Healthy U - August 2018 by Times Record

Volume 2, Edition 7 August 2018

KIDS

FIRST!

Mercy Fort Smithâ&#x20AC;&#x2122;s Ronald McDonald Family Room Sparks pediatricians discuss keeping kids well Donâ&#x20AC;&#x2122;t let food allergies keep your child down Making strides on childhood obesity

HEALTHYU Contents VOLUME 2, EDITION 7 | August 2018

HOME AWAY FROM HOME

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Local couple shares experience with preemie, Mercy’s Ronald McDonald House

A HEALTHY SCHOOL YEAR

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Sparks pediatricians discuss immunizations, lice treatments

FOOD ALLERGIES

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Mercy Fort Smith offers tips for coping

MEDICAL DIRECTORY

22-23 16

Access to the area’s leading medical providers by category so readers can easily ﬁnd contacts for their areas of need.

ON THE COVER Bentley Neece, 6, returns the ball to his grandmother, Michelle Niewald, as they play at The Links’ tennis courts. [BRIAN D. SANDERFORD/TIMES RECORD]

about HEALTHYU Healthy U is a monthly publication of the Times Record, focusing on issues of health and wellness for the River Valley area. It publishes the third Saturday of every month. For more information: ccosta@swtimes.com

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Publisher Crystal Costa Editor Mardi Taylor Contributing Writer Carole Medlock, Cyd King Photographers Brian Sanderford, Jamie Mitchell Production Manager Christy Morrison ADVERTISING Sales Manager Julie Newman

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Are your kids too clean? Research reveals dangers of killing germs By Sammy Caiola The Sacramento Bee

Parents have made an enemy of bacteria for years. They’ve sanitized tabletops, disinfected playthings and wiped down grocery store carts to keep their children safe from unseen germs. That instinct is a natural one, experts say, but emerging research about the body’s bacteria, fungi and other cells that cover our skin, gastrointestinal tract and other areas suggests that we may be taking hygiene vigilance a little too far. That, in the long run, weakens our immune systems. Scientists are only beginning to understand the millions of microbes that make up the human microbiome, said UC Davis microbiologist Jonathan Eisen, but researchers are finding that antibiotics, household disinfectants and other sanitizing products are also killing the “good bacteria” that help our bodies fend off disease. Many believe that the shortage of certain microbes explains recent spikes in childhood allergies and asthma. “Our skin, anything we eat, any orifice or opening, is going to be exposed to microbes and get microbes on it and in it,” said Eisen, who jokingly calls himself a “guardian of microbial diversity.” “We’re at the point where we’re way too haphazard with killing microbes because people think they’re bad. There’s reason to believe that there are short- and longterm consequences, and we shouldn’t use these things unless we need them, and we should use them with caution.” People in developing countries, who grow up in less sterile environments, eat mostly non-processed foods and spend more time around people and animals, have more varieties of microbes in their gastrointestinal tracts than people in the United States, recent studies show. At the same time, food allergy rates are lower in Africa and South America than in North America, Western Europe and Australia, according to the World Allergy Organization. The findings play into the “hygiene hypothesis,” or the idea that childhood infections acquired through 4

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Aliyah Lopez stops to peer out over the children’s play area at Creekmore Park. Aliyah is the 23-month-old daughter of Laura and Larry Lopez of Muldrow. [JAMIE MITCHELL/TIMES RECORD]

unhygienic contact bolster the immune system against disease later in life. Erin Byerly, a Fair Oaks, Calif., parenting blogger and mother of two daughters, said there’s an expectation for American parents to keep their kids ultra-clean. After doing her own research about germ exposure, Byerly decided to stop worrying about dirt, dust and anything else her 3- and 4-year-old daughters might get into.

“There’s a lot of guilt with parenting and wanting to do a good job, and there’s a belief that clean is good and therefore cleaner is better and safer,” Byerly said. “It went way beyond what would have been natural. ... No matter how sanitized you make an environment for a little child, they’re going to eventually grow up and be around these germs, and if their body isn’t equipped to handle it, it’s going to be a bad idea.”

Of course, too many germs can also carry risks for children, said Dr. Ralph Morris, a Minnesota physician. He helped found the “Moms Against Cooties” campaign, run by the chemicalindustry-sponsored Water Quality and Health Council, to inform parents about proper infection prevention. Let children get dirty, he said, but stay vigilant about surfaces that pose distinct health risks, such as bathroom surfaces

Once the B. infantis microbes are established, they get to work keeping bad germs out of the bloodstream. Without this breast-milk-fueled bacteria to protect it, a newborn’s gut is more vulnerable to harmful microbes, Mills said. “The end products of B. infantis growth on breast milk prevents bad things from growing,” Mills said. “Milk is, in a sense, farming what actual survives and persists in the gastrointestinal tract. It encourages certain organisms, and it discourages certain organisms.”

Alissa Winnie of Mulberry stays in front of her brother, Jacob, as they race at Grand Slam Fun Center. [BRIAN D. SANDERFORD/TIMES RECORD]

and kitchen counters — especially after working with raw meat. “It’s really all about a balance between exposure (to) and avoidance of environmental pathogens,” Morris said. “It’s important to have basic cleanliness and sanitation, but I think sometimes people go overboard.” Germ exposure starts in utero and keeps forming through adulthood, making the first few months and years of a child’s life a crucial time for building a healthy microbiome. Many experts, including Roseville allergist and immunologist Dr. Travis Miller, believe the ways babies are delivered help determine their future health. Babies born vaginally take in healthy microbes from the birth canal, organisms that babies delivered by cesarean section don’t pick up, Miller said. That may place C-section babies at a disadvantage from the get-go, he said. One study from Henry Ford Hospital found that babies delivered by C-section are five times more likely than vaginally born babies to develop allergies, coinciding with climbing U.S. allergy rates over the last decade. A recent report from Harvard’s T.H. Chan School of Public Health showed babies delivered by C-section also have a 15 percent higher risk of obesity. Both studies pointed to the absence of birth canal microbes as a possible explanation. Breast milk also plays a key role in kicking off the microbiome, said Mills, of UC Davis. The complex sugars in human milk feed a microbe called Bifidobacterium infantis, which babies get from their mothers.

How dirty is dangerous? Land Park, Calif., mother Amanda Bauer said she tries to be careful about keeping her two young daughters clean. She doesn’t carry hand sanitizer around with her, she said, but always makes sure her 7- and 9-year-olds wash their hands after going to the grocery store. Around the house, she cleans off door handles, remote controls and other heavily touched items with Lysol wipes, especially when someone is sick. “I’m big on washing hands after they touch places where many people have touched,” she said. “But I’m not obsessive about it, because too clean isn’t too healthy either.” Recent science supports Bauer’s beliefs. A study from Swedish researchers found that children whose families washed dishes by hand had significantly lower rates of eczema and slightly lower rates of allergies than children whose families used a dishwasher. Other studies have shown children who live with dogs and cats tend to be healthier because the pets pass on their own beneficial microbes. That runs counter to how many American children are raised. Most are born in sterile emergency rooms, play in sanitized day care and eat washed produce. American children receive, on average, between 10 and 20 courses of antibiotics before they reach adulthood. While those interventions have saved millions of lives, they also have robbed American children of important germs, Eisen said. “Parents can start to try and think like a gardener or an ecologist. It’s not just about feeding your kids and protecting them from dangers — it’s about nurturing their ecosystem in some way,” he said. Distributed by Tribune Content Agency LLC.

