After Childhood Cancer

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By Beth Kurt, MD

kidsjumpingLess than 20 percent of children survived cancer in the 1960’s. Fortunately, the five-year survival rate for childhood cancer is now approaching 80 percent. (1)

As a consequence of these improved survival rates, more teenagers and young adults who have undergone cancer therapy will go on to face special challenges when transitioning from active cancer treatment to resuming a normal life. Many survivors of childhood cancer experience late occurring health complications related to their cancer or its treatment; thus, regular medical follow-up is critical to maintain good health.

Recent studies have found that significant numbers of childhood cancer survivors do not receive the follow-up care needed. (2) The reasons may include financial difficulties, lack of insurance or a desire to move past a cancer diagnosis. To make matters more difficult, most primary care providers have cared for only a handful of childhood cancer patients and are not well-equipped to refer families to cancer centers to provide the best follow-up care. (3)

At our After Care and Transition (ACT) Program clinic visits, we provide a summary letter to the patient and their primary care physician, which details information about the cancer diagnosis, treatment and health problems that may occur as a result. We also provide resources for further reading and ways to stay healthy.

Among the issues that cancer survivors need to discuss and learn about at their follow-up doctor visits are:

• Signs and symptoms that should prompt a visit to their doctor.

• Risk for infertility and premature menopause.

• Risk for long-term heart toxicity and ways to improve or maintain heart health.

• Resources for mental health counseling.

• College scholarship opportunities.

• Other preventative health measures: use of sunscreen/risk for skin cancer, hearing protection etc.

One particular challenge stems from normal tensions between adolescent desires for autonomy and privacy, and strong parental desires to protect and care for their child both during and long after a life-threatening illness.

doctorDuring appointments with our patients, we do our best to educate adolescents and young adults about the importance of learning their own medical histories and speaking up when they have a concern about how they are feeling. This can be difficult, as adolescents may be inclined to deny symptoms like pain, depression or certain worries in front of their parents, and “neglect” to share information unless the right questions are asked. Well-meaning parents, on the other hand, are so used to being the primary historian and making decisions for their child, that it’s a learning process for them, too.

We encourage patients and their physicians to contact us if they have questions about how a health concern may relate to their cancer history. All of us at the ACT clinic keep an open-door policy, even after patients have officially “graduated” from the practice.

References:

1) National Cancer Institute

2) Oeffinger KC, Mertens AC, Hudson MM, Gurney JG, Casillas J, Chen H, et al. Health care of young adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Ann Fam Med 2004;2:61-70.

3) Nathan PC, Daugherty CK, Wroblewski KE, Kigin ML, Stewart TV Hlubocky FJ et al, Family physician preferences and knowledge gaps regarding the care of adolescent and young adult survivors of childhood cancer. J Cancer Survivor, 2013.

– Beth Kurt, MD, pediatric oncologist, Spectrum Health Medical Group and co-director of the After Care and Transition (ACT) Program for childhood cancer survivors at Helen DeVos Children’s Hospital in Grand Rapids, MI.

Beating Childhood Obesity

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obeseboyvectoreatingFrom Your Health Journal…..”I had to promote an article by Angela Mollard in the Telegraph from Australia entitled Love the key to beating deadly child obesity epidemic. Childhood obesity is not just a problem in the United States, but all over the world. We are worried this could be the first generation of children whose life expectancy may be shorter than their parents. Obesity related illness such as heart disease, asthma, type 2 diabetes, cancer, and weaker joints are all on the rise. Changes is needed, education of families on healthy lifestyle is critical. The author points out how things have changed for children, as they even need their tonsils removed to breathe, as the states that ‘fat is the new normal’ in her article. She states that the love of our children should be the driving force to keep them healthy – getting them involved in sport, making sure they reduce sedentary lifestyle and technology, get them an hour of physical activity each day, and promote healthy eating. Please take the time to visit the Telegraph web site (link provided below) to read this full article. It is well written, honest, and direct! I found her article refreshing and sincere.”

From the article…..

Not much makes me cry but tears of quiet despair roll as I write.

Our children are so fat they’re having their tonsils removed just to breathe. Hips – once the curse of the elderly – are being replaced, worn out under the sheer weight of these kids’ bodies.

We are supposed to protect children. Instead, we’ve shackled them with this hideous, life-destroying condition we seemingly have no power to halt. We are flailing with obesity, unable to turn the tide because, fat, frankly, is the new normal.

