July 2016 www.womanthismonth.com 81 of sex to dictate health policy, nor should we permit myths to blur our judgement. The lives of countless young women and men count on us being guided by evidence rather than rhetoric. The second category of opposition is rooted in safety fears. Like all clinical compounds, Gardasil has been extensively tested for years, constantly monitored for potential adverse effects. By all measures it has been found to be a safe and effective intervention. The complication rate is low, with the most frequent reactions being irritation at the site of injection, and fainting postinjection - precisely the minor temporary reactions seen with any shot. The case for the safety of the HPV vaccine is supported by myriads of clinical substantiation and years of data, whereas the opposing side is comprised of anecdotes, emotive petition and effortlessly exposed allegations. Despite all the sound and fury, the unassailable nittygritty of the matter is that the HPV vaccine has the potential to save lives. SPORT CRAZY My son is obsessed with sport. He seems healthy and fit but does seem to get a lot of injuries and I struggle to get him to eat enough. How do I make sure he’s not missing out on essential dietary requirements? Too frequently we hear about the millions of children and adolescents who are sedentary, overweight and obese. The amount of physical activity recommended for kids aged six to 17 is at least one hour per day of indoor or outdoor sport all year round. F The experts’ thinking about the needs of active youths and how hormones may influence child athletes is changing. While not everyone agrees with the specifics, there’s one common refrain: Children are not small adults. Their rapid growth and increase in muscle mass changes their nutrient and fluid needs in unique ways. The distribution of macronutrients recommended for active children and child athletes is the same as for less active peers. Protein aids muscle recovery when consumed after exercise and should account for 10 to 15 per cent of calories. Recommendations for total protein intake are 0.95g/kg/day for kids aged four to 13 and 0.85g/ kg/day for adolescents aged 14 to 18. Carbohydrate is the most important source of energy for an active child or adolescent and should represent 55 per cent of calories (more on heavy training days), about five to eight grams per kilogram of body weight. Fat should account for 25 to 30 per cent of total calories. Emphasise the wholesome fat that’s found in avocados, tuna, canola oil, soy and nuts. Fluid intake should be overseen and monitored during and after physical activity. This should result in an hourly fluid intake of 13ml/kg. Fluid replacement postexercise should include about 4ml/kg for each hour of activity. More is needed for children who sweat heavily. DELAYED DEVELOPMENT My daughter will be 14 in July but hasn’t yet started her periods. Is this normal or should I take her to the doctor? Puberty starts when the pituitary gland begins to produce two hormones, luteinising hormone (LH) and follicle-stimulating hormone (FSH), which cause the ovaries to enlarge and begin producing oestrogens. The growth spurt starts shortly after breasts begin to develop, and the first menstrual cycle begins about two to three years later. A girl who has not started to have breast development by the age of 13 is considered to be delayed. Some girls with delayed puberty are simply late maturers, but once they start, puberty will progress normally. This is called constitutional delayed puberty. So it is likely to occur if the mother started her periods after age 14 (the average is about 12 and a half) or if the father was a ‘late bloomer’. Decreased body fat is a major cause of pubertal delay in girls. It can be seen in girls who are very athletic. If these aren't the case, I suggest you visit a paediatric endocrinologist who will provide you with expert opinion. If you have a question for Dr Jinan, please email editor@ redhousemarketing.com.
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