Welcome to the Family

WELCOME!

We at Parent & Child know that most of you have more than one child at home. So when we decided to do a cover story on babies, we thought, "What can we tell our wise readers that they don't already know?" Then it came to us: Let's give our expecting moms and those with recent arrivals some of the latest information on baby care, plus some refreshers, Add new baby products and advice from real moms, and we've got something truly useful, Certainly first-time moms will benefit, too!
BACK TO BABY BASICS

Pediatrician Jennifer Shu, M.D., F.A.A.P., is the co-author of Heading Home with Your Newborn: From Birth to Reality. Here, Dr. Shu discusses some major themes in the first year of life.
Sleeping and Swaddling

The small bundle in your arms sure can saw wood. During the first month, she'll spend more time asleep than awake — as much as 16 to 20 hours a day. By 6 months, she'll be down to 14 to 16 hours, including three naps.

Your goal early on is to start good sleep habits so she'll fall asleep on her own at night. For example, as wonderful as it is, you don't want your newborn to drift off when she's in your arms too often or she'll learn that being held or fed is her cue to go to sleep. As for your own sleep schedule, night feedings should decrease as your baby gets older. When you do them, keep the room dark and quiet. Don't make a big deal out of it — do a quick feeding and put her back to sleep.

You may want to consider swaddling your baby at night as well. It can help comfort her by preventing the natural startle reflex (you can keep her arms in or out of the swaddling cloth), which can wake her. You'll know your baby doesn't want to be swaddled anymore if she tries to get loose, which will happen around 6 months.

No matter what, your baby should always be put to sleep on her back to reduce the chances of SIDS (Sudden Infant Death Syndrome). Also, keep all loose and fluffy items out of the crib. Never place anything like stuffed animals, bumpers, or pillows in the crib.
Weight and Feeding

Like adults, every baby is different. Your infant's size depends on a variety of things, from birth weight to family genes. It's normal for a baby to lose weight in his first week and gain it back by the end of the second. He can lose up to 10 percent of his body weight, but he shouldn't lose more than that. Keep an eye on him in this regard — sometimes when a baby loses too much weight, his metabolism slows down to conserve energy, and he sleeps all the time and doesn't gain the weight back. That's why during the first week, we advise parents to feed their baby every two to four hours during the day.

For premature babies, it's comforting to know that a lot of preemies catch up in terms of growth and development by the time they're 2 years old (the less premature they are, the quicker they'll catch up). Our advice is, don't expect things to happen in a rush.

Sometimes parents wonder about spitting up or vomiting. Is my baby OK inside? Keep in mind that a baby's lower esophageal sphincter, which is located at the top of her stomach, isn't strong yet. If she has a gas bubble or is laid down too soon, what's in her stomach will come up in her mouth. If she's happy except during refluxing episodes, we call her a happy spitter. If she's unhappy, not growing well, and crying often in between feedings, consult your doctor.

Regarding solids, the latest recommendation is that a baby should start them at 4 to 6 months. What's new for some parents is that, in the past, we said a baby should eat fruits and vegetables before meat. That's not true anymore. You can introduce these foods anytime. For allergy reasons, just be sure to wait between introducing each new one. And, because allergy recommendations keep changing, ask your pediatrician any and all food questions. Also, be sure you know your family's allergy history (including eczema and asthma) so you can discuss this with your pediatrician.

If your baby is crying for three hours a day, she may have colic. We know that colic seems to be worse in the evening and tends to last from three weeks to three months before it gets better. Swaddling may help. Some people try homeopathic remedies and medicine, but this really warrants evaluation by a pediatrician to make sure there isn't something medical that needs to be treated.
Diapering and Pacifiers

There are entire chapters devoted to diapering, but the basics are this: You'll want to change your baby after you've fed her or after she's woken up. If you have a baby boy, point his penis downward to avoid being sprayed. If you have a girl, be sure you wipe from front to back to avoid infection. Remember that you don't have to use a wipe after every wet diaper, as this could cause irritation. Just make sure the area dries off before you put the next diaper on. A common irritation, diaper rash can come and go, and some babies are more sensitive than others. If your baby is prone to rashes, you may have to apply diaper cream and change him more frequently.

When it comes to pacifiers, the news is mixed. While recent studies have shown that pacifiers may lead to a decrease in SIDS, it's best not to give a baby a pacifier too early if you can help it, because they can interfere with her becoming comfortable with breastfeeding — if that's your feeding method. If you're bottlefeeding your baby, pacifiers don't interfere much because the shape and feel of the plastic nipples are very similar.
Babies and Siblings

It's natural for a big brother to be curious about his new sister and want to touch her. That's fine, but have him (everyone!) wash his hands first since her immune system isn't strong yet. If her brother wants to kiss her, a peck on the top of the head is the best place for keeping germs away. Always keep sick children and adults out of range.

You're also bound to run into some jealousy toward the baby on the part of your older child. While it's a complex issue, the most important thing you can do now is to spend individual time with your older child — without the baby present. Another tip: Keep your older child's routine the same. With his own fun things to do, he'll spend less time focusing on competing for your attention.
Safety and Sanity

In the car, keep your baby in a rear-facing baby seat for as long as possible — until she's at least 1 year old and 20 pounds. Some studies even claim that rear-facing seats might be beneficial until your child is 3 or 4 because the potential for whiplash is heightened for a child when she's facing forward.