And who wants to hear from a woman who isn’t?

But if we don’t talk about it – and God knows I’m tiptoeing here – then we might as well close the door on everything that is awkward and confronting: sexual abuse, immigration, domestic violence. We owe our children solutions to this crisis but in the absence of any we should at least be having a conversation. Only through the kernels of shared thoughts will come answers.

People are not fat by choice.

Something within them aches; something so private and – in many cases – undetectable that food is the only thing that soothes. Bread becomes a pillow, butter a blanket to wrap yourself in against the sharp edges of life.

I know because friends have been brave enough to tell me.

One eats to stave off the hunger of childlessness; another numbs her rotten childhood with the warmth of doughnuts and the unquestioning hug that is cake.

Overeating, as author Caitlin Moran points out, is the addiction of choice of carers and, therefore, women. Unlike drink or drugs, food abuse allows you to function.

“Fat people aren’t indulging in the ‘luxury’ of their addiction making them useless, chaotic or a burden,” she writes. “Instead, they are slowly self-destructing in a way that doesn’t inconvenience anyone.”

To read the complete article…..Click here

Childhood Woes

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friendFrom Your Health Journal…..”I had to promote a great article in the New York Post written By Dr. Allen Frances entitled A disease called ‘childhood’. Do 1 in 5 NYC preteens really suffer a mental woe? Recently, The New York Post reported that more than 145,000 city children struggle with mental illness or other emotional problems. n the last 20 years, rates of attention deficit disorder have tripled, while autistic disorder and childhood bipolar disorder have each increased by a remarkable 40-fold. In the article, Dr. Allen makes a very important statement by declaring human nature just doesn’t change that quickly, but the labels follow fashion and can escalate dramatically without there being an actual increase in symptoms. Our kids haven’t suddenly become sicker, it’s just that diagnoses are applied to them more loosely. This article is a must read. I encourage all of you to visit the New York Post web site (link provided below) to read the complete article.”

From the article…..

Do 1 in 5 NYC preteens really suffer a mental woe? A psychiatry expert argues we’re overdiagnosing —and overmedicating — our kids

Last week, The Post reported that more than 145,000 city children struggle with mental illness or other emotional problems. That estimate, courtesy of New York’s Health Department, equals an amazing 1 in 5 kids. Could that possibly be true?

There is nothing tougher in psychiatry than accurately diagnosing a mental disorder in a pre-teenager. It is so easy to make mistakes both ways — to miss problems that desperately need attention and to attend to problems that are better left alone.

Getting the right diagnosis and predicting its future course is especially difficult in kids because their symptoms have such a short track record and are often heavily influenced by transient factors like developmental differences: family, school and peer stress; and the use of drugs.

It usually takes a while before an illness declares itself — and often, it turns out that no diagnosis is necessary because the symptoms go away without intervention.

That said, there’s been a massive mislabeling of psychiatric diagnosis among children because of recent medical fads.

In the last 20 years, rates of attention deficit disorder have tripled, while autistic disorder and childhood bipolar disorder have each increased by a remarkable 40-fold.

Human nature just doesn’t change that quickly, but the labels follow fashion and can escalate dramatically without there being an actual increase in symptoms. Our kids haven’t suddenly become sicker, it’s just that diagnoses are applied to them more loosely.

Some of the broadening usefully captures missed cases, but there has been a big overshoot because of aggressive drug-company advertising. Once the adult market was saturated, pharmaceutical manufacturers turned their greedy attention to kids and began a sometimes illegal campaign to convince doctors, parents and teachers that every childhood problem is a mental disorder, the result of a chemical imbalance that requires a pill solution.

To read the full article…..Click here

Public Schools Screen Students For Childhood Obesity Using BMI

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obeseboyvectorbellyFrom Your Health Journal…..”A very interesting article from a local ABC/FOX channel entitled Public Schools Screen Students for Childhood Obesity using BMI out of Massachusetts. The Massachusetts Department of Public Health requires public schools to screen each student for their BMI in 1st, 4th, 7th and 10th grade. Then all parents are sent a letter with the results. Last year in West Springfield over 33% of students in any of these grades was considered overweight or obese. Of course, this has been a sensitive issue in many parts of the United States, where parents do not want the schools to test their children due to the embarrassment of the situation or lack of sensitivity to the children. Once it has become a routine in many areas, the controversy has lessened to a point where students are not feeling uncomfortable with it, and testing is completed in a non-embarrassing manner. BMI, or Body Mass Index estimates the ideal weight of a person based on its size and weight. The Body mass index is valid for an adult man or woman (18 to 65 years). A high BMI is associated with increased risk of death. The risk of death increases with a high overweight for both men and women (cancer or other diseases) . The factor increases if the person smokes. What is your opinion on this issue? Use the comments section below to share your thoughts, and please visit the ABC/FOX web site (listed below) to read the complete article.”

