By- Dr. Jonathan WoodParasomnias are “repetitive unusual behaviors or strange experiences that occur in relation to sleep.” These include common occurrences like nightmares, night terrors, sleepwalking, teeth grinding, and bedwetting, but also the more unusual REM sleep behavior disorders and epileptic nighttime wandering. These can be confusing and sometimes quite dramatic. Fortunately, the most common parasomnias are generally the least worrisome. Sleepwalking is one of these common, but benign parasomnias.Who sleepwalks?Sleepwalking or “somnambulism” is common and most occurs predominantly in childhood. Up to 15% of children age 5-12 will sleepwalk at some point. Generally, the episodes become less common in adolescence, with the majority resolving before adulthood. That said, up to 10% sleepwalkers start in adolescence and 2-3% of adults will occasionally sleepwalk. What is the pattern?Sleepwalking occurs in deep non-REM sleep, a stage that occurs in the first third of the night. Eyes are often open and sleepwalkers will appear awake, albeit clumsy and generally purposeless in their movements. If they talk, their speech will often be slow, as will their responses to stimulation. Sleepwalkers generally have no memory of their escapades. These excursions are generally short and harmless, but occasionally have involved more complex and potentially dangerous behaviors like cooking or leaving the house.What predisposes to sleepwalking?Sleepwalking runs in families and there may be genetic factors. There also may be predisposing factors for sleepwalking, especially in teens and adults. These include use of alcohol or sedatives, emotional stress, anxiety, sleep deprivation, obstructive sleep apnea, infection, fever, and occasionally environmental stimuli. Contrary to older teachings, it is now known that there is no association between childhood sleepwalking and psychiatric disorders.What should be done?Be assured of the benign nature of sleepwalking. Be reassured that your child is not ill or disordered. Make the environment as safe as possible by removing obstructions in bedrooms, locking or alarming doors to the outside, etc. Generally, since sleepwalking occurs early in the sleep, parents are often awake when their children sleepwalk and can therefore help them back to bed. If sleepwalking occurs predictably and frequently, awakening your child 20-30 minutes prior to the expected event every night for a several months may extinguish the behavior. This should be discussed with your doctor. Medications are not recommended for sleepwalking. They are sometimes suggested, but the evidence for this is poor and generally comes with more risk than benefit.What should not be done?Don’t try to awaken the sleepwalker! It is rarely successful and can result in the child becoming confused, agitated, or even violent. Waking the child is difficult, counterproductive and unnecessary. The best approach is to let the episode subside and then direct the sleepwalker gently back to bed and to sleep. There is no point in telling children about their sleepwalking episodes: in some children this can cause unnecessary anxiety.What about sleepwalking adults?Sleepwalking in adults, as mentioned, is much less common. If onset is in adulthood, sleepwalking also has a higher incidence of being associated with an underlying neurologic disorder. A physician should be consulted about adult-onset sleepwalking to assure its benign nature. Sleepwalking that occurs later in the night may not be true non-REM somnambulism, but rather a “REM sleep behavior disorder”. This is more of an “acting out of dreams” disorder and is due the patient not having the usual semi-paralysis of muscles that normally accompanies REM sleep and dreaming. This can be dangerous to the patient and his/her sleep partner and needs to be investigated. It is particularly important to not try to arouse an adult from this type of disorder that occurs later in the night’s sleep.Conclusions?Sleepwalking in children and adolescents can be frightening, but does not mean your child is ill or disordered. They will virtually always “grow out of it.” Avoid medications and complex work-ups for this benign condition. Be calm, establish regular sleep routines, make the environment safe, and gently guide your child back to sleep.
By- Dr. Joan Marie PellegriniMost of us know that if we need surgery, we need to choose a qualified surgeon. We then assume that the surgeon and their hospital will do everything they can to prevent any post-operative complications. Unfortunately, the medical community has known for decades that surgical quality is heterogeneous across the country and sometimes even within a state or city. It is not news that some hospitals have lower complication rates than others. There has been quite a bit of research into what these high performing hospitals are doing that may be leading to better results. Fortunately for the consumer, there are now several national quality partnerships aimed at improving processes within the operating room and recovery room to actively reduce post-operative complications.These quality measures are attempting to “hard wire” certain processes. “Hard wiring” means that something will happen based on protocol rather than on individuals having to remember to ask for it to happen. Many industries have proven that protocols lead to better results compared to letting individual practitioners deciding what to do. Getting a patient ready for surgery and then recovering the patient is a very complex process and it is quite easy to forget seemingly unimportant details. We have good surgical results in this country but the goal of these quality initiatives is to have excellent results and to decrease our complications from surgery by at least 25%. Most of these initiatives started several years ago and there has been excellent progress.The quality measures differ somewhat depending on the type of surgery. However, it is now mandatory to do a “time out” prior to making an incision to make sure that everything that needs to be done has been done. Some of the things this” time out” verifies is that the team agrees they have the right patient and the correct procedure according to the consent form, the right antibiotic has been given if indicated and at the right time, that certain medications have been given if indicated, and that the necessary equipment is available and functional. Other measures that are addressed are the patient’s temperature and glucose level. Special warming devices are used to prevent hypothermia during surgery. Also, if the patient’s blood glucose level is elevated, they will be given insulin even if they are not diabetic in order to prevent certain post-operative complications. Extra oxygen is given to all patients after some types of surgery because it has been shown to reduce wound infections. These above measures are why some patients wake up in the recovery room with oxygen and insulin drips even though they do not have lung disease or diabetes.The good news is that there are many national quality measures that are being put into practice and are working to reduce complications as a result of surgery. Because these are national measures, you can be confidant that you will be given the same care no matter which hospital you go to as long as that hospital is participating in these programs. In the future, there will be even more quality programs nationally in an attempt to standardize care across the nation.If you would like more information you may search for SCIP (Surgical Care Improvement Project) or ACS NSQIP (American College of Surgeons National Surgical Quality Improvement Program).
