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A Healing Separation is a structured time apart which can help a couple heal a relationship that isn't working. It can also help revitalize and renew a relationship that is working. The Healing Separation is designed to transform the basis of a love relationship ? moving it from neediness to health. A successful Healing Separation requires that both partners be committed to personal growth, and to creating healthier relationships with themselves and each other. Such a framework will allow them to carve out a new and more fulfilling relationship than they've known in the past.

The Healing Separation, like the old-style "trial separation," involves living apart for a while, with the decision as to whether or not to end the relationship put off until some future time. Unlike unplanned and unstructured separations, however, the Healing Separation is a working separation, in which you and your partner dedicate yourselves to investing in your own personal growth. If you can create a better relationship with yourself, that can allow different and healthier relationships with others.

Sometimes your work during a Healing Separation may be on "the old relationship," and sometimes it may be on "the old you." The Healing Separation is a creative way to strengthen both partners and build a new relationship without dissolving the partnership. Each partner agrees to the following goals for this separation:

• To provide time and emotional space outside of the love relationship so I can enhance my personal, social, spiritual, and emotional growth.

• To better identify my needs, wants, and expectations of the love relationship.

• To help me explore my basic relationship needs, and to help me determine if these needs can be met in this love relationship.

• To experience the social, sexual, economic, and parental stresses which can occur when I have separated from my partner.

• To allow me to determine if I can work through my process better apart than I can in the relationship.

• To experience enough emotional distance so I can separate out my issues, which have become convoluted and mixed up together with my partner's issues in our relationship.

• To provide an environment to help our relationship heal, transform, evolve into a more loving and healthy relationship..

Some structure and awareness can help improve the chances of success of the healing separation. Unplanned and unstructured separations will most likely contribute to the ending of the relationship. This healing separation agreement attempts to provide structure and guidelines to help make the separation a more constructive and creative experience, and to greatly enhance the growth of the relationship rather than contributing to its demise.

Key Elements of the Healing Separation Agreement

• Length of separation (Most couples have a sense of how long a separation they will need or want. It may vary from a few weeks to six months or longer.)

• Time to Be Spent Together (A healing separation ideally should include some quality time together on a regular basis. creating a new relationship.)

• Personal Growth Experiences (Ideally a healing separation would include as many personal growth experiences as feasible, practical, and helpful.)

• Relationships and Involvements Outside of the Relationship (Ideally a joint decision and compromise should be made concerning social involvement, romantic, and sexual relationships outside of this relationship.)

• Living Arrangements (Experience has shown that the in-house separation, with both parties continuing to live in the family home, results in a less creative experience. It seems to dilute the separation experience and keeps both parties from experiencing as much personal growth as is possible with separate living arrangements. It may not give enough emotional space to the person who needs it.)

• Financial Decisions (Some couples will decide to continue joint checking accounts, savings accounts, and payment of bills. Other couples will completely separate financial aspects of the relationship.... If there is any chance for [significant] disagreement, each person could take out half of the assets and open separate accounts.)

• Motor Vehicles (It is suggested ownership and titles not be changed until a decision has been made about the future of the love relationship.)

• Children (It is important when a couple does a Healing Separation to minimize the emotional trauma for the children involved.)

Adapted from Rebuilding: When Your Relationship Ends, by Dr. Bruce Fisher and Dr. Robert Alberti. Available at online and local bookstores or directly from Impact Publishers, Inc., PO Box 6016, Atascadero, CA 93423-6016, http://www.bibliotherapy.com/ or phone 1-800-246-7228.

Reviewed by athealth on February 8, 2014.

Most Americans consume too many calories and not enough nutrients, according to the latest revision to the Dietary Guidelines for Americans. In January 2005, two federal agencies--the Department of Health and Human Services and the Department of Agriculture (USDA)--released the guidelines to help adults and children ages 2 and up live healthier lives.

Currently, the typical American diet is low in fruits, vegetables, and whole grains, and high in saturated fat, salt, and sugar. As a result, more Americans than ever are overweight, obese, and at increased risk for chronic diseases such as heart disease, high blood pressure, diabetes, and certain cancers.

Of course old habits are hard to break, and the notion of change can seem overwhelming. But it can be done with planning and a gradual approach, says Dee Sandquist, a spokeswoman for the American Dietetic Association (ADA) and manager of nutrition and diabetes at the Southwest Washington Medical Center in Vancouver, Wash.

"Some people can improve eating habits on their own, while others need a registered dietitian to guide them through the process," Sandquist says. You may need a dietitian if you are trying to lose weight or if you have a health condition such as osteoporosis, high blood pressure, high cholesterol, or diabetes.

Sandquist says that many people she counsels have been used to eating a certain way and never thought about what they were actually putting into their bodies. "Someone may tell me they drink six cans of regular soda every day," she says. "When they find out there are about nine teaspoons of sugar in one can, it puts things in perspective. Then I work with the person to cut back to three cans a day, then to two and so on, and to start replacing some of the soda with healthier options."

Others are eating a lot of food between mid-day and bedtime because they skip breakfast, Sandquist says. Another common scenario is when someone has grown up thinking that meat should be the focus of every meal. "We may start by having the person try eating two-thirds of the meat they would normally eat, and then decreasing the portion little by little," Sandquist says. Cutting portion size limits calories. So does eating lean cuts of meat and using lower-fat methods of preparation such as broiling.

Sandquist says that when people strive for more balance in their diets, they tend to enjoy mixing up their food choices. "A lot of times, they've been eating the same things over and over. So when they start trying new foods, they find out what they've been missing."

Barbara Schneeman, Ph.D., director of the Food and Drug Administration's Office of Nutritional Products, Labeling, and Dietary Supplements, encourages consumers to make smart food choices from every food group. "The Nutrition Facts label is an important tool that gives guidance for making these choices," she says. The label shows how high or low a food is in various nutrients.

Experts say that once you start using the label to compare products, you'll find there is flexibility in creating a balanced diet and enjoying a variety of foods in moderation. For example, you could eat a favorite food that's higher in fat for breakfast and have lower-fat foods for lunch and dinner. You could have a full-fat dip on a low-fat cracker. "What matters is how all the food works together," Sandquist says.

Older people are most likely to improve their eating habits, but nutrition is important for people of all ages, says Walter Willet, M.D., chairman of the nutrition department at the Harvard School of Public Health. "We know that when people have health problems or their friends become ill, these are strong motivators of change," says Willet. "The more serious the health condition, the more serious the change. We'd rather people made changes early and prevent health problems in the first place."

So what if you're feeling trapped by a diet full of fast-food burgers and cookies? You can work your way out slowly but surely. Here are tips to move your eating habits in the right direction.

Look at What You Eat Now

Write down what you eat for a few days to get a good picture of what you're taking in, suggests Cindy Moore, director of nutrition therapy at the Cleveland Clinic Foundation. "By looking at what you eat and how much you're eating, you can figure out what adjustments you need to make," she says.

Sometimes she asks patients to write down what they are feeling. Were you nervous, happy, or sad when you ate five slices of pizza in one sitting? "The very nature of writing things down in a food diary can help patients make changes," Moore says. "Someone will tell me, 'I didn't want to have to write that I ate nine cookies, so I ate two instead.'"

Start With Small Changes

You don't have to go cold turkey. In the end, you want to achieve a long-term healthy lifestyle. Small changes over time are the most likely to stick. "If you want to eat more vegetables, then try to add one more serving by sneaking it in," Moore says. "Add bits of broccoli to something you already eat like pizza or soup. If you need more whole grains, add barley, whole wheat pasta, or brown rice to your soup."

When you think about what you need to get more of, the other things tend to fall into place, Moore says. "If you have some baby carrots with lunch or add a banana to your cereal in the morning, you're going to feel full longer." You won't need a food that's high in sugar or fat an hour later, she adds.

Also, look for healthier versions of what you like to eat. If you like luncheon meat sandwiches, try a reduced-fat version. If you like the convenience of frozen dinners, look for ones with lower sodium. If you love fast-food meals, try a salad as your side dish instead of french fries.

"Pick one or two changes to start with," Moore says. "Once the changes have become habits, which usually happens in about two to four weeks, then try adding one or two more. In six to 12 months, you'll find that you've made substantial changes."

Use the Nutrition Facts Label

To make smart food choices quickly and easily, compare the Nutrition Facts labels on products. Look at the percent Daily Value (%DV) column. The general rule of thumb is that 5 percent or less of the Daily Value is considered low and 20 percent or more is high.

Keep saturated fat, trans fat, cholesterol, and sodium low, while keeping fiber, potassium, iron, calcium, and vitamins A and C high. Be sure to look at the serving size and the number of servings per package. The serving size affects calories, amounts of each nutrient, and the percentage of Daily Value.

The %DV is based on a 2,000-calorie diet, but recommended calorie intake differs for individuals based on age, gender, and activity level. Some people need less than 2,000 calories a day. You can use the %DV as a frame of reference whether or not you consume more or less than 2,000 calories. The %DV makes it easy to compare the nutrients in each food product to see which ones are higher or lower. When comparing products, just make sure the serving sizes are similar, especially the weight (grams, milligrams, or ounces) of each product.

Control Portion Sizes

Understanding the serving size on the Nutrition Facts label is important for controlling portions, Moore says. "Someone may have a large bottled drink, assuming it's one serving," she says. "But if you look at the label, it's actually two servings. And if you consume two servings of a product, you have to multiply all the numbers by two." When the servings go up, so do the calories, fat, sugar, and salt.

