Shoulder Injury/Post Surgery Exercise Guide Dr. J. Shawn Leatherman

The rotator cuff is a frequent site of injury. Although the supraspinatus muscle and tendon is most commonly involved, it is important to rehab all four muscles of the cuff. Regular exercises to restore normal shoulder motion, flexibility and proper scar formation, promote a gradual return to everyday work and recreational activities which is important for your full recovery. Your orthopaedic surgeon, chiropractic physician or physical therapist may recommend that you exercise from 10 to 15 minutes 2 or 3 times a day during your early recovery period.

The below exercises are for the initial rehabilitation. This guide should help you better understand your exercise and activity program. All exercises should be performed with slow methodic movements, and they should be performed in a relatively pain free arc of motion.

• Pendulum, Circular - Bend forward 90 degrees at the waist, using a table for support. Rock body in a circular pattern to move arm clockwise 10 times, then counterclockwise 10 times.
  Do 3 sessions a day.
• Shoulder Flexion (Assistive) - Clasp hands together and lift arms above head. Can be done lying down (drawing A) or sitting (drawing B). Keep elbows as straight as possible.
  Repeat 10 to 20 times. Do 3 sessions a day.
• Supported Shoulder Rotation - Keep elbow in place and shoulder blades down and together. Slide forearm back and forth.
  Repeat 10 times. Do 3 sessions a day.
• Walk Up Exercise (Active) - With elbow straight, use fingers to "crawl" up wall or door frame as far as possible.
  Hold 10 seconds. Repeat 3 times. Do 3 sessions a day.
• Shoulder Internal Rotation (Active) - Bring hand behind back and across to opposite side. Do not force the movement.
  Repeat 10 times. Do 3 sessions a day.
• Shoulder Flexion (Active) - Raise arm to point to ceiling, keeping elbows straight.
  Hold 10 seconds, relax 2 seconds. Repeat 3 times. Do 3 sessions a day.
• Shoulder Abduction (Active) - Raise arm out to side, elbow straight and palm downward. Do not shrug shoulder or tilt trunk.
  Hold 10 seconds, relax 2 seconds. Repeat 3 times.Do 3 sessions a day.
• Shoulder Extension (Isometric) - Stand with your back against the wall and your arms straight at your sides. Keeping your elbows straight, push your arms back into the wall.
  Hold for 5 seconds, relax for 2 seconds. Repeat 10 times.
• Shoulder External Rotation (Isometric) - Stand with the involved side of your body against a wall. Bend your elbow 90 degrees. Push your arm into the wall.
  Hold for 5 seconds, relax 2 seconds. Repeat 10 times.
• Shoulder Internal Rotation (Isometric) - Stand at a corner of a wall or in a door frame. Place the involved arm against the wall around the corner, bending your elbow 90 degrees. Push your arm into the wall.
  Hold for 5 seconds, relax 2 seconds.Repeat 10 times.
• Shoulder Internal Rotation (Against gravity) - Keep elbow bent at 90 degrees. Holding light weight, raise hand toward stomach. Slowly return.
  Repeat 10 times.Do 3 sessions a day.
• Shoulder External Rotation (Against gravity) - Keep elbow bent at 90 degrees at side. Holding light weight, raise hand away from stomach. Slowly return.
  Repeat 10 times.Do 3 sessions a day.
• Shoulder Adduction (Isometric) - Press upper arm against a small pillow alongside your body.
  Hold 5 seconds. Repeat 10 times. Do 3 sessions a day.
• Shoulder Abduction (Isometric) - Resist upward motion to the side, push arm against back of chair.
  Hold 5 seconds. Repeat 10 times. Do 3 sessions a day.

After an exercise session has been completed, it is appropriate to ice the shoulder to decrease inflammation and reduce soreness. Ice should not be placed directly on the shoulder unless it is an ice-water solution. Re-freezable gel packs are a good option, with a thin layer of cloth between the ice pack and the skin. Application time is 20 minutes post exercise.

The initial recovery period can last from 4-8 weeks post injury or surgery, depending on the extent of the trauma, additional modalities such as ultrasound or interferential current, nutritional supplementation, and individual healing rate. After this period of time it is appropriate to add small weights and or resistance bands to the above exercise protocols for increases in functional strength. Normal weight training programs, sports interaction, and activities of daily living that require increased physical demand should not be initiated without re-examination and the approval of your doctor.

ANKLE SPRAINS Dr. J. Shawn Leatherman

ANATOMY & FUNCTION

Joints are formed where bones come together. The bones are held together by tissue called ligaments. Ligaments allow for controlled motion of the bones at the joint and limit excessive motion. Sprains occur when ligaments are stretched more than normal and result in a partial tear or complete tear of the ligament. This ligament damage results in the development of abnormal motion at the joint due to the loss of stability.

The ankle is a joint which is formed by the TIBIA and FIBULA (bones above the ankle in the foreleg) and the TALUS (below the ankle joint). The ankle joint allows for the upwards (dorsi-flexion) and downwards (plantar-flexion) motion. The end of the shin bone (tibia) forms the inner bony prominence of the ankle called the medial malleolus. The outer bony prominence is called the lateral malleolus and is formed by the small outer bone called the fibula.

Stability arises from two important factors: the unique structural arrangement of the bones forming the joint, and the surrounding ligaments. Joint instability may develop after damage occurs to one or more of the bones surrounding the joint, a fracture, but instability from surrounding ligament damage is more common.

KEY TERMS:

• Tibia, Fibula, Talus, Calcaneus
• Medial and Lateral Malleolus
• Inversion and Eversion
• Plantar Flexion (PF) and Dorsi-flexion (DF)
• Isotonic Exercise

SPRAIN
The term sprain merely indicates that a ligament has been damaged. Sprains are divided into several groups depending on the severity of damage to the involved ligament. The sprain occurs when the ankle is turned unexpectedly in any direction that is further than the ligaments are able to tolerate. Typically, the sprain occurs with running, jumping, sharp direction changes, or stepping on uneven ground. The risk factors for having an ankle sprain include, uneven ground, previous untreated ankle injuries, being overweight, or using poorly fitting or worn out shoes.

Grade I Sprain (First Degree)
A Grade I sprain is the most common and requires the least amount of treatment and recovery. The ligaments connecting the ankle bones are often over-stretched and damaged microscopically, but not actually torn. The ligament damage has occurred without any significant instability developing.

• Mild sprain, mild pain, little swelling, and joint stiffness may be apparent
• Stretch and/or minor tear of the ligament without laxity (loosening)
• Usually affects the anterior talofibular ligament
• Minimum or no loss of function
• Can return to activity within a few days of the injury (with a brace or taping)

Grade II Sprain (Second Degree)
A Grade II injury is more severe and indicates that the ligament has been more significantly damaged, but there is no significant instability. The ligaments are often partially torn.

