The Kidfixer Newsletter

A quarterly newsletter from Doctors Mesibov, Altman, Jacobs & Rubinos            Autumn 2017


Are Early Physical Activity and Sedentary Behaviors Related to Working Memory at 7 and 14 Years of Age?

From the Journal of Pediatrics

The question a recent study asked is the following: Are healthy lifestyle habits, such as high levels of physical activity and low levels of sedentary behavior, necessary for the development of basic learning, motor, and social skills in children? The results of the study: A resounding YES!

One of the most relevant executive functions for learning is working memory, the ability to keep information “online” for a short period of time for cognitive processing. Working memory develops significantly across childhood and adolescence, which has important implications for academic achievement. The authors of this study aimed to investigate the association between physical activity and sedentary behavior at preschool age and working memory later in childhood and again in adolescence.

Data on extracurricular physical activity and sedentary behavior were collected through questionnaires administered to parents when children were 4 and 6 years of age. Parents answered the following question regarding physical activity, “During a typical week, how long does your child perform extracurricular exercise in each day, eg, dance/swimming lessons, or just playing, running, cycling, skating, swimming, etc.?” Also, “How many hours does your child watch TV per week?”, and “Outside school, how long does your child dedicate to games or sedentary activities (eg, puzzles, books, dolls, homework, computer/video games)?”

The result? Low levels of extracurricular physical activity at 4 and 6 years of age were associated with poorer cognitive performance in terms of working memory at 7 years of age and at 14 years of age as well.

Conversely, there was a positive association between extracurricular physical activity levels at 4 years of age and working memory performance at 7 years of age. Regarding older children, the results indicated that time spent in extracurricular physical activity at 6 years of age predicted working memory performance 8 years later.

In conclusion, this study showed that low physical activity levels at preschool age may be associated with poorer working memory performance at primary school age  and in adolescence as well. Or, to put it another way, it’s never to early to get your preschooler away from the TV, iPad and Game Boy, and into some good physical activity.

Linking Diet and Headaches

Certain foods and drinks are more often headache triggers than others

From the Tufts Nutrition Newsletter

People get headaches for many different reasons. Sometimes they may be triggered by what we eat or drink. Going too long without eating also may trigger headaches.

"Certain foods are notorious for causing headaches," says Egilius Spierings, MD, PhD, a neurologist, clinical professor and director of the Headache & Face Pain Program at Tufts Medical Center. "Examples include dark chocolate, aged cheeses, cured meats and alcohol, as well as certain additives, such as MSG (monosodium glutamate) and nitrites." Dietary triggers of headache for one person may not affect someone else. Still, it's helpful to know more common dietary culprits.


Compounds called biogenic amines such as histamine, tyramine and phenylethylamine, may contribute to headaches in some people. Certain foods, such as tomatoes, avocados and spinach, naturally contain higher amounts of histamine and/or tyramine. Dark chocolate contains phenylethylamine.

Amounts of biogenic amines are generally highest in foods in which bacteria break down certain amino acids, such as during fermentation or as the food ages, ripens or spoils. Examples are alcoholic beverages, fermented vegetables (like sauerkraut), processed meats (like salami), aged cheeses (like Swiss), soy sauce and some fish, particularly if mishandled.

But, most people eat such foods without problem. "People have enzymes in their gut that help break down biogenic amines," says Vincent Martin, MD, director of the University of Cincinnati Headache and Facial Pain Center. "But, some people have decreased activity of such enzymes. For example, activity of diamine oxidase, an enzyme that breaks down histamine, has been found to be significantly lower in certain subgroups of migraine sufferers compared to non-migraine groups."

Alcoholic Drinks:

Alcohol is a vasodilator, which means it causes blood vessels to expand. Tufts' Spierings explains that when blood vessels in the brain expand, the nerve fibers coiled around them are stretched. That activates the nerve fibers and can cause the release of inflammatory chemicals and pain.

"In addition to alcohol itself, certain products of fermentation (including histamine and tyramine) in alcoholic beverages, such as whiskey, beer and wine, may trigger a headache," Spierings says. "Many of these fermentation products dilate blood vessels."

Some people link red wine with headaches and attribute this to sulfites, which may be added as a preservative. But, realize that white wines often contain more sulfites than red wine. More likely headache culprits in red wine are phenolic flavonoids (such as tannins), which typically are much higher in red wine than white wine. Histamine may be another culprit, as red wine may have up to 200-fold more histamine than white wine.