By- Dr. Amy MoviusWintertime in Maine means playing in the snow, and after our very respectable storm this holiday, many Mainers and visitors did just that. Snowmobiling is a popular way to enjoy the snow in our state, though it is not an activity to be engaged in lightly as recent tragedies remind us. Snowmobiles are large, heavy, powerful machines. 35% of accidents involving snowmobiles that result in injury or death occur in people less than 25 yrs of age: 25% in 15-24 year-olds and 10% in children less than 15yrs. Males outnumber females three to one and head injuries are the leading cause of injury or death, usually from hitting a fixed object such as a tree. Children less than 16yrs are also frequently injured from falling off snowmobiles or having them roll over onto them. Children less than 8 yrs of age who are injured or killed are usually passengers or being towed behind snowmobiles. In persons over 16yrs, drowning from falling through ice becomes a prominent cause of death as well. Factors contributing to accidents include operator error, speeding, use on inappropriate terrain, snowmobiling at night, and alcohol use. Other risks to be considered when snowmobiling include frostbite, hypothermia, hearing loss, and white finger syndrome.If you choose snowmobiling as an activity for you and your family, please do so responsibly, and with the consideration of the following guidelines.1. Don’t let anyone less than 16yrs operate a snowmobile. Though this is not a legal requirement, the American Academy of Pediatrics urges you to think of operating a snowmobile as you would driving a car, requiring the same degree of strength, skill and maturity.1 Completion of an instruction and safety course is desirable. 2. Children less than 6 years should not ride as passengers on snowmobiles because of inadequate strength and stamina.3. A “graduate license” approach is recommended for new operators. Specifically new operator use should initially be limited to daylight hours and on groomed trails. Use of a speed limiting governor to limit maximum speed possible is also recommended for new operators.24. Never use alcohol or drugs before/during snowmobiling.5. Protective clothing should be used including goggles, waterproof snowmobiling suit, gloves, rubber-bottomed boots and an approved helmet.36. Carry emergency supplies including a first aid kit, survival kit that includes flares, and a cellular phone.7. Don’t snowmobile alone.8. Avoid ice is there is any uncertainty about its condition.9. Carry a maximum of 1 passenger.10. Use headlights and taillights at all times. 11. Never tow or pull someone behind a snowmobile (ex = in saucer, tube, sled, skis) for amusement.References1. Snowmobiling Hazards. American Academy of Pediatrics, Committee on Injury and Poison Prevention. Pediatrics Vol. 106 No. 5 November 2000. Statement of Reaffirmation 20072. Maine Snowmobile Laws 2008-09 Footnotes1. Maine state law allows children 10yrs and older to operate snowmobiles without adult supervision and children 14yrs and older to cross public ways on snowmobiles.2. The effect of graduated licensing for teenage snowmobilers has not been determined. However, graduated licensing for teenage drivers has reduced the number of motor vehicle-related deaths in teenagers.3. Maine law currently requires persons under 18yrs to wear protective headgear on snowmobiles being used on public trails funded by the Department of Conservation, Bureau of Public Lands. This applies to both operators and passengers.
By- Dr. Joan Marie PellegriniThis is one of the times of year when many of you will be planning a road trip. Unfortunately, this is also a time of year of treacherous driving. Before you begin your trip, please take a moment to assess a few safety issues:ï® Is your car in good condition? Are the tires bald? Bald tires make driving in inclement weather much more dangerous. The economy is hurting most people and one of the things that many people chose to forego is car maintenance. Tires are expensive. However, failure to negotiate the weather and having an accident is even more expensive and can be very dangerous.ï® Do you have safety flares in case of an accident? You should also make sure your hazard lights work. This also happens to be the darkest time of year. If you are stopped on the side of the road, you want to ensure your visibility to other motorists.ï® Do you have warm clothes (hat, mittens, boots, coat) for each passenger. Many people donâ€™t bother with this detail because they will pre-warm their vehicle and donâ€™t plan on walking outside. However, there are many reasons why you may get caught walking. This is particularily important if your are driving in a snow storm.ï® Please remember that black ice is unpredictable and that bridges will ice over even when the road seems clear.ï® Please allow extra space between yourself and the car in front of you so that you may more safety come to a stop.
By- Dr. David RydellGastroesophageal reflux disease or acid reflux occurs when the lower esophageal sphincter or valve is faulty. This allows the food and fluid in the stomach which is very acidic to flow backwards into the esophagus. This can result in a burning sensation in the chest (heartburn) or a sour taste in the mouth. It can also cause a dry cough, asthma like symptoms or difficulty swallowing. These symptoms can be brought on in patients with a faulty valve by smoking, alcohol, overeating and laying down shortly after a meal. The lower esophageal valve is aided in closing by the higher pressure inside the belly cavity. In the case of a hiatal hernia (where part of the stomach has slipped through the diaphragm into the chest) this assistance is no longer present.Treatment begins by evaluating and eliminating the many food and lifestyle triggers. Symptoms are often brought on by eating citrus fruits, chocolate, caffeinated beverages (coffee, tea & soft drinks), alcohol, fatty & fried foods, mint flavoring, garlic, onions, tomatoes and spicy-foods. Lifestyle triggers include obesity and pregnancy due to the increase in pressure within the belly cavity and smoking.Medications come in three basic types:Acid neutralizers such as Tums, Maalox, Rolaids, Mylanta and Alka-Seltzer that contain hydroxide or bicarbonate ions to neutralize the acid that is inside the stomach.Acid preventers such as short acting Tagamet, Zantac and Pepcid or longer acting Prilosec, Prevacid, Nexium, Aciphex or Protonix work to block the production of acid by the cells of the stomach wall.The irritation of the esophagus is thus reduced, the patient is still refluxing they just have fewer symptoms.The third type of medication is a group that works to tighten the valve and promote the emptying of the stomach in the proper direction, out into the small intestine. These include Urecholine and Reglan.As with most medications there are a variety of potential side effects both mild and severe and these medications are only effective when we remember to take them at their regularly scheduled times.When lifestyle changes and medications are not controlling symptoms adequately there are surgical and endoscopic ways of correcting the faulty lower esophageal valve. The Nissen fundoplication or wrapping of the upper part of the stomach around the esophagus to recreate the valve was first performed in 1955. Since that time the procedure has been performed using both an open and laparoscopic technique. The long term results are very good with about 90% of patients not needing regular anti-acid medication 10 years after surgery. The major drawback is that it is an invasive operative procedure with the associated risks and complications.Two years ago a new endoscopic procedure was approved by the FDA. This procedure does not involve an incision, but rather with the patient asleep under a general anesthetic using the endoscope the valve can be recreated in patients with acid reflux and a hiatal hernia less than one inch. A permanent stitching material is used to create a one inch long 270 degree valve that has resulted in nearly 80% of patients being completely off all medications 2 years later. For more information visit www.endogastricsolutions.com/esophyx_for-pt.htm
By- Dr. Amy MoviusNoise induced hearing loss, or NIHL, is (unsurprisingly) hearing loss that occurs from being exposed to overly loud noise. It is often the insidious result of exposure to excess noise over time. Unfortunately, this type of hearing loss is permanent. NIHL can occur from exposure to high sound levels in the environment – such as traffic, or noise inherent in certain occupations. Likewise, NIHL from loud music has become a major concern for our teenagers and young adults due to the popularity of personal listening devices such as ipods.A more surprising source of noise pollution is loud toys. The groups most vulnerable to injury from noisy toys are infants and toddlers, for whom many of these toys are targeted. These children will often hold these toys close to their faces or even against their ears. While developmentally appropriate, this behavior increases the sound level, and therefore the chance of hearing injury. There is little in the way of oversight for the production of these toys. In 2003 the Toy Industry Association set a voluntary sound limit on toys of < 90 decibels at 10 inches away from the ear. For perspective, this is roughly equivalent to the sound of a lawn mower. This limit is also voluntary, NOT required, and there is no obligation for toy manufacturers to list the sound level on toy packaging either. Clearly, it falls to the surrounding adults to police the exposure of these children to excessively noisy toys. There are some easy ways to judge whether an audio toy's noise level is safe, and perhaps modify it if needed.Listen to the toy holding it 12 inches or less from your own head. If it is loud enough to make you flinch, it's too loud.For a more exact assessment, sound level meters can be purchased at electronic stores (around $40). Hold the meter up to the speaker portion of a toy - if it registers > 85 decibels, the toy is too loud.Noisy toys sometimes have volume controls and/or on-off switches. Keep them turned down, or even off.If a noisy toy doesn’t have any control switches, cover the speaker with packing tape to muffle the sound (for older children) or get out your screwdriver and remove the batteries altogetherFor many households with small children, Christmas and toys go hand in hand. This year, ask friends and family to let you screen the toys they want to buy your kids. Also, remember to protect your children’s hearing with ear plugs or ear mufflers when attending any loud events to celebrate this holiday season, as the noise levels at concerts, sporting events, and the like are often above safe limits. Lastly, if you think a toy is too loud, report it to the Consumer Product Safety Commission at cpsc.gov/incident.html.
