You may be happy to chip in for everything from baby carriers, tricycles and rebounders to school tuition. But you may not have given as much thought to nutrition. The best gift you can give your grandchild is the gift of health. Your health and theirs. You’ll enjoy that investment for the rest of your life.

The new age of grandparenting    

I was raised by a single mom. We lived with my grandparents, who I call my co-parents. (I think I turned out okay!) That was unusual 80 years ago, but not so much anymore.Grandparents today have more meaningful roles in their grandkids’ lives. Many are taking on caregiving responsibilities. There are more extended families living under the same roof. Here in California, the trend is for young couples to build small homes for their parents in their backyards.This is helpful for the grandkids and their parents. It’s also good for you, the grandparents. Becoming involved in your grandkids’ lives gives your own life more meaning. Studies show this can help you live longer and live better.

The nutrition opportunity 

I write a lot about how to get children, especially picky eaters, to consume more nutritious meals. A good diet is essential for their brain development as well as their muscles, bones and other parts of their growing bodies. As grandparents, you can have a huge influence on what they eat.I’ve been a pediatrician for more than 50 years. Today, I see a lot more grandparents during office visits. The good news: They are generally more savvy about nutrition than parents. The bad news is that they waited too late. Some of my grandparents will say, “Dr. Bill, I’m 60. I’m frail. I have weak bones. I wish I’d started eating better when I was younger.”It’s never too late, no matter what your age group. Not only can you generally make improvements in your own health, but sharing that information with your kids and grandchildren will be lessons learned by future generations. These can be full-circle moments.

How to get started 

As grandparents, we share stories. We pass down traditions. We should also be passing along nutritional wisdom. Here’s how I would approach this.

• Explain to parents why it’s important to start young. If you preload grandkids with good nutrition when they are young, their minds and bodies will be ready to handle things that happen later on.
• Be very diplomatic. Sometimes you just have to say to their parents: “I love our grandchild so much! I just want to prepare him/her to be strong in the future.”
• Offer to handle some of the food costs. Parents will tell me, “But Dr. Bill, healthy foods cost more!” Enter you, the grandparents. You can say, “Honey, don’t let financial considerations impact your shopping list. We will make up the difference.”
• Restock the pantry for your grandchildren and yourselves. Ship healthy ingredients to the kids. Or, leave them behind after you’ve been watching the grandkids. One of my favorites ingredients is Healthy Heights Kidz Protein shake mixes, which are designed by pediatricians especially for kids. In addition to shakes, they are great to use as an ingredient to add important nutrients to other recipes. Not only do children need more protein, you do as well. The number-one health concern of grandparents is frailty. You need more protein for your own muscles and bones!
• Involve your grandkids in food preparation. Our 4-year-old grandson loves to help me make smoothies with Grow Daily shake mixes. He adds a fistfull of blueberries and kiwis, and he loves to scoop the shake powder from the bag. You want to do things with your grandchildren, not for your grandchildren. When they are involved, they are more likely to want to drink it or eat it.
• Be proactive. Help grandchildren learn cooking skills. Encourage them to be active. Have conversations about food. Post healthy reminders around the house. We have tips you can download on our website. Search “healthy reminders” on AskDrSears.com.
• Be a healthy role model. Foods that are low fat or low carb are not good for children or adults. Serve smart fats and smart carbs. Smart fats are things like omega-3s from salmon that are good for the brain. Smart carbs are the ones that have fiber.
• Teach your kids and grandkids about body composition. BMI went out of favor 10 years ago! Body composition — your muscle and bone mass, and your body fat distribution — are far more important than what the scale shows. If your grandchild is big boned and has big muscles, and the school tells parents their BMI is too high, you should say, “Don’t worry. This child is blessed with a body type that gives him/her large muscles and strong bones.” Waist size is the number-one scientifically studied parameter of health. If their waist isn’t potbellied, and you can’t grab a big piece of flab on their belly, their scale weight doesn’t matter. We use the term ‘lean’. That means the right body composition for your genetic body type.

What memories do you want your grandchildren to have of you? Many will be about food. I still fondly remember cooking with my grandpa. As important, what do you want to leave for your grandchildren? Teaching them healthy eating habits is an enduring investment that will carry them through their entire lives.

Dr. Sears, or Dr. Bill as his “little patients” call him, has been advising busy parents on how to raise healthier families for over 50 years. The father of 8 children, he and his wife Martha have written more than 45 books including “The Healthiest Kid in the Neighborhood,” and hundreds of articles on parenting, childcare, nutrition, and healthy aging. He is the co-founder of the Dr. Sears Wellness Institute for training health coaches, and he runs the health and parenting website AskDrSears.com.