• Moderate to severe pain, swelling, and joint stiffness are present
• Partial tear of the lateral ligament(s)
• Moderate loss of function with difficulty on toe raises and walking
• Takes up to 2-3 months before regaining close to full strength and stability in the joint
  

Grade III Sprain (Third Degree)
A Grade III sprain is the most severe. This indicates that the ligament has been significantly damaged, and that instability has resulted. A grade III injury means that the ligament has been torn.

• Severe pain may be present initially, followed by little or no pain due to total disruption of the nerve fibers
• Swelling may be profuse and joint becomes stiff some hours after the injury
• Complete rupture of the ligaments of the lateral complex (severe laxity)
• Usually requires some form of immobilization lasting several weeks
• Complete loss of function (functional disability) and necessity for crutches
• Usually managed conservatively with rehabilitation exercises, but a small percentage may require surgery
• Recovery can be as long as 4 months

On the medial (inside) of the ankle is the deltoid ligament complex which goes from the medial malleolus of the tibia to the talus, but is not frequently injured.

The lateral ligaments are the most commonly injured. The mechanism of injury is the forceful INVERSION of the foot in relation to the lower leg. On the lateral side, the ligaments are typically damaged in a direction that goes from the front to the back, with the most severe injury being in the front (anterior) and the least severe being in the back (posterior). Therefore, the most commonly damaged ligament is the anterior talo-fibular ligament and the least commonly damaged is the posterior talofibular ligament.

• ANTERIOR TALO-FIBULAR LIGAMENT (goes from the talus to the fibula)
• CALCANEO-FIBULAR LIGAMENT (goes from the calcaneus to the fibula)
• POSTERIOR TALO-FIBULAR LIGAMENT (goes from the talus to the fibula)

DIAGNOSIS (DX)
DX is determined by examination of the location of the bruising, swelling, and tenderness. It is also necessary to perform stress testing of the ligaments to determine whether the ligament has been torn. Stress testing of the ligaments is done by pushing on the ankle and attempting to determine if there is any abnormal motion at the joint which would indicate that a ligament has been torn. In addition, x-rays are often performed to check for the possibility of a chipped bone or fracture.

When performing a stress test of the ligaments, a posteriorly directed force is applied to the front of the tibia (shin bone). If the ankle ligaments are completely torn, the tibia will visibly shift backwards at the ankle joint. When the force is removed, the tibia will snap back into its proper position at the ankle joint. When this abnormal motion occurs, the anterior talo-fibular ligament (ATFL) has been torn.

Compare the normal ankle with the abnormal ankle. In the later x-ray, the torn ATFL has allowed the tibia to shift backwards. Notice how the joint surfaces of the tibia and the talus (red circle) are not lined up in the second x-ray.

TREATMENT (TX)

Depending on the severity of the sprain, treatment may range from simply wearing a supportive brace, to using a walking cast, or even having the ankle operated on. The type of treatment depends on several factors including severity of injury, presence of associated injuries, the routine stresses that are placed upon the ankle, and the general medical condition of the injured patient.

Many problems resulting from sprains are due to blood and edema (swelling) in and around the ankle. Minimizing swelling helps the ankle heal faster. Most sprains heal completely within a few weeks. With increasing injury severity, the rehabilitation process becomes more complex and extensive. Chronic or recurrent lateral ankle sprains usually receive some type of strengthening program and proprioception training due to poor balance on the injured leg.

Treatment-Phase I (Early Phase):
Goal: Decrease post-injury swelling, bleeding, and pain. Protect the healing ligament(s).

Avoid the first 24 hours:

• Hot showers, Hot packs
• Heat rubs (e.g. Ben Gay)
• Drinking alcohol
• Aspirin–it prolongs the clotting time of blood and may cause increased bleeding into the ankle (Tylenol or ibuprofen (Advil) may be taken to help with pain, but will not speed up the healing process)

The PRICE regimen is the most important aspect of the initial management of a sprain:

PROTECTION

• Ligaments must be maintained in a stable position so healing can occur
• Get off your feet if pain persists
• Use an ankle stirrup or brace if necessary
• Non-weight bear or partial weight bear with crutches to control other inhibitors of healing
• Early walking is essential, since weight bearing inhibits contractures (tightness) of tendons, which may lead to tendonitis
  

REST

• Allow injured ankle to rest for approximately 24 hours after the injury
• Caution should be taken against vigorous exercise
• Exercise for the uninjured leg may be performed
• Isometric exercises (to increase static strength and assist in decreasing atrophy) with toes pointing up (DF) and then down (PF), progressing to toes pointing in (Inv) and then out (Ev)–done in pain free motion (each exercise held for 6-8 count)

ICE

• Ice the ankle every 2 hours for 20 minutes to decrease pain, swelling, and spasticity for the first 48-72 hours
• Do not place ice on the ankle for over 20 minutes

COMPRESSION

• Done with ice
• Place air or cold water within enclosed bag to provide pressure to decrease swelling
• Ace wraps, which may be wet to facilitate the passage of cold, could be used - wrap distal to proximal
• To add more compression, a horseshoe-shaped felt pad may be inserted under the wrap over the area of maximum swelling

ELEVATION

• Elevate as much as possible with ice and compression
• Elevate foot higher than the waist to reduce swelling and pain
• Keep the leg elevated while sleeping
• Elevation allows gravity to work with lymphatic system rather than against it
• Elevation also decreases hydrostatic pressure to decrease fluid loss and also assists in venous and lymphatic return through gravity

Treatment-Phase II (Rehabilitation Phase):
Goal: To increase motion and strength, aid in circulation and help eliminate residual inflammatory agents.
This phase begins when swelling stops increasing and pain lessens, so that the ligament(s) have reached a point in the healing process at which they are not in danger given minimal activity. Pain is the guide as to how much activity is enough.

STRETCHING

• Do stretches before and after activity
• Vigorous heel cord/calf stretches initiated ASAP (hold stretches for 20 seconds each, performed every 2 hours) - moderate pull but no pain
• Begin with active Dorsi-flexion and Plantar-flexion activities
• Progress to Inversion and Eversion exercises when tenderness over the ligaments decrease
• All activities should be done slowly without pain at high repetitions (3 sets of 20)
• Toe curls–place a towel on the floor and curl your toes to pick up the towel
• Marble pickups–pick up marbles with your toes
• Perform alphabet exercise–rest heel on floor and write the alphabet in the air with your big toe, making the letters as large as you can
• Stationary bike

STRENGTH
Begin with isometric exercises with progression to isotonic exercises (with and without resistance) in a pain free motion .As the ligament heals further and ROM increases, strengthening exercises may begin in all planes of motion . Pain should be used as the basic guideline for deciding when to start Inversion and Eversion isotonic exercises.