By- Dr. Jonathan WoodThis Thursday, Nov 19th, 2009, is the 34th Annual Great American Smokeout. Join the American Cancer Society – – use this day to encourage smokers to quit smoking or to outline a long-term plan for quitting. Remember, less smoking = more birthdays!smokers who quit at age 35 gain an average of eight years of life expectancy smokers who quit at age 55 gain about five years even long term smokers who quit at 65 gain three years people who stop smoking before age 50 can cut their risk of dying in the next 15 years in half compared with those who continue to smoke.Other important facts to consider when making your plan to quit smoking:87% of lung cancer deaths can be attributed to tobacco. Quitting reduces the risk of lung cancer – – 10 years after quitting, lung cancer risk is cut nearly in half compared to the risk for people who have continued smoking during that time. 30% of all cancer deaths can be attributed to tobacco. Tobacco use remains the single largest preventable cause of disease and premature death in the US. Tobacco is responsible for nearly 1 in 5 deaths!Are you around children? o Each year, an estimated 150,000 to 300,000 lung infections in children under 18 months old are attributable to secondhand smokeo Secondhand smoke significantly increases the number and severity of asthma attacks in children, affected 200,000 to 1 million children each yearWhy quit now?Perhaps you think that if you have been smoking all your life, quitting canâ€™t really help youâ€¦ Not true!!! What can a lifelong smoker expect in terms of health advantages? 20 minutes after quitting: Your heart rate and blood pressure drop. 12 hours after quitting: The carbon monoxide level in your blood drops to normal. 2 weeks to 3 months after quitting: Your circulation improves and your lung function increases. 1 to 9 months after quitting: Coughing and shortness of breath decrease: cilia (tiny hair-like structures that move mucus out of the lungs) regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs, and reduce the risk of infection. 1 year after quitting: The excess risk of coronary heart disease is half that of a smoker’s. 5 years after quitting: Your stroke risk is reduced to that of a non-smoker.10 years after quitting: The lung cancer death rate is about half that of a person who is still smoking. The risk of cancer of the mouth, throat, esophagus, bladder, cervix, and pancreas decreases. 15 years after quitting: The risk of coronary heart disease is that of a non-smoker’s.And how significant is the problem in Maine?14% of high school students and 18% of adults in Maine smoke.An estimated 79,000 children are exposed to secondhand smoke in Maine2,200 adults in Maine die each year due to diseases attributable to their own smoking.An estimated 27,000 children currently under 18 in Maine will ultimately die prematurely from smoking.Read more about Maine tobacco statistics at:http://tobaccofreekids.org/reports/settlements/toll.php?StateID=MEMore questions?So is there a safe way to smoke? Are menthol cigarettes safer? What exactly is it in cigarette smoke that is harmful? Is smoking really addictive? What does cigarette smoke do to the lungs? How does smoking affect pregnant woman and their babies? Answers to these and other questions can be found at:http://www.cancer.org/docroot/PED/content/PED_10_2x_Questions_About_Smoking_Tobacco_and_Health.aspSo how can you quit? No one said it is easy, but there are increasing numbers of resources available for smokers committed to becoming non-smokers. Go for it!A good place to start is the â€œBreathe Easy, New Englandâ€ website – – check it out and find out how to get help:http://community.acsevents.org/site/PageServer?pagename=C_NE_GASO_homepageThursday, November 19, 2009American Cancer Societyâ€™s â€œGreat American Smokeoutâ€ www.cancer.org/GreatAmericans
By- Dr. Joan Marie PellegriniFirst, I should declare a conflict of interest since I am an avid coffee drinker. None the less, Iâ€™ve had patients and friends tell me that they are going to try to cut down how much caffeine they consume. When I ask why they are concerned, I hear about the fear of heart disease, cancer, and breast disease. It turns out that these are not valid concerns.Caffeine acts on certain receptors in the brain and body to increase metabolism and alertness. Everyone knows that it helps keep us awake. Most of the time, caffeine is consumed precisely for that â€œside-effectâ€. The International Olympic Committee also knows that it is a performance enhancer and hence they test athletes for how much caffeine is in their bodies. A certain amount is acceptable.A typical cup of coffee contains approximately 100 mg of caffeine. Some brands are more potent. For instance, a Starbuckâ€™sÂ® â€œshortâ€ coffee contains 180 mg. A moderate amount of caffeine consumption is considered to be 2-4 cups of coffee a day (200-300 mg caffeine). Anything intake above 500 mg is considered to be a potential for adverse consequences. Too much caffeine can cause tremors, anxiety, insomnia, stomach upset, palpitations, high blood pressure, and a head ache. Each person has their own sensitivity to the effects of caffeine. Fortunately, there is no good evidence to link caffeine intake with any type of cancer or heart disease. It is now also known to be a myth that caffeine causes breast disease. Caffeine has only very rare interactions with any medications. Therefore, caffeine is an incredibly safe â€œdrugâ€. This is great news because it also is the most widely consumed drug in the world.Now that we can relax about the safety of caffeine, we need to ask ourselves why we consume caffeine and why we consume as much as we do. If you consume minimal or only moderate doses of caffeine, you do not need to worry. However, if you are one of many people who consume large doses of caffeine on a daily basis, you really should examine your habits. Do you get enough sleep? If not, what can you do to improve this area of your health? Do you have problems with inattention during the day? If so, why? Are you having problems with tremors, palpitations, high blood pressure, stomach upset, or diarrhea? Are you taking one of the few drugs that can interact with caffeine? Depending on the answers to the above questions: could you consider switching to a non-caffeinated drink? If you would like to look up the amount of caffeine in a drink, there is a very comprehensive website listing almost every drink available. This website is www.energyfiend.com.