"Caffeine is a vasoconstrictor," Spierings says. "When you have caffeine in your system all of the time on weekdays, and then it wears off on the weekend [when you don’t get your typical coffee or other caffeinated drinks], you get rebound vasodilation. The result is a headache."

Caffeine-withdrawal headaches are more likely with higher daily caffeine intake but can happen with as little as 100 milligrams of caffeine a day. That's about what’s in a cup of coffee or 2 cups of tea.

"It's reasonable for migraine-prone people to continue drinking caffeinated beverages, but they should keep the daily amount small to moderate (such as 1 or 2 cups coffee) and maintain a regular schedule of drinking it," Martin says. "If they can’t keep a consistent dose and schedule, it may be best for them to avoid caffeine."


Headaches may be a symptom of celiac disease (a genetic-based illness requiring complete elimination of gluten, a protein in wheat, rye and barley). "Approximately 1 in 5 people with confirmed celiac disease suffer from headaches," says John Leung, MD, director of the Center for Food Related Diseases at Tufts Medical Center and a clinical assistant professor at Tufts' Friedman School. "And, research shows 57 to 71% of celiac patients' headaches improve with a strict gluten-free diet. Headache also is a common complaint in those with non-celiac gluten sensitivity and in wheat allergy."

Finding Triggers:

A headache may not develop until a few hours after eating a food, or even the next day. Elimination diets and food/symptom diaries may help (details, above, right). Headache specialists can help identify other causes of recurring headaches (such as muscle tension, dehydration or monthly hormonal changes in women) and prescribe medication.

Going trick-or-treating? Here are Some Safety Tips

From the CDC

Swords, knives, and other costume accessories should be short, soft, and flexible.
Avoid trick-or-treating alone. Walk in groups or with a trusted adult.
Fasten reflective tape to costumes and bags to help drivers see you.
Examine all treats for choking hazards and tampering before eating them. Limit the amount of treats you eat.

Hold a flashlight while trick-or-treating to help you see and others see you. WALK and don’t run from house to house.
Always test make-up in a small area first. Remove it before bedtime to prevent possible skin and eye irritation.
Look both ways before crossing the street. Use crosswalks wherever possible.
Lower your risk for serious eye injury by not wearing decorative contact lenses.
Only walk on sidewalks whenever possible, or on the far edge of the road facing traffic to stay safe.
Wear well-fitting masks, costumes, and shoes to avoid blocked vision, trips, and falls.
Eat only factory-wrapped treats. Avoid eating homemade treats made by strangers.
Enter homes only if you’re with a trusted adult. Only visit well-lit houses. Never accept rides from strangers.
Never walk near lit candles or luminaries. Be sure to wear flame-resistant costumes.

6 Ways to Encourage Your Child to Eat Fish

From Parenting Magazine

Nutritionally speaking, fish is a great catch for kids: The omega 3's in fatty fishes like salmon have brain-boosting power, and some varieties are rich in vitamin D, which experts are urging everyone to get more of. Plus, the American Academy of Pediatrics says fish is fine for kids under a year old. In fact, a new study has found that babies who eat fish before 9 months have a reduced risk of developing eczema. Of course, you'll want to limit ones that are high in mercury (swordfish, shark, tilefish, king mackerel, and white albacore tuna), but barring those, the ocean is yours! How to bring out the seafood lover in your child:

1. Be super-picky when it comes to bones. Just one stray can be irreversibly "ewwww"-inspiring for some kids (not to mention potentially dangerous).

2. Keep it moist. Poaching any type of fish, especially white-fleshed ones like flounder and sole, in a little water or broth will allow it to cook thoroughly without drying out. Plus, it's easy: Depending on the fish, you can be eating in a few minutes or less!

3. Mix it up. Try this kid-friendly version of a classic Italian tuna ragout: Drain and dump a can of chunk light tuna (the safer type) into a pot, add your family's fave jarred tomato sauce, heat, and spoon over pasta.

4. Fish the frozen-food aisle. No time to cook? Shop for pre-prepped fish sticks (check labels for baked ones made from whole fish fillets with no fillers), salmon burgers, or marinated fillets that you can just heat and serve. Done!

5. Deem it dippable. Serve up fish sticks or bite-size pieces of those store-bought salmon burgers with ketchup, tartar sauce, honey mustard, or ranch.

6. Sneak it in at snack time. Mix canned wild salmon with mayo or plain Greek yogurt and spread on whole-grain crackers.

What is She Saying?! Does your Child Articulate Properly for Her Age?

