Compulsive exercise

Melissa has been a track fanatic since she was 12 years old. She has run the mile in meets in junior high and high school, constantly improving her times and winning several medals. Best of all, Melissa truly loves her sport.

Recently, however, Melissa's parents have noticed a change in their daughter. She used to return tired but happy from practice and relax with her family, but now she's only home for 15 minutes before she heads out for another run on her own. On many days, she gets up to run before school. When she's unable to squeeze in extra runs, she becomes irritable and anxious. And she no longer talks about how much fun track is, just how many miles she has to run today and how many more she should run tomorrow.

Melissa is living proof that even though exercise has many positive benefits, too much can be harmful. Teens who exercise compulsively are at risk for both physical and psychological problems.

About Compulsive Exercise

Compulsive exercise (also called obligatory exercise and anorexia athletica) is best defined by an exercise addict's frame of mind: He or she no longer chooses to exercise but feels compelled to do so and struggles with guilt and anxiety if he or she doesn't work out. Injury, illness, an outing with friends, bad weather — none of these will deter those who compulsively exercise. In a sense, exercising takes over a compulsive exerciser's life because he or she plans life around it.

Of course, it's nearly impossible to draw a clear line dividing a healthy amount of exercise from too much. The government's 2005 dietary guidelines, published by the U.S. Department of Agriculture (USDA) and the U.S. Department of Health and Human Services (HHS), recommend at least 60 minutes of physical activity for kids and teens on most — if not all — days of the week.

Experts say that repeatedly exercising beyond the requirements for good health is an indicator of compulsive behavior, but because different amounts of exercise are appropriate for different people, this definition covers a range of activity levels. However, several workouts a day, every day, is overdoing it for almost anyone.

Much like with eating disorders, many people who engage in compulsive exercise do so to feel more in control of their lives, and the majority of them are female. They often define their self-worth through their athletic performance and try to deal with emotions like anger or depression by pushing their bodies to the limit. In sticking to a rigorous workout schedule, they seek a sense of power to help them cope with low self-esteem.

Although compulsive exercising doesn't have to accompany an eating disorder, the two often go hand in hand. In anorexia nervosa, the excessive workouts usually begin as a means to control weight and become more and more extreme. As the rate of activity increases, the amount the person eats might decrease. Someone with bulimia also may use exercise as a way to compensate for binge eating.

Compulsive exercise behavior can grow out of student athletes' demanding practice schedules and their quest to excel. Pressure, both external (from coaches, peers, or parents) and internal, can drive an athlete to go too far to be the best. He or she ends up believing that just one more workout will make the difference between first and second place . . . then keeps adding more workouts.

Eventually, compulsive exercising can breed other compulsive behavior, from strict dieting to obsessive thoughts about perceived flaws. Exercise addicts may keep detailed journals about their exercise schedules and obsess about improving themselves. Unfortunately, these behaviors often compound each other, trapping the person in a downward spiral of negative thinking and low self-esteem. 

Why Is Exercising Too Much a Bad Thing?

We all know that regular exercise is an important part of a healthy lifestyle. But few people realize that too much can cause physical and psychological harm:

• Excessive exercise can damage tendons, ligaments, bones, cartilage, and joints, and when minor injuries aren't allowed to heal, they often result in long-term damage. Instead of building muscle, too much exercise actually destroys muscle mass, especially if the body isn't getting enough nutrition, forcing it to break down muscle for energy.
• Girls who exercise compulsively may disrupt the balance of hormones in their bodies. This can change their menstrual cycles (some girls lose their periods altogether, a condition known as amenorrhea) and increase the risk of premature bone loss (osteoporosis). And of course, working their bodies so hard leads to exhaustion and constant fatigue.
• An even more serious risk is the stress that excessive exercise can place on the heart, particularly when someone is also engaging in unhealthy weight loss behaviors such as restricting intake, vomiting, and using diet pills or supplements. In extreme cases, the combination of anorexia and compulsive exercise can be fatal.
• Psychologically, exercise addicts are often plagued by anxiety and depression. They may have a negative image of themselves and feel worthless. Their social and academic lives may suffer as they withdraw from friends and family to fixate on exercise. Even if they want to succeed in school or in relationships, working out always comes first, so they end up skipping homework or missing out on time spent with friends. 

