and now three weeks seems like nine months. everybody is asking me as far as the delivery, am i going to have an epidural? am i not? i don't think it's something you can plan because it depends on the timing, when you get to the hospital, and how it personally is going. it typically sounds like, wait till they're five minutes apart-- the contractions, that is, and then, you know, give the call and take the ride.

narrator: pregnancy is usually a 38-week procs. healthwise, there's much a woman needs to do and learn during that nine months. barbara korsch: i think that, you know, usually people don't make a conscious effort to prepare for that. they are in the state of mind, and let's hope they have someone who's going to father the child whom they respect and whose values they like. i like to say that a pregnancy begins when two people who are in love with each other decide that they're going to become pregnant and raise a child till that child is 20 to 30 years of age, not before. j.p. garamone: we've been married 13 years. we pretty much put the decision off till later on. we really thought that we would, you know, travel and do a lot of things together, etc., etc., and then when the time was right, we'd figure, you know, we'd talk about it then. and then one day, it was like, is this going to be a nursery or is this going to be a guest room?

tracey garamone: and i went for my annual doctor's appointment and said we're thinking about it and next thing you know, the next month, it happened. well, there's no question that if we take from the very beginning, planning a pregnancy is far more likely to yield a good outcome than an unplanned pregnancy for a variety of reasons. not every woman is perfectly healthy. doctor: tracey? not ever woman understands that, for example, you can reduce the chance of having a neural tube defect by taking folic acid in the pre-conceptual and the early conceptual period. if you wait until you're pregnant, it's often too late, to, in fact, impact any change on the outcomes. tracey garamone: well, i was in fairly good physical shape. i take vitamins that are equal to, if not better than prenatals, so i was set up for that. the most important thing is the folic acid so that was in place. caffeine i had already cut out of my system a couple years ago so that was easy. but alcohol, definitely, you know, came to a halt, because we are social drinkers

and we do love wine tasting and things of that nature. so... it'll come back. overindulgence is not going to work, whether we eat too much red meat, even though it's good for iron, if we eat too much of anything, it's not going to be good for us. so again, use logic in deciding how you handle your pregnancy. i needn't tell you, i needn't tell anybody that alcohol's not going to be good in pregnancy. i needn't tell anyone that using illicit drugs is not going to be healthy for your pregnancy. because ultimately that baby, if the mom uses regularly enough and in high enough quantity, the baby will become dependent on the drug in the same way that an adult would. in the wall of the lining of the uterus, there's a hormone that plays a very important role in the developing brain. so this is a signal from the mother that plays a role in how the baby's brain develops. so clearly speaking, we're talking about a drug,

alcohol, that affects the mother's metabolism, where that signal doesn't get delivered to the fetus to allow normal brain development. in the last five to seven years, the rates have started to climb back up again in terms of women drinking while they're pregnant. it's the more highly educated, the more high income, typically white women who appear to be escalating their alcohol use. i think, in part, folks feel very comfortable that this problem was addressed and successfully licked back in the 80's and that it's something we can move on away from at this point. and that is absolutely not the case. smoking also increases the risk of premature delivery and low birth weight.

in fact, babies whose mothers smoke are at greater risk for sudden infant death syndrome. calvin john hobel: sometimes it's hard to look at just the effect of smoking by itself, because smoking women have other habits that compound the effect of smoking. for example, nutrition. women who smoke tend to have poor nutrition. they may also be the person who's not taking their vitamins so they have a folic acid deficiency. so when you combine poor nutrition and not taking adequate vitamins, then in combination, that can lead to more serious problems. women often become more health conscious when they become pregnant. and that often translates into a more healthy diet. women aren't "eating for two," as the old saying goes.

they only need a few more calories. but they do need to eat well. undernourished pregnant women have a higher risk of miscarrying, having premature or underweight infants and delivering babies with birth defects. i gained weight pretty rapidly, which i was surprised, because i was exercising very regularly and eating-- i eat very well balanced. so it just-- my body was getting ready on its own and my doctor said not to be concerned about that. i've done a lot of reading. i've read about every book i can get my hands on, and they all said the same thing, you know, 25-35 pounds. j.p. garamone: we've been eating basically the same way for years and years and years, so it's not too much of an effort here for us. you know, the pickles and iccream really weren't an issue. fasting during pregnancy is not good. normally for a non-pregnant person,

