Children with developmental issues,
syndromes, or conditions that put them at high risk for fluid
in the middle ear should be checked for it, according to new
guidelines from the American Academy of Otolaryngology-
Head and Neck Surgery Foundation.
You might hear your doctor call the middle-ear fluid " otitis
media with effusion." It can build up after a cold or other
infection, and it usually clears up on its own in about 4 to 6
weeks -- but sometimes it doesn't go away and affects a
child’s hearing, or may become infected.
And the symptoms can be easy to overlook, says Richard
M. Rosenfeld, MD, MPH, of SUNY Downstate Medical Center
in Brooklyn, N.Y. Rosenfeld chaired the committee for both
the original 2004 guidelines and the 2016 update.
"We're recommending for the first time that at age 12 to 18
months, these children [at higher risk] be screened to see if
they have otitis media with effusion," Rosenfeld says. "The
previous guidelines said don't screen anybody, it's not
helpful. We're still saying don't screen the otherwise-
healthy child."
Another recommendation strengthens a previous guideline
against using treatments like antibiotics or steroids, except
under exceptional circumstances.
"In this version, we say don't do it. Period. There aren't any
good reasons to do it, and that includes antibiotics ,
steroids , antihistamines , and decongestants ,"
Rosenfeld says. "The biggest change here is we've added
nasal steroid sprays... which are often prescribed to treat
middle-ear fluid even though all the best evidence
[including] several randomized trials, say it doesn't work."
Researchers found about 30% of doctors still use antibiotics
to treat the fluid, despite the 2004 recommendations
advising against it. Also, about 15% to 20% of the children
who should get hearing tests aren’t getting them routinely,
he says.
The new recommendations say that surgery to take out the
adenoid glands is no longer recommended to treat middle-
ear fluid in children younger than 4. The previous guidelines
said it was an option in kids who needed a second set of
ear tubes . But research doesn’t show it helps children,
Rosenfeld says.
About 90% of children have ear fluid by 5 years old, and it is
especially common in those with developmental challenges.
About 2.2 million new cases are diagnosed every year in
the United States, at a cost of $4 billion, the researchers
say.
The study was funded by the American Academy of
Otolaryngology-Head and Neck Surgery Foundation.
Various coauthors report receiving royalties from Springer
International, Plural Publishing, and Engage Learning; a
Harvard Medical School Shore Foundation Faculty Grant;
teaching/speaking honoraria from Interacoustics Inc and
the Arizona Ear Foundation; research funding from the
National Institute on Deafness and Other Communication
Disorders and the Centers for Disease Control and
Prevention; consulting fees or research funding from
Acclarent, Medtronic, Styker, and Cook; financial interest in
nasal spray for OM (not yet in phase I trials); and stock
holdings in Otodyne. One coauthor also reports being a
salaried employee of the American Academy of
Otolaryngology-Head and Neck Surgery Foundation.

There’s a common misconception that beta-carotene found
in fruits and vegetables is the same thing as vitamin A. It’s
not.
Beta-carotene is the precursor (inactive form) of retinol, the
active form of vitamin A. While beta-carotene is converted
into vitamin A in humans, only 3% gets converted in a
healthy adult. And that’s assuming you’re not one of the
45% of adults that don’t convert any beta-carotene into
vitamin A at all.
This means that – contrary to popular wisdom – vegetables
like carrots and red peppers are not adequate food sources
of vitamin A.
Vitamin A is found in significant amounts only in animal
products like liver and grass-fed dairy. You’d have to eat a
huge amount of beta-carotene from plants to meet vitamin
A requirements during pregnancy. For example, 3 ounces of
beef liver contains 27,000 IU of vitamin A. As the chart
below illustrates, to get the same amount of vitamin A from
plants (assuming a 3% conversion of beta-carotene to
vitamin A), you’d have to eat 4.4 pounds of cooked carrots,
40 pounds of raw carrots, and 50 cups of cooked kale!
And remember: that’s assuming you’re not one of the 45%
of people that don’t convert any beta-carotenes into retinol
at all!
Obviously, since we only eat 3-5 pounds of food per day on
average, vegetables aren’t a viable food source of vitamin
A.