Moore also suggests dishing out a smaller amount on your plate or using smaller plates. "If you put more food in front of you, you'll eat it because it's there," she says. According to the ADA, an average serving size of meat looks like a deck of cards. An average serving size of pasta or rice is about the size of a tennis ball. Here are some other ways to limit portions: Split a meal or dessert with a friend at a restaurant, get a doggie bag for half of your meal, get in the habit of having one helping, and ask for salad dressing, butter, and sauces on the side so you can control how much you use.

Control Calories and Get the Most Nutrients

You want to stay within your daily calorie needs, especially if you're trying to lose weight, says Eric Hentges, Ph.D., director of the USDA Center for Nutrition Policy and Promotion. "But you also want to get the most nutrients out of the calories, which means picking nutritionally rich foods," he says. Children and adults should pay particular attention to getting adequate calcium, potassium, fiber, magnesium, and vitamins A, C, and E.

According to the Dietary Guidelines, there is room for what's known as a discretionary calorie allowance. This is for when people meet their recommended nutrient intake without using all their calories. Hentges compares the idea to a household budget. "You know you have to pay all the bills and then you can use the leftover money for other things," he says. "The discretionary calorie allowance gives you some flexibility to have foods and beverages with added fats and sugars, but you still want to make sure you're getting the nutrients you need."

For example, a 2,000-calorie diet has about 250 discretionary calories, according to the Dietary Guidelines.

Know Your Fats

Fat provides flavor and makes you feel full. It also provides energy, and essential fatty acids for healthy skin, and helps the body absorb the fat-soluble vitamins A, D, E, and K. But fat also has nine calories per gram, compared to four calories per gram in carbohydrates and protein. If you eat too much fat every day, you may get more calories than your body needs, and too many calories can contribute to weight gain.

Too much saturated fat, trans fat, and cholesterol in the diet increases the risk of unhealthy blood cholesterol levels, which may increase the risk of heart disease. "Consumers should lower all three, not just one or the other," says Schneeman. Saturated fat is found mainly in foods from animals. Major sources of saturated fats are cheese, beef, and milk. Trans fat results when manufacturers add hydrogen to vegetable oil to increase the food's shelf life and flavor. Trans fat can be found in vegetable shortenings, some margarines, crackers, cookies, and other snack foods. Cholesterol is a fat-like substance in foods from animal sources such as meat, poultry, egg yolks, milk, and milk products.

Most of your fats should come from polyunsaturated and monounsaturated fatty acids, such as those that occur in fish, nuts, soybean, corn, canola, olive, and other vegetable oils. This type of fat does not raise the risk of heart disease and may be beneficial when consumed in moderation.

Make Choices That Are Lean, Low-fat, or Fat-free

When buying meat, poultry, milk, or milk products, choose versions that are lean, low-fat, or fat-free. Choose lean meats like chicken without the skin and lean beef or pork with the fat trimmed off.

If you frequently drink whole milk, switch to 1 percent milk or skim milk. Many people don't taste a difference. Some mix whole milk with lower-fat milk for a while so the taste buds can adjust. This doesn't mean you can never eat or drink the full-fat versions, Schneeman says. "That's where the discretionary calories come in."

Other tips to reduce saturated fat include cooking with non-stick sprays and using olive, safflower, or canola oils instead of lard or butter. Eat more fish, which is usually lower in saturated fat than meat. Bake, grill, and broil food instead of frying it because more fat is absorbed into the food when frying. You could also try more meatless entrees like veggie burgers and add flavor to food with low-fat beans instead of butter.

Focus on Fruit

The Dietary Guidelines recommend two cups of fruit per day at the 2,000-calorie reference diet. Fruit intake and recommended amounts of other food groups vary at different calorie levels. An example of two cups of fruit includes: one small banana, one large orange, and one-fourth cup of dried apricots or peaches.

Eat a variety of fruits--whether fresh, frozen, canned, or dried--rather than fruit juice for most of your fruit choices. "The whole fruit has more fiber, it's more filling, and it's naturally sweet," says Marilyn Tanner, a pediatric dietitian at the Washington University School of Medicine in St. Louis. Still, some juices, such as orange and prune, are a good source of potassium.

Ways to incorporate fruit in your diet include adding it to your cereal, eating it as a snack with low-fat yogurt or a low-fat dip, or making a fruit smoothie for dessert by mixing low-fat milk with fresh or frozen fruit such as strawberries or peaches. Also, your family is more likely to eat fruit if you put it out on the kitchen table.

Eat Your Veggies

The Dietary Guidelines recommend two and one-half cups of vegetables per day if you eat 2,000 calories each day.

Tanner suggests adding vegetables to foods such as meatloaf, lasagna, omelettes, stir-fry dishes, and casseroles. Frozen chopped greens such as spinach, and peas, carrots, and corn are easy to add. Also, add dark leafy green lettuce to sandwiches. "Involve kids by letting them help pick vegetables in different colors when you're shopping," Tanner suggests. Get a variety of dark green vegetables such as broccoli, spinach, and greens; orange and deep yellow vegetables such as carrots, winter squash, and sweet potatoes; starchy vegetables like corn; legumes, such as dry beans, peas, chickpeas, pinto beans, kidney beans, and tofu; and other vegetables, such as tomatoes and onions.

"Look for ways to make it convenient," Tanner says. "You can buy salad in a bag. Or buy a vegetable tray from the grocery store and put it in the refrigerator. Everything's already cut up and you can just reach in and eat it throughout the week."

Make Half Your Grains Whole

Like fruits and vegetables, whole grains are a good source of vitamins, minerals, and fiber. The Dietary Guidelines recommend at least three ounces of whole grains per day. One slice of bread, one cup of breakfast cereal, or one-half cup of cooked rice or pasta are each equivalent to about one ounce. Tanner suggests baked whole-grain corn tortilla chips or whole-grain cereal with low-fat milk as good snacks.

In general, at least half the grains you consume should come from whole grains. For many, but not all, whole grain products, the words "whole" or "whole grain" will appear before the grain ingredient's name. The whole grain must be the first ingredient listed in the ingredients list on the food package. The following are some whole grains: whole wheat, whole oats or oatmeal, whole-grain corn, popcorn, wild rice, brown rice, buckwheat, whole rye, bulgur or cracked wheat, whole-grain barley, and millet. Whole-grain foods cannot necessarily be identified by their color or by names such as brown bread, nine-grain bread, hearty grains bread, or mixed grain bread.

Lower Sodium and Increase Potassium

Higher salt intake is linked to higher blood pressure, which can raise the risk of stroke, heart disease, and kidney disease. The Dietary Guidelines recommend that people consume less than 2,300 milligrams of sodium per day (approximately one teaspoon of salt). There are other recommendations for certain populations that tend to be more sensitive to salt. For example, people with high blood pressure, blacks, and middle-aged and older adults should consume no more than 1,500 milligrams of sodium each day.

Most of the sodium people eat comes from processed foods. Use the Nutrition Facts label on food products: 5%DV or less for sodium means the food is low in sodium and 20%DV or more means it's high. Compare similar products and choose the option with a lower amount of sodium. Most people won't notice a taste difference. Consistently consuming lower-salt products will help taste buds adapt, and you will enjoy these foods as much or more than higher-salt options.

Prepare foods with little salt. The DASH (Dietary Approaches to Stop Hypertension) eating plan from the National Heart, Lung, and Blood Institute recommends giving flavor to food with herbs, spices, lemon, lime, vinegar, and salt-free seasoning blends. Consult with your physician before using salt substitutes because their main ingredient, potassium chloride, can be harmful to some people with certain medical conditions.

Also, increase potassium-rich foods such as sweet potatoes, orange juice, bananas, spinach, winter squash, cantaloupe, and tomato puree. Potassium counteracts some of sodium's effect on blood pressure.

Limit Added Sugars

The Dietary Guidelines recommend choosing and preparing food and beverages with little added sugars. Added sugars are sugars and syrups added to foods and beverages in processing or preparation, not the naturally occurring sugars in fruits or milk. Major sources of added sugars in the American diet include regular soft drinks, candy, cake, cookies, pies, and fruit drinks. In the ingredients list on food products, sugar may be listed as brown sugar, corn syrup, glucose, sucrose, honey, or molasses. Be sure to check the sugar in low-fat and fat-free products, which sometimes contain a lot of sugar, Tanner says.

Instead of drinking regular soda and sugary fruit drinks, try diet soda, low-fat or fat-free milk, water, flavored water, or 100 percent fruit juice.

For snacks and desserts, try fruit. "People are often pleasantly surprised that fruit is great for satisfying a sweet tooth," Tanner says. "And if ice cream is calling your name, don't have it in the freezer. Make it harder to get by having to go out for it. Then it can be an occasional treat."

