoephedrine, dextromethorphan, etc., be given to children under the age of 4 years.

In most circumstances acetaminophen is preferred in children to treat fever and pain. Generally speaking, never give aspirin to children, unless prescribed by a physician.  Using aspirin during an illness caused by a virus (such as the flu, chickenpox or an upper respiratory infection) can cause Reye syndrome, a potentially life-threatening disease with symptoms that include nausea, vomiting and extreme fatigue that progresses to a coma.  Some OTC medicines contain aspirin, so it's important you read labels and check with your doctor before using them. Be aware that some aspirin-containing medications use words other than aspirin such as salicylate or acetylsalicylic acid.

However, many medications should be taken until finished as prescribed by the doctor - even if your child begins to feel better.  Antibiotics help to kill bacteria in the body, so it's important to finish all doses even after symptoms disappear because the infection can return if the antibiotic is stopped too early.

Other tips I like to share with parents who are worried about using medication correctly include:

• Don't try to diagnose your child's problem yourself. Always check with your doctor if you're unsure whether symptoms require medical treatment. You may also look at "Should I Call the Doctor?" on our Web site.
  
• Never use leftover medications. For example, doctors may prescribe or pharmacists will sometimes dispense more liquid medication than is needed in case some is spilled or measured incorrectly. If you have liquid left over after your child has completed the course of treatment, throw it out. For medicines taken as needed, pay attention to the expiration date to make sure you are not giving an outdated medication.
  
• Never give your child medication that has been prescribed to someone else. Even if two people have the same illness, they may require different drugs with different doses and directions.
  
  
• If you're purchasing OTC medications, check the packaging for possible tampering, and don't use medications in cut, torn or sliced packages.

I also encourage you to develop a relationship with a local pharmacist so that your family's medication history is in a central location. Your pharmacist and pharmacy are an extension of your health care team and play a vital role in the health of your child.  

- Morgan Cole

My colleague, Mike Forness DO, an orthopaedic surgeon at Helen DeVos Children's Hospital, is this week's guest blogger. 

We all have passions in life.  As a pediatrician, helping children is clearly one of my passions.  What's another passion? Preventing lawn mower injuries.

As parents and caregivers, we simply can't underestimate the power of a lawn mower. The powerful machines are dangerous on so many levels. A mower has extremely sharp blades moving at high speeds that can project objects at more than 200 miles per hour and with a force greater than a gun.

Can you help me prevent injuries this summer by observing the five N's?

• No bare feet. Sturdy shoes should be worn when mowing.
• No one in the yard. Keeping children inside is the best protection.
• No riders. Never let a child ride with an adult on a riding mower.
• No child operators. Children under 12 should not operate a push mower and children under 16 should not operate a riding mower.
• No mowing in reverse.

Lawn mower accidents often require multiple surgeries as the accidents injure growth plates in a child's leg.

Other injury prevention tips:

• To prevent injuries from flying objects, such as stones or toys, remove objects from the lawn before mowing begins.
• The adult mowing should wear hearing and eye protection.
• Start and refuel the mower outside, not in a garage or shed.
• Mowers should be refueled with the motor turned off and cool.
• Never pull the mower backward or mow in reverse.
• Always turn off the mower and wait for blades to completely stop before removing the grass catcher.
• Never reach under a lawn mower with your hands to unclog the discharge chute or free a jammed blade.
• Turn off the lawn mower to cross pathways and roads

-   Dr. Forness

"Daddy, you have hair growing in your ear," my daughter said to me as she gave me a Father's Day hug. That's not quite what I expected to hear from her but continue to be amazed at the things she observes and, in turn, teaches me.

As parents, we sometimes think our only role is to teach our children - after all, the word discipline means "to teach." But, children have so much to teach us as well. When my wife and I discovered we were going to have a baby, we went through many of the "normal" reactions of future parents readying ourselves for the challenge. Then we found out we were having two babies! Now that they've just finished kindergarten, we, like many others, are up against our newest challenge of juggling summer camps, daycare and work schedules.

