ParentingNH April 2019

HEALTHY FAMILIES SPRING EDITION • MEASLES IN NH – ARE WE AT RISK? • BUNCHES OF BRUNCHES

COMPLIMENTARY

Up close with Carrie Cariello

Mom, author, autism advocate

APRIL 2019

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2 www.parentingnh.com | APRIL 2019

PRESIDENT/PUBLISHER:

Sharron McCarthy, x5117 smccarthy@mcleancommunications.com EDITOR:

Melanie Hitchcock, x5157 editor@parentingnh.com

CONTENTS features 33

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APRIL

Up close with autism advocate Carrie Cariello

Preventing Type 2 diabetes in kids and teens

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17 Could a measles outbreak happen in New Hampshire?

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The keto diet explained

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departments 2 From the

editor’s desk

4 The short list 6 I want that 40 Dad on board 41 House calls 42 Out & about 44 Time out

ON THE COVER: Author, advocate and mom Carrie Cariello. Photo taken March 7, 2019, at her home by Kendal J. Bush Photography. Check out Kendal’s work at www.kendaljbush.com. www.parentingnh.com

| APRIL 2019 1

contributors • APRIL

from the editor’s desk HARD WORK EVENS THE PLAYING FIELD When the news broke recently that two Hollywood actresses and 48 others were indicted for their roles in a scheme in which parents paid to have their kids’ records falsified so they could get into elite colleges and universities, I wasn’t shocked. I wasn’t even surprised. It’s no secret that money can buy preferential treatment and encourage someone to look the other way.

But the saddest part of the admissions scandal is that in many cases the parents paid the hundreds of thousands of dollars not because their kids wanted to go to a top school, but because the parents wanted to be able to say that they did.

The media has been quick to call those involved “lawnmower” parents — parents that “mow” down challenges instead of empowering their child to do that on their own. That’s an insult to those parents who have the best interests of their child at heart. One of the actress’s kids said on social media she didn’t even want to go to college. What a waste.

But even for the parents with good intentions who bribed their child’s way into a school so they could get a better education and further ahead, it was also not money well spent.

The perception that a college education at an elite school results in more success is false.

What dictates success, and what money can’t buy, is a student’s work ethic, ambition, and desire to achieve. No matter where you go, you only get out of your education what you put into it. You can’t buy knowledge, but you can work hard and take all the opportunities that a school has to offer.

Quite frankly when you get to the top of your field, no one cares where you went to school.

Instead of breaking out the checkbook, the best thing parents can do for their kids is to encourage them to excel, to take ownership of their education and become lifelong learners. Life does not get easier after college – the lessons they learn by tackling obstacles will be with them long after they receive their diploma and serve them well in whatever career they choose.

MELANIE HITCHCOCK, EDITOR

KRYSTEN GODFREY MADDOCKS is a former journalist and marketing director who now regularly writes for higher education and technology organizations in New Hampshire and Massachusetts. Mom to 4-year-old Everett, she has lived in the Seacoast for the past 20 years.

CRYSTAL WARD KENT is a freelance writer who has written for numerous local and regional magazines. She owns Kent Creative in Dover, a creative services agency providing writing, design and marketing, and is also the author of several books and children’s books.

MARY ELLEN HETTINGER, APR is an award-winning reporter, editor and writer, and accredited public relations professional.

She won a bronze award in 2017 from the Parenting Media Association for her news feature on perfluorochemicals in New Hampshire’s water supply.

MELANIE PLENDA is an award-winning freelance journalist and mom based in Keene. Her work has appeared in The Atlantic.com, The Daily Beast, American Baby, and Parents. com among other media outlets. Melanie won two awards from the Parenting Media Association in March 2019 – a silver award for Special Series writing and a bronze award for profile writing.

sponsor note Dartmouth-Hitchcock Health and the Children’s Hospital at DartmouthHitchcock (CHaD) are proud to sponsor this Healthy Families issue.

After all, the health of children and families is what we’re all about.

DARTMOUTH-HITCHCOCK HEALTH (D-HH), New Hampshire’s only academic health system, serves patients from across New England. D-HH provides access to more than 1,500 primary and specialty care physicians in almost every area of medicine, delivering care at its flagship academic medical center, Dartmouth-Hitchcock Medical Center (DHMC) in Lebanon, New Hampshire.

In 2018, DHMC was named as the number one hospital in New Hampshire by U.S. News & World Report, nationally ranked in gynecology and recognized for high performance in 14 clinical specialties. D-HH system members include

2 www.parentingnh.com | APRIL 2019

New London Hospital, Cheshire Medical Center in Keene, Alice Peck Day Memorial Hospital in Lebanon, Visiting Nurse and Hospice for Vermont and New Hampshire, Mt. Ascutney Hospital and Health Center in Windsor, Vermont and 24 Dartmouth-Hitchcock clinics that provide ambulatory services across New Hampshire and Vermont. The D-HH system trains nearly 400 residents and fellows annually and performs state-of-the-art research in partnership with the Geisel School of Medicine at Dartmouth and the White River Junction VA Medical Center in White River Junction, Vermont.

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| APRIL 2019 3

the short list AMOSKEAG FISHWAYS LEARNING AND VISITORS CENTER IS NOW A SEASONAL OPERATION

REGISTER TO ATTEND FIRST-EVER YOUTH SUMMIT Dartmouth-Hitchcock is hosting a two-day summit at the Grappone Center in Concord on April 5 and 6 that will explore the issues that significantly impact youth, families, schools and communities — mental health and stigma, bullying, cyberbullying, addiction, eating disorders, sexuality and gender, gun violence, concussions and sports injuries, academic pressures, social media, cyber predators, peer pressure and more.

High school students from across New Hampshire are driving the content of the summit. Goals for the summit include drafting recommendations for policy changes and creating a one-year Youth Summit Commission to be followed by a white paper to share at the state and federal levels and presented by student champions, among others.

On day 1, students selected by their schools to attend will drive the discussion; adult experts will assist and connect students to resources. On day 2, the same topics will be tackled, but students will have a lead role in facilitating the discussion in some of the sessions with the adults.

Educators and school administrators, legislators, guidance counselors, coaches, school psychologists, medical professionals, business leaders and community leaders are encouraged to sign up to attend day 2 of the summit on Saturday, April 6, from 8:30 a.m. to 1:30 p.m. Go to www.dartmouth-hitchcock.org for more information or register at Eventbrite.

Enter to win 2 weeks of summer camp

30th annual Girls Inc. Auction underway

Camp Birch Hill in New Durham and ParentingNH is giving away a two-week summer session for a boy or girl, age 6-12, valued at $3,000.

Camp Birch Hill specializes in skill development and exploring new interests, with a focus on fun. With activities from horseback riding to ultimate Frisbee and volleyball to swimming, there’s something for everyone and kids are sure to create friendships and memories for a lifetime.

The winner can choose from Session I (June 30-July 14) or Session III (July 28-Aug. 10). Go to www.parentingnh.com/birchhill by April 30 to enter.

The Girls Inc. Auction that began as an auction on a local cable station has evolved into an online auction and live auction gala.

The goal is to raise funds so Girls Inc. never has to turn a girl away. The online auction is open and continues through April 10 at 8 p.m.

Check out the items and start your bidding now. New items are being added every day.

And don’t miss the gala on Friday, April 12, from 6 to 9 p.m. at the Courtyard by Marriott Nashua, which will feature silent and live auctions. Tickets are $75. Bid on auction times and buy tickets at www.biddingforgood.com.

4 www.parentingnh.com | APRIL 2019

With the sale of the Amoskeag Dam and hydro-facility completed, the contract between NH Audubon and Eversource that supported the program has ended.

Amoskeag Fishways is transitioning into a seasonal operation that will be open from April to July when fish are migrating up the Merrimack River. During the fish passage season, the facility will be managed by students hired from local universities. Tours of the facility during the remainder of the year will still be available with advance scheduling.

“Since we began teaching in 1991 and became a partnership in 1995, we have had 660,000 visitors and 180,000 program participants,” said Helen Dalbeck, former Executive Director of the Fishways. “Our programs reached 127,000 Manchester area school children through 5,350 school programs — that’s epic.”

ParentingNH, New Hampshire’s first and only statewide magazine for parents of children and teens, was recognized in 11 categories, including General Excellence, at the Parenting Media Association’s 2019 Editorial and Design Awards.

The magazine won a silver award for overall General Excellence. Also, gold awards for Best Redesigned Publication, Best Website, Humor Column and Publisher’s Editor’s Note; silver awards for Overall Writing, Non-Traditional Story Form Feature, Special Series, Ancillary Publication General Excellence and Ancillary Publication Overall Design for its Family Summer Fun Guide, and a bronze award for Profile Story.