Differences in Saturated Fat and Calorie Content of Commonly Consumed Foods

Cheese Food Category	Portion	Saturated Fat Content (grams)	Calories
Cheese • Regular cheddar • Low-fat cheddar	1 oz. 1 oz.	6.0 1.2	114 49
Ground Beef • Regular (25% fat) • Regular (5% fat)	3 oz. (cooked) 3 oz. (cooked)	6.1 2.6	236 148
Milk • Whole (3.24%) • Low-fat (1%)	1 cup 1 cup	4.6 1.5	146 102
Breads • Croissant (medium) • Bagel, oat bran (4")	1 medium 1 medium	6.6 0.2	231 227
Frozen desserts • Regular ice cream • Frozen yogurt, low-fat	1/2 cup 1/2 cup	4.9 2.0	145 110
Table spreads • Butter • Soft margarine, zero trans fat	1 teaspoon 1 teaspoon	2.4 0.7	34 25
Chicken • Fried leg with skin • Roasted breast with no skin	3 oz. (cooked) 3 oz. (cooked)	3.3 0.9	212 140
Fish • Fried • Baked	3 oz. 3 oz.	2.8 1.5	195 129

ARS Nutrient Database for Standard Reference, Release 17

Some Nutrient Content Claims

fat-free	less than 0.5 grams of fat per serving
low-fat	3 grams or less per serving (if the serving size is 30 grams or less or 2 tablespoons or less, no more than 3 grams of fat per 50 grams of the food)
light	one-third fewer calories or half the fat of the "regular" version
low-sodium	140 milligrams or less per serving (if the serving size is 30 grams or less or 2 tablespoons or less, no more than 140 milligrams of sodium per 50 grams of the food)
lightly salted	at least 50 percent less sodium per serving than the "regular" version
reduced	when describing fat, sodium, or calorie content, the food must have at least 25 percent less of these nutrients than the "regular" version

USDA Smart Snacks

• Unsalted pretzels
• Applesauce
• Low-fat yogurt with fruit
• Unbuttered and unsalted popcorn
• Broccoli, carrots, or cherry tomatoes with dip or low-fat yogurt
• Grapes
• Apple slices with peanut butter
• Raisins
• Nuts
• Graham crackers
• Gingersnap cookies
• Low- or reduced-fat string cheese
• Baked whole-grain tortilla chips with salsa
• Whole-grain cereal with low-fat milk

Source: FDA Consumer Magazine
Adapted from Healthier Eating
Date: May-June 2005 Issue
Author: Michelle Meadows

Reviewed by athealth on February 5, 2014.

Adopting healthy behaviors - even later in life - can help prevent, delay, and control disease. In fact, research has shown that a healthy lifestyle matters more than your genes in helping you to avoid poor health as you age. A healthy lifestyle can protect you from frailty, too. Preventing health problems also saves money. The cost of providing health care for an older American is 3 to 5 times greater than the cost for some-one younger than 65. So why wait? Take these steps to boost your physical health and self-esteem:

• Get moving! By age 75, about 1 in 2 women does not engage in any physical activity. But physical activity can help people of all ages - even those with serious health problems. For instance, muscle-building physical activity can help people with heart failure in ways that medicine cannot. Talk to your doctor about safe ways for you to become active.
• Eat healthy food. Nutrient-rich foods are vital to our health as we age. If shopping for or preparing good food is hard for you, contact your local Area Agency on Aging (the number is in the phone book) or Eldercare locator. You may be able to enjoy free or low-cost meals for older people at a community center, church, or school or have meals delivered to your home.
• Quit smoking. If you have smoked for many years, you might think it's too late for you to quit - that the damage is done. But quitting has immediate health benefits even for lifelong smokers and people with smoking-related diseases. For instance, smokers have twice the risk of dying of heart disease as nonsmokers. But this risk begins to drop after quitting. After 15 years of not smoking, past smokers' risk of heart disease is similar to those who have never smoked.
• See your doctor regularly for health screenings and vaccines. Tell your doctor about any health changes you notice. Also, tell your doctor if you feel sad, lonely, or like you don't have the energy or interest in doing things you once enjoyed.
• Be safe when drinking alcohol. The body responds differently to alcohol with age. Even a small amount can impair judgment, coordination, and reaction time. And many medicines do not mix well with alcohol. Talk to your doctor about your alcohol use and the medicines you are taking.
• Stay connected. You can protect yourself from isolation and depression by interacting with others. Get involved with a volunteer, hobby, or special interest group. Local senior centers offer social programs. Your local Area Agency on Aging can help you connect with outreach programs if you are homebound.

ALERT - Don't Be a Victim of Health Scams

Living with chronic health problems can be hard. You might be willing to try just about anything to feel better - including unproven remedies that promise a quick or painless cure. Be smart and talk to your doctor before buying a product that sounds too good to be true. Quacks - people who sell unproven remedies - target older people. Those who fall victim to their scams waste money and put their health at risk.

Normal age-related decline affects most of our body's organs and systems. How and when this happens is different for each of us. It depends on many factors, including our genes, lifestyle, and health history. "Normal" Aging [is considered:]

• Brain: Brain structure changes with age, the effects of which are unclear. Healthy older people might notice some mild changes, such as needing new information repeated or more time to learn something new.
• Heart and Arteries: The heart muscle thickens, and arteries tend to stiffen with age. This makes it harder for the heart to pump oxygen-rich blood throughout the body. It also becomes harder for the body to take out the oxygen from blood.
• Lungs: The amount of air the lungs can breathe in and out can decrease with age, causing shortness of breath while working hard or during brisk activities.
• Kidneys: Over time, the kidneys don't work as well at removing waste from the blood.
• Bladder: With age, the bladder cannot hold as much urine.
• Body Fat: Levels of body fat stay about the same from middle age until late life, when body weight tends to decline. Older people tend to lose both muscle and body fat. Fat also shifts from just beneath the skin to deeper organs.
• Skin: The skin thins and loses elasticity as it ages, leading to wrinkles and sags. Loss of sweat and oil glands can lead to dry and flaky skin. Spots appear on sun-damaged skin.
• Hair: Hair often grays and becomes brittle. Some women also notice hair loss or thinning.
• Muscles: Without physical activity, muscle mass declines up to 22 percent in women between age 30 and 70, affecting strength, flexibility, and balance.
• Bones: Bone mineral is removed and replaced throughout life. Beginning in the 40s, bone may be lost faster than it can be replaced. Bone loss speeds up even more after menopause. Over time, bones can weaken and become brittle.
• Eyes: In midlife, it can become harder to focus on close-up items, such as a book. From 50 on, glare tends to interfere more with vision, and seeing in low-light and detecting moving objects become more and more difficult. Seeing detail can become a challenge in the 70s.
• Ears: Higher pitched sounds become more difficult to hear with age. Understanding speech, especially if there is background noise, can be a problem, even for older adults with good hearing.
• Reproductive System: Menopause marks the end of a woman's reproductive years. She no longer has periods and she cannot become pregnant.
• Hormones: Hormones are chemical messengers that control the function of many organs and tissues. As we age, our bodies make less of certain hormones, such as estrogen and growth hormone, and more of others, such as parathyroid hormone (PHT). Estrogen and PHT affect bone health. Researchers are studying the effect of this change on aging.
• Immune System: The organs and cells of the immune system work throughout the body to protect it from infection. With age, these cells become less active, making the body less able to defend against bacteria and viruses. Researchers think that this system might play an important role in the aging process.

Adapted from The Healthy Woman: A Complete Guide for All Ages
Chapter on Healthy Aging
U.S. Department of Health and Human Services, Office on Women's Health 2008
Page last modified or reviewed on January 24, 2014

Here are a few simple tips to help your children reduce their screen time and increase physical activity in order to maintain a healthy weight.

• Know how much screen time, active time your family is getting. By knowing how much screen media, including TV, DVD, video games and non-school- or work-related computer and Internet use, your family spends and how much physical activity they get, you will be more aware of their needs for physical activity to maintain energy balance.
  
• Talk to your family. Explain to your children that it's important to sit less and move more to stay at a healthy weight. They will also be more energized, have a chance to practice certain skills (such as riding a bike or shooting hoops), and have fun with friends and peers. Tell them that you also are going to limit your screen time and increase your physical activity, so you will all be working toward this goal together.
  
• Set limits on screen time. Set a house rule that your children may spend no more than two hours a day of screen time. More importantly, enforce the rule once it's made.
  
• Minimize the influence of TV in the home. Do not put a TV or computer in your child's bedroom. This tends to physically isolate family members and decrease interaction. Also, children who have TVs in their room tend to spend almost 1 1/2 hours more in a typical day watching TV than their peers without a set in their room.
  
• Make meal time, family time. Turn off the TV during family meal time. Better yet, remove the TV from the eating area if you have one there. Family meals are a good time to talk to each other. Research has shown that families who eat together tend to eat more nutritious meals than families who eat separately. Make eating together a priority and schedule in family meals at least two to three times a week.

• Provide other options and alternatives. Watching TV can become a habit for your child. Provide other alternatives for them to spend their time, such as playing outside, learning a hobby or sport, or spending time with family and friends.
• Set a good example. You need to be a good role model and also limit your screen time to no more than two hours per day. If your kids see you following your own rules, then they will be more likely to follow. Instead of watching TV or surfing the Internet, spend time with your family doing something fun and active.
• Don't use TV to reward or punish a child. Practices like this make TV seem even more important to children.
• Be a savvy media consumer. Don't expect your child to ignore the influences of television advertising of snack foods, candy, soda, and fast food. Help your child develop healthy eating habits and become media savvy by teaching them to recognize a sales pitch. Ask your child why their favorite cartoon character is trying to get them to eat a certain brand of breakfast cereal. Explain to them that this is a way for advertisers to make the cereal more appealing to young people, so that they ask their parents to buy it for them and the company can make money.
• Make screen time, active time. Stretch, do yoga, lift hand weights while watching TV; challenge the family to see who can do the most push-ups, jumping jacks or leg lifts during commercial breaks, or switch to an exercise tape during commercials.
• Try a screen time log. Print and complete this log to determine how much time you are spending in front of a screen. Help your family do the same. Place the log in an easy location for everyone to use and see, such as near the family television, by the computer, or on the refrigerator. If screen time for you or your family members is less than 2 hours a day, pat yourselves on the back! If it's 2 hours or more, then check out the Get Moving section to help you reduce your screen time and switch to some physically active alternatives.Click here to print a copy of a sample Children's Screen Time Log.

Adapted from Helpful Ways to Reduce Screen Time
National Heart Lung and Blood Institute

Reviewed by athealth on February 5, 2014.

by Marian Marion, PhD

Children's anger presents challenges to teachers committed to constructive, ethical, and effective child guidance. This digest explores what we know about the components of children's anger, factors contributing to understanding and managing anger, and the ways teachers can guide children's expressions of anger.