I was recently quoted in USA Today about the changes that some fathers go through around the delivery or adoption of their first child. You can read the story to find out what interesting purchase I needed to make for my wife at Babies 'R Us. The newborn period is a time of stress for both parents and no parenting book can truly explain what one can expect. Some handle the stress of becoming a parent better than others. Many of the responses to stress are genetic and not in our control but require that we learn new coping strategies. The article focused on hormones men experience around the time of the birth of their child. We've known for quite some time that the delivery of a baby is a spark for the onset of depression in women, but now we are starting to understand better that men too are at risk for postpartum mood disorders.

As a pediatrician, I am concerned for the health not only of the infant during delivery, but also of the parents. If the parents of a developing child are not physically and mentally able to handle the challenges that await, it can be harmful to the infant and, in some cases, tragic. Child abuse in the first year of life peaks when the infant is around two months old - the same time that the infant is at the peak of crying.

Pediatricians need to look out for parents who might be struggling during the initial stages of an infant's life to help guide them to resources to get help with depression or other social stressors that may be impacting the care that they can give to their new baby. Friends and relatives of new parents can look for signs of stress or depression and offer to help the new parents. Instead of asking to help hold or feed the infant, offer to help clean the house, buy groceries or cook dinner to allow the parents more time to bond with the baby. To learn more about postpartum mood disorders and the value of a true pediatric medical home, listen to my interview for Health Radio from earlier this year. You can also participate in an upcoming Spectrum Health Web chat about postpartum depression. Click here for more information.

Kids can teach us many things about ourselves and we need to be resilient in our responses to the challenges that they pose. The role of being a parent is one of teaching and of learning. What pieces of advice do you have for new parents or those expecting their first baby soon? Are there things you wish you had known then that you know now?

My colleague Kyle Morrison, an exercise physiologist with the Helen DeVos Children's Hospital Healthy Weight Center, is this week's guest blogger.

Encouraging kids to be active is one way parents can help children maintain a healthy weight. Parents can instill a love of physical activity and help kids fit it into their everyday routines. Doing so can establish healthy patterns that will last a lifetime.

Healthy, physically active kids also are more likely to be academically motivated, alert and successful. They will have stronger bones, better manage their weight and sleep better. It can be hard to motivate some kids to be active.

Three keys include:

1. Choosing age-appropriate activities is essential: If you don't, children may be become bored or frustrated.

2. Giving kids plenty of opportunity to be active: Kids need parents to make activity easy by providing equipment and taking them to playgrounds and other activity hot spots, including community pools, ice rinks, parks and playgrounds.

3. Keeping the focus on fun: Kids are far less likely to participate if they don't enjoy it.

When kids enjoy an activity, they want to do more of it. Practicing a skill - whether it's swimming or riding a tricycle improves their abilities and helps them feel accomplished, especially when the effort is noticed and praised. These good feelings often make kids want to continue the activity and even try others.

The best way for kids to be active is by incorporating physical activity into their daily routine. Toddlers to teens need at least 60 minutes daily. This can include free play at home, active time at school and participation in classes or organized sports.

It's helpful to think of being active in categories. Here are my recommendations.

Preschoolers: Preschoolers need play and exercise that helps them continue to develop important motor skills - kicking or throwing a ball, playing tag or follow the leader, hopping on one foot, riding a bike, freeze dancing or running obstacle courses.

Although some sports leagues may be open to kids as young as four, organized and team sports are not recommended until they're a little older. Preschoolers can't understand complex rules and often lack the attention span, skills and coordination needed to play sports. Instead of learning to play a sport, they should work on fundamental skills.

School-age: With school-age kids spending more time watching television and playing computer games, the challenge for parents is to help them find physical activities they enjoy and feel successful doing. These can range from traditional sports like baseball and basketball to Scouting, biking and hiking.

As kids learn basic skills and simple rules in the early school-age years, there might only be a few athletic standouts. As kids get older, differences in ability and personality become more apparent. Commitment and interest level often go along with ability, which is why it is important to find activities that children feel successful participating in and will do on a consistent basis. Schedules start getting busy during these years, but don't forget to set aside some time for free play.

Teenagers: Teens have many choices when it comes to being active - from school sports to after-school interests, such as yoga or skateboarding. It's important to remember that physical activity must be planned and often has to be sandwiched between various responsibilities and commitments.