Finally, it's a good idea to get outside. You'll go nuts if you stay indoors the whole time! Use your judgment — limit your outdoor time in cold weather and make sure you bundle your baby's head, hands, and feet, since this is where she can lose heat easily.
Moms Online Bookmark these four helpful websites: DinnerBeat dinnerbeat.com

Organize a family meal schedule and share recipes with friends
— Emily Z., Fort Mill, SC
Mom Logic momlogic.com

Touching lifestyle stories and thought-provoking articles
— Erin W., El Dorado Hills, CA
Stroller Traffic strollertraffic.com

A fun blog for keeping up-to-date on current parenting products
— Nikki C, Summit, NJ
The Cradle thecradle.com

Moms connect with other moms about pregnancy and infancy
— Laurie G., Los Angeles, CA
First-Year Advice Real moms speak

"Cut yourself some slack. If your baby cries, she may just be getting used to the world." — Candace L, Miller Place, NY

"Layer your baby's bedding. If he gets sick or soaks through a diaper, it's quick and easy to pull off the mess." — Liza B., Milwaukee, WI

"The days will seem really long, but the years really short. Enjoy as best you can every moment, even the frustrating ones." — Lucy A., Thomson, GA

"Get out of the house without the baby once in a while. See friends — it's refreshing." — Chelsea G., Encinitas, CA
First-Year Books New parenting ideas TALK TO ME, BABY! by Betty S. Bardige

Learn from a developmental psychologist why engaging talk is the foundation of your baby's language, intellectual, and social-emotional growth. Includes fun activities. Brookes Publishing, $25.
HAPPY BABY by Robert W. Sears, M.D.

Simple advice for "going green" to ensure good health and development. Features recipes, nutrition tips for nursing moms, and coupons. Harper Paperbacks, $17.

Find P&C's best new baby picks for day trips, mealtime, baths, and the nursery on page 46.

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By Lambeth Hochwald

Lambeth Hochwald is a freelance journalist specializing in health, family, and marriage. She's also an adjunct professor of journalism at New York University.

Car-Seat Safety

Choosing, installing, and using your baby's car seat correctly can be tricky. How tricky? Believe it or not, the National Highway Traffic Safety Administration (NHTSA) estimates that more than 80 percent of car seats are installed or used wrong. Yet it's so important to get it right. Here, we clear up the confusion and tell you what you need to know, each step of the way.
    STEP 1: BUYING BABY'S FIRST SEAT
    Selecting the right car seat and learning how to use it properly will take longer than you think. To allow yourself enough time--and to cover the possibility of an early arrival--start shopping around your sixth month of pregnancy. For a newborn, you're looking at two choices: an infant seat, which is always rear-facing, or a convertible seat used rear-facing. Infant seats, most often designed for babies up to 20 or 22 pounds, double as carriers. Most infant seats come with a detachable base, kept in the car, which allows you to remove the baby from the car without disturbing her. Convertible seats can be used from birth to 40 pounds, eliminating the need for an infant seat. If you can afford it, we recommend buying a separate infant seat because they fit small babies best. If you do choose a convertible seat, pick one with a five-point harness, which provides a more secure fit for an infant. Also, look for one that can be used rear-facing to at least 30 pounds.
    Once you decide on the type of baby car seat you want, select a brand and model. All new car seats meet federal safety performance standards when used correctly. So the way to decide on a specific model is to figure out which one will fit your car best and will be easiest to install correctly. The key: Try before you buy. If the store allows it, try out a few floor models in the parking lot. If you can't, make sure you can return the seat once the box is opened. When you've got the seat you think is right, make an appointment for an inspection with a certified child-passenger safety technician. Some vehicles are simply incompatible with some car seats. Everyone can benefit from expert guidance, but you'll especially need it if you've got bucket seats, a fold-down armrest in the back seat, or seat belts that are anchored forward of the seat back. Make your appointment sooner rather than later so you can return the seat if the technician finds that it isn't a match for your car. DaimlerChrysler's Fit for a Kid Program (877/FIT4AKID) provides free child safety seat inspections, as do local police departments. Car Seat Data (www.carseatdata.org) has a database that lets you search for which seats work in which vehicles.
    STEP 2: INSTALLING THE SEAT
    Do this in advance. You don't want to have to figure it out in the hospital parking lot.
    According to the NHTSA, the safest position in the car is whichever rear position allows the seat to be installed as tightly as possible and at the right angle. Generally, the middle of the rear seat is considered safest, but if there is a indentation or bump in that position, or some other factor that makes it difficult to install the seat properly, then move the seat next to a window.
    Your main objective is to get the seat in tightly. Push down on it with your full weight with one hand while tightening the seat belt with the other. Lock the seat belt according to the vehicle's owner's manual instructions. The seat shouldn't jiggle more than an inch in any direction. If it does, check to see whether the buckle is fastened right at the place where the belt turns to go through the slot in the safety seat. In this position, the belt may be able to loosen. Unfasten the buckle, twist the shorter end of the belt once, and reattach it. This will keep it tightly locked in most vehicles.
    If your seat belt has a free-sliding latchplate, one through which the belt can slide even when it's buckled, you'll need a locking clip. All new car seats come with one. If you lose it, you can buy a replacement from the manufacturer, or from retail stores such as Babies R Us. Here's the right way to use it: 1) Install the seat tightly; 2) hold the two parts of the belt together at the latchplate and unbuckle it; 3) thread the belt through the locking clip, no more than one inch from the latchplate; 4) buckle the belt again.
    Harness straps on a rear-facing seat should come through the slots that are at or slightly below your baby's shoulders.
    STEP 3: SECURING BABY IN THE SEAT
    The big moment has finally arrived. Baby is going home, and he's ready to ride in his new seat. Points to remember:
    --The harness straps should be tightened so that you can't get more than two fingers between the harness and the child's collarbone.
    --The harness retainer clip should be at the level of Baby's armpits.
    --The seat should be reclined at a 45 degree angle. Many infant seats come with a level indicator, which shows you when the seat is reclined at the right angle. If your infant's head is flopping forward, the seat may not be reclined enough. There are a few tricks that can help you achieve the right angle if your seat doesn't have a level indicator. If you're using the detachable base that comes with the seat, try installing the seat without it (check the manufacturer's instructions). Don't worry; the seat is just as safe used alone as it is with the base. If the seat is still too upright, wedge a tightly rolled towel under the end of the seat closest to the rear of the car.
    STEP 4: WHEN BABY GOES FRONT-FACING
    Simply put, your baby should be rear-facing as long as possible. Many parents think that Baby should be turned around when he weighs 20 pounds and has celebrated his first birthday. Actually, the American Academy of Pediatrics emphasizes that the 20-pound/1-year mark is the absolute earliest point at which you can consider turning your baby's seat forward. Baby's spine is better protected in a head-on collision--and, some experts say, in a side-impact collision--when he's facing the rear of the car. If your baby is in an infant seat and has outgrown it (when his weight has exceeded the seat's limit or when the top of his head is less than two inches from the top of the seat), it is safer to buy a convertible seat that faces rear until 30 or 35 pounds than it is to buy a combination convertible/booster seat. Although the latter accommodates babies as light as 20 pounds, it can't be used rear-facing. You'll have to buy a booster when the convertible seat is outgrown (when your child hits 40 pounds), but the trade-off in peace of mind will be worth it.
    Since some convertible seats go up to 35 pounds in a rear-facing position, your child can ride rear-facing well past his second birthday. The time to switch your child to a forward-facing position is when he has exceeded the rear-facing weight limit for his convertible seat, or when the top of his head is less than an inch from the top of his convertible seat.
    When Baby goes front-facing, the harness straps should be rerouted to come through the slots that are at or slightly above his shoulders.
    Since September 1999, most forward-facing seats for children up to 40 pounds have had top tethers. Cars sold after September 2000 have been equipped with corresponding anchors. A top tether is a webbed strap on the back of the seat that hooks into a bolt anchor in a vehicle's rear deck, floor, roof, or seat back. With most child safety seats, the top tether is attached when Baby goes front-facing. (There is one convertible seat on the market that is equipped with a rear-facing top tether.) Check your seat instructions and your vehicle's owner's manual for specific information.
    A big reason so many seats are untethered is that so many of us drive pre-2000 cars and assume we can't use tethers. But many automakers will install the anchors for free. Contact your car manufacturer for details; you'll find a list of the major car manufacturers' customer service numbers at www.nhtsa.dot.gov.
    You may have heard of LATCH, which stands for Lower Anchors and Tethers for Children, a system designed to simplify correct car-seat installation by eventually eliminating the need to use seat belts. In September 2002, the second phase of LATCH begins. Cars will have two sets of lower anchors in the back seat, and all infant and convertible seats will have a set of straps that attach to those lower anchors.
    FOR MORE HELP:
    --National Safe Kids Campaign: 800/441-1888; www.safekids.org --National Highway Traffic Safety Administration (NHTSA): 800/424-9393; www.nhtsa.dot.gov
    --American Academy of Pediatrics: www.aap.org
    --Juvenile Products Manufacturers Association: www.jpma.org --Safety Belt Safe USA: www.carseat.org
    --Consumer Reports recently rated 33 seats in all price ranges for ease of installation and use and for crash protection. Ratings and full report can be accessed free online at www.consumerreports.org
    --International Association of Chiefs of Police: 800/843-4227

