Misconceptions about Miscarriage

Many women suffer silently, a cycle that leads to further misconceptions and isolation. Below, NPR talks to women about their personal experiences & challenges, along with the medical facts:

Most people think a miscarriage is rare, and many believe that if a woman loses a pregnancy that she brought it upon herself. Neither of those things is true, but the enduring beliefs cause great pain to women and their partners.

In fact, almost half of people who have experienced a miscarriage or whose partner has had one feel guilty, according to a survey to be published Monday in Obstetrics & Gynecology. More than a quarter of them felt shame. Many felt they’d lost a child.

When NPR asked visitors to its Facebook page to tell us what they wished people knew about miscarriage, the response was overwhelming — 200 emails and counting, many heartbreaking. Their sentiments often echoed what the survey found.

“I wish people knew how much it’s possible to miss a person you have never met, and to mark time by their absence,” wrote one woman. “I will always think about how old my baby would be now and what our lives would be like if I hadn’t lost the pregnancy.”

The survey came about after Dr. Zev Williams realized that many of his patients had misconceptions about miscarriage. “I’d tell them how common a miscarriage was, and they seemed shocked,” says Williams, an OB-GYN who directs the Program for Early and Recurrent Pregnancy Loss at Einstein College of Medicine of Yeshiva University and Montefiore Medical Center in New York.
In fact, between 15 percent and 20 percent of clinically recognized pregnancies end in miscarriage, defined as a pregnancy loss earlier than 20 weeks of gestation. (Pregnancy loss after that point is called a stillbirth.) Miscarriage is actually “by far the most common complication of pregnancy,” says Williams. He and his colleagues wanted to find out how widespread some of the mistaken beliefs about miscarriage are.

They asked 1,084 adults about miscarriage and its causes. They also asked the 15 percent of survey respondents who had suffered a miscarriage, or whose partner had, about their experience. The results echoed what he’d seen in his patients: Some 55 percent of all respondents believed that miscarriage occurred in 5 percent or less of all pregnancies.

The cultural silence around miscarriage contributes to those misunderstandings, Williams says. “A lot of other conditions that people used to speak of only in hushed tones, like cancer and AIDS, we speak about a lot more,” he says.

Not so for miscarriage. Because early pregnancy loss is so common, women are often advised not to share their pregnancy news with friends and family until the start of the second trimester. At that point the chance of miscarriage has drastically declined. But that secrecy means women who do miscarry in the first trimester may not get the support they need, Williams says.

“It’s bizarre that the topic is so taboo,” wrote one reader on Facebook. “I really feel an obligation now, having had a miscarriage, to mention my miscarriage when I’m talking about fertility or the process of conceiving or childbirth.” She added a sentiment that many other women expressed: “I felt alone until I realized there is this big, secret miscarriage club — one that nobody wants to be a member of — and when I realized it existed, I felt angry that no one told me they had active membership.”

Chromosomal abnormalities in the fetus cause 60 percent of miscarriages. A handful of other medical conditions are also known to cause miscarriage. Most survey respondents knew that genetic or medical problems were the most common cause of early pregnancy loss. But they also mistakenly believed that other factors could trigger a miscarriage: a stressful event (76 percent); lifting something heavy (64 percent); previous use of contraception like an IUD (28 percent) or birth control pills (22 percent); and even an argument (21 percent). Some 22 percent believed that lifestyle choices, like using drugs, tobacco or alcohol, were the single biggest cause of miscarriages. That’s not true.

Those who shared their experiences with NPR said many of those myths were repeated back to them by friends, family or colleagues after their own miscarriages. One said someone blamed her high heels. That kind of talk can be incredibly painful, even if you know you have the facts on your side.

“I wish people understood that miscarriages are the flip side of the coin,” wrote one woman. “If you’ve had a healthy pregnancy that went full term — you won a lottery. Short of obvious substance abuse and bull riding — your healthy baby is not the result of anything you did or didn’t do. As much as you want to think you are in control — you aren’t. And the same goes when I lost each pregnancy — as much as I wish I could have been — it was not in my control.”

The feelings of guilt, shame and enormous loss reported in the survey were a common theme among those who told their stories to NPR. “I felt, and feel, literally broken, and betrayed by my body,” wrote one woman. “It’s irrational, but there is such a deep shame attached to not being able to carry a baby to term…. I don’t want another baby, I want THIS baby, the one I thought I would have, the one I started planning for, hoping for, dreaming about, talking to. All that got taken away from me.”