Do what you can to make it easy for your teen to exercise by providing transportation and the necessary gear or equipment. In some cases, the right clothes and shoes might help a shy teen feel comfortable biking or going to the gym.

In addition to a child's age, it's important to consider his or her fitness personality. Personality traits, genetics and athletic ability combine to influence kids' attitudes toward participation in sports and other physical activities, particularly as they get older.

Your positive attitude as a parent can go a long way. It will often help a child who is reluctant to exercise or be active. It's helpful if you are active yourself and support your kids' interests.

- Kyle Morrison

Dan McGee, MD, a pediatrician and hospital medicine specialist is our guest blogger this week.

As the parent of two former competitive swimmers, I am a big advocate for swimming. I couldn't be happier with the recently revised American Academy of Pediatrics guidelines on swimming for infants and toddlers.

New evidence suggests children ages 1 to 4 may be less likely to drown if they have had formal swimming instruction. The academy is now recommending parents enroll their children in swim lessons based on individual readiness, including the child's frequency of exposure to water, emotional development, physical abilities, and certain health concerns related to pool water infections and pool chemicals versus sheer age alone.

Regardless of age, I support the following American Academy of Pediatrics guidelines and encourage you and your family to observe the guidelines as many of you look forward to a long holiday weekend.

• Never - even for a moment - leave small children alone or in the care of another young child while in bathtubs, pools, spas or wading pools, or near irrigation ditches or standing water. Bath seats cannot substitute for adult supervision. Empty water from buckets and other containers immediately after use.
• Closely supervise children in and around water. With infants, toddlers and weak swimmers, an adult should be within an arm's length. With older children and better swimmers, an adult should be focused on the child and not distracted by other activities.
• If children are in out-of-home child care, ask about exposure to water and the ratio of adults to children.
• If you have a pool, install a four-sided fence that is at least four feet high to limit access to the pool. The fence should be hard to climb and have a self-latching, self-closing gate. Families may consider pool alarms and rigid pool covers as additional layers of protection, but neither can take the place of a fence.
• Children need to learn to swim. Classes may reduce the risk of drowning in younger children as well, but, because children develop at different rates, not all children will be ready to swim at the same age.
• Parents, caregivers and pool owners should learn CPR.
• Do not use air-filled swimming aids, such as inflatable arm bands, in place of life jackets. They can deflate and are not designed to keep swimmers safe.
• All children should wear a life jacket when riding in a boat. Small children and nonswimmers should also wear one at water's edge, such as on a river bank or pier.
• Parents should know the depth of the water and any underwater hazards before allowing children to jump in. The first time you enter the water, jump feet first; don't dive.
• When choosing an open body of water for children to swim in, select a site with lifeguards. Swimmers should know what to do in case of rip currents

- Dr. McGee

I'm excited to include a new feature of Double Duty: guest bloggers. I hope you'll enjoy reading and engaging in conversation with other Helen DeVos Children's Hospital physicians. My colleague John Schuen, MD, specializes in treating children with chronic lung conditions with such as asthma.

As a pediatrician and specialist in children's lung issues, I'm often asked if kids with asthma can participate in sports and go to summer camp. The answer is yes! Being active and playing sports does more than help a child with asthma stay fit, maintain a healthy weight and have fun - it can actually strengthen a child's breathing muscles and help the lungs work better.

For these reasons, your child's doctor may recommend exercise as part of the asthma treatment plan. If you have your doubts about whether sports and asthma mix, consider all the professional and Olympic athletes who have asthma. Nearly 17 percent of U.S. Olympic athletes had asthma and 30 percent of them won medals in the 1996 Olympics.

There are two important things to remember when preparing your asthmatic child for a sports or camping experience.

1. Your child's asthma must be under control in order for them to participate

2. When your child's asthma is well controlled, he or she can - and should - be active just like anyone else.

If your child has asthma and wants to experience a traditional summer camp but you're not comfortable sending them away, consider Helen DeVos Children's Hospital Asthma Camp. Our camp is designed for children ages 8 to 13 years old. Children participate in traditional camp activities such as canoeing, crafts, archery, swimming, hiking, an overnight campout and an honor's campfire at Camp Tall Turf in Hesperia, Michigan. They are supervised by pediatric physicians and nurse practitioners in the case of an asthma flare up. It's a safe environment for kids with asthma to experience the joy of summer camp while being medically supervised. Visit the asthma camp page to learn more.