The new home improvement

On Tuesday nights, Dan Quigley's house pipes a not-so-subtle snippet from The Coasters tune "Yakety Yak" over the speakers in his son Richard's room: "Take out the papers and the trash." From the networked PC in the utility closet, the house monitors the back door to see if it opens, says Quigley, founder of Premise Systems, a Redmond, Wash. company that helps people make their homes smarter. "If it doesn't, the system sends [an E-mail] reminder at 6 the next morning," he says.

Like the TV and the telephone (stories, Pages 52 and 56), the house is getting an Internet-based upgrade. By plugging a house's heating and cooling, electrical, and security systems into a computer and the Internet, tech-savvy homeowners are giving the once static shelter a mind of its own. Worried that you left the lights on? Call your house with your cellphone and turn them off. Need to let a friend into your house but can't leave the office? Open the front door over the Internet and watch who enters via a webcam. In the near future, smart houses could also be fitted with smart appliances. Researchers are now at work on closets and refrigerators that would match information from the Web with your personal data to advise you on daily dilemmas such as what to wear or what to cook.

Smart houses have been slow to catch on. Homeowners have been daunted by costs that could run to thousands of dollars for nothing more than remote-controlled lighting and by the know-how needed to set up these systems. "The problem has been that it takes too much time to save you time," says Glover Ferguson, chief scientist at the Accenture consulting firm, which has built prototype intelligent wardrobes and medicine cabinets. But companies ranging from Whirlpool to Motorola are betting that more homeowners will soon become converts. The Internet, affordable home computer networks, and wireless systems are making the technology simpler and smarter, and vendors like GM's OnStar and Sears are trying to ease the setup by offering standard packages. Already estimated to be a $1.1 billion industry, the home automation market could climb to $3 billion by 2005 as more companies jump in, according to the Allied Business Intelligence research group in Oyster Bay, N.Y.

Phone home. Automating a house's infrastructure allows a central PC to adjust the thermostat, set or disarm security systems, turn lights on or off, and perform other functions on a preprogrammed schedule. Add motion sensors, and a smart house can also tailor these functions to the level of activity in a room. Set up properly, an automated home can save energy by turning off gadgets when you leave for work in the morning, yet greet you with the perfect temperature, lighting, and your favorite song when you return. And by logging in to a secure Web page, you can control these functions wherever you are.