The report was published on June 8 in  Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

Previous research has shown that due to their exposure to chemotherapy and/or radiation, childhood cancer survivors may face up to a five-fold increased risk of cardiovascular disease and death, compared to the general population. Multiple studies have shown that most adult childhood cancer survivors report receiving only general medical care, not specific to their experience with cancer. Previous research also suggests that cancer survivors are not receiving recommended cardiovascular screenings in a timely manner due to limited awareness of future health complications by survivors and health care professionals.

“These findings make underdiagnosis and undertreatment significant concerns for the estimated half a million childhood cancer survivors living in the United States,” said lead study author Eric J. Chow, M.D., M.P.H., an associate professor in clinical research and public health sciences at the Fred Hutchinson Cancer Center in Seattle.

In this study, cardiovascular risk factor undertreatment was defined as being diagnosed with high blood pressure, high cholesterol or diabetes and having higher-than-recommended levels of “bad” cholesterol, triglycerides or blood glucose. (No detail were available about Type 1 or Type 2 diabetes diagnosis.)

Participants were recruited from the Childhood Cancer Survivor Study (CCSS), a large study that includes people who were diagnosed with cancer before age 21 between 1970 and 1999 at health care centers in the U.S. and Canada, and who survived at least five years. Between September 2017 and April 2020, researchers recruited from the pool of U.S.-based CCSS participants childhood cancer survivors who were at least 18 years old, free of heart disease or heart failure, living within 50 miles of nine major U.S. metropolitan areas (Atlanta, Boston, Denver, Houston, Minneapolis, Philadelphia, Pittsburgh, Seattle and Columbus, Ohio). Those recruited were also taking part in a separate clinical trial testing the potential of a telehealth-care plan to improve cardiovascular outcomes among long-term survivors of childhood cancer. Among this group, which was 85% white adults and 57% women, the most common types of cancer were leukemia, lymphoma and bone cancer.

Researchers measured blood pressure, lipids, glucose and hemoglobin A1c levels in nearly 600 adults (median age 37 years) an average of 28 years after cancer diagnosis and obtained similar data on a comparison group of nearly 350 same-age adults without a history of cancer. The analysis found:

Cancer survivors were more likely than those without a history of cancer to have hypertension (18% vs. 11%, respectively), abnormal lipid levels (14% vs. 4.9%, respectively) and diabetes (6.5% vs. 3.2%, respectively).

Participants in both groups had similar rates of underdiagnosed hypertension, high cholesterol and diabetes: 27.1% among cancer survivors and 26.1% among the comparison group. However, cancer survivors were 80% more likely to be undertreated for these conditions compared to their study counterparts.

“Serious heart disease is uncommon in young adults in the general population, which includes childhood cancer survivors, therefore, greater awareness of the significantly higher cardiovascular disease risk when there is a history of cancer is important,” Chow said. “Raising awareness among primary care professionals as well as improving survivors’ ability to self-manage their health may mitigate the increased risks. There are specialized heart disease risk calculators designed for cancer survivors, and those may be more accurate in predicting future cardiovascular disease risk than risk calculators designed for the general population.”

The analysis also included the results of a self-reported questionnaire assessing medical history, such as cardiovascular health and treatment; diet, exercise and other lifestyle habits; and people’s belief in the ability to manage their own health.

Information on the comparison group of peers who had no history of childhood cancer came from the 2015-2016 National Health and Nutrition Examination Survey, in which participants had standardized health examinations and in-home interviews, comparable to the questionnaire taken by the cancer survivors.

The most underdiagnosed and undertreated cardiovascular disease risk factors among the cancer survivors were hypertension at 18.9% and lipid disorders at 16.3%.

Among the cancer survivors, men were twice as likely to be underdiagnosed and undertreated for the cardiovascular disease risk factors; while survivors who were overweight or obese were 2-3 times more likely to be underdiagnosed and undertreated.

Cancer survivors who had two or more unhealthy lifestyle factors, such as physical inactivity and low consumption of fruits and vegetables, were twice as likely to be undertreated than the comparison group.

The study also found that childhood cancer survivors who reported higher self-efficacy – a stronger belief in their ability to manage their own health – had 50% lower odds of undertreatment for the cardiovascular disease risk factors studied. “That perhaps is not surprising, yet it suggests that efforts to help survivors learn how to take greater ownership of their health conditions may help to improve longer term outcomes,” Chow said. “This has been shown in patients with other chronic health conditions outside of cancer as well.”

Among the study’s limitations are the potential for measurement error and misclassification among the cancer survivors and comparison group because of one-time health assessments.

Studies published in the American Heart Association’s scientific journals are peer-reviewed. The statements and conclusions in each manuscript are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.

The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public’s health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with us on heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1.

Although cardiovascular disease, which includes heart disease and stroke, is more common among older people, the risks often begin much earlier in life. Previous research confirms physical and psychological abuse and other adverse experiences in childhood increase the risk of developing obesity, Type 2 diabetes, high blood pressure and high cholesterol, which, in turn, increase the risk for cardiovascular diseases.