Thanks to our readers and advertising partners, ParentingNH, a resource for parents since 1993, is looking forward to being able to continue to provide accurate and up-to-date information on important issues to Granite State families.

All in a day’s work www.parentingnh.com

| APRIL 2019 5

I want that

Celebrate with the Story Egg

AN EASTER EGGS-TRAVAGANZA

The Easter Story Egg kit includes a hardcover book and seven hand-crafted wooden nesting eggs. Each egg within the set has a story that relates to a day in Holy Week. As the children open each egg they discover the Easter story.

AVAILABLE AT WWW.STARKIDSCOMPANY.COM; $34.99

Allergy-friendly alternative Eggnots look and feel real but no refrigeration is needed.

Personalize, dye and color the ceramic eggs that are 100-percent safe for those with egg allergies. Eggnots are the perfect starting point for almost any craft, and your finished keepsake will last as long as the memories do.

AVAILABLE AT WWW.EGGNOTS. COM; $10.95 AND UP

Chocolate eggs (yes, please)

Work off your Easter candy

Skip the basket

Easter would not be the same without candy. Van Otis Chocolates in Manchester makes an array of sweet treats for Easter including gummy eggs, chocolate-dipped Peeps, marshmallow eggs and of course chocolate bunnies in all varieties and sizes. I’ll take a few bags of the dark chocolate foiled eggs (½ pound, $11.50).

Egg Weights are hand weights that fit perfectly in the palm of your hand, but without the bulkiness of dumbbells.

They help increase the intensity of any workout, with less injury and stress to your body.

The weights are ergonomically designed to conform to your body’s natural motion whether it’s for running, boxing, hiking or sports training.

Head to Etsy to put in an order for a personalized jumbo Easter egg that you can fill for that special someone. The plastic eggs, approximately eight inches tall, come in blue, green, pink or purple. The crafter WickedAccentsnh2015 is based in Loudon. Eggs ship in three to five business days.

GO TO WWW.VANOTIS CHOCOLATES.COM FOR MORE INFORMATION.

AVAILABLE AT WWW.EGGWEIGHTS. COM; $24.95 (1 POUND SET) AND UP

AVAILABLE AT WWW.ETSY.COM; $5

6 www.parentingnh.com | APRIL 2019

SUMMER CAMPS

Affordable tuition, priceless education

The Workforce Development Center at MCC offers educational, fun summer camps.

2019 Summer Camps for Youth Entering 6th-8th Grades Code

Camp Name

Dates

Days

Times

Cost

NCMI91M

Nuts, Bolts and Thingamajigs

July 8-12

MTWRF

8:45am-2:30pm

$175

NCMI86M

STEM (Science, Technology, Engineering and Math) Camp

July 15-18

MTWR

8:45am-2:30pm

$175

NCMI107M

Solid Modeling

July 22-25

MTWR

8:45am-2:30pm

$175

NCMI85M

Robotics Camp

July 29 - August 1

MTWR

8:45am-2:30pm

$175

NCMI90M

Girl’s Career Camp

August 5-8

MTWR

8:45am-2:30pm

$175

Discover the benefits of STEAM education It’s not too early, enroll your child today!

Hampstead Academy is a place where you can be you. We educate the whole child, focusing on STEAM—science, technology, engineering, arts and math. Students develop their academic potential and individual talents in a caring atmosphere that cultivates creative thinking, upstanding character, service, and enthusiasm.

Workforce Development Center at Manchester Community College

REGISTER FOR AN INFO SESSION: REGISTER FOR AN INFO SESSION: hampsteadacademy.org (603) 329-4406 hampsteadacademy.org(603) 329-4406

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Register online at:

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Hampstead Academy Hampstead Academy

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The Works Summer Camp is like no other!

June 24th through August 23rd.

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www.parentingnh.com

| APRIL 2019 7

Carrie Cariello with son, Jack, 14. Carrie blogs about the challenges of Jack’s diagnosis, but also the many bright moments in her family’s life.

PHOTO BY KENDAL J. BUSH

8 www.parentingnh.com | APRIL 2019

Tell i

l ing

her story

Author and blogger Carrie Cariello talks about her son’s autism, advocacy and finding a balance

BY KRYSTEN GODFREY MADDOCKS

R

aising a child with autism is kind of like going for a boat ride in the wide open water.

One minute it’s all smooth sailing — the radio is playing softly, no one is screaming a profanity — and all of a sudden, you come to an abrupt stop, like the anchor has dropped.

This is how Carrie Cariello, 44, describes raising her autistic son, Jack, in her Huffington Post blog: “Here is What No One Says Out Loud about Raising a 13-Year-Old Son with Autism,” published in April 2018. It is one of many that have been published in outlets such as TODAY Parents, the TODAY Show, and Parents.com.

Her blogs — posted each week on her website, CarrieCariello.com — tug at the heartstrings of parents who struggle with the conflicting emotions the come from loving someone with autism.

In them, she writes candidly about her experiences with her blue-eyed son Jack, 14. Now more than six feet tall and 180 pounds, he’s getting older and still wants to know whether a restaurant serves Coke or Pepsi. (He prefers Pepsi.).

He also suffers from anxiety and needs to self-

stimulate to keep himself in check. But he has a superb memory — if you tell him your birthday and ask him what it is two years from now, he’ll remind you what day you were born.

He is a dichotomy. He is complicated. He is loved.

“Did I tell you my son has autism?”

Cariello writes that she often repeats this phrase to servers, home repair technicians, and others she encounters in her orbit.

Her honesty is a source of power and strength to her readers, who relate to the trials, tribulations, and humor that autism brings to the Cariello family of Bedford, which includes four other children, ages 15, 13, 11, and 10, and husband, Joe. She writes about the emotional toll of autism while exposing the bright moments.

The Cariello family on vacation. From left to right, back row: Jack, Carrie, dad Joe and Joseph.

Front row: Charlie, Rose and Henry.

COURTESY PHOTO

www.parentingnh.com

| APRIL 2019 9

CARRIE CARIELLO ON ‘CREATING A LIFE’

Carrie has authored two books: “What Color is Monday?” and “Someone I’m With Has Autism.”

She also blogs regularly at www.carriecariello.com.

COURTESY PHOTO

Cariello connects with many parents through her blog and on social media. When parents receive an autism diagnosis for their child, they often feel isolated and alone. Cariello urges parents to take one step at a time and keep forging ahead. While their lives may not be traditional, they can find happiness that includes autism if they take the time to create it.

She offers parents of children with or without special needs the following tips: 1. Go out with your husband (or partner) once a week. Make it nonnegotiable, she says, noting that it is hard, but necessary, for adults to connect without losing themselves in the day-to-day grind.

2. Find your outlet. Parents should not drown in their child’s autism diagnosis, she says, as it takes up time naturally. Hot power yoga and CrossFit are her outlets in addition to speaking and writing, but parents should find something they like to do and do it.

3. Let other people do their jobs.

Cariello stresses that some parents of children with autism form adversarial relationships with teachers, school administrators, or others due to the stress of managing autism. To be an advocate does not mean you have to be aggressive, Cariello said. “People often say I would do anything for my child. Sometimes that means rolling over a bit.”

Find out more about Carrie Cariello at www.carriecariello.com or on Facebook at www.facebook.com/whatcolorismonday.

10 www.parentingnh.com | APRIL 2019

“His brain is wired in a different way,” she writes in ‘Here is What No One Says Out Loud About Raising A 13-Year-Old Son with Autism.’ “Because of this, he doesn’t read social cues or fully comprehend language or understand why you shouldn’t ask a woman if she’s pregnant.”

Her blogs serve as a companion piece to the two books she’s written about living with her son’s autism: “What Color is Monday? How Autism Changed One Family for the Better” (2012) and “Someone I’m With Has Autism” (2015).

“What Color is Monday?” won its title when Jack asked his mother, “What color do you see for Monday?” In her first book, Cariello discusses Jack’s autism diagnosis and the family’s approach to embracing autism, rather than “conquering” it. Her sequel, “Someone I’m With Has Autism,” discusses how Cariello and her husband tell Jack about his autism and show his siblings how to love him exactly how he is.

Cariello also speaks about her journey with autism throughout the country. In 2015, she was a featured speaker in TEDxAmoskeagMillyard Women in 2015, where she wowed the audience with her ability to tell her story with poise, grace, and humor.

