Question:
My 8 yr old daughter is showing signs of premature onset of pubery; she has adult-grade underarm odor, blemishes, headaches, and a few hairs under her arms. I have researched out the possible reasons, ie: environmental(plastics & pollutiants) & dietary(hormones in meats & dairy, etc) causes, and am being/have been as cautious as possible. Now I am seeking intervention to stop/slow this process and save her childhood. It is not genetics, in her case(my side of family-puberty started around 15, her fathers side-around 13). Is there a way to slow this overabundance of estrogen!! Homeopathic, or safe medicine??? I am doing everything else. Please help. Thank you
Sarah Doty   

Dr. Greene’s Answer:
I share your concerns, Sarah, about kids being exposed to too many estrogens from dietary and environmental sources – and in some cases (too many cases) from excess body fat.

You may be pleased, or not, to know that onset of puberty in an 8-year-old girl is now considered normal. Early puberty is usually defined as starting before the 8th birthday in girls.

The starting age for puberty has been falling in recent years, and in 1999 the Pediatric Endocrine Society lowered the age of concern even younger, suggesting intervening only when puberty starts before the 7th birthday in white girls or before the 6th birthday in black girls.

I do recommend that 8-year-olds in puberty have a careful evaluation by a doctor skilled in this area. There are medicines (and if there is abnormal hormone secreting tissue – surgery) that can slow or stop puberty until a better time.

Other than that, vigorous daily exercise is perhaps the safest and most effective way to slow puberty. In fact, young female athletes sometimes don’t start their periods until they decrease their training schedule, or increase their body fat to 16%.

Aiming for an ideal body weight can be helpful too, through getting a healthy amount of calories every day. I don’t recommend skipping meals, though, or restricting calories below what kids need to thrive.

Quercitin compounds, nutrients found in fruits, vegetables, leaves and whole grains (notably in green and black tea, citrus fruits, apples, red grapes, buckwheat, red onions, tomatoes, broccoli and leafy greens) are known to bind to estrogen receptors in the body and help correct effects from too much estrogen exposure.

The jury is out on whether quercitin supplements, in their isolated form, would help or hurt here.

But I am a big fan of making quercitin-rich foods a part of the diet every day. There’s enough variety in these foods that they could even be part of every meal and snack.

Some studies have found significantly higher quercitin levels in organic produce.

What you are already doing to avoid unecessary estrogens in meats, plastics, pesticides and personal care products is wise for any child, and especially with puberty starting at 8 years old. Your daughter is fortunate to have such an informed and pro-active mother. My best to you both.

People used to be convinced that ulcer disease was caused by stress. The treatment of ulcers turned upside down when it was discovered and then proven that they were triggered by bacteria – it wasn’t a psychological problem after all. What if babies who cry a lot more than others aren’t just “fussy babies” but are crying because of bacteria causing their intestines to be swollen, red, and tender? A groundbreaking new study suggests that this may be the case.

Colic is often defined as following the “rule of 3′s” – babies less than 3 months old who cry for at least 3 hours a day on at least 3 days a week. Researchers at the University of Texas followed 36 otherwise healthy babies, half of whom had colic. Those with colic in this study cried and fussed for an average of 5.2 hours a day. The healthy babies cried and fussed for an average of 1.7 hours a day.

The researchers measured stool calprotectin, a white blood cell protein that increases when the intestines are inflamed (red, swollen, and tender). Those babies with colic averaged stool calprotectin levels that were more than twice as high – at levels you would see in an older child diagnosed with inflammatory bowel disease.

Was the inflammation caused by food allergies? By infection? By the variety of bacteria that colonize the gut? Any of these seem like plausible explanations – though in this small study, many of the 19 babies who had colic were breast-fed or elemental-formula-fed, and had not responded to removing potential allergens from the diet.

The researchers analyzed the many species of bacteria in their intestines. They found a rich variety of species in the healthy babies, and a significant reduction of diversity in the babies with colic. They also found a particular family of bacteria, Klebsiella species, to be almost 10 times more common in those with colic.

Was the altered diversity of gut bacteria the cause of the inflammation? Or a result of the inflammation? Were Klebsiella species inciting agents or bystanders? It’s too soon to say for sure. But this study strongly suggests that colic is often an inflammatory condition of the intestines – not just a psychological or developmental condition. A revolutionary idea! And when parents say that their baby’s tummy hurts, they may be right.

I wouldn’t be surprised if colic proves to be an infant inflammatory bowel disease that is sometimes a result of food allergies and sometimes a result of bacteria such as Klebsiella.  Probiotics (beneficial bacteria) could be helpful either way. We’ll look at that evidence tomorrow.