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Telemedicine program benefits Magazine students Partnership with UAMS helps district reduce obesity rate UAMS

MAGAZINE — More than half of obese fifth- through eighth-graders in the Magazine School District reduced their obesity in the past year after participating in a program by the University of Arkansas for Medical Sciences Center for Distance Health. The program is part of the School Telemedicine in Arkansas program that began in 2016 to combat health disparities in four rural Arkansas school districts. It is funded by a $1.2 million grant from the Health Resources and Services Administration of the U.S. Department of Health and Human Services. Part of the STAR program focuses on reducing and preventing obesity and is designated HealthyNOW. From October 2017 through April, HealthyNOW was piloted in the Magazine School District in Logan County. When the program began, 62 students, or 39 percent, of the 159 students in the Magazine School Districts fifth- through eighth-grades were categorized as obese based on calculating the students’ body mass indexes (BMI), a measure of body fat based on weight 6

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in relation to height. By the end of the program year, 51 percent of those students had a lower BMI. “We couldn’t be more pleased with the outcomes,” said Tina Pilgreen, project coordinator for HealthyNOW. “Not only did we have great results, students were engaged and excited to learn about physical activity and healthy eating. More importantly, they took the information home to share with their families.” HealthyNOW was carried out through a partnership of UAMS and the University of Central Arkansas’ Exercise Science and Dietetic Programs. The program had two tiers — Tier 1 was obesity prevention providing weekly physical activity challenges and rewards; Tier 2 added one-on-one exercise and nutrition counseling. Thirty-one percent of the students participated in the Tier 1 weekly physical activity challenge and some reduced their BMI. Sixty-six percent of the students who were obese and who enrolled in Tiers 1 and 2 reduced their BMI. Next year, the HealthyNOW program will launch in the Lamar, Jasper and Malvern school districts, Pilgreen said. STAR began in September 2016 in

school districts in Magazine, Lamar, Jasper and Malvern. The first year focused on behavioral health and was designed to provide on-the-spot care for students in need of annual assessments and medication management. Students and their parents or guardians met with a behavioral health provider directly from the school via a live video network. This prevented gaps in treatment and reduced travel time and absences from school and work. Since its inception, nearly 200 behavioral health visits have been conducted through telehealth resulting in 474 hours of saved time and 20,000 fewer miles driven to visits. The first year of the grant focused on behavioral health and was designed to provide on-the-spot care for students in need of annual assessments and medication management. Students and their parents or guardians met with a behavioral health provider through telehealth directly from the school. This prevented gaps in treatment and reduced travel time and absences from school and work. Since its inception, nearly 200 behavioral health visits have been conducted through telehealth

resulting in 474 hours of saved time and 20,000 fewer miles driven to visits. The second year results after the first year showed significant promise in combatting obesity and promoting a healthy lifestyle. In the 2018-19 school year, STAR will launch a teledentistry program in the four school districts. “We will be using oral cameras that will allow dental health professionals to give a remote exam,” said Gordon Low, A.P.R.N, principal investigator for the STAR program. “Our goal is to give students greater access to dental professionals and reduce the amount of seat-time lost due to travel related to routine dental exams.” STAR also created online educational modules related to physical and emotional health and well-being for any school in Arkansas to access. The HRSA grant will continue through the 2019-20 school year. To find out more about the UAMS center for distance health and the STAR program, visit http://sites.uams. edu/star/. Visit www.uams.edu or www. uamshealth.com or on Facebook, Twitter, YouTube or Instagram.

How kids’ brains react to food may cause overeating By Mary Bernard The Philadelphia Inquirer

Nearly one in five U.S. children is obese, according to the most recent estimates from the Centers for Disease Control and Prevention. A new study by Pennsylvania State University that linked overeating to the brain’s response to food rewards may help to shed light on the national epidemic that can lead to Type 2 diabetes, high blood pressure, and breathing problems. Among the kids in the study, a high responsiveness to food rewards, rather than money, indicated a higher likelihood to overeat and to eat even when they weren’t hungry. The researchers measured responsiveness using blood-oxygen-level dependent imaging (BOLD) on a functional magnetic resonance imaging scan (fMRI), which indicates the locations in the brain with the most activity. The results remained the same, regardless of the children’s weight and body mass index. “(Responsiveness) was happening independently of if the child had obesity, so the parent might not even realize that their child is on a trajectory to overeat,” said Shana Adise, coauthor of the study and current post-doctoral fellow at the

A study found that the way kids’ brains react to food may cause them to overeat. [DREAMSTIME]

University of Vermont. Adise worked on the study while completing her PhD at Penn State. Certain food habits as a child, such as an inability to stop eating or a tendency to hide snacks, can indicate an unhealthy relationship with food. Even if the child has a healthy BMI, such habits might precede obesity later in life. Parents should avoid behaviors that put a lot of emphasis on food, such as using

food consistently as a reward and, even, restricting kids’ access to food, said Kathleen Keller, coauthor of the study and an associate professor in the department of nutritional sciences and food science at Penn State. “Children are still developing, so this is a really critical period of time,” Adise said. “Things could become a permanent habit later in life.” The 59 children in the study, ages 7 to 11,

visited a lab on four occasions. Once, they ate a meal to establish a baseline appetite. That same day, 20 minutes later, they were offered more food to judge their tendency to eat when they aren’t hungry. Another time, the children were offered a buffet of food to measure their proclivity to overeat. At the final session, the fMRI scanned the children’s brains while they played a guessing game and were given either a food, money or neutral reward for a correct answer. The researchers found children whose brains were more excited by food rewards also had a tendency to overeat at the buffet and eat when not hungry. “People who are vulnerable to overeating, they are people who value food over other types of rewards,” Keller said. “It’s clearly starting at a time when children are young, before they develop obesity.” However, certain eating behaviors might have been exacerbated in the study. By only meeting four times and serving foods that the child may not be exposed to at home, eating habits in the lab may not necessarily mimic normal eating habits perfectly. “This is the beginning of the road,” Adise said. Distributed by Tribune Content Agency LLC.

Experts say healthy lunch improves kids’ attention, energy levels By Rachel Duthie More Content Now

Candy. Chocolate chip cookies. Pancakes with smiley faces. With the start of the new school year, parents can get answers like these when they ask their kids, “What do you want to eat for lunch?” Most every parent knows that getting a child to eat healthfully can be difficult. Many children have tunnel vision when it comes to food, making it difficult for them to try new options — let alone healthier ones — in their lunchboxes. “Fruits and vegetables can appear scary to kids, and to them it may not taste as good compared to saltier or sweeter alternatives,” said Jessica Buschmann, clinical dietitian at the sports medicine

department at Nationwide Children’s Hospital. “But it’s important to expose healthy foods to kids early so they can form healthy, lifelong habits.” Healthful eating has been shown to enhance academic performance in children. Kids who eat their fruits and vegetables have improved attention spans, energy levels and cognitive function, according to a study by the CDC. The biggest mistake parents can make is to settle on convenience and pack refrigerated, pre-packaged meals for lunch, said Alexis Tindall, a dietitian specializing in childhood obesity at Nationwide Children’s Hospital. “These typically contain high-caloric foods that contain little nutrition. They also usually come with a sweetened beverage, which just adds more calories,”

she said. “By actually making the food themselves, parents get more control in what their kid is eating.” School lunches should include at least three of the five food groups of all different varieties, Tindall added. If you’re not sure if you’re packing a good mix, check the colors: Wellrounded meals should include different hues, such as deep greens, reds and browns. Sweet treats and saltier foods, such as chips, should only be eaten on special occasions and should not make regular appearances in the lunchbox, she said. Sugary and carbonated drinks should be avoided at all costs. If your child can’t stand the taste of plain water, opt for sugar-free brands. If you’re dealing with a picky eater, first

try involving them in the conversation. Cook alongside your child in the kitchen, and even let them have input when grocery shopping. “Not only will kids have more exposure to what they’re eating, but they’ll also develop cooking skills when making foods they like,” Buschmann said. “It’s also very empowering for a child to say that they made their own meal.” Show your child that healthy food can be fun and flavorful. Try a homemade yogurt with granola and fruit, celery with peanut butter, or turkey and cheese pinwheels. No matter what, keep size in mind — even with new, healthful recipes. “Parents may get nervous and overpack. But the more food, the more calories,” Tindall said. “And in today’s society, everything is big. Portion food.” HEALTHYU

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Home away from home Mercy Fort Smith’s Ronald McDonald Family Room provides support for parents By Mardi Taylor Times Record

When Rhett Dollard came into the world 12 weeks early, his parents needed all the support they could get. They found that support — and more — at the Ronald McDonald Family Room at Mercy Fort Smith. Rhett’s early birth was sudden and unexpected for Brittany and Michael Dollard. At Brittany’s 25-week ultrasound, everything seemed fine. But shortly afterward, Brittany developed high blood pressure that caused distress to the baby. He was delivered by emergency C-section at 28 weeks’ gestation (about 12 weeks early) on March 7. He weighed 1 pound, 9 ounces. “He was the tiniest little thing I’d ever seen,” Brittany said. Rhett spent 108 days in the neonatal intensive care unit at Mercy, and his parents spent a great deal of time agonizing because there was little they could do to help. “I was like, ‘I’m sleeping in the lobby, because there’s no way I’m leaving the hospital,’” Brittany said. “I want to be there, I want to see him.” She had been discharged several days after Rhett’s birth and didn’t know exactly what to do, but the couple had visited friends who used the Ronald McDonald Family Room about three years ago, so they knew it was available. Other friends and family members encouraged them to take advantage of it as well. They were able to secure a room the same day Brittany was discharged. They stayed for almost six weeks. Difficult days The early days after Rhett’s birth were particularly hard for the Dollards. “They kept warning us that first day,” Michael Dollard said. “... He was breathing on his own that whole first day, but they (said) it was a ‘honeymoon period’ that, once he kind of wears down, by the next morning, he 8