- Dr. Schuen

When our first patient walks through the doors of the Helen DeVos Children's Hospital Healthy Weight Center, it will symbolize the beginning of a new era of pediatric care in Michigan. The patient will be obese, possibly sick from carrying too much weight around for anywhere from 5-17 year, but will have made one of the best decisions of their young life. The patient, along with the parent or guardian, will have decided that the time is now to change unhealthy lifestyle choices. The time is now to step up and get help from the Helen DeVos Children's Hospital Healthy Weight Center. The decision for the patient may come with a significant amount of fear but also a huge amount of hope.

The poor choices made in the past may have been eating too much, too often, at the wrong times and of the wrong foods. Or perhaps the patient will have been far too inactive, either without the motivation to run and play, no safe place to be active, exposure to too many distractions like television, gaming, phone or computer screens or maybe not in the state of mental health that allowed for enough movement that burns sufficient calories. Future posts here on the Double Duty blog will address specifics about how you can keep your family healthy and active.

The critics have and will say again "Just eat less! You don't need a center for that." Well, for what is probably the most common example of "it's easier said than done," this problem we have of childhood obesity is far more complicated than that. Our society, and growingly societies around the world, is set up to fail many children and lead them to becoming obese at a very young age. The accessibility and acceptability of food that promotes the consumption of far too many calories and parents who are in a situation of needing to provide for their kids but not necessarily aware or able to control their children's consumption of these foods are some of the issues. A lack of safe places to run around, a perceived lack of time in the day, competing activities at home or in school that de-prioritize healthy play time and activity in place of sitting and looking at a screen and not allowing sufficient physical education in place of classroom education in school are others. There are real concerns about the poor quality and unhealthy content of foods that are routinely marketed or made available to kids and which parents and schools buy for children to eat or drink without possibly knowing the consequences.

The staff members at the Helen DeVos Children's Hospital Healthy Weight Center plan to help turn the lives of these patients and families around. We will work as a cohesive team providing assessments for diseases that come with obesity like diabetes and fatty liver. We will assess food diaries and calorie expenditure. We will check for hurdles that slow the ability to change but don't prohibit it like lack of transportation or treatable depression. We will maintain an active and educational Web site,  where families, schools and medical offices can find the information they need and to connect with resources and events throughout our community.

For patients who enter our doors it will be unlike any other doctor's office visit. It will be much more. It will look a lot like what the future of health care holds for all patients as our team provides coordinated, multidisciplinary care. Our secretary will have already "met" them over the phone and our social worker will have already worked through many barriers to making it to our center. The time spent with the doctor will be de-emphasized and visits with our dietician and exercise physiologist will be just as important. These team members will individualize a prescription for leading a healthier life at a healthier weight for each child and family.

The patient who comes today will join a team of medical professionals whose members all have the same goal: finding ways for that patient to lead a healthy life with a healthier weight. Staff members at the Healthy Weight Center have loftier goals. Our hope is that:

• What we do will catch on with what other pediatric clinicians and medical office staff do in our area of the country
• One person or many people who work in medical offices, schools, daycares or restaurants in our region will step up and make changes
• When a child comes to the doctor their weight is assessed - every time - and a discussion is held with the family - every time - about healthy choices they can and should be making
• Schools will build more curricula about healthy eating and activity, and that they will allow kids to play and learn ways to be active when they are not at school
• Restaurants will offer healthier food choices for kids making it easy for parents to pick healthy food by serving kids' meals with a fruit and vegetable - every time - just like what is suggested to happen at home
• Cities will decide that we can find a way to build bike paths on streets or add support to making parks even more enjoyable
• Parents will start buying healthier foods such as calorie-free drinks and cook more at home, have family meal time more often, limit screen time, provide  a chance for kids to play hard and sleep well at night and not be alarmed when their child's medical office or school wants to bring up the subject of healthy weight

There are many strategies and recommendations for advice to give families about making choices that will lead their children, and themselves, to live with a healthy weight and one without the many risk factors that promote diseases that can happen at such young ages and require expensive and time-consuming medical care. Our hope is that these messages get out to those who need them. We don't, however, have all of the answers which is why we plan a robust research program in collaboration with experts from Michigan State University to study the causes of obesity and the strategies employed to lead families to make changes.

