Your Family Medical Diary: A Gift Your Child Cannot Do Without!
Of all the gifts we give our children, the one they cannot do without is the gift of knowledge that is their family's medical history. We now know that there is a link between childhood nutrition and adult disease, and we also know that it is in childhood that steps need to be taken to effectively diagnose, treat, and possibly prevent chronic illnesses. Obesity, heart attack, stroke, heart disease, high blood pressure, Type II diabetes, cancer, and osteoporosis reveal themselves later, in adult years, sometimes even the late adult years. And all of these diseases have multiple causes acting simultaneously—an interaction between genetics and the environment.
We can control some important environmental factors—nutrition and exercise—to lower the risk of these diseases. But let's not forget the genetic component. Although we can't alter our genes, we can find out if our children are genetically prone to any one of these diseases and put maximum effort into helping them develop the patterns that will lower their risk for that disease. So, how do we go about obtaining this genetic information?
The Telling and the Testing-Your Family Health Diary
The best way to gather genetic information is through a carefully researched family medical history. If you are a parent or if you're preparing to become a parent, start collecting as much health data on your family as possible. Call it your Family Health Diary and update it as often as possible. We've included sample pages to insure your Family Health Diary is as complete as possible.
Begin by seeking out the oldest living members of the family, probably grandparents, but maybe even great-grandparents. Since the questions you'll be asking are personal and sensitive, explain that you need this information to help your pediatrician or family physician make certain decisions about treating their grandchild or great-grandchild. Then talk to any first-degree relatives of the family member you are interviewing—their brothers or sisters. If you can't talk to them directly, ask others in the family about their medical history. And be sure to ask your own parents about their history and yours.
Write all of this information in a diary, your Family Health Diary It will be of great use not only in helping your child today but also someday in the future, when it will be useful in helping your grandchildren and great-grandchildren.
Find out what caused the deaths of their parents or grandparents, if anyone had any of the diseases we're discussing. For example, were their parents or grandparents overweight? Were they obese? Did anyone have high blood pressure? Did anyone survive cancer? Did anyone fracture a hip or other bones in old age? Did anyone have a heart attack or stroke? How about diabetes? And be sure to ask the family member you're interviewing whether he or she has had any of these diseases.
After you've gathered this information and recorded it in your Family Health Diary, look for any patterns that emerge.
Let us assume that all four grandparents are still living and you've interviewed each of them. One of your grandparents is overweight and had a sibling who was overweight. That's a pattern of obesity in your side of the family. Now, suppose the same pattern emerges in your spouse's family, and further, you and your spouse are both struggling to keep your weight down. You now have evidence that your child will be at risk for obesity: a history of obesity on one or both sides of your child's family indicates that there is a genetic predisposition.
What do you do now? Take the measurements outlined below more often than normally recommended and intervene as soon as the rate of weight gain begins to accelerate. If your child is an adolescent, sit down and discuss the problem with him. Tell him he may be at increased risk of obesity and ask him to read the Family Medical Diary. Let him know that you're encouraging a pattern of healthy eating and exercise, and you're doing it before he begins to show any evidence of becoming obese.
Heart Disease, High Blood Pressure, Hypertension, and Diabetes
Now suppose that your Family Health Diary indicates a clear history of heart disease (sometimes fatal at a young age) on one or both sides of the family. This will call for some careful detective work. Does anyone in the family also have a history of stroke, suggesting that high blood pressure could be the cause? Is there a history of diabetes (high blood sugar)? How about obesity? Were the cholesterol levels high? Did that family member smoke? These are all risk factors for heart attacks, so it is important to get as much specific information as possible.
What about you? Do you know your blood pressure readings, your cholesterol numbers, and your blood sugar? Are you overweight? All of these factors are important in deciding just how rigorous you'll have to be in employing dietary and exercise techniques during pregnancy and with your infant, toddler, school-age child, and adolescent. If a clear history of hypertension emerges, you'll want to be even more vigilant about limiting sodium and avoiding obesity. And if a clear history of diabetes emerges, again this means obesity must be avoided. Type II diabetes is now being reported in increasing numbers of obese children and adolescents. As you now know, obesity in childhood can play a direct role in heart disease and an indirect role in increasing the risk of hypertension, diabetes, and high cholesterol—three other direct causes of heart attacks.
If your family health history shows a pattern of heart disease, it clearly becomes important for your child to be both monitored for and protected from those factors that are direct causes of heart attacks. And it's important that you, as the parents, also are assessed for these factors.
Blood pressure should be monitored more often in children with family health histories of heart attacks. If your child becomes obese, her blood-sugar levels should be determined and the obesity treated according to your child's age and stage of development. As your child reaches adolescence, it is vital that you tell her that smoking (itself a major risk factor for heart attacks) is particularly detrimental to her health.
How about levels of cholesterol and other lipids? Some physicians feel that all children should have their serum cholesterol determined, but most do not think this is necessary (See The Testing, below.) If a child has a strong family history of heart disease there is no doubt that a series of blood tests to determine total cholesterol—LDL (bad) cholesterol, HDL (good) cholesterol, and other lipids (triglycerides) should be done before age three. These tests are simple and can be done by a single finger prick. If the tests are abnormal, it's recommended that you feed your child a diet low in saturated fats. No more than 30 percent of daily calories (or no less than 20 percent) should come from fats-10 percent saturated and trans fats, 10 percent polyunsaturated, and 10 percent monounsaturated. In fact, all children at around ages four or five should follow this low-fat protocol. (These tests should be repeated yearly, and if they remain high, a more stringent fat-restriction program may be in order.)
Finally, is there a history of osteoporosis in your family? Have there been hip or wrist fractures in older members, particularly the women? If so, your child must be considered at risk for this disease in later life. This is particularly true for girls, who are ten times as likely to develop osteoporosis as boys. Unfortunately, there is no test that can be done to confirm this extra risk. Bone density tests involve radiation (we certainly don't want to expose our children routinely to radiation) and must be done serially in adults to be of value. In addition, there are no normal values for children at any age. That makes your family health history even more important in determining risk.
Once this history is assembled you can decide whether your child falls into the high-risk category. If she does, than the preventative measures remain the same as for all children. You want her to build bones that are as strong as possible. Calcium is the key, but avoiding phosphorous-laden sodas is also important. Since calcium absorption is greatest from breast milk, if possible, children at risk should be breast-fed.
Finally, any weight-bearing exercise—such as jogging, jumping, running—is important, as it stimulates bone growth. All children should be encouraged to take these recommendations seriously, especially those at genetic risk for osteoporosis.
To start off, take a look at the Family Health Tree. This tree targets the chronic disease history of your immediate family. Once you familiarize yourself with the Tree, begin to collect as much health information as possible from each family member to be included in the Family Health Diary.