you can fast for 24 hours without having a metabolic effect, but during pregnancy that time is shortened. so women who fast for 12 to 13 hours have a significant increased risk of having a low birth weight baby, or a baby who delivers pre-term. if a woman has dinner in the evening, let's say at 6:00, and then doesn't have a snack at bedtime and then gets up at 8:00 or 7:00 the next morning, doesn't have breakfast, and then maybe has a late breakfast or lunch, that's way more than 13 hours. so, in our studies so far, we found that about 40% of women have periods of fasting for more than 13 hours. so i think fasting is prevalent in pregnant women. all these health guidelines--

it's enough to make a woman's head spin-- not a good idea, since she may be nauseous already. but her medical practitioner and her own common sense can give her all the tools she needs for a healthy pregnancy. barbara korsch: from a physical health point-of-view, anything that is good for the mother's health is good for her during pregnancy. you know, the mothers go to extremes nowadays. i mean, they may read greek poetry to their belly, you know, in the hope that the child will be exposed to something beautiful and this will improve his mind, and... classical music, even in utero, not only after birth, which was highly touted recently and so on. so they would do many things. now as far as i'm concerned, there's no evidence that this has a direct impact on the baby's brain. but if you think logically, if the mother relaxes when she listens to mozart and her pulse rate slows down and her entire circulatory system and body is less stressed,

this can only be healthy for the baby. doctor: the baby's heartbeat sounds great. it sounds calm right now. there's data now to show that women who have stress have a greater risk of having a baby that has an anomaly of either the heart or the central nervous system, like spina bifida, heart abnormalities that are more likely to occur in a woman who has stress. and then also there's been a study showing that women who have stress are more likely to have a miscarriage. so this really focuses us toward the early part of pregnancy. researchers are also studying how acute stressors

like domestic violence and natural disasters affect pregnancy. calvin john hobel: recently our team showed a relationship between the northridge earthquake that occurred here in the l.a. basin and those women who experienced the earthquake during the early part of pregnancy. it had a significant effect on their gestational length meaning that they were more likely to deliver early and in some cases, you know, pre-term delivery. there are many factors associated with premature births. some, such as smoking and poor nutrition, are risks women can avoid. others, such as stress, may be more difficult to control. but often premature labor is beyond anyone's control. whatever the cause, it creates serious problems.

pre-term birth is the second leading cause of infant morbidity and mortality. the leading cause, is, you know, congenital anomalies and so the two are sort of close to each other but actually pre-term birth is second. and so there's immediate problems with the delivery of a pre-term baby, and it's related to gestational age. babies who are born before 32 weeks, or 31 weeks, we call very low birth weight babies. about 8% are born prematurely and they weigh less than five pounds, five pounds or less. and of those, of all the deliveries, about 1.5%, one and one half percent, are born with extremely low birth weight. it's what we now call "the micro prematures" because they are very tiny. they are less than three pounds. they have pulmonary problems, problems with breathing.

they can have bleeding into their brain and these events really increase the risk of these babies having, you know, mental retardation, cerebral palsy, learning difficulties later on in life. so the maternal fetal medicine specialists, the obstetricians that specialize in this, as soon as they suspect premature labor, they try to prolong this because we know that five, seven days, a little bit over a week makes a big difference. several years ago we've shown that to be born at 24 weeks is much worse than being born at 25 weeks, even though medically we say 24 to 26 weeks. it's very different. because of medical advances in the last 20 years, many more premature babies are not only surviving, but surviving with fewer physical problems. augusto sola: i think everyone can understand that this baby born premature, let's say 10 weeks early, was not supposed to be breathing outside of the womb,

so they don't have these all well developed. the treatment starts actively in the delivery room of these babies. and what we do there is we insure that enough oxygen is being delivered to the baby's heart, brain, lungs, kidneys. we also make sure that their temperature doesn't drop. and we move the baby usually to the intensive care unit because these premature babies need treatment for several days, weeks-- or even the tiniest ones, for months-- to insure that they make it, you know, uneventfully. the baby, as a member of that family, has special needs. but the parents, they also have special needs to reach. i actually had a perception one day, and then i believe it very clearly, but actually babies-- just like parents are asking us, "please take care of my baby--" babies are asking, "please take care of our parents." medical advances have helped prolong pregnancies

and saved premature babies. advances have also given physicians ways to see how a pregnancy is progressing. a commonly used technique is ultrasound scanning. this procedure uses high-frequency sound waves to visualize the fetus. lawrence d. platt: well, i personally believe a woman should be offered an ultrasound in every pregnancy because i personally will tell you i know of no test that can offer us as much information in a shorter time as ultrasound, provided it's being performed with someone that understands and is well-trained and has the proper credentials and accreditation of ultrasound. using an ultrasound, a health care provider can detect structural abnormalities, estimate the age of the fetus, see if there is more than just one fetus, and confirm fetal position. i had no idea that it would be that clear and that you could actually count the fingers and almost see the fingernails and the profile of the baby. it's pretty intense.