We hope today is the start of a reversal of the epidemic of childhood obesity in our area of the world. We know we will not do this alone and can't do this without committed patients and families. We can't do this without a committed community of schools, restaurants, policy makers and philanthropists. Our team is committed. Helen DeVos Children's Hospital is committed. In fact, Spectrum Health's annual gala will support our center this year. We hope things will be different in our region and that the efforts of our communities will make a difference for the children who live here. The patient who walks through our door today has taken the first step.

What steps are you taking or will you take within your family, school, workplace or community? What steps do you think others in our community can and should take? Please share your thoughts.

The long overdue retraction by the British Medical Journal Lancet of a 1989 study linking injection of the MMR vaccine to autism should reassure parents that this important vaccine is safe and will protect their children from life threatening disease.

Not only is the original study that tried to show an association between the vaccine and gastrointestinal symptoms completely discredited, but the subsequent studies which investigated the safety of MMR have all shown the vaccine to be safe.

Now, parents who have to decide whether to vaccinate their child against measles, mumps and rubella can feel good that the combination shot saves the child pain (one shot versus three), saves time (one visit instead of three), and is safe.

Much damage to the perception of vaccine safety was done by Dr. Wakefield and his unethical "study." In recent years the folks who wanted to believe in this theory have inappropriately extended their concern to preservatives like thimerosol and now to the H1N1 vaccine. As a result, a percentage of our population is either partially vaccinated or totally unvaccinated.

When you decide not to vaccinate your child, you put your child at risk of getting that illness and you also put all children exposed to your child at higher risk of getting that illness.

Let me explain. If a child is not vaccinated for a particular illness, they obviously are at an increased risk as there is no way their immune system has any way of fighting off the virus or bacteria. When a child receives a vaccine, there is a small chance that their immune system will not make a response, leaving this child susceptible to the offending organism should it ever come around. This non-responding child is at a higher risk of coming across the organism when around unvaccinated children. The more unvaccinated children, the higher the risk for the child whose parents tried to make her immune.

As a parent of two kindergartners, a part of me wants to know if their classmates are fully vaccinated. I don't know if they are vaccine responders or not. Doctors don't typically check to make sure. I don't want my fully vaccinated kids or other kids to be at a higher risk of coming across a vaccine-preventable illness. Perhaps, if there were unvaccinated kids in their classroom, I would insist that I know my children's immune status. And, perhaps, if it showed that they did not respond to a vaccine, then we could try again to see if they would respond.

I endorse the recommended vaccine schedule that is published each year by the American Academy of Pediatrics and Centers for Disease Control. Yet, I see and hear many things in the media and popular press that annoy me as they are comments that are not fully grounded in up-to-date medical science or even common sense.

As a pediatrician I've received too many digital alerts from the American Academy of Pediatrics. You see, these alerts are about deaths. The AAP is now routinely sending out urgent emails to us when they are informed of more deaths of children in the U.S. from vaccine-preventable illnesses.

We are all trying to do what is best for kids. I have both a medical education which has taught me to stay current in scientific study and I have, at least, a sufficient amount of common sense (although my wife might argue this one sometimes). Here is what I know for sure:

1. Children should not die in the U.S. (or anywhere for that matter) from vaccine-preventable diseases.
2. Causes for many medical conditions, including autism, are not yet discovered.
3. Vaccines that are currently recommended for all children in the U.S. have been tested to a degree that makes me comfortable with their safety.
4. The benefits of vaccinating children and adults against disease far outweigh the known side effects.

When deciding whether to fully vaccinate your child, you are deciding whether to put other children at higher risk of injury or death. Hemophilus Influenza Type B (HIB), is the bacteria that causes meningitis or brain infection. HIB kills unvaccinated children, partially vaccinated children and those who are vaccinated but happen to not have responded to the vaccine.

