www.cpmc.org

Spring 2006

t’s a basic truth: If you consume more caloriesthan you burn, you gain weight. But what,exactly, is a calorie? And are there any differ-ences among calories from different food sources?

“Calories represent the energy-producing poten-tial in food,” says California Pacific Medical Center

Registered Dietitian Trudy Theiss, M.S., R.D., CDE. “Theenergy released when your body metabolizes food fuels thegrowth and maintenance of body tissues, the conduction ofelectrical nerve impulses, the work of muscles during physi-cal activity and the heat production necessary to maintainbody temperature. If you take in more calories than requiredfor those body functions, your body stores the excess as fat.”

Cutting down on sugarTheiss notes that some calories are “better”than others.

“Better calories”come from nutrient-rich foods that containlots of vitamins and minerals.“In today’s diets, sugar, whichis not a nutrient-rich food, can make up a large part of the

daily calorie intake,”says Theiss.To cut down on sugar in children’s diets, Theiss sug-

gests limiting fruit juices, since they can contain as muchsugar as sodas. “Fresh fruit is always a better choice thanjuice because you get fewer calories, plus more fiber and

other nutrients,”she explains.

Fat in your child’s dietIn addition to monitoring sugar intake, parents should

be concerned about the number of calories from fats.“Fats are a necessary nutrient, but excess fat caloriesare quickly converted into body fat,” Theiss says.

INSIDE:

2 The Doctor Is In

3 Yoga and tai chi

4 Confronting healthcare disparities

6 California Pacific’scardiac team mendstiny hearts

7 Healthy eating habits begin early

INot All Calories Are Created EqualThe ones in nutrient-rich foods are best � An interview with Trudy Theiss, M.S., R.D., CDE

�ALL AGES

continued on page 5

2

Pacific, we are seeing an increase in manyhealth issues related to obesity, namely,a rise in childhood diabetes, sleep apnea,orthopedic problems and psychiatricissues. The obesity epidemic is particu-larly disturbing because overweight children often become obese adults,with problems such as diabetes, heartdisease and hypertension.

To combat the obesity epidemiclocally, California Pacific pediatriciansare establishing a pediatric obesity

program that will be unveiled later in 2006. This effort will target at-risk communities within San Francisco,providing them with convenient cliniclocations, community programs, anddiet and exercise classes. We will sharemore news about this program in afuture issue.

We hope this issue of HealthyKids givesyou some needed information and toolsto keep your family’s health in check!Please let us know of any pediatric healthquestions (see our “Doctor Is In” columnbelow), newsletter feedback or topicsuggestions. Our editorial contact infor-mation is provided at the back of thismagazine. We look forward to hearingfrom you! �

Obesity, a growing epidemic among children,

is poised to pass tobacco as America’s lead-

ing preventable killer. For children, the health risks

associated with obesity are serious. At California

Combating Childhood ObesityA Special Focus for HealthyKids � by David Tejeda, M.D., chair, Department of Pediatrics,

and Oded Herbsman, M.D., medical director, Pediatric Inpatient Services

Q: My son’s verbal skills are the leastdeveloped in his preschool class.

I’m not sure if it’s because he is theyoungest in the class, or the fact that he’sexposed to both English and Chinese athome. When should I be concernedabout his language development andhow do I pursue an assessment?

A: It is important to discuss yourconcerns with your child’s pedia-

trician. All children should routinelyhave developmental assessments, whichtypically occur at well-child visits. Usethese visits to discuss any issues relevantto your child’s age. There is a wide rangeof normal language development.Yourpediatrician will help determine if yourson’s speech is delayed. If so, referral fora hearing test or further evaluation maybe warranted. Learning two languages atthe same time may be a factor in mild,

transient delay in language development.However, it does not cause significantlanguage delay. Reading to your childdaily has a positive impact on languagedevelopment. �

The Doctor Is In Your child’s health questions answered � by David Tejeda, M.D., chair, Department of Pediatrics

Reading to your child

daily has a positive

impact on language

development.

www.cpmc.org

If you have a child’s healthquestion that you wantaddressed in a futureissue of HealthyKids,e-mail it to us at:bosquejp@sutterhealth.org,or visit www.cpmc.org/pediatrics. Due to spacelimitations, we cannotguarantee that all ques-tions will be answered.