^{Rhoads JM, Fatheree NY, Norori J, Liu Y, Lucke JF, Tyson JE, and Ferris MJ. “Altered Fecal Microflora and Increased Fecal Calprotectin in Infants with Colic.” J Pediatr; 2009. In press.}

An astonishing forty percent of healthy babies and toddlers in a recent study had low levels of vitamin D. Results of this important study appear in the June 2008 Archives of Pediatrics and Adolescent Medicine. Children can get vitamin D in the diet, but the skin can also make vitamin D in response to time in the sun. Optimal levels of vitamin D are important not only for bone health, but also for helping to prevent cancer, infections, and other important diseases. Severe vitamin D deficiency can cause rickets, a bone condition that has been increasing around the world (even in sunny California, Nevada, Texas, and North Carolina, among other US states).

What predicts low levels of vitamin D? The child’s gender? Their nutrition? The amount of time spent in the sun? The season of the year? Sunscreen use? The darkness of the skin? Parents’ health habits? The current study looked at healthy children up to age two who went to Children’s Hospital Boston for a routine health visit over the course of a year and a half. Vitamin D levels were measured by blood tests. The 40 percent found to have low levels is similar to what a previous study found in US teens (42 percent not getting enough). About 12 percent of the healthy babies and toddlers in this study had levels low enough to be called vitamin D deficient. Their bones were checked by x-ray, and about a third of them already had decreased bone density. And 7.5 percent of them already had the bone changes of rickets.

Overall, the season of the year didn’t correlate with the children’s odds of vitamin D deficiency (although, unexpectedly, average vitamin D levels in the babies were higher in the winter!). There was no affect on vitamin D levels found based on the amount of time spent outdoors, skin color, sun sensitivity, or sunscreen use – considered individually or together. Nor was there any difference based on gender. Breastfed babies, though, who weren’t getting vitamin D drops, were 10 times more likely to be deficient.

Among toddlers, vitamin D levels closely mirrored how much milk they drank. Eating fortified cereal had no impact on vitamin D levels. In toddlers, vitamin D did vary a bit with body weight. Obese toddlers were somewhat more likely to have lower vitamin D levels.

Bottom line: I support the American Academy of Pediatrics recommendation that breastfed babies all start taking at least 200 IU of vitamin D within the first two months of life. I think 400 IU may even prove to be better. It’s not that breast milk is lacking; it’s that throughout most of human history babies spent a lot more time outdoors than they do today, without sunscreen, and with bodies adapted to the latitude where they lived. In this Boston study, the child who was outside the most averaged only 3 hours outdoors per day. When my parents were young, a lot of children lived on farms and were outside most of the day during the summer months Because of the changes in the earth’s ozone layer, though, it’s no longer safe to spend so much time in the sun without sunscreen, which puts the brakes on making vitamin D. Some sunshine is great for kids, but in this century it’s important to protect kids from too much sun exposure. –What about older kids? For children age one through eight who don’t drink 2 cups of vitamin D milk a day, or for those over nine years old who don’t drink 3 cups of vitamin D milk a day, I recommend ensuring another source of vitamin D.

Gordon CM, Feldman HA, Sinclair L, Williams AL, Kleinman PK, Perez-Rossello J, Cox JE. Prevalence of Vitamin D Deficiency among Healthy Infants and Toddlers. Archives of Pediatrics and Adolescent Medicine. 2008; 162:505-512.

Up to 5 percent of children will have a febrile seizure by the 5th birthday, something parents often describe as one of the most frightening moments of their lives (febrile seizures, not the 5th birthday). Watching a generalized seizure in someone you love can grab your heart by the throat. I know. It’s happened to me.

But I also know that simple febrile seizures are not the threat they appear to be. A simple febrile seizure is one that is brief (lasting less than 15 minutes – yes that seems like an eternity), generalized (it’s not just one limb or one side convulsing), and occurs only once in a 24-hour period in a child with a fever and no other known cause.

The 2008 Clinical Practice Guideline from the American Academy of Pediatrics, the first update since 1999, is filled with good news for children and parents. There is no evidence that repeated simple febrile seizures lessens the IQ, worsens behavior, or that the seizure itself is dangerous or might cause death. Many parents whose child has had a simple febrile seizure feel responsible to be extra careful to try to prevent or treat fevers. The 2008 Guidelines confirm that parents can relax about this. There is no evidence that treating fevers, however aggressively, reduces the odds of another febrile seizure at all, or that having another febrile seizure would be dangerous.

At least three anticonvulsant drugs can be effective at preventing future febrile seizures if taken regularly – but they are not recommended because they can have serious side effects and the seizures do not. Another drug, diazepam (Valium), can prevent some febrile seizures if given by mouth at the beginning of a fever, or can stop a seizure already in progress if given by rectum. Valium is not routinely recommended in the guidelines unless the parents’ anxiety is high – in which case it might be given to the child.

I could see how Valium might also make sense for some families with other needs or who aren’t close to medical care, in case the child has a complex, rather than simple, febrile seizure.

I hope, though, that these guidelines will help reduce the stress parents feel about controlling fevers and about simple febrile seizures. These seizures aren’t comfortable for parents or for kids, but they aren’t dangerous either.