Near Detroit, GM's OnStar at Home pilot program has already automated a handful of houses, allowing owners to use the Web to "find out if an errant baseball went through your window or if someone is really breaking in," says Tony Barra, head of the Internet Home Alliance, which coordinates the service. The home system incorporates the same voice-recognition technology as the OnStar systems found in top-of-the-line GM car models. It allows homeowners to send one- or two-word voice commands from a car equipped with the OnStar service or from any phone. Returning from a summer vacation, a driver can dial up OnStar, say "home" to trigger a preprogrammed thermostat setting, and return to a frosty air-conditioned house without wasting energy for weeks.

Do it yourself. OnStar plans to expand the test to 100 homes before deciding whether the service should be marketed widely, says Barra. Sears, which has partnered with Morrisville, N.C.-based Home Director Inc., has started to offer a similar Connected Home package, with less-extensive voice-command control, to new-home builders in Atlanta and Denver. Prices range from $1,500 to $4,000, or about 1 percent of the cost of the home.

For those who merely want to smarten up a few things around the house, an affordable option is open to anyone with a little bit of tech savvy. X10 is a communications language that lets home systems and appliances network with each other via wireless signals or a house's electric power lines. In general, users plug the device they want to control, such as a lamp or a coffee maker, into an X10 module, available from companies including X10 Wireless Technology--the people behind those annoying Web pop-up ads. The module plugs into the wall. The device can then communicate with a PC that has its own X10 connector. By logging on to a special Web page, you can access your PC to control the lights or appliance remotely, or, as the ads promise, monitor your front door with an X10 webcam.

Beyond its adaptability, the X10 system is affordable, with starter sets available for $50 and expansion modules for as little as $13 apiece. But it also has significant problems. The radio frequency at which the devices communicate often travels farther than it should. As a result, neighbors using the gadgets can trigger one another's devices inadvertently. More worrisome, the wide-ranging signals from the wireless X10 cameras offer a peek inside your house to anyone who wants to hack the signal.

The fixes for these problems--changing frequencies or adding encryption--hint at the barriers slowing home automation from becoming a mainstream hit. "You have to be a bit of a geek to make it happen right now," says Ferguson. "But once a few more companies come together, it's going to take off very quickly."

This house thinks of everything

It's not at the level of The Jetsons, but the Internet and gains in PC-based home networks are helping people make their houses smarter. Typically, an Internet-linked PC monitors and controls infrastructure including heating and cooling, lighting, and security along with appliances and gadgets. Here are some of the smart-home features available now and in the near future.

TALKING TO THE WALLS

An owner can check in remotely by communicating with his home PC or a home-automation company's server, via the Web or voice commands.

Home Electrical

Personal digital assistant

Wireless or landline phone

Laptop

GARAGE

Call from the road to check that the garage door is closed. One system, from GM, lets you use your car to command your home.

LIVING ROOM

Smart windows change tint on command, eliminating shades and blinds. Need music? The stereo zaps music to wherever you are.

KITCHEN

This prototype fridge tracks the expiration date of products inside and can reorder from an online grocer. No more bad milk!

FRONT DOOR

Knock, knock! A motion-sensitive webcam sends a peek of who's at the door to a PC or PDA, and the intercom calls your cellphone. Buzz your visitors in remotely.

BATHROOM

Wondering about a prescription's side effects? This prototype medicine cabinet can check on the Web. It also uses face recognition to make sure you don't take someone else's pills.

BEDROOM

Dress smarter with this prototype closet, which checks an Internet weather site and your PDA schedule to suggest what you should wear.

GATEWAY

Your home PC is the boss of your house, controlling thermostat, lights, security system, and other gadgets according to a schedule you set or commands you send in.

DIAGRAM: This house thinks of everything

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By Kenneth Terrell.

Battle of the balls: Nike refuses to let Adidas take all the glory

With much fanfare, Adidas last week unveiled Brazuca, the official match ball of the 2014 World Cup. The ball boasts a an all-over swirl of red, blue, green and black. The pattern suggests the traditional multicolored wish bracelets often seen on the wrists of Brazilians. It's also meant to reflect the fun and energy associated with the sport in Brazil.

Adidas already has a number of integrated efforts to promote the ball, a film showing Brazuca in action on the field and in the streets, set to The Kinks' "All Day and All of the Night." It's accompanied by a 360-degree interactive version. Also as part of the ball's introduction, Adidas is indoctrinating new football fans extremely early on with a promotion out of MSLGroup Espalhe that promises free Brazucas to newborn babies.

But in what's coming to be a World Cup tradition, Nike all but streaked across the pitch. It too unveiled its own new ball. The launch spot for Nike's Ordem ball stars soccer player Wayne Rooney going head to head with pro golfer Rory McIlroy-on a golf course. For unfamiliar ground, the soccer athlete has impressive skills, even skipping the ball over a water trap. Throughout, both players are pretty neck and neck until the final shot is made-by none other than Brazilian soccer legend Ronaldo.

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See also more team sports resources here!

Sport nutrition for young athletes

Nutrition is an important part of sport performance for young athletes, in addition to allowing for optimal growth and development. Macronutrients, micronutrients and fluids in the proper amounts are essential to provide energy for growth and activity. To optimize performance, young athletes need to learn what, when and how to eat and drink before, during and after activity.

La nutrition sportive des jeunes athletes

La nutrition est une partie importante de la performance sportive des jeunes athlètes, sans compter qu'elle favorise une croissance et un développement optimaux. Il est essentiel de consommer la bonne quantité de macronutriments, de micronutriments et de liquides pour fournir l'énergie nécessaire à la croissance et aux activités. Pour optimiser leur performance, les jeunes athlètes doivent apprendre quoi, quand et comment manger et boire avant, pendant et après l'activité.

