Backpack Tips

I remember seeing a child with a complaint of shoulder pain in the office during the last school year. Did she have a history of trauma? No. Was she in athletics? Perhaps it was overuse. No. Did she ever injure her shoulder in the past? No, but she did complain of numbness and tingling in her arm as well. Was she sleeping on a lumpy or worn out mattress? No. It turns out that the problem was her backpack. She routinely carried about 40 pounds of books on her right shoulder every day and eventually she developed shoulder pain and nerve irritation.

Kids haul around a lot of stuff in those backpacks and they are a known source of shoulder and back pain in children. So much so, that there are medical studies devoted to the subject. As the school year begins, it's a good time to make sure your child's backpack meets criteria for carrying her homework, books and personal items in as safe and comfortable manner as possible.

Here are some things to look for in a backpack:

• The straps should be wide to distribute weight evenly. They should be easy to adjust.


• The pack should always be worn on both shoulders in order to allow easy balance. Some packs have a waist belt that can help to distribute weight better. Padding in the backpack reduces pressure points on the back.


• The pack itself should be fairly light-weight so that it doesn't contribute much weight to the load. Some packs have wheels that allow them to be rolled like luggage. This is helpful, but keep in mind that in the winter they can't roll through the snow.

You may also talk to your child and help her to organize her things efficiently in all of the compartments of the backpack. Heavier items should be centered on the back if possible. Encourage your child to make stops at her locker throughout the day rather than carry all of her supplies for the day at once. If despite these measures the pack seems to be too heavy (more that 20% of your child's weight) talk to the school and other parents to encourage changes. Hopefully, with these measures you won't need to worry that your child will come home complaining of a back ache.

Dr. George Idarraga
Pediatrician
Meriter McKee
meriterkids.com

Too Much Sugar - Part 2

(...continued from Tuesday's post...)

The kinds of calories that we eat affect are bodies in different ways. For example, fat in the diet has no effect on our insulin levels. Protein generally does not have much impact on insulin levels either, but in excess amounts protein can also be stored as fat. Carbohydrates exist in many forms such as complex carbohydrates and simple sugars. The rate at which a carbohydrate is absorbed into the blood affects the body's insulin response. In general, carbohydrates that are absorbed rapidly will cause higher increases in insulin levels. This can be a problem because insulin is a storage hormone. Broadly speaking, it promotes fat storage and inhibits our ability to burn fat. People who have chronically high insulin levels tend to hold on to their fat and will actually burn their muscle for energy when their glycogen stores are low. If you are insulin resistant, you are in a tough hole because you have decreased muscle mass (muscle at rest is metabolically active and burns more calories than fat) and your body has a hard time burning fat. That is why so many obese people have a hard time losing weight.

Glycemic index takes the body's insulin response into account. High glycemic index foods tend to lead to higher blood sugar levels, higher insulin levels, insulin resistance, and over time, lead to higher body fat levels and increased risk for obesity, heart disease and diabetes. Some high glycemic index foods include: white bread, pasta, rice, many cereals, foods containing a lot of simple sugar (candy and most desserts), sweetened beverages and low fiber baked goods. Low glycemic index foods include: vegetables, most fruits, minimally processed grains, legumes, lean meats and natural fats. You can “Google” glycemic index and easily find references on the internet. But a simpler rule to follow is avoiding processed food. Processed food is mostly that stuff in the middle of the grocery store. You know what I'm talking about. Man-made food. Stuff that comes in a box that you add boiling water to, or that you get in the freezer section and you throw in the microwave or heat up in the oven. Ready to eat. That's what I call factory food. It tends to have all sorts of stabilizers and preservatives in it. If the bacteria and mold won't eat it, why should you?

Soft drinks, juices and sports drinks are basically sugar water. Remember the 4.2 grams of glucose in your bloodstream. Well, a 12 ounce can of Coca Cola contains 39 grams of sugar (high fructose corn syrup - we'll save that battle for another day). Sorry to beat up on you Coke, it could just as easily be Pepsi. But let's face it, I had to dig around on your website for 10 minutes and bounce my way through 5 pop-up pages just to get to your nutritional information. Are you trying to hide something? I don't know many teenagers who limit themselves to a mere 12 ounces of a soft drink. So the average 12 ounces of soda contains almost 10 times your body's active glucose load.