Three Components of Anger

Anger is believed to have three components (Lewis & Michalson, 1983):

1. Emotional State of Anger. The first component is the emotion itself, defined as an affective or arousal state, or a feeling experienced when a goal is blocked or needs are frustrated. Fabes and Eisenberg (1992) describe several types of stress-producing anger provocations that young children face daily in classroom interactions:

• Conflict over possessions, which involves someone taking children's property or invading their space.
• Physical assault, which involves one child doing something to another child, such as pushing or hitting.
• Verbal conflict, for example, a tease or a taunt.
• Rejection, which involves a child being ignored or not allowed to play with peers.
• Issues of compliance, which often involve asking or insisting that children do something that they do not want to do--for instance, wash their hands.

2. Expression of Anger. The second component of anger is its expression. Some children vent or express anger through facial expressions, crying, sulking, or talking, but do little to try to solve a problem or confront the provocateur. Others actively resist by physically or verbally defending their positions, self-esteem, or possessions in nonaggressive ways. Still other children express anger with aggressive revenge by physically or verbally retaliating against the provocateur. Some children express dislike by telling the offender that he or she cannot play or is not liked. Other children express anger through avoidance or attempts to escape from or evade the provocateur. And some children use adult seeking, looking for comfort or solutions from a teacher, or telling the teacher about an incident.

Teachers can use child guidance strategies to help children express angry feelings in socially constructive ways. Children develop ideas about how to express emotions (Michalson & Lewis, 1985; Russel, 1989) primarily through social interaction in their families and later by watching television or movies, playing video games, and reading books (Honig & Wittmer, 1992). Some children have learned a negative, aggressive approach to expressing anger (Cummings, 1987; Hennessy et al., 1994) and, when confronted with everyday anger conflicts, resort to using aggression in the classroom (Huesmann, 1988). A major challenge for early childhood teachers is to encourage children to acknowledge angry feelings and to help them learn to express anger in positive and effective ways.

3. An Understanding of Anger. The third component of the anger experience is understanding - interpreting and evaluating - the emotion. Because the ability to regulate the expression of anger is linked to an understanding of the emotion (Zeman & Shipman, 1996), and because children's ability to reflect on their anger is somewhat limited, children need guidance from teachers and parents in understanding and managing their feelings of anger.

Understanding and Managing Anger

The development of basic cognitive processes undergirds children's gradual development of the understanding of anger (Lewis & Saarni, 1985).

Memory. Memory improves substantially during early childhood (Perlmutter, 1986), enabling young children to better remember aspects of anger-arousing interactions. Children who have developed unhelpful ideas of how to express anger (Miller & Sperry, 1987) may retrieve the early unhelpful strategy even after teachers help them gain a more helpful perspective. This finding implies that teachers may have to remind some children, sometimes more than once or twice, about the less aggressive ways of expressing anger.

Language. Talking about emotions helps young children understand their feelings (Brown & Dunn, 1996). The understanding of emotion in preschool children is predicted by overall language ability (Denham, Zoller, & Couchoud, 1994). Teachers can expect individual differences in the ability to identify and label angry feelings because children's families model a variety of approaches in talking about emotions.

Self-Referential and Self-Regulatory Behaviors. Self-referential behaviors include viewing the self as separate from others and as an active, independent, causal agent. Self-regulation refers to controlling impulses, tolerating frustration, and postponing immediate gratification. Initial self-regulation in young children provides a base for early childhood teachers who can develop strategies to nurture children's emerging ability to regulate the expression of anger. [This may be particularly problematic if I child has been diagnosed with a disorder such as ADHD or ODD.]

Sidebar: There appears to be a link between ADHD and bullying. A 2008 study conducted in Sweden, showed that children with ADHD are four times more likely than their peers to bully other children, and they are almost ten times as likely than other children to be bullied.

Guiding Children's Expressions of Anger

Teachers can help children deal with anger by guiding their understanding and management of this emotion. The practices described here can help children understand and manage angry feelings in a direct and nonaggressive way.

Create a Safe Emotional Climate. A healthy early childhood setting permits children to acknowledge all feelings, pleasant and unpleasant, and does not shame anger. Healthy classroom systems have clear, firm, and flexible boundaries.

Model Responsible Anger Management. Children have an impaired ability to understand emotion when adults show a lot of anger (Denham, Zoller, & Couchoud, 1994). Adults who are most effective in helping children manage anger model responsible management by acknowledging, accepting, and taking responsibility for their own angry feelings and by expressing anger in direct and nonaggressive ways.

Help Children Develop Self-Regulatory Skills. Teachers of infants and toddlers do a lot of self-regulation "work," realizing that the children in their care have a very limited ability to regulate their own emotions. As children get older, adults can gradually transfer control of the self to children, so that they can develop self-regulatory skills.

Encourage Children to Label Feelings of Anger. Teachers and parents can help young children produce a label for their anger by teaching them that they are having a feeling and that they can use a word to describe their angry feeling. A permanent record (a book or chart) can be made of lists of labels for anger (e.g., mad, irritated, annoyed), and the class can refer to it when discussing angry feelings.

Encourage Children to Talk About Anger-Arousing Interactions. Preschool children better understand anger and other emotions when adults explain emotions (Denham, Zoller, &Couchoud, 1994). When children are embroiled in an anger-arousing interaction, teachers can help by listening without judging,evaluating, or ordering them to feel differently.

Use Books and Stories about Anger to Help Children Understand and Manage Anger. Well-presented stories about anger and other emotions validate children's feelings and give information about anger (Jalongo, 1986; Marion, 1995). It is important to preview all books about anger because some stories teach irresponsible anger management.

Communicate with Parents. Some of the same strategies employed to talk with parents about other areas of the curriculum can be used to enlist their assistance in helping children learn to express emotions. For example, articles about learning to use words to label anger can be included in a newsletter to parents.

Children guided toward responsible anger management are more likely to understand and manage angry feelings directly and non aggressively and to avoid the stress often accompanying poor anger management (Eisenberg et al., 1991). Teachers can take some of the bumps out of understanding and managing anger by adopting positive guidance strategies.

References

Brown, J. R., & Dunn, J. (1996). Continuities in emotion understanding from three to six years. Child Development, 67(3), 789-803. EJ 528 209.

Cummings, E. (1987). Coping with background anger in early childhood. Child Development, 58(4), 976-984. EJ 359 847.

Denham, S. A., Zoller, D., & Couchoud, E. A. (1994). Socialization of preschoolers' emotion understanding. Developmental Psychology, 30(6), 928-937. EJ 498 090.

Eisenberg, N., Fabes, R., Schaller, M., Carlo, G., & Miller, P. (1991). The relations of parental characteristics and practices to children's vicarious emotional responding. Child Development, 62(6), 1393-1408. EJ 439 967.

Fabes, R. A., & Eisenberg, N. (1992). Young children's coping with interpersonal anger. Child Development, 63(1), 116-128. EJ 439 998.

Hennessy, K. D., Rabideau, G. J., Cicchetti, D., & Cummings, E. M. (1994). Responses of physically abused and nonabused children to different forms of inter-adult anger. Child Development, 65(3), 815-828.

Honig, A., & Wittmer, D. (1992). Prosocial Development in Children: Caring, Sharing, and Cooperation: A Bibliographic Resource Guide. New York: Garland.

Huesmann, L. (1988). An information processing model for the development of aggression. Aggressive Behavior, 14(1), 13-24.

Jalongo, M. (1986). Using crisis-oriented books with young children. In J. B. McCracken (Ed.), Reducing Stress in Young Children's Lives (pp. 41-46). Washington, DC: NAEYC.

Lewis, M., & Michalson, L. (1983). CHILDREN'S EMOTIONS AND MOODS. New York: Plenum.

Lewis, M., & Saarni, C. (1985). Culture and emotions. In M. Lewis & C. Saarni (Eds.), The Socialization of Emotions (pp. 1-17). New York: Plenum.

Marion, M. (1995). Guidance of Young Children. Columbus, OH: Merrill.

Michalson, L., & Lewis, M. (1985). What do children know about emotions and when do they know it? In M. Lewis & C. Saarni (Eds.),The Socialization of Emotions (pp. 117-139). New York: Plenum.

Miller, P., & Sperry, L. (1987). The socialization of anger and aggression. Merrill-Palmer Quarterly, 33(1), 1-31. EJ 351 314.

Perlmutter, M. (1986). A life-span view of memory. In P. B. Baltes, D. L. Featherman, & R. M. Learner, Life-Span Development and Behavior (Vol. 7). Hillsdale, NJ: Erlbaum.

Russel, J. A. (1989). Culture, scripts, and children's understanding of emotion. In C. Saarni & P. L. Harris (Eds.), Children's Understanding of Emotion (pp. 293-318). Cambridge, England, UK: Cambridge University Press.

Zeman, J., & Shipman, K. (1996). Children's expression of negative affect: Reasons and methods. Developmental Psychology, 32(5), 842-850. EJ 534 557.

Condensed by permission from Marian Marion, "Guiding Young Children's Understanding and Management of Anger," Young Children 52(7), 62-67. Copyright 1997 by the National Association for the Education of Young Children.

Marian Marion, PhD, is Professor of Early Childhood Education at Governors State University, University Park, Illinois.

Reviewed by athealth on February 5, 2014.

How much independence should I give my child?

As children enter adolescence, they often beg for more freedom. Parents walk a tightrope between wanting their children to be confident and able to do things for themselves and knowing that the world can be a scary place with threats to their children's health and safety.

Some parents allow too much of the wrong kind of freedom or they offer freedom before the adolescent is ready to accept it. Other parents cling too tightly, denying young teens both the responsibilities they require to develop maturity and the opportunities they need to make choices and accept their consequences.

