Tag Archives: Pediatrics

Pediatrics study: TV Ratings System Downplays Sex, Violence, Smoking

30 Aug

Some one told moi a story about a woman who wanted to introduce her 12 year old son to culture. The way she set about the introduction was to buy tickets for the entire Ring by Wagner. Perhaps, her son thoroughly enjoyed the Ring. More likely, he probably developed a hatred for opera. About the time that school starts around the beginning of September, many arts organizations begin their season. It is good to introduce your child to all types of artistic endeavors, but one should chose wisely by looking for cues as to what the child’s interests are and having an awareness of content. Barbara J. Wilson, Ph.D. wrote the thoughtful article, What’s Wrong with the Ratings? http://www.medialit.org/reading-room/whats-wrong-ratings

Education News reported in Report: TV Ratings System Downplays Sex, Violence, Smoking:

A new study recently published in the journal Pediatrics suggests that the TV rating system currently in place in the United States is inaccurate and does not always reflect the true amount of violence, smoking, and drinking occurring in television shows.

The study found TV Parental Guidelines ratings to be ineffective in three out of the four behaviors studied.  In addition, at least one risk factor was noted in every show, including shows for children as young as seven.

In all, researchers looked at 17 TV shows for instances of violence, sexual behavior, alcohol use, and smoking.  Findings suggest shows that held a rating of TV-Y7, intended for children age seven or older, had similar levels of violence as shows rated TV-MA, meant for mature audiences only.

“From prior research, we know that youth between 8 and 18 years consume, on average, 7.5 hours a day of media content,” said Joy Gabrielli, lead author of the study and a clinical child psychologist at the Geisel School of Medicine at Dartmouth.

Gabrielli added that young children and teens watch shows on televisions as well as on additional forms of digital media, such as telephones and tablets.

The Telecommunications Act of 1996 mandated the creation of a TV rating system and a hardware, or V-chip, that would allow parents to block any questionable content.  As a result, the TV Parental Guidelines were created in addition to a monitoring board to ensure accuracy, uniformity, and consistency of the guidelines, reports Susan Scutti for CNN.

Violence was found in 70% of all episodes looked at for at least 2.3 seconds per episode minute.  Meanwhile alcohol was seen in 58% of episodes for 2.3 seconds per minute, sexual behavior in 53% of shows for 0.26 seconds per minute, and smoking in 31% of shows for 0.54 seconds per minute.

Shows rated TV-Y7 were found to show significantly less substance abuse.  However, other rating categories did not discriminate substance use as well, which was seen as much in shows rated TV-14 as they were in shows rated TV-MA.

TV ratings were found to be the most effective for sexual behavior and gory violence.


See, TV rating system not accurate, little help to parents, study says     http://www.cnn.com/2016/08/22/health/tv-ratings-not-accurate-parents/


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August 2016

Industry Television Ratings for Violence, Sex, and Substance Use

Joy Gabrielli, Aminata Traore, Mike Stoolmiller, Elaina Bergamini, James D. Sargent

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OBJECTIVE: To examine whether the industry-run television (TV) Parental Guidelines discriminate on violence, sexual behavior, alcohol use, and smoking in TV shows, to assess their usefulness for parents.

METHODS: Seventeen TV shows (323 episodes and 9214 episode minutes) across several TV show rating categories (TVY7, TVPG, TV14, and TVMA) were evaluated. We content-coded the episodes, recording seconds of each risk behavior, and we rated the salience of violence in each one. Multilevel models were used to test for associations between TV rating categories and prevalence of risk behaviors across and within episodes or salience of violence.

RESULTS: Every show had at least 1 risk behavior. Violence was pervasive, occurring in 70% of episodes overall and for 2.3 seconds per episode minute. Alcohol was also common (58% of shows, 2.3 seconds per minute), followed by sex (53% of episodes, 0.26 seconds per minute), and smoking (31% of shows, 0.54 seconds per minute). TV Parental Guidelines did not discriminate prevalence estimates of TV episode violence. Although TV-Y7 shows had significantly less substance use, other categories were poor at discriminating substance use, which was as common in TV-14 as TV-MA shows. Sex and gory violence were the only behaviors demonstrating a graded increase in prevalence and salience for older-child rating categories.