Not everyone was so deeply affected; some said the miscarriage came as a relief, either because the pregnancy was unwanted, or because they’d known something wasn’t quite right. Or they said it was painful at the time, but that they’d moved on and weren’t particularly haunted by the loss. “You have every right to feel ALL of your emotions you have,” wrote one person. “Whether you feel grief or relief, your emotions are never wrong.”

But because the loss can be so great, people said they wished others would acknowledge a miscarriage without reverting to a laundry list of well-intentioned but hurtful lines: “Well, at least you know you can get pregnant.” (One reader said this was particularly upsetting after her seventh miscarriage.) “You can always try again.” “If you adopt, you’ll get pregnant.” “It happens for a reason.” “It’s God’s plan.” (That, wrote another reader, sounds an awful lot like “God doesn’t want you to be a parent.”)

Far better, people said, is to simply say, “I’m sorry. Is there anything I can do for you?”

Over and over again, we heard a wish that there was more private and public discussion of miscarriage. “Many women in my family had suffered one or more, and I had no idea until I had one myself,” wrote one woman. “I felt that no one I knew had gone through this.”

Several readers said this code of silence was even stronger for the partners of women who miscarry. One reader wrote that her husband “had hopes and dreams and fears and so much joy tied up into 9.5 weeks of cells,” but he didn’t get time off work, flowers or well-wishes from colleagues or visits from friends to “listen to him cry,” as she did. Instead, “He had to suffer alone.”

The new survey found that 46 percent of respondents who’d miscarried said they felt less alone when friends talked about their own miscarriages. Even a celebrity’s disclosure of miscarriage helped.

One person who recently suffered a miscarriage summed it up: “While I’m definitely still healing emotionally, I would be happy to talk more about it. So many people grieve silently, but I’ve found that talking really helps the most.”

That’s the kind of conversation that Williams says he and his co-authors would like to spark with their survey. “Miscarriage is ancient. It’s always been there.” And all too often, he says, “people often blame themselves and don’t discuss it.”



Alzheimer’s Disease – Common Questions

1. What is the difference between dementia and Alzheimer’s disease?

“Dementia” and “Alzheimer’s disease” are often used interchangeably, but they are different. “Dementia” is an umbrella term for a variety of diseases and conditions that develop when nerve cells in the brain no longer function properly. Symptoms of dementia include changes in one’s behavior or judgment, memory, and ability to plan activities and finish tasks.

Alzheimer’s disease is the most common type of dementia, at 60-80%. With Alzheimer’s disease, changes in the brain eventually affect basic bodily functions such as walking and swallowing.

There are over 100 types of dementia. After Alzheimer’s disease, the most common form is vascular dementia from tiny, almost imperceptible strokes, at up to 20%.

Some researchers believe that up to 45% of dementias are “mixed dementia”—Alzheimer’s disease plus another dementia.

Other types of dementia include dementia from Parkinson’s disease, Frontotemporal dementia, and Lewy Body dementia. “Early onset” (or “Familial” Alzheimer’s disease) occurs before age 60, and comprises 5-7% of Alzheimer’s disease cases.

2. Is there a test to diagnose Alzheimer’s disease?
No tests exist to confirm a diagnosis of Alzheimer’s disease. However, doctors can diagnose “probable Alzheimer’s disease” with 90% accuracy with neuropsychological testing and by ruling out other causes of memory problems and cognitive decline. A medical history can rule out depression; lab work can rule out urinary infection, thyroid dysfunction, and vitamin deficiencies; and a CT scan and MRI can rule out strokes, trauma and tumors.

A new PET scan is available in some memory care clinics, in which an intravenous injection of florbetapir, a radioactive drug approved by the Food and Drug Administration in April 2012, binds to amyloid plaques, a protein most researchers think plays a role in Alzheimer’s disease. Amyloid PET scans show plaques on 96% of people with severe Alzheimer’s disease and two-thirds of those with mild cognitive impairment. Researchers caution that one-third of people aged 65 and over exhibiting normal cognition also show amyloid plaques on these PET scans—and they may never develop Alzheimer’s disease. That’s a large false-positive rate. And at this time, Medicare does not cover the test, which costs several thousand dollars.

3. If there is no cure for Alzheimer’s, why is early diagnosis a good idea?
If you suspect that you or a loved one are showing signs of cognitive decline, there are a number of reasons why early detection and diagnosis are important:

The cognitive decline may be caused by something treatable, such as depression or a vitamin B12 deficiency, and early diagnosis prevents further decline;
It’s important to discuss the diagnosis with family members and begin the search for appropriate support services;
Such a discussion reduces anxiety by naming the problem;
Medication and other approaches may be used to manage symptoms;
Early diagnosis gives people the option of joining clinical trials;
It allows more awareness of how some combinations of medications make symptoms worse;
It alerts doctors and family members to the possibility that the person may need assistance with daily tasks such as cooking and managing medications;
It may reduce falls and other accidents because caregivers are more aware of the dangers;
It allows an awareness of financial problems such as the person giving money to scams;
It allows the person with dementia and their family members to plan for the future.