Research tells us that adolescents do best when they remain closely connected to their parents but at the same time are allowed to have their own points of view and even to disagree with their parents. Here are some tips to help balance closeness and independence:

• Set limits. All children sometimes resist limits, but they want them and they need them. In a world that can seem too hectic for adults and adolescents alike, limits provide a security. Oftentimes, adolescents whose parents do not set limits feel unloved. Setting limits is most effective when it begins early. It is harder but not impossible, however, to establish limits during early adolescence.

• Be clear. Most young teens respond best to specific instructions, which are repeated regularly. As middle school teacher Sharon Sikora notes, "Don't just say, 'I want your room clean,' because they don't know what that means. Say, in a non-argumentative way, 'This is how I perceive a clean room.' They may say, 'I don't really want the lamp over here, I want it over there.' Give them the freedom to express themselves."

• Give reasonable choices. Choices make young teens more open to guidance. For example, you can tell your son that his algebra homework must be done before bedtime, but that he has a choice of completing it either before or after supper. And you can tell your 14-year-old daughter that she can't hang around the video arcade with her friends on Saturday night, but she can have a group of friends over to your house to watch a movie.Using humor and creativity as you give choices may also make your child more willing to accept them. One middle school teacher couldn't get her own child to hang up clean clothes or put dirty clothes in the laundry basket. So she gave her daughter two options - either all the clothes had to be picked up or everything would go on the floor. "I was washing the clothes, then putting them in piles on the floor," the teacher recalls. "It made me crazy, but it worked." After two weeks, her daughter got tired of the stacks on the floor and she began picking up her clothes.

• Grant independence in stages. The more mature and responsible a young teen's behavior is, the more privileges parents can grant. You might first give your young teen the right to choose which sneakers to buy within a certain price range. Later you can let him make other clothing purchases - with the understanding that price tags won't be removed until you approve the items. Eventually, you can give him a clothing allowance to spend as he likes.

• Health and safety come first. Your most important responsibility as a parent is to protect your child's health and safety. Your child needs to know that your love for her requires you to veto activities and choices that threaten either of these. Let your child know what things threaten her health and safety - and often the health and safety of others - and put your foot down. Doing this is made more difficult, though, because adolescents have a sense that nothing can hurt them. At the same time that he feels that everything he experiences is new and unique, an adolescent also believes that what happens to others will not happen to him. His beliefs are based on the fact that adolescence is the healthiest period of time during our lives. In this period, physical illnesses are not common and fatal disease is rare. The important thing to emphasize to your child is that, while he may be very healthy, death and injury during adolescence are most often caused by violence and accidents.Your child needs to know that your love for her requires you to veto activities and choices that threaten either of these.

• Say no to choices that cut off future options. Some things aren't worth fighting about. It may offend you if your son wears a shirt to school that clashes wildly with his pants, but this isn't a choice that can cut off future possibilities for him. Young teens may have a growing sense of the future, but they still lack the experiences required to fully understand how a decision they make today can affect them tomorrow. They may have heard that smoking is unhealthy, but they do not fully understand what it means to die of lung cancer at the age of 45. Talk to your children about the lifelong consequences of choices they make. Help them understand there are good and bad decisions and that knowing one from the other can make all the difference in their lives. Let your child know that you are "the keeper of options" until he is old enough and responsible enough to assume this responsibility: He may not skip school and he may not avoid taking tough courses that will prepare him for college.

• Guide, but resist the temptation to control. The earlier section on being an effective parent discussed the importance of striking a good balance between laying down the law and allowing too much freedom. With most young teens, it's easiest to maintain this balance by guiding but not controlling. Young teens need opportunities to explore different roles, try on new personalities and experiment. They need to learn that choices have consequences. That means making some mistakes and accepting the results. But parents need to provide guidance so that young teens avoid making too many poor choices.You can guide by being a good listener and by asking questions that help your child to think about the results of her actions: "What could happen if you let someone who is drunk drive you home?" Your guidance may be better appreciated if you ask your child's advice on a range of matters and follow the advice if it seems reasonable: "What should we cook for Daddy's birthday?" "I don't have to work on Saturday. Is there anything special you'd like to do?"The fine line between guiding and controlling may be different for different children. Some children, whether they are 7 or 17, need firmer guidance and fewer privileges than do other children at the same age. One middle school teacher explains how the different behavior of her own two teens created a need for different limits: "My daughter understood a midnight curfew to mean that she either had to be in the house with the door locked by 12 or else she must have placed the call from the emergency room informing her parents that she had broken her leg. My son, who was 15 months younger, understood a midnight curfew to mean that he could call at 11:59 p.m. to inform his parents that he'd be home after the pizza he'd ordered with his buddies had arrived and been consumed and he'd driven home his 6 friends."

• Let kids make mistakes. We want our children to grow into adults who can solve problems and make good choices. These abilities are a critical part of being independent. To develop these abilities, however, young teens on occasion may need to fail, provided the stakes aren't too high and no one's health or safety is at risk. Making mistakes also allows young teens to learn one critical skill - how to bounce back. It's hard for a child to learn how to pick himself up and start over if his parents always rescue him from difficulties.

• Make actions have consequences. If you tell your child that she must be home by 10 p.m., do not ignore her midnight arrival. You lose credibility with your child if she suffers no consequences for returning home two hours late. However, the punishment should fit the crime. Grounding a child for six weeks restricts the entire family. Instead, you might talk with your child about how coming in two hours late has affected you. You've been up worrying and have missed your sleep. But you'll still have to get up the next morning at your regular time, make breakfast, do your chores and go to work. Because her lack of consideration has made your life harder, she will have to complete some of your chores so that you can get to bed earlier the next night.

Finally and despite what we often hear and read, adolescents look to their parents first and foremost in shaping their lives. When it comes to morals and ethics, political beliefs and religion, teenagers almost always have more in common with their parents than their parents believe. As a parent, you should look beyond the surface, beyond the specific behaviors to who your child is becoming. Your teenager may want to dye her hair purple and pierce most parts of her body, but these expressions may be independent of her sense of who she is and who she will become. At the same time that many of your child's behaviors are ultimately harmless, some of them may not only be harmful but also deadly.

Parents need to talk to their children and make it clear that many of the major threats to their future health and happiness are not a matter of chance, but are a matter of choice - choices like drinking and driving, smoking, drugs, sexual activity, and dropping out of school.

Research tells us that adolescents who engage in one risky behavior are more likely to participate in others, so parents need to be front and center, talking to their children about the potentially deadly consequences of opening that Pandora's box.

Source: US Department of Education
Last Modified: 09/11/2003

Reviewed by athealth on February 5, 2014.

Our children deserve to learn important lessons from us and to acquire important habits with our help. They need help in learning what matters to us. We want our children to grow up to be responsible adults. We want them to learn to feel, think, and act with respect for themselves and for other people. We want them to pursue their own well-being, while also being considerate of the needs and feelings of others.

Today, there is wide recognition that many of our children are not learning to act responsibly while they are young. Studies show that many children see nothing wrong with cheating on tests. Some see nothing wrong with taking things that don't belong to them.

If proper attitudes and behavior are not learned early, problems can mushroom with even worse consequences when children are older. As crime has increased, teen-age offenders have shown less and less feeling for their victims. But even for the youngsters who will never commit a crime, it is better to learn responsibility when they are young, rather than when they are older and they have to change bad habits.

This [material] focuses on practical suggestions for helping young children appreciate the importance of acting responsibly in their everyday lives. Further, it provides ideas on how to help them make responsible choices, and stick with them, even when doing so is hard and the material rewards are few.

Many parents will also want to share with their children deeply held religious and moral convictions as a foundation for ethical behavior. This [material] discusses habits of fairness, respect, courage, honesty, and compassion that responsible people share, and it can be used by parents with different beliefs.

As parents, we can give our children the best in us by helping them acquire habits and character traits that they can rely on in their own lives. If we help them learn to take pleasure in thinking and behaving well, they will have the best chance to lead good lives as individuals and as citizens in the community. This will be true no matter what unpleasant situations or bad influences they come across.

What Do We Mean by Responsibility?

None of us is born acting responsibly. A responsible character is formed over time. It is made up of our outlook and daily habits associated with feelings, thoughts, and actions. Responsible people act the way they should whether or not anyone is watching. They do so because they understand that it's right and because they have the courage and self-control to act decently, even when tempted to do otherwise.

We want our children to appreciate the importance of being responsible. We also want them to develop the habits and strength to act this way in their everyday lives. Learning to be responsible includes learning to:

• respect and show compassion for others;
• practice honesty as a matter of course;
• show courage in standing up for our principles;
• develop self-control in acting on our principles;
• maintain self-respect.

Respect and Compassion for Others

As part of being responsible, children need to respect and show concern for the well-being of other people. Respect ranges from using basic manners to having compassion for the suffering of others. Compassion is developed by trying to see things from the point of view of others, and learning that their feelings resemble our own.

Daddy, why is Grandma crying?

She is very sad. One of her closest friends just died. Come and sit with me. Do you remember how you felt when your gerbil, Whiskers, died?

I felt sad and lonely.

I'm sure Grandma feels that way, too. Maybe you can think of a way to help her.

I could give her a hug. . .

That's a great idea! I'm really glad you thought of it.

Respect for others also includes the habit of treating people fairly as individuals, regardless of race, sex, or ethnic group. As we mature, respect includes realizing that not all our obligations to others, such as caring for a family member who is sick, are chosen freely. And it includes tolerance for people who do not share our beliefs or likes or dislikes, as long as they do not harm others.

These habits are especially important because many of the wrongs people commit result from indifference to the suffering they cause.

Honesty

Honesty means telling the truth. It means not misleading others for our own benefit. It also means trying to make decisions, especially important ones, on the basis of evidence rather than prejudice. Honesty includes dealing with other people and being honest with ourselves.