CONCLUSIONS: TV Parental Guidelines ratings were ineffective in discriminating shows for 3 out of 4 behaviors studied. Even in shows rated for children as young as 7 years, violence was prevalent, prominent, and salient. TV ratings were most effective for identification of sexual behavior and gory violence.

What’s Known on This Subject:

A voluntary, industry-run TV Parental Guidelines rating system has existed for 20 years to help parents decide which shows are appropriate for children; yet the usefulness of TV ratings in discriminating shows on risk-behavior depiction remains unclear.

What This Study Adds:

Violence was prevalent across all shows, regardless of rating, so parents could not rely on TV Parental Guidelines to screen for this behavior. Only TV-7 consistently predicted lower levels of sex, alcohol, or tobacco, compared with TV-PG, TV-14, and TV-MA.

Almost 20 years have passed since Congress approved the Telecommunications Act of 1996. In Section 551 (“Parental Choice in Television Programming”), Congress noted: (1) “television influences children’s perceptions of values and behavior common and acceptable in society,” (2) “television shows expose children to many depictions of violence,” (3) “children so exposed are prone to see violence as acceptable and have greater tendency for aggressive behavior,” (4) “casual treatment of sexual material on television erodes parental ability to develop responsible attitudes and behavior in their children,” (5) “parents express grave concern over violent and sexual programming,” and (6) “there is compelling governmental interest in empowering parents to limit these negative influences.”1 Congress instructed the telecommunications industry to develop a television (TV) ratings system and TV manufacturers to integrate hardware (the V-chip) to allow parents to block objectionable content

The TV industry responded that year with the TV Parental Guidelines, structured around a similar self-regulatory system previously developed for motion pictures. Shows are rated by the companies that produce them and classified into rating categories based on content and appropriateness for different age groups. The industry established a TV Parental Guidelines Monitoring Board to “ensure accuracy, uniformity, and consistency of the guidelines.”2 The rating categories were integrated into programming to allow parents to see the rating for each show and to block by rating (or channel) using V-chip technology.

In the ensuing 20 years, research confirms the prescience of Congress’ expressed concerns. Studies have identified relations between viewing media violence and aggression in children.3,4 Prospective studies have strengthened the notion that viewing sexual content on TV affects risky sexual behavior among adolescents and increases the risk of teen pregnancy.5,6 Moreover, studies have documented a robust relation between seeing depictions of smoking and drinking in movies and youth substance use.710 Subsequently, concerns about media effects on youth behavior appear even more justified by the science, and research suggests that parental guidelines should include behaviors beyond sex and violence, such as alcohol and tobacco use.11

As stated in their own documentation, the TV industry recognized that the usefulness of the TV Parental Guidelines for informing parents would be based in part on their “accuracy, uniformity and consistency.”2 In a literature search on “TV Parental Guidelines” we were able to identify studies that either examined, through content coding, the presence of various risk behaviors1214 or how parents perceive and use the ratings system,1517 but were surprised to find limited tests of its accuracy, uniformity, or consistency across risk behaviors. The present research is a first attempt to quantify violence, sex, and alcohol and tobacco use in a sample of TV programs according to the TV Parental Guideline rating category.


We selected TV shows across 4 rating categories (ie, TV-Y7, TV-PG, TV-14, and TV-MA) as defined by the TV Parental Guidelines.2 TV-Y7 is defined as being “directed to older children” (age 7 years and above). TV-PG is defined as “parental guidance suggested” and may “contain material that parents may find unsuitable for younger children.” TV-14 is denoted as “parents strongly cautioned,” as it is a program that “contains material that many parents would find unsuitable for children under 14 years of age.” TV-MA is listed as “mature audience only,” because it is a program “specifically designed to be viewed by adults and therefore may be unsuitable for children under 17.” Seven shows were purposively chosen because they were popular with youth (identified through the Nielsen list of shows most popular with youth aged 12–17 years), and 10 other shows were purposively chosen given the high likelihood of the presence of risk behaviors with the intent to maximize statistical power to find TV rating effects, if they existed. The 17 shows (154 hours across 323 episodes) with descriptions of air times, ratings, and episodes are provided in Table 1.