Obtain a strip (about 2 feet long) of elastic belting material, surgical tubing (from a medical supply store), or a bike tire inner tube and work your ankle in four directions. Pull the tubing taut, making sure that the tube is placed at the base of your toes, and do the exercises only with your foot and ankle, not the whole leg

• Out and up: sit on floor or chair, loop tubing over foot and around table leg, with heel on floor, work ankle out and up
• In and up: as above, but loop tubing to provide tension against an inward motion, with heel on floor, work ankle in and up
• Straight up: as above, but with heel on floor, work ankle straight up
• Straight down: hold tube loop against bottom of foot, with heel on floor, work ankle down
• At the beginning of the rehabilitation process, use ankle weights (1-2 lbs) for light resistance in the four directions described above (2-4 sets of 20)
• Heel/toes raises–stand on a step with your heels slightly off the step and slowly rise up on your toes and equally slowly lower heel down; when this exercise becomes simple to perform, do the exercise using only the injured leg in a pain free motion
• Single knee flexion exercises–stand on injured leg and bend that knee and straighten it

PROPRIOCEPTION

• Defined as the knowledge of where one's body is in space
• Following ankle sprains, the injury can cause balance deficits (from loss of proprioception), and therefore increasing the risk of re-injury and poor healing
• The greater ligament disruption, the greater proprioception loss
• Early weight bearing on the ankle (e.g. standing/walking) decreases proprioception loss - begin by standing with eyes closed and progress to standing on injured leg with eyes closed
• Wobble-board ankle activities

Treatment-Phase III (Full Functional Level):
Goal: Return to prior level; return to activity

• Must have full ROM
• Must have 80-90% strength in injured ankle compared to the uninjured ankle
• Strengthen the uninjured leg
• Run in a pool, using a floating device; swimming
• Tape the ankle if necessary
• High-topped footwear to stabilize the ankle
• Cleats should be outset along periphery of the shoe to provide stability
• Gradual progression of functional activities that slowly increase stress on ligaments
• Full weight bearing when you can walk without a limp
• Lunges forward, on a 45° angle, and sideways with injured and uninjured leg
• Pain-free hopping on affected side (start with hopping with both legs and progress to hopping with only injured leg)–four-square hopping drills
• Step up and over, forward and sideways, on high step in pain free motion
• Stand on your toes of the injured ankle for 20 seconds, and hop on your toes 10 times
• Begin Stairmaster, treadmill, biking
• Running can be started as soon as you can walk in a fast pace without pain; initially, start jogging in a straight line, and progress to running from smooth, flat surface to uneven surfaces
• Cutting exercises: run in figure eights, cross-over walking
• Jump rope

RESIDUAL ANKLE INSTABILITY
Occasionally, when the ligaments heal, they are weaker or looser then prior to the injury. This results in an ankle that is more likely to be unstable and twist more easily. When this happens, PT often allows the adjacent muscles to strengthen and stabilize that joint. Sometimes, it is necessary to wear a brace when walking on uneven ground or during sports to support the ankle. Rarely, it is necessary to surgically reconstruct the ligaments. Prevention is the best way to protect the ankle from initial and further injury.

Prevention:

• Wear the correct shoes for the event. Proper footwear provides comfort and balance
• Wear hiking shoes or boots in rough terrain
• Different sports activities call for specific footwear to protect feet and ankles. Use the correct shoe for each sport. Don't wear any sports shoe beyond its useful life. Remember that wet conditions may necessitate a change in footwear.
• Do not walk barefoot on paved streets or sidewalks.
• Watch out for slippery floors at home and at work
• Be aware of uneven terrain, potholes, and high curbs.
• If you get up during the night, turn on a light. Wear a brace or have ankle taped when doing activities that have a high incidence of ankle injuries (such as basketball, volleyball, soccer, tennis, and other sports requiring a lot of stopping, starting, and twisting motions)

Back Pack Troubles for Children and Adolescents Dr. J. Shawn Leatherman

Are you sending your child off to school with a backpack tossed over his/her shoulder? Most parents in America are without any consideration for the problems that can result. Although backpacks have become as common as pencil and paper, you need to think twice about what may be occurring. While carrying a backpack may seem harmless, it can cause health problems, including back and neck problems which may or may not be painful.

Backpack Injury on the Rise: Research reveals an alarming danger with improper childhood backpack use. According to the U.S. Consumer Product Commision, of the 6,512 children treated in hospital emergency rooms in one year for injuries related to backpacks, 54% involved children aged 5-14. In 2002 & 2003, approximately 21,000 emergency room visits were attributed to bags and backpacks. Not only does acute injury occur, but also long term damage. A study conducted by the American Academy of Orthopaedic Surgeons adds to the growing body of research on the negative impact of backpack use. Investigators surveyed more than 100 physicians at Children's Memorial Hospital, Chicago, Illinois and Alfred I. DuPont Hospital for Children, Wilmington, Delaware. The study revealed that backpack injuries are on the rise. In total, 58% of the orthopedists reported seeing patients complaining of back and shoulder pain caused by heavy backpacks. More than 70% of the orthopedists surveyed indicated that heavy backpacks can become a clinical problem in school-age children if not enough attention is made to decrease some of the weight being carried in the packs. For example, carrying 12 pounds in a backpack and lifting it 10 times per day equals 120 pounds lifted each day. That is equivalent to 21,600 pounds in a school year (nearly 11 tons), or 6 full size automobiles. Now imagine this load being carried on only one shoulder.

You don’t need to be a scientist or physician to understand the effects of backpacks on children. Visit a local school and watch the kids struggle to walk while bent sideways or flexed forward under the weight of an overloaded backpack. You can easily realize the inherent dangers on the structure of the spine. Carrying a heavy load that is distributed unevenly or improperly, day after day, week after week, will impart stress to the spinal column and the long-bones, in the legs of a growing child. Consider the phrase, “As the twig is bent, so grows the tree.”

Back Packs Affect Teen Postures: In the November 1st, 1999 edition of the journal SPINE, association of poor posture was studied in relation to back pack wearers. What postural influences do backpacks have on teenagers' spines? To answer this question, researchers evaluated the head-on-neck posture of 985 high school students, aged 12 to 18 years. Specifically, the investigators assessed the craniovertebral angle of subjects wearing backpacks, and not wearing backpacks. The study found that backpack use significantly altered head-on-neck posture in every age group studied. This finding was most pronounced in younger students. Additionally, Simmons College reported in February of 2001, “55% of students carry more than the recommended 15% of body weight in their backpacks.”