Pamme Boutselis, lead organizer of the TEDxAM event, met Carrie while doing research for an autism article. Mesmerized by her honesty and ability to expose her vulnerability in print, she said she knew that Carrie’s words would have a tremendous effect on the TEDxAM audience in Manchester, even though she had yet to hear her speak.

“When I connect in some capacity with people and am bowled over by them, I don’t forget them. I knew the impact Carrie’s words had on me would be replicated hundred-fold if she had the opportunity to speak at our event,” Boutselis said. “Her authenticity shines through and we all gain a better understanding and deeper empathy for their challenges and others, too.”

CHARTING A NEW COURSE A career as an author and public speaker in the autism community was not part of Cariello’s master plan.

Until her fourth child was born, Cariello had worked for 10 years as a marketing director for a construction company. Writing and public speaking comprised a major part of her professional life. Still, she never anticipated downshifting from her marketing career. Then suddenly her life took a sharp turn, thanks to Jack’s autism diagnosis.

“I have two moments which defined my start in writing. I ran the Boston Marathon for the Doug Flutie Foundation. A young man stepped in front of me on Heartbreak Hill and said, ‘I believe in you,’” she said. “It resonated so strongly. I bought a necklace that said ‘Believe’ on it. When Jack got really riled, and I couldn’t calm down, I would look at the necklace and think of the man that said, ‘I believe in you.’”

The second time took place at a hotel in North Conway where they met a dog. Since Jack was terrified of dogs, Cariello wasn’t sure how well the encounter would go.

Would Jack become hysterical? Would the dog owner understand?

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| APRIL 2019 11

CAMP PONEMAH at Hampshire Hills Athletic Club Milford, NH

r Happy Place Where Kids Find Thei

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“The dog owner was kind and gentle. He met Jack where he was.

It was eye-opening. People are willing (to meet you where you’re at) if you let them into your world a little bit,” she said.

Cariello jokes that she is a natural-born storyteller who picked up her aptitude for public speaking in graduate school. She remains humble about her ability to engage naturally with audiences about very personal experiences.

“I am just telling my story. This is how I feel about it. I don’t have to convince someone or relate research or prove a point,” she said.

She has traveled to speak to audiences locally and across the country, but said she prefers not to travel too often, because she says it throws off her schedule at home and can be lonely.

Amy Hamand, program director at Imagine A Way, an Austin, Texas-based charity that raises money to pay for therapeutic services for autistic children, invited Cariello to speak at the organization’s gala in 2017. She first heard about Carrie through her blog, which she shared to Imagine A Way’s Facebook page. Hamand’s boss saw it, loved it, and invited Carrie to speak at its major fundraising event.

“There are so many different stories and people talking about autism in different ways — what causes autism and how do you help kids with autism,” Hamand said. “She touched our donors because people want to give when they can really see what it is truly like to have a child with autism. She also tells it like it is. It is hard. It is OK to admit that it’s hard — it’s not disrespectful to our children.”

Cariello also describes her new career as a mindful choice. It allows her to juggle writing and speaking engagements, while also managing a busy family life. Aside from devoting time and attention to Jack, she’s built a schedule that can accommodate driving lessons, drumming classes, and hockey practice. She also finds time for self-care, which includes yoga and CrossFit. A disciplined organizer, Cariello hates living in chaos and usually has dinner prepared before 10 a.m. That way, when Jack comes home before school, he can put the finishing touches on the meal.

“I am wired for organization. Focus on what you execute well and grow that piece of you,” she said.

MAPPING OUT A NEW LIFE

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One gift that Jack’s autism brought the Cariello family was the idea that they could design their own lives. Jack’s diagnosis forced them to re-evaluate what is important and create a life that nurtures him and one another.

“No one wants to describe their life as busy, so why create a busy life?” Cariello said. “If you want a life best described as ‘mindful,’ or ‘peaceful,’ or ‘well-traveled,’ align your choices to meet it.”

Joe Cariello owns two dental practices, but finds time to taxi the other children to their after-school activities while Cariello tends to Jack. Cariello said that she has freedom to write and speak, which lights her up inside and fulfills her, while it also allows her to fit in the “cracks” of her family.

“Through Jack I found something — I have a voice in advocacy

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| APRIL 2019 13

that I would have never stumbled upon any other way,” she said.

They’ve adjusted their parenting due to Jack’s limitations, as well. The family’s schedule cannot be so overwhelming that it disrupts Jack so they tend to bond together as a family around weekly outings and at meal times. Cariello said they are also more understanding of their other children’s’ strengths and have dropped some of the rigidity around expectations such as earning all As or excelling at every sport.

“They are all different thinkers. I have been able to meet them where they are,” she said.

Cariello is toying with the idea of writing a third book that speaks to the issues of marriage and balancing a family in a modern world.

“It’s about taking back the power that at some point we gave away; we thought other people should dictate who we should

14 www.parentingnh.com | APRIL 2019

be,” Cariello said. ”When I design my own life, I can’t help but sit up a little taller — it’s a powerful notion for me.”

MAKING PEACE WITH A FUZZY FUTURE In one of Cariello’s most recent blogs, she admits that as Jack gets older, it’s harder to envision what his future will look like. She used to compare the gaps in milestones between Jack and his brother Joseph, who is just a year older. In pictures, the two tall, dark-haired young men look very much alike. But the trajectories of their lives couldn’t be more different.

Joseph is now about to get his license to drive. He plays sports and has friends.

Cariello says they don’t even “look like the same species” anymore.

In her latest blog, “The Peace We Make,” she acknowledges that the gap is widening.

Jack is getting bigger. This is getting

harder. Will he sweep floors? Sort clothing? Collect recycling?

She writes: “It stings. That’s all I’m saying. Right now I am on the jagged side of the mountain, and I am holding on for dear life.”

But in typical Cariello fashion, rather than linger too long on what might be, she wishes her son happiness.

“And as the sun lowers in the cool sky, I just hope he looks my way even once. I hope he tells me something about his day.

I hope he is happy.

Grief, hope, peace.

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One day, peace.”

Krysten Godfrey Maddocks is a former journalist and marketing director who now regularly writes for higher education and technology organizations in New Hampshire and Massachusetts.

Mom to 4-year-old Everett, she has lived in the Seacoast for the past 20 years.

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6

Could a measles outbreak happen here?

M

A look at the numbers, the laws and the disease itself

BY MELANIE PLENDA

easles was declared eliminated in the United

States almost 20 years ago largely due to the success of the measles vaccine.

But there were 17 measles outbreaks in the United States in 2018, according to the Centers for Disease Control, and more than 70 cases so far have been recorded in just one outbreak — in Washington State — this year.

The number of parents opting out of vaccinations combined with the number of international travelers entering the country with the infection is spreading measles cases. Could an outbreak —

defined as three or more cases — like the one in Washington State happen in New Hampshire?

WHAT IS MEASLES? Measles is a virus that starts like a cold or flu with fever, runny nose, cough, red eyes, and sore throat, according to the CDC. It’s followed by a rash that spreads over the body.

“The issue with measles is that it’s one of the more — one of the most — infectious agents that we deal with in public health because of how it’s transmitted and how easily it’s transmitted,” state epidemiologist Dr. Benjamin Chan said.

“Measles is a virus that is transmitted through air. So someone can contract measles by breathing the air or breathing in an airspace that someone infected with measles has passed through, and that measles virus can remain suspended in the air for up to two hours.”

According to the CDC, if one person has measles, 9 out of 10 people around him or her will also become infected if they are not protected, and an infected person can spread measles to others even before knowing they have the disease — from four days before developing the measles rash to four days afterward. www.parentingnh.com

| APRIL 2019 17

PHOTO © MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH.

Measles usually runs its course, but for some the virus can lead to lung infections like pneumonia or encephalitis, a swelling of the brain.

“There are kids who get encephalitis, for example, or who have post-infection complications, which can be devastating, even fatal,” said Dr. Alex Granok, infectious disease specialist Southern NH Medical Center in Nashua.

About one in four people in the U.S. who get measles will be hospitalized; one out of every 1,000 people with measles will develop brain swelling, which could lead to brain damage; one to two of 1,000 people with measles will die, even with the best care, according to the CDC.

THE VACCINE

A brief history of measles outbreaks In a given year, measles cases can occur for many reasons: An increase in the number of travelers who get measles abroad and bring it into the U.S., or further spread of measles in U.S. communities with pockets of unvaccinated people.