To understand the importance of being truthful to others, our children need to learn that living together depends on trust. Without honesty, trusting each other becomes impossible.

Honesty with ourselves involves facing up to our own mistakes and biases, even when we have to admit them to others. It includes self-criticism. The point is to learn from our errors and to do our best to correct them, not dwell on them.

Courage

Courage is taking a position and doing what is right, even at the risk of some loss. It means being neither reckless nor cowardly, but facing up to our duties. It includes physical courage, intellectual courage to make decisions on the basis of evidence, and moral courage to stand up for our principles.

Courage does not mean never being afraid. It can involve trying to overcome our fears, such as a fear of the dark. But our children also need to learn that sometimes it is all right to be afraid.

Daddy, a man showed us money by the school playground today.

What did you do?

We ran for the teacher.

Why did you do that?

We were scared. You and Mommy and our teacher Mrs. Jones said never take anything from grown-ups we don't know. Run away. Go and tell somebody we know.

Good for you. It was right to be scared. Lots of people are nice, but some are very mean. They can hurt you. The mean ones sometimes try to fool people by pretending to be nice. Now, tell me, what did the man look like?

Courage becomes especially important by the time children become teenagers. They often have to stand up against peer pressure to do the wrong thing, such as using drugs.

Self-Control

Self-control is the ability to resist inappropriate behavior in order to act responsibly. It relates to all of the different aspects of responsibility mentioned so far, including respect and compassion for others, honesty, and courage. It involves persistence and sticking to long-term commitments. It also includes dealing effectively with emotions, such as anger, and developing patience.

Self-Respect

People with self-respect take satisfaction in appropriate behavior and hard-won accomplishments. They don't need to put others down or have a lot of money in order to respect themselves. People who respect themselves also view selfishness, loss of self-control, recklessness, cowardice, and dishonesty as wrong and unworthy of them. As they mature, if they have learned the lessons of responsibility, they will develop a good conscience to guide them.

In addition, people who respect themselves respect their own health and safety. Similarly, they are unwilling to be manipulated by others. Patience or tolerance does not mean allowing others to mistreat us.

While we help children have high standards for themselves, we also need to let them know that failure is no embarrassment when we have done our best. For example, losing a game when we have played our best, and our opponents have simply played better, is no disgrace.

How Can Parents Encourage Responsible Behavior?

Everyday Experiences

Especially when they are young, children learn best about responsibility in concrete situations. What they do and what they witness have lasting effects. Most of the activities described in this book are for you and your child.

We are always teaching our children something by our words and our actions. They learn from seeing. They learn from hearing. They learn from overhearing. They learn from us, from each other, from other adults, and by themselves.

All of us acquire habits by doing things over and over again, whether in learning to play a musical instrument, to pick up after ourselves, to play games and sports, or to share with others. The best way to encourage our children to become responsible is to act as responsibly as we can in their presence. We must genuinely try to be the sort of people we hope they will try to become.

We can show them by our words and by our actions that we respect others. We can show them our compassion and concern when others are suffering. They need to see our own self-control, courage, and honesty. They need to learn that we treat ourselves, as well as others, with respect, and that we always try to do our best. As they grow older, they should have the chance to learn why we live as we do.

Daddy, why are you leaving that note on the garbage can?

There is broken glass inside, Matthew, and I don't want the garbage collectors to get hurt because of me. I am warning them about the glass.

Are they your friends?

No. I don't know them.

But you don't want them to get hurt. . .

As our children watch us daily, as we talk to them, encouraging their questions and trying to answer them thoughtfully, they begin to understand us and we begin to understand them. Understanding each other well is the best way to teach our children respect for our ideals of good character.

Using Literature and Stories

Children learn about responsibility through many activities, including reading stories. They learn by identifying with individual characters or because the message from a favorite story strikes a particular chord. Children can be touched deeply by good literature, and they may ask to have things read to them again and again.

Children can learn all sorts of lessons from stories. They might learn about courage by reading about David standing up to Goliath. Or they might learn the value of persistence and effort from The Little Engine That Could.

When they are older, reading can help prepare children for the realities and responsibilities of adulthood. It is usually better for children to read a good book about such things as war, oppression, suicide, or deadly disease before seeing these things up close.

When our children grow up they often remember stories that were told to them by family members when they were young. When we tell stories to our children, we should remember old favorites of ours, like The Three Little Pigs, not leaving out a single time the wolf says, "I'LL HUFF, and I'LL PUFF, and I'LL BLOW YOUR HOUSE IN!"

Developing Judgment and Thoughtfulness

Judgment on ethical issues is a practical matter. Children develop their capacity for judging what is a responsible act, just as they come to appreciate the meaning of responsibility, through practice. Especially when they are young, children need to see moral questions in terms that are meaningful to them.

We can also help our children develop good judgment by talking through complicated situations with them. One way is to help them understand the long-term consequences of different choices. If they tell us about a story they have read, we might ask them to imagine what the result might have been if a favorite character had acted differently.

Sometimes, it can be difficult to know the difference between acting bravely and acting recklessly or how to balance duties when they conflict. As parents, we can help by making it clear, through what we do as well as what we say, that it is important in such situations to think carefully and honestly about what should be done, as well as to keep in mind how others will be affected by what we do.

Your child's ability to reason about different issues, including ethical ones, will improve as your child matures. Just as reasoning can lead to a more thoughtful understanding of responsibility, or what actions to take in a complicated situation, it may also become easier to rationalize selfish or reckless behavior. But if you have helped your young child develop strong habits of considering the welfare of others, honesty, courage, and admiration for worthy accomplishments, your child will have a solid foundation on which to build.

Activities

As parents, sometimes we think that we must set aside particular times or create special situations in order to teach our children. But that is far from the truth when it comes to learning responsibility. While it is important to have some times together when you won't be disturbed, the most ordinary situations in everyday life are filled with opportunities for sound teaching, if parents pay attention to them.

This [section] contains activities to encourage the habits of responsibility in your child. Most of them are not, however, the kind of activities that you can do together for half an hour once a week. Instead, they are more like rules of thumb, ideas to build on. They illustrate the concepts introduced in the previous sections. They should stimulate your own thinking and your own ideas.

Just remember one thing: teaching our children about responsibility doesn't mean that we can't laugh or that we have to be grim. Our children should see that we can be serious about our principles, while still being able to play and have fun.

Dad, can I show you what we did in ballet class today?

Sure.

It was hard. We had to get way up on our toes and twirl around like this.

Great. Let me try it. . .oops! Now, what's so funny about that? Well, OK. I guess we all aren't as graceful as you are.

Getting to Know Others

Children need to be shown and taught respect for others. Other people have feelings and hopes, just as we do. We have much to learn from each other - from people who live far away and from those who lived long ago.

What to do:

• Set a good example by acting respectfully toward others. Always make it clear that prejudice is wrong and that all of us are equals, no matter our color, gender, or background.
• Show an interest in learning about and from others - from neighbors and relatives, and from books about our own and other civilizations. Tell your child interesting things you have learned.
• Encourage your child to learn about many different lands and people, to learn more than one language, and to read stories about children from all over the world. Show your child how you try to see things from the point of view of others.
• Listen attentively when your child wants to tell you about interesting things discovered about history, geography, religions, art, and ways of life.

We can help our children understand that there are often things to learn from those who lived in the past and from those whose lives are different from our own. We can teach our children to behave respectfully toward people and not pre-judge them. Sometimes, however, we must make it clear that some people behave in ways that are harmful, and such behavior should not be tolerated.

Magic Words, Caring Deeds

The magic words are "please" and "thank you." There are other manners we are constantly teaching our children as well.

What to do:

• Show your children the manners you expect at home first. The next time you eat dinner together, have the children pretend they are eating in a restaurant. How should they talk to each other? What should they say when the waiter brings their food? Or have the children pretend they are riding the bus. What should they do if the bus stops suddenly and they bump into someone? How should they carry a large package on the bus?
• The next time your children mention something nice another person did for them, suggest they write a thank you note. It doesn't have to have a lot of words. It can have pictures as well.
• You, too, can write short notes to your child to indicate your appreciation for something done right.

Children need to learn that little signs of appreciations can be very important to other people. And manners are a part of respecting and caring for the feelings of others. If we turn the chore of learning manners into a game, children will get the practice they need without embarrassing us or themselves.

As you teach the importance of manners, you may need to be honest about what your child can expect from others:

Mom, why do you make such a fuss when I eat with my mouth open?

Because it's ugly for other people to see. Good manners show respect for other people.

What's respect?

It means caring how other people feel.

If I care about them, will they care about me?

Not always, Paul. Some people don't care and never will, no matter how kind we are to them. But in our family, we do care.

Gifts from the Heart

Have your child give a gift of himself at the next holiday or any time he wants to do something nice for anyone else.

What to do:

• Talk to your child about gift giving. What does it mean to give something to someone else?
• Instead of buying a gift, have your child make a gift. Does your child have a special talent? Maybe your child would like to sing or write a song for a relative? Is there a chore your child could do? Maybe wash dishes for a week. Is there a special toy that could be loaned to a sister or brother for a week?
• Use materials from around the house so that little, if any, money is spent.
• If the gift is an activity or chore, have your child make a card with a note on it, telling what the gift will be.
• Have your child use imagination in making an inviting package. Perhaps your child could paint a small rock and wrap it in a big box. Or make an envelope out of the comics from the Sunday newspaper.

Most young children don't have enough money to buy a gift for a friend or relative. You can teach your child that a gift that shows effort and attention can mean more than a gift from the store.

Honesty, the Best Policy

Children need to learn that benefiting from manipulating or lying to others is dishonest and unworthy of them.