It’s important to note that under the Affordable Care Act, anyone with Medicare Part B is eligible for an annual wellness visit that includes a cognitive assessment, an evaluation of risk factors for diseases such as Alzheimer’s, and recommendations for referrals to programs to help reduce those risk factors (such as seeing a nutritionist or joining a smoking cessation program). This annual visit is fully covered with no deductible, co-insurance, or co-payment.

4. Is Alzheimer’s hereditary?
In Familial (early-onset) Alzheimer’s (5-7% of Alzheimer’s cases), gene mutations cause a cascade of effects in the brain leading to increased amyloid, a protein that many researchers believe plays a role in the development of Alzheimer’s disease. If one parent carries the mutated gene, the child has a 50% chance of developing the disease; if both parents carry the gene, the risk increases to 75% percent.

In Alzheimer’s disease over age sixty, there is something called a “risk factor” gene—APOE ε4 allele. This gene increases your risk somewhat if you inherit it from your parents. According to the National Institute on Aging, “Some people with one or two APOEε4 alleles never get the disease, and others who develop Alzheimer’s do not have any APOEε4 alleles.” For that reason a blood test for the allele is not recommended for people at risk for Alzheimer’s disease.

Some studies suggest that you are more likely to develop Alzheimer’s disease if you mother had it.

5. Is there any way I can reduce my risk of developing dementia?
There are no proven ways to prevent Alzheimer’s disease, the most common type of dementia. Take heart, however. Research suggests many ways you may be able to reduce your risk.

Some researchers say that exercise may be our most powerful antidote for dementia. The Alzheimer’s Association recommends 30 minutes of daily exercise. A study by neurologists at Rush University Medical Center shows that daily activity of all kinds—from formal exercise to activities such as washing dishes, cleaning, and cooking—may reduce the risk of developing Alzheimer’s disease, even in people over age 80. In another study, subjects who walked forty minutes a day for a year regained volume in their hippocampus, reversing brain shrinkage. In a third study, people with mild cognitive impairment who did resistance weight training two times a week over six months showed an increase in their memory and executive function (the ability to multi-task).

If you can, try to avoid the most common risk factors for Alzheimers. In addition to factors you can’t control, such as a family history of Alzheimer’s, these risk factors include serious head trauma; poor cardiovascular health; high blood pressure; stroke; diabetes; high cholesterol; obesity in middle age; and smoking. To that list I’d add two lesser-known risk factors: sleep apnea and high blood sugar levels. Both sleep apnea and pre-diabetes (blood sugar levels that are normal but high) are woefully under-diagnosed, so if you suspect that you have either, please get tested. Both conditions affect the health of your brain.

As far as diet is concerned, there is little agreement on what exactly will help prevent dementia, though doctors say that what is good for the body is good for the brain. And no dietary supplements have been proven to reduce the risk of dementia, though there is anecdotal evidence that coconut oil may be helpful.

Social activity and mental stimulation are crucial. Combining social activity and mental stimulation with regular exercise is more effective than doing only one or the other. Sports, cultural activities, emotional support, and close personal relationships are all key.


Picky Eaters – When to Worry?

By PERRI KLASS, M.D. OCT. 10, 2016

The New York Times

I saw one of the white-food kids a couple of weeks ago — a 9-year-old boy who lives on French fries, chicken fingers, white rice and white bread. Some white-food kids are so strict that their parents have to warn the restaurant that if there’s a little ceremonial dusting of parsley on the French fries, the child won’t eat them.

My patient’s mother was despairing: He won’t touch a vegetable, she said. He isn’t getting any healthy food at all. Some picky eaters are scrawny, but this one was chunky. In fact, it’s surprising to me how often a parent tells me, if I express some concern about the rapid rate of weight gain, that the child hardly eats anything, the child has no appetite, the child is incredibly, heartbreakingly, picky. And though I could tell you a perfectly true story about a mother who said just that as her child sat in the exam room, munching his way through a large bag of pizza-flavored Doritos, the truth is that it can be genuinely painful for parents to watch their children refuse food, and worry that they are somehow failing to provide the necessary vitamins, protein and vegetables.