Conversely, healthy childhood experiences — nurturing, loving relationships in a well-managed household, including having family members who are involved and engaged in the child’s life — may increase the likelihood of heart-healthy behaviors that may decrease the cardiovascular disease risks. In this study, researchers explored whether nurturing relationships and well-managed households may offset the likelihood of higher cardiovascular risk factors.

“Our findings demonstrate how the negative and positive experiences we have in childhood can have long-term cardiovascular consequences in adulthood and define key heart disease risk disparities by race and sex,” said study lead author Liliana Aguayo, Ph.D., M.P.H., social epidemiologist and research assistant professor at Emory University’s Rollins School of Public Health in Atlanta.

According to an AHA news release, researchers examined information from the Coronary Artery Risk Development in Young Adults (CARDIA) Study, an ongoing, long-term study among 5,115 Black and white adults enrolled from 1985-1986 to 2015-2016. Study enrollment occurred in four U.S. cities: Birmingham, Alabama; Chicago; Minneapolis; and Oakland, California. More than half of the study participants were women, and nearly half were Black adults. At the start of the study, participants were 25 years old, on average. All participants received initial clinical examinations and eight additional examinations every few years to assess cardiovascular risks over 30 years.

At ages 33 to 45, participants completed a survey of questions to assess areas of their family life during childhood. For this analysis, three areas were examined:

Abuse: how often a parent or adult in their home pushed, grabbed, shoved or hit them so hard that they were injured; and how often a parent or adult in their home swore at them, insulted them or made them feel threatened.

Nurturing: how often a parent or adult made them feel loved, supported or cared for; and how often a parent or adult in the family expressed gestures of warmth and affection.

Household organization: did they feel the household was well-managed, and did their family know where they were and what they were doing most of the time. (No definitions or criteria were provided for the term “well-managed;” study participants were instructed to determine if the term described their childhood family experience.)

Participants were categorized based on their responses to the survey questions:

Roughly 30% of participants reported experiencing “occasional/frequent abuse,” which included those who responded, “occasionally or moderate amount of time” or “most or all of the time” to questions related to abuse.

About 20% of participants reported they experienced abuse “some or little of the time,” which was categorized as “low abuse.”

About half of the participants reported no childhood abuse and described their family life during childhood as nurturing and well-managed.

Among the adults who reported experiencing abuse during childhood, the risk of Type 2 diabetes and high cholesterol — but not obesity and high blood pressure — was higher, compared to the adults who reported no abuse in childhood. The increase in risk, however, appeared to vary depending on gender and race.

Researchers noted:

The risk of high cholesterol was 26% higher among white women and 35% higher among white men who reported low levels of abuse in childhood, compared to same sex and race adults who reported no abuse in childhood.

The risk of Type 2 diabetes was 81% higher among white men who reported occasional/frequent abuse during childhood, compared to adults who reported no abuse in childhood.

Black men and white women who said they experienced abuse and grew up in a dysfunctional household were more than 3.5 times as likely to develop high cholesterol as those who reported no abuse during childhood. In contrast, among people who reported growing up in a well-managed household, the risk of high cholesterol decreased by more than 34%.

An unexpected finding: The risk for cardiovascular disease risk factors was not higher among Black women who reported experiencing abuse in childhood.

Several limitations may have affected the study’s results. This study was a retrospective analysis of data collected in the CARDIA study in 2015-2016; no new surveys were conducted with the CARDIA study participants. The questionnaires about childhood family experiences were completed when the participants were adults, relying on memories, which may include some inaccuracies or incomplete recollections. In addition, participants’ BMI (body mass index), which is a measurement of weight according to height, was recorded only in adulthood, with no data on BMI during childhood for comparison.

“Further research is needed to better understand the potential mechanisms linking childhood abuse and family environment to higher heart disease risk factors, as well as the impact of structural racism and social determinants of health, which likely influenced the differences we found by race and sex,” Aguayo said. “This information is critical to strengthening cardiovascular disease prevention interventions and policies, particularly those that focus on people who experienced abuse or other trauma during childhood.”

The pattern of low clinic utilization by Black children was accompanied by more frequent emergency department visits compared to the other groups. The difference in utilization at the CHC level suggests there are other factors beyond affordability influencing disparities in health care utilization. The study, published in Annals of Family Medicine, was largely supported by the National Institute on Minority Health and Health Disparities (NIMHD), part of the National Institutes of Health (NIH).

The seven-year observational study was conducted across 18 states using electronic health record data of 41,276 children with asthma. It found that 54% of Black children had fewer than two visits annually, while for white and Spanish-preferring Latino children, it was 49.2% and 30.1%, respectively. The minimum standard of care for children with asthma is two visits annually. The researchers compared acute asthma care visits within CHCs, and the equivalent use within hospital emergency departments by race, ethnicity, and language.