Keywords: Adolescents; Athletes; Children; Nutrition; Sports

Proper nutrition is vital for child and adolescent athletes to attain proper growth and perform optimally in sports. Young athletes need to learn what foods are good for energy, when to eat certain foods, how to eat during an event, and when and what to eat to replenish after activity. A well-balanced diet containing appropriate amounts of macronutrients (protein, carbohydrates and fat) and micronutrients (vitamins and minerals) is essential to provide enough energy for growth and activity. Fluids are also essential for hydration to support growth and athletic performance.
ENERGY REQUIREMENTS

Basic nutrition is important for growth, achieving good health and scholastic achievement, and providing energy ( 1). Sports nutrition enhances athletic performance by decreasing fatigue and the risk of disease and injury; it also enables athletes to optimize training and recover faster ( 1). Balancing energy intake with energy expenditure is crucial to prevent an energy deficit or excess. Energy deficits can cause short stature, delayed puberty, menstrual dysfunction, loss of muscle mass and increased susceptibility for fatigue, injury or illness ( 2, 3). Energy excess can result in overweight and obesity ( 4).

Before puberty, minimum nutritional and energy requirements (caloric needs) are similar for boys and girls. Energy requirements for adolescents are more variable, depending on age, activity level, growth rate and stage of physical maturity (Table 1) ( 1). These recommended energy allowances are the minimum necessary to ensure proper growth and bodily functions. Extra calories are needed during growth spurts and to replenish energy expended during athletic endeavours ( 1, 5, 6). For example, a 30 kg girl playing soccer for 60 min would expend an average of 270 calories, or a 60 kg boy playing ice hockey for 60 min would expend an average of 936 calories ( 6).
MACRONUTRIENTS

Macronutrients, such as carbohydrates, protein and fats, provide the fuel for physical activity and sports participation.
Carbohydrates

Carbohydrates are the most important fuel source for athletes because they provide the glucose used for energy. One gram of carbohydrate contains approximately four kilocalories of energy. Glucose is stored as glycogen in muscles and liver. Muscle glycogen is the most readily available energy source for working muscle and can be released more quickly than other energy sources ( 1). Carbohydrates should comprise 45% to 65% of total caloric intake for four-to 18-year-olds ( 1, 7). Good sources of carbohydrates include whole grains, vegetables, fruits, milk and yogurt.
Protein

Proteins build and repair muscle, hair, nails and skin. For mild exercise and exercise of short duration, proteins do not act as a primary source of energy. However, as exercise duration increases, proteins help to maintain blood glucose through liver gluconeogenesis ( 2). One gram of protein provides four kilocalories of energy. Protein should comprise approximately 10% to 30% of total energy intake for four-to 18-year-olds ( 7). Good sources of protein include lean meat and poultry, fish, eggs, dairy products, beans and nuts, including peanuts.
Fats

Fat is necessary to absorb fat-soluble vitamins (A, D, E, K), to provide essential fatty acids, protect vital organs and provide insulation. Fat also provides the feeling of satiety. It is a calorie-dense source of energy (one gram provides nine kilocalories) but is more difficult to use. Fats should comprise 25% to 35% of total energy intake for four-to 18-year-olds ( 7). Saturated fats should comprise no more than 10% of total energy intake ( 1, 3). Good sources of fat include lean meat and poultry, fish, nuts, seeds, dairy products, and olive and canola oils. Fat from chips, candy, fried foods and baked goods should be minimized.
MICRONUTRIENTS

Although there are many vitamins and minerals required for good health, particular attention should be devoted to ensuring that athletes consume proper amounts of calcium, vitamin D and iron. Calcium is important for bone health, normal enzyme activity and muscle contraction. The daily recommended intake of calcium is 1000 mg/day for four-to eight-year-olds and 1300 mg/day for nine-to 18-year'olds ( 7, 8). Calcium is contained in a variety of foods and beverages, including milk, yogurt, cheese, broccoli, spinach and fortified grain products.

Vitamin D is necessary for bone health and is involved in the absorption and regulation of calcium. Current recommendations suggest 600 IU/day for four-to 18-year-olds ( 8). Normal values of vitamin D also vary depending on geographical location and race. Athletes living in northern latitudes or who train indoors (eg, figure skaters, gymnasts, dancers) are more likely to be vitamin D deficient ( 2). Sources of vitamin D include fortified foods, such as milk, and sun exposure. Dairy products other than milk, such as yogurt, do not contain vitamin D.

Iron is important for oxygen delivery to body tissues. During adolescence, more iron is required to support growth as well as increases in blood volume and lean muscle mass ( 1). Boys and girls nine to 13 years of age should ingest 8 mg/day to avoid depletion of iron stores and iron-deficiency anemia ( 7). Adolescents 14 to 18 years of age require more iron, up to 11 mg/day for males and 15 mg/day for females ( 7). Iron depletion is common in athletes because of diets poor in meat, fish and poultry, or increased iron losses in urine, feces, sweat or menstrual blood ( 2). Therefore, athletes, particularly female athletes, vegetarians and distance runners should be screened periodically for iron status ( 2). Iron-rich foods include eggs, leafy green vegetables, fortified whole grains and lean meat.
FLUIDS

Fluids, particularly water, are important nutrients for athletes. Athletic performance can be affected by what, how much and when an athlete drinks. Fluids help to regulate body temperature and replace sweat losses during exercise ( 8, 9). Environmental temperature and humidity can affect how much an athlete sweats and how much fluid intake is required ( 1, 9, 10). Hotter temperatures and higher humidity make a person sweat more, and more fluid is needed to maintain hydration. Dehydration can decrease performance and put athletes at risk for heat exhaustion or heat stroke ( 1, 9, 10).

