Author: Vincent Iannelli, MD

Is Acute Flaccid Myelitis Contagious?

Many people were surprised by a comment by Dr. Robert Redfield, the director of the Centers for Disease Control and Prevention, in an interview for “CBS This Morning,” during which he said that acute flaccid myelitis:

“doesn’t appear to be transmissible from human to human.”

Wait, then how do kids get it?

Is Acute Flaccid Myelitis Contagious?

Since we don’t actually know what causes AFM, it is certainly possible, although rather unlikely, that it is caused by something that is not communicable.

But remember, the leading theory is that AFM is caused by an enteroviral infection, either EV-D68 and EV-A71, as most kids develop symptoms shortly after they had viral symptoms, and these two viruses are most commonly identified.

And you are typically contagious when you are sick with an enteroviral infection.

So how can the CDC Director say that AFM “doesn’t appear to be transmissible from human to human?”

It is because even if the virus that causes AFM is communicable, you can’t actually catch AFM from someone.

adult child cooperation daylight
Wash your hands to help avoid viral infections. Photo by Andres Chaparro on Pexels.com

Just like polio.

While the polio virus itself is communicable, paralytic polio isn’t. You can’t catch paralytic polio. Instead, you can catch polio, and then you have the small chance that it develops into paralytic polio.

It may not sound like a big difference, but it is.

Just consider what might happen if AFM itself was contagious, and if most of the kids who were exposed to someone with AFM developed AFM themselves…

We would likely see a lot more cases of AFM, especially in clusters in homes, daycare centers, and schools.

Instead, most cases seem to be isolated.

AFM Clusters

But aren’t there reports of clusters of AFM?

“In September 2016, an acute care hospital in Arizona notified the Maricopa County Department of Public Health (MCDPH) of a suspected case of AFM and subsequent cluster of 11 children who were evaluated with similar neurologic deficits; differential diagnoses included transverse myelitis and AFM.”

Notes from the Field: Cluster of Acute Flaccid Myelitis in Five Pediatric Patients — Maricopa County, Arizona, 2016

Yes, kind of.

But they aren’t clusters of epidemiological linked cases.

In Arizona, for example, only four of the 11 children were confirmed to have AFM and “no epidemiologic links were detected among the four patients.”

“In October 2016, Seattle Children’s Hospital notified the Washington State Department of Health (DOH) and CDC of a cluster of acute onset of limb weakness in children aged ≤14 years.”

Acute Flaccid Myelitis Among Children — Washington, September–November 2016

Similarly, at Seattle Children’s Hospital, the ten cases in their “cluster” had nothing in common, except for having prodromal respiratory or gastrointestinal symptoms about seven days before developing AFM symptoms.

It is likely that you see “clusters” at some hospitals simply because they are referral hospitals for a large region.

But even if we don’t know why some kids with these viral infections develop paralysis and other don’t, if they are the cause, then you wouldn’t develop AFM if you never actually had the virus.

“While we don’t know if it is effective in preventing AFM, washing your hands often with soap and water is one of the best ways to avoid getting sick and spreading germs to other people.”

About Acute Flaccid Myelitis

So handwashing and avoiding others who are sick is still the best strategy to try and avoid getting AFM.

And getting vaccinated against polio and using insect repellents can help you avoid other known causes of AFP – polio and West Nile virus.

More on Preventing AFM

The Case for Making AFM Reporting Mandatory

There have been 158 cases of acute flaccid myelitis (AFM) so far this year, with another 153 cases under investigation by the CDC and state and local health departments.

“Acute flaccid myelitis (AFM) is not nationally notifiable; CDC relies on clinician recognition and health department reporting of patients under investigation (PUIs) for AFM to learn more about AFM and what causes it.”

But could there be more cases?

The Case for Making AFM Reporting Mandatory

Although AFM isn’t yet a nationally notifiable disease,  120 other diseases are, from Anthrax and Botulism to Vibriosis and Zika virus disease.