What to do:

• Tell the story about the boy who cried "Wolf!" so many times to get attention that when the wolf finally came, no one believed him.
• Ask your child if anyone has ever lied to her. How did that make her feel?
• Be careful to follow through on things you say to your child. Commitments that may seem minor to you can mean a lot to your child. Make promises and keep them.

Our children need to learn about the importance of trusting each other in our everyday lives. Without honesty, trust becomes impossible.

There's a Monster in My Room!

Sometimes our children have needless fears that we can help them overcome.

What to do:

• Listen when your child mentions a fear, even if it sounds silly to you.
• With your child, come up with a plan for facing up to the fear.
• Go through the plan together. Let your child take the step that confronts the fear, although it may be helpful for you to be there.

Our children can acquire courage if we help them gain practice in standing up to their unnecessary fears. In addition, if we take seriously what are real concerns to them, they will trust us and feel safe telling us their thoughts and feelings.

Bully

Children should learn not to allow others to mistreat them. At the same time, we want them to learn how to reach understandings peacefully, whenever possible.

What to do:

• Listen to your child and find out if others are not treating your child as they should. This will encourage your child to trust you and come to you when there is a problem.
• Help your child consider various ways of dealing with a particular problem.
• If the problem is the way another child is behaving, suggest working out the problem by talking with the other child, or a responsible adult.
• If the problem is another adult, however, or if your child is seriously threatened by other children, you will need to intervene directly.

A part of self-respect is not tolerating mistreatment by others. Finding appropriate ways to deal with unpleasant behavior by others is an important, if sometimes difficult, part of growing up.

Sidebar:There appears to be a link between ADHD and bullying. A 2008 study conducted in Sweden, showed that children with ADHD are four times more likely than their peers to bully other children, and they are almost ten times as likely than other children to be bullied.

Helping Out

Our children need to learn that as they get older and can contribute more, more will be expected of them.

What to do:

• As your child matures, consider additional ways your child can contribute to the household.
• Discuss the new duties with your child. Avoid describing them in ways that seem like a punishment. Instead, you can imply that they require a new level of ability, which your child now possesses.
• With younger children, it helps sometimes if you do the chores together and talk or make it fun. But don't do your child's work!
• If possible, new tasks should stretch a child's abilities and encourage satisfaction in good work. Praise something done well, especially a new challenge.

Doing chores is a useful way to learn persistence and to learn that when we live up to our responsibilities we enable others to trust and rely on us.

A Job Well Done

We need to show our children that we take satisfaction in acting properly and accomplishing difficult tasks.

What to do

• Through your daily activities, show your children that you care about a job well done.
• Perhaps our children's most important tasks are to work hard at school and do homework. When we check homework and point out mistakes, we help them to see how an error has arisen. When we let them correct the error themselves, we inspire self-confidence. It is also important for us to show them that we appreciate their good efforts.
• Teaching our children self-respect does not mean complimenting everything they do. Our children also need honest criticism from time to time. When we do criticize, it should be of things they have done, not them personally.
• Most of all, we should help our children form the self-confidence and self-respect that come from opportunities to do good work as students or as family members.

Helping children form self-respect is based on how we treat them and our own example.

There are many opportunities to teach self-respect through our actions:

Dad, nobody's going to see inside the model's wing. Why do you work so hard with all those little pieces?

Because that's the right way to build the plane, Martha. It makes the wings strong when the plane flies, and that's more important than what people see. I want to make the best plane I can. Do you want to help?

Our Heroes

Many children love to look at portraits or photographs, especially if you can tell stories about the people in the pictures.

What to do:

• Select a photo of a person in your family with an impressive quality or accomplishment. Tell your child about the person and about what the person did. Perhaps your grandparents had the courage to immigrate from another country or your parents sacrificed in order to support you in school. Talk about the results of these actions.
• Collect photographs from newspapers or magazines about impressive people in your community. With your child, talk about their actions that merit admiration or praise.
• In addition to relatives or others, you may want to display portraits of other people who deserve our admiration and respect. A picture of Anne Frank, a young girl who wrote a diary while she and her family live in hiding from Nazi Germans and who died in a concentration camp, can inspire conversation about courage and compassion for others. A portrait of Martin Luther King, a great civil rights leader who believed in non-violent change, can lead to discussions of great accomplishment despite prejudice. Choose people whom you admire and feel comfortable talking to your child about.

By the stories we tell about the people we admire, we can inspire children and remind them of those qualities we think are important.

Oops!

Sometimes, as parents, we don't act the way we should in front of our children.

What to do:

• Try to be honest with yourself and your child if you find that you've done something that sets a bad example. Sometimes we need to think a little bit about an event to realize that we've done something inappropriate.
• If your child has observed your behavior, it's especially important that you be honest. A simple statement is appropriate in most cases; there is no need to turn your admission into a major event.
• Follow up with an apology to anyone you have treated badly and, if possible, by making up for what you have done. It's important that our children, especially older ones, see that we face up to our own mistakes.

Will You Be My Friend?

Our children need to learn to choose their friends wisely.

What to do:

• Talk to your child about what is important in a friend. In addition to being fun, what other qualities are important? What about honesty, dependability, a real interest in your child's welfare?
• Talk to your child about the type of friends to avoid. Ask if your child can remember a friend who couldn't be counted on.

Our children should learn that it is important to choose friends and companions who care about others and act responsibly.

Share a Story

One important way parents can help their children learn respect for others, self-control, or other aspects of responsibility is through the use of fables or stories. You can read to your child, and you can encourage your child to read on his own.

What to do:

• Turn off the T.V. or other distractions.
• Find stories that exemplify important aspects of character that your child might enjoy.
• Talk to your child about the behavior of different characters in the story. Ask your child how some of the behavior might apply to your own lives.
• Share some stories or books that you have found meaningful with your child. (It is important for your child to see you reading and enjoying stories as well.)
• Come up with your own stories. These can be family stories, such as baby stories (when your child was little. . .) that can become a part of your child's personal history.

Stories can be good ways to learn important lessons. Your child can identify with characters in meaningful situations without your having to lecture.

Parents and the Schools

Parents need to work with teachers and other parents to ensure that children are brought up well. An African proverb says, "It takes an entire village to raise one child." It is important for parents and other adults to cooperate in order to have common goals for them. Close communication is essential.

Parents can visit with teachers to discuss ways they and the school can reinforce the same lessons about good character. Children are less likely to do much homework, for example, if parents let them watch television for hours.

Parents can learn from teachers what their children are studying and what interests them. A teacher or school librarian can provide good ideas for activities to do at home.

Parents can cooperate with each other, too. They can agree on standards of supervision at parties and on entertainment. Some parents may be free to escort children to museums, libraries, athletic events, and extracurricular school activities, when others are not. Taking turns can provide better opportunities for all the children.

Source: Helping Your Child Learn Responsible Behavior
Updated December 1995

Reviewed by athealth on February 5, 2014.

Helping Your Overweight Child

Healthy eating and physical activity habits are key to your child's well-being. Eating too much and exercising too little may lead to overweight and related health problems that may follow children into their adult years. You can take an active role to help your child - and your whole family - learn healthy eating and physical activity habits that last a lifetime. Is my child overweight?Children grow at different rates at different times, so it is not always easy to tell if a child is overweight. If you think that your child is overweight, talk to your health care provider. He or she can tell you if your child's weight and height are in a healthy range.How can I help my overweight child?Involve the whole family in building healthy eating and physical activity habits. This benefits everyone and does not single out the child who is overweight.Do not put your child on a weight-loss diet unless your health care provider tells you to. If children do not eat enough, they may not grow and learn as well as they should.

Be Supportive

• Tell your child that he or she is loved, special, and important. Children's feelings about themselves are often based on how they think their parents feel about them.
• Accept your child at any weight. Children are more likely to accept and feel good about themselves when their parents accept them.
• Listen to your child's concerns about his or her weight. Overweight children probably know better than anyone else that they have a weight problem. They need support, understanding, and encouragement from parents.

Encourage Healthy Eating Habits

• Buy and serve more fruits and vegetables (fresh, frozen, canned, or dried). Let your child choose them at the store.
• Buy fewer soft drinks and high-fat or high-calorie snack foods like chips, cookies, and candy. These snacks may be OK once in a while, but always keep healthy snack foods on hand. Offer the healthy snacks more often at snack times.
• Make sure your child eats breakfast every day. Breakfast may provide your child with the energy he or she needs to listen and learn in school. Skipping breakfast can leave your child hungry, tired, and looking for less healthy foods later in the day.
• Eat fast food less often. When you do visit a fast food restaurant, encourage your family to choose the healthier options, such as salads with low-fat dressing or small sandwiches without cheese or mayonnaise.
• Offer your child water or low-fat milk more often than fruit juice. Low-fat milk and milk products are important for your child's development. One hundred percent fruit juice is a healthy choice but is high in calories.
• Limit the amount of saturated and trans fats in your family's diet. Instead, obtain most of your fats from sources such as fish, vegetable oils, nuts, and seeds.
• Plan healthy meals and eat together as a family. Eating together at meal times helps children learn to enjoy a variety of foods.
• Do not get discouraged if your child will not eat a new food the first time it is served. Some kids will need to have a new food served to them 10 times or more before they will eat it.
• Try not to use food as a reward when encouraging kids to eat. Promising dessert to a child for eating vegetables, for example, sends the message that vegetables are less valuable than dessert. Kids learn to dislike foods they think are less valuable.
• Start with small servings and let your child ask for more if he or she is still hungry. It is up to you to provide your child with healthy meals and snacks, but your child should be allowed to choose how much food he or she will eat.
• Be aware that some high-fat or high-sugar foods and beverages may be strongly marketed to kids. Usually these products are associated with cartoon characters, offer free toys, and come in bright packages. Talk with your child about the importance of fruits, vegetables, whole grains, and other healthy foods - even if these foods are not often advertised on TV or in stores.