Listing of TV Program Sample


Here is the Pediatrics statement on media:

Media and Children

Media is everywhere. TV, Internet, computer and video games all vie for our children’s attention. Information on this page can help parents understand the impact media has in our children’s lives, while offering tips on managing time spent with various media. The AAP has recommendations for parents and pediatricians.

Today’s children are spending an average of seven hours a day on entertainment media, including televisions, computers, phones and other electronic devices. To help kids make wise media choices, parents should monitor their media diet. Parents can make use of established ratings systems for shows, movies and games to avoid inappropriate content, such as violence, explicit sexual content or glorified tobacco and alcohol use.

Studies have shown that excessive media use can lead to attention problems, school difficulties, sleep and eating disorders, and obesity. In addition, the Internet and cell phones can provide platforms for illicit and risky behaviors.

By limiting screen time and offering educational media and non-electronic formats such as books, newspapers and board games, and watching television with their children, parents can help guide their children’s media experience. Putting questionable content into context and teaching kids about advertising contributes to their media literacy.

The AAP recommends that parents establish “screen-free” zones at home by making sure there are no televisions, computers or video games in children’s bedrooms, and by turning off the TV during dinner. Children and teens should engage with entertainment media for no more than one or two hours per day, and that should be high-quality content. It is important for kids to spend time on outdoor play, reading, hobbies, and using their imaginations in free play.

Television and other entertainment media should be avoided for infants and children under age 2. A child’s brain develops rapidly during these first years, and young children learn best by interacting with people, not screens.

Additional Resources


Here is the press release from the American Academy of Pediatrics:

TV Ratings on Sex, Violence and Substance Abuse Offer Little Help to Parents


Research shows there is a relationship between young people seeing sexual content on television and the risk of teen pregnancy, seeing violence and teen aggression, and seeing depictions of smoking and drinking and youth substance use, which is why the US Congress asked the entertainment industry to develop a TV Parental Guidelines rating system over 20 years ago. However, a study conducted by researchers at the C. Everett Koop Institute at Dartmouth and published in the September 2016 Pediatrics (published online Aug. 22), “Industry Television Ratings for Violence, Sex and Substance Use,” shows these industry ratings were ineffective in warning parents about content that might not be appropriate for children to view. Researchers compared 323 episodes of 17 television shows for sex, violence, smoking and drinking, and found that only sex and gore were demonstrably more prevalent in mature rated shows. All other risk behaviors were pervasive across most rating categories, especially interpersonal violence (occurring in 70 percent of episodes) and alcohol use (in 58 percent of shows), but also smoking (31 percent). Study authors concluded that in this sample of shows, the ratings system did little to help parents discriminate and limit exposure to these behaviors. More research is needed across more television shows to monitor and improve the TV Parental Guidelines.
The American Academy of Pediatrics is an organization of 66,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org.


What Questions Should a Parent Ask a Venue About Content?

Does a particular venue have a ratings system for content?

What is the model for the ratings system? Is it like film ratings or ESRB?

How descriptive is the rating system, does it give examples of the type of language or situation which might be problematic?

Where is the rating for each production listed? Is it in the descriptive brochure? Is this information on the web site? Are box office personnel familiar with the ratings?

If a family has concerns about a particular production, how should concerns be addressed to the venue if the family finds the production does not match the rating description?

Families have different viewpoints about what is appropriate content for their child or children. Some families seek out a variety of experiences for their children while others are more restrained in what they feel is appropriate. All families need to ask questions about content to find what is appropriate for their child and their value system.

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Concussions: American Academy of Pediatrics issued recommendations for “return to learn” checklists

27 Oct

Moi wrote in Don’t ignore concussions:
Kids Health has some great information about concussions at their site:

What Is a Concussion and What Causes It?
The brain is made of soft tissue and is cushioned by spinal fluid. It is encased in the hard, protective skull. When a person gets a head injury, the brain can move around inside the skull and even bang against it. This can lead to bruising of the brain, tearing of blood vessels, and injury to the nerves. When this happens, a person can get a concussion — a temporary loss of normal brain function.
Most people with concussions recover just fine with appropriate treatment. But it’s important to take proper steps if you suspect a concussion because it can be serious.
Concussions and other brain injuries are fairly common. About every 21 seconds, someone in the United States has a serious brain injury. One of the most common reasons people get concussions is through a sports injury. High-contact sports such as football, boxing, and hockey pose a higher risk of head injury, even with the use of protective headgear.
People can also get concussions from falls, car accidents, bike and blading mishaps, and physical violence, such as fighting. Guys are more likely to get concussions than girls. However, in certain sports, like soccer, girls have a higher potential for concussion.http://kidshealth.org/teen/safety/first_aid/concussions.html#a_What_Is_a_Concussion_and_What_Causes_It_