I think I can say with a degree of certainty that we consume too much sugar. In fact, the average American consumes 300 to 600 grams of carbohydrate in all its forms on a daily basis. It is no wonder so many of us are overweight. For healthy weight management I recommend between 100 to 150 grams of carbohydrate daily (that's for an adult). It should come in the form of vegetables and fruits (yes, vegetables and fruits are nature's carbs). If you read Dr. Grant's post and are running regularly (please give it a try - you'll only have yourself and Dr. Grant to thank) you can allow yourself more. Read his excellent introduction to running for novices.

Endurance athletes can burn through a lot of glucose. But please try to avoid processed foods and sugary/high glycemic foods in your diet, and I promise you it will be easier to maintain a healthy weight. Eat foods that are as unprocessed as possible and avoid anything that is "modified" "processed" "trans" "partially trans" "inverted" or any other industrial sounding word.

Dr. George Idarraga
Pediatrician
Meriter McKee
3102 Meriter Way, Madison
6008.417.8388
meriterkids.com

Too Much Sugar – Part 1

I recently read that the average adult has about 1 teaspoon of glucose (sugar) in his or her bloodstream at one time. That's a normal size adult with a normal blood glucose level. So that's about 4.2 grams of sugar dissolved in the bloodstream at any time. It doesn't seem like very much but even a small excess of sugar (glucose) in the blood, if present for a long time, can start to cause all sorts of damage.

People with poor blood glucose control, be they type 1 or type 2 diabetic, or even pre-diabetic, are at risk for all sorts of medical problems: kidney disease, heart disease, hardening of the blood vessels, loss of vision, nerve damage, poor blood circulation - to name a few. That is why when we consume sugar, in any of its forms, the pancreas secretes insulin to transport the sugar (glucose) out of the bloodstream and into cells where it won't cause harm.

So what does our body do with the sugar we consume? Some of it will be used as fuel to support our immediate metabolic needs. Some of it will be stored as glycogen in the liver and muscles. Our brain will burn a significant portion of it and store a small fraction of it in glial cells (a type of nerve cell). The average brain can go through about 500 Calories of glucose a day. You may have heard that the brain runs only on glucose. Well, that's not entirely true. The brain needs a minimum of about 20 percent of its Calories from glucose, but it can actually run mostly on ketones, another type of fuel that our body can use. Our red blood cells run exclusively on glucose. If there is excess sugar present after all this it will be stored as - fat. Yes. Fat. It's important to remember that this is a dynamic process. We are constantly consuming and expending energy, and hopefully if the intake matches the output, our weight stays constant and we don't get fat.

So why are so many of us overweight and obese? Well. While inactivity definitely contributes to obesity, it turns out that the answer is a little more complicated than “calories in = calories out.” Visit again on Thursday when I’ll post “part 2” to answer this question.

Dr. George Idarraga
Pediatrician
Meriter McKee
3102 Meriter Way, Madison
608.417.8388
meriterkids.com

Taking Time to Enjoy Summer

I remember that when I was a kid, summer seemed to last forever. I couldn't wait for the school year to end because I knew that those endless days were just around the corner. Those last few weeks of the school year were agony - the weather had already turned and we would sit in our desks perspiring (schools didn't have air conditioning in the stone age) and pretending that we were dutifully attending to our studies, but really we were dreaming of the summer's promise.

I recall afternoons spent shooting hoops on the Bauer's driveway or playing baseball with all the other neighborhood kids in the empty lot across the street - the ball diamond was a well worn path in the weedy grass. Sometimes we would cross the train tracks to go across the big highway (two lanes really, but to us it seemed tantamount to crossing a national border) to buy a few pieces of candy, some Zots, Pop Rocks, Root Beer Barrels, with the change we had managed to hoard from Dad's pockets. Aside from Little League and swimming lessons, my three brothers and I didn't really get a lot done over the summer. Or at least it seemed that way. I did manage to catch you-know-what from my Mom once when I went fishing all day and forgot about my piano lesson. But as I look back upon my childhood summers I do realize that they were a valuable component of my upbringing. I now appreciate that I was given the opportunity of free time, time that I could spend exploring, playing, engaging in what I found value in, even as a kid. I learned a lot about myself. And I learned a lot about how to occupy my free time without being told what to do.