A cure for the Back Pack Blues: Neck and back pain is pervasive in our society. Much of this is brought on by bad habits that were started during our younger years such as inappropriate back pack usage. Slinging a backpack over one shoulder or allowing it to ride low on the back may provoke serious postural and vertebral misalignments. These misalignments restrict normal movement, reduce function, affect balance, symmetry and spinal health, which predispose ailments such as neck pain, back pain and headaches. Chiropractic physicians have long recognized the hazards of improper loading of the spine, and as specialists in spinal biomechanics need to educate on the proper usage of back packs. In an effort to reduce backpack related injuries and to ensure the health and safety of your child, follow the preventive measures listed below.

1. The max weight of your child’s LOADED backpack should never exceed 15% of his/her body weight. (American Pediatric Association) This includes the weight of the backpack itself. Too much weight causes the child to lean forward and round the shoulders in an attempt to manage the load leading to postural abnormality and stress on the spinal column, muscles, discs, and ligaments.
2. Insist on your child wearing BOTH shoulder straps to eliminate asymmetrical loading of the torso.
3. Make sure the backpack rests firmly against the back with the top just below the base of the neck.
4. Look for wide and padded straps. This helps to increase surface area and disperse weight while decreasing pressure on the shoulders and the nerves around the arm pits. In addition padded waist straps will keep the weight close to the body and aid proper balance.
5. Teach your child to load the backpack as evenly as possible. Keep the heaviest items centered and closest to the body. Lighter items are to be placed to the sides and top.
6. Lifting technique is important. Always bend at the knees, use both hands, and lift with the legs not your low back. Carefully place the backpack on one shoulder at a time and never sling it over the shoulders.
7. Adjust the straps properly. A secure backpack is snug but not too tight, hugging the chest wall, with the buckle of the strap being approximately two inches below the armpit.
8. For older children, encourage them to make frequent stops at their locker daily to replace books that are not needed, and reducing the overall load carried.
9. Talk to your child about the importance of using a backpack correctly. A child who is educated and understands the importance of ergonomic factors early in life can apply the knowledge at school, home, and later in life, reducing the effects of poor postural loading of the torso and spine.

Additional Parameters and Ideas: It may be advisable to talk to your child’s teachers and administrators at school. It might be possible for students to have two sets of textbooks, one to be left at school, and one for home usage which will eliminate the need for unnecessary transportation of study materials. Many classrooms have utilized lighter-weight workbook materials and handouts to minimize the daily carried loads for students. Lastly, you may want to look at stroller bags such as airline carry-on luggage. They are frequently large enough to handle a student’s need without the burden of heavy lifting and roll with ease. These bags fit into many school lockers and they are easier to transport. As always check with your local school officials for any policies and/or regulations you may need to follow, and measure the size of your child’s locker beforehand.If your child has already been subjected to improper backpack usage or has already complained of neck and back pain, it is important to address the underlying causes. Subtle spinal disorders, postural abnormalities, and asymmetric fixation or movement disorders of the spine, often go unnoticed until the problem has been made worse or chronic. Because of this, it is especially important to call your chiropractic physician if your child is experiencing any pain or discomfort in the shoulders, neck, legs, or back. Don’t ignore this potential threat to your child’s developing skeletal structure and health. Spinal correction is specific, gentle, and more effective when addressed early on, and home exercise routines can be developed to strengthen your child’s spine to aid in the prevention of further problems. Backpacks with air cells are available to lessen the impact of weight placed on the shoulders, as well as the back musculature.

For any additional information please feel free to call the doctors at Suncoast Healthcare Professionals. 850-864-0800

“Healthy Food” and “Teenager” can coexist in the same sentence. Dr. J. Shawn Leatherman

Most adolescents are responsible for making their own lunches or buying it at school. You can load up your teenager’s lunch with kale bunches, apple slices, broccoli spears, organic milk and whole grain bread slathered in hummus, but, seriously, what is the likelihood they will actually eat it? The likelihood is higher when you model the same behavior and provide the reasons why. Unfortunately, if your child’s health and nutrition is left up to their school, you are probably in big trouble! The majority of schools in the nation plan your child’s meal around their budget, not nutrition and health. Parents need to give their children basic guidelines for what is included in a nutritious lunch, and should always be role models for healthy eating ourselves. In reality, we often leave the rest up to the kids, believing they are old enough to take responsibility for their own food choices. Some are! Some aren’t!

Numerous choices however, include using their lunch money on occasion, or more than occasion, to buy junk food and soft drinks from vending machines inside the school or in the lunch line itself. Sometimes adolescents skip lunch all together.

According to nutrition expert, Dr. Renu Mansukhani, The eating behavior of adolescents is influenced by a number of variables. Unfortunately, as your kids age, become teens, and develop their own values, your influence no longer trumps all the rest as it did when they were younger. While we can still model and give them good food choices, a teen’s own personality and body image, peer influence, societal norms, school and community environment, all affect what he or she will eat.

Parents need to be proactive in their child’s choices by recognizing how their adolescent actually thinks about health and nutrition. Offer sound advice on proper food choices. If you don’t know what these choices are, seek them out. Teens are more independent in their food choices than younger children. Even teens brought up eating healthy may make the wrong choices. Here are the four worst food habits of teens, what you can do about them, and a few ideas to help your child recognize and make improved food choices.

• Skipping breakfast is the foremost bad food habit for teenagers. According to the American Dietetic Association, more than half of male teens and more than two-thirds of female teens do not eat breakfast on a regular basis. Breakfast is the most important meal of the day. Eating breakfast can upstart your teen’s metabolism, which helps with weight control, mood and school performance. Skipping breakfast increases the desire to snack on refined foods and sweets (empty carbohydrates) to boost energy levels.

You can ensure that your teen eats a healthy breakfast by making the foods readily accessible to him. Make it a part of your routine to put breakfast on the table and sit with your teen while you both enjoy a healthy breakfast. If time is a problem, initiate earlier to bed, earlier to rise principles. Or, go for the grab and eat on the way breakfasts such as hard boiled eggs, nuts, fruit, or hearty bran muffins.

• Emphasize the here and now. “Don’t you want to grow up to be big and strong?”, may work for younger kids, but not teens. They live for the moment as their lives are in constant transition. Emphasize how eating healthy, including their daily breakfast, will help them feel better now, give them more energy for activities they love, and improve their complexion and appearance.
• Soft drink consumption is the second bad habit. Let’s start with the facts. According to the Centers for Disease Control, carbonated soft drinks are the number one source of calories in the American diet for adults and kids. Given that soda has zero nutritional value, this is an alarming statistic. The American Academy of Pediatrics says sweetened drinks like soda and sports drinks contribute to obesity because the calories are in liquid form. The theory is that eating solid food creates satiety, you feel full, and thus eat only a certain amount. Liquid does not give you the same sensation of fullness, so sweetened drinks with their loads of calories are adding to the normal dietary intake.