The Nationally Reportable Disease List depends on state laws for any mandate to report.
The Nationally Notifiable Condition List depends on state laws for any mandate to report.

Who picks them?

The Council of State and Territorial Epidemiologists.

“Although AFP surveillance is commonly conducted in many countries currently still at risk for ongoing transmission of poliovirus, AFP is not a reportable condition in any U.S. state and routine surveillance and assessment for AFP is not performed. Therefore, understanding the baseline incidence and epidemiology of AFM and its public health impact in the United States is significantly limited.”

Revision to the Standardized Surveillance and Case Definition for Acute Flaccid Myelitis

Acute flaccid paralysis (AFP) isn’t a reportable disease in the United States either.

While many people would like AFM to be added to the the Nationally Notifiable Condition List, the CSTE has instead recommended that we:

  1. Utilize standard sources (e.g. reporting to a local or state public health department) for case ascertainment for acute flaccid myelitis (AFM), including clinician and laboratory reporting, reporting by hospitals, hospital discharge notes, neurology or infectious disease consult notes, MRI reports and images, outpatient records, and extracts from electronic medical records, etc.
  2. Utilize standardized criteria for case identification and classification for acute flaccid myelitis (AFM) but do not add AFM to the Nationally Notifiable Condition List . If requested by CDC, jurisdictions (e.g. States and Territories) conducting surveillance according to these methods may submit case information to CDC.
  3. Report cases as soon as possible and continue surveillance.
  4. Share data to “measure the burden of acute flaccid myelitis (AFM).”

And the CDC has agreed.

“CDC concurs with this position statement. We look forward to continuing to work with our jurisdictional partners to address this important public health issue. This standardized case definition provides an opportunity to better define the spectrum of illness seen with AFM and to determine baseline rates of AFM in the United States. During review of the position statement, a few minor edits were identified as necessary for clarification, and we are working with the author to make these changes.”

What would be the difference if AFM was added to the Nationally Notifiable Condition List?

For one thing, because the list of reportable conditions varies from state to state, it would provide a uniform case surveillance and case definition.

But we already have that in the CSTE Position Statement on Acute Flaccid Myelitis.

The big issue is that there is no federal law that actually mandates reporting for the diseases on the list! Or even to report them to the CDC.

“Each state has laws requiring certain diseases be reported at the state level, but it is voluntary for states to provide information or notifications to CDC at the federal level.”

CDC on Data Collection and Reporting

It is up to state laws – in each and every state.

“The legal basis for disease reporting is found at the state level, where inconsistent laws may differ in terms of which conditions are reportable and their reporting process.”

Brian Labus on Differences In Disease Reporting: An Analysis Of State Reportable Conditions And Their Relationship To The Nationally Notifiable Conditions List

So even if the Council of State and Territorial Epidemiologists added AFM to the Nationally Notifiable Condition List, you would then need each state to pass a law adding AFM to their lists of notifiable diseases.

“Currently AFM is not a reportable condition in Texas.”

TxDSHS on Acute Flaccid Myelitis

How long would that take?

Zika is on the Nationally Notifiable Condition List, but guess what, like AFM, it isn’t on the reportable condition list in many states…

Utah has already added AFM to its list of notifiable conditions. Has your state?
Utah, Washington and Colorado have already added AFM to their list of notifiable conditions. Has your state?

Want to get more cases of AFM reported to the CDC?

Let’s raise awareness about AFM and educate parents and health professionals to get all cases diagnosed, as they can then get reported to local and state health departments, who will then report them to the CDC.

Making AFM reporting mandatory might sound like a big deal, but will it really make any difference in getting kids diagnosed and treated?

“Ultimately, we would have to decide what the purpose of making something nationally notifiable is. We can investigate it just as well without that designation, and keeping things at the state level (for now) allows a lot more flexibility in how we define and investigate it. It might seem frustrating because it isn’t on the nationally-notifiable list, but that honestly doesn’t matter in terms of how we investigate things.”