See, Update: Don’t ignore concussions https://drwilda.com/2012/05/20/update-dont-ignore-concussions/

Jan Hoffman reported in the New York Times article, Concussions and the Classroom:

Because of heightened awareness about the hazards of sports-related concussions, many states have implemented standards determining when an injured student may resume playing contact sports. But only a few states have begun to address how and when a student should resume classwork.
On Sunday the American Academy of Pediatrics issued recommendations for “return to learn” checklists to alert doctors, school administrators and parents to potential cognitive and academic challenges to students who have suffered concussions.
“They’re student athletes, and we have to worry about the student part first,” said Dr. Mark E. Halstead, the lead author of “Returning to Learning Following a Concussion,” a clinical report in this week’s Pediatrics.
For adolescents prone to risk-taking behaviors, concussions are not just the nasty by-products of sports. Dr. Halstead, an assistant professor in pediatric sports medicine at Washington University, recently treated a 15-year-old girl whose concussion came not from a soccer match, but because “she was running backwards in a school hallway and cracked heads with someone.”
The academy emphasized that research about recovery protocols and cognitive function is scant: There is no established rest-until-recovered timeline. The new recommendations are based on expert opinions and guidelines developed by the Rocky Mountain Youth Sports Medicine Institute in Denver.
Doctors generally recommend that a student with a concussion rest initially, to give the brain time to heal. That may mean no texting, video games, computer use, reading or television. But there’s a big question mark about the timing and duration of “cognitive rest.” Experts have not identified at what point mental exertion impedes healing, when it actually helps, and when too much rest prolongs recovery. Although many doctors are concerned that a hasty return to a full school day could be harmful, this theory has not yet been confirmed by research.
The student’s pediatrician, parents and teachers should communicate about the incident, the recommendations said, and be watchful for when academic tasks aggravate symptoms such as headaches, dizziness, sensitivity to light and difficulty concentrating. The academy acknowledged that case management must be highly individualized: “Each concussion is unique and may encompass a different constellation and severity of symptoms.”
Most students have a full recovery within three weeks, the article said. But if the recovery seems protracted, specialists should be consulted.
Many school officials do not realize they can make simple accommodations to ease the student’s transition back to the classroom, the academy said.
To alleviate a student’s headaches, for example, schedule rests in the school nurse’s office; for dizziness, allow extra time to get to class through crowded hallways; for light sensitivity, permit sunglasses to be worn indoors. Students accustomed to 45-minute classes might only be able to sit through 30 minutes at the outset, or attend school for a half-day.
“Parents need to follow up with schools and make sure plans are being followed,” Dr. Halstead said…. http://well.blogs.nytimes.com/2013/10/27/concussions-and-the-classroom/?ref=education&_r=0


From the American Academy of Pediatrics
Clinical Report
Returning to Learning Following a Concussion
1. Mark E. Halstead, MD, FAAP,
2. Karen McAvoy, PsyD,
3. Cynthia D. Devore, MD, FAAP,
4. Rebecca Carl, MD, FAAP,
5. Michael Lee, MD, FAAP,
6. Kelsey Logan, MD, FAAP,
7. Council on Sports Medicine and Fitness, and Council on School Health
Following a concussion, it is common for children and adolescents to experience difficulties in the school setting. Cognitive difficulties, such as learning new tasks or remembering previously learned material, may pose challenges in the classroom. The school environment may also increase symptoms with exposure to bright lights and screens or noisy cafeterias and hallways. Unfortunately, because most children and adolescents look physically normal after a concussion, school officials often fail to recognize the need for academic or environmental adjustments. Appropriate guidance and recommendations from the pediatrician may ease the transition back to the school environment and facilitate the recovery of the child or adolescent. This report serves to provide a better understanding of possible factors that may contribute to difficulties in a school environment after a concussion and serves as a framework for the medical home, the educational home, and the family home to guide the student to a successful and safe return to learning.