Febrile Seizures: Clinical Practice Guideline for the Long-term Management of the Child with Simple Febrile Seizures. Pediatrics 2008; 121:1281-1286.

You can send fruit with kids to school, but how do you get them to actually eat it? I can remember trading away healthy lunch fare as a child, or just bringing home an uneaten orange in my lunch bag. I soon learned to toss uneaten healthy food in the trash, to avoid uncomfortable questions at home. What can help school kids learn to prefer the fruit in their lunch?

One answer is to have their friends bring fruit to school also.

A study published on May 13, 2008 in the Journal of Epidemiology and Community Health underlined the importance of what their friends eat. Peer influence is huge in school-aged kids. When schools opened a new snack bar that served only fruit, it did nothing to either increase fruit consumption or to decrease chips and cookies – unless they also asked families to stop sending salty or sugary snacks to school. But if schools did take that extra step, daytime fruit sales and real fruit eating shot up.

Talking with your school about adopting a similar policy, or talking with the parents of your children’s closest friends, may be one of the most important steps you can take to improve their eating habits at that age. And modeling healthy eating at home, including reducing the availability of salty and sugary snacks in the pantry, is the other side of the same equation.

J. Epidemiol. Community Health Epub May 13 2008. doi:10.1136/jech.2007.070953

Researchers at the University of North Carolina, Chapel Hill evaluated nearly 400 seven- to ten- year-old elementary school children to find out how much active play they were getting and whether they had good aerobic fitness. They also took other measurements, including height, weight, body fat, blood pressure, etc. They checked these same children seven years later, when they were all teens in high school. The results were sobering.

Almost 5 percent of the teens had already developed metabolic syndrome, a serious early form of both heart disease and type 2 diabetes that used to be a disease of middle age adults. Kids who were inactive in elementary school (less than 20 minutes each day of moderate intensity active play) were more than five times more likely to end up with metabolic syndrome as teens.

How much kids play now may affect their odds of heart disease for the rest of their lives. I recommend at least 1-2 hours of active play for kids each day, both to enjoy childhood now and to help them continue to thrive as they grow.

McMurray RG, Bangdiwala SI, Harrell JS, Amorim LD. Adolescents with metabolic syndrome have a history of low fitness and physical activity levels Dynamic Medicine 2008, 7:5

Medical Centers are equipped with oxygen outlets on the wall. When newborns are having trouble at birth, 100% oxygen is routinely used as part of the resuscitation efforts. But around the world, not all babies who need resuscitation are conveniently close to an oxygen supply. A study published in the August 2003 Pediatrics looked at 609 babies from around the world who had needed resuscitation. Half of them received supplemental oxygen, but half received only room air.

When the babies were 18 to 24 months old, no difference could be found between the two groups.

Getting the air moving is more important than what the babies are breathing.

To me, this study underlines the value of all parents and people working with children being trained in cardiopulmonary resuscitation  (CPR). Rather than waiting for an ambulance or hospital outfitted with oxygen, there is great value in getting started even if all you have is room air and no fancy equipment. Room air resuscitation can work, and work well.

What happens when parents go outside to smoke? If parents completely ban smoking within the home, the nicotine byproducts in their baby’s urine are clearly reduced, according to a study in the August 2, 2003 British Medical Journal.

Even though this reduction is only slight, every little bit helps.

Most smoking parents understand that the smoke is harmful to their babies, causing SIDS, asthma, and other respiratory problems. Most parents have taken at least two steps to decrease the smoke around their baby, and most believe that the steps they are taking do reduce their baby’s tobacco exposure.

But only 18 percent of the smoking parents in the study actually ban smoking in the home. And the lesser measures that most parents use, such as smoking in a different room or only when the baby is not home, or opening windows, or using fans or air ionizers, result in very high levels of nicotine by-products in the baby.

I understand that stopping smoking is very difficult. Having a baby in the home is a wonderful time to give yourself (and your baby) the valuable gift of not-smoking. If someone in the family does smoke, however, consider making inside your home a smoke-free haven.

On average, kids in day care during the first three years of their lives get about twice as many colds as their peers during those years. But each time a child fights off a cold, she develops immunity to that virus.

A study in the February 2002 issue of the Archives of Pediatrics and Adolescent Medicine followed a large group of these children for 13 years. At ages 6 to 11, the children who had gone to day care had only about 1/3 as many colds as their peers who didn’t. Kids who attended day care are spared throughout the elementary school years, when being home sick might make a bigger difference.

Each year in the US there are about 23 million days of school absence from the common cold.

When do people “catch” ulcers? Many ulcers are caused by a type of bacteria called Helicobacter pylori. When does this infection occur? A study published in the March 16, 2002 issue of the Lancet followed people from infancy into adulthood. The average age of infection was 7.5 years.

Most people who eventually would be infected were already infected by age 10, even though the ulcers did not appear until adulthood. How do children “catch” ulcers? The bacteria are swallowed.

Cleaning the hands before eating and before preparing food is the best way known to prevent this.