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Be Well for Parents - October 2011 Issue

Feature: Video Game, Computer & TV Time Management

Feature: Video Game, Computer & TV Time Management

There’s no escaping screen-centered media these days. As parents, we see video games, computers and television occupying far too much of children’s time. And with research pointing out the negative effects of too much screen time – a sedentary lifestyle, lack of interest in schoolwork, reduced social interaction, even violent behavior – it’s no wonder we’re concerned.

“In this day there is virtually an invasion into the home of media – and very little we can do about it,” says Michael Manos, PhD, Head of the Center for Pediatric Behavioral Health at Cleveland Clinic Children’s Hospital. “Parents are rightfully concerned about the effects of it and what their children are exposed to.”

Entirely eliminating media from a child’s life is unrealistic. But because you can't control it completely, Dr. Manos says, the best thing to do is put parameters around it.

Limit recreational screen time

In general, Dr. Manos says, children from about ages 3 to 10 should be limited to one hour of screen time a day (including video games, the computer and TV) for anything other than schoolwork.

He explains that when children are very young, their primary engagement should be with their parents, adding, “there are absolutely no benefits to a child being propped in front of a television.” In fact, the American Psychological Association recommends that from birth until 3 years of age, a child’s exposure to television should be extremely limited.

Beyond age 10, Dr. Manos admits that limits may be tough to enforce. Although you may be able to control the hours of screen time at home, children will be going to their friends’ homes, where there may be no such limits.

Video games: A judgment call

Not all video games are bad, says Dr. Manos; many can be educational. However, most video games provide an exciting alternate reality that puts the gamer into a highly aroused state. The danger with this highly aroused state is that other activities such as schoolwork and chores, in contrast, then seem tame and boring. When children spend too much time playing video games, they may become apathetic about these ordinary activities.

Violent video games, however, are another matter. “There is a relationship between violent video games and violent and aggressive behavior,” Dr. Manos says. “Observing violent behavior increases the propensity for some children to imitate aggressive or violent behavior.”

Violent games have been shown to increase the gamer’s heart rate and put him or her into an aroused state in which aggressive emotions are increased, making it more likely that he or she will act in an aggressive way.

“Gamers of violent video games are no longer just watching violence – like an alien being killed – now they themselves are the killers,” he says. He notes that some games even reward players for committing crimes and killing people.

Use screen time as a reward

It’s always more difficult to withhold computer and television time from a child as punishment than it is to provide access to it based on appropriate behavior.

“Kids want to watch TV, and parents don’t want to fight,” Dr. Manos says.

But the key is to start young and have children “earn” access to screen time by engaging in schoolwork, social activities and chores around the house. “Rather than trying to pry it away from them, making the parent the punishing agent, children become responsible themselves for access to it,” he concludes.

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Tip: Emerging Social Butterflies: Let Kids Mingle

Tip: Emerging Social Butterflies: Let Kids Mingle

Kids have their ups and downs when it comes to friendships. But research shows they need at least one friend around their age to connect with. Sharing with peers helps children better manage the stresses of growing up – and keeps isolation and depression at bay. Put your kids in situations where they can bond with peers who share their interests. Then step back and let the conversation flow.

Parents Children's Health Essentials – October 2011 Issue

Feature: Does Your Child or Teen Need Flu Vaccine This Year?

Feature: Does Your Child or Teen Need Flu Vaccine This Year?

The answer is “yes” for everyone older than 6 months of age – and as early as possible. Both the Centers for Disease Control and Prevention and the American Academy of Pediatrics recommend that all children and adolescents be immunized against influenza. Immunization is especially important for children with chronic illnesses such as asthma.

This year’s seasonal flu vaccine is identical to last year’s trivalent vaccine and contains the three strains of influenza virus most likely to spread between October 2011 and March 2012.

Flu a danger even for healthy kids

While many people believe that healthy children can withstand a bout of flu, about half of the children who died last year from influenza were previously healthy and did not have an underlying medical condition. Despite the recommendation that all children over the age of 6 months be vaccinated against influenza, many of these deaths occurred in children who did not receive an influenza vaccination.