Brian Labus, PhD, MPH

Cases still get investigated without being on the Nationally Notifiable Condition List.

Cases still get reported without being on the Nationally Notifiable Condition List.

And that’s good, because adding AFM to the Nationally Notifiable Condition List is not something that would happen overnight.

CP-CRE was added to the National Notifiable Disease List in 2018 at the 2017 CSTE annual meeting.
CP-CRE was added to the National Notifiable Condition List in 2018 at the 2017 CSTE annual meeting.

The CSTE would probably discuss it at their next meeting (next summer), and if approved, it would take effect at the beginning of the new year – January 2020. But then, then CDC has to get approval from the Office of Management and Budget (OMB) to actually get permission to start collecting the data on AFM for the Nationally Notifiable Condition List. All of that likely means that the earliest we would see “national” reporting for AFM would be sometime in 2022.

Does that mean we should jump on it now if it is going to take so long, or should we wait to figure out a definitive cause, and then put that on the Nationally Notifiable Condition List?

Whatever we do, remember that it still wouldn’t be mandated reporting unless each and every state actually passes a law mandating reporting of AFM cases to the CDC. Again, being on the Nationally Notifiable Condition List simply means that states are strongly encouraged to report their cases, as they do now. There are several diseases on the Nationally Notifiable Condition List that states never add to their own notifiable conditions list.

“It is voluntary that notifiable disease cases be reported to CDC by state and territorial jurisdictions (without direct personal identifiers) for nationwide aggregation and monitoring of disease data. Regular, frequent, timely information on individual cases is considered necessary to monitor disease trends, identify populations or geographic areas at high risk, formulate and assess prevention and control strategies, and formulate public health policies. The list of notifiable diseases varies over time and by state. The list of national notifiable diseases is reviewed and modified annually by the CSTE and CDC. Every national notifiable disease is not necessarily reportable in each state. In addition, not every state reportable condition is national notifiable.”

CDC on Data Collection and Reporting

Mostly, folks should understand that simply being on the Nationally Notifiable Condition List may not mean as much as they think it does.

“Although disease and condition reporting is mandated at the state, territory, and local levels by legislation or regulation, state and territory notification to CDC is voluntary. All U.S. state health departments, five territorial health departments, and two local health departments (New York City and District of Columbia) voluntarily notify CDC about national notifiable diseases and conditions that are reportable in their jurisdictions; the data in the case notifications that CDC receives are collected by staff working on reportable disease and condition surveillance systems in local, state, and territorial health departments.”

CDC on Data Collection and Reporting

And that epidemiologists at the local, state, and national level are working hard to identify all cases of AFM, which will hopefully help them figure out what is causing these cases, how to treat kids who are already affected, and how to prevent new cases.

They are identifying more and more cases of AFM even though few states have mandatory reporting, AFM isn’t on the Nationally Notifiable Condition List, and reporting of cases to the CDC is voluntary.

More on Making AFM Reporting Mandatory

Updated on December 10, 2018

Autistic Adults

A common argument for those who believe in a true autism epidemic that is associated with vaccines is that there are no autistic adults.

“Where are all the adults with classic autism? Where are the hand flapping, head banging, self-abusive, spinning, screaming, rocking, stimming, non-verbal and violent 40, 50, 60, 70, 80 and 90 year olds wearing autism helmets and diapers? Where are the grown-ups at the mall experiencing violent tantrums, seizures and GI tract problems?”

Robert F Kennedy, Jr on Is the Autism Epidemic Real?

Of course, the argument is easy is disprove.

Kennedy on Classic Autism

The worst part of Kennedy’s statement is how he chooses to define “classic autism.”

“Functioning labels do not always relate to people’s real skills and can be based on hurtful stereotypes about autistic people. They also assume that people’s skills cannot change over time.”

Finn Gardiner on The Problems with Functioning Labels

Considering that he has also used the term holocaust when talking about autism, it’s not a surprise though.