REASONS FOR AN INCREASE IN RECENT CASES THROUGH 2018: 2018: The U.S. experienced 17 outbreaks in 2018. Three outbreaks in New York State, New York City, and New Jersey, respectively, contributed to most of the cases. Cases in those states occurred primarily among unvaccinated people in Orthodox Jewish communities. These outbreaks were associated with travelers who brought measles back from Israel, where a large outbreak is occurring. Eighty-two people brought measles to the U.S. in 2018.

This is the greatest number of imported cases since measles was eliminated from the U.S. in 2000.

2017: A 75-case outbreak was reported in Minnesota in a Somali-American community with poor vaccination coverage.

2015: The United States experienced a large (147 cases), multi-state measles outbreak linked to an amusement park in California.

The outbreak likely started from a traveler who became infected overseas with measles, then visited the amusement park while infectious; however, no source was identified. Analysis by CDC scientists showed that the measles virus type in this outbreak (B3) was identical to the virus type that caused the large measles outbreak in the Philippines in 2014.

2014: The U.S. experienced 23 measles outbreaks in 2014, including one large outbreak of 383 cases, occurring primarily among unvaccinated Amish communities in Ohio. Many of the cases in the U.S. in 2014 were associated with cases brought in from the Philippines, which experienced a large measles outbreak.

2013: The U.S. experienced 11 outbreaks in 2013, three of which had more than 20 cases, including an outbreak with 58 cases.

2011: In 2011, more than 30 countries in the WHO European Region reported an increase in measles, and France was experiencing a large outbreak. These led to a large number of importations (80) that year. Most of the cases that were brought to the U.S. in 2011 came from France.

2008: The increase in cases in 2008 was the result of spread in communities with groups of unvaccinated people. The U.S. experienced several outbreaks in 2008 including three large outbreaks.

— Excerpted from the Centers for Disease Control https://www.cdc.gov/measles/ cases-outbreaks.html

18 www.parentingnh.com | APRIL 2019

Generally speaking, any child older than 12 months can get the measles, mumps, rubella (MMR) vaccine and it’s roughly 99 percent effective at preventing infection.

Granok said the side effects from the vaccine itself includes redness and swelling at the injection site and can include a slight fever and rash. He said this happens because the body is doing its job in creating antibodies to fight the virus.

There are some people who can’t get the vaccine for medical reasons. They include newborn babies, pregnant women and those who are immunosuppressed. Some cannot get the vaccine due to religious reasons. Combined this is about 2 percent of the population in New Hampshire.

Vaccination can be a philosophical issue. Some parents and caregivers think the vaccine will harm their children so they opt out.

One of the early concerns relative to vaccinating children, Granok said, was the mercury in the preservatives used in the shot.

“Even though the amounts were very small and you could actually get more mercury by eating certain fish, for example, on a regular basis, most vaccine manufacturers ended up taking those preservatives out,” he said. “… And then later on we would hear lots of claims about worries about autism, which I think medical sciences has more than sufficiently debunked, but people don’t always want to believe that.”

Chan adds that a Danish study released in March 2019 further debunked these claims after researchers studied more than 600,000 vaccinated children to look for a possible connection between the MMR vaccine and autism. They found none.

Granok said another argument is that because these diseases are very rare, why vaccinate my child and take the chance they could have a reaction to a vaccine when the chances of them catching the disease in the first place are so low?

“It’s those kinds of arguments that lead to a disease like measles being reintroduced into a group of people,” said Granok.

Granok said one of the most important things when it comes to vaccinating a population is to make sure that enough people in that population are vaccinated.

“Otherwise the disease can still be present within the population as a whole,” he said. “And then it can spread to people who maybe have not been vaccinated for one reason or another, or for those people that the vaccine doesn’t work as effectively.”

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What he’s explaining is the concept of “herd immunity.” The idea is if you have a certain number of people in the population vaccinated, the disease can’t get a foothold in that population. “It might affect one or two people out of 100, but then it kind of stops there,” he said.

“For most of our diseases we need vaccination coverage of 90 plus percent to prevent it from spreading within a population.”

For a disease that’s not very contagious, you may only need 80 or 85 percent vaccinated, he said to prevent the disease from spreading. But a disease like measles, you need the numbers to be in the mid-90s to prevent it from spreading.

“In New Hampshire, vaccination numbers are a little bit harder [to determine] than in other states because we haven’t had a vaccine registry. But the CDC estimates there are probably like 92 percent to 93 percent for most of those early childhood vaccines [in New Hampshire].

“In Washington State they are right around 90 percent for a disease like measles. They are pretty much at the threshold where you can start to see outbreaks and we’re a little bit above that.”

“We’re certainly not 98 percent like some states are so it could happen here if it gets into our population, particularly where vaccine coverage is low.”

WHERE IS MEASLES COMING FROM, WHERE IS IT NOW? Measles is still common in many parts of the world, including countries in Europe, Asia, the Pacific, and Africa, the CDC said.

Worldwide, 19 cases of measles per 1 million persons are reported each year and 89,780 people, mostly children, die from the disease, according to the CDC “Even if your family does not travel internationally, you could come into contact with measles anywhere in your community,” according to the CDC website. “Every year, measles is brought into the United States by unvaccinated travelers (Americans or foreign visitors) who get measles while they are in other countries. Anyone who is not protected against measles is at risk.”

In fact, on March 1, 2019, the state’s Department of Health and Human Services reported that the state had been notified an international traveler with confirmed measles took a bus on Feb. 26, from South Station in Boston

20 www.parentingnh.com | APRIL 2019

to the Manchester Transportation Center.

According to the CDC there have been six official outbreaks reported in 2019 so far occurring in New York State, Washington State, Texas, Illinois and California. Other cases have been reported in Colorado, Connecticut, Georgia, Kentucky, New Jersey, and Oregon and New Hampshire.

“These outbreaks are linked to travelers who brought measles back from other countries such as Israel and Ukraine, where large measles outbreaks are occurring,” the CDC said.

But another reason, Chan said, has to do with the laws in those states.

“The states that have been seeing some of these measles outbreaks are states that have more lax laws around this, namely many of them allow what we call philosophical exemptions,” Chan said. “Meaning that because of belief or desire, people can opt out of getting vaccines and still go to school or child care.”

In New Hampshire, anyone entering school or child care must be vaccinated. The state only grants waivers to those who can’t get the vaccine for medical or religious reasons.

“We do not have a philosophical exemption,” Chan said. “And that’s something that a lot of other states, especially those that are currently experiencing measles outbreaks, are talking about getting rid of, because that has led to larger susceptible population and contributed to these measles outbreaks.”

THE REGISTRY Another way states can keep track of vaccinations and where there may be larger pockets of unvaccinated people is through a state registry. Every state except for New Hampshire keeps track through a voluntary repository.

This is not only convenient in terms of a person’s vaccination record traveling with them from doctor to doctor and state to state, but it can help with education and outreach in areas where there may be lower vaccination numbers, said Colleen Haggerty, the section chief for the state’s immunization program.

Plus, Chan adds, it can help infectious disease officials track the effectiveness of vaccines.

“In response to outbreaks,” he said, “you may or may not have heard we’re in the ear-

ly stages of a Hepatitis A virus outbreak. An immunization registry is being used in other states to track the effectiveness of moving Hepatitis A vaccine out into the community in response to outbreaks.”

Haggerty said while the state got permission and a contract to set up this system in 2014, it has not yet been fully implemented.

The first two years after getting the contract the state was working on updating expired administrative rules pertaining to vaccinations. And then in 2016, Haggerty said, they ran into trouble with “functionality of the system.”

“We want to make sure that any system that is rolled out for health care providers is really going to be a benefit to them and work without issues,” Haggerty said. “We’ve been working the last couple of years on assuring that all the things are in place to make for a very accurate system that will provide a benefit not just to us in public health and health care providers, but just citizens of New Hampshire.”

It is not clear when the registry may be available in New Hampshire.

Granok and Chan agree that vaccinating is a public safety issue and we have to take responsibility to protect others from getting sick, or dying.

“Most parents in our generation don’t realize that, you know, in parts of the world where they don’t have these vaccines kids die of these illnesses all the time,” Granok said. “I always use the argument that my kids were vaccinated then I would certainly want [other parents] to [vaccinate] and know not only are you protecting your kid, but maybe you’re protecting the baby next door who hasn’t had their vaccines yet.”

Chan said, “We have the best interest of kids, but also our populations that we serve in mind as well. So we have to consider what is the best public health recommendation or action for protecting not only the individual but also the population of our communities and the state that we live in.”

For more information on vaccinating children visit the CDC’s vaccination website at www.cdc.gov/vaccines.