  Warning Signs

  Someone may be exercising compulsively if he or she:

  • won't skip a workout, even if tired, sick, or injured
  • doesn't enjoy exercise sessions, but feels obligated to do them
  • seems anxious or guilty when missing even one workout
  • does miss one workout and exercises twice as long the next time
  • is constantly preoccupied with his or her weight and exercise routine
  • doesn't like to sit still or relax because of worry that not enough calories are being burnt
  • has lost a significant amount of weight
  • exercises more after eating more
  • skips seeing friends, gives up activities, and abandons responsibilities to make more time for exercise
  • seems to base self-worth on the number of workouts completed and the effort put into training
  • is never satisfied with his or her own physical achievements

  It's important, too, to recognize the types of athletes who are more prone to compulsive exercise because their sports place a particular emphasis on being thin. Ice skaters, gymnasts, wrestlers, and dancers can feel even more pressure than most athletes to keep their weight down and their body toned. Runners also frequently fall into a cycle of obsessive workouts.

  Getting Professional Help

  If you recognize some of the warning signs of compulsive exercise in your child, call your doctor to discuss your concerns. After evaluating your child, the doctor may recommend medical treatment and/or other therapy.

  Because compulsive exercise is so often linked to an eating disorder, a community agency that focuses on treating these disorders might be able to offer advice or referrals. Extreme cases may require hospitalization to get a child's weight back up to a safe range.

  Treating a compulsion to exercise is never a quick-fix process — it may take several months or even years. But with time and effort, kids can get back on the road to good health. Therapy can help improve self-esteem and body image, as well as teach them how to deal with emotions. Sessions with a nutritionist can help develop healthy eating habits. Once they know what to watch out for, kids will be better equipped to steer clear of unsafe exercise and eating patterns.

Broken Bones Sprains and strains

A broken bone requires emergency medical care. Your child might have a broken (fractured) bone if he or she heard or felt a bone snap, has difficulty moving the injured part, or if the injured part moves in an unnatural way or is very painful to the touch.

A sprain occurs when the ligaments, which hold bones together, are overstretched and partially torn. A strain is when a muscle or tendon is overstretched or torn. Sprains and strains generally cause swelling and pain, and there may be bruises around the injured area. Most sprains and strains, after proper medical evaluation, can be treated at home.

 

What to Do:

For a Suspected Broken Bone:

• Do not move a child whose injury involves the neck or back, unless he or she is in imminent danger. Movement can cause serious nerve damage. Phone for emergency medical help. If the child must be moved, the neck and back must be completely immobilized first, ideally with at least one other person assisting you. Keeping the head, neck, and back in alignment, move the child together as a unit.
• If a child has an open break (bone protrudes through the skin) call 911 immediately. If there is severe bleeding, apply pressure on the bleeding area with a gauze pad or a clean piece of clothing or other material. Do not wash the wound or try to push back any part of the bone that may be sticking out.
• If the child must be moved, apply splints around the injured limb to prevent further injury. Leave the limb in the position you find it. The splints should be applied in that position. Splints can be made by using boards, brooms, a stack of newspapers, cardboard, or anything firm, and can be padded with pillows, shirts, towels, or anything soft. Splints must be long enough to extend beyond the joints above and below the fracture.
• Place cold packs or a bag of ice wrapped in cloth on the injured area.
• Keep the child lying down until medical help arrives. If he or she gets lightheaded, try to position the head at a slightly lower level than the chest, and if you can, lift the legs.