Submit Your Question

California Pacific pedia-

tricians are establishing

a pediatric obesity

program that will be

unveiled later in 2006.

Yoga, which originated in India,engages participants in a series of pos-tures that promote strength, balance,flexibility and relaxation. Its regular usehas been reported to improve attentiondeficit disorder (ADD) and asthma, aswell as migraines and other pain prob-lems. Although very little research hasbeen done on its health benefits forchildren, yoga is generally a safe activitythat, at the very least, will help withrelaxation and stress reduction.

Finding a child’s yoga classSome adult yoga studios offer classes

specifically for kids, while others caterexclusively to children and may includeactivities such as dance or art classes.Children as young as 3 may be interestedin yoga; many of the postures are namedfor animals that children like to imitate.

Before registering your child, ask toobserve a class. Classes for smaller chil-dren may be geared toward having fun,while those for older kids and teens maybe quieter and more relaxing. A goodteacher can engage children of all ages.He or she will encourage correct posi-tioning and offer alternatives for childrenwho are less flexible. Children should betaught and reminded to respect and tunein to any pain they may feel. The lessonsin body awareness, as well as strength,balance and flexibility, will help childrenwith other activities as well.

Tai chi for childrenTai chi, also known as “meditation in

motion,” is an ancient form of Chinesemeditation that uses a series of slowmovements, with controlled breath, to

quiet the mind, relax the body andimprove balance. In Chinese medicine,tai chi is recommended to balance thebody’s organ systems and restore health.Health benefits are well-documented inadults, but again, little research has beendone in children. Classes for childrenwill generally be found at martial artsstudios. Look for teachers who instructwithout criticizing and encourage anoncompetitive atmosphere.

Yoga and tai chi are generally safe forhealthy children — including those withspecial needs — but, as with any exerciseprogram, consult your pediatrician beforeregistering your child in a class. While theresearch into these exercises for childrenis minimal, both clearly have advantagesin being noncompetitive and helping toestablish physical activity and mentalwellness habits that can last a lifetime. �

A s yoga and tai chi gain popularity among

adults for pain management and injury

prevention, many parents wonder if these

activities are also appropriate for children.

3www.cpmc.org

Yoga is generallya safe activity

that, at the veryleast, will helpwith relaxation

and stress reduction.

Yoga engages par-

ticipants in a series

of postures that

promote strength,

balance, flexibility

and relaxation.

Exercise for the Mind and Spirit, As Well As BodyYoga and tai chi offer exercise, relaxation � by Jennifer Cohen, M.D., pediatric hospitalist

�AGES 5-15

4

To confront this astonishing disparityand other instances of inadequatehealth care coverage for San Francisco’sAfrican American community, CaliforniaPacific Medical Center joined forcesthree years ago with all hospitals in the city to form the African AmericanHealth Disparity Project (AAHDP).

“Many African Americans in SanFrancisco live in communities that havebeen marginalized,”says Nadine Burke,M.D., MPH, a California Pacific pedia-trician with a master’s degree in publichealth.“San Francisco’s health careproviders have historically not done a

good job addressing the disparities in health care delivery for the AfricanAmerican community. For example,the rate of asthma hospitalization forchildren living in the Bayview district isroughly six to seven times that of chil-dren living in the Marina. One of ourgoals is to dramatically reduce the num-ber of preventable hospitalizations.”

Dr. Burke joined California Pacific asa direct result of the hospital’s involve-ment in the AAHDP. “This type of workis my dream — to create programs thathelp ensure all San Francisco childrenhave the opportunity to grow up healthy,

regardless of the neighborhood inwhich they live.”