Want to know your BMI?

From the article…..

Childhood obesity rates have more than tripled in the last 30 years. That’s according to the Centers for Disease Control and Prevention. Body Mass Index or BMI, is used to determine obesity rates in public schools across the state.

It’s a regulation that has been in place for 5 years. The Massachusetts Department of Public Health requires public schools to screen each student for their BMI in 1st, 4th, 7th and 10th grade. Then all parents are sent a letter with the results. Last year in West Springfield over 33% of students in any of these grades was considered overweight or obese. But according to West Springfield Superintendent Russell Johnston, the regulation does help.

“It helps to just communicate to parents two important things. Here are the results and if you have any concerns about this we encourage you to speak with your pediatrician or your child’s nurse to follow up because this is just one indication of your child’s weight,” Johnston said.

To read the complete article…..Click here

Duck, Duck, Goose: Tackle Childhood Obesity Early With Group Games

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By Jacqueline Horsfall

boygirlplayvectorThe preschool group was busily cleaning up blocks, paints, and plastic dinosaurs when I entered the classroom. A hand tugged at my sweater. “Who are you?” asked a curly-headed four-year-old. “I’m the Game Lady,” I said. “We’re going outside and run, jump, and make noise.” She flashed me a big grin. “Oh, yay!” She took my hand and dragged me toward the door leading to the playground area. “C’mon, everybody,” she called to her classmates. “Let’s play games.”

It doesn’t take threats or bribery to entice preschool children into physical exercise. But it does require dedicated adults—parents, teachers, babysitters, child care staff—to take an active role at home or school in leading structured games and high-energy activities instead of simply shooing kids outside, saying, “OK now, go find something to do.”

What? you say. Me lead a game? Don’t worry. The best games are the ones that are easy to learn quickly. Freeze Tag. Duck-Duck-Goose. Red Light Green Light. Dodge ball. London Bridge. The test of a winning game comes from young players themselves when they shout, “Let’s play it again!”

Here are a few pointers to help you get your game-on:

1. Be the Game Leader for one game. In subsequent play, any child may become the new Leader or all may take turns being the Leader. That leaves you free to supervise, referee, or become a player by joining the group.

2. Start with warm-ups and end with cool-downs. These bending and stretching exercises focus on joint flexibility, breath work, and coordination—essential to any good workout—but kids see them only as part of the game.

3. Don’t spend a lot of time explaining how the game is played—just play it. Kids catch on quickly once the Leader demonstrates the first time around. Rule #1 is: Rules are made to be broken. If a rule of play doesn’t work, get rid of it and substitute one of your own or ask the players for their suggestions.

4. Be creative. Dream up variations on old favorites. I’ve switched up Tag by incorporating a science lesson, wrapping a child in a gauzy-fabric “cocoon” and unfurling it, letting him/her fly away like a butterfly—with the group chasing after.

5. Keep competition low-key. From my own experience, very young children are more concerned with having a turn, rather than winning.

6. There is no set “play time.” Some games are so much fun, kids beg for repeated play. With a small preschool group, I’ve run three games consecutively to fill a 30-minute time slot. When players tire of one game, begin another.

7. Help children with weak motor skills, but keep it fun and part of the game. Scoop up a child and run to the finish line, nudge a ball in a child’s direction, guide little feet and hands, and give each a turn as Leader.

Bring your enthusiasm and creativity to high-energy group games and instill a love of physical activity in youngsters that will last a lifetime. Start early—with kids as young as 3—and help nip childhood obesity in the bud.

– Jacqueline Horsfall has over 15 years experience in youth-and-family nature programming. She is the author of EarthGames: 50 Nature Games for Ages 3+ – full of chanting “play-it-again” action games that are easy to learn quickly, yet substantial enough to last through repeated play. All games were tested for effectiveness in group play.