For a Suspected Sprain or Strain:

• If the injury involves the neck or back (even if there is no pain), do not move the child unless in imminent danger. Movement can cause serious nerve damage. Phone for emergency medical help. If the child must be moved, the neck and back must be completely immobilized first, ideally with at least one other person assisting you. Keeping the head, neck, and back in alignment, move the child together as a unit.
• It may be difficult to tell the difference between a sprain and a break. If there is any doubt whatsoever, phone your doctor or take your child to the nearest hospital emergency department. An X-ray can determine whether a bone is broken.
• First aid for sprains and strains includes rest, ice, compression, and elevation (known as RICE).
  • Rest: for at least 24 hours, rest the injured part of the body.
  • Ice packs (or cold compresses): apply for up to 10-15 minutes at a time every few hours for the first 2 days to prevent swelling.
  • Compression: wear an elastic bandage (such as an ACE bandage) for at least 2 days to reduce swelling.
  • Elevation: keep the injured part above heart level as much as possible to ease swelling.

• Do not apply heat in any form for at least 24 hours after an injury. Heat increases swelling and pain.
• Your doctor may recommend an over-the-counter pain reliever, such as acetaminophen or ibuprofen.

Breakfast basics

You probably heard it from your own parents: Breakfast is the most important meal of the day. But now you're the one saying it — to your sleepy, frazzled, grumpy kids, who insist "I'm not hungry" as you try to get everyone fed and moving in the morning.

Even if you eat a healthy morning meal every day, it can be tough to get kids fueled up in time for school, childcare, or a day of play. But it's important to try. Here's how to make breakfast more appealing for everyone.

Why Bother With Breakfast?

Breakfast is a great way to give the body the refueling it needs. Kids who eat breakfast tend to eat healthier overall and are more likely to participate in physical activities — two great ways to help maintain a healthy weight.

Skipping breakfast can make kids feel tired, restless, or irritable. In the morning, their bodies need to refuel for the day ahead after going without food for 8 to 12 hours during sleep. Their mood and energy can drop by midmorning if they don't eat at least a small morning meal.

Breakfast also can help keep kids' weight in check. Breakfast kick-starts the body's metabolism, the process by which the body converts the fuel in food to energy. And when the metabolism gets moving, the body starts burning calories.

Also, people who don't eat breakfast often consume more calories throughout the day and are more likely to be overweight. That's because someone who skips breakfast is likely to get famished before lunchtime and snack on high-calorie foods or overeat at lunch.

Breakfast Brain Power

It's important for kids to have breakfast every day, but what they eat in the morning is crucial too. Choosing breakfast foods that are rich in whole grains, fiber, and protein while low in added sugar may boost kids' attention span, concentration, and memory — which they need to learn in school.

Kids who eat breakfast are more likely to get fiber, calcium, and other important nutrients. They also tend to keep their weight under control, have lower blood cholesterol levels and fewer absences from school, and make fewer trips to the school nurse with stomach complaints related to hunger.

Making Breakfast Happen

It would be great to serve whole-grain waffles, fresh fruit, and low-fat milk each morning. But it can be difficult to make a healthy breakfast happen when you're rushing to get yourself and the kids ready in the morning and juggling the general household chaos.

So try these practical suggestions to ensure that — even in a rush — your kids get a good breakfast before they're out the door:

• stock your kitchen with healthy breakfast options
• prepare as much as you can the night before (gets dishes and utensils ready, cut up fruit, etc.)
• get everyone up 10 minutes earlier
• let kids help plan and prepare breakfast
• have grab-and-go alternatives (fresh fruit; individual boxes or baggies of whole-grain, low-sugar cereal; yogurt or smoothies; trail mix) on days when there is little or no time to eat

If kids aren't hungry first thing in the morning, be sure to pack a breakfast that they can eat a little later on the bus or between classes. Fresh fruit, cereal, nuts, or half a peanut butter and banana sandwich are nutritious, easy to make, and easy for kids to take along.

You also may want to check out the breakfasts available at school or daycare. Some offer breakfasts and provide them for free or at reduced prices for families with limited incomes. If your kids eat breakfast outside the home, talk with them about how to make healthy selections.

What not to serve for breakfast is important too. Sure, toaster pastries and some breakfast bars are portable, easy, and appealing to kids. But many have no more nutritional value than a candy bar and are high in sugar and calories. Read the nutrition labels carefully before you toss these breakfast bars and pastries into your shopping cart. 