“We all deserve to be respected for who we are.”

Amy Sequenzia on It is About Respect

But we shouldn’t let folks like Robert F Kennedy, Jr define what autism is for everyone.

Autistic Adults

What’s the first clue that there are autistic adults?

Yes, that’s right, it is all of the autistic adults!

Did you know that the Autistic Children’s Aid Society of North London formed in 1962? It later became the The National Autistic Society.

And the first meeting of the National Society of Autistic Children was held in 1965. It became the Autism Society of America.

Around this time, the Sybil Elgar School (1965) was established as the first school for autistic children and Somerset Court (1972) was established as the first residential community for autistic adults.

Think about Kennedy’s claim. Are we to believe that we have no autistic adults now, but in 1972, there was a need for a residential community for autistic adults?

Also consider that the children diagnosed with autism by DSM-III criteria (1980) are now adults, as that was almost 40 years ago.

Some folks, like Robert F Kennedy, Jr, would likely be surprised that autistic adults published a book to help autistic teens and adults go to college.
Some folks will likely be surprised to know that autistic adults published a book to help autistic teens and adults go to college. They shouldn’t be!

Where are the autistic adults?

They are easily found, if you choose to look for them.

Like everyone else, many of them are:

And sure, some have more issues than others. Some are living at home or in supported living arrangements, too many live in poverty, and tragically, too many die young.

That’s why it is important that we all do more to support autistic children, autistic adults, and their families, instead of continuing to believe these folks who push propaganda about vaccines.

More on Autistic Adults

What to Know About Xofluza for the Flu

Most people don’t understand that we have limited options to treat folks with the flu.

They still think that Tamiflu is some kind of wonder drug.

It isn’t. At best, if you take it within 48 hours of the start of your flu symptoms, you might “shorten the duration of fever and illness symptoms, and may reduce the risk of complications from influenza.”

Other flu drugs aren’t that much better, which is why they are typically reserved for those who are considered at high risk for flu complications.

What to Know About Xofluza for the Flu

That’s why many of us welcomed news of a new flu drug – Xofluza (baloxavir marboxil).

“This is the first new antiviral flu treatment with a novel mechanism of action approved by the FDA in nearly 20 years. With thousands of people getting the flu every year, and many people becoming seriously ill, having safe and effective treatment alternatives is critical. This novel drug provides an important, additional treatment option.”

Scott Gottlieb, M.D., FDA Commissioner

Unfortunately, while it has a new mechanism to treat the flu, there are plenty of reasons to not get too excited about Xofluza, despite what the headlines might be telling you:

  • the clinical benefit seems similar to Tamiflu
  • the two studies that were used to get Xofluza approved only looked at folks with mild to moderate flu symptoms (those with severe flu symptoms were excluded) and only looked at folks without complex medical problems, so we don’t know if it reduces hospitalizations, flu complications, or deaths from flu
  • flu virus strains might be able to mutate and develop resistance to Xofluza, although it is not clear if these strains could then be passed to others
  • the single dose treatment is only approved for adults and kids who are at least 12 years old
  • at $120 to $150, it is more expensive than generic Tamiflu

Still, if it works just as well as Tamiflu, but really does have fewer side effects, then that is a good thing, especially if it isn’t overused.

“The significant reduction in influenza viral replication with baloxavir treatment suggests the potential for reducing influenza virus spread to close contacts and should be studied through randomized, controlled trials in households and during institutional influenza outbreaks such as in longterm care facilities.”

Timothy M. Uyeki, M.D., M.P.H., M.P.P. on A Step Forward in the Treatment of Influenza

Could Xofluza make you less contagious to others?

That would be a good way to control outbreaks.

Why isn’t it approved for younger kids? The pediatric studies haven’t been completed yet, but among the postmarketing studies that the FDA are requiring are in infants, children between the ages of 12 months to less than 12 years, and the final report of a pediatric study from Japan.