By- Dr. David PrescottThroughout the course of history, people have coped with a variety of illnesses and diseases that have been severe and widespread. Along with the physical impact of such illnesses, each widespread disease or epidemic has brought various levels of social anxiety, stress, and in extreme cases near panic. While our society today is nowhere near this level of public anxiety, it is important to keep a balanced psychological approach to this issue. High levels of public attention and media coverage are necessary to help prevent the spread of influenza. However, these frequent messages can inadvertently raise our anxiety and lead to high levels of stress or feeling somewhat helpless. The following tips will help you deal more effectively with the psychological stress associated with flu season. Stay Connected: Following tips for minimizing the spread of influenza involves being careful about interpersonal contact. However, we should not let good health practices disrupt our normal social networks, which are important in maintaining a sense of “normal.” In the worst case, social isolation of people who have flu-like symptoms can add to stress levels and make coping with being sick more difficult. Try to offer support to people with the flu, and look for ways to stay connected that minimize the chance of spreading an illness (phones, computers). Deal with Facts: In times of high stress there is a human tendency to take rumors at face value, make false assumptions, or follow trains of logic that are not based in fact. Facts can be a little boring when compared to rumor, but facts are very helpful in reducing unwanted stress. Find a credible source, like www.flu.gov to stay updated. And, don’t forget to actually do the things recommended by health experts. Sometimes, rumors or false assumptions lead us to put off making good health choices. Pursue Many Roads to Better Health: Much attention has been given to the availability of flu vaccine. However, if you are not yet able to get the vaccine, try not to let that translate into, “There is nothing I can do!” Remember that there are lots of ways to work on staying healthy. Proper sleep, diet, and exercise help your body fight off illness and stress. Good hand hygiene, like washing thoroughly with soap and water, is something over which you have total control. And, be sensible about close physical contact with people who are ill. Have a Plan: One of the biggest ways that the anxiety cycles spins out of control, is to repeatedly go through the “worry” process without ever developing a plan to address the worry. Your plan doesn’t need to be complicated. But, it may help to write out or talk through what you will do if influenza is identified in your school or where you work. And, if someone in your family contracts influenza, just have a simple plan of what you will do until they are well. Communicate with Your Children: Children, particularly younger children, are very vulnerable to the stress around them. Most children will observe adult behavior and emotions for cues on how to manage their own emotions. That is, your children watch you to figure out how they should react. It is usually best to discuss flu prevention efforts honestly and simply, using information that is appropriate for your child’s age. Maintaining familiar routines, as much as possible, when a family member is sick is also helpful in reducing anxiety and stress in children. When has Stress Become a Problem that Needs Professional Help? Defining the line between normal anxiety and anxiety which requires professional help is, of course, largely up to an individual. Some guiding points may be if anxiety or worry begins to significantly interfere with your job, school, or family, then you may need to talk with a psychologist or counselor. Feeling hopeless or highly discouraged for 2 consecutive weeks or more is often a symptom of clinical depression, and should prompt a visit to your primary care doctor or a mental health professional. For More Information: Acadia Hospital Web Site: www.acadiahospital.orgAmerican Psychological Association Help Center: www.apahelpcenter.orgU.S. Department of Health and Human Services: www.flu.gov
By- Dr. Erik SteeleIf you think you have the flu, this year we want you to think a little differently before you go to see your doctor or the emergency department. We would like to have you think about â€¦ not coming? That’s right – consider not coming in. There are a few reasons to consider that approach:1. Most health care workers have not yet been vaccinated against H1N1 influenza (the so-called swine flu) and if all of them get the flu from patients coming in with the flu, we will not have enough health care workers – doctors, nurses, respiratory therapists, etc – to take care of the sickest patients:2. If you are not at high risk for complications, you are not likely to be treated with anything from a doctor except advice, reassurance, and perhaps a prescription that can be called in over the phone:3. You could infect other people sitting in the office or emergency department waiting rooms. The tough part of making this decision is that some patients can get sick enough with influenza – the regular type and the H1N1 influenza – that they really do need to be seen by their primary care provider or the emergency department. How do you know if you, or a loved one, is so sick they should be seen right away, and not stay at home? Well, here are a few guidelines:1. Are you severely ill – too sick to get up and about for food, bathroom, etc.?2. Do you have real trouble with shortness of breath, severe lightheadedness when you are standing, or a severe headache associated with your illness?3. Is the sick person so ill they are less alert that normal, not as responsive as they should be?4. Is the patient too sick to take usual medications?5. If the patient is a child, do they just look ‘lousy’ to you?6. Do they have a significant rash in association with their illness?7. Do they have other health conditions that put them at higher risk of complications from influenza? These include being pregnant, having underlying heart disease (such as congestive heart failure) or lung disease (such as asthma or COPD / emphysema)? If they have any of these problems, call the patient’s physician about the illness and talk to them about being seen, or go to the emergency department if the patient seems too sick to wait.There is also a little questionnaire you can go to on the Web that will help you make this decision. It is available at XXXXXXXXX. You can complete the brief survey, and it might be able to help you with your decision. Don’t bother with the survey if the patient is too sick to wait around. And as always, you don’t have to make this decision alone – if you are uncertain, or worried about the patient (including if you are the patient), call your primary care provider and ask for some help making your decision.