One of Dr. Burke’s dream programsis about to become a reality whenCalifornia Pacific opens the BayviewChild Health Center at the Arthur H.Coleman Medical Center on 3rd Street.This center will offer such medical

Across the United States, the infant mortality rate among African_Americans is more than double the rate among the general

population, according to the Centers for Disease Control andPrevention. In San Francisco, the infant mortality rate for AfricanAmericans is four times the rate of the city’s general population.

Going “online”can expose young-sters to predators or cause them towaste hours in chat rooms. In addition,rising “screen time”can cost kids theexercise they need to keep fit.

“Activity levels are waning, due tochanges in [school] curricula, computertechnology and community resources,”says Carl Foster, Ph.D., president of theAmerican College of Sports Medicine.“As a result, our kids are getting fatterand may be the first generation not tohave a longer life expectancy than theirparents.”

Children and teens shouldget at least 60 minutes a day of physicalactivity, according to the 2005 dietaryguidelines from the U.S. Department of Agriculture and the Department ofHealth and Human Services.

How can you help? A lot of doctors say you should take

TVs and PCs out of kids’ rooms andlimit screen time to less than two hours a day. They also say you shouldencourage more exercise. This is a ter-rific opportunity to spend quality time

with your children by walking withyour kids a few nights a week aftersupper, for instance. Consider shuttingoff the weekend cartoons to do a familyactivity like bike riding, hiking orswimming.

“While your children may complainin the short term, they will be healthierand better developed people for havinga little less electronic input,”says Dr.Foster, a professor of sports science at

Television and video games have deprived children of outside play

for years. Now that most homes have a personal computer and

about a third of kids ages 8 to 18 have one in their room, health

experts have raised concerns about safety and inactivity. �AGES 5-15

Confronting African American HealthPutting kids’ needs first � An interview with Nadine Burke, M.D., MPH

Dr. Burke joined California Pacific as a direct

result of the hospital’s involvement in the

African American Health Disparity Project.

Get Your Kids to Log Off“Screen time” cuts into physical pastimes

www.cpmc.org

Children andteens should get at least

60 minutes a dayof physical

activity.

Dietary guidelinesfrom the U.S.

Department ofAgriculture and the

Department ofHealth and Human

Services

�ALL AGES

the University of Wisconsin–LaCrosse.“The key is to create something else

for them to do outside without beingoverbearing about it or orchestrating theplay. You may need to band togetherwith other parents and organize an after-school program to provide a safe venue.But kids, being kids, are plenty smartenough to think up fun things to do.”�

“We Can!” (National Heart, Lung,and Blood Institute):http://wecan.nhlbi.nih.govPC-Turnoff Organization:www.pcturnoff.orgAmerican College of Sports Medicine:www.acsm.orgNational Coalition for PromotingPhysical Activity: www.ncppa.orgPresident’s Council on PhysicalFitness and Sports: www.fitness.gov

To Learn More To help develop healthy eating patterns in children, Theiss offersseveral recommendations:

Be aware of what your children are eating at home and school.Limit consumption of sodas and processed or “fast” foods.Offer healthy choices of foods with low calorie density, andallow children to decide how much or whether to eat.Never force a child to “clean your plate.”Limit fat consumption to about 30 percent of total caloric intake.Avoid being overly restrictive about which foods children eat— the sense that some foods are “forbidden” may lead tounhealthy eating behaviors.Encourage children to eat foods that are high in water andfiber content, both of which help make them feel full longer.Try to have relaxed family meals and encourage children toeat more slowly and recognize when they are full.Make sure your children get plenty of exercise.For more guidance in developing a healthy diet for your children,

Theiss suggests consulting the Web site for the USDA’s food pyra-mid, www.mypyramid.gov, or an authoritative book such as Childof Mine, by registered dietitian and social worker Ellyn Satter. “If,in spite of your best efforts, you notice your child is gaining toomuch weight, be sure to consult your pediatrician,” she adds.