Other postmarketing studies of Xofluza will include hospitalized patients, the use of Xofluza as post-exposure prophylaxis to prevent influenza in household contacts of an index case, and to monitor resistance.

Are you excited about Xofluza?
Are you excited about Xofluza?

Should folks be excited about Xofluza? While it is certainly nice to have an alternative to Tamiflu, an alternative that worked a lot better would have really gotten most of us excited.

Right now we’ll settle for folks only using anti-viral flu medications, whether it is Tamiflu, Relenza, or Xofluza, when they are truly necessary – for high risk children and adults.

Remember, not everyone with the flu needs these medications.

And they are certainly not a substitute for a flu vaccine, unless you have a true medical contraindication to getting vaccinated.

More on Xofluza

What Causes Acute Flaccid Myelitis?

Most people are aware that there is a so-called “mystery illness” going around.

A “mystery illness” that is paralyzing some kids.

What’s so mysterious about it?

What is Acute Flaccid Myelitis?

Lots of things are mysterious about acute flaccid myelitis…

We don’t know exactly what causes it, who will get it, why they get it, or how to treat it, etc.

What do we know?

  • AFM is not new, although we are seeing more cases lately
  • AFM refers to acute (sudden onset) flaccid (droopy or loose muscles) myelitis (inflammation of the spinal cord) and it is a subtype of acute flaccid paralysis
  • most cases occur in children, with the ages of affected children ranging from 5 months to 20 years, although some adults have been affected
  • these children have a magnetic resonance image (MRI) showing a spinal cord lesion largely restricted to gray matter and spanning one or more vertebral segments
  • it is thought that AFM can be caused by viruses (polio, non-polio enteroviruses, West Nile virus, Japanese encephalitis virus, CMV, EBV, adenovirus, etc., environmental toxins, and genetic disorders, and although no common etiology has been found in these recent cases, most experts think that these cases are caused by a neuroinvasive infectious process, likely of viral etiology, including EV-D68 and EV-A71.
  • these cases of AFM are not thought to have a post-infectious immune-mediated etiology
  • cases are occurring sporadically – after 120 cases in 34 states in 2014, there were only 24 cases in 17 states in 2015, but then 149 cases in 39 states in 2016 and 33 cases in 16 states in 2017. And there have been at least 158 cases in 36 states in 2018, with another 153 cases under investigation.
  • outbreaks of EV-D68 and sporadic cases of AFM have also been seen in other countries recently, including Denmark, France, the Netherlands, Spain, Sweden and the United Kingdom (UK)
  • most cases occur in the late summer and early fall
  • most had symptoms of a preceding viral illness, including respiratory symptoms or diarrhea
  • some were unvaccinated
  • few were recently vaccinated
  • no specific treatments, including steroids, IVIG, plasmapheresis, interferon, and anti-viral medications, have been associated with better outcomes
  • some patients have recovered, while many others have persistent paralysis
  • there has been at least one death
  • some, but not all, were positive for enterovirus D68
  • in Colorado this year, 9 of 14 cases were linked to EV-A71 infections
  • although there was a national outbreak of EV-D68 in 2014 that coincided with the first AFM cases, we didn’t see the same kind of outbreak in the following years
  • AFM isn’t polio, Guillain-Barrésyndrome (GBS), acute disseminated encephalomyelitis (ADEM), or transverse myelitis
  • EV-D68 is not new, being first discovered in California in 1962

While that’s a lot of good information, for parents wanting to protect their kids and avoid AFM, there is some key information missing. Same for those wanting to help treat their kids who have or have had AFM.

So although some folks don’t like that it is being called a “mystery illness,” there is still a lot of mystery to it.

It is no mystery that AFM isn't associated with vaccines - experts review patient vaccination records.
It is no mystery that AFM isn’t associated with vaccines – experts review patient vaccination records.

But that doesn’t mean that experts aren’t working very hard to take all of the mystery out of AFM.

What Causes Acute Flaccid Myelitis?