As your child learns new words and phrases, it sometimes can be difficult to know exactly what she’s saying. This is quite normal, since the acquisition of a new vocabulary is not always in sync with clearer speech. The child of 2, for example, will usually begin combining words into phrases, while the 3 year-old may already be making 3 and 4 word sentences. These phrases and sentences will soon become familiar to a parent, who hears them frequently and in context, while to grandma, it may sound like gibberish.

How then does one know if a child’s articulation — or clarity of speech — is appropriate? The following test will give you a clue that your child is progressing as expected. Have your child repeat each of the following words after you. Each highlighted sound is worth 1 “point.” You’ll see that some words have 2 possible points. Add up all the points that your child gets from repeating the words, and compare her score to the norms below.

1. Table

2. shiRt

3. Door

4. trUNk

5. Jumping

6. zipPER

7. GRapes

8. FLag

9. THumb

10. tooTHbrush

11. Sock

12. vacUUm

13. Yarn

14. & 15. MoTHer

16. TWinkle

17. & 18. WagoN

19. & 20. GuM

21. & 22. HouSe

23. & 24. PenCil

25. & 26. FiSH

27. leaF

28. caRRot

Evaluation should be made according to the following normal scores:

Age in years Number of Sounds

2 1/2 to 3     7 or more

3 to 3 1/2    15 or more

4 to 4 1/2    16 or more

4 1/2 to 5    18 or more

5 to 5 1/2    22 or more

5 1/2 to 6    24 or more

6 and older    25 or more

In addition: The child who is 2 1 / 2 to 3 should be understood at least 1 / 2 the time. The child of over 3 should be readily understood almost all the time.

Football & Brains: A Bad Match-up?

From the NY Times

We pediatricians think that team sports are terrific for young kids. They provide exercise (and keep kids off their iPads!), promote good relationships and teamwork, and give us parents something to cheer for. Sadly, there is one team sport that makes us a bit ... squeamish. That’s football. Flag football is super, but watching kids play tackle football at a young age gives us a ... headache? The following article, excerpted from a recent NY Times article, explains why:

Athletes who began playing tackle football before the age of 12 had more behavioral and cognitive problems later in life than those who started playing after they turned 12, a new study released on Tuesday showed. The findings, from a long-term study conducted by researchers at Boston University, are likely to add to the debate over when, or even if, children should be allowed to begin playing tackle football.

The study by researchers at Boston University, published in the journal Nature’s Translational Psychiatry, was based on a sample of 214 former players, with an average age of 51. Of those, 43 played through high school, 103 played through college and the remaining 68 played in the N.F.L. The researchers found that players in all three groups who participated in youth football before the age of 12 had a twofold “risk of problems with behavioral regulation, apathy and executive function” and a threefold risk of “clinically elevated depression scores.”

“The brain is going through this incredible time of growth between the years of 10 and 12, and if you subject that developing brain to repetitive head impacts, it may cause problems later in life,” Robert Stern, one of the authors of the study, said of the findings.

The study is consistent with earlier findings by Stern and others. That research found that retirees who started playing before 12 years old had diminished mental flexibility compared to those who began playing tackle football at 12 or older.

A growing number of scientists argue that because the human brain develops rapidly at young ages, especially between 10 and 12, children should not play tackle football until their teenage years.

Last year, doctors at Wake Forest School of Medicine used advanced magnetic resonance imaging technology to find that boys between the ages of 8 and 13 who played just one season of tackle football had diminished function in parts of their brains.

The N.F.L. has been promoting flag football as an even safer alternative, an implicit acknowledgment that parents are worried about the dangers of the sport and turning away from it. Participation in tackle football by boys ages 6 to 12 has fallen by nearly 20 percent since 2009.

Schools across the country have shut their tackle football programs because of safety concerns and a shortage of players. Large numbers of children have shifted to other sports like flag football, soccer, baseball and lacrosse.

Jon Butler, the executive director of Pop Warner football, said in a statement that the sport has changed significantly for the better since the players in the Boston University study participated decades ago. He said the organization’s medical advisory committee will review the study and “compare it against the number of recent studies that contradict these findings.” Pop Warner is facing a class-action lawsuit asserting that it knowingly put players in danger by ignoring the risks of head trauma. Other groups suggest that only flag football be played through the sixth grade and a limited version of tackle football in 7th and 8th grades.