Here is the press release:

After a Concussion Students May Need Gradual Transition Back to Academics
American Academy of Pediatrics offers new guidance on “returning to learning” after concussion
ORLANDO, Fla. — A concussion should not only take a student athlete off the playing field – it may also require a break from the classroom, according to a new clinical report from the American Academy of Pediatrics (AAP).
In the clinical report, “Returning to Learning Following a Concussion,” released Sunday, Oct. 27 at the AAP National Conference & Exhibition in Orlando, the AAP offers guidance to pediatricians caring for children and adolescents after suffering a concussion.
“Students appear physically normal after a concussion, so it may be difficult for teachers and administrators to understand the extent of the child’s injuries and recognize the potential need for academic adjustments,” said Mark Halstead, MD, FAAP, a lead author of the clinical report. “But we know that children who’ve had a concussion may have trouble learning new material and remembering what they’ve learned, and returning to academics may worsen concussion symptoms.”
Dr. Halstead will deliver a plenary address on concussion injuries at 10:30 a.m. ET Oct. 27 at the Orange County Convention Center. A news briefing on the new clinical report will immediately follow. Reporters interested in covering either event should check in at the press room, W203B.
Research has shown that a school-aged student usually recovers from a concussion within three weeks. If symptoms are severe, some students may need to stay home from school after a concussion. If symptoms or mild or tolerable, the parent may consider returning him or her to school, perhaps with some adjustments. Students with severe or prolonged symptoms lasting more than 3 weeks may require more formalized academic accommodations.
The AAP recommends a collaborative team approach to help a student recovering from a concussion. This team should consist of the child or adolescent’s pediatrician, family members and individuals at the child’s school responsible for both the student’s academic schedule and physical activity. Detailed guidance on returning to sports and physical activities is contained in the 2010 AAP clinical report, “Sport-Related Concussion in Children and Adolescents.”
A symptom checklist can help evaluate what symptoms the student is experiencing, and how severe they are.
“Every concussion is unique and symptoms will vary from student to student, so managing a student’s return to the classroom will require an individualized approach,” said Dr. Halstead. “The goal is to minimize disruptions to the student’s life and return the student to school as soon as possible, and as symptoms improve, to increase the student’s social, mental and physical activities.”
Because relatively little research has been conducted on how concussion affects students’ learning, the AAP based its report primarily on expert opinion and adapted it from a concussion management program developed at the Rocky Mountain Hospital for Children, Center for Concussion in Denver, Colo. The AAP calls for further research on the effects and role of cognitive rest after concussion to improve understanding of the best ways to help a student recovering from a concussion.
Information for parents about returning to learning after a concussion also will be available on HealthyChildren.org (starting Oct. 27).
The American Academy of Pediatrics is an organization of 60,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit http://www.aap.org.

Parents must be alert to what is happening with the children when they participate in athletic events and activities.




Concussion – Overview

Related :

Study: Effects of a concussion linger for months

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Harvard study: More children showing signs of adult illnesses like hypertension

16 Jul

Moi wrote in Study: Parental education reduces childhood obesity, but more physical activity may be needed:
The goal of this society should be to raise healthy and happy children who will grow into concerned and involved adults who care about their fellow citizens and environment. In order to accomplish this goal, all children must receive a good basic education and in order to achieve that goal, children must arrive at school, ready to learn. There is an epidemic of childhood obesity and obesity is often prevalent among poor children. The American Heart Association has some great information about Physical Activity and Children http://www.heart.org/HEARTORG/GettingHealthy/Physical-Activity-and-Children_UCM_304053_Article.jsp#.TummU1bfW-c
Because many children are obese, they are at increased risk of adult diseases.