Proper hydration requires fluid intake before, during and after exercise or activity. The amount of fluid required depends on many factors, including age and body size ( 9, 10) (Table 2). Before activity, athletes should consume 400 mL to 600 mL of cold water 2 h to 3 h before their event ( 1, 2, 10). During sporting activities, athletes should consume 150 mL to 300 mL of fluid every 15 min to 20 min ( 1, 2, 10). For events lasting less than 1 h, water is sufficient ( 4). For events lasting longer than 60 min, and/or taking place in hot, humid weather, sports drinks containing 6% carbohydrates and 20 mEq/L to 30 mEq/L of sodium chloride are recommended to replace energy stores and fluid/electrolyte losses ( 3, 4, 5, 9). Following activity, athletes should drink enough fluid to replace sweat losses (Table 2). This usually requires consuming approximately 1.5 L of fluid/kg of body weight lost ( 1, 10). The consumption of sodium-containing fluids and snacks after exercise helps with rehydration by stimulating thirst and fluid retention ( 1, 2, 10). For non-athletes, routine ingestion of carbohydrate-containing sports drinks can result in consumption of excessive calories, increasing the risks of overweight and obesity, as well as dental caries and, therefore, should be avoided ( 4).
RECOVERY FOODS

Recovery foods should be consumed within 30 min of exercise, and again within 1 h to 2 h of exercise, to help reload muscles with glycogen and allow for proper recovery. These foods should include protein and carbohydrates ( 2, 6). Examples include graham crackers with peanut butter and juice, yogurt with fruit, or a sports drink with fruit and cheese ( 6).
MEAL PLANNING

One of the trickiest things to manage is meal planning around athletic events. The timing of meals is very important and needs to be individualized. It is important for athletes to discover which foods they like that also help to maximize performance. They should not experiment with new foods or new routines on the day of competition.

General guidelines include eating meals a minimum of 3 h before an event to allow for proper digestion and to minimize incidence of gastrointestinal upset during exercise. Meals should include carbohydrates, protein and fat. Fibre should be limited. High-fat meals should be avoided before exercise because they can delay gastric-emptying, make athletes feel sluggish and thereby adversely affect performance ( 2, 6). For early morning practices or events, having a snack or liquid meal 1 h to 2 h before exercise, followed by a full breakfast after the event, will help ensure sufficient energy to maximize performance ( 2, 6).

Pre-game snacks or liquid meals should be ingested 1 h to 2 h before an event to allow for digestion before start of exercise ( 2, 6). Snacks can include fresh fruit, dried fruit, a bowl of cereal with milk, juice or fruit-based smoothies. During an event, sports drinks, fruit or granola bars can be ingested to help refuel and keep energy levels high.
REACHING THE FINISH LINE

A well-balanced diet is essential for growing athletes to maintain proper growth and optimize performance in athletic endeavours. An ideal diet comprises 45% to 65% carbohydrates, 10% to 30% protein and 25% to 35% fat. Fluids are very important for maintaining hydration and should be consumed before, during and after athletic events to prevent dehydration. Timing of food consumption is important to optimize performance. Meals should be eaten a minimum of 3 h before exercise and snacks should be eaten 1 h to 2 h before activity. Recovery foods should be consumed within 30 min of exercise and again within 1 h to 2 h of activity to allow muscles to rebuild and ensure proper recovery.
USEFUL WEBSITES

American Society for Nutrition: www.nutrition.org

Australian Sport Institute: www.ausport.gov.au/ais/nutrition

The Canadian Nutrient File is a searchable database containing average values for nutrients in foods: www.hc-sc.gc.ca/fn-an/nutrition/fichenutri-data/user%5Fguide%5Fd%5Futilisation01-eng.php

Coaching Association of Canada: http://coach.ca/fueling-the-young-athlete-p140142;http://coach.ca/sport-nutrition-tips-s13426

Dietitians of Canada has a table of iron-rich foods: www.dietitians.ca/Nutrition-Resources-A-Z/Factsheets/Minerals/Food-Sources-of-Iron.aspx

Gatorade Sport Science Institute: http://gssiweb.com

KidsHealth (Nemours), Feeding your child athlete: www.kidshealth.org/parent/nutrition%5Fcenter/dietary%5Fneeds/feed%5Fchild%5Fathlete.html

ACKNOWLEDGEMENT: This practice point has been reviewed by the Canadian Paediatric Society's Nutrition and Gastroenterology Committee.
CPS PAEDIATRIC SPORTS AND EXERCISE MEDICINE EXECUTIVE

Neil Cooper MD (Member at large); David Fecteau MD (Secretary-treasurer); Erika Persson MD (Member at large); John F Philpott MD (Presidentelect); Laura K Purcell MD (President); Eric Koelink MD (Liaison, CPS Residents Section); David W Warren MD (former Liaison, CPS Emergency Medicine Section)

Principal author: Laura K Purcell MD

The recommendations in this document do not indicate an exclusive course of treatment or procedure to be followed. Variations, taking into account individual circumstances, may be appropriate. All Canadian Paediatric Society position statements and practice points are reviewed on a regular basis. Retired statements are removed from the website. Please consult the Position Statements section of the CPS website (www.cps.ca) for the full-text, current version.
TABLE 1 Recommended energy requirements, Kcal/day


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Age, years: 4-6
Male:       1800
Female:     1800

Age, years: 7-10
Male:       2000
Female:     2000

Age, years: 11-14
Male:       2500
Female:     2200

Age, years: 15-18
Male:       3000
Female:     2200

Adapted with permission from reference 1
TABLE 2 Recommended minimal fluid intake during and after exercise in child athletes, based on the calculation of 13 mL/kg during exercise and 4 mL/kg after exercise


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Body weight, kg:                           25
Fluid replacement during exercise, mL/h:   325
Fluid replacement after exercise, mL/h:    100

Body weight, kg:                           30
Fluid replacement during exercise, mL/h:   390
Fluid replacement after exercise, mL/h:    120

Body weight, kg:                           35
Fluid replacement during exercise, mL/h:   455
Fluid replacement after exercise, mL/h:    140