A study looking at American youths aged 6-17 found an increase in the prevalence of soft drink consumption from 37% in 1978 to 56% in 1998. A Harvard study published in the journal Pediatrics, concluded that when sweetened drinks, (soda, sweetened iced tea, sports drinks and juice drinks with less than 100 percent juice), were replaced with bottled water in the home, kids decreased their consumption of the sugary stuff by about 80 percent. In other words, out of sight, out of mind. This study is evidence that improving nutrition at home, and hopefully at school, can have a significant impact on kids’ behavior. You can help your teen choose a healthier drink by not buying soda having water and organic fruit juice available. Artificially sweetened beverages and diet colas have their own problems and are even worse than sugary beverages. They should not be consumed at all!

• The next unhealthy food habit teens have is increased foods from ‘other’ food group. Think of the food pyramid, the ‘other’ food group is the smallest section at the top, with what is supposed to be the least amount of servings. Teens tend to eat too much high fat, trans-fat, processed, artificially flavored and colored, refined, and empty calorie snack foods that are categorized in the ‘other’ food group.

Break this habit by having fruits and healthy snacks available more often. Slowly eliminate having high trans-fat, processed and high calorie snacks. Bagged chips with orange goop may be easy to grab at the grocery store, but picking up a bag of oranges and remembering to wash, quarter and put them out on the table during snack time is much smarter. The benefits to your teen’s health are worth the effort.

Pack for their lifestyle. Teenagers and kids are on the go, especially at school. They eat what they can get their hands on and consume the fastest, and that’s usually not your carefully-packed lunch. So try giving them healthy, eat-on-the-go options, like organic granola bars, unflavored popcorn, organic cheese, bananas, apples, and baggies of grapes or nuts. Instead of sandwiches, make wraps and teach them how to do it. Wraps can be rolled in foil and stuffed in the outside pocket of a backpack with a small icepack – no lunch bag required. Buy bottled water in bulk which they can grab as they run out the door.

The final big problem: Increased eating/snacking outside of the home. Teens hit the fast food restaurants much more often then they did when they were younger. This is inevitable due to school, sports and work schedules overlapping regular meal times. To circumvent this bad habit, talk to your teen about limiting fast food to once a week. Make dinner and healthy food available to him/her when they are home. This is as easy as fixing a plate for them and allowing him to heat it up when they are home. Providing cut veggies, fruit, granola, nuts, organic yogurt etc… will promote healthy snacking.

Have your child do the math. If adolescents are using their money to buy junk food at school, have them figure out how much they are spending weekly and monthly. They will be surprised at how it adds up. Emphasize how much sooner they could buy that new pair of jeans or ipod they’ve had their eye on if they ate their packed lunch, eliminated vending machine items, and reduced fast food consumption.

The bottom line: kids are aware. They watch Discovery Health, read fitness magazines, and do know how to make reasonably healthy food choices, for the most part. But remember, they are bombarded with advertising hundreds of times a day. Your duty is to encourage proper choices and help them make it easier to fit quality nutritional foods into their lifestyle as well as yours. The common denominator for getting teens to eat healthier and avoid bad food habits is your active role in providing healthy foods. When you get in the habit of making these foods more readily available to your teen, you will see a change in their eating habits.

Child Restraint Systems: Controversy vs. Facts, What You Need to Know! Dr. J. Shawn Leatherman

On January 4, 2007, one of the most public and heated controversies on child passenger safety to date was published. Consumers Union (CU) declared they tested 12 infant carriers at the same speeds for side and frontal impacts as federal vehicle standards. Federal Motor Vehicle Safety Standard (FMVSS 213) requires child restraint systems (CRS) to be tested in 30 mph frontal impacts only. Federal standards do not call for side-impact crash tests at this time. The International Standards Organization is drafting global standards that will include side-impact tests; meanwhile, the highest standard in the world is a side-impact crash test at 19 mph that is mandatory in Australia. CU aspired to investigate side-impacts at 38 mph and frontal-impacts at 35 mph. They stated only two rear-facing infant seats (infant carrier with base) passed according to their tests. CU’s further comments included an erroneous warning and suggested recall of CRS’s to parents about the safety issues they uncovered.This story posed questions amongst child passenger safety experts and alarmed parents by claiming the 10 "failed" seats were unsafe without providing a sufficient explanation. The National Highway Transportation Safety Administration (NHTSA) immediately looked into the testing procedures of CU and found embarrassing calculation errors. The greatest error was in the side-impact test that led to most of the seat "failures." CU actually simulated a 70 mph side impact, not a 38.5 mph impact as they had thought. This exposure caused CU to withdraw their report, but they say they are planning to conduct new tests. NHTSA actually retested 11 of these seats, published the test videos and a statement regarding CU’s error on their website.

According to information released from the Spine Research Institute of San Diego (SRISD), the fact remains that every child restraint system on the store shelf has passed stringent federal standards that took years to develop. Today’s car seats are safe and effective when used correctly. Every car seat on the market in the United States has passed the same rigorous crash tests required by the U.S. Department of Transportation. As a rule, there are three websites providing comprehensive and trusted information on the usage of child passenger safety information; http://www.nhtsa.gov/ , http://www.carseat.org/ , and http://www.boosterseat.gov/.

Child Passenger Safety Week is held during Valentine’s Day week. NHTSA sponsors this event, which has been running for over 20 years, to educate parents and caregivers on the most up-to-date child passenger safety information. This includes the proper use of child safety seats, booster seats, and seatbelts according to the age and size of the child. Studies have shown that while 96% of parents believe they are installing their child restraint systems safely, only 20% actually are.

Previously, on June 13, 2006, NHTSA released their 2006 Child Safety Seat Ease of Use Ratings chart. Ninety-five percent of all child restraint systems (CRS) can be found in that year’s chart. Ratings of A, B, and C were assessed and based on level of difficulty in five installation categories. NHTSA began this program five years ago to encourage manufacturers to make their seats more user-friendly, because the installation and misuse rate has been so high.
This information can be accessed at: http://www.blogger.com/www.nhtsa.dot.gov/CPS/CSSRating/Index.cfm.But how can a chart like this benefit parents? The most common questions I get asked are: “What seat is the safest; and what seat do you recommend?” These are important questions, but CRS implementation and installation are the keys. The best child restraint system for you is one that: fits your child, fits in your car, and one you can correctly install every time.