Encourage Daily Physical ActivityLike adults, kids need daily physical activity. Here are some ways to help your child move every day:

• Set a good example. If your child sees that you are physically active and that you have fun doing it, he or she is more likely to be active throughout life.
• Encourage your child to join a sports team or class, such as soccer, dance, basketball, or gymnastics at school or at your local community or recreation center.
• Be sensitive to your child's needs. If your child feels uncomfortable participating in activities like sports, help him or her find physical activities that are fun and not embarrassing, such as playing tag with friends or siblings, jumping rope, or dancing to his or her favorite music.
• Be active together as a family. Assign active chores such as making the beds, washing the car, or vacuuming. Plan active outings such as a trip to the zoo, a family bike ride, or a walk through a local park.

A pre-adolescent child's body is not ready for adult-style physical activity. Do not encourage your child to participate in activities such as long jogs, using an exercise bike or treadmill, or lifting heavy weights. FUN physical activities that kids choose to do on their own are often best.Kids need about 60 minutes of physical activity a day, but this does not have to happen all at once. Several short 10- or even 5-minute periods of activity throughout the day are just as good. If your children are not used to being active, encourage them to start with what they can do and build up to 60 minutes a day.

Discourage Inactive Pastimes

• Set limits on the amount of time your family spends watching TV, playing video games, and being on the computer.
• Help your child find FUN things to do besides watching TV, like acting out favorite books or stories, or doing a family art project. Your child may find that creative play is more interesting than TV.
• Encourage your child to get up and move during commercials and discourage snacking when the TV is on.

Be a Positive Role Model Children are good learners and they often mimic what they see. Choose healthy foods and active pastimes for yourself. Your children will learn to follow healthy habits that last a lifetime.Find More Help Your Health Care Provider Ask your health care provider for brochures, booklets, or other information about healthy eating, physical activity, and weight control. He or she may be able to refer you to other health care professionals who work with overweight children, such as registered dietitians, psychologists, and exercise physiologists.Weight-control Program You may want to think about a treatment program if:

• You have changed your family's eating and physical activity habits and your child has not reached a healthy weight.
• Your health care provider has told you that your child's health or emotional well-being is at risk because of his or her weight.

The overall goal of a treatment program should be to help your whole family adopt healthy eating and physical activity habits that you can keep up for the rest of your lives. Here are some other things a weight-control program should do:

• Include a variety of health care professionals on staff, including doctors, registered dietitians, psychiatrists or psychologists, and exercise physiologists.
• Evaluate your child's weight, growth, and health before enrolling him or her in the program. The program should also monitor these factors while your child is enrolled.
• Adapt to the specific age and abilities of your child. Programs for 4-year-olds should be different from those for 12-year-olds.
• Help your family keep up healthy eating and physical activity behaviors after the program ends.

Weight-Control Information Network
1 Win Way
Bethesda, MD 20892-3665
Tel: (202) 828-1025 or 1-877-946-4627
Fax: (202) 828-1028
E-mail: [email protected]

Publications produced by WIN are reviewed by both NIDDK scientists and outside experts. This fact sheet was also reviewed by Leonard Epstein, Ph.D., Professor of Pediatrics, Social and Preventive Medicine, and Psychology, University of Buffalo School of Medicine and Biomedical Sciences, and Gladys Gary Vaughn, Ph.D., National Program Leader, Cooperative State Research, Education, and Extension Services, U.S. Department of Agriculture.NIH Publication No. 08-4096
Updated: January 2008

Reviewed by athealth on February 5, 2014.

Hepatitis A, caused by infection with the Hepatitis A virus (HAV), has an incubation period of approximately 28 days (range: 15-50 days). HAV replicates in the liver and is shed in high concentrations in feces from 2 weeks before to 1 week after the onset of clinical illness. HAV infection produces a self-limited disease that does not result in chronic infection or chronic liver disease.

However, 10%-15% of patients might experience a relapse of symptoms during the 6 months after acute illness. Acute liver failure from Hepatitis A is rare (overall case-fatality rate: 0.5%). The risk for symptomatic infection is directly related to age, with >80% of adults having symptoms compatible with acute viral hepatitis and the majority of children having either asymptomatic or unrecognized infection. Antibody produced in response to HAV infection persists for life and confers protection against reinfection.

HAV infection is primarily transmitted by the fecal-oral route, by either person-to-person contact or consumption of contaminated food or water. Although viremia occurs early in infection and can persist for several weeks after onset of symptoms, bloodborne transmission of HAV is uncommon. HAV occasionally might be detected in saliva in experimentally infected animals, but transmission by saliva has not been demonstrated.

In the United States, nearly half of all reported Hepatitis A cases have no specific risk factor identified. Among adults with identified risk factors, the majority of cases are among men who have sex with other men, persons who use illegal drugs, and international travelers.

Because transmission of HAV during sexual activity probably occurs because of fecal-oral contact, measures typically used to prevent the transmission of other STDs (e.g., use of condoms) do not prevent HAV transmission. In addition, efforts to promote good personal hygiene have not been successful in interrupting outbreaks of Hepatitis A. Vaccination is the most effective means of preventing HAV transmission among persons at risk for infection. Hepatitis A vaccination is recommended for all children at age 1 year, for persons who are at increased risk for infection, for persons who are at increased risk for complications from Hepatitis A, and for any person wishing to obtain immunity.

Source: Centers for Disease Control and Prevention
Page last updated by CDC November 23, 2010

Reviewed by athealth on February 5, 2014.

What Is Hepatitis?

"Hepatitis" means inflammation of the liver. Toxins, certain drugs, some diseases, heavy alcohol use, and bacterial and viral infections can all cause hepatitis. Hepatitis is also the name of a family of viral infections that affect the liver; the most common types are Hepatitis A, Hepatitis B, and Hepatitis C.

What is the difference between Hepatitis A, Hepatitis B, and Hepatitis C?

Hepatitis A, Hepatitis B, and Hepatitis C are diseases caused by three different viruses. Although each can cause similar symptoms, they have different modes of transmission and can affect the liver differently. Hepatitis A appears only as an acute or newly occurring infection and does not become chronic. People with Hepatitis A usually improve without treatment. Hepatitis B and Hepatitis C can also begin as acute infections, but in some people, the virus remains in the body, resulting in chronic disease and long-term liver problems. There are vaccines to prevent Hepatitis A and B; however, there is not one for Hepatitis C. If a person has had one type of viral hepatitis in the past, it is still possible to get the other types.

What Is Hepatitis B?

Hepatitis B is a contagious liver disease that ranges in severity from a mild illness lasting a few weeks to a serious, lifelong illness. It results from infection with the Hepatitis B virus. Hepatitis B can be either "acute" or "chronic."

What Causes Hepatitis B?

Hepatitis B is caused by a virus. A virus is a germ that causes sickness. (For example, the flu is caused by a virus.) People can pass viruses to each other. The virus that causes hepatitis B is called the hepatitis B virus.

How is Hepatitis B spread?

Hepatitis B is spread when blood, semen, or other body fluid infected with the Hepatitis B virus enters the body of a person who is not infected. People can become infected with the virus during activities such as:

• Birth (spread from an infected mother to her baby during birth)
• Sex with an infected partner
• Sharing needles, syringes, or other drug-injection equipment
• Sharing items such as razors or toothbrushes with an infected person
• Direct contact with the blood or open sores of an infected person
• Exposure to blood from needlesticks or other sharp instruments

Can a person spread Hepatitis B and not know it?

Yes. Many people with chronic Hepatitis B virus infection do not know they are infected since they do not feel or look sick. However, they still can spread the virus to others and are at risk of serious health problems themselves.

Can Hepatitis B be spread through sex?

Yes. Among adults in the United States, Hepatitis B is most commonly spread through sexual contact and accounts for nearly two-thirds of acute Hepatitis B cases. In fact, Hepatitis B is 50-100 times more infectious than HIV and can be passed through the exchange of body fluids, such as semen, vaginal fluids, and blood.

Can Hepatitis B be spread through food?

Unlike Hepatitis A, it is not spread routinely through food or water. However, there have been instances in which Hepatitis B has been spread to babies when they have received food pre-chewed by an infected person.

What are ways Hepatitis B is not spread?

Hepatitis B virus is not spread by sharing eating utensils, breastfeeding, hugging, kissing, holding hands, coughing, or sneezing.

Who is at risk for Hepatitis B?

Although anyone can get Hepatitis B, some people are at greater risk, such as those who:

• Have sex with an infected person
• Have multiple sex partners
• Have a sexually transmitted disease
• Are men who have sexual contact with other men
• Inject drugs or share needles, syringes, or other drug equipment
• Live with a person who has chronic Hepatitis B
• Are infants born to infected mothers
• Are exposed to blood on the job
• Are hemodialysis patients
• Travel to countries with moderate to high rates of Hepatitis B

If I think I have been exposed to the Hepatitis B virus, what should I do?

If you are concerned that you might have been exposed to the Hepatitis B virus, call your health professional or your health department. If a person who has been exposed to Hepatitis B virus gets the Hepatitis B vaccine and/or a shot called "HBIG" (Hepatitis B immune globulin) within 24 hours, Hepatitis B infection may be prevented.

Can Hepatitis B be prevented?

Yes. The best way to prevent Hepatitis B is by getting the Hepatitis B vaccine. The Hepatitis B vaccine is safe and effective and is usually given as 3-4 shots over a 6-month period.

Find More Information

Content source: Division of Viral Hepatitis and National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Reviewed by athealth on February 5, 2014.