Some experts are fairly sure that AFM is caused by an enteroviral infection, to the point that they hope that the CDC focuses work on an enteroviral vaccine.

Which enterovirus though?

At least two different enteroviral infections have been associated with AFM, including EV-D68 and EV-A71.

Why not just make a vaccine to prevent both?

You would first have to make a individual vaccines, before thinking about combining them, and you can’t just make any vaccine you want. If you could, we would have vaccines to protect us against RSV, malaria, HIV, and many other diseases.

Still, since EV-A71 also causes serious outbreaks of hand, foot, and mouth disease in some parts of the world, a vaccine has actually been in development for some time, and two are approved for use in China. That at least means making an EV-A71 vaccine is possible, although we would likely need to make our own.

Why did they make a vaccine for a virus that causes hand, foot, and mouth disease (HFMD)? Because unlike the HFMD that we are used to, which is typically caused by coxsackievirus A16 virus, another enterovirus, when caused by EV-A71, it can be deadly, as we have seen in outbreaks in Asia.

What about an EV-D68 vaccine?

While likely possible, since developing a new vaccine takes a lot of time, we want to be sure that is what is causing the outbreaks.

Do some kids not have either EV-D68 or EV-A71 because it just isn’t detected or because something else is causing them to have AFM? Possibly. One of the biggest issues that is troubling some experts though is that they have not detected these enteroviruses in the spinal cord fluid of many children, as you would expect if the viruses were causing the damage.

But even if these enteroviral infections are the cause, are there other risk factors that make some kids who get these enteroviral infections more predisposed to develop AFM, instead of more typical viral symptoms, like a cold or diarrhea?

And why are we seeing cases now? Did the virus, if that is the cause, just mutate into one that is more virulent?

Hopefully we get some more answers and a way to prevent, treat or cure AFM soon.

Until then, we can make sure we take steps to prevent the known causes of AFM, including polio (get vaccinated) and West Nile virus (use insect repellent), and wash hands properly to help avoid all other viral infections. You also want to get your flu vaccine! The flu can cause Guillain-Barré syndrome, which can also cause AFM.

“…is there any relationship between vaccination status and a developing acute flaccid myelitis? Meaning, are vaccines a risk factor? And the data so far says no, the overwhelming number of children who have gotten AFM have had no recent vaccination of any kind or vaccine exposure. These cases over these years have been happening before flu season and flu vaccination starts, which is one of the questions that comes up, and there hasn’t been any pattern to vaccine exposure of any kind in developing AFM. So far, we have not found a link between the two.”

Benjamin Greenberg, MD on 2018 Podcast on Acute Flaccid Myelitis

And remember, although there are many things we don’t know about AFM, we do know that vaccines do not cause AFM. It would also be great if everyone would get vaccinated so that the CDC and our local health departments could focus on health issues like AFM, instead of still battling measles outbreaks caused by folks who intentionally don’t vaccinate their kids.

What to Know About Acute Flaccid Myelitis

While it might be scary to think that there is a new condition out there that we don’t know everything about, parents should be reassured that experts are actively seeking the cause and a way to both prevent and treat AFM.

More on Acute Flaccid Myelitis

Updated on December 10, 2018

What Are the Best Foods for Kids?

What are the best foods for kids?

No, they aren’t brain foods, super foods, or clean foods…

Best Foods for Kids

Follow the My Plate guidelines to make sure your kids are eating healthy foods.
Follow the My Plate guidelines to make sure your kids are eating healthy foods.

In general,  the best foods are healthy foods packed with the nutrients that your kids need, including foods that are high in fiber, low in fat, and good sources of protein, calcium, vitamin D, and iron, etc.

And they are foods that make it easy to avoid things your kids don’t need, like trans fats and too much extra salt, added sugar and calories.

That’s why many of the best foods include things like fruits, vegetables, whole grains, lean meats, and low fat milk. Eat enough of them and you won’t have to worry about giving your kids vitamins.