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Brittany and Michael Dollard spent time at Mercy Fort Smith’s Ronald McDonald Family Room after their son, Rhett, was born almost 12 weeks premature. [MARDI TAYLOR/TIMES RECORD]

was on oxygen, quite a bit of oxygen, and then about two days later, they came in and said he just couldn’t do it, so they put him on a ventilator, and then about a day later ... they put him on a special jet ventilator. He was on that for about two weeks.” “We kept asking everybody, ‘What happened? What caused all this?’ And (our doctor) kept saying, ‘I don’t know, it just happens,’” Michael said. The couple experienced a lot of frustrations while their baby was in the hospital. Brittany called Rhett’s

feeding situation “a puzzle.” “We couldn’t really hold him; we spent forever trying to get him to take a bottle ... the last two months, we put every nipple you could put, every formula ... ,” Michael said. “The doctor, he went down to Walmart and bought every nipple, every size and everything they could do. He just wouldn’t eat.” Having the family room at Mercy available to Brittany and Michael during that time was a “godsend,” Brittany said. Living in Alma, the couple would have had almost an

hour’s drive each day when they came to visit their son. “We didn’t have to worry where we were sleeping, we didn’t have to worry about food, because we had so much other stuff that was on our mind that was going on with (Rhett) and his medical care that we were just thankful that we didn’t have to put in the extra thought, ‘OK, where’s dinner going to come from?’” Brittany said. Michael added that most days, they might not have even eaten because they were so consumed with Rhett’s

condition. “They did a meal every night,” Michael said. “And actually, someone donates it every night.” That included members of the church his father attends. “It was really nice to know we could swing up here after we got done seeing (Rhett) and get something to eat,” Michael said. The Ronald McDonald Family Room at Mercy Fort Smith opened in December 2010 and provides families with a “home away from home” while their child receives medical treatment. It’s one of four programs of the Ronald McDonald House Charities of Arkoma. Others are in Rogers and Fayetteville, plus an additional mobile dental care unit. “Any family is eligible to stay with us as long as they have a child under the age of 18 that is hospitalized here at Mercy hospital,” said Leah Jones, director of operations for Mercy Fort Smith’s Ronald McDonald Family Room. “Typically, we see the most critical families, which would be our neonatal intensive care families,” Jones said.

“That’s typically who we serve, but we’re not exclusive to that. We do have some pediatric families that will come and use us, actually during the day to take showers, lunch, things like that. We don’t check any financial information or anything like that. It’s a completely free, complimentary stay to them.” The average overnight occupancy is 91 percent, and the average length of stay for parents is eight days. Through June, 188 families have been served by the Ronald McDonald Family Room. About 3,200 families have been served since the facility opened in 2010. There are four bedrooms for overnight guests. Common areas and amenities for overnight and daytime visitors include bathroom and shower facilities, a living room with games and toys, a fully stocked kitchen, a dining room, a laundry room and a private lactation room. “Not everyone can stay overnight,” Jones said. “A lot of the pediatric parents, they have to stay in the room with the child. But (we’re here) for them to get away and get a meal and all that.”

The living room at Mercy Fort Smith’s Ronald McDonald Family Room offers a place for parents to relax. [MARDI TAYLOR/TIMES RECORD]

Welcome Lisa Newton, MD | Brock Wilson, DO Mercy Clinic OB/GYN welcomes Dr. Newton and Dr. Wilson to Fort Smith. They join a team that provides complete care – from pregnancy care to wellness and treatment throughout a woman’s lifetime.

Dr. Lisa Newton Obstetrics and Gynecology

Schedule your appointment online at mercy.net/FortSmithOBs

Mercy Clinic OB/GYN 7001 Rogers Avenue, Suite 403 Fort Smith, AR 72903 479-785-BABY(2229)

Dr. Brock Wilson Obstetrics and Gynecology

Your life is our life’s work.

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Dinner is served daily at 6:30 p.m. through donations from groups outside the hospital, including local church groups. The meals are provided by the community. “We have our share-a-meal program, and we rely on community members: civic groups, churches, organizations to sign up and provide that meal to families,” Jones said. The Dollards hope to provide one of those meals when their home life settles down a bit. Going home The Dollards took Rhett home June 23. Both parents describe the days leading up to that as overwhelming and emotional. They were allowed to stay overnight with Rhett for the first time shortly before he was discharged. “I feel like it’s more than a normal parent — someone who has a baby without a complicated pregnancy, who gets to take their baby home,” Brittany said. “I feel like with our baby, it’s just so much more that we had to deal with, that we had to learn and figure out by the time we brought him home.” The new parents continually monitor their baby, but Rhett is growing and doing well following his ordeal. The Dollards appreciate the Mercy doctors and nurses who helped Rhett. “We grew such a close relationship with everybody in (the NICU),” Michael said. “By the time I opened the door, I said they might as well give us a key card because we’re there so often. And they all knew us.” Both the Dollards say they would recommend the Ronald McDonald Family Room to anyone who may be considering using it. “I would tell them to definitely, definitely give it consideration,” Brittany said. “They have people who work here who understand what you’re going through to talk to. It’s nice to be around people who are in the same situation as you to talk to about what’s going on, because nobody else understands. Unless you’ve been in that situation, you don’t understand. “It’s so draining, and to be able to stay in the Ronald McDonald Room, and to come up here between visits, go down to see your baby and come right upstairs and take a nap, because you’re exhausted.” Jones said the program has been pretty consistent over the past four years. 10

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Dinner is served nightly at Mercy Fort Smith’s Ronald McDonald Family Room. [MARDI TAYLOR/TIMES RECORD]

“We’ve had a really consistent occupancy rate,” she said. “It’s a very busy location. We serve lots of families. Our mission, our goal, is to keep families close to their child when they’re sick.” The Dollards are grateful the Ronald McDonald Family Room provided them with that opportunity. “You want to see your baby. You want to see your baby after they’re born,” Brittany said. “When they’re in the NICU, it’s hard. And they’re only open certain times. And then, there’s nothing to do. What do you do? Sit in your car for a couple of hours? If you drive home and you live far away, it’s so much gas driving back and forth, back and forth. And to be able to stay (at the Ronald McDonald Family Room) is just amazing. It lessens your worry.” For information on the Ronald McDonald Family Room, call (479) 314-8030.

Leah Jones

A sign greets visitors to Mercy Fort Smith’s Ronald McDonald Family Room. [MARDI TAYLOR/TIMES RECORD]

How to survive the teething stage By Melissa Erickson More Content Now

Teething is uncomfortable for babies and frustrating for parents who want to soothe a fussy child. Normal symptoms of teething include fussiness, trouble sleeping, irritability, loss of appetite, drooling more than usual, and gum swelling and tenderness, said Cheen Loo, chairwoman of pediatric dentistry at Tufts School of Dental Medicine. Abnormal teething symptoms include fever, diarrhea and rash. “If your baby has any of these symptoms while teething and continues to be cranky and uncomfortable, contact your pediatrician,” Loo said. Your dentist is the best source of advice on what to do about teething, but here’s some easy-to-follow advice from Sean Boynes of the DentalQuest Institute, a non-profit organization that offers clinical care and practice management solutions for providers: “Wet and wring a clean washcloth, place it in the refrigerator or freezer to chill, then let your baby chew on it. You can also massage your baby’s gums and provide them with safe chewing toys.” Soothing ideas Teething typically begins between 6 and 8 months, although some children don’t get their first tooth until 12 to 14 months, Loo said. Teething affects babies differently. Start with non-medicinal methods first, Loo said. “Give your baby a firm teething ring to chew on. Avoid liquid-filled teething rings or any plastic objects that might break,” she said. “If plastics are a concern to parents, give the child a moist washcloth to chew. Also, be careful that the baby is chewing on age-appropriate items without small parts that could be choking hazards.” Feeding a child cool, soft foods such as applesauce or yogurt can be soothing as long as baby is eating solid food, Loo said. “Use a bottle, if it seems to help, but only fill it with water. Formula, milk or juice can all cause tooth decay,” Loo said.