Childhood Obesity And Portions

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By Dr. R. Todd Hurst and Dr. Lisa Hurst

obeseboyvectorbellyOne of the biggest health problems of today is child obesity. This isn’t just because of unhealthy diets though, it also has to do with eating too much. And all too often, we find ourselves expected to eat too much. Restaurants provide bigger portions than what we should be having. Drinks come in bigger containers. And we tend to bulk our eating time into one or two portions a day, so we habitually eat more all in one sitting.

Unfortunately, the improper proportioning of our meals has begun to weigh heavily on our health and our lives. The answer isn’t just healthier eating. It is healthier eating habits that greatly affect us the most.

Pace yourself

How often is it good to eat? Some might scold you for eating too often, but is it possible that the more often you eat, the less you might actually be eating. Eating smaller amounts throughout the day keeps you feeling full and actually improves your energy and overall health. There’s no reason to eat big meals twice a day, especially since we often find ourselves sluggish and sleepy afterwards. The body actually metabolizes your food better when you eat smaller quantities in smaller intervals, such as a good breakfast, a light lunch, a light afternoon snack, and a light dinner. This is opposed to the hefty lunch and large dinner that many of today’s busy individuals are accustomed to.

obeseboyvectoreatingAvoid over-eating situations

Because we find ourselves faced with larger portions when out in today’s restaurants, one of the simplest (and least expensive) answers is to dine at home more often. If you can prepare your own meals, you’ll find that you only prepare what you actually need to eat. You can focus on what ingredients you’re actually putting in your body as well, cutting out the bulk of fatty foods, cholesterol, and even non-essential carbs that your body doesn’t really need.

And there’s no reason you can’t leave leftovers for later. A lot of people feel compelled to clean their plate as a habit developed from childhood. It’s there, so we eat it. But why? If you’re full, then why push yourself to eat more? Don’t worry about leftovers, because they’ll be there later.

Read before you eat

Additionally, be sure that you always read the labels of your food products. It might say less than fifty calories, but that usually means per serving, not the entire container. This is where a great number of diets can go wrong, especially when a product is advertised as new and healthier. It only takes about ten seconds to read the entire label, so take a few seconds to help ensure that you’re getting the right nutrition.

chipPay attention

Another thing to keep in mind is when you don’t have food on your mind. Habitual eating affects a large number of children, especially when entertainment can prove very distracting from what’s going on around them. Avoid snacking or eating while watching television or even while working (doing homework) or when your mind is overall preoccupied.

Permanent weight loss isn’t just about eating healthy; it’s about developing healthy eating habits. If you can define your meals into healthy proportions and avoid situations that put you in an over-eating predicament, you’ll be able to keep both you and your children healthy and happy so you all can enjoy plenty of fun family activities together.

– Dr. R. Todd Hurst, MD is a board certified cardiologist and Dr. Lisa Hurst, MD is a board certified internist. After years of watching fad diets fail their patients they founded Achieve-Life, an online weight loss program,. The program is a unique combination of tools and resources that can guarantee your weight loss. And now you have the opportunity to try the difference for free! Visit this page and look for the ‘try it free’ button on the top right corner of the page.

Chicago’s Fight Against Childhood Obesity

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obesegirlvectorexerciseFrom Your Health Journal…..”A great article in the Med Ill Reports by Srushti Shahand Kaitlyn Zufall entitled Chicago schools rev up fight against obesity. As we know, childhood obesity is on the rise in many areas of the world. Obesity related illnesses are also up, including heart disease, asthma, cancer, type 2 diabetes, and weak joints. Recently, Michelle Obama spoke about how childhood obesity has improved in such cities as NYC and LA, but the condition is still prevalent in Chicago, according to statistics released at the end of February by the Chicago Department of Public Health. One in every four students in kindergarten, sixth and ninth grades in the city’s public school system is obese, reports a newly released study by the health department and Chicago Public Schools. The obesity rate for all of Illinois in 2011 was only 12 percent, according to the Centers for Disease Control and Prevention. Please visit the Med Ill Reports web site (link provided below) to read the complete article.”

From the article…..

Childhood obesity is declining in certain cities in the U. S., but the condition is still prevalent in Chicago, according to statistics released at the end of February by the Chicago Department of Public Health.

And it’s double the statewide rate of obesity in kids and adolescents.

One in every four students in kindergarten, sixth and ninth grades in the city’s public school system is obese, reports a newly released study by the health department and Chicago Public Schools. The obesity rate for all of Illinois in 2011 was only 12 percent, according to the Centers for Disease Control and Prevention.