you know, a large part of my research in ultrasound is in fetal assessment, not only identifying the patient with a chromosomal abnormality, but how is the baby doing? you know, that fetus is my patient, and so we do what's called a fetal biophysical profile-- something that we reported on over 20 years ago that's still used as a test of fetal condition-- combining it with heart-rate monitoring and looking at how is the baby doing. another diagnostic tool is amniocentesis. it involves removing some of the amniotic fluid that surrounds the fetus. geneticists observe cells from the fluid to see whether or not the fetus will be born with a genetic abnormality or other conditions, such as neural tube defects. tracey garamone: the needle is about the size of a blood-taking needle, which they've done a lot of that. i was lucky i did not have any of the adverse affects. some people do have cramping, bleeding etc. and i did not. it just was another day. you know, at this point, i don't remember exactly how long we had to wait for the results,

but yes, until we got them and knew everything was perfect, you know, there was a little bit of worry. sometimes it's not just the outcomes of the pregnancy itself that you're looking for measures. there is how you manage the patient. it may be easier for the clinician to manage the patient knowing that there's a singleton pregnancy and not twin pregnancy. it's nicer to know that you don't believe that there's an abnormality. all these become better means of assessing the condition of the baby, and that they're providing you the optimal care of your fetus. tracey garamone: my husband and i decided not to find out the sex of the baby, because we feel there aren't enough surprises in life and felt that would be one of the biggest ones that we will experience together and well as i've been kind of stating that it'll make it worth the work-- that surprise in the end, that reward. really, right now, it's just i'm hoping for a healthy baby. that's really the main concern right now. the first part of labor is cervical dilation--

rhythmic contractions of the uterine muscles that cause the cervix to dilate and to efface. when contractions are only minutes apart, it's time to get to the hospital. tracey garamone: well, about 5:00 on saturday afternoon is when i started feeling the preliminary contractions i would say, because they were very dull. but i noticed that there was repetition, so i made dinner and carried on as normal. and then about 7:00 i took it easy and had jay start to time the contractions. and again, they were at a mild stage and they were about seven minutes apart. so i called dr. galitz and asked him the protocol and he said to go to the hospital when they're at five minutes apart. so by 10:00 the five minute mark hit, and we waited for about an hour to an hour and a half to make sure it was consistent, and it wasn't, what's called the braxton hicks, which are inconsistent. and it was, they were very consistent every five minutes.

so i went to the hospital, got hooked up on the fetal monitor and the contraction monitor, and was examined and was told that i wasn't dilated. and that that's known as prodromal labor, meaning that the water hadn't broken. and there was no dilation, my cervix was 70% % effaced, so it wasn't real labor. so they had me walk around for about a half an hour, to see if there would be any change. there wasn't, so they sent me home. try not to lift or carry any heavy objects over the next couple of days. got to keep drinking a lot of fluids-- eight to ten of glasses of water or juice a day. shower only. if you feel decreased fetal movement... the next morning, you know, they just progressively started getting worse and worse, and i noticed some bleeding so i called, they said, "come back", so, ironically, it was about the same time, about 11:30-- headed bk to the hospital, 12 hours later.

same protocol. on the monitors... exam, still no dilation. still they're telling me i am not in labor. and at this point i am feeling pain and not knowing what labor would feel like otherwise. so again we got sent home because there was no progression. we'll try again another day. j. p. garamone: it was a little frustrating driving back and forth a few times to the hospital, you know. that i didn't really anticipate. - you okay? - yeah. - a little disappointed. - disappointed? yeah. the baby's not cooperating. when the cervix is fully dilated, the second stage of labor begins. the infant descends into the birth canal, normally head first. with each contraction the mother pushes,

helping the baby along. but in some cases there are complications. by early evening i was having very severe body shakes, so i called and they said, "come on back." and they said, worst case if i was not dilated, they would try to give me a shot of something like demerol so i could at least sleep through the night, because i was unable to sleep since friday night basically. and now, we're at sunday. so went back to the hospital and i had dilated to one. so was given the opportunity to take the demerol or the doctor had given an okay for an epidural due to the pain thus far and for the time of it, and that's what i opted to do. and that was the savior. love the epidural. tracey came into labor and delivery at west hills in early labor. the examination was a cervix that was about two centimeters dilated, which is very early. tracey unfortunately, is about a week overdue.