Why does this matter? Because vitamin A plays several
crucial roles in reproductive health, and many women (and
men) don’t get enough of it because vitamin A rich foods
like liver and raw dairy aren’t commonly consumed
anymore.
I’ll cover the importance of vitamin A in more detail in a
future post about cod liver oil, which is one of the best
sources of naturally occurring vitamin A.

Not enough
children and teens drink low-fat milk, a new report from the
U.S. Centers for Disease Control and Prevention reveals.
Drinking milk is important for children's bone health, but
CDC experts advise that although young people need the
calcium, vitamin D and other nutrients found in milk,
children aged 2 and older should consume low-fat milk and
milk products to avoid unnecessary fat and calories.
The research, published in a CDC report titled "Low-fat Milk
Consumption Among Children and Adolescents in the United
States, 2007-2008," showed that about 73 percent of
children and teens drink milk, but only about 20 percent of
them say they usually drink low-fat milk (skim or 1
percent).
Meanwhile, the 2007-2008 National Health and Nutrition
Examination Survey also revealed that about 45 percent
drink reduced-fat milk (2 percent) and 32 percent reported
they drink whole milk regularly.
Older children and teens drink low-fat milk more often than
younger children. Although 13 percent of kids aged 2 to 5
usually drink low-fat milk, 21 percent of kids aged 6 to 11
years said they do, along with 23 percent of teens aged 12
to 19.
Ethnicity and income also seem to play a role in the type of
milk children consume. White children drink low-fat milk
more often than black or Hispanic children. About 28
percent of the white participants said low-fat milk was their
usual milk type, compared to just 5 percent of blacks and 10
percent of Hispanics. Meanwhile, children and teens in the
highest income category reported drinking low-fat milk
more often than those in the lowest income group.
In summary, the authors of the report wrote: "The overall
low consumption of low-fat milk suggests the majority of
children and adolescents do not adhere to
recommendations by Dietary Guidelines for Americans,
2010 and the American Academy of Pediatrics for all
children aged 2 years and over to drink low-fat milk.
Recently, First Lady Michelle Obama's 'Lets Move!'
campaign and 'The Surgeon Generals Vision for a Healthy
and Fit Nation 2010' have recommended promoting water
and low-fat milk and reducing sugar-sweetened beverages
as components of comprehensive obesity prevention
strategies."

Kids are watching alarming YouTube videos on cutting and
self-injury, which may encourage the behavior. Here's what
parents need to know about spotting self-harm and helping
teens cope.
An alarming new study found that YouTube videos about
self-injury and self-harm – depicting teens cutting
themselves with razor blades, for example – have been
viewed 2.3 million times, and many of them rated favorably
(watch the example below). Most lacked warnings about
the nature of the content or viewing restrictions, according
to MedPage Today . Study authors worry that such videos
may make self-harm behavior seem normal to children or
even trigger them to attempt it.
So, what is self-injuring behavior, exactly — and could your
child be hurting himself without your knowing?
Self-injuring behavior is more common than you might
realize. Such acts, which include cutting, severe scratching,
burning, poisoning, piercing skin with sharp objects, hitting,
and biting, occur among 14 to 21 percent of children, teens,
and young adults, previous research has found.
Common reasons why teens self-harm are to make
themselves “feel alive” or to distract themselves from
intense emotions such as anger, said Allen Josephson, MD,
chief of the division of child, adolescent, and family
psychiatry at the University of Louisville School of Medicine
in Kentucky, in an Everyday Health article on teen cutting . A
complex problem, cutting is often linked to low self-esteem
and depression, as well as to other emotional health issues
including bipolar disorder , eating disorders , and obsessive
or compulsive behavior.
Though cutting and other self-harming behaviors can be
dangerous, Josephson says they’re usually not related to
suicidal thoughts or suicide attempts.
Could You Spot Warning Signs of Cutting Behavior in Your
Teen?
Though obvious signals include physical proof — such as
scars, cuts, and scratches — other less-noticeable
symptoms include spending a lot of time alone, wearing
long sleeves and pants, and claiming to have frequent
accidents, according to MayoClinic.com.
Is Your Teen at Risk for Cutting?
According to MayoClinic.com, children who have friends
who self-injure, who’ve endured sexual, physical, or
emotional abuse, or who have certain personality traits
(namely, those who are very self-critical, impulsive, or have
poor problem-solving skills) are more likely to self-inure
than others.