Led by researchers at the Oregon Health & Science University, Portland, the study is the first to demonstrate that patterns of clinic and emergency department acute-care utilization differ for Black and Spanish-preferring Latino children when compared to white children. Previous studies have documented disparities in asthma-related emergency department use. However, none have demonstrated different long-term patterns by race, ethnicity, and language across various acute care settings (clinic, emergency department, inpatient) accounting for health status, social determinants of health and routine primary care.

Additionally, the researchers tried to understand how acute care use may reflect social factors across various domains and levels of influence, including aspects of poverty, the experience of cultural affinity in CHCs, and differing effects of segregation and social deprivation. Those and other factors are outlined in NIMHD’s research framework. 

Researchers found that most children in the study experienced a wealth gap, but Black children did so more often than others. Seven in 10 (73%) lived in households that were below 138% of the federal poverty level, compared to 54% to 58% in white and Latino children. These children may have been affected by greater financial instability, the inability of guardians to take work leave or fill prescriptions leading to lower primary care usage, and increased exacerbations that could require emergency care. Eliminating the wealth gap experienced by many Black Americans may improve asthma outcomes for this population.

CHCs in this study may be more tailored to care for Latino populations by having providers/staff that may be of Latino origin as well as language services that provide some cultural affinity not experienced by the Black community utilizing these same clinics.

While other research has shown that in equally segregated and socially deprived neighborhoods, immigrants have better health outcomes (including higher primary care utilization) than non-immigrant Black people do. This contrast suggests that the effects of long-term structural racism may have influenced the findings in this study.

“The findings from this research underscore the multi-faceted nature of minority health and health disparities. There are multiple social factors and levels of influence that can impact health behavior within a population with the same diagnosis, and these must be explored to better understand and address health disparities,” said NIMHD Director Eliseo J. Pérez-Stable, M.D.

“Our discovery suggests that the CHC delivery model may be more effective at mitigating disparities in some situations and groups than others. Future research can investigate which features of the CHC delivery approach can be improved or expanded to reach all populations in need of care,” said Jorge Kaufmann, ND, M.S, of the Department of Family Medicine, Oregon Health & Science University, lead author on the study.

The study was conducted with the Accelerating Data Value Across a National Community Health Center Network (ADVANCE) Clinical Research Network (CRN). The ADVANCE network is led by OCHIN in partnership with Health Choice Network, Fenway Health, Oregon Health & Science University, and the Robert Graham Center.

National Institute on Minority Health and Health Disparities (NIMHD): NIMHD leads scientific research to improve minority health and eliminate health disparities by conducting and supporting research; planning, reviewing, coordinating, and evaluating all minority health and health disparities research at NIH; promoting and supporting the training of a diverse research workforce; translating and disseminating research information; and fostering collaborations and partnerships. For more information about NIMHD, click here to visit the agency’s website.

The immunotherapy consisted of a daily oral dose of peanut flour for 2.5 years. Remission was defined as being able to eat 5 grams of peanut protein, equivalent to 1.5 tablespoons of peanut butter, without having an allergic reaction six months after completing immunotherapy. The youngest children and those who started the trial with lower levels of peanut-specific antibodies were most likely to achieve remission. The results of the trial, called IMPACT, were published today in the journal The Lancet.

“The landmark results of the IMPACT trial suggest a window of opportunity in early childhood to induce remission of peanut allergy through oral immunotherapy,” said Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID). “It is our hope that these study findings will inform the development of treatment modalities that reduce the burden of peanut allergy in children.” NIAID, part of the National Institutes of Health (NIH), sponsored the trial and funded it through its Immune Tolerance Network.

Peanut allergy affects about 2% of children in the United States, or nearly 1.5 million individuals ages 17 years and younger. The risk of a life-threatening allergic reaction to accidentally eaten peanut is significant for these children, most of whom remain peanut-allergic for life.

When designing the study, the IMPACT trial investigators reasoned that because oral immunotherapy has the potential to change the immune system, providing peanut oral immunotherapy early in life, when the immune system is still maturing, might modify a child’s immune response to peanut. Two previous studies provided proof of concept that peanut oral immunotherapy could be given safely to very young children and have a therapeutic effect.

Nearly 150 children ages 1 to 3 years participated in the IMPACT trial at five academic medical centers in the United States. Only children who had an allergic reaction after eating half a gram of peanut protein or less were eligible to join the study. The children were assigned at random to receive either flour containing peanut protein or a placebo flour of similar appearance. The flours were mixed with foods such as applesauce or pudding to help mask their taste. No one except a site pharmacist and a site dietitian  knew who received peanut flour or placebo flour until all the data were gathered and study visits had ended.