and in that situation very often there's decreased amniotic fluid. the amniotic fluid inside the uterus acts as a cushion to protect the baby during the course of labor when the uterus is contracting and putting pressure on the baby and the umbilical cord. with decreased amniotic fluid, there's less capability to protect the baby and more often they develop distress which is what tracey's baby started to do. and th when we h thoble the problem of the heartbeat dropping and that got pretty intense and pretty scary. and as a result of that, with the early stage of her labor, we decided that the baby wouldn't tolerate labor well for the rest of the course of labor which would be eight or nine hours. so the decision was made to do an emergency "c" section that evening. j.p. garamone: you could see that everybody was under control, all the doctors were there, etc.

that was really, i think, the saving grace, that they were under control, because i was pretty nervous at that point. doctor: what i'm going to do now is just touch you on your belly. left, center, right. low and low. - anything you feel? - no. perfect. good epidural. oh, my god. - you okay, trey? - yeah. okay. we're doi fine. hello, kiddo. oh, you are a big one, aren't you? - where's the cord? - not much fluid.

around the baby's right leg. j. p. garamone: and, you know, i was a little disappointed that she didn't get to see the baby right away because it was a "c" section. other than that i think things went smoothly, so i was happy. tracey garamone: obviously most mothers want a natural delivery but at that point i wanted what was best for the baby. and i had anticipated that bonding part of the natural delivery-- they let you have the baby for an hour before they do any of the cleaning and the tests, etc. so i did miss that. i missed not being completely coherent during the delivery just due to the drugs, but the lack of pain i didn't miss, that was fine.

so it's all worked out and the baby's healthy and that's really the bottom line and what matters. barbara korsch: it's not absolutely that if you don't have the chance for this early bonding experience there will be mayhem but it is certainly a positive thing and in many instances now, the birthing process has been adapted a little bit to facilitate this early interaction between mother and child. and, for instance, we used to rip the baby away from the mother and put it in the nursery and then nobody could see it except through a window and with masks and gowns so that those early weeks would be very sterile. and now we try to do quite e opposite as a matter for this attachment process. the attachment between mother and son may have been delayed, but only for a matter of hours. linda hanna: in the last 10 years there's been a tremendous energy put on breast-feeding and the health of the infant, and the desire of women to be connecting with their babies

at a very primitive, very natural type of level and so feeding-- breast-feeding in that venue has actually become extremely popular. it's so easy now that almost anybody can breast-feed. the food that's produced by the mother is made specifically for her individual baby. although women can donatmilk for other babies, her milk is designed specifically to meet the needs of that baby at that gestational age. and so as the baby is developing in the uterus and growing, it's being fed appropriately by the placenta and by the mother. the same thing holds true for the baby after it's delivered. in addition to that, as the baby grows over time, in the year, second year, third year, the milk changes to meet that particular baby's growing needs. the carbohydrate and protein balance is perfect. there's amino acids and carbohydrates that help fuel the baby's brain and continue to help them grow on a continuum that's set, and actually quite adaptable for each individual baby. four days after the delivery, matthew is having his final check-up

before release from west hills hospital. if you have any questions that you want to ask me, i'd be happy to answer. i understand he had a circumcision yesterday. now if he urinates or, you know, poops, does that effect the circumcision at all? because i noticed when he did urinate you know, he kind of started crying more so than he ever had, and then i changed him and he was fine. do you think it's sensitive? the area is unquestionably sensitive at this point. but it's-- almost all the babies urinate and defecate over that area and we don't see any significant problem from that. tracey garamone: since he was born we're always listening for any kind of congenital cardiac abnormality. and at this point, what's the heart rate, you know, now that he's out? typically 120, 160. like it was in the womb? yes, and gradually over time, usually over the first two months or so, there'll be a very slow reduction in heart rate.

he's very active, and all of his behavior is very appropriate. all of the rooting responses are really excellent. he's doing beautifully. good. if it's in the middle of the night and you're not sure whether what you're worried about is significant or not, you can call the nurses here in the newborn nursery, because they're doing shift work around the clock. if you express a concern to them and they're worried, if it doesn't sound right to them, they'll tell you to call the pediatrician. and of course, we're available 24 hours a day. call us if you're worried about anything. tracey's discharge interview is relatively brief. just you know, be sensible and things like that. and that's about it. how about stairs? i think going up and down stairs shouldn't be a problem. we didn't cut muscles or anything like that. if you feel tired or fatigued after doing that, try to limit the number of times a day you do that. - okay. - but otherwise you can pretty much do what you want. - take it easy. - sounds good. - see you back in two weeks. - thank you.