Child Safety is Paramount. Every CRS sold meets Federal Motor Vehicle Safety Standards, or they are recalled instantly and eliminated from public consumption. Therefore, an actual safety rating is not the issue, and an expensive price tag doesn’t mean it is a safer seat, either. Never accept a seat second-hand! Is your child's health a second-hand concern? There is no valid way to determine factors like whether or not the seat was in a crash before or if the parents washed the harnesses. Even roughing up the seat could cause fractures in the seat base. Any of these events can compromise the crashworthiness of a CRS. If you are continuing to reuse a seat for multiple children, remember that a CRS will generally expire after six years.

As soon as you decide on a seat and install it, send in the registration card! You want to be notified immediately of any recalls on your CRS or its parts. Recalls can also be checked at NHTSA's website. Important: If you are in a crash and your CRS was in use by a restrained occupant, your insurance company should replace it for you. In many states, it is the law. Don’t expect them to ask you; you need to request the CRS be replaced.

The CRS fits your child. You absolutely must adhere to child height and weight requirements on every CRS. If you have a heavy child for their height, more model options are available to select wider seats and higher weight limits. Make sure the rear-facing position will accommodate your child’s height and weight for as long as possible as this is the safest position for the child. (*You should always have your child restrained in a rear-facing CRS until the age of one, and until the child weighs more than 20 lb*)

Be prepared to make adjustments before your child exceeds the limits of the CRS. Many CRS brands have additional features that may work better for you, depending on what stage of development your child has attained. For example, using a convertible seat from birth and up, choosing one that has an adjustable crotch strap and patented infant support for a safer and snugger fit around a newborn is a good start. Important: never use after-market products on your CRS. Anything after-market did not get tested with your CRS and the seat cannot be expected to perform as specified.

According to Katina Chester, NHTSA Certified CPS Technician and employee of the SRISD, in addition to improper installation and usage, one of the greatest challenges is the use of booster seats – or, rather, the lack of use. Child restraint use plunges after age 3. While some states have no booster seat laws and others require up to age 6, the real factor for booster seats is height. Children less than 4’9" tall (usually up to about age 8) should remain in a booster seat. NHTSA estimates that as few as 10% of children who should be using booster seats actually are. Many parents graduate their children from a booster to a seatbelt too soon, or even skip this stage altogether.

The CRS Fits in your car. Always try to install a seat before purchasing it. Not every seat works in just any car. For example, a square-based CRS could fit perfectly in one person’s car, but may be completely unstable in another vehicle’s rear seat because of bucket seats or a narrow hump in the center position. A CRS could be too tall or deep for a parent to fit in their rear seat and/or difficult to properly cinch down. While shopping have a store clerk accompany you to your vehicle and watch as you completely install the CRS into your rear seat according to the vehicle and CRS manufacturer’s instructions. If any CRS is difficult for you, don't buy it, or exchange it right away. If you are expecting a newborn, get your seat installed and inspected well in advance, then make sure you know how to adjust it properly. When the big day comes, you will be ready to safely transport your new edition home.

You can correctly install the CRS every time. Easier installation ideally means a lower chance of user error. You can have the most expensive seat on the market with all the bells and whistles and install it incorrectly, when your child would be much safer in a $50 CRS that you actually know how to use. NHTSA’s Ease of Use Ratings can help you identify different CRS in the category you need that are easy to install. However, don’t completely discount a seat you want because of a poor rating until you try it yourself. It may be the only seat that fits in your vehicle. Conversely, a seat can get an A in a category, and once you attempt that installation step, you could find it incredibly difficult.

The most important thing a parent can do is acknowledge the fact that 80% (nationwide average) of children are improperly restrained, 33% are restrained in an inappropriate seat for their height and weight. If you’re following manufacturer’s instructions, you’re giving your baby the safest ride possible with current technology. Make sure your infant car seat is less than six years old, has never been in a crash, is reclining at about a 45-degree angle in the car, is secured tightly in the back seat, and the harness straps are adjusted correctly for your baby. Read the instructions and follow them carefully. Even if you don’t usually read the instructions for other products, read your car seat owner’s manual cover to cover. Also read the section of your vehicle owner’s manual that deals with occupant protection.

Moreover, it is in a parent’s best interest to have their seat and child installation checked by a professional. Manufacturers are trying to make easier installation possible, but it is up to parents to make sure they are doing it correctly. Get your seat inspected by a NHTSA trained and certified CPS Technician. Ensure that you can duplicate a correct installation and have the technician supervise you doing this. This service is provided for free in most cities by child safety organizations, or technicians may provide at-home installation for a fee. Ask local children stores, hospitals, or search online for sponsored events.

Any car seat made after 2002 can be installed with either safety belts or the LATCH system in a vehicle made in 2002 or later. Use safety belts or LATCH for an infant, whichever you prefer, but not both. If you’re worried about the performance of LATCH, use the safety belt.

Important: Once your CRS is installed, keep the owner’s manual attached to the CRS. Most seats come with a compartment or tether for this. You never know when you might have an emergency and need to move the CRS to another vehicle. Also, remember to check the CRS before each use. Other passengers can accidentally loosen belts or knock off locking clips.

Quick Summary
The best Child Restraint System is one that satisfies the following three parameters.

1. Fits properly in your car.
2. Fits your child's size and weight.
3. You can correctly install every time.

View NHTSA’s 2006 Ease of Use Ratings chart at: http://www.nhtsa.dot.gov/CPS/CSSRating/Index.cfm.

• Get an idea of what CRS you might be willing to try, as well as what CRS on the list fit your child’s height and weight needs.
• Practice installing a CRS at the store using your vehicle and CRS owner’s manual before you buy it to ensure it properly fits in your vehicle and you are able to install it correctly. If you have your child with you, harness them in as well to check for a snug and proper fit.
• Have your CRS and child installation checked by a NHTSA certified Child Passenger Safety Technician. Ensure you can duplicate correct installation on your own.
• Follow proper care and maintenance procedures for your seat per the CRS manufacturer’s instructions.
• Send in your CRS registration card so you will receive any manufacturer recall notification.