Melanie Plenda is an award-winning freelance journalist and mom based in Keene. Her work has appeared in The Atlantic.com, The Daily Beast, American Baby, and Parents.com among other media outlets.

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To keto or not to keto Local experts answer your questions about the popular diet

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BY CRYSTAL WARD KENT

utter, cream, cheese. With the ketogenic

diet, aka the keto diet, these foods are no longer taboo, but are actually go-to choices.

In fact, fats are fabulous and whole grains, fruits and vegetables, along with carbs, are limited.

Fans of the popular diet, which was originally developed as a way to control seizures in children, claim the keto diet has helped them lose weight where other plans have failed.

But, is it healthy, and is the weight loss long-term?

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| APRIL 2019 23

Is Keto Safe for Kids?

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Although the keto diet originated as a way to help epileptic children, the medical community advises that eliminating food groups when it comes to children’s diets is not recommended.

“Children are still growing and developing and need a wide range of nutrients from different sources,” said Ellen Behan, a registered dietician with Exeter Health Resources in Exeter.

“If parents are concerned about their child’s weight, they should consult with their physician. If parents want to be sure that their children adopt healthy eating habits, the best way is for parents to model those eating habits themselves. Avoid things like pizza, pastries and sugary drinks. Watch portion size, and consider a healthy eating plan.”

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According to Ellen Behan, a registered dietician with Exeter Health Resources in Exeter, the keto diet can help you lose weight.

While on the keto diet plan, dieters must get 70 to 80 percent of their calories from fat, 15 to 25 percent from protein, and less than 10 percent from carbohydrates – roughly the equivalent of eating a bagel.

This type of eating forces the body to burn fat instead of carbohydrates through a process called ketosis. In ketosis, acids called ketones are produced in the blood. These are what our bodies and brains use for fuel.

“The diet can also yield some other health benefits as well,” she said. “You will see better blood sugar levels, lower blood pressure and better cholesterol numbers. Some people feel that they have higher energy levels as well, and many dieters say that they don’t feel hungry while on the diet.”

Dieters notice that not only do they lose pounds they also lose inches in key areas such as their waistline. But the losses don’t come without concerns.

Behan said those on the keto diet have an increased risk of kidney stones and increased levels of uric acid, a risk factor for gout.

Because many natural forms of nutritional hydration are banned from the diet (such as whole grains, and many fruits and vegetables), dehydration is an issue. Keto dieters need to drink at least eight glasses per day. Constipation, bloating and tummy troubles are also common because of the lack of fiber.

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Dr. Neal Malik, an assistant professor of nutrition at Bastyr University in San Diego, Calif., said, “We are learning that a high-fat diet changes the gut’s microbiome and may decrease the amount of good bacteria found there.”

Keto followers are advised to eat keto-approved vegetables such as leafy greens, bell peppers and broccoli and to take a fiber supplement.

While any diet can make you grumpy, Behan said those on the keto plan may complain of irritability and “brain fog.” In addition, the diet is hard on your liver.

Researchers at Harvard say that the liver works overtime for those on the keto diet, and that this could have long-term consequences. “The liver is responsible for metabolizing protein and producing ketones. With this diet, an extra burden is placed on the liver due to the increased intake of protein and reliance on ketones.”

Vipra Rai, a registered dietician and clinical director of Functional Medicine, Diabetes, Nutrition and Wellness Services at Derry Medical Center in Derry, agrees there are concerns, but that many can be addressed or mitigated if the diet is followed under medical direction.

She also said the health benefits, especially to those with diabetes or pre-diabetes, can be significant.

“The keto diet isn’t just a diet, it is a lifestyle, and it can be difficult to follow and difficult to eat in a healthy way if you are not fully educated about this kind of eating,” she said. “You can’t ‘go keto’ just because you like bacon and want to eat bacon all the time. You need to understand the diet’s shortcomings and realize that it is a long-term commitment.”

“We have patients who have been on the keto diet for a year, both for weight loss and due to health issues,” she said. In patients with diabetes or pre-diabetes, “We have seen incredible improvements. Blood sugar levels have dropped dramatically; some patients who were insulin dependent no longer need insulin; patients who were on the verge of developing diabetes are no longer

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“The use of e-cigarettes among high school students has dramatically increased,” says Jennifer Lavallee, APRN, a pediatric nurse practitioner at Southern New Hampshire Health. According to the 2018 Youth Tobacco Use Survey, more than 3.6 million kids nationwide use e-cigarettes, making them the most popular tobacco product on the market. Of particular concern are the rates of increased e-cigarette use by high school and middle school students in 2017 – 21% and 5% respectively. The U.S. Food and Drug Administration (FDA) has called e-cigarette use among children an epidemic and one of the biggest public health challenges today.

Parents should know not only the hazards of e-cigarette use, but also the myths and misleading claims that drive their popularity.

Vaping 101 First, a primer on the components of e-cigarettes and terms used to describe these devices. Electronic cigarettes (e-cigarettes or e-cigs), vapes, and vape-pens are just a few types of electronic nicotine delivery systems (ENDS). These devices consist of a mouthpiece, a battery, a cartridge containing an “e-liquid” or “e-juice,” and a heating component.

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Safety Concerns Many teens believe that vaping and e-cigarette use is less harmful than smoking tobacco. Although the aerosol does contain fewer toxic chemicals than tobacco smoke, most e-liquids contain nicotine; for example, one JUUL pod contains as much nicotine as a pack of cigarettes.

“Teens are more susceptible to the addictive properties of nicotine,” Lavallee says. “Nicotine at a young age has been associated with mental problems, like depression and panic disorder. In addition, the neurotransmitters involved in impulse control are permanently altered, putting kids at higher risk to try other substances later in life.” Research shows that kids who use e-cigarettes are actually more likely to smoke traditional tobacco products.

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Once teens are addicted to nicotine, Lavallee adds, they can experience withdrawal symptoms when they go without it, including anxiety, trouble concentrating, dizziness, and headaches.

Other risks include burns; Lavallee notes that some of the devices have been known to explode. They’ve also been associated with coughing and asthma symptoms.

Talk with Your Kids In February 2019, FDA Commissioner Scott Gottlieb, MD, stated “kids using e-cigarettes are children who rejected conventional cigarettes but don’t see the same stigma associated with the use of e-cigarettes.”

The FDA is just one of the organizations combating the growth of e-cigarette use among youth. New Hampshire state law prohibits the sale of ENDS products to anyone under 18, and some schools are treating these devices as drug paraphernalia. At Lavallee’s practice, Merrimack Pediatrics, the medical staff give handouts on e-cigarettes and vaping to kids starting at age 10. But much responsibility rests with parents.

“It’s important to start talking to your children at a young age about why you don’t want them to ever try this,” Lavallee says. “Prevention is absolutely key.”

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JENNifEr LaVaLLEE, APRN, is board certified as a Pediatric Primary Care Nurse Practitioner at Merrimack Pediatrics. She received her medical degree at Northeastern University in Boston, Massachusetts. Accomplished in both emergency and pediatric primary care, Jennifer has over twenty years’ experience ensuring children stay happy and healthy.

To book an appointment with Jennifer Lavallee or to find a pediatrician, visit SNHhealth.org/find-a-doctor.

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at risk. These are major health benefits. However, in order to do keto in a healthy way, you need to be educated and start under medical supervision.”

At Derry Medical Center, patients have their health assessed, blood drawn, their ketone levels are checked, and they are given a recommended diet plan to follow.

Blood work is done periodically as they follow the plan. During the eight weeks, they attend regular workshops where they learn meal plans and cooking techniques that allow them to get the nutrients they need while on a keto diet.

“We do a lot of cooking,” Rai said. “We show them how to add more vegetables, more fish, how to get healthy fats from avocados and cook with healthy oils like avocado and olive oil. We add in items such as nut butters and sunflower seeds. The goal is to create a healthy diet, and one that you are likely to follow on your own. A lot of the information online is not accurate, so this way, you are getting expert advice from medical and nutritional professionals.”

Rai adds that the keto patients also share information so they get helpful tips from others regarding recipes and what motivates them to stick to the plan.

“We even have a keto support group,” she said.

LOOKING LONG-TERM Behan said there is not a lot of data showing long-term results for keto, but data that is available indicates that if a person leaves the keto diet, the weight tends to come back on.

More concerning, the other health benefits — lower blood pressure, cholesterol and blood sugar — also don’t last unless other measures are taken to ensure that they remain at healthy levels.