I want to stop getting e-alerted that children are dying in the U.S. from HIB. I want to stop hearing outdated, factually inaccurate medical advice in the media, on websites and in the popular press. I want our limited resources to be going toward just some of the much more urgent needs in our society. One urgent need is to have available the appropriate developmental resources for those children who have autism or another form of developmental delay. I feel the pendulum of vaccine fear swinging back toward the reality of the need to protect our children from many illnesses that we truly should fear. Doctors and medical scientists have the best interest of children at heart. Those who are opposed to recommended vaccination have been quite vocal and it is time for those who choose to vaccinate to be heard. I want our families to trust medical science. I want all children to have a medical home where they can be taken to a doctor. I want all children to be fully vaccinated.

I want to hear from you on this important public health issue.

My colleague Pat Crum, parent educator with the Helen DeVos Children's Hospital Center for Child Protection, pointed out March is parenting awareness month. There are many worthy recognition months but parenting awareness is particularly important to me as the father of twins and a pediatrician.

Parenting is a full time job. I would actually argue it's one of the hardest jobs in the world. Here are Pat's 12 tips to help us be the best parents possible.

1. Take care of yourself. It is easier to meet your child's needs if you take care of your own. Over-commitment and fatigue are two of the greatest distractions from positive parenting. Take time to relax and enjoy the company of your children.

2. Speak calmly and firmly to your children when they misbehave. Tell them what they have done and what would have been a better choice. Respond to disruptive behavior immediately, consistently and decisively.

3. Realize it is okay for your child to say "no". Parents feel challenged when children say "no" or question authority. Disagreeing respectfully is a skill that must be learned and one parents can teach. Keep in mind that you want them to have the skill to say "no" to peer pressure and inappropriate situations.

4. Allow your child to practice being powerful in useful and appropriate ways. Show them a positive way to make a contribution. Let them know their actions count. Most parents want to raise a child who will be a self-reliant adult, who can make good decisions and who has the confidence to be whatever he or she chooses.

5. Give your children a voice in family rule making and the consequences for breaking rules. Fewer rules are better and should be clearly understood before a problem arises.

6. Focus your attention on what children are doing right, and you will see more of that. What you pay attention to is what you get more of. Children feel safest when the limits are firm and consistently enforced. Otherwise they may constantly push and test the limits. Children of all ages have a strong need for attention and will repeat behaviors that get a strong reaction, whether positive or negative.

7. Be patient. Being rushed is not compatible with a child's natural rhythm. The dawdling, which is sometimes seen by parents as a challenge to their authority, is normal for children. Time runs much slower for kids than the hectic pace of working adults.

8. To manage the behavior of young children, use distraction and lots of supervision. Discipline calmly. Don't assign consequences when you're angry.

9. Young children are developmentally programmed to explore. Tell them what they can do instead of punishing for what they can't do. For optimum learning, create an environment that is safe for exploration. Give them plenty of interesting things to do.

10. Put problems on your family meeting agenda and let kids brainstorm a solution. Kids are more likely to cooperate when they are involved in the solution.

11. A sense of humor is a valuable tool in working with children. A silly or playful attitude will often ease a tense situation, end a power struggle and invite children's cooperation. Laughing together is a great way to strengthen family bonds.

12. Respect others and children will respect you. We model respect through our daily interactions with others. Our children learn respect from what they observe and receive from us.

What is your best piece of parenting advice?

On the date of my last blog post, Jan. 12, 2010, the nation of Haiti experienced a horrific natural disaster that we have all heard about and witnessed through extensive media coverage. This earthquake has ended the life of many Haitians and changed life forever for those who survived. The coverage of the story in the media has been intense and graphic at times and difficult for adults to comprehend, let alone our children who are hearing of this news at home, at school and elsewhere. We've heard stories of despair and miracles. Many rescue workers, relief specialists and medical personnel from our area of the world have responded to help the Haitians start to heal.

For those of us here and geographically, if not emotionally, distant, we've been allowed to sympathize with these neighbors. Many have asked how they can help and several options have become available.

But, how does a small child here, who is exposed to either images on television, in the newspaper or through inevitable discussion of this tragedy make sense of this information? When is a child old enough or mature enough to comprehend that there are bad things in the world that happen to good people? Many children in our country are not a stranger to family tragedy and sometimes at very young ages.