Federal Motor Vehicle Safety Standard No. 213
Highlights of the Regulation for Child Restraint Systems

• Covers all types of systems (infant carriers, child seats, harnesses, and car beds) that restrain children under 65 pounds in motor vehicles.
• Requires that child restraint systems pass a 30 mph frontal sled test, which simulates a crash.
• Specifies maximum rotation during crash test for rear-facing child restraints.
• Specifies limits on child dummy measurements for forward-facing child restraints:
  - Head injury criteria (potential brain injury resulting from abrupt deceleration)
  - Head excursion (distance dummy head travels forward)
  - Force on chest
  - Knee excursion
• Requires that restraints not break during dynamic tests.
• Requires that child restraints retain a child dummy within the confines of the restraint during crash tests.
• Specifies padding requirements around the head of child restraints for use by children weighing 22 pounds or less. Flame-retardant fabric required.
• Requires that safety seats pass the 30 mph test secured with vehicle lap belt or lower LATCH attachments only as well as a more stringent test for forward-facing restraints with a tether anchored. Exceptions: child harnesses and products for children with special needs may be tested with top tether straps anchored. Boosters are tested with a vehicle lap-shoulder belt.
• Specifies the amount of force needed to open buckles on child restraints, so that toddlers cannot unbuckle themselves but adults can easily open the buckle. (Before crash test, minimum force is nine lbs. and maximum is 14 lbs.; after crash test, maximum is 16 lbs.)
• Requires permanent, visible labels on the restraint with the following information: certification that it conforms to standards for use in motor vehicles, basic instructions for correct installation, name and address of manufacturer/distributor, and date made. Air bag warning label required for rear-facing restraints. The restraint must have a designated location for storing the instruction booklet or sheet. An additional label may be present to state certification for use in aircraft.
• Permits child restraint systems to be designed as an integral part of motor vehicle seats.
• Requires that the manufacturer include a registration card with the child restraint and notify consumers of product recalls.
• As of September 1, 2002, child restraints and vehicle were required to provide LATCH attachments (FMVSS 213) and anchors (FMVSS 225). Refer to FMVSS 622 for a summary of these requirements.
  
  SafetyBeltSafe U.S.A. P.O. Box 553, Altadena, CA 91003 www.carseat.org
  310/222-6860, 800/745-SAFE (English) 310/222-6862, 800/747-SANO (Spanish)

Training for Stability of the Neck and Back…Not What You Think! Dr. J. Shawn Leatherman

A brief look around any boardroom, construction site, grocery store etc… will provide any observer an insight into poor posture and de-conditioning syndrome. A deconditioned individual has only one option for lasting pain relief which is increasing their functional capacity. The average teenager and adult have pronounced spinal displacements due to chronic poor ergonomics of basic living, poor posture, and constrained working environments. Back or neck pain is the number one reason for a visit to the chiropractic physician and medical doctor! Shouldn’t you work to prevent injury and strain? The obvious answer is yes!

The most common reasons for back and neck pains are poor lifting techniques, abnormal posture, and repetitive micro-strain coupled with the lack of stability within the muscular system, and trauma. It is sometimes difficult to avoid trauma, but if you eliminate poor technique, improve the ergonomics of your work station, and train your spine for stability, you significantly reduce your risk of injury. Remember that we live in a gravity controlled environment and all muscular actions are in direct opposition to gravity. We stabilize bridges and buildings so they won’t buckle or break, you need to do the same for your spine.

That being said, conventional strength training with free weights and isolation machines will give general overall gains in muscular strength if utilized properly, but won’t necessarily target stability of the core or the spine. Muscles to target are the multifidus, rotatores, intertransversales, transverse abdominis, and the pelvic floor. Moreover, it is important to train for balance and symmetry thereby reducing abnormal weight bearing on all joints of the body.

Lifting technique is important for optimal health and the reduction of injury. To execute a lift properly, the back should be fairly straight while maintaining the normal lordosis (forward arch of the low back). This position will activate the musculature properly for stability while not recruiting the ligaments for support. Squatting is optimal, due to its neutral spinal position and the ability to use the muscles of the legs to accomplish the lift. Stooping should be avoided, especially with repetitive movements. Stooping creates an unstable configuration for the disk with increased tensile pressure on the posterior portion of the disk due to increased compression on the anterior portion of the disk. This can easily result in a rupture of the disk. In addition, objects should not be lifted if they are placed awkwardly which may require twisting and or bending, weights should be held close to the body, and jerky movements are only appropriate for highly trained individuals such as advanced athletes under the supervision of a trainer. The last key is to create contraction of the abdominal musculature before the lift. This provides greater stabilization the spine, and your entire core. You can easily accomplish this by sucking the belly button in toward the spine. This activates the transverse abdominus muscle which is key for all movements.

One of the most deleterious activities people engage in is sitting. Sitting increases disk pressure more than standing and encourages abnormal flexion (forward bending) of the neck and upper back in addition to slumping in the chair. These postures chronically load the disks, ligaments and musculature of the spine creating micro-injury and dysfunctional movement patterns.

Many of us spend the majority of our days at a desk, computer or workstation. We need to consider and modify our workspace carefully. Adding a support for the lumbar spine reduces disk pressures. A seatback angle of 5-15 degrees from vertical will reduce low back muscle activity and disk pressure. Proper desk height is approximately 30 centimeters from the seat of the chair. Arm rests are important in limiting strain on the upper muscular complex of the back and neck to include the trapezius, rhomboids, and levator scapulae. The shoulders should be able to relax with the elbows bent at 90 degrees while the hands rest on the desk surface.

Forward movement of the head on the neck is extremely problematic. For every inch forward the head moves in relation to the neck and shoulders, the compressive forces on the lower neck increase by the entire weight of the head, 10-16 lbs. Think about the difference in holding a bowling ball close to the body, or away from the body. This illustrates the differences in muscular work needed to support the weight and the ligamentous strain. Computer monitors should be elevated so that the center of the screen is at eye level while looking straight ahead. This will reduce eye strain; further reduce muscular tension of the neck while limiting the forward flexion of the head, therefore reducing the abnormal loading of the ligamentous complex. This will also help reduce those “work headaches”. Placing the monitor higher to induce a slight extension of the head is permissible.

Now that you have proper technique, and your workstation is optimal, structural and functional training of the musculature on the back of your body and your core is the key. You must have a balanced and relaxed spinal cord for optimal function. That being said, specific training is the way to achieve spinal balance and stability, and you don’t have to go to the gym to achieve it. If you can appreciate that we spend most of our days in a flexed position, the way to relieve that cumulative stress is to train the small stability muscles in an extended position.

Most people are flexed forward at the hips/pelvis, have rounded shoulders, and a forward head and neck, this is called Global Flexion. Extending the head backwards, opening up the chest by turning the palms of your hands outward and stretching your arms backwards relieves this global flexion. The last step is to stand up and bend backwards at the waist approximately 20 degrees. You have just accomplished the task of Global Extension. If you flex or tighten up all you muscles while in this position it further accentuates the value of the exercise and also promotes increased blood flow and oxygen delivery to the body. This is a relief position that everyone should use frequently throughout the day to abate cumulative postural stresses.