"This is unfortunate, as vaccination is the single most important influenza prevention measure," notes Charles Foster, MD, a Cleveland Clinic Children’s Hospital infectious disease specialist.

It’s wise to schedule your child’s or teen’s flu vaccination as soon as the vaccine becomes available – generally early each fall – to ensure protection when flu season starts. It takes about two weeks after vaccination for immune protection to begin. “It is especially important to begin the vaccine process early if children need two doses of vaccine,” says Dr. Foster.

Boosting your child’s protection

For younger children, the number of doses is important. “A single dose of the flu vaccine may not fully protect children younger than 9 years,” says Dr. Foster. “A second ‘booster’ dose is recommended the first year a child gets vaccinated.”

Why a booster? Because children who get only one dose but need two doses may not be protected against flu.

“Although this year’s influenza vaccine is identical to last year's, it is still important to get vaccinated this year,” he adds. “Immunity from vaccination declines over time, so for optimal protection it is important to get vaccinated yearly.”

Figuring out what your child needs

The number of trivalent seasonal influenza vaccine doses your child will require depends on the child’s age and vaccine history:

  • All children 6 months and older should get vaccinated against influenza.
  • Children age 9 and older need only one dose regardless of whether they have received earlier doses of influenza vaccine.
  • Children younger than 9 receiving trivalent seasonal influenza vaccine for the first time this season need a second dose (at least four weeks after the first).
  • Children younger than 9 who received just one dose of trivalent seasonal vaccine for the first time last season need two doses of trivalent influenza vaccine this year (at least four weeks apart).

If you have any questions about how many flu shots your child needs, talk to your pediatrician or family doctor.

Good news for healthy kids 2 and up

For children age 2 or older who are otherwise healthy, another option may be available: nasal flu mist instead of a flu shot. The flu mist is a live attenuated influenza vaccine given as a nasal spray.

“If your child is younger than 2, or if your child has a chronic medical problem such as asthma or diabetes, then he or she will need the flu shot,” says Dr. Foster.

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Parents Children's Health Essentials – October 2011 Issue

Feature: Guess the Top Health Concerns for Men & Women

Guess the Top Health Concerns for Men & Women

We think we’re invulnerable when we’re young, but when we reach our late 30s, health concerns start cropping up. Major health concerns vary by age, notes Cleveland Clinic internist Raul Seballos, MD, Vice Chair of Preventive Medicine.

“Men in their 60s worry more about prostate cancer, while men in their 50s are more concerned about heart disease or ED (erectile dysfunction),” he says. “Women in their 50s are more concerned about menopause, while osteoporosis becomes a concern for women in their 60s.”

See if you've got a handle on the top health concerns for men and women. Some are unique to men, some are unique to women, and some are shared.

Here they are, in order:

Top health concerns for men
  1. Prostate cancer
  2. Heart disease risks, including high blood pressure and high cholesterol
  3. Erectile dysfunction
  4. Weight management with age
  5. Diabetes
  6. Stroke
Top health concerns for women
  1. Breast cancer
  2. Heart disease risks, including high blood pressure and high cholesterol
  3. Osteoporosis
  4. Menopause treatment options
  5. Weight management with age
  6. Diabetes
  7. Stroke

For health issues affecting both men and women, Dr. Seballos offers these tips:

Heart disease/high blood pressure/high cholesterol

If heart disease runs in your family or if your blood pressure or cholesterol levels are high, ask your doctor about taking medications to lower your blood pressure and cholesterol levels, and whether a daily aspirin might help. Your doctor will keep tabs on your cholesterol levels and blood pressure, and can order cardiac stress tests if any concerns about heart disease arise.

Weight management with age

As we age and our metabolisms slow down, it’s smarter than ever to right-size our meals by eating smaller portions of healthier food. Exercise also becomes increasingly important, to maintain flexibility and mobility. Both of these measures will help to prevent type 2 diabetes, arthritis and other weight-related problems.