"the human condition" is a 26-part series about health and wellness. for more information on this program, and accompanying materials, call: or, visit us online at:

narrator: a century ago, the potential for surviving childhood was not as promising as it is today. there was a higher childhood mortality. it wasn't uncommon to have a family where a sibling or two or three died during childhood. today, of course, that's very uncommon.

raising healthy children may not be the challenge it was a century ago, but it's far from automatic. the risks of diphtheria or scarlet fever have given way to accidents. every household, every environment offers different challenges. but there are some fundamentals that come into play. catherine parrish: i thinking limiting your exposure to germs and a balanced diet are the most important things i teach them about keeping their baby healthy... and then coming for shots. the immunizations we provide certainly make a huge difference. diseases that killed hundreds of thousands of people don't even exist in this country anymore. although some concern has been expressed about the possible side effects of vaccines, physicians firmly believe

that the benefits far outweigh any risks. vaccines have eliminated polio, and all but wiped out measles, mumps and rubella. i think the reason why we're not seeing a lot of those illnesses is just because of that. not because we're necessarily a healthier population, but because we've taken steps to try and eradicate those diseases that we could eradicate. we have a tremendous number of vaccines we didn't have even when i started practicing, for instance, the h-flu vaccine which came out in the late 80s and we started giving it before the age of 2 in the 90s. when i started practicing, my very first week in practice, i almost lost a child to h-flu meningitis. carried them in the back of my car to the emergency room, ran them in... thankfully they did well. but that's a disease we don't even see anymore because of the h-flu type b vaccine.

what we see most commonly now is respiratory infections, especially otitis media. we see a tremendous number of children with ear infections. other respiratory infections are very common-- coughs, cold, sinus and cause us a lot of visits. catherine parrish: and that's because kids aren't at home. they're in day care from six weeks of age. when we were all growing up, we grew up at home and were only exposed to our siblings and cousins, and so we weren't as sick at an early age. now moms go to work at six weeks or eight weeks of age for the child, and so kids get a lot more ear infections, a lot more colds. it may be impossible to avoid runny noses, but experts agree on some easy, yet important ways to give children a good start. catherine parrish: i think i start by telling them to enjoy their baby and love their baby. and then, in the very beginning, like in the first two months of life,

to try exposing the baby to as few strangers as possible, to bring as few germs into the house as possible, nurture the baby, feed the baby regularly, not take the baby to the mall... not take the baby to the movies, because i have some very young moms in my practice who want to get back to the mall as soon as possible. and so, you know, i try and limit the baby's exposure to pathogens that might make it sick. well, i certainly think that the perception on the part of many mothers is that the baby's very delicate, very fragile. they hold them like a breakable object, you know, and don't dare really act natural with them. and in general, of course, the baby-- a newborn can't hold his head so the head has to be supported but other than that, they are really quite tough little creatures. you don't have to be afraid of touching all the time because the baby actually needs to be touched. what's important is that their parents are picking them up, touching them, loving them, giving them stimulation, reading to them, talking to them. this is really critical in the early formative years.

without any stimulation, infants do very badly. i admitted an infant to the hospital a couple of months ago who had-- came from a really grossly deprived background. and at first, i was sure this baby was going to be very, very delayed and had something wrong with his brain. but after a few weeks of very intense attention the whole staff was so moved by this infant's plight, we never saw him in his crib. i'd come to examine him and he was always in somebody's arms, you know. but anyway, once we fed him and gave him lots of attention and talked to him, and held him, and now put him in a foster home, he's actually a normal baby. and it's one of the most extreme i ever saw-- of what total deprivation can do. stimulate your kids. read to your kids. we know that reading, is one of the best things that we can do for our children. again, i think it's this stimulation of the developing brain, making those nerve connections early

and optimally for those kids. so the data's very clear. you need to read to your children. catherine parrish: the idea for a reach out and read program came from some very bright pediatricians in boston, who decided that we do just about everything else for the young child. we're their most constant contact outside of their parents. we talk to them about car safety, home safety, nutrition, what to wear, where to go for good entertainment, why not talk to them about books? let's put these right here. which book would you like? i think we selected one. michael bryant: now we do that as early as six months for those kids, because while they can't read at that age, certainly exposing them to pictures and figures and colors and all of those things early on, i think really does enhance the foundation that they will build on ultimately. yolanda brown-willie: we read every day, maybe three or four times a day, in between me coming from school and going to work.