By- Dr. Joan Marie PellegriniIt is that time of year again when we need to talk about hunter safety. Admittedly, accidents from hunting are way down compared with a few decades ago. However, the recent events in the news serves to remind us that this enjoyable activity has some dangers that can mostly be avoided.The Maine Department of Inland Fisheries and Wildlife has a webpage (www.state.me.us/ifw/) that is an excellent source of information on the current laws governing hunting. Below, I have included the ten rules for safety. One of the most important points to make is that many feel the law in 1973 mandating hunter orange clothing and the first hunter safety courses in 1986 (Portland Press Herald Dec 4, 2008) are responsible for the dramatic decrease in hunting accidents. A hunter safety course is not just for the young and new-to-hunting. Although it is not mandated by law, everyone can benefit from a refresher once in awhile. It is easy to become complacent after many years of hunting and being around guns. Hunter safety courses are not just about how to use a gun. There is also good information on the laws, navigation, survival, etc. To find out more about these courses go to the IFW webpage.Source: Maine Department of Inland Fisheries and Wildlife10 COMMANDMENTS OF HUNTER SAFETYGive every gun the respect due a loaded gun.Watch that muzzle and control its direction, even if you happen to fall.Be sure your target is the game your hunting, and identify beyond it before you pull the trigger.Be sure the barrel and action are clear of obstructions and that the ammunition is the proper size.Unload guns when not in use. Carry guns in cases to the shooting area.Never point a gun at anything you do not want to shoot, and never play.Never climb a fence or a tree or jump a ditch with a loaded gun. Never shoot a bullet at a flat, hard surface or water. And use an adequate shooting range backstop.Store guns and ammunition separately, beyond the reach of children.Avoid alcoholic beverages and other mood-altering drugs before and during shooting.
By- Dr. Jonathan WoodThis year, consider using Halloween as an opportunity to discuss a number of global health and safety issues with your children. Yes, several pointed issues certainly all apply to the day itself. But this is also an opportunity to reinforce with your kids that the lessons of Halloween are worth applying to their lives every day of the year.Dental HealthCavities develop as a result of carbohydrates and the associated acids produced bathing the teeth. The total time and frequency of exposure is the key, not necessarily the amount of sugar. The acids remain in the mouth for approx 20 min after a snack or meal. This knowledge supports a number of healthy habits, Halloween-related or not:Candies or foods that bath the mouth for long periods (lollipops, dense sticky candies, etc) engender the greatest riskEating at proscribed meal and snack times, rather than â€œgrazingâ€, will result in a healthier dental environmentTiming your Halloween candy consumption to around meals will reduce the associated risk of cavitiesSuggesting that kids eat little bits at a time and spread their candy consumption out over time will paradoxically increase their cavity riskEvening and Nighttime SafetyAs your kids prepare to wander the neighborhoods this year, use the holiday to remind them about pedestrian safety. It is especially important to stress that the driver visibility is at its worst during dusk, the time when many trick-or-treaters are out and about.Help your children choose costumes that offer adequate vision and mobilityConsider reflective costumes or at least adding some stick-on reflector materialFlashlights! One hand for the candy bag, one hand for the flashlightâ€¦!Review basic road crossing safety and stress the fact that these principles apply year â€˜roundUse sidewalks whenever possible.Food AllergiesFor kids with food allergies, Halloween is a good time to review some of the principles of awareness and avoidance. Teach label reading to confirm that ingredients are acceptableUse the time to review the signs and symptoms of allergic reactions due to inadvertent exposureBe aware that â€œtrick-or-treatâ€ size candies occasionally do not contain the exact same ingredients as the full size versionGeneral Healthy Behaviors and Global Safety Issues With wood stoves fired up and with Jack-o-lanterns on porches, Halloween offers a context for reviewing fire safety. Also, consider fire safety when choosing costumes.Carving pumpkins offers a setting in which to review knife safety with small children and adolescents alike.Use Halloween to gently review stranger safety. Use the trick-or-treating experience to reinforce simple things like not getting in cars with strangers and not going into strangersâ€™ homes unaccompanied. Halloween can be used to emphasize that most people are good people with good intentions, but that this doesnâ€™t negate the value of prudence and being careful.Use Halloween to talk about peer pressure and mob mentality. For example, reinforce the difference between â€œtricksâ€ and vandalism. Especially with older kids and adolescents, Halloween can offer an environment for trouble making. Prepare your kids with the means to identify and avoid inappropriate situations. Offering â€œscriptsâ€ for extracting themselves can be very helpful. Most important, discuss simple common sense with your kids. Nothing will serve them better than that! So, arm those kids with essential Halloween equipment (safe costume, good shoes, candy receptacle, flashlight, cell phone) and some common sense. Theyâ€™ll have fun, learn some things along the way, and have plenty of year â€˜round good habits reinforced!
By- Dr. David PrescottDepression â€“ Progress But Still Undertreated: Great improvements have been made over the past two decades in terms of identifying and treating clinical depression. As with most health problems, early detection and treatment of depression offers the best chance for addressing the problem successfully. Estimates are that just over 16% of Americans will experience clinical depression in their lifetime. Sadly, many of those people never receive treatment. National Depression Screening Day: Each year since 1991, National Depression Screening Day has helped people learn more about depression and provided screening and treatment referrals for any interested person. Screening is now available on-line to make it even more widely available. Types of Depression: As you consider whether or not you ought to take the screening, it may help to review the primary types of depression that have been identified by mental health experts. These descriptions are also available at the national Mental Health Screening website ( www.mentalhealthscreening.org).Clinical depression or major depression is a serious and common disorder of mood that is pervasive, intense and attacks the mind and body at the same time. Current theories indicate that clinical depression may be associated with an imbalance of chemicals in the brain that carry communications between nerve cells that control mood and other bodily systems. Other factors may also come into play, such as negative life experiences including stress or loss, medication, other medical illnesses, and certain personality traits and genetic factors. Dysthymia is a milder form of depression that lasts two years or more. It is the second most common type of depression but because people with dysthymia may only have two or three symptoms, may be overlooked and go undiagnosed and untreated. Seasonal Affective Disorder is a type of depression that follows seasonal rhythms, with symptoms occurring in the winter months and diminishing in spring and summer. Current research indicates that the absence of sunlight triggers a biochemical reaction that may cause symptoms such as loss of energy, decreased activity, sadness, excessive eating and sleeping.Bipolar DisorderBipolar disorder, also known as manic-depression, is a type of mental illness that involves a disorder of affect or mood. The person’s mood usually swings between overly “high” or irritable to sad and hopeless, and then back again, with periods of normal mood in between.Need more Information?Acadia Hospital: www.acadiahospital.orgNational Depression Screening Day: www.mentalhealthscreening.org).Depression Screening Questions â€“ National Depression Screening DaySample Questions: Over the past two weeks, how often have you: Been feeling low in energy, slowed down?a. For none or little of the time. b. For some of the timec. For most of the timed. For all of the timeHad difficulty falling asleep or staying asleep? e. For none or little of the timef. For some of the timeg. For most of the timeh. For all of the timeIf you would like to complete a screening for depression and possible treatment recommendations, follow the link to National Depression Screening Day at:www.acadiahospital.orgAvailable on October 8, 2009