Topical pain relievers and medications that are rubbed on the gums are not useful because they wash out of the baby’s mouth within minutes and can be harmful if overused or swallowed, Loo said. “It is best to avoid over-the-counter pain medications with benzocaine — an ingredient in some of the options — in light of a recent FDA consumer update on its use for teething,” Boynes said. Benzocaine has been associated with methemoglobinemia, a rare but serious (and sometimes fatal) condition that reduces the amount of oxygen in the blood, Loo said.

“The FDA also urges parents not to use — and dispose of — homeopathic teething tablets after lab testing found ‘inconsistent amounts of belladonna, a toxic substance, in certain homeopathic teething tablets, sometimes far exceeding the amount claimed on the label,’” Loo said. Why care for baby teeth “There are many misconceptions about babies’ teeth, the most significant being that caring for baby teeth isn’t important — they fall out anyway,” Boynes said. “In fact, caring

for baby teeth means caring for your child’s teeth until they are age 11 or 12, which would be a long time for anyone to live with health issues associated with tooth decay.” “The American Academy of Pediatrics and the American Academy of Pediatric Dentistry now both recommend that a baby see a dentist after he gets his first tooth or by his first birthday. This instills the habit of frequent dentist visits at an early age and gives the dentist the opportunity to chat with parents about proper tooth care,” Loo said. HEALTHYU

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Olivia Johnson, 3, uses chalk to draw at the Miller Branch of the Fort Smith Library during its “Grafﬁti Sidewalk Art” program. [BRIAN D. SANDERFORD/TIMES RECORD]

Healthy school year starts with prevention Sparks doctors discuss importance of immunizations, basic hygiene, proper sleep By Carole Medlock Special to the Times Record

Preventative measures can help protect students from a variety of health-related concerns as they return to school this fall. Dr. Manar Ibrahim and Dr. Samina Nadvi, both doctors with Sparks Pediatrics, say the start of a new 12

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school year often brings an increase in pediatric patients with a variety of concerns — many of which can be addressed on the front end with prevention. Ibrahim stressed the importance of compliance with traditional, required immunizations for students attending school. She said with parents able to access information about

immunizations on the internet, more are declining shots imperative to their child’s health after questioning benefits, side effects, and a vaccine’s safety profile. But in many cases, the information obtained is inaccurate. “Immunizations are safe,” Ibrahim said. “Very safe.” She said parents should avoid listening to any source about vaccinations

other than the Centers for Disease Control and Prevention or the American Academy of Pediatrics, both of which have websites that offer informed and accurate information about traditional childhood vaccines. Nadvi added that when a child has completed a course of immunizations, the risk of them getting the disease they have been immunized

against — often a very serious disease — is extremely low. She said if a child does get the disease, the intensity and the duration of the illness is lower if you have received the proper vaccination. Although it may seem as if more immunizations are required today than in the past, Ibrahim said most are the same immunizations — only boosters have been added. She did mention the meningitis vaccine, saying it is a relatively newly added immunization required for children. But she reinforced the importance of the vaccine, calling it a “critical vaccine against a deadly illness.” Healthy habits Beyond immunizations, Nadvi said there are some easy measures that parents can take to protect their children from everyday illnesses as they return to a school environment. Basic hygiene can go a long way in keeping kids healthy, Nadvi said. Students should practice hand washing or the use of hand sanitizer regularly. Ibrahim added that since germs and bacteria can often be transferred at a school water fountain, parents may prefer to send their child to school with their own water bottle. If a student does drink from a water fountain, she said they should not put their mouth on the water spicket, where germs and bacteria may be transmitted. Good nutrition and healthy sleep habits are also important in maintaining good health. Making sure students are eating healthy snacks and are choosing healthy lunch items is important as school gets underway. In addition, eight to 10 hours of sleep each night is recommended for students all the way through high school, Nadvi said. The American Academy of Pediatrics also suggests a shutdown of all screens — computers, video game consoles, television — at least one hour before bedtime to avoid overstimulation that would hinder healthy sleep. Students who may have particular health concerns — asthma, allergies, diabetes — should see their pediatrician in the weeks before school starts, Nadvi said. Parents should prepare a letter for the school describing the student’s specific health obstacle, and the care and medicine required to keep the student healthy. Parents should also

make sure to have adequate prescriptions for both home and school, Nadvi said. A specific emergency plan may also be developed in conjunction with the school to ensure an appropriate response in any health crisis. Although a yearly flu vaccine is recommended for all students, Nadvi stressed the importance of the shot for any student with a chronic illness. The vaccine is typically not available until September or October, but students should receive the vaccine as soon as it becomes available, she said. Doctors see cases of the flu as early as October. The mist will not be available this year. Lice Another health concern that often comes with back-to-school time is the transmission of head lice. Nadvi said that lice can be seen in students of any age, depending on exposure. Students avoiding behaviors such as putting their heads together to take selfies, sharing hats, combs, scarves, or any other personal clothing items have the best chance at avoiding head lice. However, Ibrahim said the first thing to remember about head lice it that it is not a serious illness, only more of a nuisance. Ibrahim said an over the counter medicine with 1 percent permethrin is recommended by the AAP for the treatment of lice. It should be followed by manually picking bugs from the scalp and wet combing hair for any nits/eggs that may be lingering. Treatment should be repeated on the ninth and 18th days after the first treatment. And for the most effective eradication of the lice, picking the bugs and cleaning the nits should continue. The AAP does not recognize any natural treatments for lice as effective, Nadvi said. And although bed bugs can be a concern in other arenas, a student should not necessarily be at risk for being exposed to them in a school environment. Ibrahim said because of the nature of the bed bug, they like to stay in creases and folds where there is warmth, and attack primarily at night so seeing them in schools is not likely. Both doctors recommended a resource for parents: healthychildren. org. Ibrahim said the site is sponsored by the AAP and provides a wealth of resources related to childhood illness, safety and healthy living, among others.

Dr. Samina Nadvi talks about the treatment for bed bug bites at Sparks Medical Clinic, 5428 Ellsworth Road. [JAMIE MITCHELL/TIMES RECORD]

Dr. Manar Ibrahim discusses the proper treatment for head lice at during an interview at Sparks Medical Clinic. [JAMIE MITCHELL/TIMES RECORD]

HEALTHYU

AUGUST 2018

Relief from reactions Don’t let food allergies leave your child down in the mouth Mercy Fort Smith

School time means your child will be exposed to many types of foods, whether it’s at preschool or the school cafeteria. If your child has food allergies, some can make them sick. Food allergies happen when the body’s immune system thinks something your child has eaten is harmful, so it responds with symptoms that can range from mild to severe or even life-threatening. About four in 100 children have a food allergy. The most common food allergies: • Peanuts. • Milk. • Eggs. • Wheat. • Soy. • Tree nuts such as cashews and walnuts. • Fish. • Seafood. Food allergy symptoms Because the immune system doesn’t become sensitized to a food until after the first exposure, allergy symptoms usually don’t occur until the child has consumed that food several times. Breastfeeding babies who are exceptionally sensitive, however, may have allergic reactions to foods their mother eats. Food allergy symptoms may start right after eating or may take up to an hour. The most common symptoms: • Vomiting. • Diarrhea. • Blood in the stool. • Cramps. • Colic. • Hives or swelling. • Eczema. • Itchy or swollen tongue, mouth or lips. • Itchy or tight throat. • Difficulty breathing or wheezing. • Low blood pressure. Very young kids who cannot describe their symptoms may: • Scratch their lips or throat. • Pull at their tongues. • Put their hands in their mouths. In severe cases, food allergies can cause 14