Our two five-year-olds were immediately curious as the images of suffering children were shown on television and in the newspaper. We did not allow them full access to the news reports. My wife and I talked about what an earthquake is and what they can and did do to the country of Haiti. We reassured them that earthquakes are not likely to cause such damage to our own home because of where in the world we live but that we have to be aware of other natural dangers. It was important to us not to avoid the topic of this tragedy with our children, but to find a way to teach respect for others and instill a responsibility for the care of those in need.

For the past year, our children have been given small chores around the house and, if successfully completed, they earn a few cents to a dollar to save for a meaningful purchase. Our daughter decided right away that she wanted to save for an American Girl Doll. It is more difficult for my son to plan ahead so he went along with his sister and he too decided an American Girl Doll would be fine to earn. Over the last week or so, we helped our children decide on a few extra things they could do to help around the house so they could earn some extra money to be able to donate to the Haitian relief effort.

Others who have small children or work with or teach children have had to confront the awkwardness of questions and fears about the earthquake in the past several days. Some have chosen to teach about Haiti and the wonderful people and culture. Others have helped organize collections of needed supplies and other donations.

This is an important time not to avoid discussion of this tragic event with your children, but to teach the values of responding to our neighbor's need in any way you feel you can.

How have you talked about the situation in Haiti within your family? How have you responded? Money is tight and not everyone is able to donate. What other ways have you thought of contributing to the long-term healing of Haiti?

Many of you set new years' resolutions and some may have already broken them. One common act that many vow to do more of each year is reading. Children this time of year are recovering from the holiday break and need to dig in to their school studies.

Countless research studies have supported the benefits of reading in childhood and confirmed it as a healthy activity. Infants and young children benefit from being read to by adults. My childrens' school employs third graders to read to the kindergarten students. Both clearly benefit from this exercise.

As you and your children look to what can make 2010 a good year, think about reading. I, for one, am happy you've chosen to read this blog and hope that you can gather helpful information and access to new resources.

Finding the time to read more is sometimes hard. Children need to complete homework and other potentially less healthy activities compete for their time.

Developing a nighttime routine is healthy for families with young children and it should include reading. Many pediatricians suggest the four Bs: bath, brush, book and bed.

When my children were three and we'd get to the book part, they would negotiate for more and more books each night. And, now, if I skip even one sentence on page five of Alice in Wonderland, my daughter catches me and makes me go back and re-read it.

Looking for ways to encouraging reading in your home? This article will help you create a reader friendly home. This article provides insight to help coach a reluctant reader to enjoy the practice of reading.

 I'd like to generate some discussion on this topic. If you have a special way to get your children reading, let us all know. How have you included reading in your family's routines? What is your child's favorite book? Post your responses here or on our Facebook page and we'll learn from all of you. Happy reading!

The holidays are here and even if you are not particularly "into" the season, you will most likely be around those who are. It is often said that this season is about the children. It is a season of giving and we at Helen DeVos Children's Hospital hope that your family finds loved ones healthy and if not, that they are well cared for.

We've reminded you through Twitter and Facebook to be on the look out for common safety hazards which can take the joy out of this time of year. We've covered how to keep young children active during time off from school, including the kid-favorite - the snow day.

Most have done their shopping that they needed to do or were able to do by now. Many families in our area have had to cut back on the giving. This is an important time to teach children that not every year is the same for a family. Many parents have had to explain why their children will not be receiving as much this year. During a season that should be focused more on giving, this seems to be the perfect chance to steer your child's attention from what might be on their "list."

Our family participated in the Santa Claus Girls package delivery on Saturday. Both of our kids made personal deliveries to the front doors of very grateful families. It was a good experience for all of us. While taking phone donations at the STAR 105.7 "Think Outside Yourself" Radiothon on Thursday last week, a mother called. She said her three children, ages 10, 7 and 5, decided to allow her to forgo purchasing one gift each for them so that they could donate the collective $25 to Helen DeVos Children's Hospital. That night, I presented this idea to my children. My son said, "Can the present that I don't get be clothes?" He is five and it's a start.

Many of you have thought of very creative ways to invite your children to give this time of year and year around. I'd like to hear from you. How do you teach your children to give?