High Fiber Foods

Do your kids get enough fiber in their diet?

According to the latest recommendations, based on their age, the average child needs:

  • 1-3 years old – 19g fiber/day
  • 4-8 years old – 25g fiber/day
  • 9-13 years old (female) – 26g / (male) – 31g fiber/day
  • 14-18 years old (female) – 26g / (male) – 38g fiber/day
Some snack bars have up to 9g of fiber per serving!
Some snack bars have up to 9g of fiber per serving!

Is 19 or 21g of fiber a lot? What about 38g?

When you consider that a high fiber food has 5g per serving and one that is a good source of fiber only has 2.5g per serving, then it might be hard for some kids to reach recommended levels each day.

To help make sure that they do, look for:

  • high fiber foods – beans, broccoli, peas, lentils, pears, prunes, raspberries, shredded wheat cereal, spinach, whole wheat pasta, snack bars
  • foods that are good sources of fiber – air popped popcorn, nuts, apples (with the skin on), bananas, brown rice, carrots, celery, corn, figs, oatmeal, raisins, strawberries, whole wheat bread

And compare food labels, looking for foods with high amounts of fiber.

Iron-Rich Foods

Since many kid-friendly foods have plenty of iron, getting kids to eat iron-rich foods isn’t as big an issue as some parents imagine.

It can be a problem if your exclusively breastfed infant isn’t eating much baby food, your toddler or preschooler drinks too much milk and doesn’t eat much food, or when a kid on a specialized diet doesn’t eat meat or other iron-rich food (vegans and vegetarians).

Fortunately, there are plenty of iron-rich foods, even if your kids don’t eat red meat, including:

  • most types of beans
  • iron fortified bread, cereal, rice, and pasta, including those made with whole grains
  • collard greens, kale, mustard greens, spinach, and turnip greens
  • broccoli, swiss chard, asparagus, parsley, watercress, Brussels sprouts and other vegetables
  • raisins, prunes, dates, apricots and some other dried fruits
  • tofu
  • egg yolks
  • blackstrap molassses
  • nuts

Seafood and poultry are also good sources of iron.

And while the iron in non-meat sources isn’t as easily absorbed by our bodies as the iron from meat, fish, and poultry, you can boost that absorption by pairing those iron rich foods with some vitamin C, such as drinking orange juice or eating citrus fruits.

Calcium-Rich Foods

Many kids don’t drink enough milk. That’s not necessarily a problem, as some kids actually drink too much milk, but it can be if they don’t make up for it with other foods to get calcium and vitamin D in their diets.

Some brands of American singles have more vitamin D than a glass of milk!
Some brands of American singles have more vitamin D than a glass of milk!

How much calcium do kids need?

  • 700 mg a day for kids who are 1 to 3 years old
  • 1,000 mg a day for kids who are 4 to 8 years old
  • 1,300 mg a day for kids who are 9 to 18 years old

And when you consider that 1/2 cup of broccoli only has 21mg of calcium, you are probably going to want to turn to milk, cheese and yogurt and calcium fortified orange juice, cereal and bread to make sure your kids are getting enough calcium.

Other foods that are good sources of calcium include tofu, sardines, and salmon.

Foods with Vitamin D

Like calcium, good sources of vitamin D can include milk, cheese, and yogurt, but only because many of these foods are fortified. That’s why ice cream, even though it is made with milk, isn’t usually a good source of vitamin D! Neither is raw milk.

Some non-dairy foods that do contain vitamin D include:

  • fatty fish such as salmon, tuna, and mackerel (just don’t overdo it on the fish because of the risks from mercury)
  • beef liver and egg yolks
  • some mushrooms

And of course, many foods are fortified with vitamin D, including breakfast cereal and orange juice.

Are your kids getting at least 600 IU/d of vitamin D?

Protein-Rich Foods

Believe it or not, your child likely gets enough protein in their diet.