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Kastyn Wagley, 6, cuts pieces of licorice to top his cake in the “Dessert Imposter” class during the Fort Smith Parks and Recreation Department Baking Boot Camp at the Creekmore Community Center. Kastyn is the son Stephanie and Cass Wagley. [BRIAN D. SANDERFORD/TIMES RECORD]

anaphylaxis, a potentially life-threatening reaction that can hinder breathing and may lead to shock. Anaphylaxis requires immediate medical treatment (see epinephrine below). Diagnosing potential food allergies If you suspect your child may have a food allergy, seek a medical evaluation. Mercy pediatricians and allergists specialize in managing all kinds of food allergies in babies and children, so they can help determine which foods bother your child. After a physical exam, Mercy may recommend additional methods to identify “problem foods” such as: • Keeping a food diary to track what your child eats and when there is a

reaction. • Performing a skin-prick test to see your child’s reaction to different foods. • Testing your child’s blood for antibodies that indicate allergies to specific foods. • Putting your child on an “elimination diet” that cuts outs certain foods to see how your child responds. Managing food allergies Unfortunately, food allergies can’t be treated, but they can be managed to minimize or prevent reactions. Here are two ways: Dietary changes. Determine which foods your child should avoid. If your baby has food allergies and you are breastfeeding, you’ll need to avoid problem foods, too. Epinephrine. This injectable form of

adrenaline is used to stop a severe allergic reaction in an emergency. If your child has life-threatening food allergies, a pediatrician or allergist may recommend that you or your child carry epinephrine at all times. Children sometimes outgrow milk and egg allergies, but allergies to nuts and shellfish usually last a lifetime. Depending on your child’s allergies, your pediatrician or allergist may suggest re-testing for allergies when your child is older. In the meantime, you can help your child learn to manage the allergy and eat safely and enjoyably. Mercy in the Fort Smith has allergists available for appointments at Mercy Clinic Allergy and Asthma, 9101 Jenny Lind (479-274-5600), and Mercy Clinic Ear, Nose, Throat and Allergy, 6801 Rogers Ave., fourth floor (479-274-3900).

Do baby wipes trigger allergies? More Content Now

A new study warns that childhood food allergies may be caused by a common household item, but there may be an easy fix for parents. Baby wipes, genetics and allergens can combine to create the “perfect storm” and trigger childhood food allergies, according to a team of scientists at Northwestern University. Researchers hailed the discovery as a “major advance” in understanding what causes childhood food allergies, whose rise has been a mystery to the medical community. An estimated 4 to 6 percent of children in the United States suffer from food allergies. From 1997 to 2007, food allergy cases rose by 18 percent among children in America. Hospitalizations with diagnoses related to food allergies have also increased among children. At the center of this research is the baby wipe, which is ubiquitous in most homes with young children and babies, as well as a mix of environmental and genetic factors that must exist to trigger the allergy, according to the Northwestern Medicine study. The good news is that factors leading to food allergy development can be modified in the home environment, said lead study author Joan Cook-Mills, a professor of allergy-immunology at Northwestern University Feinberg School of Medicine. “Reduce baby’s skin exposure to the food allergens by washing your hands before handling the baby. Limit use of infant wipes that leave soap on the skin.

Rinse soap off with water like we used to do years ago,” Cook-Mills said. Cook-Mills made the discovery by comparing clinical data about food allergies in humans, the effects of food and environmental allergy exposure, and experiments with neonatal mice with genetic mutations that also occur in humans. Up to 35 percent of children with food allergies have skin barrier disfunction like eczema, but those irritations don’t show up until long after food allergies have started. Cook-Mills used a neonatal mouse model with skin barrier mutations and tried exposing its skin to food allergens like peanuts. The peanuts alone had no effect. “Then I thought about what are babies exposed to,” Cook-Mills recalled. “They are exposed to environmental allergens in dust in a home. They may not be eating food allergens as a newborn, but they are getting them on their skin. Say a sibling with peanut butter on her face kisses the baby. Or a parent is preparing food with peanuts and then handles the baby.” Next, she read about skin research studies that delivered compounds through the skin by using soap. “I thought, ‘Oh my gosh! That’s infant wipes!’” Cook-Mills said. The top skin layer is made of lipids (fats), and the soap in the wipes disrupts that barrier, Cook-Mills said. These novel animal studies provide a basis to test what will more effectively block the development of food allergy in infants and children, Cook-Mills said. HEALTHYU

AUGUST 2018

Kids’ fitness is improving Research shows children still may not be as fit as their parents were at the same age Grant Tomkinson and Justin J. Lang, University of Ottawa University of North Dakota/The Conversation

Physical fitness is important for success in sports and athletics, but it is also important for good health. If you are generally fit, you probably have a strong heart, brain, muscles and bones, all of which help you to exercise and improve your chances of living a long, fit and healthy life. The most important type of fitness for good health is aerobic fitness, which is your ability to exercise or be physically active at a constant pace for a long period of time (say, more than 20 minutes), such as running, walking, biking, swimming, rowing, or playing aerobic sports such as soccer or basketball. Monitoring national and international trends in kids’ aerobic fitness is important to understand trends in the underlying current and potential future health of a population. Research shows that if you are aerobically fit as an adult, then you are less likely to develop or die from chronic conditions such as heart disease, stroke and some cancers. And, if you were fit as a kid, then you are more likely to be a fit and healthy as an adult. Take a second to think about your own fitness level. Do you think you were as fit as today’s kids when you were their age? This has been a topic of much discussion in recent decades. Most people say that kids’ fitness has declined, some say that it has not changed at all, while few are willing to say that it has improved. To help settle this debate, our research team has spent the past two decades gathering historical fitness data on millions of kids from around the world. Improvements in some kids We systematically analyzed decades of data from hundreds of studies 16

AUGUST 2018

| HEALTHYU

Landon McCorkle, left, and Isaiah Washington, right, portraying foxes, catch the rabbit, Clay Anzalone, at the Janet Huckabee Arkansas River Valley Nature Center during its “M is for Mammals” program. [BRIAN D. SANDERFORD/TIMES RECORD]

across many different countries to compare the aerobic fitness of kids of the same age and gender, all measured using the same fitness tests. In 2003, our research was the first to conclusively show that kids’ aerobic fitness did in fact decline around the world at the end of the 20th century. In our very large study of 25 million kids aged 6 to 19 years from 27 countries, we showed that aerobic fitness declined worldwide between 1970 and 2000, with kids in 2000 about 15 percent less fit than their parents were when they were kids. Yet there is some good news suggesting that kids’ fitness levels may no longer be on the slide. We recently published an update to our 2003 study in the British Journal of Sports Medicine, which examined trends in the aerobic fitness levels of

1 million kids aged 9 to 17 years from 19 high-income (such as Australia, Canada, the United States, etc.) and upper middle-income (such as Brazil and South Africa) countries between 1981 and 2014. We measured aerobic fitness using the 20-meter shuttle run, also called the “beep” test, or the PACER test. The beep test is the world’s most popular field test of aerobic fitness for kids. It is a progressive exercise test involving continuous running between two lines 20 meters (66 feet) apart in time to recorded beeps. The time between beeps gets progressively shorter, and the test is over when you can no longer run the 20-meter distance before the audio beep. Our updated study confirmed that kids’ aerobic fitness levels had in fact

declined in the 1980s and 1990s, but interestingly, the decline appears to have slowed since 2000 with fitness levels plateauing over the past decade. While trends in fitness differed between countries, most showed overall declines. After 2000, however, aerobic fitness improved in Brazil and Japan; plateaued in Australia, Canada, Greece, South Africa and Spain; and declined in Portugal, the United Kingdom and the United States. Today’s kids are still less fit than their parents were when they were kids, but the gap is about half as much as previously thought — and now about 7 percent. What’s the cause? We explored links between trends in aerobic fitness and trends in broad socioeconomic and health factors in each country, including income inequality, physical activity levels, and overweight and obesity levels. The strongest indicator of a country’s fitness level was the gap between rich and poor, as measured by the Gini Index. Countries with a widening gap between the rich and poor experienced the largest declines in aerobic fitness between 2000 and 2014. Countries with a widening gap between rich and poor tend to have a growing number of poor people. Poverty is linked to poor social and health outcomes in high- and upper-middle income countries, known as the social determinants of health. An indirect result of poverty could be a lack of opportunities, time and resources to be physically active and to participate in activities that improve or maintain an individual’s aerobic fitness level. Assuming this link is causal, policies that tackle income inequalities and build on improving the social determinants of health within countries could lead to improved aerobic fitness levels to not only stem the declining fitness tide, but to turn the fitness tide around for good for people of all ages.