Alexandra Sifferlin reports in the Time article, Sick Before Their Time: More Kids Diagnosed With Adult Diseases:

Diabetes, obesity and elevated blood pressure typically emerge in middle-age, but more young children are showing signs of chronic conditions that may take a toll on their health.
The latest report on the trend, from researchers at Harvard Medical School found that children and adolescents are increasingly suffering from elevated blood pressure. Published in the American Heart Association journal Hypertension, the study showed a 27% increase in the proportion of children aged 8 years to 17 years with elevated blood pressure over a thirteen-year period.
The scientists compared over 3,200 children involved in the National Health and Nutrition Examination Survey (NHANES) III in 1988-1994 to over 8,300 who participated in NHANES in 1999-2008. The national survey records health, eating and lifestyle behaviors of the volunteers. More kids in the recent survey were overweight, with larger waistlines than those in the previous cohort. And the children with body mass index (BMI) readings in the top 25% of their age group were two times more likely to have elevated blood pressure than the kids in the bottom 25%.
The kids did not have diagnosed hypertension, which requires a threshold of 140 -90, but elevated blood pressure — anything above 120-80 — at such young ages could prime them for hypertension later. “High blood pressure is dangerous in part because many people don’t know they have it,” said lead study author Bernard Rosner, a professor of medicine at Harvard Medical School in a statement.
The results are only the latest to reveal the first signs of chronic conditions that normally don’t occur until middle-age, in children and teens.


Childhood Blood Pressure Trends and Risk Factors for High Blood Pressure
The NHANES Experience 1988–2008
1.Bernard Rosner,
2.Nancy R. Cook,
3.Stephen Daniels,
4.Bonita Falkner
+ Author Affiliations
1.From the Childhood Blood Pressure Trends and Risk Factors for High Blood Pressure, Boston, MA; Professor and Chairman, Department of Pediatrics, University of Colorado School of Medicine, Aurora CO (S.D.); and Professor of Medicine and Pediatrics, Thomas Jefferson University, Philadelphia, PA (B.F.).
1.Correspondence to Bernard Rosner, Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, 181 Longwood Ave, Boston, MA 02115. E-mail stbar@channing.harvard.edu
The obesity epidemic in children makes it plausible that prevalence rates of elevated blood pressure (BP) are increasing over time. Yet, previous literature is inconsistent because of small sample sizes. Also, it is unclear whether adjusting for risk factors can explain longitudinal trends in prevalence of elevated BP. Thus, we analyzed a population-based sample of 3248 children in National Health and Nutrition Examination Survey (NHANES) III (1988–1994) and 8388 children in continuous NHANES (1999–2008), aged 8 to 17 years. Our main outcome measure was elevated BP (systolic BP or diastolic BP ≥90th percentile or systolic BP/diastolic BP ≥120/80 mm Hg). We found that the prevalence of elevated BP increased from NHANES III to NHANES 1999–2008 (Boys: 15.8% to 19.2%, P=0.057; Girls: 8.2% to 12.6%, P=0.007). Body mass index (Q4 versus Q1; odds ratio=2.00; P<0.001), waist circumference (Q4 versus Q1; odds ratio=2.14; P<0.001), and sodium (Na) intake (≥3450 mg versus <2300 mg/2000 calories; odds ratio=1.36; P=0.024) were independently associated with prevalence of elevated BP. Also, mean systolic BP, but not diastolic BP, was associated with increased Na intake in children (quintile 5 [Q5] versus quintile 1 [Q1] of Na intake; β=1.25±0.58; P=0.034). In conclusion, we demonstrate an association between high Na intake and elevated BP in children. After adjustment for age, sex, race/ethnicity, body mass index, waist circumference, and sodium intake, odds ratio for elevated BP in NHANES 1999–2008 versus NHANES III=1.27, P=0.069.
Key Words:
blood pressure
body mass index
National Health and Nutrition Examination Survey
nutrition surveys
waist circumference
Received December 10, 2012.
Revision received January 8, 2013.
Accepted May 13, 2013.
© 2013 American Heart Association, Inc.

The issue of childhood obesity is complicated and there are probably many factors. If a child’s family does not model healthy eating habits, it probably will be difficult to change the food preferences of the child. Our goal as a society should be:

A healthy child in a healthy family who attends a healthy school in a healthy neighborhood ©


University of Illinois Chicago study: Laws reducing availability of snacks are decreasing childhood obesity

New emphasis on obesity: Possible unintended consequences, eating disorders https://drwilda.wordpress.com/2012/01/29/new-emphasis-on-obesity-possible-unintended-consequences-eating-disorders/

Childhood obesity: Recess is being cut in low-income schools

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