Nearly 79 million Americans have prediabetes (elevated blood sugar), the precursor to type 2 diabetes. Type 2 diabetes can lead to heart disease, stroke, kidney failure, blindness and loss of limb. If you have prediabetes, studies show that a healthier diet and increased activity can restore your blood sugar to normal and prevent diabetes. Controlling your weight, cholesterol and blood pressure are critical, and if you smoke, it’s more important than ever to quit.


Become familiar with warning strokes or transient ischemic attacks (TIAs). If you or someone you know develops weakness or numbness of the face, arm or leg(s), confusion, speech or comprehension problems, vision loss, dizziness, or difficulty with walking, balance or coordination, call 9-1-1. Immediate treatment in the emergency department with clot-busting medication can be lifesaving.

For men with the following health concerns, Dr. Seballos has this advice:

Prostate cancer

Schedule a prostate screening, including a simple blood test of PSA levels, every year starting at age 50. If your father or brothers developed prostate cancer early or if you are African-American, start screening at age 40 or 45. Fortunately, prostate cancer is highly curable when caught early. Today, not every man with a high PSA level has to have surgery or radiation therapy. Depending upon age and risk factors, surveillance, or “watchful waiting,” may be recommended.

Erectile dysfunction

ED is very common, especially if you have developed diabetes or have had your prostate removed. In addition, men with ED are 1.6 times more likely to suffer a heart attack or stroke. That’s why it’s important to discuss your cardiovascular risk factors with your physician before asking for one of the ED medications.

For women with the following health concerns, Dr. Seballos has these pointers:

Breast cancer

In your 20s and 30s, get a clinical breast exam by a health professional at least every three years; after age 40, get an exam every year. Breast self-exam (BSE) is an option in your 20s and beyond, but know its benefits and limitations, and report any breast changes to a health professional right away. At age 40, start yearly screening mammograms, and continue them for as long as you’re in good health. Have any abnormality on a breast exam or mammogram checked out right away; if an abnormality is found, you may need more frequent mammograms. If there is breast cancer in the family, you may need BRCA gene testing. Women with the BRCA 1 or BRCA2 gene mutation are at very high risk of breast cancer.


Exercise is your friend when it comes to bone health. Being physically active, and getting adequate calcium and vitamin D in your diet or through supplements are some of the steps you can take to prevent bone fragility and fractures. It’s also important to avoid smoking, which weakens your bones.

Menopause and its treatments

Menopause does bring “change,” but talk to your doctor if symptoms arising from changing female hormone levels become troublesome. Hormone replacement therapy (HRT) can help some women manage hot flashes and night sweats, mood swings and other problems. A risk profile will determine whether or not HRT is right for you.

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Recipe: Grilled Chicken & Vegetable Pasta Toss

Recipe: Vegetable Cream Cheese Pinwheels

Make delicious pinwheels from whole wheat tortillas, light vegetable cream cheese and a healthy array of veggies.


2 8-ounce containers light vegetable cream cheese, softened
4 whole-wheat tortillas (12-inch size)
2 green onions, minced
½ cup red bell peppers, diced
½ cup celery, diced
¼ cup black olives, drained and diced
¼ cup carrots, shredded

  1. In mixing bowl, blend cream cheese and green onions.
  2. Spread cream cheese blend over each tortilla evenly. Sprinkle celery, red bell peppers, black olives and carrots on top of cream cheese spread.
  3. Roll up each tortilla tightly.
  4. Wrap tortillas in plastic wrap and chill for two hours.
  5. Just before serving, slice each tortilla roll into 1-inch pieces.

Makes 48 servings


Per serving:
48 calories
2 g fat
1 g saturated fat
2 g protein
5 g carbohydrates
5 mg cholesterol
89 mg sodium
25 mg potassium
0.6 g fiber

Recipe from our Children's Hospital Pediatric Nutrition Support Team

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Parents Children's Health Essentials – October 2011 Issue

Let's Move It! Free Mobile App

Let Cleveland Clinic and your mobile phone keep you motivated. More than just a pedometer, our free mobile app offers walking challenges, a calorie tracker and videos to encourage and inspire.