What If Your Teen Is Harming Herself?
The worst thing you can do is yell or criticize, say experts,
which may just prompt your child to harm herself further.
Make sure to tell him you love him no matter what, advises
MayoClincic.com. Since self-harm is a complicated
emotional and behavioral issue, your child will probably
need professional help to treat and prevent the problem. If
you’re concerned about your child and not sure how to seek
help, start with his pediatrician or family doctor, according
to MayoClinic.com. Get parent-to-parent advice on cutting
in our Family Health forum.

Exercise doesn't have to be all about calisthenics. These
activities help you make it fun!
Before our lives were so high-tech, family members were
more physically active and got plenty of exercise naturally.
Today, however, we go everywhere by car and sit for hours
in front of the TV or computer. This sedentary lifestyle has
been tied to obesity and a slew of related-health problems
ranging from diabetes to depression.
Related: 10 Cities for an Active Family Vacation
The U.S. Department of Health and Human Services reports
that children who are consistently more active are likely to
be healthier adults. And people who don’t exercise are at
risk of developing high blood pressure, osteoporosis , heart
disease , and other chronic illnesses. Sounds like a
prescription to get moving — now!
Family Exercise: Shift out of Idle
"Childhood obesity is proportional to the amount of time
spent watching TV," says George W. Shannon, MD, a family
physician in Georgia who serves on the board of directors of
the American Academy of Family Physicians. "TV should be
limited to time after supper, to sit down and watch
informative and educational channels such as PBS, the
History Channel, or the Discovery Channel. Limit those TV
hours."
Related: A Guide to Keeping Kids Healthy
Dr. Shannon also suggests limiting any other sedentary
distractions such as sitting at the computer. "Put your
computer in a common area so kids are not in their
bedrooms for hours at a time," he says.
10 Great Family Fitness Exercise Ideas
Now that you've set the ground rules for sedentary
activities, plan some family togetherness time. The idea is
to get 60 minutes of moderate to vigorous exercise every
day . So, how can you get your family moving in a way that's
fun and doesn't feel like a punishment? Here are some easy
ways to reach that goal together.
1. Walk to school. Lace up your walking shoes and
join the kids for a brisk walk to and from school
each day.
2. Check out physical participation video games.
"I'm delighted with some of the newer action
toys such as the [Nintendo] Wii games. People
have the ability to play tennis, bowling, baseball,
skateboarding, and snowboarding," Shannon
says. "Kids love them. I'm generally trying to get
kids away from the TV, but in this case, if they
are swinging a bat or dancing, it's great."
3. Build strong bones. Be sure to include bone-
strengthening exercise as well, such as
hopscotch, jumping rope, gymnastics, or
volleyball — any "weight-bearing" activity, one
that you do standing up.
4. Take a tour of the park. Make going to the park
a reward for a job well done, a good test grade,
or anything that deserves a positive non-food
reward. When you get there, play a fast game of
Frisbee or pitch a ball.
5. Turn birthdays into an active adventure. Make
your presents for birthdays related to activities.
Plan a family ski or snow-tubing day trip or visit
a nearby zoo. A bike makes a great gift for every
family member, as does a basketball hoop in the
driveway and a badminton net in the back yard.
Make sure that Mom and Dad are included in the
bike rides and pick-up games, too.
6. Get to the playground. Muscle-strengthening
exercise doesn't mean just weight lifting . Take
the kids to the playground to swing on the bars,
climb a tree, or play tug-of-war.
7. Go to the head of the class. To learn a new
activity, take a class together, such as martial
arts, dance, or yoga — a favorite among hard-
to-please teen girls.
8. Walk the dog. Treat your dog to daily walks that
include the entire family.
9. Plant a garden. Whether you choose fruit and
vegetables or just some pretty flowers, get the
kids involved in an organic gardening project.
They'll get some brisk exercise digging,
planting, and weeding. Then the whole family
can enjoy the fruits of their labor with fresh
produce and cut flowers.