Moving on, posture is the next consideration. Your posture should not be a conscious task, but with the level of deconditioning in the population, conscious postural improvements are necessary. This is mostly common sense, and your mother has telling you to do this since you were a child. Exercise your postural muscles while walking. Stand up straight, hold your head up high and walk with confidence looking ahead of yourself, not at the ground. Pull your shoulders back, breathe deeply, and take confident long strides. This alone will bring more oxygen to your body by fully opening up the lungs, increasing blood flow, and reducing abnormal stress on spinal structures. You can also practice this position on a physio-ball or thera-ball to improve your seated posture and balance. Complex postural issues and stability issues need to be addressed by a professional.

Remember that weight training, aerobic activity, and general fitness types of activities are only good for you if done with proper form, balance, control and stability. If you don’t have good posture and spinal symmetry, a traditional workout program will only make those problems worse. It is essential to incorporate stability into your spine and your life before starting any exercise program. You should see a medical or chiropractic physician before starting a fitness regime to make sure you are in good health and able to handle the rigors of increased physical activity. If you have any cardiovascular issues, a stress test should be performed. Many subsequent doctor visits are caused by improper fitness activities; it is better to see you doctor before rather than after.

All chiropractic physicians will be able to teach you about postural imbalances and how to improve your own posture, but many chiropractors have additional post-doctoral training in advanced postural biomechanics and structural correction to help you attain improved spinal dynamics. Ask your chiropractic physician to tell you about their training, and provide written documentation about their qualifications. To learn more about postural correction check out http://www.idealspine.com/. In addition, a Certified Pilates instructor, http://www.nypilates.info/, http://www.pilates-trainning.com/ or Certified Personal Trainer http://www.nsca-lift.org/, http://www.ncsf.org/ can have great benefit. Remember to check their qualifications as well.

Children and Whole Food Diets Dr. J. Shawn Leatherman

During at least some of their childhood, you've probably watched your son, daughter, nephew or niece notice, "the grass is definitely greener on the other side of the fence." One of the biggest challenges to your family's healthy lifestyle is your child's perception that other people are privileged simply because they eat differently. As a parent, your strategic awareness and preparation for your child's fascination with the Standard American Diet (SAD) is paramount.
Adults are just as bad, conforming to the SAD just because so many other people are doing it. Or, they ascribe to some new fad diet which promises to work especially for them. You must not conform to all majority cultural practices, especially practices that are kind of dumb, and definitely not good for your health?

At no time is the parents' advantage greater than in earliest childhood for understanding the crucial role of food in setting the course for either chronic disease or a lifetime of good health. You must establish a healthy routine. By the time a child is ready to start their schooling; he or she has already developed a strong interest in being like their friends and doing what their friends are doing. Don’t let them conform.

Capture the natural head start of early learning and use it to your advantage. The example you set begins with the prenatal diet, as well as the quality of your child's food sources and choices. Before your child is pulled by the influence of those outside your family, manifest healthful choices at home.

Use family time to create an atmosphere of a near-perfect healthy lifestyle. Your child will get used to this and will associate home and family with health for the rest of his or her life. Changing to a whole-food diet can of course be accomplished later, but it will be harder. Tantrums, grumbling and other exaggerations of angst may make your quest difficult. The earlier you do it, the easier it will be.

Create a Routine
An easy, healthy routine is your greatest strength. Become accustomed to buying, preparing and eating whole organic foods. Make them the first impulse for meal preparation. Your goal is to build a solid dietary foundation for your child, improving their overall habits for a lifetime. Eventually it will become second nature for them to reach for whole rather than processed foods and to value those produced without synthetic fertilizers, pesticides, MSG, artificial colors, sweeteners and preservatives.

Kids learn from experience to appreciate the great energized feeling they get from a handful of carrot sticks, a meal with dark leafy greens, or a glass of organic whole milk. Make raw vegetables and fresh fruits available instead of boxed or bagged chips, cookies etc… Not only are they better for child’s health, they don’t have extra packaging or get stale in 30 minutes.

If you are just now transitioning to a whole-food diet, let your children binge on as much whole healthy food as they want. The inherent advantage of eating whole fresh foods is their sheer bulk replaces the chemicals and denatured food derivatives that we might otherwise eat. Now they won’t be full of crap, just full. Some suggestions for starting your kids off:

1. Start early and maximize the effectiveness of your efforts.
   
   • Breast-fed babies have a huge lifetime of health advantages over formula-fed babies. You will never again have the opportunity to make such a strong health impact, and at less expense than formula feeding. If circumstances only allow you to breastfeed your baby for a short time, the multitude of advantages is enormous, and will manifest throughout your child's life.
2. The first solid foods a child eats should be whole foods. Cooked squash, carrots, broccoli and other vegetables, avocado, banana and watermelon are good choices.
   
   • Snacks and meals for toddlers and preschoolers should be entirely whole foods. Their beverage is water, and that's it, until you find an organic/raw milk source. And even then, the main beverage is water. As a matter of fact your infant should not have any milk other than breast milk until the age of 1 year. Toddlers don’t need to know that empty foods like pasta, cookies, and ice cream exist. They might fill you up, but they do not nourish! You should additionally stay away from citrus, strawberry, and peanut butter for the first year as they may trigger allergic responses. Also never give a child under the age of 2 honey!
   • Parents shout, "How can I feed them healthy food? Hot dogs, and macaroni & cheese are the only things that they'll eat?" Obviously these parents started off with the wrong items in the kitchen. They are going to have to endure some tantrums to establish a better way of eating. This will be made easier if you keep the TV away from them.
3. Television indoctrinates the ingestion of processed foods and pharmaceutical lifestyle.

The messages you're striving to keep your child away from are delivered continually, and are deliberately placed in children’s programming.

• “You deserve a break today”, or “I’m lovin’ it!”
• Eat out, or open a package to get your ready-made food.
• Pour yourself a glass of colored liquid … “OH YEAH!”
• Your life is just not happy until you take a pill, or two.
• If Superman likes it, so will you!
• And my favorites … “enriched” or “wholesome”

If you have to de-program what the TV is telling your kids, you won't be able to compete. Start your own program! Advertise healthy foods and exercise not only with your words, but with your actions as well.

Either get rid of the TV or keep it in a room that always remains locked. Plan to view occasionally with your child and explain why sweet foods on TV are not good choices. Yes, this will force you to actually interact with your children more, but aren’t they worth it? Don’t you want to keep them away from pressure marketing? Don’t you want them to be free thinkers? Obviously you are not going to get rid of the TV. But the concept is to be aware of what they watch and monitor what exposure you allow them to have with television as well as their diets! Remember that their lifetime nutritional choices start with your choices, you are MOM and DAD, you are everything. Make your input count.