The Bastyr University studies caution that excess dietary fat may cause the body to produce byproducts called lipid peroxides, which can damage cells and tissues, including those in the

www.parentingnh.com

| APRIL 2019 29

heart. If a person commits to keto for the long-term, having regular checkups and blood work would be wise, noted Rai. The other challenge, Rai said, is that people get bored with the food limitations and the challenges of “cooking keto.” Many people often abandon the plan for those reasons.

COUNTING CALORIES STILL WORKS According to Behan, monitoring your calorie intake is critical.

“To maintain a healthy weight, that usually means 1,200 to 1,500 calories for women per day, and 1,500 to 1,800 calories for men per day,” she said.

“You also have to get moving. In terms of a diet that is both effective and healthy, the medical community recommends the Mediterranean diet. It’s full of lean protein, whole grains, veggies, and healthy fats, such as olive oil. It offers a wide range of food options so you don’t get bored, and, it’s also a lifestyle change. The Mediterranean diet isn’t just a diet; it’s rethinking how you eat. It’s about savoring your food — cooking healthy, and sitting down to eat a relaxing, leisurely meal. It makes eating more about the quality and experience of food than how much you eat. People who truly adopt this mindset tend to have healthy weight loss, and keep the weight off.”

Rai said keto is not for everyone and “there is no ‘one size fits all’ when it comes to dieting.” She said keto is working for some, both for weight loss and in achieving better health.

Crystal Ward Kent is a freelance writer who has written for numerous local and regional magazines. She owns Kent Creative in Dover, a creative services agency providing writing, design and marketing, and is also the author of several books and children’s books.

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Not just for adults anymore Type 2 diabetes is on the rise in kids, but it’s preventable

BY MARY ELLEN HETTINGER

I

f you knew you could prevent high blood pressure, heart disease, vision loss, kidney disease, and nerve damage that might lead to your child needing an amputation, would you? Of course you would.

But if your child or teen is overweight, and especially if the child is obese, they could already be well on their way to experiencing a chronic illness that is dangerous, can be disabling, and may even be life-threatening.

Type 2 diabetes used to be called adult-onset diabetes but now, due primarily due to the high-fat, high-carbohydrate American diet and sedentary lifestyle it’s become much more common in children.

www.parentingnh.com

| APRIL 2019 33

Dr. Mark Harrison

We specialize in providing excellent dental care that is especially suited to the needs of children,

and adolescents.

Terms to know A1C test: A blood test to diagnose diabetes and monitor blood sugar levels for diabetes management.

Carbohydrate: A nutrient that provides energy, it can be a sugar or a starch. Carbs are found in fruits and vegetables, grain products, dried bean and peas, milk and yogurt.

Insulin: A hormone produced in the pancreas that allows sugar to pass into cells, where it’s converted to energy.

Type 1 (or juvenile-onset) diabetes: This is caused when the body cannot make enough insulin. This type commonly occurs before age 20 but can develop at any time.

Type 2 diabetes: The body still makes insulin but is unable to keep blood sugars within a normal range. This typically affects people over 40 who are overweight and have a family history of diabetes.

But children are developing this disease at an alarming rate.

For an expanded glossary of terms about diabetes, see www.chadkids.org/diabetes.

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Your pediatrician or primary care physician may become concerned and call for blood tests at a regular checkup if your child is overweight.

Symptoms of type 2 diabetes in children include increased thirst and frequent urination, blurred vision, and unusual tiredness. Another sign of diabetes is blackish skin in the armpits and back of the neck.

Having a family history may be a factor, and if your child is diagnosed with diabetes, it affects the entire family.

“Diabetes is a family affair,” said Emily Frydman, MD, a pediatric endocrinologist at Dartmouth-Hitchcock in Manchester. “In many cases it’s a problem that a parent or family member may already be dealing with.”

Blood tests screen for A1C, an indicator of blood sugar levels over time. If this is high, then a fasting blood sugar test is called for. The average age of diagnosis is 14 to 16, Frydman said, but children as young as 10 or 11 who are very overweight may already have type 2 diabetes and should be checked.

If A1C is high, treatment is insulin only. There are not a lot of oral medications approved by FDA for children, Frydman said.

Then the family has to get involved. “They have to be willing to change, with healthy eating and exercise. This is a very difficult population to help — no one wants to be told what they need to eat, and to exercise.”

Frydman manages a team at Dartmouth-Hitchcock that includes an exercise physiologist, a nutritionist and a social worker. They hold a clinic once a month for youth age 12 to 18 with type 2 diabetes, most of whom are referred through a doctor who specializes in obesity.

Kids think they’re invincible, Frydman said, but with youth the complications of diabetes start much sooner, including their eyes, kidneys and feet.

“Everything an adult can get a kid can get too, and complications happen faster,” making getting diabetes under control an urgent matter.

Hope Damon is a registered dietitian practicing at the Nutrition Counseling Center in New London. She said the whole family needs to be involved, but having your child diagnosed with a chronic illness is a real blow.

“Name an emotion that is stress-producing, and parents probably have had it or have it, including anxiety, worry, self-blame, because their child is overweight. The parent may be overweight as well.

“They say, ‘I should have tried harder to manage their weight,’ or if the parent has diabetes, ‘He got it from me, it’s my fault.’ We have to help them move beyond that, because it’s not helpful. Taking care of the disease is far more important,” Damon said.

TO PREVENT DIABETES “If we help children live an active lifestyle and eat much like we want everyone to eat in terms of general wellness, there would be less type 2 diabetes in children,” Damon said.

“Run around with your kids, talk a walk, shoot hoops, go swimming, ride bikes, snowshoe. Having an active lifestyle from the get-go can prevent obesity and diabetes.” Limit screen time to a couple of hours a day.

Incorporate healthy eating and exercise — and make it fun — early on.

Avoid “empty” calories (i.e., sugar and carbs with no nutritional value) by drinking water frequently and soda, sports drinks, coffee drinks and fruit juice occasionally or rarely.

According to Damon, it would be ideal if children did not grow up drinking diet or regular soda.

“Regular soda doesn’t work at all because it’s a beeline of sugar into bloodstream that raises blood sugar to an alarming level. It’s totally contraindicated for someone with type 2 diabetes,” she said.

“Diet soda doesn’t have sugar or calories or carbs in it, which makes it a better choice than regular soda. However, the news isn’t very reassuring about diet soda.” Research shows that consuming noncaloric sweeteners can cause an increased craving for carbs, said Damon.

Fruit juice can also be problematic, she said, because juice is concentrated liquid carbohydrates. A 16-ounce drink or smoothie can contain the same amount of carbs as three to five pieces of fruit, the dietitian said, and “Who eats three to five apples, oranges, or bananas at a time?”

It’s important for everyone to eat more fruits and vegetables for nutrition, fiber, and they fill you up. Frozen or canned fruit (in natural juice) and vegetables are fine when fresh isn’t available or is too pricey.

It’s unrealistic to think you’ll never hit the drive-thru again, but more healthful choices include grilled or broiled meats, bypassing the fries, and selecting salads with dressing on the side. A kids’ meal offers smaller portions. Options such as whole-grain buns, pasta or bread, and brown rice have fiber and fill you up longer, staving off blood sugar spikes.

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TEENS AND AUTONOMY For teenagers with diabetes, dealing with food is hardest, said Damon, even though there isn’t anything they can’t eat. But there is a loss of spontaneity, which is an important part of our culture.

“We want to eat what we want to eat when we want to eat it,” she said.

Having diabetes means being disciplined about what to choose, and the amount you eat. This is especially hard for teens, who want to be socially normal and go out for pizza with their peers.

Pizza is a challenging food for diabetics. With a white flour crust and carbs in the sauce, “Pizza has a considerable effect on blood sugar.”

“Teens want to be a little different with their hair or tattoos,” Damon said, “but not ‘my body doesn’t work normally’ different.” Also, having type 2 diabetes means your parents are weighing in on what you’re eating at a later age than your peers. www.parentingnh.com

| APRIL 2019 35

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Caring for a child with type 2 diabetes isn’t that different from other challenges in parenting, Damon said, when it comes to power struggles.

You have to find middle ground and choose your battles.

Parenting toddlers and teens can seem like an endless game of “Let’s Make a Deal,” giving choices and negotiating terms. That’s why Damon doesn’t tell her clients “you can’t have that.”

“It pushes people into a corner,” she said. So she’ll negotiate with the teenager who loves chocolate chip cookies, asking, how much are you eating now, would you be willing to limit the amount to less than that, “and then I suggest what to eat instead to reduce cookie intake.”

Type 2 diabetes can be brought under control even if the child or teen remains overweight, Damon said.