10. Follow your kids' lead. "This year I bought my
granddaughter the Playskool Dance Cam
because she loves to dance," Shannon says. "It
takes a picture of a child dancing and puts it on
TV dancing with cartoon characters. My basic
words of advice are 'go with the flow.' If your
child shows interest in some activity, such as
dancing, encourage it and go with her to
participate."

Energy in a can or a bottle sounds appeals at any age, but
for children and young adults these drinks raise the risk of
caffeine overdose.
Mon. Feb. 14, 2011 — Popular energy drinks — which may
contain high levels of unregulated ingredients — could pose
a health risk to children, adolescents, and young adults,
who consume many of the drinks sold, a review suggests.
The review found that almost half of 5,448 caffeine
overdoses reported in 2007 involved people under age 19,
according to Sara M. Seifert, BS, of the University of Miami,
and colleagues.
Many energy drinks contain 70 to 80 mg of caffeine per 8-
oz. serving — about three times the concentration in cola
drinks, Seifert and co-authors noted in a special report
published in the March issue of Pediatrics .
10 Ways to Start Your Day Without Caffeine
Surveys suggest that up to half of the energy drinks on the
market are consumed by adolescents and young adults —
and reports in the literature have linked the drinks to
serious adverse effects in young people, including seizures,
diabetes, cardiac abnormalities, and mood and behavioral
disorders, the authors wrote in background to their review.
"Energy drinks have no therapeutic benefit, and many
ingredients are understudies and not regulated," Seifert and
her co-authors concluded. "Both the known and unknown
pharmacology of various ingredients, combined with reports
of toxicity, suggest that these drinks may put some children
at risk for serious adverse health effects."
"In the short term, pediatricians need to be aware of the
possible effects of energy drinks in vulnerable populations
and screen for consumption to educate families," they
added.
Marketed in more than 140 countries, energy drinks
constitute the fastest growing segment of the U.S. beverage
market, with sales expected to exceed $9 billion in 2011.
And about half of the energy drinks sold in the U.S. are
consumed by individuals younger than 25—including
elementary school kids and teens.
Consumption of high doses of caffeine has been associated
with a variety of serious adverse effects, documented
primarily in the popular press but also in sporadic case
reports in the medical literature.
The growing energy-drink market, combined with the
reports of serious adverse events, provided a rationale to
investigate the potential risks, the authors continued.
Children with underlying health problems — including
cardiovascular, renal, or liver disease, seizures, diabetes,
mood and behavioral disorders, or hyperthyroidism — or
those who take certain medications, may be especially
vulnerable to the adverse effects of high doses of caffeine
and other ingredients found in energy drinks.
"Although the U.S. Food and Drug Administration limits
caffeine content in soft drinks, which are categorized as
food, there is no such regulation of energy drinks, which are
classified as dietary supplements," the authors wrote.
"Despite the large, unregulated market for energy drinks
and reports in the literature and popular media of serious
adverse events associated with their consumption, research
into their use and effects has been sparse."
Seifert and colleagues conducted a search of the medical
literature, trade media, and other potential sources of
information about the potential health implications of
energy drinks.
They identified 121 references, two thirds of which were in
the scientific literature.
Although caffeine is the main ingredient in most energy
drinks, various additives can further increase the caffeine
concentration, especially guarana, but also kola nut, yerba
mate, and cocoa.
Every gram of guarana (Paullinia cupana ) contains 40 to 80
mg of caffeine, as well as theobromine and theophylline.
Interaction with other plant compounds has the potential to
increase the half-life of guarana.
Because manufacturers do not have to specify the caffeine
content of other ingredients in energy drinks, the actual
caffeine concentration might exceed the amount on the
label, the authors noted.
The review identified several other ingredients common to
energy drinks, including taurine, L-carnitine, ginseng, and
yohimbine.
The authors also found a potential for drug interactions with
certain energy-drink ingredients, such as 5-hydroxy
tryptophan, vinpocetine, yohimbine, and ginseng.
Overall, the review suggested that 30 percent to 50 percent
of young people consume energy drinks, although the type
of drink and frequency of consumption varied substantially.
Adverse events associated with energy drinks could not be
tracked in the U.S. until recently because exposures were
coded as caffeine or "multisubstance exposure," and
included with caffeine-related adverse events. According to
the authors, the American Association of Poison Control
Centers created a separate reporting code for energy drinks
in 2010.