Tips for Staying Healthy

Disparities

www.cpmc.org 5

services as vaccinations, well-childexams and urgent-care visits, along withfollow-up and continuous care for long-term health problems. Families can alsoget referrals to medical specialists forproblems ranging from diabetes toasthma. To contact the Bayview ChildHealth Center, call 415-600-2460.

“We want to ensure that children getthe specialized care they need so thatthey don’t end up in the emergencyroom,”notes Dr. Burke, who will staffthe facility along with other CaliforniaPacific health care professionals.

The Center will accept all forms ofinsurance and help families enroll in var-ious city, state and federal medical cover-age programs.“Children in San Franciscoare universally insured through programssuch as Healthy Kids,” Dr. Burke explains.“Parents often aren’t aware of theresources available to them. We are committed to helping families protectthe health of their children.” �

Nadine Burke, M.D.,MPH, pediatrician,California PacificMedical Center

“We want toensure that

children get thespecialized care

they need.

”

Parents should be selective about thetype of fats their children consume, andlimit saturated and trans-fats as muchas possible. Remember, the lower the fatcontent, the bigger portion you get forthe same number of calories.”

Consumption of calorie-dense foodsand lack of adequate exercise are directlyrelated to the increasing rate of obesityamong children and teens in the UnitedStates, Theiss notes. Monitoring yourchildren’s diets to make sure they aren’ttaking in too many calories and encour-aging children to get plenty of exercise arekey to preventing childhood obesity. �

Not All Calories continued from page 1

Trudy Theiss, M.S.,R.D., CDE

“In today’s diets,sugar, which is

not a nutrient-richfood, can make

up a large part ofthe daily calorie

intake.

”

www.cpmc.org6

“Charlie was in the Well-Baby Nurserywhen we were informed that he lookedblue,” Sarah remembers.“They took himto the NICU for tests, where doctorsdetermined he had a closed valve in hisheart. Charlie was given a drug calledprostaglandin to keep open a communi-cation between his pulmonary artery andaorta. Without that drug, no blood couldget into the lungs, and the oxygenlevel in his circulatory systemcould not sustain life.

California Pacific MedicalCenter Pediatric Cardiologist NikolaTede, M.D. was one of the physicianswho immediately attended to Charlie inthe NICU.“Charlie had a murmur thatsounded louder than the normal transi-tional murmur of a newborn,”recalls Dr.Tede.“After performing an echocardio-gram [cardiac ultrasound], we quicklyconfirmed Charlie had pulmonary atresiawith an intact septum.”

Heart disease prevalent in newborns“Most people don’t realize how

prevalent heart disease is in newborns,”Dr. Tede continues.“Up to 1 percent ofall babies will have some form of con-genital heart defect, and most of theseproblems become apparent very shortlyafter birth.”

Shortly after his diagnosis, two-day-old Charlie Pinto underwent surgerywith Michael Black, M.D., chief ofCalifornia Pacific’s Division of PediatricHeart Surgery.“A newborn baby’s heartis so incredibly tiny that we have to use

the most minimally invasive procedurespossible,”notes Dr. Black.

During Charlie’s surgery, Dr. Black usedexceptionally small incisions and micro-scopic cameras to magnify and illuminatethe area surrounding Charlie’s heart.Then,Dr. Black used Charlie’s own tissue tocreate a new valve. Because of Charlie’syoung age, a portion of his initial defectwas left to promote growth. After his heartdeveloped further, Dr. Black used the sameincisions nine months later to completelyclose the hole in Charlie’s heart, leavinghim with normal circulation.

Minimally invasive surgery used for heart repairs

“Every child’s condition is different,”Dr. Black continues.“Because we havesuch a highly skilled cardiac team, aswell as the most leading-edge technolo-gies available, we are able to think cre-atively to develop unique strategies thatexceed treatment expectations.”