By- Dr. Amy MoviusEastern Equine Encephalitis (EEE) is a very rare, but serious, viral disease that has killed several horses in Maine this fall.Â â€œTriple Eâ€, as it is sometimes called, can be very dangerous and even deadly in humans as well. The Eastern Equine Encephalitis Virus (EEEV) was first seen in Maine in 2005 when it was found in some mosquitoes, birds, and horses.Â Then, in the fall of 2008, a man in Cumberland County died of this disease.This fall, the EEEV has killed horses in 5 different counties of Maine.Â This is significant as horses are infected the same way humans are â€“ from being bitten by an infected mosquito.Â The â€œreservoirâ€ for EEEV is actually in songbirds.Â Mosquitoes, especially those found around hardwood wetlands and costal areas, can pick up the virus from birds and then infect humans (and horses).Â It is seen most often in late summer and early fall.Â Humans and horses infected with EEEV are not themselves infectious to anyone else.Â The increase of this disease in horses means that the virus is, unfortunately, alive and well in Maine in 2009.Â Most people who become infected with EEEV will have a mild flu or no obvious illness at all.Â For some individuals, however, encephalitis develops.Â Encephalitis occurs when there is inflammation around the brain.Â Symptoms can include fever, headache, behavior changes and progress to coma and death.Â Residents of wetland areas endemic for EEEV are at risk for contracting the infection, and persons over 50 and less than 15 years of age are more prone to developing serious disease.Â Sadly, 1/3 of people who develop encephalitis will die and of those who survive, many have permanent brain damage.Â Currently, there is no effective treatment for EEE and no vaccine for humans.Â The key to staying safe is prevention!Â Â Â Â Â Â Â Â Â Â Â 1.Â Always use an insect repellent when outdoors.Â DEET, picaridin, IR3535, and oil & lemon eucalyptus products are effective and should be applied to skin and clothes.Â Clothing may also be treated with permethrin, which will stay effective through several wash cycles.Â Â Â Â Â Â Â Â Â Â Â 2.Â Cover up outdoors with long sleeves/pants.Â Use nets to cover infant carriers.Â Â Â Â Â Â Â Â Â Â Â 3.Â *Limit or reschedule outdoor group evening activities, such as school athletic events.Â Participants and spectators should use insect repellents.Â All of these activities should end at least 1 hour before sunset if the temperature is greater than 50 degrees.Â This is because mosquito bites are most frequent at dusk and dawn.Â Â Â Â Â Â Â Â Â Â Â 4.Â Clean up standing water around your yard: repair any window screens that need it.Maine is full of wetlands and mosquitoes, and this virus is expected to be a problem next year as well.Â We need to use and develop defensive strategies now to protect ourselves while we continue to enjoy our beautiful state.Reference:Â Maine Center for Disease Control and Prevention
By- Dr. Joan PellegriniAlthough anyone at any age can get a concussion, this time of year is particularly important because of the start of the sports season in the schools. A concussion happens when there is a blow to the head that causes either a loss of consciousness, a brief lapse of memory, or a feeling of dizziness or being dazed. Most of us do not consider concussions to be serious and therefore we shrug it off and encourage the athlete to get back on the field quickly. Unfortunately, a concussion is a form of brain injury and this is why it is so important to avoid concussions. People who have a concussion are at an increased risk of having seizures over the next five years. Also, multiple concussions can lead to learning disabilities and some loss of cognition. There is even a theory that multiple concussions can increase your risk of developing Alzheimerâ€™s Disease.Post-concussive syndrome is poorly understood. It is also very difficult to predict. This is a complex disorder that may cause headache and dizziness for weeks or months. There may also be mood or personality changes, diminished concentration, fatigue, nausea, balance issues, and loss of appetite. It is easy to see why this syndrome could cause serious problems with school, work, or family life.The most important thing about concussions is to prevent them. Many high risk sports require helmets. However, there are several sports with high risk that do not require helmets such as soccer and field hockey. Once you or your child suffers a concussion, it then becomes extremely important to avoid another concussion. Certainly, the brain needs time to heal. However, medical professions are uncertain how long the injury may take to heal. Currently, the recommendation is to avoid risky behavior until all symptoms have completely resolved. This may mean keeping your child out of the sport for several weeks or more. If your child had a concussion and then returns to the sport after a time of healing, it is important for the coach to look for signs of incomplete healing such as slow response times, balance issues, etc.If you suspect that your or a family member may be suffering from post-concussive syndrome, your family physician can refer you to a specialist that deals with brain injury. This physician may even refer to very specialized physicians that deal specifically with the neuropsychiatric complications of brain injury.
By- Dr. Jonathan WoodBeing admitted to the hospital is can be scary and traumaticâ€¦ for the patient and for the patientâ€™s family.Being critically ill, needing invasive procedures or having a hospitalized child all accentuate these feelings The medical lingo is difficult to understand, the issues discussed often carry great importance, and there are often unanswered questions. Whatâ€™s more, caretakers often seem to be overworked or in a hurry. And then money is invariably an issue: missed work, inadequate insurance, childcare needs, day-to-day living away from home, etc. More stress.In the end, many people report a sense of â€œloss of controlâ€. What can be done?Arrgghhhh!While I cannot offer a fix for the sometimes beleaguered state of modern medicine, I will suggest one central thing that can help with all the above: improved communication. And much of it is within your control.Some suggestions:Ask questionso Who are you? Insist that people introduce themselves and explain their role in your care. Where do they fit in the lists above?o Why are we doing this? Insist on understanding why tests are being done and what is going to happen with the information.o May I speak with my doctor? Ideally there is one doctor orchestrating all of your care. Ideally there is excellent communication between doctors and amongst all the participants in the care team. Insist on a team and a good leader.Learn the system (i.e. who are all these people?)Hospitals depend upon a complex system of personnel that is often very confusing and very difficult to understand. Examples:o Primary Care docs (e.g. Internist, Family Practitioner, Pediatrician)o Inpatient Specialists (e.g. Hospitalist, Intensivist)o Specialists (e.g. Surgeon, Psychiatrist, OB-Gyn)o Sub-Specialists (e.g. Cardiologist, Neurologist, Orthopedic surgeon)o Midlevel Providers (e.g. Nurse Practitioner, Physician Assistant)o Nurses (e.g. bedside nurse, charge nurse)o Ancillary Personnel (e.g. Respiratory Therapy, Physical Therapy, Occupational Therapy, Nutritionists, Social Workers, Care Managers)o Trainees (e.g. residents, nursing students, medical students)Tell your caretakers your worries â€“ donâ€™t be afraid to tell people what concerns you or what would make you more comfortable. Nothing is off limits!Leave your biases at homeo Believe in the system â€“ Much of believing is understanding. Work to understand the system (see above) and increased confidence will follow. o Donâ€™t worry about offending â€“ Doctors are people – – you can talk to them like you talk to anyone. Sometimes people feel intimidated, but it is important to move beyond this. Be yourself. Remember: you are the consumer. Be polite and expect the same in return.o Gender â€“ The days of female nurses and male doctors are long over. Do not make assumptions based on gender and treat all your caretakers with respect. Insist on the same in return.o Teaching Hospitals â€“ Much of the best care in the US is delivered in teaching hospitals. No one is experimenting on you. On the contrary, these are often very concerned, very smart, and often less busy students or residents who can be very helpful in you quest for quality healthcare. Take advantage of the opportunity!o Culture Differences â€“ Maine attracts caregivers from all cultures. These people are invariably well trained and very caring. Treat them with respect and expect the same in reverse. If accents are difficult to understand, be frank, polite, and patient.Know what is expected of you and your family when you are dischargedo Ask questionso Get to know your â€œcare managerâ€ or â€œdischarge plannerâ€o Be sure you understand your medications and doses (including changes from when your arrived)o Have instructions repeated as many times as it take to understando Know who you need to see after leaving and where and when.While these suggestions wonâ€™t make being hospitalized fun, they may take some of the unnecessary fear and anxiety out of the process. In the end, remember… communication is the key!