Body weight, kg:                           40
Fluid replacement during exercise, mL/h:   520
Fluid replacement after exercise, mL/h:    160

Body weight, kg:                           45
Fluid replacement during exercise, mL/h:   585
Fluid replacement after exercise, mL/h:    180

Body weight, kg:                           50
Fluid replacement during exercise, mL/h:   650
Fluid replacement after exercise, mL/h:    200

Body weight, kg:                           55
Fluid replacement during exercise, mL/h:   715
Fluid replacement after exercise, mL/h:    220

Body weight, kg:                           60
Fluid replacement during exercise, mL/h:   780
Fluid replacement after exercise, mL/h:    240

Adapted with permission from reference 9
REFERENCES

1. Hoch AZ, Goossen K, Kretschmer T. Nutritional requirements of the child and teenage athlete. Phys Med Rehabil Clin N Am 2008;19(2):373-98.

2. Dietitians of Canada, the American Dietetic Association, and the American College of Sports Medicine. Joint position statement: Nutrition and athletic performance. Can J Diet Pract Res 2000;61(14):176-92.

3. Meyer F, O'Connor, H, Shirreffs SM ; International Association of Athletics Federations. Nutrition for the young athlete. J Sports Sci 2007;25 (Suppl 1):S73-S82.

4. American Academy of Pediatrics, Committee on Nutrition and the Council on Sports Medicine and Fitness. Sports drinks and energy drinks for children and adolescents: Are they appropriate? Pediatrics 2011;127(6):1182-9.

5. Unnithan VB, Goulopoulou S. Nutrition for the pediatric athlete. Curr Sports Med Rep 2004;3(4):206-11.

6. Litt A. Fuel for young athletes: Essential foods and fluids for future champions. Windsor: Human Kinetics, 2004.

7. Otten JJ, Hellwig JP, Meyers LD, eds. Dietary reference intakes: The essential guide to nutrient requirements. National Academies Press, 2006: < http://nap.edu/openbook.php?record%5Fid=11537> (Accessed June 28, 2012).

8. Institute of Medicine Dietary reference intakes for calcium and vitamin D. Consensus Report, November 30, 2010: <www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D.aspx> (Accessed June 28, 2012).

9. Rowland T. Fluid replacement requirements for child athletes. Sports Med 2011;4K4):279-88.

10. American College of Sports Medicine. Position stand: Exercise and fluid replacement. Med Sci Sports Exerc 2007;39(2):377-90.

PHOTO (BLACK & WHITE)

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By Laura K Purcell, Canadian Paediatric Society, Paediatric Sports and Exercise Medicine Section, 2305 St Laurent Boulevard, Ottawa, Ontario KIG 4J8. E-mail info@cps.ca, website www.cps.ca

Does This Make My Hair Look Fat?

No matter how fine or thin your mane, with the right products and styling solutions, the answer to that question can be a resounding yes.

Botox. Faux tans. Eyelash extensions. In an era in which formerly taboo cosmetic topics have become mainstream, another is finally coming out of the beauty closet—and it's about time. "Hair loss used to be whispered about, because many women believed they were alone," says Stephen Pullan, a hair expert at the Philip Kingsley Clinic in New York City. "But as more people start to discuss it, others are encouraged to do the same and, ultimately, seek treatment. At the clinic, I see more women than men dealing with hair loss." Stats back him up: 40 percent of Americans who have thinning hair are women, according to the American Hair Loss Association. Clearly, it's no longer a problem only for middle-aged dudes.

Genetics, hormonal changes, and even how often you blow-dry can cause your hair to peace out. But no matter what's making you lose it (in more ways than one!), these tests will help you get to the root of your skinny-hair issue. Then follow our advice to fatten up fast.

1 Your Hair Is So Fine(and not in a good way)

Maybe she's born with it…or maybe it's aging? Some women have had baby-fine hair since pre-K; others watch their strands wither over time. (FYI: That's considered normal. As we age, our hair follicles shrink and produce thinner strands.)

THE TRESS TEST

Pull your hair into a ponytail and look at the size. "If its base diameter is the width of a penny or less, your hair is probably fine," says Tresemmé hairstylist Tyler Laswell. If your tail has shrunk so much that it could be a contestant on The Biggest Loser, you might have age-related thinning. "If you can wrap a hair tie around your ponytail base three or more times, and it used to go around once or twice, your hair's probably growing in thinner than it used to," says Jill Crosby, a Los Angeles hairstylist.

BULK UP

> Have a cocktail party.

Nope, not the boozy kind. "My all-time favorite products for boosting fine, thin hair are mousses and salt sprays, because when used together, they give hair a light, airy volume that lasts," says Laswell. Before blow-drying, mist a few spritzes of salt spray onto damp hair, then rake a golf ball–size blob of mousse into roots and massage down to ends (halve that mousse amount if your hair is shorter than shoulder-length). Try R+Co Rockaway Salt Spray ($25, randco.com) and Tresemmé 24 Hour Body Foaming Mousse ($5, at drugstores).

> Be a tease.

Teasing isn't just for rat's-nest runway looks; it's a trick Laswell uses often to make scrawny hair look big. His top tip: "Don't just tease the roots, as many women do. Gently backcomb the entire head with a fine-tooth comb, starting at the top and working to the ends. Then use a boar-bristle brush to smooth the outermost layer." Voilà—fullness sans flyaways.

> Curl small.

If hair is straight, add insta-oomph with a curling iron. "The secret here is to wrap small, one-inch sections of dry hair around a 1½-inch curling iron and alternate directions—wrap some around the barrel away from your face, and some toward it. You'll get a higher number of waves for a fuller look, and the random directions prevent a flat, clumped-together uni-curl," Laswell says.

