Cutting: How to Help Our Children

razorblade-01Everything old is new again. A few decades ago, kids who wanted to hurt themselves used lit cigarettes, pulled out their hair, punched their fists through glass doors, or beat their heads against a wall. Nowadays, the most common method of self-injury is cutting. Parents don’t understand it; sometimes they don’t even see it. I have had parents tell me it didn’t make sense, that their children were only doing it to get attention, or that they were just doing it because it’s a fad. Parents are afraid and confused, and they react with anger and denial. As always in parenting, knowledge is essential. If we want to help our children, we need to start with understanding them.

What is Cutting? 

Cutting is one aspect of self-injury. “Cutters” slice shallowly through their skin with a sharp object, like a razor. They generally cut in areas that can be hidden and are easily reached, most often their inner forearms. We also see it on chests, abdomens, and the inside of legs. They usually slice a series of 2 or 3 inch parallel lines into their skin in the chosen area.

People who self-injure also sometimes burn themselves, punch themselves, bang their heads, break their bones, or carve designs into their skin. They will pull out their hair, bite themselves, or pick at wounds so that they don’t heal. They look in mirrors and  yell obscenities at themselves to make sure they know that they are not worth the air that they breathe. We absolutely have to take this seriously.

Why do they cut?

It is a way of focusing and externalizing emotional pain. Physical pain is much easier to handle than the anger, frustration and depression they carry inside. Self injury is usually impulsive, prompted by an event that causes emotional devastation. Afterwards, they feel relief: they made a decision, took action and punished themselves for the crime of existing. There is a sort of pride in the fact that they were strong enough to see the punishment through. They are balanced on an edge: if they chose, they could cut a little deeper and not have to exist any more. They transiently feel in control, at least of their own bodies; the power is theirs. Later, they are overtaken with shame and guilt. The belief that they are worthless is reinforced, because what kind of an idiot would do this to themselves? The cycle starts over.

Who cuts?

Girls self-injure more frequently than boys; teens more often than young adults. Peer pressure has a huge effect: supportive friends can protect your child from him or herself, and allow a healthier outlet for the pain. Friends who also self-injure will pull them in the wrong direction. If a child is alone and lonely, the anger and self hatred can circle in their heads and build.

Kids are also more likely to break out razors if they have been neglected or abused, and after they experience a trauma; conflicts at home or in school can intensify the behavior. Self-injury is also more common in kids who have questions about their identity or sexuality. It is more common when kids are under the influence of alcohol or drugs. Last, it is more common in kids with eating disorders, depression, and psychiatric disorders.

As these children get older, their methods of self-injury change. Young adults develop eating disorders, become sexually promiscuous, drink to excess, take drugs, and put themselves in harm’s way. They might walk in front of a moving car to see if the car can stop in time, irritate people to start fights, or engage in damaging relationships. It is the motive that matters, not the method.

How do we know?

The first step in helping these kids is to notice that they are doing it, and to care. A child who self-injures will have scars from prior cuts, or burns. They will have fresh injuries: broken bones, bruises, cuts, or burns, with poor explanations. They will cover the area of their bodies with these injuries; usually children are quick to show their injuries and tell you the story of how it happened. If you never see your child’s forearms, look. These kids will keep sharp objects handy. In the same way a lighter should make you wonder if your child smokes, a razor blade should inspire you to start a conversation about cutting.

A child who cuts tends to be a loner who has problems maintaining relationships. They tend to have emotional labiality, moving from happy to angry in a split second. There are frequently other behavioral issues, such as trouble in school or with the police. They do sometimes tell their parents, but are not always heard. If your child tells you that there is no point, nothing will ever work out, or they wish they were dead, listen. It is human nature to try to communicate, but we do not always do it in a way that others understand. Self injury is not only a symptom and self therapy. It is also communication, if you will only look, see, and care.

How do we help?

What do we do about it, after we stop crying and shaking?

  • We treat it seriously. Open a conversation, and listen. It is a small step from “I deserve to bleed” to “I deserve to die.” Bring your child to the doctor, even if he or she doesn’t want to, even if you promised you wouldn’t.  He or she will need to see a therapist.
  • Provide emotional support: accept your child exactly as he or she is, love them, and let them know that you will love them no matter what. Don’t yell, punish, threaten, or judge. Issue no ultimatums.
  • Lower their daily stress level. Sometimes this is as easy as letting them know that they do not have to be perfect; sometimes cutting back their work load of academics, job, and extracurricular activities will help. Keep their home stable and safe, and be a good example.
  • Work to repair their self esteem. Part of this will be work with a psychologist. Encourage them to find friends with like interests (perhaps sign them up for classes or activities that they find interesting?), and engage them in activities at which they excel. Nothing repairs self esteem like achievement. Do things together that they enjoy.
  • Their therapist should teach them to distract themselves from circular negative thinking. This is a learned skill; it is much easier to repeat the same old ugly “truths” over and over in your head, until it seems impossible to change.
  • That psychiatrist should also work on teaching them to stand up for themselves. Girls especially are not good at saying “no.” Self respect is essential to prevent self-injury.
  • Monitor the media they interact with, because there are sites that glorify and reinforce self injury. Also monitor them for signs that they are relapsing.
  • Take an interest in who their friends are, and how those relationships are going. Are they able to maintain a friendship, or do they run through friends frequently?

Self injury is astoundingly common, very real, and serious. We need to see our children, listen to them, and believe them. The history in their heads is the true one to them, and the one that matters. Denying it’s validity only reinforces their belief that they themselves are stupid, or wrong, or worthless. Empower them to deal with their truth. Support them with your love, acceptance, and respect. Give them a better measuring stick with which to judge themselves: one that puts their own personality, talents and abilities at the top.

Childhood Obesity: How do we have an impact?

broccoli-01So, last week’s blog was about the whys behind the increase in childhood obesity: why it has gained such a firm hold in our society, and why we need to care. This week is about how we can promote change, going into the future. What works? What is the plan?

Our objective is clear: we want healthy children. To achieve this when our children are overweight, we need to decrease the calories they take in, and increase their activity: get rid of junk foods and get them moving. If children take in more calories than they work off, the excess is stored as fat. Math works.

We also need to get our children to eat only nutritious foods, except on special occasions. If kids eat junk, which does not have in it the nutrients they need, they have to overeat total calories to get those nutrients. Bad idea. So how do we make this happen?

We start by using the power of positive reinforcement. It is a proven fact that rewards work better than punishments to change people’s behavior. It is human nature to repeat actions that make us feel happy and appreciated. Hence the popularity of slobbery dogs. Even better: how long would you go to work if you did not get a paycheck? Do you find that you do better work when you feel appreciated? If we are going to change habits, we need to focus on the positive and let go of the negative. We need to make eating healthful foods and being active more rewarding than stopping for fast food and eating chips. This is not hard, because there are a multitude of easy rewards appropriate for eating your broccoli: from smiles and hugs to feeling good and saving money. How could a toy in a kid’s meal possibly compare?

Never try to place blame: it evades personal responsibility and it solves nothing. Similarly, not only is it unkind to judge and condemn people for being overweight, it is also ineffective as a means for change: it doesn’t work. Stop doing it, and intervene when someone else does it.

Do set up the playing field in your favor. Only buy healthful foods. It is much harder to eat a doughnut when you get home from school if no one bought doughnuts. It is difficult to buy a soda at school if there is no vending machine. It is immeasurably easier to win a battle that is never engaged.

Consistency and routine are your best weapons to take into the fray. If you sometimes stop for fast food on the way home from school, simply getting into the car can elicit demands. The trigger is already in place to remind your children of their habit.  Alternatively, if you never stop for fast food on the way home, why would it even come up in the conversation? If the routine is “never”, the response to a request for a snack cake is a head shake and a laugh; if the routine is “sometimes”, the response to a no is whining, each and every time. Children’s minds settle comfortably into routine and habit, so a habit of only eating healthful food will save you a lifetime of arguments.

Rethink what and how you feed your children at the most basic level, to redesign those routines. Start with awareness of what your children need every day, then plan meals that will get them there. Don’t buy the foods that do not have the nutrients they need. Get rid of preconceptions based on family history, media, and friends (contrary to popular belief, there is no daily requirement for potato chips, and “only one soda a day” is one too many). Evaluate your family home and everyday habits. When and where are we keeping food and eating it? What needs to change? Does your child walk by a pantry filled with snack cakes and chips as he gets home from school? What might happen if we throw those out and place a bowl of fruit in his path? What if the only cold drinks in the refrigerator were water and low fat milk? What if we required our family to gather at the dinner table and converse? Change the routines, because when we change a habit the effect of that small change is magnified by the multitude of days in which that habit would have persisted.

On the other side of the equation is the burning off of those calories. The target for children’s activity is a minimum of 45 – 60 minutes of vigorous exercise as many days as possible. This needs to include all kids, not just athletes, because the purpose is to get fit, not to win fame. By no means should this be their only activity: as a general rule, if they are awake and not tied to a desk or reading, they should me moving. The first step to getting them moving is to limit non-educational screen time to maximum of 2 hours per day. Bore them into activity. They can choose the type, as long as they are moving. The second step is to get up and do it with them.

Make a plan and a commitment, and then act:

  • First, purge the pantry of all junk food (no “We paid good money for that food!”) Throw it away.
  • Make a meal plan of nutritious foods for the week, considering your schedule, and write out a grocery list. Only buy what is on the list. Read labels (watch total calories, not just fat or sugar). Emphasize fresh, seasonal foods.
  • Aim for fully half of what your family eats to be fruits and vegetables.
  • Make less food, and serve smaller portions. Hungry children can have seconds and thirds on the broccoli, not the potatoes, because you didn’t make more potatoes.
  • Teach your kids to eat slowly, putting their fork down between bites to enjoy conversation with the rest of the family. Let their brains catch up with their stomachs.
  • Eat more high fiber foods (they are more filling), less meat and starch.
  • Eat at home, as a family. Restaurant portion sizes are too large, and they use too much salt, fat, and sugar.
  • Teach your children to eat when they are hungry rather than for reward, comfort, or boredom; also to stop eating when they are no longer hungry. Be a good example.
  • Make it a rule that treats are only for special occasions.
  • Do not expect a quick fix; results come over the long term.
  • Last, realize that kids have one big advantage: if they just keep their weight the same, they can grow into it. Don’t make weight loss the goal. The goal is a long-term habit of eating a nutritious diet.

Ignore the peanut gallery, because you have to persevere: their lives depend upon it. It is the responsibility of the parent, caregiver, coach, and school to offer the children in their care nutritious foods and to be a good example. Do not feel guilty because they are temporarily unhappy! You love them; therefor you will not give them foods that cause all those awful health problems. You will do this for ever and ever, because when the grown-ups are consistent, the kids give up.

Recruit your friends and family, because “it takes a village” (sorry, couldn’t resist). This might in the end mean avoiding people – family and friends – who undermine your efforts. Grandma can see her baby when she learns to behave.

Community support is absolutely necessary if we want to turn this around. Schools must consider what food is available for breakfasts, lunches, and in vending machines. The adults in children’s lives need to be good examples: from parents to teachers to Hollywood actors and sports figures. Education needs to be readily available for both children and their grown-ups. Adult education resources are needed for parents, childcare workers and community leaders to learn about nutrition, the basics of meal planning, grocery shopping, and cooking.

If we can change the community of thought about food and exercise, kids will not be alone in developing new healthy habits. Their parents will also become more fit, as they role model healthy behavior. Our society’s medical costs will shrink, along with a mountain of heartbreak, family stress and financial woes.

When people have knowledge about nutrition and are in the habit of eating healthy food when they are actually hungry, they will pass this knowledge and these habits down to their children, and their children’s children, and healthy habits will persist. They can change the future of their family.

We can do this, and it is absolutely worth doing.

Childhood Obesity: Why It Happens

So. My goal for this blog was to be both accurate and comprehensive; broccoli-01the result was that it was very long. We need to have a thorough understanding of both the why’s and the how to’s if we want to make a difference in childhood obesity. This week covers just the first half, so you won’t nod off before the end. Today is all about the what and why; next week is about how we fix the problem.

Obesity is defined as weight more than 20% above a person’s ideal weight for their height. Morbid obesity is weight in enough excess that it affects a person’s health, or “causes morbidity.” In 2010, more than 1 in 3 children were overweight or obese. At a time in their lives when children should be running free and unencumbered, they are instead carrying the baggage of a society that has lost its way. Although issues like hypothyroidism and low levels of Leptin (a hormone that makes us feel full) can cause weight gain, medical causes account for less than 1% of the overweight kids.

Obesity has more than doubled in children and tripled in adolescents in the past 30 years. Rather than 5 or 7% of children being morbidly obese, as they were in the 80’s, now 18% are. Three quarters of these obese teens will become obese adults.

Why do we care? There are, of course, the physical health risks, including:

  • heart disease
  • stroke
  • high blood pressure
  • type 2 diabetes
  • degenerative arthritis
  • chronic back and knee pain
  • slipped capitofemoral epiphysis (a crippling hip injury)
  • ankle fractures
  • several forms of cancer (colon, thyroid, prostate, and breast, among others)
  • pseudogynecomastia (breast development in boys)
  • gallstones
  • obstructive sleep apnea
  • pancreatitis
  • skin infections
  • deficiencies of zinc, calcium, iron, magnesium, and folic acid from a junk food diet

There are also serious mental health risks, including low self-esteem, body image issues by as young as 5 years, anxiety, and depression. Overweight children are frequently the victims of exclusionism, taunts, and ridicule. Bullying overweight people is one of the last socially acceptable forms of bigotry.

Last, there are lifestyle limitations. For overweight children activity is harder, and the vicious cycle of a sedentary lifestyle causing weight gain, which causes a lower activity level, which causes weight gain, persists. Fueling this also is the fact that obese children will be offered fewer opportunities: they are rarely the first picked for the team, or the cool new job. Even their dating choices will be affected, partly by their appearance, but more by the damage to their self-esteem. There are also financial stresses, from the expense of processed foods, to increased medical costs, to fewer chances in the workplace.

So why do we do nothing about it?

First, we simply don’t see it. When our whole family, neighborhood, region, or country is overweight, after a while it becomes what we see as normal. Add on that our child has always been this shape. When shown silhouettes of children and asked which is most similar to their own child, parents of overweight children will pick out a thinner silhouette as theirs. The extra pounds become as invisible as the individual trees in the forest.

We don’t know what to do to fix it and, as adults, we are embarrassed to admit our ignorance. Add to this that people fear change. Grown-ups like to feel capable and comfortable in their lives. People generally take what they learned in childhood as true, and continue unquestioningly down that reassuring and undemanding path. It can take an unexpected event, like a child being diagnosed with diabetes, to shake them up and make them think about their choices. Even then, parents need to be able to find the resources to learn, and there are few easily accessible ways for an adult with only a few spare minutes to learn about nutrition, grocery shopping, cooking, and exercise. So we flounder, and persist in our habits.

If we do decide to change, it can be just too hard. Learning about nutrition, grocery shopping, cooking and exercise, in addition to working at our jobs and taking care of our families, is difficult to fit into the schedule. Then we have to actually do the grocery shopping, cooking and exercising. Add on fighting with children, and possibly a spouse, used to eating whatever they want and zoning out in front of a screen (TV or computer) whenever they want. It is immeasurably easier to let them snack on junk and watch a screen, than to make them eat vegetables and exercise.

Moreover, people believe that preparing nutritious food and getting their kids to be more active requires resources that they do not have. They truly believe fresh nutritious foods are expensive, when in actuality 4 servings of vegetables or 3 servings of fruit can be had for about a dollar. They believe their kids won’t eat healthy foods, and the groceries they spent their hard earned money on will rot. They have seen it happen before. When kids have both healthy food and junk options, flavor saturated junk wins, and healthy foods go bad. Similarly, parents believe that if they want their kids to exercise, they have to pay for expensive exercise programs and organized sports. In reality, play is free.

People see their behavior as acceptable, because everyone they know eats and behaves in the same way. Even the advertisements they see, and the TV and movies they watch, inevitably show people eating fast food and junk.

Last, the reason we hide even from ourselves: parents are unwilling to have change interfere with their own lives. They don’t want to spend what little free time they have preparing food and exercising with their children. They are comfortable with their routines. It is easier to let the screen entertain the kids, and they have no real interest in getting up and playing with their progeny. They are equally unwilling to do without the foods they like, even though they know they should do better. Since no one wants to cop to this, they instead pile the weight of conviction onto all the other, less guilt inducing, reasons.

If we want to improve our children’s health, these are the obstacles and the challenges. Human nature is an unalterable certainty. Ignoring it while trying to force change will get us nowhere. Next week’s blog will be about how to work within the confines of human nature to change the choices parents make, and help our children live healthier lives.

a Gluten Free Blog…

I recently heard some very strange theories about gluten. wheat-01Reminiscent of the telephone game we played as children, whispering into each other’s ears down a line, what people hear at the end is very different from the reality spoken at the beginning. Let’s clear up some confusion.

Our ancestors survived in no small part due to the development of cultivated grasses: the seeds of grasses are high in carbohydrates for energy, protein for strong muscles, and fiber for bowel function. They contain iron, B vitamins, zinc, and magnesium. They could be dried and stored, so groups of people could stay in one place and survive the winter. Worldwide throughout history, every culture has developed some sort of grain based food as a staple, from bread to flatbread, corn tortillas to rice.

Gluten is the protein found in wheat, spelt, barley, and rye grains. It gives elasticity to bread dough so that it can rise and maintain its shape and chewiness. Gluten is pervasive in our foods: it is in breads, pastas and cereals, is added into low protein foods to improve their nutritional value, and is present in everything from ketchup to soy sauce to beer. It is even in our cosmetics, hair and skin products.

Our bodies use the amino acids that make up gluten to build our muscles and everything from our fingernails to the cartilage in our noses; to make our immune system work so it can fight off disease; to communicate within our bodies; to carry oxygen through our bloodstreams; even to make sperm able to swim so the next generation can be born. We cannot make all of these amino acids ourselves, so we have to ingest them. Whole grains are an excellent source.

Since whole grains contain so many nutrients and have such fantastic health benefits, and since avoiding gluten is both inconvenient and expensive, let’s make sure living gluten free makes sense, before we commit.

Celiac disease is the condition we worry about with gluten. It is caused by an immune reaction to the gluten protein: it acts as an allergen in genetically predisposed people, like pollen to people with hay fever. It is most common in the Saharawi in the Western Sahara and Spain. In the US, about 7 in 1000 people have it. It is programmed into the DNA of affected people, inherited from their ancestors, like having blue eyes or brown hair. The inheritance is complex, with many genes contributing, so the disease has a variety of presentations. Children most typically present between 6 months and 2 years of age with weight loss, diarrhea, muscle wasting and abdominal distention. Some less common presentations include:

  • Iron deficiency anemia
  • Poor growth
  • Delayed puberty, infertility
  • Itchy bumps on the elbows, knees, and buttocks
  • Mouth ulcers
  • Arthritis
  • Chronic tiredness
  • Behavioral problems, depression
  • Headaches
  • Weak, thin bones with frequent fractures

It is more common in people with Type 1 Diabetes, Down’s syndrome, autoimmune disease, and thyroiditis. The symptoms can be more severe when there is concurrent illness, like rotavirus or a toxin ingestion.

In the people who have Celiac, gluten triggers an inflammatory reaction which causes the little absorptive pillars in the small intestine to die off, and causes crypt hyperplasia in the walls of the gut. This affects the person’s ability to absorb nutrients, resulting in the weight loss, diarrhea, and the other symptoms listed above. It also causes the production of antigliadin antibody (AGA), tissue transglutaminase (tTG), and antiendomysium antibody (EMA), which can be tested for and are used to screen for Celiac disease. Convenient, yes?

If you think your children might have Celiac disease, get them tested. If the test is positive, he or she will need to see a specialist and have a biopsy done to confirm the diagnosis. Children who test positive for Celiac disease need to consult with a nutritionist, both to learn which foods and products contain gluten, and to learn how to maintain a healthful diet without the many things that include gluten. Short term, deficiencies of trace elements, vitamins and minerals are common with a gluten free diet (zinc, magnesium, iron and B vitamins especially); long term risks include cancers of the gut and recurrent bone fractures. Deficiencies can lead to anemia, poor immune function, poor growth, skin lesions, messed up heart and brain function, and a host of other unpleasant symptoms. Living gluten free is not something you would want to attempt without knowledge and expert guidance.

A gluten free diet is a medical necessity for people with Celiac disease. It is not a healthful way to lose weight. It is also not a good way to nourish your child. Sustenance should not be a fashion trend.

Children use food to lengthen their bones, grow their muscles, build their brains, and give them energy to run, climb, and think. We need to avoid feeding our children things like concentrated sweets, sodas, and greasy fast food; we do not need to avoid whole grain breads and cereals.

Whole grain and protein are not in any way toxic, even though a very few people are allergic and have to avoid them. Pretending to have an allergy to be “hip” is just silly, and disrespectful of the people who actually have Celiac disease.

If your children do not have Celiac, stick to a nutritious diet including whole and enriched grains. Feeding your children a gluten free diet when they don’t have Celiac disease is not only inconvenient and expensive, it also carries with it serious risk to your children’s health.

To grow, two-year-olds should have about three ounces of grain per day; by four, they should get five ounces; between nine and eighteen, they need to take in between five and eight ounces. At least half of this should be whole grain; the rest should be enriched (iron, vitamins and minerals added back in).

Don’t let fads decide for you what to feed your child; rely on common sense and nutritional science. Focus on fresh fruits and vegetables, then add whole and enriched grains and a little protein. Sit down and eat together as a family, and watch your munchkins grow and thrive.