By- Dr. David PrescottWhy Is Reducing the Stigma of Mental Illness Important? There are probably dozens of reasons that challenging the stigma of mental illness and addiction is important. But none seem more compelling than the fact that nearly two-thirds of people who experience a mental illness never receive any type of professional help for their problems. The negative attitudes, fears, and stereotypes that surround mental illness are one of the largest barriers to people receiving professional help. Stigma: A Mark of Social Disgrace? One definition of stigma is â€œa mark of social disgrace.â€ The concern is that our own personal fears and distrust lead us to think about people with mental illness in a way that makes the problem worse. Stigma leads to treating people with mental illness differently than we would treat them if they didnâ€™t have a mental illness. Examples of the forms that stigma against mental illness can take include: Stereotyping People with Mental Illness â€“ for example, assuming that people with severe mental illness can never have a job or a family of their own. Fearfulness â€“ not talking to someone with mental illness or purposefully avoiding them. Discrimination â€“ for example, not considering a person with known mental illness for a volunteer position, renting an apartment, or considering them for a job, based solely on the knowledge that they have, or have had, a mental illness. Language â€“ talking about mental illness in a way that makes fun of people with mental illness or perpetuates stereotypes, makes it harder for stigma to be eliminated. Avoid the Temptation to Say â€œMental Illness Doesnâ€™t Affect Me: People usually are not very happy if someone suggests they are prejudiced or hold negative stereotypes. Or, many people may see the issues around mental illness and addiction as not really affecting them or their family. However, the fact is that one in five people worldwide will have a mental or neurological disorder at some time in their life. This statistic virtually guarantees that everyone will be impacted by mental illness, and our ability to provide help in promoting recovery. Steps Towards Reducing Stigma: Eliminating societal level stereotypes of mental illness is an enormous goal. But, like all big problems, there are important steps that start with individuals. Some things that you could do include: Become More Knowledgeable: When we donâ€™t know the facts, it is easier to rely on a stereotype or false belief. Knowledge about mental illness is readily available on the web or in books. Knowing a few simple facts, like that the majority of people with mental illness recover from that illness, can help reduce stigma. Watch your Language: One good place to start is to use â€œpeople firstâ€ language â€“ saying â€œpeople with mental illnessâ€ instead of â€œthe mentally ill.â€ And, obviously, eliminating derogatory terms like â€œpsychoâ€ is important. Listen: If you know someone with mental illness, listen to their story and their experience. You donâ€™t need to have professional knowledge about treatment to listen. Just offer the respect and dignity you would offer any friend. For More Information: Federal Substance Abuse and Mental Health Service Administrationâ€™s â€œWhat A Difference a Friend Makesâ€ Campaign: www.whatadifference.samhsa.govAcadia Hospital Web Site: www.acadiahospital.orgNational Alliance for the Mentally Ill: www.nami.org
By- Dr. Amy Movius School is back in session and for households with children, this necessitates a shift of routine that includes getting kids to and from school as well as school related activities. The logistics of more coming/going from more places deserves some special attention, as each year approximately 900 children in the US are killed while walking and more than 50,000 are injured. Unlike adult, child pedestrians tend to be injured in broad daylight under optimal conditions – meaning no impairment of visibility or poor road conditions. Boys outnumber girls in injuries sustained. Looking back, the number of child pedestrian fatalities has decreased by almost 50% since 1997. Before congratulating ourselves, however, we must realize this is not due to an improvement in pedestrian safety. Rather it is merely a consequence of fewer kids walking at all. In 1969, 42% of all children walked or biked to school: increasing to 87% for those who lived within a mile of school. Today, a whopping 16% of children walk or bike to school and a large proportion of kids living less than a mile away are still driven to/from school. This behavior is consistent with the alarming increases in obesity and decreases in exercise seen in our country’s children. One of the goals of the Healthy People 2010 initiative is to increase the proportion of trips less than a mile that are made by walking. Weather permitting, school travel is a great opportunity to incorporate this healthy lifestyle, though obviously not at the expense of children’s safety. Safety is the second most common reason cited by parents who opt not to have their children walk to school. Evaluating the factors that contribute to child pedestrian injuries can be helpful in creating safer walking conditions for children. The first contributor to child pedestrian injuries is the child him/herself. Children have limited ability to scan traffic activity and are poor judges of vehicle distance, speed, and estimating time needed for street crossing. Children are also inherently quick moving and impulsive. That most child pedestrian accidents occur when children dart into the street, not at intersections is further proof of this. Adults tend to overestimate the ability of our children to navigate traffic, simply because we don’t appreciate the physical and perceptive limitations of their age. For this reason, the AAP states children less than 10 should not be unsupervised pedestrians. A second contributor to pedestrian accidents is, unsurprisingly, the driver. It is more difficult to see children because they are small. This is even worse in vehicles of elevated height such as SUVs, vans, and trucks. (Incidentally, the injuries caused by these vehicles tend to be worse than normal passenger cars). Also just as children are poor judges of traffic distance, drivers are poor judges of child pedestrian distance, again because of their smaller size. Speed is a huge contributor to accident occurrence and severity of injuries. Cars going fast take longer to slow and stop. Whereas there is an 85% chance of survival for a pedestrian struck by a vehicle going 20mph, there is an 85% chance of death for a pedestrian stuck by a vehicle going 40mph. A last consideration is the environment in which a child walks. In urban areas, high traffic and poor visibility due to parked cars are concerns. For more rural areas, few traffic lights, lack of sidewalks or any barrier between pedestrian and vehicle routes are major concerns. Encouraging children to walk more is a worthwhile effort and a few guidelines can make is much safer. First, supervision by an adult is the most effective tool to keeping child pedestrians safe. Remember, no child pedestrian under 10 yrs of age should be unsupervised. Second, adults should be good role models when walking. We can hardly expect our children to take crosswalks, sidewalks and crossing signals seriously if we do not. Plan the safest route to your child’s destination, perhaps enlisting community and government resources to establish and protect these paths. The pedestrian equivalent of a car pool can also be formed, where parents take turns walking a group of children to school. Several resources such as Safe Routes to School (which is federally funded), Kids Walk, and Walk to School Day can help get you started. Lastly, children who have been involved as pedestrians in accidents have a very high incidence (30%) of Acute Stress Disorder and Post-Traumatic Stress Disorder. This is true even for very minor accidents. Most are not brought to professional help. If your child has been in a “near miss” accident they may have symptoms such as reexperiencing the incident, avoidant behavior, hyper arousal, or dissociation (shut down). Please take your child to their medical provider if there is any concern. Reference:Policy Statement – Pedestrian Safety, American Academy of Pediatric 2009, www.aap.org www.healthypeople.gov