and then my oldest two daughters also read to him at night. so it's very important because he's getting ready to start kindergarten next year, so he really needs to know what he's doing. catherine parrish: it's a very exciting thing and i haany, many young families who never owned a book before i gave them one. i have moms who haven't learned to read themselves, who've gone to literacy programs after i started giving their children books. i have moms who have come back after three and four years in this program with their young toddler going to kindergarten reading, so excited that their children can read already. and it's just a very, very positive and rewarding thing and it's something we can do to give kids a step ahead in this urban community. but health professionals caution that the idea is to stimulate babies for normal development-- not to hurry them along. now, throw it to me. ck it up. throw it to me... throw it. ( chuckling ) throw it.

can you throw it with your hands? this whole, you know, business again of wanting the fastest baby is very, very noxious, because, you know, they want to have the fastest car, and they want to have the fastest baby and they think you can control that. one of the most exciting things about working with children is this tremendous developmental drive. whatever they know how to do, they want to do all the time. they don't want to just walk, they want to run. they try to climb everything. so you don't need to teach them any of those things and trying to do that is counterproductive. now, of course, they have to have the stimulation. it's always a balance. so for most of the developmental milestones, if given some stimulation, some freedom, some interaction around it, they will learn it as fast as they can. and because young children are busy exploring their world keeping them safe is one of the most pressing health needs.

michael bryant: talking about toddlers... probably the thing we worry about most is accidents, because kids at two, three, four years of age are so prone to injuries and accidents, and these are things that obviously are non-intentional. and so prevention begins to be the key. and looking for those, what i like to call, hidden dangers in your home that kids can get into. i mean, kids do things that we would never imagine that they would venture into, simply because of their curiosity and so most of my advice for parents would be around injury and accident prevention. catherine parrish: everywhere from the child's home where there could be exposure to normal things that you have to make safe for the young toddler, like light sockets or stairs and using gates, and i think those are the things people are used to hearing about.

and for instance, baby walkers which are very dangerous-- and we try to keep parents from using them. we saw horrible accidents with them all the time. michael bryant: there are parents who have a lot of confidence in the floaties. the floaties are the things that you put on kids arms that allow them to stay afloat in water. and they are very cumbersome, they get in the way, they impede their ability to flail and move their hands and so they remove them. they don't have the knowledge that that's what keeping them afloat. and so it's things like that for the young kids. as children get older, they may still resist wearing protective devices. barbara korsch: then there are certain recreational things children use which are dangerous-- skateboards, roller blades, very dangerous. and we counsel a lot about helmets, elbow guards and all that because many of the children who engage in high-risk athletics don't wear the necessary protective gear. unfortunately, many children live with other risks as well. barbara korsch: causes of injury-- sadly, violence

is still at the top of the list even in childhood. i, in my own practice, have had several children who were killed from gun accidents, and i ask every family in my practice whether there are any guns in the home. do you keep it unloaded? do you keep it locked? do you keep it where your children can't reach it? so gun safety is a big thing that i didn't think i was going to have to talk about when i started practicing that i talk about all the time now. we've lost two children to guns in this practice, both teenagers. one was caught in a gun exchange over drug money. another was shot because she was dating someone's boyfriend at 12. it's a scary world out there. there's so much to talk about in terms of safefety. and actually in medicine it's hard to do

in the time we're given to pick and choose which topics are the most important for each family and each child. and, of course, there are other topics which are important to a child's health. barbara korsch: we used to worry about malnutrition. now our biggest, biggest problem, big in every sense of the word, is obesity at all ages. i see parents using food as rewards all the time, and generally it's food of low nutrient density. it's like candies, cookies, lollipops, the usual sorts of things. tyler was sort of nice... and she's saying please... and basically when you use a food as reward, you're holding up that food as something special. when you think about it, it doesn't quite make sense. it's like, "you're a good boy, here's a lollipop that will cause you to have tooth decay,

and has almost nothing in it for your health and well-being." how much sense does that make? that's a big problem that we have, in particular, in overweight children, where grandma's way of rewarding you is a trip to the local fast food chain. i won't impugn any one chain, they're all there-- you know, and fries and a burger are the way to your heart. we have to change that myth. fries and a burger should not be the way to your heart. it's the way to atherosclerosis. david faxon: in a recent study on autopsies of children and young adults, in the teenager range, a very high percentage had plaques, had hardening of the arteries evident before the age of ten. and by the age 20, the majority had plaques. an estimated 15% of american children