Charlie’s parents are extremely happy with the care Charlie received atCalifornia Pacific.“We never thought ofour situation as a tragedy,”says John.“Drs. Tede and Black were very positiveabout our options and were so willing to talk to us at length.”Sarah agrees,“There’s always hope, and the medicaladvancements now are amazing.”Evenbetter, though, is Charlie’s recovery. Now1 year old, Charlie is a charming little boywho is developing well and keeping hisparents busy chasing after him! �

Charlie Pinto with

mom Sarah (right)

and Pediatric

Cardiologist Nikola

Tede, M.D., nearly

one year following

his heart surgery.

After having a healthy second pregnancy anddelivering a beautiful baby boy one year ago,

San Francisco residents Sarah and John Pinto couldn’thave been happier.“My delivery was a piece of cakeand our son, Charlie, was perfect,” remembers Sarah.Within hours, though, Charlie’s life was at risk.

Mending Hearts Is Strength of California Pacific TeamThe Pinto family’s story � by Laura Miyashita

Michael Black, M.D.,chief, Division ofPediatric Heart

Surgery

“Because we have such ahighly skilled cardiac team,we are able tothink creatively.

”

�INFANTS

California Pacific MedicalCenter is a regional leaderin pediatric cardiovascularcare. To find out more about our pediatric ser-vices, visit our Web site atwww.cpmc.org/pediatricsor call our SpecialtyReferral Line at 888-637-2762.

For more information

7www.cpmc.org

“Introducing children to a wide vari-ety of foods at an early age helps develophealthy eating habits that will continuethrough the years,”says Sharon Meyer,CNC, a certified nutritionist at CaliforniaPacific Medical Center’s Institute forHealth & Healing. “One way to do thatis to involve your kids in cooking. Theywill be proud of the dishes they createand excited to eat them. It also enablesyou to educate your children as to wherevarious foods come from and what con-stitutes a healthy meal.”

For children, a healthy diet encom-passes more than just three meals a day.“It’s better for children to eat smallermeals, with healthy snacks betweenmeals,” Meyer says.

Children also require plenty of cal-cium, but it doesn’t have to come frommilk. “Studies have shown that absorp-tion of the calcium in cow’s milk isinferior to that of calcium from plantsources,” Meyer notes. She recommendsleafy green vegetables, cooked beansand peas, nuts, seeds and whole grains,

in addition to dairy sources of calcium.Meyer offers the following snack

ideas and a recipe to help ensure ahealthy diet.

Snack ideas:Trail mix: pecans, walnuts, almonds,cashews, soy nuts, raisins, dried cran-berries. Note: Avoid giving nuts andraisins to toddlers under 2, and superviseolder toddlers when they eat these foods,as they can present a choking hazard.Plain yogurt with 1 teaspoon honeyand fresh or thawed frozen fruit (ifnot lactose intolerant). Note: Do notgive honey to children under age 1.String cheeseHummus with carrots, steamed broc-coli, red peppers or jicamaSweet potato chips:— Slice sweet potatoes thinly.— Lay on a baking sheet; sprinkle

with olive oil, salt and pepper.— Bake at 375 degrees until crisp.— Serve plain or with hummus or

guacamole.Fruit �

Involving your kids

in cooking enables

you to educate your

children as to where

various foods come

from and what con-

stitutes a healthy

meal.

Getting children to eat a healthy diet with agood balance of nutrients isn’t always easy.

There is hope, however, for every parent who hashad to contend with a picky eater who refuses to touch those “icky”green beans.

Healthy Family RecipesGood habits begin early � An interview with Sharon Meyer, CNC

“Introducing

children to a widevariety of foods at an early agehelps develophealthy eatinghabits that will

continue throughthe years.