By- Joan Marie PellegriniThis is to quote Thomas Judge, Director of Lifeflight of Maine. For years, we have known that Mainers are hesitant to call the ambulance when they are having chest pain. There are many reasons for this. Most people think that their pain is â€œreally no big deal.â€ There is denial that they may actually be having a heart attack. Also, who want â€œall those ambulances and people showing up at my door.â€ All the neighbors will be wondering what is going on. Also, the ambulances are busy and should be left to pick up the â€œreally sickâ€ people. And, for people who live fairly close to a hospital, â€œI can get their faster by just driving myself.â€Most people think that they will know if they are having a heart attack. This is because they assume the symptoms are the same for everyone. Unfortunately, this is not true. The chest pain can come on gradually or suddenly. It can be mild or severe. It can be in the front or back of the chest. It can radiate up to the chin or down the arms or even seem to be in the abdomen. A heart attack can happen to people who appear healthy and who feel well. A heart attach can happen even if youâ€™ve had a physical that states you are healthy. Sure, there are other diagnosis that can cause similar symptoms but arenâ€™t as serious (reflux disease, gallbladder disease, joint and muscle disease). However, this is the job of the Emergency Room physicians to determine.Here is what most people forget: the treatment starts once the Emergency Medical personnel arrive. They can get you oxygen, aspirin, and other medications that may be indicated. They can look at your heart rhythm. They can communicate directly with the doctors at the Emergency Room. If you truly are having a heart attack, timing is everything. The saying is â€œTime is muscle:â€ the more time that goes by without enough oxygen to the heart muscle, the more muscle that dies. There are some patients who need to have a procedure right away to open one or more of the arteries in their heart. This procedure is done in the cardiac catheterization lab (cath lab). If you are one of the patients who are having this type of heart attack, it is the goal of the doctors treating you to have you in the cath lab in less than 90 minutes. Your chances of getting your treatment this quickly are much higher if you call an ambulance.So, if there is even a remote possibility that you may be having a heart attack, pick up the phone and call 911. Donâ€™t even think twice about it. So, if there is even a remote possibility that you may be having a heart attack, pick up the phone and call 911. Donâ€™t even think twice about it.
By- Dr. Jonathan WoodFrench friesMozzarella sticksHot dogsSpaghetti with red saucePB & JMac and cheeseChicken fingersGrilled CheeseSound familiar? Pick any five of the above and you have the classic all-American Kids’ Menu! And increasingly, this is not just a restaurant menu: it’s the home menu as well!Why do we expect so little from children when it comes to eating?Why are their choices so few and so boring?Why so unhealthy? Where are the fruits? Vegetables? Complex carbohydrates?Do we precondition children to this at an early age?And then continually reinforce it over the course of their early years?Does this stunt their taste buds? What about their culinary imagination and adventurousness?Bottom line:Where is the fresh fish?Where are the beans or broccoli?Where is the grilled teriyaki chicken?Where is the tabbouleh or hummus?Does all the above encourage an unhealthy diet in later childhood, adolescence, and adulthood, one that contributes to obesity and promotes certain diseases and cancers? The definitive answer to this question is difficult to pin down, but the logical answer is “yes”!We are programmed to want sweet high energy food from the time we are born. Breast milk fits the bill and we add to the sweet and fatty selections throughout infancy and childhood. The taste for salt is active by 6 month and we continue to feed that desire through our entire life. Bitter foods (e.g. spinach) typically require repeated exposure in order for one to develop a desire for the taste. In order for children to develop a taste for some of the more “difficult” flavors, it (1) takes time and patience and (2) is easier if it is done early in childhood.Americans are busy people (too busy?) and increasingly have less time for meal preparation. Furthermore, as parents we seem programmed to worrying about our children starving themselves. They won’t! If presented with healthy food, children will eat it. If we worry about their rejected choices and immediately substitute with one of those sweet or fatty or salty foods that we know they will eat, we may feel better. But they will ultimately suffer. Your kids may miss the opportunity to develop tastes for more healthy foods and be destined to look for and get the Kids’ Menu throughout childhood.Soooooâ€¦How can we combat this?How can we change the fact that the most common vegetable eaten by toddlers is French fries?How do we capitalize on the fact that what children eat in the first 2 years of life is a strong predictor or whether they are eating fruits and vegetables at age 10?Make a point of repeatedly offering young children a variety of foods.Start early with fruits and vegetable as snacks – – establish good habits and life will be much easier down the line.Be patient – – don’t rush to replace good stuff on their plate with just any calories. Children will NOT starve themselves!Don’t focus on “it’s good for you”. Simply tell them “this is what’s for dinner”.Make it a family affair – – choose a good balanced menu and don’t “dumb down” the choices for the younger kids.Don’t go cold-turkey on the tasty “unhealthy” stuff – – research also shows that kids may well overindulge later on the “forbidden delights”Avoid the Kids Menu! If you go to a restaurant, inquire about small portions of the adult selections. Or let the kids order some healthy choices from the appetizer menu.Finally, consider offering some exciting or even exotic choices to kids early on. Challenge those developing taste buds and you may provide them with the inclination to stretch their diet down the line. The more they have experienced as kids, the more desirable options they will likely have for a healthy diet as adults.Some books to consider if interested in further reading:Hungry Monkey: A Food-Loving Father’s Quest to Raise an Adventurous Eater by Matthew Anster-Burton (Houghton Mifflin)The Gastokid Cookbood: Feeding a Foodie in a Fast-Food WorldBy Hugh Garvey and Matthew Yeomans (Wiley)My Two-Year-Old Eats Octopus: Raising Children Who Love to Eat EverythingBy Nancy Tringali Piho (Bull Publishing) (due in November 2009)