“Weight loss is very valuable, any amount, and you don’t have to become thin. But while you’re doing the very best you can with weight control, you need to look at activity, how food is distributed through the day, types of carbohydrates and quantity. You want to get your carbs from plant foods that aren’t highly refined, lentils and legumes, lots of vegetables, whole fruits.”

A child diagnosed at 10 is still growing and developing. They get taller, hormones change and their activities vary, all of which changes their needs and the ability to maintain control of diabetes, said Damon. Going away to school is another major challenge.

‘I CAN DO THIS!’ The good news? Children and teens can help control their blood sugar through medication, by losing even a small amount of weight, and physical activity. Seeing that they can lose weight and control their blood sugar levels can empower obese teens to continue weight loss and commit to a healthier lifestyle.

Parents need to support them, saying, “I know this is really hard for you, I’m so sorry you have to deal with this,” said Damon.

Because they need to monitor blood sugar levels throughout the day, a person with diabetes needs to check after lunch, for example. Teens usually need to go to the nurse’s office, and “they’re not elated about doing that.”

Damon noted, if we understood diabetes better as a culture, it would be easier for people to cope. To that end, she suggests teens consider presenting on their disease as a school project, as a good learning experience for all involved.

“Compliance is an ongoing part of the work to help people make good decisions for themselves,” the dietitian said.

When you get a family working together, she said, a good outcome is that we get to the point that parents say “It’s not the worst thing that could happen, and we’re a happy, healthier family than before.”

Mary Ellen Hettinger, APR is an award-winning reporter, editor and writer and accredited public relations professional. She won a bronze award in 2017 from the Parenting Media Association for her news feature on perfluorochemicals in NH’s water supply.

For more information: • American Diabetes Association: www.diabetes.org • Children’s Hospital at Dartmouth: www.chadkids.org/diabetes • New Hampshire Diabetes Prevention: www.preventdiabetesnh.org

36 www.parentingnh.com | APRIL 2019

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181 Route 13 BROOKLINE NH 603-721-5531 • scribblesearlylearningcenter.com www.parentingnh.com

| APRIL 2019 39

dad on board SNAKE 1, BILL 0 ADVENTURES IN OPHIDIOPHOBIA, AKA MY FLORIDA FREAK-OUT

Shine Brighter.

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603.547.1430 cmf.org/autism Locations in Concord, Manchester, and Greenfield, NH! 40 www.parentingnh.com | APRIL 2019

BY BILL BURKE

Our family recently visited friends who moved from New Hampshire to the Tampa area.

During our stay, we stopped at a number of attractions, including a really great not-for-profit zoo. It went pretty much as I thought it would, until it became a danger-fraught experience from which I may never recover.

You’re supposed to see animals in zoos. It’s what you pay for and typically what happens. If you don’t see any animals, it’s very likely you’re in a field or perhaps a not-zoo. This was most definitely a zoo. We saw all kinds of animals, and my daughter even got to feed a giraffe.

What follows is an annotated narrative of our near-death experience that day.

16-year-old: “My dad took us to the zoo in Florida and he saw a snake and freaked out.”

Eventually, it became time to leave, and our group of eight made for the exit along a pathway. I was in front, so I was the first to spot the peril.

A snake that I’d estimate to be about six feet long was blocking our path.

This was not a reptilian exhibit, but an honest-to-goodness, Florida-native, non-animated, non-curated serpent.

16-year-old: “It was probably two feet long. No one cared.”

Not sure if I mentioned this yet, but I’m rather irrational when it comes to snakes.

My first thought was to avoid eye contact with it. It’s the hockey fight approach — if you don’t make eye contact, it’ll blow over before it grabs your jersey and flips your helmet off. But because it’s super easy to not make eye contact with a snake, this tactic quickly became irrelevant.

Instead, I did what anyone would do. I spun around and alerted the others with the international sign of danger. I said, “noooope” while passing them going the other way.

16-year-old: “He was being overly dramatic. It wasn’t doing anything.”

I am fully aware that with its warm, lush environment, Florida is a natural habitat for snakes and other evil creatures. Probably orcs.

16-year-old: “Not evil.”

As it turns out, this snake was of the delightful phylum. It’s charm offensive included completely ignoring us and getting itself into the underbrush nearby – but not before my daughter decided to sidle up to it, attempting to pat it. Here’s the thing: the way I see it, you don’t pat snakes. You especially don’t pat Florida snakes. The snakes we have here in New Hampshire are, for the most part, harmless. This is not the case in Florida, I think.

16-year-old: “It was cute.”

After our narrow escape, I went online and did a search. It turns out that this snake was probably an Eastern Racer. Totally harmless, aside from the coronary it nearly gave me just by existing and the hysterical laughter it elicited from my apparently fearless child.

Bill Burke is a writer who lives far, far away from snakes in southern New Hampshire (16-year-old: “He knows there are snakes here.”) with his wife and daughter. He is also Managing Editor of Custom Publications for McLean Communications.

house calls IS MY CHILD BEHAVING NORMALLY? CONSIDER THE TYPICAL BEHAVIOR FOR YOUR CHILD’S DEVELOPMENTAL STAGE

BY JULIE BALABAN, MD It is common for parents to wonder whether their child’s behavior is normal or if it indicates an emotional or mental health problem. Some problems — substance abuse, self-harm or aggression — are more obvious than others such as anxiety, depression or learning challenges.

When considering a child’s mental health, it’s critical to keep their world in perspective. Kids live in a world largely out of their control. They don’t get to select their school, teacher, or their home or family. Sometimes a worrisome behavior is a reaction to what is going on around them and does not always mean the child has a mental health disorder.

There are three guidelines that help determine childhood mental health: 1. Determine the level of impairment caused by the child’s behavior While this varies by child and family, parents must evaluate how disruptive their child’s behavior is, and if it’s upsetting normal development. For instance, if a younger child is anxious when leaving a parent and responds well to various soothing techniques, they are likely experiencing an ordinary developmental behavior. However, if the child’s behavior keeps them from participating in activities, or causes a parent to be chronically late for work or they continue the behavior as they age, the child likely needs help.

2. Be heard Sometimes parents have a feeling something isn’t right with their child and raise the concern with their pediatrician. Many times parents want to confirm certain behaviors are normal. Parents frequently identify behavioral and learning disabilities through observation. They are the experts, and if they have a feeling that something isn’t right, it should be taken seriously.

3. Always check it out The first step in identifying a potential behavior issue is to check in with family members, friends and your child’s school. Talking about age-appropriate behavior with others and comparing how your child is acting to others helps determine if your child needs help. For example, depression is a common concern for parents of teens. Adolescence is a time of typical moodiness, but depression is not normal. It’s important to look at your child’s behavior compared to the wide range of typical behaviors for their developmental stage.

If your child stays in their room constantly, but still participates in activities with friends, that’s a good sign there isn’t a severe problem. But if they used to love playing soccer and now refuse to join the team or won’t go out with friends that could indicate depression or another problem. Teachers can share how your child acts in school — whether they participate as usual, joke with friends at lunch or are sullen and distant. Peer-related activities are the last to suffer. However, a child who goes out with friends may still need help.

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Julie Balaban, MD, leads the Children’s Hospital at Dartmouth-Hitchcock’s (CHaD’s) Child and Adolescent Psychiatry Team and serves as Assistant Professor of Psychiatry and Pediatrics, Section of Child and Adolescent Psychiatry, at Geisel School of Medicine at Dartmouth.

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www.parentingnh.com

| APRIL 2019 41

out & about

COMPILED BY MELANIE HITCHCOCK

There are lots of activities and demonstrations for all ages at Discover WILD New Hampshire Day. PHOTO COURTESY OF NHFG

Fish & Games’ Discover WILD New Hampshire Day 20 SATURDAY CONCORD — New Hampshire Fish and Game, 11 Hazen Drive. Discover WILD New Hampshire Day, celebrating 30 years, is a fun way for the family to explore the state’s wildlife resources and outdoor traditions. See live animals, big fish, trained falcons, and retrieving dogs in action. More than 60 outdoor and conservation organizations will share exhibits and demonstrations. Kids will love arts and crafts and other hands-on activities such as archery, casting, fly-tying, and air rifle. New this year: Traditional arts demonstrations from members of the New Hampshire Arts Council. See how bamboo fly-rods are crafted, decoys are carved, and traditional ash baskets are constructed. Rain or shine. Free admission. 10 a.m. to 3 p.m. www. wildnh.com

NEW SHANGHAI CIRCUS 6 SATURDAY MANCHESTER – Palace Theatre, 80 Hanover St. Over 40 acrobats from China bring the Orient to Manchester in a fastpaced, exciting production.