are seriously overweight-- twice as many as two decades ago. twenty-five percent are at risk for obesity and many already show biochemical changes such as elevated cholesterol and blood pressure. and as a consequence of that, in certain populations, particularly in certain hispanic communities and in african american communities, we are seeing associated with that obesity the onset of frank-- what we call type ii diabetes where these children actually need medications to control glucose. although genetics plays a role in obesity, for many children, it's their environment that determines whether they will gain unneeded pounds. children's diets today are high in sugar and fat-- invitations to health problems. are you guys hungry? yeah. yeah. want some lunch? nancy anderson: setting an example is the most important thing that an adult can do to help your children

learn healthy habits, whether it be diet or exercise. the other thing is to teach them, again, what is moderation. every kid's going to love french fries if you give it to them, but if you teach them that this is a sometimes food and that there are everyday foods that you want to eat every day, and sometimes foods are okay once in a while. i think it gives them a healthy look at moderation and so that hopefully you prevent extremes in either direction. joanne ikeda: young children are naturally neophobic. they have a distrust and a dislike of new foods. you put a new food in front of a toddler, and they generally don't go, "oh, whoopee, a new taste sensation!" it's more like, "what's that? i haven't seen that before. i don't think i'm going to like that." can you try me some strawberries, please? you know there's strawberries in your juice.

you know there are strawberries in this juice? and you love this juice so much. try just a little bit of strawberries? you ch it all up? can you try a little bit for me? how about carrots? you want to try carrots today? can we try to eat the carrot? parents say to me, "oh, my child won't eat vegetables, but that's because they've given up too easily. they need to keep serving them, and they also need to model enjoying them. look, i'll try to eat some if you'll eat some? look, see? mmm. that's very good. it's really, really good, buddy. with repeated exposure, you can break down this neophobia and actually get to a point of acceptance. just a little bite for daddy? realize when kids start eating, they have a very clean slate.

you know, they develop the tastes that we have acquired over years and years of experience. and so to the extent that you introduce foods that are healthy, then you kind of tailor their palate to enjoy those kinds of foods. if you introduce those kinds of foods that you and i like because they're sweet, because they're tasty, then you are also tailoring the palate of the child. but you have this clean slate to work with, if you start with nutritional foods then you're going to create a child who looks to have those kinds of things. but it's more than just bad food choice that is a factor in obesity. inactivity is also a culprit. children aren't getting as much exercise as they should. one reason is they spend too much time in front of the television set. television watching is the single thing that has been consistently associated with obesity and there have even been some really interesting studies that if a child is just watching television,

where they tend to sit very passive, they're usually also snacking, you know. that their metabolism actually goes down. it's a little bit like hibernation. it's sort of not the television, it's what the parents are doing. it's like you could blame television because parents are saying, "i don't want to be bothered," or, "i'm not going to create the environment for you to be physically active in, so watch tv." and when you do the study, it looks like, "well, oh, it's tv that's to blame," you know, when in fact, it's not necessarily tv to blame. researchers have found that when television viewing is limited, children fill their time with more active pursuits. some children find it easier to be "active" than others. catherine parrish: county kids grow up in an environment where they can ride their bikes, they can play ball outside and it's safe. they're in good after school programs, or schools that have after school sports and so county kids exercise.

city kids don't, for the most part. there have been interesting studies, for example, done comparing physical activity levels in inner city kids compared with suburban kids and one of the things you find is that... inner city kids may do very well on things like push-ups, sit-ups and less well in running and aerobic type of activities. and the investigators discovered that the reason that that had happened was because in this particular study which had been done in a large city that coaches didn't let the kids during p.e., that they had, they didn't let them go out on the playground because the playground was dangerous. p.e. was inside and so the activities that they did was a lot of calisthenics, sit-ups, push-ups, things like that. catherine parrish: i hear lots of stories when i see these kids for check-ups, and many of them are overweight, about how, "i'd like to play a sport but my school doesn't have that." "i can't get to the program. it's on the other side of town."

