In the study, published in the , about three-quarters of parents surveyed underestimated the total amount of sugar in foods commonly found in the diets of children: orange juice, pizza, yogurt, ketchup, granola bars and more. The biggest divergences occurred in foods thought to be “healthful”; for example, more than 90 percent of the 305 study participants underestimated the amount of sugar found in yogurt by an average of 60 percent.

More concerning was the fact that parents’ misjudgments tended to be related to their children’s body weight. Those children with the highest body mass index tended to have parents who made the greatest misjudgments of sugar content.

medical director of the , and  of the UofL , aren’t surprised. It is a situation they see virtually every day in their practices.

“This happens quite a bit,” said Felton, who is a fellow of the American Academy of Pediatrics (AAP). “Parents simply don’t know how much sugar is in the food they feed to their children. They believe they are feeding healthy meals and can’t understand why their child is overweight.

“Generally speaking, you should limit your younger child’s intake of added sugar to 12-16 grams a day – that’s about 3-4 teaspoons. For pre-teens and teens, it should be no more than 8 teaspoons.”

Although the German study only examined medical health and sugar underestimation, Martinez says the problem is a contributing factor to dental problems as well.

“Sugar contributes to tooth decay,” Martinez said. “If left untreated tooth decay can be painful — and painful teeth will affect a child’s performance in school.”

Preventing cavities and decay is the first line of defense, he said. Martinez also urges parents to find a dental home for their child, and schedule a dental exam, cleaning and fluoride treatment. For children experiencing extreme decay, the UofL School of Dentistry offers Silver Diamine Flouride, a 58-percent solution that stops decay in its tracks.

Both Martinez and Felton echo a point made in the study: Food labeling needs improvement. The study authors recommend a “traffic-light system”: a red dot on the label for high sugar content and a green one for minimal sugar. 

“Food labels can be confusing because they list ingredients in terms of percentages of daily recommended values,” Felton said. “Parents may read that a container of yogurt has 25 grams of sugar, but they often do not know how that should fit into their child’s diet.

“Plus, parents are busy and don’t have time to thoroughly read labels, let alone keep track of how many grams of sugar their children consume in a given day. A simpler labeling system would help enormously.”

For now, the providers recommend that parents “assume that there is too much sugar in food and try to cut back where you can,” Felton said. “Instead of buying yogurt with fruit or other flavorings already in it, for example, buy plain yogurt and add your own fresh fruit to it. Don’t add sugar to the breakfast cereal you give to your children. Serve them water or milk instead of highly sweetened juices or sodas.”

“The worse thing parents can do is allow their children to drink juice or anything other than water in a sippy cup all day, which disrupts the ph balance of the mouth,” Martinez said. Better, he says, to drink juice or milk in one sitting rather than over the course of several hours.

Martinez and Felton also reminded parents of released a year ago by the AAP.  The recommendations urge parents, when possible, to feed their children whole fruit rather than juice, where fiber and other nutrition can be gained. And, the Academy has reduced the quantity of fruit juice for children according to age:

• No juice for children younger than 12 months.
• 1-3 years – Limit fruit juice to a maximum of 4 ounces per day (1/2 cup)
• 4-6 years – No more than 4-6 ounces (1/2 cup –  ¾ cup)
• 7-18 years – Limit juice to 8 ounces per day (1 cup)

Following these guidelines will at least limit sugar intake and help lead to healthier smiles and bodies, Martinez said.

Sharing a ride down a slide with your child may appear to be fun but it could cause serious injury, said medical director of the . Felton cites a USA Today photo showing a playground accident that broke a 1-year-old girl’s leg, leading to national attention to slide safety for little ones.

In a video shared to Facebook on an incident that took place in 2015, Heather Clare of Huntington, New York, shared footage in which she put her 1-year-old daughter on her lap and took her “down a slide during a family outing at a local park.” The child’s “right foot caught the side of the slide, snapping her tibia and fibula.” In her Facebook post, Clare advocated “for warning signs at playgrounds telling parents not to ride down slides” with their kids.

Felton agrees: “From 2002-15, there were 350,000 children under the age of 5 who were injured on slides, according to the Centers for Disease Control. A 2017 study published in the journal of the American Academy of Pediatrics showed that more than 350,000 children younger than 6 years old were injured by going down a slide in the United States between 2002 and 2015,” she said.

“In the majority of cases, children experienced a fracture after their foot caught the edge or bottom of a slide while sitting on a parent’s lap.”

For the safest outcome, Felton said, parents should allow their child to go down slides alone.

“Children exposed to extreme cold for too long and without warm, dry, breathable clothing can get frostbite or life-threatening hypothermia,” Felton said. “Children are more at risk from the cold than adults. Because their bodies are smaller, they lose heat more quickly.”

The medical director of the , Felton provides the following advice on how to handle frostbite and hypothermia in little ones:

Frostbite: Frostbite happens when the skin, and sometimes the tissue below it, freezes. Fingers, toes, ears and noses are most likely to get frostbite. Frostbitten skin may start to hurt or feel like it’s burning, then quickly go numb. It may turn white or pale gray and form blisters. 

What to do:

• If you suspect frostbite, bring your child indoors to gently warm up. Don’t rub the affected area, and don’t pop any blisters.
• Avoid placing anything hot directly on the skin. Soak frostbitten areas of the body in warm – not hot – water for 20 to 30 minutes. Warm washcloths can be applied to frostbitten noses, ears and lips.
• After a few minutes, dry and cover your child with blankets. Give him or her something warm to drink.
• If the pain or numbness continues for more than a few minutes, call your pediatrician.

Hypothermia: When the body’s temperature drops below normal from the cold, dangerous hypothermia begins to set in. A child may start shivering, a sign the body is trying to warm itself up, but then become sluggish, clumsy or slur words. 

What to do:

• Hypothermia is a medical emergency, so call 911 immediately.
• Until help arrives, bring your child indoors. Remove any wet clothing, which draws heat away from the body.
• Wrap your child in blankets or warm clothes, and give him or her something warm to drink.
• Cover core body areas like the chest and abdomen.
• If your child stops breathing or loses a pulse, give mouth-to-mouth resuscitation or CPR.

Preventing frostbite or hypothermia

“Frostbite and hypothermia are different conditions, but some wintertime planning and safety steps can help protect your child from both,” said Felton, who also cares for patients at Norton Children’s Hospital. She provides the following tips to parents:

• Check the wind chill: In general, playing outside in temperatures or wind chills below minus-15 degrees Fahrenheit should be avoided. At these temperatures, exposed skin begins to freeze within minutes. When possible, children waiting for school buses should wait inside their home or car with parents to avoid exposure.
• What to wear: Several thin layers will help keep kids warm and dry. Insulated boots, mittens or gloves, and a hat are essential. Make sure children change out of any wet clothes right away.
• Take breaks: Set reasonable limits on the amount of time spent playing outside to prevent hypothermia and frostbite. Make sure kids have a place to go for regular indoor breaks to warm up.

The Pediatrics Clinic at Sam Swope Kosair Charities Centre is part of and is located at 982 Eastern Parkway.