During a 30-week period, the children in the treatment group ate gradually escalating daily doses of up to 2 grams of peanut protein, equivalent to about eight peanuts. The children then continued to consume their daily dose of peanut or placebo flour for an additional two years.

Next, the children underwent an oral food challenge in which they received gradually increasing doses of peanut protein up to a cumulative maximum of 5 grams. They then stopped treatment and avoided peanut for six months.

Finally, the children underwent a repeat oral food challenge with 5 grams of peanut protein. Those who did not have an allergic reaction during the challenge were later fed 8 grams of peanut butter, equivalent to 2 tablespoons, on a different day to confirm that they could eat peanut without having an allergic reaction.

At the end of the treatment period, 71% of children who had received peanut flour were desensitized to peanut, compared to only 2% of those who had received the placebo flour. Desensitization was defined as being able to eat 5 grams of peanut protein during the first oral food challenge without having an allergic reaction.

After six months of peanut avoidance following treatment, 21% of children who had received peanut flour could eat 5 grams of peanut protein during the second oral food challenge without having an allergic reaction and therefore were in remission. By contrast, only 2% of children who had received placebo flour were in remission at that time.

The investigators found that lower levels of peanut-specific immunoglobulin E antibodies at the start of the trial and being younger predicted whether a child would achieve remission. In an analysis done after the investigators could view the study data, they found an inverse relationship between age at the start of the trial and remission, with 71% of the 1-year-olds, 35% of the 2-year-olds and 19% of the 3-year-olds experiencing remission.

Although nearly all the children who received peanut flour had at least one dose-related reaction during treatment, most reactions were mild to moderate in severity. Twenty-one children received the rescue drug epinephrine for 35 moderate reactions to peanut flour during the 2.5-year treatment period.

The Immune Tolerance Network conducted the trial under the leadership of A. Wesley Burks, M.D., and Stacie M. Jones, M.D. Burks is chief executive officer of University of North Carolina Health (UNC), dean of the UNC School of Medicine, and vice chancellor for medical affairs at UNC at Chapel Hill. Jones is a professor of pediatrics at the University of Arkansas for Medical Sciences and Arkansas Children’s Hospital in Little Rock.

Smoking cigarettes is a well-established risk factor for developing RA. However, it’s unclear whether secondhand smoke, sometimes called passive smoking, also raises risk of the disease. The National Institute of Health (NIH) reports that a research team led by Drs. Kazuki Yoshida and Jeffrey A. Sparks of Brigham and Women’s Hospital and Harvard Medical School set out to investigate the link between secondhand smoke exposure over the lifespan and RA in adulthood.

The researchers looked at different categories of secondhand smoke exposure and RA risk. They examined the effects of maternal smoking during pregnancy, parental smoking during childhood, and living with a smoker as an adult. The study was supported by several NIH institutes, led by NIH’s National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and National Cancer Institute (NCI). Findings were published in Arthritis and Rheumatology, on August 18, 2021.

The team analyzed data from nearly 91,000 women in a study of registered nurses, the NIH said in a news release. Participants completed health questionnaires every two years from 1989 to 2017. Researchers collected information about secondhand smoke exposure when the women were 35 to 52 years of age. Medical records were used to confirm RA diagnoses.

Over the almost three decades, 532 women developed RA, the NIH release reported. Of those, about two-thirds were “seropositive,” meaning that blood samples tested positive for certain types of antibodies directed against the body’s own proteins.

The researchers used statistical modeling to estimate the effect of secondhand smoke on seropositive RA risk. They were able to control for other factors like becoming a smoker as an adult. Parental smoking during childhood was associated with a 75% increase in risk of seropositive RA. This risk was even greater among those who smoked as adults.

No link was found between maternal smoking during pregnancy and adult RA risk after accounting for later smoking exposure. Similarly, the researchers found no evidence that living with a smoker as an adult directly increased RA risk, although a firm conclusion wasn’t possible because of the close correlation between living with a smoker and smoking as an adult.

“Our findings give more depth and gravity to the negative health consequences of smoking in relation to RA, one of the most common autoimmune diseases,” Yoshida says.

In infants and children, secondhand smoke is already associated with numerous health effects, including increased risk of respiratory infections, more frequent and severe asthma attacks, ear infections and SIDS. This study is among the first to suggest a direct influence of parental smoking on the development of RA. The team is planning to expand the study in the future to include both men and women.

But the holiday looks very different from a parent’s point of view. They’re concerned about the effect of too much sugar on their child’s teeth, but it seems impossible to stem the tide of treats.

There is hope, though – these tips should help kids have most have a fun Halloween without ending up in the dentist’s chair:

*Bring a water bottle for the kids – drinking water between eating candy can help wash away the sugar that is building up on their teeth and may make them feel fuller.

*Feed them first – make sure the kids eat before they go out so that they aren’t snacking on more candy than they should.