Happy holidays on behalf of everyone at Helen DeVos Children's Hospital.

My first blogged piece of advice could be to not have a family pet. That will, however, not be my advice as there are countless scientific studies suggesting many health benefits come with pet ownership.

Children can learn aspects of responsibility and parents can learn how long it takes for the children to shirk that responsibility. If you wanted to avoid the breeds of dogs that, according to national statistics, are more likely to bite a child, you would avoid the Rottweiler, Pit Bull and German Shepherd breed. Dog ownership has been reported to lower the chance of children developing asthma if exposed to the pets early in life. There is some risk of allergies when owning any pet and reptiles can carry some communicable disease. Pregnant women should not change cat litter boxes due to the risk of toxoplasmosis. So, there are some things to consider. If you are considering a pet and wondering what kind to get, here's an article to read as you research the decision.

As a pet-owning family, you take a risk. You sign up to, more than likely, deal with the loss of a family pet and for a child, or anyone bonded to Fido, it can be a tragic occurrence. Our family recently experienced the loss of a pet when our turtle Patrick died.

Our daughter had learned in a book that turtles can live to be 100. I knew anything short of that for Patrick was going to be hard to explain. Trying to be a good dad and knowing the significance of this event, I made a plan. My wife and I called our two 5-year-olds to the dining room table.

My wife said "we need to tell you something serious."

They came.

I said, "I went to check on Patrick. He must have gotten sick. He died."

My son's eyes got huge and I noticed because it took my daughter a few seconds to realize what I had just said. We explained we could bury him. We talked about turtle heaven. We shared some of the memorable times with Patrick. They asked a couple questions and then my daughter, unexplainably, started laughing.

She talked, laughed and asked questions about whether she could play with Patrick outside. She was clearly in denial. Our son seemingly skipped this stage of grieving.

They asked to say goodbye and I showed them Patrick who was now in a small cardboard box suitable for a turtle coffin. We talked some more and then it hit her. She exploded with tears and cried and wept the rest of the evening.

She wrote a note for Patrick and taped it to his box. We made plans to bury him after their dentist appointment the next day.

Just before bed, our daughter said, still weepy, "Patrick didn't get to live to 100, when I get to heaven, I'm going to visit Patrick."

A few minutes later she said, "Can we get a dog?"

Mist or shot?

This time of year we all think about ways to stay healthy. For those families, like mine, who have decided to get a flu shot, we've been faced with the choice of a shot in the arm or the newer version of a spray in the nose.

Last year I asked my twin four-year-olds what they wanted.

"No shot!" was their simultaneous response. Once they had time to think about it, they became less decisive.

'Hmm, a spray in my nose, I'm not sure I like that idea either," they seemed to think.

When it came time to decide, they couldn't. They went back and forth.  Like any parent, my wife and I try to walk that fine line between providing too many choices and being overly controlling. But this time, I needed to step in. They got the shot last year.

This year was a bit different. They were able now, at age 5, to decide that mist in the nose sounded better. They both opted for that. Again, things went well.

Now, with H1N1 vaccine options coming available, here we are again. Shot or mist?

Some are not eligible for either and some patients can get the shot and not the mist. The availability of all versions of the flu vaccines has been an issue for physician offices to say the least.

Your child's doctor's office will tell you what vaccines they have available and help you determine your child's eligibility for each.

I have asthma so I got the shots. My wife, well, she keeps saying she has that on her to-do list.

Whatever you decide about the flu vaccines, remember to wash hands, sneeze into tissue or sleeves, reduce your exposure to sick people, stay home from school and work for 24 hours after the fever has resolved, and stay hydrated with fluids.

If your kids do get sick, remember children four and younger should not receive over-the-counter cough and cold medicines as they are ineffective and potentially harmful if the dose is miscalculated. The younger the child who gets influenza, the more likely serious problems are to occur, such as ear infections, pneumonia, dehydration and hospitalization.

Next fall we hope to offer just one seasonal flu vaccine which, if necessary, will incorporate the H1N1 strain.

It is my hope that if you encounter an influenza virus in your house, that everyone has been properly vaccinated, if eligible, and that all recover as quickly as possible.