The New Shanghai Circus celebrates the exotic wonders of China while showcasing dramatic interpretation of classic Chinese dance and physical performance art. Features spectacular backdrops, beautiful costuming, and state-of-the-art lighting. Tickets: $24.50-$54.50.

Two shows: 2 and 7 p.m. 6685588; www.palacetheatre.org

COURTESY PHOTO

42 www.parentingnh.com | APRIL 2019

THE VERY HUNGRY CATERPILLAR 6 SATURDAY ROCHESTER – Rochester Opera House, 31 Wakefield St. The Very Hungry Caterpillar by Eric Carle has delighted generations since it was published in 1969. Eric’s well-known books captivated readers with his iconic colorful hand-painted tissue paper collage illustrations and distinctively simple stories, introducing generations of children to a bigger, brighter world. The Very Hungry Caterpillar Show features a menagerie of 75 lovable puppets, faithfully adapting four of Eric Carle’s stories, Brown Bear, Brown

OUR PROMISE TO NICHOLAS

l 11t h A n n u a

Bear, 10 Little Rubber Ducks, The Very Lonely Firefly and of course, the star of the show – The Very Hungry Caterpillar. Tickets: $24-$26. 1 p.m. 335-1992; www. rochesteroperahouse.com

E G G H UNT

l iva fest

Fun Games, Toe Jam Puppet Band, The Easter Bunny, Red Sox Mascot Tessie, Silent Auction, Raffles, Treats & More...

EARTH DAY FESTIVAL 13 SATURDAY AUBURN – Massabesic Audubon Center, 26 Audubon Way. The 12th annual Earth Day Festival celebrates the wonders of Earth and strengthens our appreciation for clean water, air and soil. There will be live music, games, a bonfire, face painting, and a raffle. Visitors can meet live animals, watch a rehabilitated raptor be released back into the wild, visit over a dozen earth-friendly vendors and get tips on how to be water wise.

Admission: $10 individuals; $25 families. 10 a.m. to 3 p.m. 6682045; www.nhaudubon.org

COURTESY IMAGE

BABY ANIMALS: HERITAGE BREEDS AT THE BANKE APRIL 20-28, DAILY PORTSMOUTH – Strawbery Banke, 14 Hancock St. Welcome spring with the 4th annual Baby Animals: Heritage Breeds at the Banke, showcasing a variety of heirloom breeds of barnyard baby animals — and their moms — that would have been familiar to earlier generations. The event takes place under a tent on museum grounds. It’s a family-friendly opportunity to learn about domestic livestock typical on coastal northern New England farms from the 17th century to present day. Tickets: Adults, $10; children 5-17, $5; free to children under 5. 10 a.m. to 5 p.m. For more information and to get information about the Children’s Breakfast with the Animals, go to www.strawberybanke.org.

Proudly Sponsored By:

Granite State Gastrointestinal Consultants

EGG HUNT

AMAZING VERNAL POOLS 27 SATURDAY LACONIA – Prescott Farm, 928 White Oaks Road. A vernal pool habitat is critical for certain species of salamanders and frogs, but they are often overlooked.

Visit a couple of vernal pools at Prescott Farm to search for eggs of these mysterious creatures.

The program is part of the Our Big Backyard Series. For ages 7-11 with an adult. $8 per person.

10 to 11:30 a.m. 366-5695; www. prescottfarm.org

FUNERGY FESTIVAL 28 SUNDAY NORTH CONWAY – North Conway Community Center, 78 Norcross Circle. 4 Our Kids Recycling Services presents the 9th Annual Earth Day Funergy Festival. Enjoy a celebration of energy and resource conservation. Funergy is a bottled water-free event with environmentally friendly vendors, activities and demonstrations for all ages. Try the Recycling Can Crusher, the Scrap Wood Catapult, the Pedal Powered Shower Bike, or taste Ray’s Solar S’mores.

Get a free skate boarding lesson, build a bee house, and make your own reusable bag or solar oven brownie box (brownie included) and more. Free. 10 a.m. to 1 p.m. Find 4 Our Kids Recycling Services on Facebook.

EVERY 10 MINUTES

SATURDAY April 13, 2019 NH Sportsplex Bldg. # 2, 68 Technology Drive, Bedford, NH 8:30am to 12:00pm

TICKETS NOW SOLD ONLINE ourpromisetonicholas.com Online $8 Per Person $28 Per Family

At the Door $10 Per Person $32 Per Family

Working together to cure Batten Disease For information about Our Promise to Nicholas Foundation go to:

www.ourpromisetonicholas.com

ACT I CAMP ACT II CAMP July 8 - July 20 SHOWCASE PERFORMANCE on Saturday, July 20

July 22 - Aug 3 SHOWCASE PERFORMANCE on Saturday, Aug 3

Mondays - Fridays (9am - 5pm) Before & After Camp Care available!

For more information and registration, please visit our website or contact our Summer Theatre Camp Staff at (603) 816-2695 or education@peacockplayers.org.

Tickets - (603) 886-7000 or online

NEWSIES (May 10th –19th)

For Easter egg hunt and Earth Day listings, and our expanded events calendar, go to

WWW.PARENTINGNH.COM www.parentingnh.com

| APRIL 2019 43

time out

BUNCHES OF BRUNCHES

BY MELANIE HITCHCOCK

Y

ou’re working Monday through Friday, your Saturday was booked weeks ago, but is your Sunday free? You know, say from about mid-morning to early afternoon? If you can sneak out of the house for a few hours, brunch is the perfect time to hang out with friends or your other half to catch up and fill up on delicious food.

Brunch can transform a typical Sunday into a Sunday Funday and no one will look at you funny if you have a bit of booze (yay, mimosas!) before noon. A number of Granite State restaurants have special brunch menus. Here are a few standouts.

The Foundry If you haven’t tried the Riverside Sunday Brunch Buffet at The Foundry, you are missing out on one of the best brunches around. No matter how picky or adventurous your palate is, you will have no trouble filling your plate, probably even twice! Start off with homemade pastries and fresh fruit, make your way to the carving station, pick up a few local oysters and some smoked salmon, then make a point of trying the homemade meatballs and seasonal selections.

50 Commercial St. • Manchester • 10 a.m. to 2 p.m. • $27 www.foundrynh.com

Music, Mimosas, and More: Brunch at the Currier Entertainment is the little something extra the Currier Museum of Art brings to the brunch table once a month. Listen to live music while dining on your made-to-order omelet, specialty coffee and other breakfast and lunch offerings. Brunch is the second Sunday of the month. Reservations required.

150 Ash St. • Manchester • 10 a.m. to 2 p.m. • $19.95 www.currier.org

44 www.parentingnh.com | APRIL 2019

Peddler’s Daughter

The Old Salt Head to the Seacoast where the Old Salt makes brunch an event.

In addition to a large menu that includes Eggs Benedict, poached salmon, imported cheeses and Belgian waffles made to order, you can also enjoy edible arrangements of fresh fruits and satisfy your sweet tooth with the help of the three-foot Belgian chocolate fountain.

The menu is diverse and features everything from disco fries, to chicken and waffles, to frittatas. But don’t miss out on your opportunity to have a real Irish Breakfast — sausage, eggs, black pudding, bacon, gratin tomato, brunch potatoes and brown bread.

Wash it all down with a bloody Mary or Irish cider.

40 Lafayette Road • Hampton • 9 a.m. to 1:30 p.m. • $21.99 www.oldsaltnh.com

48 Main St. • Nashua • 11 a.m. to 3 p.m. (also on Saturdays) www.thepeddlersdaughter.com

Lakehouse Grille in Meredith – Jazz brunch every Sunday

And a few more…

Bedford Village Inn in Bedford – Brunch also served Saturdays The Bistro at LaBelle Winery in Amherst – Menu changes weekly

Vida Cantina in Portsmouth – Featuring Mexican favorites

ALLIYAH LIVES WITH SICKLE CELL DISEASE, BUT IT DOESN’T STOP HER FROM LIVING LIFE TO THE FULLEST.

Alliyah S. Manchester, NH

NEW HAMPSHIRE’S ONLY CHILDREN’S HOSPITAL. Born with sickle cell disease, Alliyah has relied on the Children’s Hospital at Dartmouth-Hitchcock (CHaD) her entire life. As the only children’s hospital in New Hampshire that offers advanced pediatric services, CHaD is dedicated to providing every child with outstanding and compassionate primary and specialty care. With a focus on innovative research and education, Dartmouth-Hitchcock is there for Alliyah and her family every step of the way.

go.d-h.org/kids