*When they do get home, make sure the kids have a small portion of candy – and put the rest away until tomorrow.

*Brush and floss after eating the candy – of all nights of the year that kids should brush their teeth, Halloween is number 1 on the list. Decay is the process of bacteria living on the teeth, metabolizing these sugars easily and producing a level of acid that can break down the tooth structure. The offending bacteria and the food source have to stay on the tooth surface for a long amount of time, which iss why it’s important to brush and floss as soon as possible after eating candy.

It also helps to recognize the different kinds of damage candy can do, so you can, hopefully, steer kids clear of it. Candy that melts and disappears quickly is better because the sugar on some candy can produce cavity-causing acid. Chewy treats and hard candy are damaging to teeth because they spend a prolonged amount of time stuck to teeth. Dark chocolate has less sugar than milk chocolate. Sugar-free candy is also an option.

Happy Halloween!

Scientists at the National Institutes of Health (NIH); Stanford University, California; and Dana-Farber Cancer Institute, Boston, identified two drugs that worked together to both kill cancer cells and counter the effects of a genetic mutation that causes the diseases. Combining panobinostat and marizomib was more effective than either drug by itself in killing DMG patient cells grown in the laboratory and in animal models, the researchers said. Their studies also uncovered a previously unrecognized vulnerability in the cancer cells that scientists may be able to exploit to develop new strategies against the cancer and related diseases.

The results were published Nov. 20 in Science Translational Medicine, according to a news release from NIH.

DMGs are aggressive, hard-to-treat tumors that represent the leading cause of brain cancer-related death among U.S. children. DMGs typically affect a few hundred children a year between ages 4 to 12; most children die within a year of diagnosis. Most cases are caused by a specific gene mutation.

In an earlier study, Stanford neuro-oncologist Michelle Monje. M.D., Ph.D., and her colleagues showed that panobinostat could restore the DIPG mutation to a more normal state. While panobinostat is already in early clinical testing in DIPG patients, its usefulness may be limited because cancer cells can learn to evade its effects.

So Monje’s team wanted to identify other drugs – and combinations of them – that could affect the cancer.  “Very few cancers can be treated by a single drug,” said Monje, a senior author of the study who treats children with DIPG and other diffuse midline gliomas. “We’ve known for a long time that we would need more than one treatment option for DIPG. The challenge is prioritizing the right ones when there are thousands of potential options. We’re hopeful that this combination will help these children.”

Monje and the National Cancer Institute’s Katherine Warren, M.D., now at Dana-Farber Cancer Institute and Boston Children’s Hospital, collaborated with Craig Thomas, Ph.D., and his colleagues at the NIH’s National Center for Advancing Translational Sciences (NCATS). Thomas and his team used NCATS’ drug screening expertise and matrix screening technology to examine drugs and drug combinations to see which ones were toxic to DIPG patient cells.

The screening technology they used enable scientists to rapidly test thousands of different drugs and drug combinations in a variety of ways. Scientists can examine the most promising single drugs and combinations, determine the most effective doses of each drug and learn more about the possible mechanisms by which these drugs act.

“Such large, complex drug screens take a tremendous collaborative effort,” said Thomas, also a senior study author. “NCATS was designed to bring together biologists, chemists, engineers and data scientists in a way that enables these technically challenging studies.”

The screening studies also provided important clues to the ways the drugs were working.  As a result, the collaborative team subsequently conducted a series of experiments that showed the DIPG cells responded to panobinostat and marizomib by turning off a biochemical process that shuts down malevolent growth in cell energy.

Monje stressed the panobinostat-marizomib combination might be an important component of a multitherapy strategy, including approaches that harness the immune system and those that disrupt factors in the tumor “microenvironment” that cells depend on to grow. Like Warren, Monje emphasized the need to better understand how drugs target and impact the DIPG cells’ vulnerabilities.

“Our work with NCATS showed the need to gather more preclinical data in a systematic, high-throughput way to understand and prioritize the strategies and agents to combine,” Monje said. “Otherwise we’re testing things one or two drugs at a time. We want to move past this guesswork and provide preclinical evidence to guide clinical decisions and research directions.”

Plans are underway for clinical trials of the drug combination and of marizomib alone.

CRF, also referred to as aerobic fitness, refers to the body’s ability to supply oxygen to muscles during physical activity. Children with healthy CRF are more likely to live longer and be healthier as adults. Children with low or unhealthy CRF at higher risk for developing premature heart disease, type 2 diabetes (T2D) and high blood pressure at younger ages, and they are at increased risk for premature death from heart disease and stroke as adults. Children with obesity are the most likely to have poor CRF.

In addition, studies have linked better CRF in children with improved academic achievement, clearer thinking, better mental health and a higher sense of self-worth and life satisfaction, according to studies cited in the statement. Since the 1980s, studies have demonstrated a downward trend for CRF among youth both in the U.S. and internationally.