People are often pretty judgmental about picky eaters, disapproving strongly of the children themselves (“So unadventurous, so fearful of new tastes!”); of their parents (“Don’t they know it’s their responsibility to make the rules!”); and, inevitably, of our degenerate and too-permissive times (“Why, when I was a child, we ate what was put in front of us, and no nonsense!”).

Dr. Natalie Muth, a pediatrician in Vista, Calif., near San Diego, who is also a registered dietitian and the co-author with Sally Sampson of “The Picky Eater Project,” to be published by the American Academy of Pediatrics next month, told me that it’s important to expose children to different flavors even through what the mother eats during pregnancy and breast-feeding. (The techniques used in the book were explained in more detail last year in a series of posts on the Motherlode blog.)

She said many children become comparatively picky around the age of 2, so it’s important to expose younger children to many foods, many times. They are more open to trying new things in that first year of eating solid foods, between 6 and 18 months, and multiple exposures help them learn to like different flavors.

“I talk about training your taste buds; it can take a lot of tries to like something,” Dr. Muth said. “You don’t even have to chew and swallow, just take it on your tongue.”

And that 2-year-old who may be developmentally more neophobic — nervous about new things — also is developmentally ready for all the struggles of separation and independence. “We’re all born liking sweet and salty, and a 2-year-old is no exception,” said Dr. Muth. “But also, a 2-year-old is trying to assert himself.”

When those struggles persist around food, and parents find themselves faced with that picky eater, the idea is to go on offering foods, go on encouraging repeated tastes, go on letting the child see other family members eat different foods — to do all that but to let the child make the actual decisions about what to eat. “There’s a division of responsibility, which was first described by the dietitian Ellyn Satter,” Dr. Muth said, “parents choosing what’s offered and when, the child choosing what to eat of what’s offered.”

As a pediatrician, I worry when children don’t gain weight — or sometimes, when they gain too much, like some white-food eaters. We start with the assumption that picky eaters are just picky, and studies have shown that while they may not eat many vegetables, they generally take in about the same amount of food as other children.

Parents may find it helpful — and reassuring — to give multivitamins to children whose diets are very limited, even as they are encouraging them to expand their range.

“A hungry child will eventually eat,” Dr. Muth said. “Your best shot is having your child hungry at mealtimes when there is a variety of food.”

And though it can be a long process, Dr. Muth says, she encourages parents to keep trying, and not to give way to the temptation to create parallel meals. “One family, one meal,” she said. “Maybe include something that your child will eat, but don’t cater to the picky preference by making a second meal or making some alternative always available.”

The child will either come around or else learn to cook, she said, and children who do learn to cook have been shown to be more interested in trying new foods.

This can be a long process, and very distressing for parents; pediatricians can help make sure that the child is, in fact, growing normally, and help address the question of whether something else might be going on.

In those rare cases when a child doesn’t grow properly, you have to consider more serious issues, from food allergies and GI problems to autism and other developmental issues.

I have a pediatrician friend whose own baby wouldn’t eat. He did fine on breast milk and formula, but when it came time to make the transition to solid foods, he just didn’t seem to have any appetite. It was impossible to get food into him, and his growth failure was significant enough that his pediatrician began diagnostic tests for some of the many possible syndromes and chronic illnesses that can cause what we call failure to thrive.

The child was also slow to start talking, and it was his speech therapist who suggested that there might be a connection to his difficulties with eating. He needed specialized occupational therapy to help his mouth do its various jobs; when he got better at chewing and swallowing, he began to gain weight and grow.

But most children don’t have a serious medical problem. Yet despite a parent’s best efforts to offer a variety of foods, some children are pretty resistant. I know that the mother of that 9-year-old in my exam room thought that she was failing her son, and she probably worried that I was judging her for his weight gain, and for giving him all that white food, which was the only food he would eat.
Those were not the messages I intended to send, but the emotional overtones of eating and feeding continue to be powerful for parents, as their children grow up. We feel directly responsible for what our children eat — and what they don’t eat — but the negotiations around autonomy and responsibility are more complicated than that.

“It’s not a lost cause,” Dr. Muth said. “We can help kids be more healthy and adventurous eaters, but it takes time.”

Vaccine Side Effects – the Facts

What about serious side effects? How often do they occur, and should you worry about them? This is an issue that has been studied repeatedly and intensively. Here are some facts that should help put your mind at ease.

Yes, there are reports of serious side effects that have been blamed on vaccines. But proving that the vaccine caused these side effects is often hard to do. In many cases, children simply develop illnesses around the time they’ve received a vaccine, and the immunizations get blamed unfairly. Don’t forget that infants and children are given vaccinations at a time in life when certain health conditions begin and become apparent to both parent and doctor. In most cases, the evidence just isn’t there to support a cause-and-effect link with vaccines.

That’s the case with the myth linking the diphtheria-tetanus-pertussis (DTP) vaccine with sudden infant death syndrome (SIDS). The first dose of the vaccine is administered when a baby is 2 months old, which coincides with the time of life when the risk of SIDS is highest. Thus, you would expect some SIDS deaths to occur in this age group, whether children receive the immunization. In fact, a number of studies dating back to the 1980s looked at the incidence of SIDS deaths occurring at the time of the DTP vaccine. The researchers concluded that the number of deaths was at a level about equal to the number that would be expected to take place by chance. In short, there just isn’t any scientific evidence linking the vaccine with SIDS. Even so, many of the myths surrounding vaccines seem to have a life of their own. Below, you’ll find a description of some of these unfounded claims, as well as a look at what the scientific evidence shows.

Measles-Mumps-Rubella Vaccine and Autism
Autism is made up of many chronic developmental disorders and is often first diagnosed in toddlers. The number of cases of autism is reportedly on the rise, and some critics insist that the measles-mumps-rubella (MMR) vaccine is to blame. Others say the increase can be attributed to better reporting of autism cases by doctors. In 2001 and again in 2004, the Institute of Medicine (IOM) Immunization Safety Review Committee, an independent body of experts who have no conflict of interest with pharmaceutical companies or organizations that make vaccine recommendations, studied a possible MMR-autism link and found no evidence supporting such a connection. A panel of experts brought together by the AAP reached the same conclusion. Most of the authors of the original study linking MMR to autism have retracted their support of the study.

Risks of Thimerosal?
Since the 1930s, some vaccines have included a mercury-containing preservative called thimerosal. It has been used as an additive to vaccines because of its ability to prevent contamination by bacteria or fungi. Critics have argued that thimerosal-containing vaccines are the cause of a number of neurologic and developmental disorders, ranging from autism to attention-deficit/hyperactivity disorder and speech and language delays. The IOM safety committee studied this issue and concluded that the evidence favors rejection of a causal relationship between thimerosal-containing vaccines and autism. Since the end of 2001, most of the vaccines recommended by the AAP are available in thimerosal-free formulations. Some vaccines, such as the MMR, polio, and chickenpox vaccines, have never contained thimerosal.

Multiple Immunizations and Immune Disorders
Because some immunizations are given together, parents are often concerned that multiple vaccines might trigger health problems associated with the immune system. Can they increase your child’s risk of infections? Can they lead to the development of type 1 diabetes or various allergic diseases including asthma? After looking at this issue, the IOM committee concluded that there is no evidence of a cause-and-effect relationship between multiple immunizations and a greater risk of infections and/or type 1 diabetes. As for a link with asthma and other allergic disorders, there simply isn’t enough evidence to either accept or reject a connection with multiple vaccinations given together.

Hepatitis B Vaccines and Multiple Sclerosis
Although critics have claimed that hepatitis B immunizations can cause or trigger a relapse of multiple sclerosis, the IOM safety committee could find no scientific support for this theory. The same report also concluded that there is no evidence that the hepatitis B vaccine causes other types of nervous system problems, including Guillain-Barre

Why are preservative ingredients in vaccines?

Each ingredient has a specific function in a vaccine. These ingredients have been studied and are safe for humans in the amount used in vaccines. This amount is much less than children encounter in their environment, food and water.

Aluminum salts – Aluminum salts help your body create a better immune response to vaccines. Aluminum salts are necessary to make some of the vaccines we use more effective. Without an adjuvant like aluminum, people could need more doses of shots to be protected. Everyone is exposed to aluminum because there is much aluminum in the earth’s crust. It’s present in our food, air and water, including breast milk and formula. The amount of aluminum in vaccines is similar to that found in 33 ounces of infant formula. Aluminum has been used and studied in vaccines for 75 years and is safe.

Formaldehyde – Formaldehyde is used to detoxify diphtheria and tetanus toxins or to inactivate a virus. The tiny amount which may be left in these vaccines is safe. Vaccines are not the only source of formaldehyde your baby is exposed to. Formaldehyde is also in products like paper towels, mascara and carpeting. Our bodies normally have formaldehyde in the blood stream and at levels higher than in vaccines.

Antibiotics – Antibiotics, such as neomycin, are present in some vaccines to prevent bacterial contamination when the vaccine is made. Trace amounts of antibiotics in vaccines rarely, if ever, cause allergic reactions.

Egg protein – Influenza and yellow fever vaccines are produced in eggs, so egg proteins are present in the final product and can cause allergic reaction. Measles and mumps vaccines are made in chick embryo cells in culture, not in eggs. The much smaller amount of remaining egg proteins found in the MMR (measles, mumps, rubella) vaccine does not usually cause a reaction in egg allergic children.

For more info on vaccine studies visit the AAP’s Healthy Children vaccine research page.


Dental Health – Fluoride & Children

FAQ: Fluoride and Children

Fluoride from drinking water and other sources such as toothpaste can strengthen tooth enamel and help prevent tooth decay. Below is a list of questions that parents frequently ask about fluoride and how it can help their children.

Q: Why do children need fluoride?
A: Fluoride is an important mineral for all children. Bacteria in the mouth combine with sugars and produce acid that can harm tooth enamel and damage teeth. Fluoride protects teeth from acid damage and helps reverse early signs of decay. Make sure your children are drinking plenty of water and brushing with toothpaste that has fluoride in it.

Q: Is fluoridated water safe for my children?
A: Yes. The American Academy of Pediatrics (AAP), along with the American Dental Association (ADA) and the Centers for Disease Control and Prevention (CDC), agree that water fluoridation is a safe and effective way to prevent tooth decay.

Q: Should I mix infant formula with fluoridated water?
A: According to the ADA, it is safe to use fluoridated water to mix infant formula. The risk if mixing infant formula with fluoridated water is mild fluorosis. However, if you have concerns about this, talk with your pediatrician or dentist.

Q: What if I prefer not to use fluoridated water for infant formula?
A: If you prefer not to use fluoridated water with formula, you can:

Breastfeed your baby.
Use bottled or purified water that has no fluoride with the formula.
Use ready-to-feed formula that does not need water to be added.
Q: What if we live in a community where the water is not fluoridated? What can we do?
A: Check with your local water utility agency to find out if your water has fluoride in it. If it doesn’t, ask your pediatrician or dentist if your child is at HIGH risk for dental caries (also known as tooth decay or a cavity). He or she may recommend you buy fluoridated water or give you a prescription for fluoride drops or tablets for your child.

Q: How else can my child get fluoride?
A: There are many sources of fluoride. Fluoridated water and toothpaste are the most common. It is also found in many foods and beverages. So making sure your child eats a balanced diet with plenty of calcium and vitamin D is a great way to keep teeth healthy. Your dentist or pediatrician may also recommend a topical fluoride treatment during well child or dental visits at various stages of your child’s development.

Q: When should my child start using fluoride toothpaste?
A: The AAP and the ADA recommend using a “smear” of toothpaste on children once the first tooth appears and until your child is 3. Once your child has turned 3, a pea-sized amount can be used.

Q: What is dental fluorosis and will fluoridated water mixed with infant formula increase the risk?
A: Although using fluoridated water to prepare infant formula might increase the risk of dental fluorosis, most cases are mild.

Fluorosis usually appears as very faint white streaks on the teeth. Often it is only noticeable by a dental expert during an exam. Mild fluorosis is not painful and does not affect the function or health of the teeth.

Once your child’s adult teeth come in (usually around age 8), the risk of developing fluorosis is over.


Breast Cancer – FAQs on Screening

October is Breast Cancer Awareness Month – get answers to some FAQs and latest screening guidelines below:

American Cancer Society

1. What is new with the guideline? How does it differ from previous ACS guidelines?

The biggest change to the guideline is that we now recommend that women at average risk for breast cancer start annual screening with mammograms at age 45, instead of age 40, which was the starting age in our previous guideline. Now, women ages 40 to 44 can choose to begin getting mammograms yearly if they want to.

In addition, the new guideline says that women should transition to screening every two years starting at age 55, but can also choose to continue screening annually.

The ACS is also no longer recommending a clinical breast exam (CBE) as a screening method for women in the U.S. Breast self-exam is also no longer recommended as an option for women of any age.

2. This guideline is for women at average risk for breast cancer, but how do I know if I am at average risk?

The best way to determine if you are at average or high risk for breast cancer is to talk with your health care provider about your family history and your personal medical history. In general, women at high risk for breast cancer include women with a family history of breast cancer in a first degree relative (mother, sister, or daughter), women with an inherited gene mutation, and women with a personal history of breast cancer. Learn more about breast cancer risk factors.


3. What exactly should a woman do at age 40? Should she get screened or not? How should she decide?

The risk of breast cancer is lower in women between the ages of 40 to 44. Still, some women will choose to accept the greater chance of a false-positive finding and the harms that could come from that (biopsy pain and anxiety, for instance) as a reasonable tradeoff for potentially finding cancer. The decision about whether to begin screening before age 45 is one that a woman should make with her health care provider.

4. Why can women choose to start screening every two years at age 55?

Although breast cancer is more common in older women, after menopause, breast cancer grows more slowly in most women, and is easier to detect early because the breasts are less dense. Since most women are post-menopausal by age 55, and because the evidence did not reveal a statistical advantage to annual screening in post-menopausal women, the guidelines committee concluded that women should move to screening every two years beginning at age 55. Still, the guideline says women may choose to continue screening every year after age 55 based on their preferences.

5. Why is a clinical breast exam (CBE) no longer recommended?

Clinical breast examination (CBE) is a physical exam done by a health professional. During the beginning of the mammography era, the combination of CBE and mammography was associated with a lower risk of dying from breast cancer, and CBE was shown to offer an independent contribution to breast cancer detection. Since then, as mammography has improved and women’s awareness and response to breast symptoms has increased, the few studies that exist suggest that CBE contributes very little to early breast cancer detection in settings where mammography screening is available and awareness is high.

In addition, there was moderate evidence that doing CBE along with mammography increases the rate of false positives. Based on this information, the new guideline does not recommend CBE for U.S. women at any age.


6. What are the limitations of mammography and why is it important for women know about them?

Mammography is the best test we have at this time to find breast cancer early, but it has known limitations — it will find most, but not all, breast cancers. The Society supports informing women about the limitations of mammography so they will have reasonable expectations about its accuracy and usefulness. Studies show that informing women of the limitations of mammography before they have one decreases anxiety and improves later adherence with screening recommendations.

The accuracy of mammography improves as women age – thus, accuracy is slightly better for women in their 50s than women in their 40s and slightly better for women in their 60s than women in their 50s, and so on. However, a woman undergoing breast cancer screening needs to know that mammography at any age is not 100% accurate. Overall, mammography will detect about 85% of breast cancers.

Women also need to be prepared for the possibility of being called back for additional testing, even though most women who get further testing do not have breast cancer. On average, about 10% of women are recalled for further evaluation, including additional mammography and/or ultrasound, and sometimes a biopsy to determine if cancer is present.

Women also need to know that if their mammogram result is normal, but they detect a symptom months later before their next mammogram, they should see a doctor right away.

7. What about women who are at higher risk?

The Society has separate recommendations for women at increased risk for breast cancer, which are also being updated.



8. What about screening women in their 30s and younger? They get breast cancer, too. Doesn’t ACS care about that?

Cases of breast cancer in women who are in their 30s are rare, but that doesn’t make them any less tragic or important. The reason why none of the major guidelines recommend routine screening in this younger age group is because the evidence so far shows that the risk of harms such as false positive, additional procedures, and potential overdiagnosis outweighs the potential benefits, and routine screening for women in their 30s or younger doesn’t reduce deaths from cancer. The bottom line is that you can and should talk to your doctor about any concerns you have with your breast health at any age.


‘Mindful’ Eating – Promoting Healthy Habits in Kids

How schools are using ‘mindful eating’ to help prevent eating disorders

By Juli Fraga
At Waddell Language Academy, a K-8 School in North Carolina, Monica Mitchell-Giraudo, a French immersion middle school teacher, instructs 19 sixth-graders to gather into a circle.

“Okay, everyone, let’s take a few mindful breaths, and think about our gratitude for Amy, who brought us apples for snack today,” says Mitchell-Giraudo. “As you take these breaths, try to tune into your body. What sensations do you notice?”

“I notice my stomach is already growling,” chuckles Ben.

“My mouth is watering,” exclaims David.

Another student follows David and then another until each child has had their turn. After each of her student’s observations, Mitchell-Giraudo rings her Tibetan meditation bell. Each time the children remain still, despite the loud chimes.

Next, she instructs her students to hold and examine the apples. First, they pick up the fruit and roll it between their fingertips. Then, on her suggestion, they bring the apples to their noses, using their sense of smell to savor the flowery scent of their snack before taking the first succulent bites.

“Excellent, class,” says Mitchell-Giraudo. “Also, as a gentle reminder, before you eat the apple, ask yourself whether or not you’re hungry.” The students nod in recognition. “Remember, you don’t have to eat if your body isn’t giving you a hunger signal,” she says.

These students are learning a practice called “Mindful Eating,” that focuses on cultivating “present moment awareness” during meal times. Mindful eating invites participants to “pay attention” to the food in front of them and engage their five senses (sight, smell, hearing, taste and touch) before consuming a single morsel. This mindfulness practice builds the children’s awareness of important physical cues like hunger and satiety.

While mindful eating is scientifically proven to help prevent overeating and obesity, a new psychological study suggests that it may also forestall eating disorders, such as anorexia and bulimia, which affect 30 million people each year and are the deadliest of psychiatric illnesses. Surprisingly, anorexia nervosa is deadlier than major depression, schizophrenia or bipolar disorder. In fact, individuals who suffer from this severe illness are at higher risk of suicide, as well as prone to major health complications, such as cardiac arrest.

The National Eating Disorders Association states: “For young women, 15-24 years-of-age, Anorexia is twelve times more fatal than all other causes of death among this age group. Only 1 in 10 eating disorders sufferers will receive treatment for that illness, which makes prevention programs even more valuable.”

According to eating disorders researchers Michael Levine and Linda Smolak at Kenyon College, “By having children and adolescents participate in prevention programs, such as mindful eating, it can protect them from anorexia, bulimia and binge eating disorder.”

The positive life-affirming feedback from the children who participate in the program is the biggest testament to just how much these newly learned life skills are helping them.

“Mindful eating helps me respect the food that goes into my body,” asserts Jamie, a middle-school student in Mitchell-Giraudo’s class. “I can make better food choices,” she says, “because when I slow down to eat, I can tell which food is filled with fake ingredients and which foods are organic.”

“Mindful eating teaches children how to connect with their body signals, and learn how to eat intuitively,” says Kelsey Latimer, an eating disorders psychologist at the Center for Pediatric Eating Disorders and Children’s Health in Dallas. “This form of intuitive eating helps us distinguish between physical and emotional hunger and can help curtail overeating and binging.”

While Mindful Eating has been used in medical settings and eating disorder treatment centers, bringing the practice into the classroom as a preventative tool is a new concept.

“These programs buffer against eating disorder development,” suggests Latimer, “especially when administered during the late middle-school years. That’s a crucial period because it’s when students have been exposed to social the messages that “thin is in” but most have not yet manifested disordered eating habits to obtain a thinner physique.”

Mitchell-Giraudo, herself a graduate of the Mindful Schools program, echoes Latimer.

“It’s wonderful to see my students engage in 45 minutes of eating mindfully, especially since they used to scarf down their food in less than 10 minutes,” she says.

“By slowing down, my students have learned how to tell the difference between artificial and authentic flavors,” says Mitchell-Giraudo, “and this knowledge helps them make healthier food choices.”

Penelope says she is grateful that she’s learned these life skills. “Mindful eating is a great way to eat because it helps you feel good about yourself,” she says. “It’s helped me think about what I put into my body, which helps me grow stronger and do better in sports, too.”

While middle school is the ideal time to introduce eating disorders prevention programs, high school students can benefit just as much from the practice as those who are younger.

Aggie Giglio Kip, a nutritional counselor at Phillips Academy in Andover, Mass., incorporates mindful eating with her students in the dining hall.

The self-serve cafeteria bustles with activity as the students collect their food, flatware and beverages. Once they sit down to eat, Kip encourages them to unplug from other distractions, which means turning off their cellphones and powering down their computers. “Mealtimes are an opportunity to practice just eating,” she says.

Kip suggests that they “eat without judgment,” refrain from negative body talk and avoid measuring their self-esteem based on the foods they choose to eat. This is important since many of these teenagers struggle with the social and emotional changes of adolescence, including body image dissatisfaction.

For example, when Kip hears students say, “I ate the cookies — I was so bad,” a red-flag sign of negative body talk, she insists that they redefine the experience by using their senses to describe the flavors in the cookie. As an example, if a student feels guilty about eating oatmeal raisin cookies, Kip will ask her to focus and describe the scent and taste of the cinnamon, oatmeal and raisins.

Unfortunately, these kinds of courses are in short supply because many educators and school administrators believe that social and emotional programs are too expensive or time-consuming to implement. At many schools, teachers and school staff are often overwhelmed, overworked and underpaid. To save costs and reduce staffing issues, the schools bring prevention programs and/or leadership training into the schools like the Body Positive, founded by Connie Sobczak and Elizabeth Scott. The program trains educators and school staff in the principles of mindful and intuitive eating and teaches a series of self-exploration exercises that help them examine their feelings and attitudes about food and weight so that they can relay these messages to their students, too.

Kathy Laughlin, director of counseling at San Domenico High School in San Anselmo, Calif., is a fan of the Body Positive training. “The risk factors for eating disorders at my school are very high,” he says. “Since we began to incorporate this program, I have not seen as many girls with issues related to body hatred.” As the evidence demonstrates, implementing a mindful eating practice is one of the best ways to help students develop a healthy mind and body connection — one which will bolster them for years to come.