Breakfast Ideas to Try

The morning meal doesn't have to be all about traditional breakfast items. You can mix it up to include different foods, even the leftovers from last night's dinner, and still provide the nutrients and energy kids need for the day.

Try to serve a balanced breakfast that includes some carbohydrates, protein, and fiber. Carbs are a good source of immediate energy for the body. Energy from protein tends to kick in after the carbs are used up. Fiber helps provide a feeling of fullness and, therefore, discourages overeating. And when combined with heathy drinks, fiber helps move food through the digestive system, preventing constipation and lowering cholesterol.

Good sources of these nutrients include:

• carbohydrates: whole-grain cereals, brown rice, whole-grain breads and muffins, fruits, vegetables
• protein: low-fat or nonfat dairy products, lean meats, eggs, nuts (including nut butters), seeds, and cooked dried beans
• fiber: whole-grain breads, waffles, and cereals; brown rice, bran, and other grains; fruits, vegetables, beans, and nuts

Here are some ideas for healthy breakfasts to try:

• whole-grain cereal with low-fat milk topped with fruit
• whole-grain waffles topped with peanut butter or ricotta cheese and fruit
• whole-wheat pita stuffed with sliced hard-cooked eggs
• hot cereal topped with nuts or fruit sprinkled with cinnamon, nutmeg, allspice, or cloves
• half a whole-grain bagel topped with peanut butter and fresh fruit (banana or apple wedges) and low-fat milk
• breakfast smoothie (low-fat milk or yogurt, fruit, and teaspoon of bran, whirled in a blender)
• vegetable omelet with whole-wheat toast
• bran muffin and berries
• sliced cucumbers and hummus in a whole-wheat pita
• lean turkey and tomato on a toasted English muffin
• heated leftover rice with chopped apples, nuts, and cinnamon
• low-fat cream cheese and fresh fruit, such as sliced strawberries, on whole-grain bread or half a whole-grain bagel
• shredded cheese on a whole-wheat tortilla, folded in half and microwaved for 20 seconds and topped with salsa

And don't forget how important your good example is. Let your kids see you making time to enjoy breakfast every day. Even if you just wash down some whole-wheat toast and a banana with a glass of juice or milk, you're showing how important it is to face the day only after refueling your brain and body with a healthy morning meal.

First Aid: Common Cold

Kids can get eight colds a year - ormore. The common cold sends morekids to the doctor than any otherillness. Most colds are caused by aspecific type of virus found in the air and on the things we touch.The prescription for the common cold is simple: time, rest, and TLC.

Signs and Symptoms

• stuffy or runny nose (may start out watery, then turn thick yellowor green)
• itchy or sore throat
• sneezing
• cough
• headache
• mild fever
• feeling tired
• loss of appetite

What to Do

• Ease discomfort with:
  • acetaminophen or ibuprofen as needed (check package forcorrect amount)
  • a cool-mist humidifier or steamy bathroom
  • saline (saltwater) drops for the nostrils
  • gentle suction of nasal mucus using a bulb syringe whennecessary
• Offer lots of fluids (breast milk or formula for babies; water andjuice for older kids - but no caffeinated beverages).
• Never give cough or cold medicine to children under 2years old. Call a doctor first for older kids.
• Never give aspirin to a child.

Seek Medical Care

If Your Child Has:

• cold symptoms that get worse or last more than a week
• cough and congestion triggered by pollen, dust, pets, etc.
• a barking cough or a cough that is severe and occurs in spasms
• difficulty breathing
• a high fever and appears ill; or any fever in a baby 3 monthsold or younger
• a sore throat that makes eating and drinking difficult
• a bad headache

Think Prevention!

Remind kids to:

• avoid anyone who has a cold or smokes (secondhand smokeincreases kids' risk of getting sick)
• wash hands well and often, especially after nose-blowing andplaying with other kids
• sneeze and cough into shirtsleeves or tissues - not hands