Why sunscreen year round is important Sun protection in childhood cuts melanoma risk later By Mari A. Schaefer The Philadelphia Inquirer

Just because summer is over doesn’t mean kids don’t need to be protected from the sun. Slather that sunscreen on your kids and don’t hold back. It could help save their lives. A study out of Australia found that using sunscreen in childhood can reduce the risk of developing melanoma, the deadliest form of skin cancer, by 40 percent in young adults. As with most cancers, the risk of melanoma increases with age. But according to the American Cancer Society, melanoma is one of the most common cancers in young adults (especially young women). Researchers at the University of Sydney analyzed data collected from nearly 1,700 Australians, ages 18 to 40. They looked at those who were regular users of sunscreen in childhood and compared to those who rarely used the products. The results were published last week in JAMA Dermatology. “The association of sun exposure and sunburn with melanoma risk, particularly in childhood, is well established and this study showed that regularly using sunscreen was protective against the harmful effects of sun exposure,” said Anne Cust, lead researcher and director of the Cancer Epidemiology and Prevention Research group at the University of Sydney’s School of Public Health. About two in three Australians will be diagnosed with some type of skin cancer by the time they are 70, according to the study. It is estimated that in 2018, more than 91,000 people in the United States will be diagnosed with melanoma. In the last 10 years, rates for new cases of melanoma have been rising on average 1.5 percent each year, according to the U.S. Centers for Disease Control and Prevention.

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The Australian study was funded by the National Health and Medical Research Council (NHMRC), Cancer Council NSW, Cancer Council Victoria, Cancer Council Queensland, and the U.S. National Institutes of Health. The CDC recommends these measures to avoid UV radiation: • Stay in the shade, especially during midday hours. • Wear clothing that covers your arms and legs. • Wear a hat with a wide brim to shade your face, head, ears, and neck. • Wear sunglasses that wrap around and block both UVA and UVB rays. • Use sunscreen with a sun protection factor (SPF) of 15 or higher, and both UVA and UVB (broad spectrum) protection. • Avoid indoor tanning. Distributed by Tribune Content Agency LLC.

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HEALTHYU

AUGUST 2018

Help kids create great dental habits

StatePoint

That first wiggly tooth indicates a new childhood milestone — loss of the first “baby” tooth. While this is often a time for cute photos and a visit from the tooth fairy, it should also be an opportunity to reinforce the importance of good oral care with children so that their new permanent teeth stay healthy and last a lifetime. Tooth decay is one of the most common chronic diseases among children in the U.S., but it is also preventable. This finding by the Centers for Disease Control and Prevention (cdc.gov/ oralhealth/basics) highlights just how important it is to help kids take good care of their teeth. “The sooner the better when it comes 18

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to helping children understand the importance of taking care of their permanent (‘adult’) teeth. As children grow, encourage them to take more responsibility for their oral hygiene, but continue to supervise them until you’re comfortable with their routines,” says Dr. Michael Hahn, national dental director for Cigna. Dr. Hahn recommends the following tips for a healthy mouth: • Attack plaque: Let your child know that “plaque” leads to tooth decay — it’s like your tooth “getting sick.” Plaque has bacteria and acids that can hurt a tooth’s outer enamel and cause tiny holes that lead to cavities. Brush for two minutes, twice a day. Help your child understand what two minutes actually “feels” like by playing

a favorite song for that length of time, or use a kitchen timer, smartphone alarm, hourglass of sand or stopwatch. • Floss: Daily flossing is important too. Because flossing may be tricky for small hands, help them until about age 10. • Snack smart: Healthy teeth rely on smarter snacks. Fruits and vegetables can help reduce plaque buildup. On the other hand, sugary and sticky foods can remain on teeth for hours, providing time for bacteria and acids to begin their damage. If your children drink soda, encourage the use of a straw so less of the liquid coats their teeth. • Visit the dentist: Regular dental checkups are essential. These visits can detect problems when they are still small and are less complex to treat. Getting

used to seeing the dentist in childhood will help keep this important practice going as an adult. • Reward positive behavior: Praise your child for doing a good job. You know your child best — offer that “something special” as incentive, particularly when the dentist gives a great report. “It’s easier to teach a younger child good habits, than to break an older child of poor ones. Encourage your kids to take good care of their teeth. You’ll put them on track for strong, healthy teeth that will last a lifetime,” says Dr. Hahn. For additional dental tips, visit cigna. com/dental-resources. For detailed questions or concerns about a child’s oral health, it is important to consult a dentist.

Young binge drinkers at risk for heart disease By Cyd King Special to the Times Record

FAYETTEVILLE — Young adults who frequently binge drink were more likely to have certain risk factors for cardiovascular disease than non-binge drinkers, according to new research in the Journal of the American Heart Association. “Compared to previous generations, the pervasiveness, intensity (number of drinks) and regularity (several times per week) of binge drinking may place today’s young adults at greater risk for more profound rates of alcoholattributable harm,” said Mariann Piano, Ph.D., R.N., study lead author and Nancy and Hilliard Travis Chair in Nursing and Senior Associate Dean for Research at Vanderbilt University School of Nursing in Nashville, Tenn. “Young adults need to be aware that the consequences of repeated binge drinking may harm their hearts, said Serena Munns, executive director of the Northwest Arkansas office of the American Heart Association “The risk extends beyond poor school performance and increased risk for accidental injury,” she said. Although drinking by persons under

the age of 21 is illegal, people age 12-20 years drink 11 percent of all alcohol consumed in the United States, according to information released earlier this year by the Centers for Disease Control and Prevention. More than 90 percent of this alcohol is consumed in the form of binge drinks. On average, underage drinkers consume more drinks per drinking occasion than adult drinkers. The effects of binge drinking differ between the sexes, the study indicated. “Young men who reported that they repeatedly binge drink had higher systolic blood pressure and total cholesterol, while young women who repeatedly binge drink had higher blood sugar levels compared to nonbinge drinkers,” Munns said. Previous studies have found that binge drinking — often defined as consuming five drinks or more in a row for men (four or more drinks for women) per occasion within the past 30 days — increases cardiovascular risk among middle-aged and older adults. But among younger adults age 18 to 45 specifically, the relationship between binge drinking, blood pressure and metabolic factors remained unclear.

This study examined cardiovascular risks, including high blood pressure, cholesterol and blood sugar, among 4,710 adults 18- to 45-years-old who responded to the U.S. National Health and Nutrition Examination Survey (NHANES) in 2011-2012 and 201314. Participants reported non-binge drinking, binge drinking (1-12 times yearly), or frequent binge drinking (more than 12 times yearly). Then researchers compared blood pressure, cholesterol and blood sugar levels among the three groups. Researchers found: • High frequency binge drinking (more than 12 times a year) was reported by 25.1 percent of men and 11.8 percent of women. Binge drinking 12 times a year or less was reported by 29.0 percent of men and 25.1 percent of women. • Young men who reported repeated binge drinking had higher systolic blood pressure (the force on blood vessels when the heart beats) and higher blood total cholesterol than non-binge drinkers and binge drinking young women. • Young women who said they binge drink had higher levels of blood sugar than non-binge drinking women.

All results persisted even after considering diet and physical activity. “Implementing lifestyle interventions to reduce blood pressure in early adulthood may be an important strategy to prevent cardiovascular disease later in life,” Piano said. “Young adults should be screened and counseled about alcohol misuse, including binge drinking, and advised on how binge drinking may affect their cardiovascular health.” This study showed only an association, not a cause and effect relationship, between binge drinking and cardiovascular risk factors. The American Heart Association suggests moderate alcohol consumption for adults who choose to drink. The Association defines moderate alcohol consumption as an average of one to two drinks per day for men, and one drink per day for women. A drink is 12 ounces of beer, four ounces of wine, or 1.5 ounces of 80-proof spirits. Excessive alcohol consumption increases the risk for alcohol dependency, cardiovascular risk factors including high blood pressure and obesity, stroke, certain types of cancer, suicide and accidents. HEALTHYU

AUGUST 2018

Erratic teen behavior may mean more It’s often difficult to know what’s normal — and what’s not By Emily Bazar Kaiser Health News