“CRF is a single measure that shows how strong the heart, lungs and blood circulation are in children. Whereas measuring body weight, blood pressure, cholesterol and blood sugar levels tell us about each of these individual risk factors, measuring CRF provides a comprehensive assessment of a child’s overall health,” said Geetha Raghuveer, M.D., M.P.H., FAHA, chair of the writing committee for the new scientific statement, a cardiologist at Children’s Mercy Hospital and professor of pediatrics at the University of Missouri, both in Kansas City, Missouri.

According to the statement, one of the biggest contributors to low CRF in children is the decline in physical activity among young people. Children play fewer physically active games and are exercising less.

Children are also more sedentary than they were in the past, although it is not clear if the sedentary time itself or the resultant lack of physical activity is correlated with CRF in young people. Studies (conducted prior to the COVID-19 pandemic) show that children are spending more time using their electronic devices for recreation and entertainment in addition to education needs – sedentary activities have replaced physical activity. However, a recent meta-analysis that combines the results of multiple studies found that increased sedentary time was correlated with lower levels of CRF in children, yet not among teens.

CRF in youth can be improved by spending more time doing repeated bursts of vigorous physical activity otherwise called high-intensity interval training, such as regular sprint running sessions coupled with periods of rest or low-intensity exercise. Sports that include periods of vigorous physical activity such as basketball, soccer, tennis and swimming, among others, should be encouraged.

“Cardiorespiratory fitness is crucial for good heart and overall health both in childhood and as children become adults,” said Raghuveer. “We’ve got to get kids moving and engaged in regular physical activity, such as in any sports they enjoy. The best activity is the activity a child or teen likes and that is sustained for a longer period. The habits they learn when they’re young will directly benefit their health as they become adults,” said Raghuveer.

Children need to play more physically active games.

However, there are many challenges for parents who may want to help children be more physically active. Social determinants of health, such as socioeconomic status and neighborhood characteristics, greatly affect children’s CRF. Studies cited in the statement have found that lower-income families tend to have children with lower or unhealthy CRF, possibly because they do not have access to safe places to exercise, play sports and be physically active. In many communities, physical education is not provided in schools, and outdoor recess opportunities have been reduced or eliminated.

In addition, many lower-income families live in food deserts, making it difficult to find or afford healthy foods, factors which contribute to obesity in young people and adults.

“Every child would benefit from CRF testing as part of a yearly physical,  and doing so may identify children who would benefit from lifestyle interventions that can help improve health,” said Raghuveer. Currently, CRF is not routinely measured by health care professionals, except in children with specific conditions such as congenital heart disease, asthma or cystic fibrosis. There are a wide variety of tests and protocols that can be used to measure CRF, some of which can be administered in a pediatric health care  office.

The most accurate measure of CRF in children is the cardiopulmonary exercise test, which is conducted while a participant is exercising to exhaustion, typically on a treadmill or cycle ergometer (specially adapted stationary bike).

Other office-based tests include:

*the PWC170 test (Physical Work Capacity Corresponding to a Heart Rate of 170 beats per minute), which is conducted with a cycle ergometer

*a six-minute walk test that measures the distance achieved in six minutes; however, this is only considered useful for children with already suspected low CRF

*step tests, where a participant steps up and down on a 12-inch bench in an effort to engage larger muscle mass, with a goal of 24 steps/minute for a duration of three minutes. (Step tests can be a good alternative when space is limited; they can be conducted in office settings with minimal equipment or on school bleachers for groups of children.)

Patient questionnaires to assess the level of physical activity for a child or teen tend to be unreliable and not effective for measuring CRF because they are self-reported and do not include testing.

Although the CRF tests noted above can be implemented in a pediatric health care office, many professionals don’t have enough time, space or personnel to administer the tests.

In many cases, schools provide a great avenue for CRF testing, because they widely administer the 20-meter Shuttle Run, which is an effective measure of CRF and is the most widely used CRF test in the world. During this test, a student runs between lines set 20 meters apart until a facilitator sounds a “beep.” The intervals between beeps accelerate towards the end of the test, and the student must run faster. Students are scored on the number of laps run.

Many schools also measure body mass index (BMI), weight, abdominal strength, upper-body strength and flexibility through a group of tests called Fitness Gram, which is administered in all 50 states.

The other field-based test is a run test where the participant is given a set distance or a maximum duration time and instructed to complete the test in the shortest amount of time or the greatest distance as possible during that time.

“As is current practice for immunization records that health care professionals share with schools with parental consent, schools could share CRF testing results with health care professionals. This bidirectional communication will result in health care professionals knowing more about their young patients, so interventions and counseling can begin,” said Raghuveer. “As so happens now, there are important pieces of information regarding a child’s health that are not easy to access because they are in a silo.”