"it's not safe to ride a bike in my neighborhood." "i can't... my bike got stolen. i haven't been able to ride one since that." "my mom won't let me play basketball at the schoolyard because it's not safe." there's going to be a lot of what we as a society, as parents, as individuals, construct for our children, and the kinds of environments that we create for kids to be physically active, despite that fact that there's going to be a great deal of genetic difference from child to child. a few of them are going to become great athletes-- most won't. but many will benefit from what we can identify as optimal patterns of exercise during childhood. if good nutrition and exercise become a habit, there's a better chance children will grow into healthier adults. but scheduling too much activity isn't a good idea, either. kerry syed: i think that children, in general, are very little impressionable people.

and as we go through childhood, you know, our parents make us do certain things-- "you need to be in soccer. you need to be in ballet. you need to do this," but they never think about, "does my child like this?" they think, "i just want you to be active." jennie trotter: most parents are working and then you have after school or then you have other obligations that the kids have, so what we're trying to let parents know, first of all, is to be able to say no. first of all understanding that your kids' agenda and schedule that you may have to say, "that's too much." we stress them in more ways than you can imagine. many kids start their day at before-school care at 7:00 in the morning. then school till 2:30 or 3:00, then after-school care till they finally get home between 5:00 and 7:00 in the evening and eat dinner and have that one hour that they're supposed to cram a whole day in with mom or dad,

and then go to bed and do it again. in the more suburban community, the stress is running from school to soccer, to violin to dinner to fitting in homework to going to bed. and so i think, you know, we've gotten away from letting kids be kids. kids need time to kick their shoes off and do nothing and be in their house, with their things, with their family. and the kids who don't get enough of that... come to see me. and what do i hear? i hear... "he's having headaches all the time. he's having stomachaches all the time." we weren't meant to run at that pace as youngsters. i don't know if we were meant to run at that pace as adults. jennie trotter: sometimes you just practice some relaxations whether it's, you know, listening to music or exercising together. there's some great slow moving, deep breathing exercise

that say, you know as a rule, or having family meetings because there's so much going on to talk about who's doing what. for some families, the concept of family meetings, or even just time together, may be difficult to achieve. the family uniis defin in very different terms these days. we have single parent families, we have parents where both parents have to work in order just to make ends meet. catherine parrish: i see many children who are latchkey children, who get very little one-on-one time with their mom or dad, who have nintendo, sega, four pairs of sneakers. spending time with your mother or father is probably the most precious gift you can give your children. not so much the quantity but the quality of that time, and that that child recognizes that as a special time for him to share with his mom or his dad or both, or whomever the caregiver is. as children get older, the value of time together,

and communication with trusted adults may be even more important. catherine parrish: i've been right here in baltimore city the whole time i've practiced, and as kids grow up, they feel that they need to trust someone. and you know, it's hard to trust your mom or dad when you're a teenager. i think we've all been there. it's not because mom or dad does anything wrong, it's just you're trying to find yourself at that age and maybe, mom or dad doesn't know what that is and you haven't figured out you can trust them. and so i become the person they can trust. and many kids come to me between the ages of 12 and 18 to tell me about experimenting with sex or drugs and to hear what i have to say about that. and if i say the right thing, many of them don't continue to experiment that way. they do trust my opinion. a recent study found that nearly 1/2 of teenagers received no counseling during their doctor's visit,

and only 3% received information on issues such as smoking, sexually transmitted diseases and weight control. but those are precisely the areas in which teens make poor choices and put their health at risk. catherine parrish: i think probably the biggest problem we have in the urban environment is that young children, both girls and boys-- i was going to say girls, but it's definitely both-- become sexually active at way too young an age. it's heavily accepted in the city to have a child before you're 15 or 16 years old, to have sexual relations with multiple partners before the age of 15 or 16, to have venereal disease before the age of 15 or 16. there's nothing right about having sex when you're 10-- or 12, or 14. and i take a very strong stand on that in my practice. but i'm one voice in a very large community

and when six of your friends have had babies by the time they're 15, it's a very hard message to fight. a lot of it has to do with peer pressure, and then they get so much from the media. and then you have a whole lot of kids right now that do not have that kind of parent monitoring. because a lot of parents are out making money and trying to support a better way of living in their new age. and then you have so much drugs that are out that you didn't have before, as well as, you know, alcohol. edward mccabe: we know from the studies, kids who take drugs, kids who are involved in gangs, are more likely to be involved in violent acts. we tend to sometimes not be as sensitiveo these issues. we can't predict every violent act, but when there are signs ahead of time, we need to recognize that maybe we need to try and get some help for those individuals.

the adolescent physicians are very good at talking to those kids and helping to identify which kids are at higher risk than others. so that i think that we need to use the appropriate health professionals to try and help us do a better job. parents face a wide range of health issues as their child matures. the baby with the runny nose, grows into a teenager who rarely has a bad cold, but is confronted with health issues such as smoking and alcohol. as they grow, children learn about health by what they see around them. kids learn better by example. we can say as much but the first two best role models are the-- you know, the people or the parents that are in the home.

"the human condition" is a 26-part series about health and wellness. for more information on this program and accompanying materials, call: or, visit us online at: