For parents of babies and young children, there is an abundance of information and advice on everything from teething to toilet-training. But what about the next, anxiety-provoking, developmental stage in a child's life -- adolescence? Much of the discussion on adolescent health focuses on major issues like alcohol and drug abuse, but there are more basic, but nonetheless important, questions: What should your teen be eating, or not eating? How much should she or he be sleeping? What about vaccinations?
For answers on these and other topics relevant to adolescent health, we turned to four local experts: Dr. Michael Lamacchia, chairman of pediatrics at St. Joseph's Children's Hospital in Paterson; Stacey Antine, registered dietician, nutritionist and the founder and CEO of HealthBarn USA in Wyckoff; Dr. Jeffrey Boscamp, chairman of pediatrics at The Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center; and Dr. Wayne Yankus, Midland Park pediatrician and candidate for the presidency of the American Academy of Pediatrics.
Parents already know that a piece of fruit is better than a cupcake and fast-food burgers should not make up a large part of their child's diet. Stacey Antine takes the concept of good nutrition beyond a set of rules to a shift in lifestyle.
"Parents shouldn't be the food police," she insists. "When we think about nutrition, we do it as a treatment for a problem. Why wait until it becomes a crisis?" Education is at the core of Antine's message for kids of all ages, what she calls "food literacy." She strongly suggests that if teens don't know how already, they should learn to cook. "They love to express themselves that way and it makes it more fun." The recipes she's created for her classes at HealthBarn are nutritionally sound, without being bland, boring or "health-food-y." And families should eat together around the table as much as possible. "It's critical from a communication standpoint. Once teens go into their rooms, they're in a hole."
Dr. Michael Lamacchia's department works with Paterson teens and their families as a unit, helping them to develop healthier eating habits according to the family's individual and cultural needs. "It's not one-size-fits-all. The parents are role models, so this has to be a lifestyle that is related not just to the child, but to the family as a whole."
Michelle Obama and celebrity chef Jamie Oliver have thrust the issue of obesity in young people into the spotlight. Lamacchia agrees that this is a serious concern for teens, particularly since the Center for Disease Control has released a statement that this generation of adolescents might be the first generation to have a lower life expectancy than the generation before it.
"Obesity is a major issue. The reason why it's such a big deal to get adolescents healthy and fit is because by the time you are an adolescent and you are overweight, there's an 80 percent chance that will translate into being an overweight adult, putting you at much greater risk for heart disease, stroke, osteoarthritic disease, et cetera," says Lamacchia.
He suggests behavior-modification activities like not watching TV while eating, introducing healthier snacks and broadening kids' palates to include more fruits, vegetables and lean proteins. "Do small steps but make them last."
According to Dr. Wayne Yankus, teens need eight to nine hours of sleep a night. "Teens have a circadian rhythm change with puberty. It is normal for them to fall asleep later and wake up later." He cites experiments with delayed school start times in Minnesota and Virginia, which proved that high schoolers' grades went up, SAT scores and class attention improved and pregnancy rates dropped. But since Bergen schools are unlikely to institute a later start to the school day anytime soon, teens will have to get those eight to nine hours by going to bed earlier. And, says Yankus, "naps are not a good idea for teens or college students -- continuous sleep is better."
Antine maintains that teens who don't sleep well are more likely to have weight issues. "You burn the most calories in your sleep," she says, adding that a relaxing routine before bed is just as important to the adolescent as it is to the small child. You won't be reading your 15-year-old a bedtime story, but getting them to spend the half-hour before bed reading or listening to (quieter) music instead of playing video games or being on the computer will help them unwind and improve the quality of their sleep.
As an infectious disease specialist, Dr. Jeffrey Boscamp stresses that teens should be vaccinated for flus like H1N1. "Flu is usually a severe disease in the elderly -- this one was severe in children and adolescents," he says of the outbreak that swept through northern New Jersey a year ago. "It's not something we're used to seeing in otherwise healthy kids. We pushed hard to get kids immunized."
Lamacchia, also an infectious disease specialist, says that the human papillomavirus vaccine, given to adolescent girls to prevent cervical cancer, is another important preventative measure parents should take. He explains that the flu vaccines -- not just for H1N1 but other strains as well -- are especially important for teens who have an underlying health issue, like asthma, but also for the general population. "Someone who is infectious can infect someone with one of these risk factors," notes Lamacchia.
Boscamp says that the word "flu" is often used incorrectly to describe what is actually a severe cold.
"Flus are bad things; the real flu is high fever, every muscle in your body hurts -- it's like being hit by a truck. The people who have actually had the flu are the people who never miss a flu shot after that."
He maintains that, because vaccines have kept so many serious diseases at bay, people either forget or are unaware of how serious these diseases are.
"When I started the pediatric infectious disease department at HUMC, I used to see bacterial meningitis every month Ð there were deaths. Now we have a vaccine. It's wonderful, but you need a historical perspective to realize why we need to keep immunizing," adds Boscamp.
He attributes a good deal of the misinformation on vaccinations to what's online.
"Adolescents are all over the Internet and read these things that are not accurate. People are very confused -- if the disease isn't around and they read that the vaccines aren't safe then why do it. The vaccines really are very, very safe. We always suggest that people discuss it with a doctor they trust."
Antine points out that while nearly every young child starts out playing soccer or baseball, as they get older, those who aren't as competitive get dropped from the team. "If your kid's not a jock, by the teenage years there's nothing to do; they may lose interest in staying active," she warns. Antine suggests alternative physical activities in keeping with your teen's interests: golf, yoga, hiking, horseback riding, cycling -- even just walking or biking to school will help.
Lamacchia runs a program in partnership with several schools, one component of which is teaching kids fun fitness routines they can do at home, a good option for teens who may be shy or anxious about going for a brisk walk or jog alone.
Yankus, who is the physician for the Ridgewood school district, brings up a related issue regarding sports -- head trauma. Even though teen athletes may insist they are ready for a return to the team after a concussion, in light of new information, parents are cautioned to be especially wary.
"We are learning that head trauma and/or concussions can be cumulative," he notes. "Return to activity should be gradual and headache syndromes could last weeks to months including an ADD-like syndrome or behavior as a result of multiple head trauma."
"Depression is real for teens and often not recognized," maintains Yankus. "Parents need to 'check in' once in a while with teens on behavior and mood -- don't always write it off to puberty and hormones. Many teens 'self-medicate' by taking drugs to blunt their moods."
Lamacchia says low self-esteem is prevalent in adolescents and that parents need to pay attention to "things that are persistent and on a regular basis."
According to Yankus, "'Tweens are under great pressure early in growth and puberty to look and act like 18-year-olds. The advent of social media makes privacy, decisions on personal behavior and damage control harder for kids and their parents."