Among countries that have collected data on adverse effects
associated with energy drinks, Germany has maintained
records since 2002 and documented effects that included
liver damage, kidney failure, respiratory disorders, agitation,
seizures, psychotic conditions, rhabdomyolysis,
tachycardia and cardiac arrhythmias, hypertension, heart
failure, and death.
Ireland documented 17 incidents, including two deaths,
between 1999 and 2005. New Zealand reported 20 energy
drink-associated incidents, including nausea, vomiting,
abdominal pain, "jitteriness," racing heart, and agitation.
Does Caffeine Help You Live Longer?
Seifert and co-authors also reviewed potential and
documented adverse events associated with specific
ingredients found in energy drinks. They called for more
research into the safety of energy drinks, as well as
consideration of regulatory control.
"Until research establishes energy-drink safety in children
and adolescents, regulation, as with tobacco, alcohol, and
prescription medications, is prudent," they wrote in
conclusion.

If you think you're taking care of your skin by shaving and
then throwing on some aftershave, think again. Learn the
basics about skin care for men.
Men don't spend a lot of time worrying about skin care. In
fact, according to a new study by the NPD Group, a
consumer market research company, only one-quarter of
men currently use any facial cleanser, moisturizer, or other
skin product. Most just splash some water on their face,
shave, and go about their business.
But maybe you should think twice about what you're doing
to your face. While men don't go through the elaborate skin
care rituals that women do, there are products you can use
and steps you can take that will protect and nourish your
skin, keeping it looking younger longer.
Great Grooming Products Every Man Needs
There are certain skin care products men should have on
hand for daily skin care:
Face cleanser. You should wash your face twice
a day with a good cleanser. If possible, it should
contain an alpha hydroxy acid to help wash
away dead skin cells, keep the pores clean, and
reveal new skin.
Shaving cream. You'll want to buy a product that
will properly lubricate the skin so the razor
blade will glide over it, preventing razor burn.
You can choose a shaving cream or gel in
pressurized cans, or you can buy shaving soap
that comes in a small tub and is applied with a
brush. Some men believe the brush makes the
hair stand straighter for easier shaving.
Aftershave lotion. Many men use an aftershave
lotion to soothe the skin after shaving. The
lotion may contain an antiseptic to prevent
infection, a moisturizer, or fragrance.
Moisturizer. Skin tends to dry out as its
essential oils diminish with age, but a good
moisturizer can help. You might want to choose
a moisturizer that contains antioxidants like
vitamins A, C, and E, which can protect skin
cells from aging. Steer clear of creams or lotions
with sodium lauryl sulfate, which tends to
remove natural oils from the skin.
Sunscreen. Sunscreen is the best thing you can
do to prevent aging of your skin, and it should
be applied whenever you expect to spend time
outdoors. Some experts even recommend
applying sunscreen right after shaving. Make
sure it has an SPF factor of at least 15.
Shaving for Skin Care
Shaving has hidden advantages — the exfoliation that takes
place every time you shave can keep the skin of your face
looking young and healthy. But if you shave improperly, you
can cause razor burn or razor bumps, which form when
facial hair cut too short curls back into the skin. To shave
properly, follow these steps:
Soften your beard. Thoroughly wet your face
with hot water. Prior to wetting the beard, you
might even want to apply a warm washcloth to
further soften hairs.
Apply shaving cream. Cover your entire beard
with shaving cream. Work it in well to make the
hairs stand up and to lubricate the skin.
Shave. Use a sharp razor, and shave in the
direction the hairs lay. Avoid repeating strokes,
and keep your skin relaxed.
Rinse. Rinse the remaining shaving cream off
your face. Use cool or warm water, as hot water
will dry out your skin.
Saving Face With Anti-Aging Treatments
The best anti-aging product you can use is sunscreen,
which both moisturizes your skin and prevents sun damage.
However, to treat skin that is beginning to show signs of
age, like fine lines and dullness, consider a tretinoin gel or
emollient (Retin-A Micro, Renova). These vitamin-A
derivative topicals enhance the natural production of
collagen and elastic fibers in the skin as they treats
discoloration, wrinkles, and the degeneration of elastic
tissue. They're available only by prescription, so talk to
your doctor.