Kids should eat a variety of protein rich foods though, including lean meats, seafood, poultry, eggs, legumes (beans and peas), nuts, seeds, and soy products.

“Strategies to increase the variety of protein foods include incorporating seafood as the protein foods choice in meals twice per week in place of meat, poultry, or eggs, and using legumes or nuts and seeds in mixed dishes instead of some meat or poultry. For example, choosing a salmon steak, a tuna sandwich, bean chili, or almonds on a main-dish salad could all increase protein variety.”

2015-2020 Dietary Guidelines for Americans

For most kids, it is the variety of protein that’s the problem, not the overall amounts, as most of their protein likely comes from red meat and dairy products.

What to Know About the Best Foods for Kids

Are you worried that your kids are too picky? Are they overweight, with portion sizes that are too big?

Learn to make healthy food choices and help avoid kid-friendly junk foods, but still make sure your growing kids are getting all of the vitamins, minerals, and nutrients they need.

A registered dietician can be especially helpful in planning a healthy eating plan for your kids if you are still having trouble.

More on the Best Foods for Kids

What Is the Evidence for CBD Oil?

Are you wondering if your kids should be taking CBD oil?

That’s probably not a question you would be thinking of asking just a few years ago, but now that CBD products are everywhere, with hundreds of millions of dollars in sales, and claims that it can treat everything from seizures and anxiety to cancer, you might be thinking you need to jump on this new fad.

What Is CBD Oil?

Many folks are likely skeptical when they hear about all of the benefits of CBD oil.

This is the stuff that is extracted from marijuana plants, right?

How is it even legal to sell CBD oil or gummies infused with CBD?

To understand that, you have to understand that cannabidiol (CBD) oil is the part of the marijuana plant that doesn’t get you high. That comes from tetrahydrocannabinol (THC).

And many of the products you see with CBD oil that is sold over-the-counter aren’t even derived from marijuana, but instead come from hemp plants.

Labeling something as hemp doesn’t necessarily make it legal though. Regulators in Ohio, for example, recently announced that CBD oil derived from hemp is illegal and that the only legal CBD oil will be dispensed in state-licensed dispensaries.

What Is the Evidence for CBD Oil?

There is definitely evidence that CBD oil can have beneficial effects in some medical conditions.

Except for treating some types of resistant seizures, there is no good evidence that CBD oil has all of these other benefits.
Except for treating some types of resistant seizures, there is no good evidence that CBD oil has all of these other benefits.

In fact, the FDA recently approved Epidiolex oral solution for the treatment of seizures associated with two rare and severe forms of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome. Epidiolex is an oral solution of oil-based CBD that is extracted from marijuana plants.

What other medical conditions?

While it is not approved to treat any other medical conditions, cannabidiol is being studied to treat people with ADHD, anxiety, autism, schizophrenia, chronic pain, Multiple Sclerosis, Parkinson disease, Tourette syndrome, and substance use disorders.

Should You Try CBD Oil?

What does that mean right now if you have a child with anxiety or another disorder and you are interested in CBD oil?

Although it might be tempting to buy and try the CBD oil that you can find at your local health food store, remember that they aren’t the same thing as Epidiolex, the prescription version of CBD. When you buy an over-the-counter CBD product, you have no idea what dosage of CBD you are really getting.

Anyway, until further testing is done, you have no idea what dose to give your child with anxiety or any other disorder besides seizures anyway.

And like other drugs, CBD oil can have side effects.

So unless you can get in a clinical trial, you should likely wait and continue your current therapies.

But since Epidiolex is approved to treat certain seizures, can’t your doctor simply prescribe it off-label to treat other conditions, like anxiety, if they wanted to? While that does often happen for other medications, it is very unlikely to happen for Epidiolex, even after the rescheduling process is completed and it is no longer a Schedule I substance and can be prescribed in states where it is illegal to prescribe medical marijuana.

It is estimated that Epidiolex will cost over $30,000 a year.

More on the Evidence for CBD Oil