”Sharon Meyer, CNC,certified nutritionist,

California PacificMedical Center

Institute for Health& Healing

�ALL AGES

1 can tuna or salmon1/4 cup minced green onions1 celery stalk, chopped1 tsp. lemon juice1 tbsp. olive oil1 tbsp. chopped fresh parsley1/4 tbsp. Dijon mustardsalt and pepper2 whole-wheat tortillasMix all ingredients in a bowl. Spoon the mixture onto the tortillasand wrap.

Tuna or Salmon Salad Wraps

Visit www.cpmc.org/pediatrics for more nutritious recipes.

To Learn More

www.cpmc.org

Nearly 3 million cases of suspectedabuse and neglect are reported in theUnited States each year. The NationalAssociation for Children’s Hospitals andRelated Institutions (NACHRI) and itsmembers, such as California PacificMedical Center, are leaders in providingmedical care to abused and neglectedchildren. They teach coping skills to dealwith the frustration and anger that everyparent feels at one time or another whilechild-rearing. Hospitals dedicated to thecare of children and their families alsoprovide parenting classes, fact sheets,

support groups and other resources toguide parents through the stresses ofraising children.

Worried that a child you know or see in a public place is being maltreated?Child-focused hospitals and medicalproviders can help connect you to anappropriate community resource whereyou can anonymously report your concerns.

Some parents worry that if their children are injured accidentally, notthrough abuse, they will be suspected ofchild abuse if they bring them to a hos-pital. That’s why child-focused hospitalsare working together to weave a seam-less, timely and effective system ofabuse response that helps protect inno-cent parents and provides necessarymedical care and emotional healing tothe nation’s most vulnerable children.

Working with hospital leaders,pediatricians and allied organizations,NACHRI developed a guide to theestablishment, development andenhancement of child abuse serviceswithin child-focused hospitals. Theseguidelines are helping the communityof child-focused hospitals provide thehighest level of quality care possible toabused and neglected children. �

Child-Focused Hospitals Lead ChildAbuse Treatment and Prevention EffortsM ost parents don’t want to hurt their children

intentionally. But the stress of an infant who

won’t stop crying or the daily struggles of caring for

a child with special needs can overwhelm even the

most loving parents. Whether you are struggling to

build positive discipline skills or have seen another

parent or caretaker abuse a child but don’t know

what to do,your children’s medical provider can help.

Non-Profit Organization U.S. Postage

PAIDPermit No. 1741San Francisco, CA

California Pacific Medical CenterDepartment of PediatricsP.O. Box 7999San Francisco, California 94120-7999

Return Service Requested

Articles in this newsletter are written by professional journalists or physicians who strive to present reliable, up-to-date information. But no publication can replace the care and advice of medical professionals, and readers are cautioned to seek suchhelp for personal problems. ©2006 StayWell Custom Communications, 780 Township Line Road, Yardley, PA 19067, 267-685-2800. Some images in this publication may be provided by ©2006 PhotoDisc, Inc. All models used for illustrative purposesonly. Some illustrations in this publication may be provided by ©2006 The StayWell Company; all rights reserved. (206)

NN AA CC HH RR IINational Association of Children’sHospitals and Related Institutionswww.childrenshospitals.net

California Pacific MedicalCenter is an associatemember of NACHRI.For more information on this organization and its efforts to preventand treat child abuse and neglect, visit www.childrenshospitals.netand select “ChildAdvocacy.” CaliforniaPacific Medical Centeroffers a PostpartumDepression Support Group through NewbornConnections. Call 415-600-BABY for details.To view other resources,visit www.cpmc.org orask your child’s healthcare provider.

To Learn More

For Q&A contributions or to opt out of this mailing, please contact John Bosque atbosquejp@sutterhealth.org or 415-600-2991.

Editorial TeamJennifer Cohen, M.D.Oded Herbsman, M.D.Steve Martel, M.D.Laura MiyashitaTim Nicholls, M.D.David Tejeda, M.D.

Contributing WriterSusie Caragol