Mary Rose O’Leary has shepherded three children into adulthood, and teaches art and music to middle-school students. Despite her extensive personal and professional experience with teens, the Eagle Rock, Calif., resident admits she’s often perplexed by their behavior. “Even if you have normal kids, you’re constantly questioning, ‘Is this normal?’” says O’Leary, 61. Teenagers can be volatile and moody. They can test your patience, push your buttons and leave you questioning your sanity — and theirs. Mental health challenges are a serious — and growing — problem for teenagers: Teen and young-adult suicide has nearly tripled since the 1940s. The rate of 12- to 17-year-olds who struggled with clinical depression increased by 37 percent in a decade, according to a recent study. And schizophrenia and other psychotic disorders often manifest themselves in adolescence. In fact, half of all mental health conditions emerge by age 14, and three-quarters by 24, says Dr. Steven Adelsheim, director of the Stanford Center for Youth Mental Health and Wellbeing, part of the university’s psychiatry department. For parents, it’s often hard to separate the warning signs of mental illness from typically erratic teenage behavior. When O’Leary’s son, Isaac, now 23, was a teen, he had two run-ins with police — once for hosting a wild party while his mom was away, and again when he and a friend climbed up on the roof and challenged each other to shoot BB guns. O’Leary dismissed those incidents as teenage pranks. But she did start to worry when she was in the midst of divorce proceedings with her then-husband and noticed that Isaac started exhibiting some unusual behavior. He complained of stomachaches and racked up absences from school. That’s when she decided it was time for the family to see a therapist. “It’s a question of what’s normal for my kids,” 20

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she explains. Mental health experts say the first step in recognizing possible mental illness in your children is to know their habits and patterns — to spot when they deviate from them — and to create an environment in which they feel comfortable talking with you. Instead of asking your teen to talk, share an activity that will give your child the chance to open up: Cook dinner together, walk the dog, take a drive, says Tara Niendam, an associate professor in psychiatry at the University of California-Davis. “You just want to know how they’re doing as a person. How are things going at school? How are their friends? How are they sleeping?” she explains. As part of getting to know your teen, monitor and limit your child’s social media activity, says Dr. Amy Barnhorst, vice chair for community mental health in the UC-Davis psychiatry department. “Social media gives us this important window into what’s going on in teenagers’ lives,” she says. Once you know your child’s baseline, you’ll be more attuned to signs of mental illness: persistent changes in your child’s everyday life that last more than a week or two. Be aware of disruptions in sleep, appetite, grades, weight, friendships — even hygiene Maybe your son is spending even more time alone in his room. Perhaps your daughter, who is particular about her appearance, stops wearing makeup and isn’t showering. “It’s really when you see kids falling off the curve in every sphere of their lives,” Barnhorst says. “They’re having problems with their academics, problems with their family, problems with their friends, problems with their activities.” Essentially, take note when “there’s a lot of shifting and chaos” in their lives, she adds. Remember, you’re looking for changes in many aspects of your child’s life that last for a few weeks, not the typical — but temporary — sadness that comes with a breakup or the unfortunate mouthing off

you get when you ask your kid to clean his room. If your child still has the same friends and is participating in the same activities, unpleasant behavior “is not necessarily something to worry about,” Barnhorst says. “That could just be teenagers going through growing pains.” But some behavioral changes could indicate a deeper problem. For instance, teenagers with depression may be more irritable than usual, Adelsheim says. They might snap at friends or even the family dog, he says. “Young people will talk about their fuse being shorter than normal,” Adelsheim

says. “Things that normally wouldn’t bother them do bother them.” When you become worried that your child’s behavior may indicate something more serious, offer your child love and support — and seek help, experts say. (And avoid phrases like “What’s wrong with you?” and “Snap out of it” when talking with your kids, Niendam advises.) If your child threatens suicide, or you think he’s in imminent danger, take him to the emergency room. If there’s no immediate danger, start with your child’s pediatrician or primary care physician. In some cases, the pediatrician will be able to address the problem

directly — or may refer you to a mental health specialist. This is where it could get tricky. You may face a long wait for a specialist — especially if you live in a rural area — and may find that many aren’t accepting new patients. Barnhorst suggests calling your health insurance plan and asking for a list of in-network therapists, psychologists and psychiatrists. Then hit the phone and hope for the best. “One of the most serious problems we have in this country on the mental health front is the lack of access to care,” says Dr. Victor Schwartz, chief medical officer

of the Jed Foundation, a New Yorkbased organization that works to prevent suicides in teens and young adults. “We haven’t trained enough professionals. They’re not distributed well enough across the country.” Another option, he says, is to check with nearby universities to see if they have mental health clinics that train students and see patients. While you’re seeking medical help, don’t forget to contact your child’s school, which may be able to make accommodations such as offering your child extra time for testing, Niendam says. HEALTHYU

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HEALTH & WELLNESS DIRECTORY BEHAVIORAL MEDICINE Sparks Behavioral Health 1001 Towson Fort Smith, AR 72901 479-709-7455 Mercy Clinic Behavioral Health 2713 S. 74th St., Ste. 203 Fort Smith, AR 479-573-3130 CARDIOLOGY Cardiology Center at Sparks 1500 Dodson Ave., Ste. 60 Fort Smith, AR 72901 479-709-7325 Mercy Clinic Cardiology Phoenix Ave. 6101 Phoenix Ave., Ste. 401 Fort Smith, AR 479-573-3042 Mercy Clinic Cardiology Rogers Ave. 7001 Rogers Ave. Fort Smith, AR 479-314-4650 CARDIOTHORACIC & VASCULAR Mercy Clinic Cardiothoracic & Vascular Surgery 7001 Rogers Ave., St. 401 Fort Smith, AR 479-452-1188 Sparks Cardiothoracic and Vascular Surgery, Inc. 600 Lexington Ave. Fort Smith, AR 72901 479-709-7025 CONVENIENT CARE Mercy Convenient Care – River Valley 3505 S. 79th Street Fort Smith, AR 22

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479-709-8686 Mercy Convenient Care – Zero Street 1400 Zero Street Fort Smith, AR 479-573-3082 Sparks Clinic Urgent Care 2521 Alma Hwy Van Buren, AR 72956 479-709-7020 CarePlus - Sparks 14 Gothic Ridge Rd. Van Buren, AR 72956 479-471-0011 Sparks Medical Clinic 5428 Ellsworth Road Fort Smith, AR 72903 479-709-7440 COSMETIC SURGERY Surgical Associates of Fort Smith - Sparks 923 Lexington Ave. Fort Smith, AR 72901 479-709-73504 EAR, NOSE & THROAT Sparks Ear, Nose & Throat Center – West 520 Towson Suite A Fort Smith, AR 72901 479-573-7985 ENDOCRINOLOGY Sparks Thyroid and Endocrinology 4700 Kelley Hwy. Fort Smith, AR 72904 479-709-7460 FAMILY MEDICINE

Alma Family Medical Clinic - Sparks 937 Highway 64 East Alma, AR 72921 479-632-3855

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Cornerstone Family Medical Clinic - Sparks 14 Gothic Ridge Road Van Buren, AR 72956 479-474-1100 Greenwood Family Medical Clinic - Sparks 1480 West Center Street Greenwood, AR 72936 479-996-5585 SouthPointe Family Practice - Sparks 3808 Gary Street Fort Smith, AR 72903 479-709-7120 Sparks Clinic Family Medicine 6100 Massard Road Fort Smith, AR 72916 479-709-7250 Sparks Clinic Family Practice 4700 Kelley Hwy. Fort Smith, AR 72904 479-573-7990 Sparks Plaza Family Practice 1500 Dodson Ave., Ste. 195 Fort Smith, AR 72901 479-573-7910 Sparks Fort Smith Family Practice 1500 Dodson Ave., Ste. 175 Fort Smith, AR 72902 479-573-7840 Sparks Family Medicine – South 8600 South 36th Terrace Fort Smith, AR 72908 479-709-7465 Spiro Family Medical Clinic - Sparks 702 West Broadway Spiro, OK 74959 918-962-2442

Van Buren Family Medical Clinic - Sparks 209 Pointer Trail West Van Buren, AR 72956 479-474-3399

Mercy Clinic McAuley Family Medicine 3420 S. 74th Street Fort Smith 479-573-3740 Mercy Clinic Primary Care – Chaffee Crossing 7003 Chad Colley Blvd Barling 479-452-2098 Mercy Clinic Primary Care – Cliff Drive 3700 Cliff Drive Fort Smith 479-259-9286 Mercy Clinic Primary Care – Fianna Hills 9101 Jenny Lind Rd. Fort Smith 479-274-6000 Mercy Clinic Primary Care – Free Ferry 1000 Waldron Road Fort Smith 479-221-9922 Mercy Clinic Primary Care – Greenwood 20 N. Asher Greenwood 479-996-4111