I worry that we are depriving our children this same opportunity when we overschedule them. I hear ads on the radio offering academic day camps - so kids won't forget all the precious knowledge that has been pumped into them over the school year. (Not to disparage, but when's the last time you used the quadratic equation?) I think it's important to maintain a sense of balance in our childrens' summer schedules. They really do need some unscheduled time over the summer. Sometimes a kid just needs to be a kid.

So as summer approaches, I ask you to keep in mind, and think back to your own childhoods, what you remember most fondly about your summers growing up. And to give your kids some free time.

Dr. George Idarraga
Pediatrician
Meriter Pediatrics
2275 Deming Way, Suite 220
Middleton, WI 53562
608.417.8388
meriterkids.com

What is Homeschooling?

The question most people ask me when I tell them that my children are homeschooled is, "I don't really know what that is. Can you tell me more about homeschooling?" If I could explain homeschooling in one sentence I would consider myself exceptional or fortunate. I will attempt here to give you an inkling of what homeschool is like for my family, but I also want you to know that homeschooling, by its very nature an individualized approach to education, is unique in every homechooling family. We are fortunate here in Wisconsin to have one of the best homeschooling laws in the country, and as a consequence, we have a unique variety of homeschoolers in our state.

For some people homeschooling consists of a small area in the home set up like a miniature classroom, complete with a small chalkboard and all the other paraphernalia we associate with school - desks, textbooks, etc. One or both parents may share in the teaching responsibilities and the children may take tests and do homework, just as they would in a brick and mortar school. Many families will purchase a prepackaged curriculum and some will even enroll in accredited online schools. An example of this would be the Wisconsin Virtual Academy (often referred to as WiVA). If this is your idea of what homeschoolers do, you are both right and wrong, because while this model may exist in many home schools, it does not represent all of us.

For many families homeschooling consists of no fixed curriculum. They approach teaching through a child-focused, self-directed form of education in which a mentor offers guidance with minimal restriction in what a child is free to explore. This form of homeschooling is oftentimes referred to as unschooling. Unschoolers believe that children have inherent learning abilities that are frequently stifled and even corrupted by traditional schooling. They believe that learning is a social process that can occur naturally and continually through collaborative activities. Just as children learn to walk, to interpret spoken language and to compose their own thoughts and speech, so too can they learn to read and write and do math with the guidance of their parents (and without being forced to do it). What's that you say? "But how can children learn unless we force them to learn? Isn't learning supposed to be work? Isn't it supposed to be unpleasant?" Well, ask yourself. Do you ever have to be forced to do things you are really interested in? If you enjoy quilting, or gardening, or even physics, do you ask someone to force you to do it? Have you found yourself enjoying going to the library to read up on something because you want to "learn" more about it? If so, you are guilty of unschooling. In a sense, then, unschooling is learning by living, and discovering your path through the guidance of a loving parent.

There is a third type of homeschooler, and though I don't have anything more than anecdotal experience to back me up, I think it is where most homeschooling families are, and that is somewhere in the middle of the two examples I presented above. Many of us start on one end of the spectrum and end up taking elements of both philosophies and integrating them in an approach that works for our respective families. This is kind of where our family is. It works well for us. I feel fortunate that my kids are excited about the things they are learning, that they are becoming critical thinkers and that they are being given the chance to find and pursue their passion in life. If you would like to read more about homeschooling I recommend The Homeschooling Book of Answers: The 88 Most Important Questions Answered by Homeschooling's Most Respected Voices by Linda Dobson.

Dr. George Idarraga

Pediatrician

Meriter Pediatrican
2275 Deming Way, Suite 220
Middleton, WI 53562
608.417.8388
meriter.com/pediatrics