2 Your Hair Is Thin at the Tips

From the ears up, your hair is commercial-caliber. sadly, look as if they belong on a scarecrow.

THE TRESS TEST

Toss your hair over one shoulder and tilt your head to the side. See some weird spacing and sparseness at the bottom few inches? Oh, hey, damage. "Hair grows around six inches per year, so if it's shoulder-length, it's seen winter, summer, cold air, dry air, sun, lots of blow-drying, hot tools, and lots of brushing," says Pullan. "This combination may cause dryness and split ends that can snap off, making ends look scraggly." A thinner-at-the-ends ponytail may be another marker that you've reached the breaking point.

BULK UP

> Get a trim.

Hanging onto hair that's hanging by a thread? Not the best idea. "Cutting off the dry split ends to even out the density at the bottom and top can make hair appear thicker," says Nioxin hairstylist Danielle Caputo-Estorino.

> Condition and rebuild.

Adding moisture back into hair that is both thin and damaged is a catch-22, because many ultra-moisturizing conditioners contain oils and waxes that can make hair limp, causing it to look even wispier, says Pullan. Once a week before shampooing, use a treatment like Philip Kingsley Elasticizer ($50, philipkingsley.com), which contains castor and olive oils, silicone, and elastin that strengthen and hydrate inside the cuticle, rather than sit on top. And before blow-drying, work a mixture of equal (dime-size) parts heat-protective cream and body-enhancing gel or mousse through lengths and ends. (If you air-dry, skip the cream.) Try Bumble and Bumble Repair Blow Dry ($30, bumbleandbumble.com) and L'Oréal Paris Advanced Haircare Volume Filler Densifying Gelee ($7, at drugstores).

> Beat the heat.

Good news for flatiron-philes: It's not the tool that's to blame; it's how you use it. "Most women set the iron to 400°F or 410°F, which can dry out and eventually break the ends of the hair. You aren't trying to fry eggs here," says Caputo-Estorino. Start at 200°F to 250°F, and go a bit hotter only if that temperature doesn't work. When styling, spray on a heat protector, then pass the iron over each section slowly, and no more than twice. If a curling iron is your weapon of choice, hold the hair for five to 10 seconds, max.

3 Your Hair Is Falling Out

Stop envisioning yourself as Homer Simpson. "Around 30 percent of my patients are women experiencing hair loss, or androgenic alopecia, and it terrifies them. They think they're eventually going to go bald—but that's usually not the case," says Doris Day, M.D., a New York City dermatologist. Excess shedding can be related to a slew of lifestyle factors, such as stress, hormonal imbalances, and nutritional deficiencies. While many of these can be reversed (say, with meditation or dietary changes), a few products can also regrow your strands.

THE TRESS TEST

Hair loss on you looks different than it does on your dad, so rather than check for a receding hairline, scope out your part. "If it's widening in an evergreen tree–like pattern, that's a marker of female pattern hair loss," explains Day.

BULK UP

> Look for minoxidil.

It's the magical ingredient that has helped grow millions of hairs since the '80s. And as the only FDA-approved topical treatment to stimulate hair follicles to reverse hair loss, why the heck wouldn't you use it? "We're starting to talk about minoxidil for the scalp the way we talk about retinol for the face," says Day. One to try: Women's Rogaine 5% Minoxidil Topical Aerosol ($50 for a four-month supply, at drugstores). Massage the product into a clean scalp once daily, at least four hours prior to shampooing. "Hair may fall out for two more weeks, a signal that new hair is right behind it. It's like teeth—you have to lose your baby ones so the adult ones can grow in," says Day. (Another promising sign that hair loss isn't the silent issue it once was? Rogaine now has some minoxidil-containing friends on the shelves, from brands like Pantene and Redken.)

>Try combo therapy.

Dealing with the trifecta of fallout, thinness, and damage? Supplement minoxidil with Redken Cerafill Defy Instant Thickening Kit ($70, redken.com for salons), which comes with a shampoo, conditioner, and daily toner to prevent breakage, thicken strands, and inhibit DHT—the hormone-related chemical that leads to hair loss.

> Choose to diffuse.

When blow-drying, lose the brush and add a diffuser head, which won't put tension on your hair's cuticle and make it flat, says Crosby. Then fill in sparse spots with a product that deposits fibers onto your scalp temporarily, making hair seem more dense. Try Viviscal Hair Filler Fibers ($25, viviscal.com).

FEED YOUR SCALP

Herbivores, take note: "Hair follicles can be sensitive to nutritional imbalance," says Pullan, who notices that many of his female clients experience hair loss when they go vegetarian. That's because they might lack protein and iron. Healthy hair growth requires protein, and iron could improve blood circulation, which may also help.

To get a meatless fix, add nuts and beans to your plate, suggests nutritionist Keri Glassman, R.D. And if you juice, keep it up! Leafy greens have vitamins and minerals that may promote circulation to the scalp—just add a scoop of plant-based protein powder for a big-hair boost.

WH Online

Learn how to add more va-va-voom to your hair with must-try tips at WomensHealthMag.com/November.

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By Jill Percia

PAIN IN THE DRAIN 

A pleasant PSA for those losing a gazillion hairs in the shower: Your shampoo habits—not something dire—could be the culprit. "It's considered normal to lose up to 100 hairs per day, many of which stay entwined in the hair until you shampoo and condition—that's when hairs start to glide out," says Pullan. Do the math: If you wash your hair every third day, fallout might be closer to 300 strands.

BIGGER IS BETTER 

The style that's blowing up at Drybar, a nationwide blow-dry-only salon? The Southern Comfort—its most voluminous option! To DIY: Distribute mousse evenly through damp roots and hair, then blow-dry with a large, ceramic round brush, lifting it upward as you smooth each section, says Drybar founder Alli Webb.