“Our hope is that this statement will also inspire research into finding valid, lower-cost alternative options for traditional cardiopulmonary exercise testing to assess CRF in all children, and improved CRF tests that can be done in an office with limited space and without the need for formally trained exercise physiology personnel.”

“In the meantime, requiring physical activity for every grade level through high school would be a step in the right direction,” said Raghuveer.

For information from the AHA on fitness for the whole family, click here.

About the American Heart Association

The American Heart Association is a leading force for a world of longer, healthier lives. With nearly a century of lifesaving work, the Dallas-based association is dedicated to ensuring equitable health for all. We are a trustworthy source empowering people to improve their heart health, brain health and well-being. We collaborate with numerous organizations and millions of volunteers to fund innovative research, advocate for stronger public health policies, and share lifesaving resources and information. Connect with us on www.heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1.

I spoke with water safety expert Kelly Gaines to gain insight on this topic. Gaines is the owner of Charlotte Aquatics in Charlotte, North Carolina, which has taught swim lessons for all ages since 1996.

Adult supervision is essential, Gaines says, “during bathtime, pool time, and when you’re not even thinking about swimming.” In fact, she herself had a close call when her daughter was a toddler. “I always thought that if my child fell into my pool, then I would know about it. Then one beautiful day I was out working in the garden and I just happened to look up.” Her two-year old was falling into the pool reaching out for a dropped toy. “It was so quiet and so quick, there could very easily have been a much worse outcome.” It can take as little as 20-60 seconds for a child to stop resisting and become completely submerged.

Barriers are also key: pool fences, covers, gates and alarms that prevent unsupervised children and uninvited guests from entering the pool. Self-closing and self-latching gates are especially important, because it’s very easy to accidentally leave the gate open.

Classes teach swimming techniques, safe behavior and life skills. There are swim classes available for ages and skill levels. Generally, the better someone is at swimming, the more likely they are to emerge safely after an incident like slipping into the pool or falling off a dock. “If you can’t keep your head above water, you can’t breathe,” says Kelly Gaines. “When you can swim, you can pop back up, turn around and get to the wall, ladder or the closest exit point, even if it’s behind you.” Swim lessons can also develop a sense of comfort in the water and the ability to float, which both contribute to self-preservation.

Don’t jump in if you don’t know how deep the water is.

On the other hand, parents shouldn’t let their kids’ ability to swim lull them into a false sense of security. Even strong swimmers are susceptible to making mistakes, tiring out, getting injured or being dragged under by external forces like pool equipment, clothing or horseplay. Accidents happen and when they do, someone must be there to respond.

It’s an awful feeling to see your child struggle and be unable to help them, Gaines says. So at the very least, if you can’t swim, learn to do so right away. It’s never too late – adult swim classes are offered at YMCAs and swim schools across the country. Gaines also recommends CPR and First Aid certification for all parents.

It’s also necessary to learn the signs of drowning. Every incident is different, but it does not look like it does in the movies. As Gaines explains, swimmers in distress are usually too exhausted to thrash, splash or call for help. Instead, “they go vertical, with their legs hanging down. They’re not moving forward. They’re gasping for breath with their mouth at or just above the water.” When a small child with no skill level or strength drops into the water, they tend to sink right down. The air in their lungs might cause a quick bob or bounce, but after that they become submerged within just a few moments.

Water Safety Rules You Should Always Follow

Whenever you’re around the water, these rules apply to children and adults alike.

Never swim without supervision. Adults must watch children at all times, and should not swim by themselves.

In group settings like family barbecues or big gatherings, avoid the group mentality that assumes someone else will be watching the kids. Too often, no one ends up doing it. Instead, Gaines and other swimming experts urges adults to appoint a designated Water Watcher. “Take shifts, even 15-30 minutes at a time. That means you’re not on your phone, not flipping burgers, you’re only watching the kids in the water.”

Don’t play on the pool deck and remove toys from the vicinity.

Don’t jump in if you don’t know how deep the water is. Shallow water can cause injuries, and water that’s too deep can be physically overwhelming.

If a child goes missing, check the water first. If your kid sneaks away and there’s a pool, fountain, lake or any other water nearby, look for them there before spending time looking elsewhere.

Water wings and novelty inflatables are not designed to save a life. If a child is relying on them, an adult needs to stay within arm’s reach at all times. Otherwise, fit children and non-swimmers with life jackets that are U.S. Coast Guard approved.

If you’re not a strong swimmer, don’t jump in after a person who is struggling in the water. Instead, extend or throw them something to grab onto to help them stay afloat.

While young children are more prone to accidents, adolescents and adults tend to put themselves at risk by showboating, horsing around or otherwise using poor judgment. Counsel older kids about these risks, and know that they could be an issue when supervising them.

Courtesy of www.safety.com. For more on the author, Emily Ferron, click here.