107 S. Logan Charleston 479-573-3120

100 N. Walnut, St A Mansﬁeld 479-928-4404

Mercy Clinic Family Medicine – Ozark 201 S. 70th Street Ozark 479-667-1590

Mercy Clinic Family Medicine – Poteau 2110 N. Broadway Poteau 918-647-7416 GASTROENTEROLOGY Gastroenterology Center - Sparks 1001 Towson Ave., Ste. 100 Fort Smith, AR 72901 479-709-7430 GENERAL SURGERY Arkansas Surgical Group - Sparks 1500 Dodson Ave., Ste. 250 Fort Smith, AR 72901 479-573-7940

Mercy Clinic Family Medicine – Paris 300 S. 9th Street Paris 479-963-2131 Mercy Clinic Primary Care – Paris 500 E. Academy Paris 479-963-5421 Mercy Clinic Family Medicine – Van Buren 2800 Fayetteville Road Van Buren 479-314-4000 Mercy Family Medicine – Waldron 1341 W. 6th Street Waldron 479-637-2136 Mercy Family Medicine – Booneville 128 Daniel Avenue Booneville 479-675-2455

Mercy Clinic Primary Care – Hope Campus 301 S. E Street, Ste. A Fort Smith 479-431-3425

Mercy Family Medicine – Cedarville 708 Pirates Way, Cedarville 479-235-3025 Mercy Family Medicine – Magazine 351B E. Priddy Street Magazine 479-969-8768

Mercy Clinic Family Medicine – Charleston

Mercy Family Medicine – Mansﬁeld

Surgical Associates of Fort Smith - Sparks 923 Lexington Ave. Fort Smith, AR 72901 479-709-7350 Sparks Clinic Specialist 2010 Chestnut Van Buren, AR 72956 479-471-4290 Mercy Clinic General Surgery 2713 S. 74th Street Fort Smith, AR 479-573-3101 GERIATRICS Adult Medicine Specialists - Sparks 1120 Lexington Ave. Fort Smith, AR 72901 479-709-7260 SeniorCare Behavioral Health - Sparks 1001 Towson Ave. Fort Smith, AR 72901 479-441-5601

HEALTH & WELLNESS DIRECTORY HEARING

Beltone 1100 Lexington Ave Fort Smith, AR 479-782-5858

Graham Hearing

Graham Hearing Services, Inc. 1005 Lexington Ave. Fort Smith, AR 479-783-5250 HEMATOLOGY/ ONCOLOGY Sparks Clinic Cancer Center 1001 Towson Ave. Ste. 300 Fort Smith, AR 72901 479-709-7435 Sparks Radiation Treatment Center 1502 Dodson Ave. Fort Smith, AR 72901 479-709-7190 Mercy Clinic Oncology 7001 Rogers Ave., Ste. 200 Fort Smith, AR 479-314-7490 Mercy Radiation Oncology 7301 Rogers Ave. Fort Smith, AR 479-314-7545 INFECTIOUS DISEASE Sparks Center for Infectious Disease 1001 Towson Ave., Ste. 200 Fort Smith, AR 72901 479-709-7447 INTERNAL MEDICINE Adult Medicine Specialists – Sparks

1120 Lexington Ave. Fort Smith, AR 72901 479-709-7260

1500 Dodson Ave., Suite 290 Fort Smith, AR 72901 479-709-7175

Sparks Plaza Internal Medicine 1500 Dodson Ave., Ste. 180 Fort Smith, AR 72901 479-573-7820

Mercy Clinic Neurology 7303 Rogers Ave., Ste. 101 Fort Smith, AR 479-314-7590 NEUROSURGERY Mercy Clinic Neurosurgery 2713 S. 74th Street, Ste. 301 Fort Smith, AR 479-573-3723

Mercy Clinic Primary Care – Cliff Drive 3700 Cliff Drive Fort Smith, AR 479-259-9286 Mercy Clinic Primary Care – Sallisaw 1015 E. Choctaw Ave. Sallisaw, OK 918-774-0034 INTERNAL MEDICINE & PEDIATRICS Mercy Clinic Internal Medicine & Pediatrics 7800 Dallas Street Fort Smith, AR 479-314-4940

INTERVENTIONAL PAIN MANAGEMENT Mercy Clinic Interventional Pain Management 3501 W.E. Knight Drive Fort Smith, AR 479-709-6755 NEPHROLOGY Renal Care Associates Sparks 1500 Dodson Ave., Ste. 280 Fort Smith, AR 72901 479-709-7480 NEUROLOGY Sparks Clinic Neurology 3808 Gary Street Fort Smith, AR 72903 479-709-7050 Sparks Neuroscience Center

OBSTETRICS/ GYNECOLOGY Mercy Clinic OB/GYN 7001 Rogers Ave., Ste. 403 Fort Smith, AR 479-785-2229 Sparks Obstetrics & Gynecology 1500 Dodson Ave., Suite 230 Fort Smith, AR 72901 479-709-7490 OCCUPATIONAL MEDICINE Sparks Occupational Medicine 8600 South 36th Terrace Fort Smith, AR 72908 479-709-7422 ORTHOPEDICS Mercy Clinic Orthopedics – River Valley 3501 W.E. Knight Drive Fort Smith, AR 479-709-6700 Sparks Clinic Orthopedics 1506 Dodson Ave. Fort Smith, AR 72901 479-709-7000 PEDIATRICS Sparks Pediatrics 5428 Ellsworth Road Fort Smith, AR 72903

479-709-7337 Summit Pediatric Clinic Sparks 209 Pointer Trail West Van Buren, AR 72956 479-474-3399 Mercy Clinic Pediatrics 3224 S. 70th Street Fort Smith, AR 479-314-4810 PLASTIC & RECONSTRUCTIVE SURGERY Mercy Clinic Plastic & Reconstructive Surgery 2717 S. 74th Street Fort Smith, AR 479-573-3799

PODIATRY Mercy Clinic Podiatry – River Valley 3501 W.E. Knight Drive Fort Smith, AR 479-709-6700 Sparks Clinic Orthopedics 1506 Dodson Ave. Fort Smith, AR 72901 479-709-7000 PULMONOLOGY Sparks Clinic Lung Center 1001 Towson Ave., Ste. 400 Fort Smith, AR 72901 479-709-7433 Mercy Clinic Pulmonology 7303 Rogers Ave., Ste. 302 Fort Smith, AR 479-314-4620 SLEEP DISORDERS Sparks Sleep Disorders Center 1001 Towson Ave. Fort Smith, AR 72901 479-441-5255 Mercy Clinic Sleep Medicine 7001 Rogers Ave., Ste. 200

Fort Smith, AR 479-314-8917 SPORTS MEDICINE Mercy Clinic Sports Medicine 3501 W.E. Knight Drive Fort Smith, AR 479-709-6700 THERAPY SERVICES Sparks Outpatient Physical, Speech & Occupational Therapy 624 Towson, Ste. B Fort Smith, AR 72901 479-441-5361 Sparks–Van Buren Outpatient Physical Therapy Pulmonary Rehab 2020 Chestnut Van Buren, AR 72956 479-471-4545 UROLOGY Sparks Urology Group 5500 Ellsworth Road Fort Smith, AR 72903 479-709-7295 Sparks Clinic Urogynecology & Urology 520 Towson, Suite B Fort Smith, AR 72901 479-709-7080

WOMEN’S SERVICES Sparks Obstetrics & Gynecology 1500 Dodson Ave., Ste. 230 Fort Smith, AR 72901 479-709-7490 The Women’s Center Sparks 1500 Dodson Ave., Ste. 140 Fort Smith, AR 72901 479-709-1913 Sparks Clinic Urogynecology & Urology 520 Towson, Suite B Fort Smith, AR 72901 479-709-7080 WOUND CARE Sparks Wound Care & Hyperbaric Center 1001 Towson Ave. Fort Smith, AR 72901 479-441-5078 Mercy Wound Care & Hyperbaric Center 7306 Rogers Ave. Fort Smith, AR 479-314-2804

COMING UP.... MEN’S HEALTH healthy NEXT EDITION: SATURDAY, SEPTEMBER 15TH

living well in the river valley

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When your family needs back-to-school vaccinations, or school or sports physicals, we’ve got you covered. We’re also here to treat illnesses and injuries for your whole family. Our convenient locations are staffed by kid-friendly physicians. To make an appointment, call 479-782-CARE (2273) and ask about same-day appointments. SparksPhysicians.com

SAME-DAY APPOINTMENTS.

PHYSICALS AND VACCINATIONS. ONE NUMBER:

479-782-CARE.

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