For Chicago, the kids who are either overweight or obese add up to a startling 36.5 percent of kindergartners, 48.6 percent of sixth graders and 44.7 percent of ninth graders.

The study accompanies an action plan, the Healthy Chicago Public Schools Agenda for Student Health and Wellness, also released jointly by CPS and the health department.

The action plan addresses multiple student health issues such as obesity, tobacco use and HIV prevention. The plan calls for obesity prevention through actions such as eliminating the use of food or fitness opportunities as rewards or punishments and implementing a standardized curriculum for physical education.

To read the complete article…..Click here

Child Obesity Is Not the Problem

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rollerbladeFrom Your Health Journal…..”I had to promote a wonderful article written by Marci Warhaft-Nadler of The Huffington Post entitled Child Obesity Is Not the Problem. In a day and age where obesity is being thrown in our faces, and children are being ‘frightened’ into staying thin, this article was quite refreshing to read. The author states that obesity is a real issue, but we should focus on healthier lifestyle instead. The plain truth is so many children today are leading a poor, unhealthy lifestyle. Their environment is different than it was 25 years ago, so when times change, so must our actions. Obesity related illness is on the rise such as heart disease, cancer, type 2 diabetes, asthma, and weaker joints. So yes, a change is needed to help children be healthier by changing their lifestyle. There is nothing wrong with focusing on the obesity epidemic, as education is the key to improvement, but let’s also focus on the child’s environment, and what changes need to be made. Please visit the Huffington Post web site (link provided below) to read the complete article.”

From the article…..

There, I said it. And I’ll say it again: Childhood obesity is not the problem.

While it’s become nearly impossible to turn on a TV or read a newspaper without hearing about the obesity epidemic and it seems like there are anti-obesity campaigns popping up everywhere, I believe we are focusing our energy on the wrong problem.

Is obesity a serious issue? Yes. But obesity is just one symptom of the real issue which is unhealthy living. By focusing solely on obesity, we are turning a “lifestyle” issue into a “fat” one and are completely missing out on giving people the information they need to be truly healthy.

The dangerous part about this is that instead of encouraging people to get healthy we are demanding that they get skinny and the truth is, skinny is not always synonymous with healthy.

Our “war on obesity” is creating a generation of kids who are terrified of being overweight and because of our society’s obsession with thinness, they don’t even know what being overweight truly looks like! Watching TV or reading magazines and being inundated with unrealistic images of unattainable physiques can have most kids feeling inadequate within minutes. When the media is telling them that they need to be skinny to be beautiful and anti-obesity campaigns are telling them they need to be skinny to be healthy, the only message they’re hearing is: YOU NEED TO BE SKINNY!

Here’s a shocker: You can’t always tell how fit or unfit a person is simply by what they look like. Being a little overweight and active is healthier than skinny and sedentary. Weight is not the ONLY factor in a person’s overall health.

To read the full article…..Click here

Parents Are The Key In The Battle Against Childhood Obesity

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obeseboyvectorbellyFrom Your Health Journal…..”I had to promote an article I recently found on the Toronto Star web site written by Patrick Luciani entitled Parents Are The Key In The Battle Against Childhood Obesity. It is a very important article for you (as a parent) to read, so please visit the Toronto Star web site (link provided below) to read the complete article. We have read here on many accounts how the government may be trying to regulate soft drinks and implement what they call a ‘fat tax’ on various items. A recent report suggests that that obesity costs society billions of dollars in rising health costs, and will only get worse if we do nothing. There is something truly upsetting seeing children who are obviously overweight and struggling with a range of health problems. So, if the government intervenes, they feel they may be able to reduce obesity, thus reduce health care costs in the future. But, the article in the Toronto Star suggest that parents be held accountable for their children’s weight, and this can make the difference needed to reduce health care, and most importantly, produce healthier children. I encourage you all to visit the Star’s web site to read this well written and informative article.”

From the article…..

Government regulations are no substitute for effective parenting.

What are we to make of a recent report entitled No Time To Wait prepared by the Ontario’s Healthy Kids Panel released last week? It has nice pictures of happy healthy kids along with the appropriate number of visible minority adults smiling and cooking with their kids. As with all these reports about health, it makes endless recommendations for government to solve rising childhood obesity numbers.

The report argues that obesity costs society billions of dollars in rising health costs, and will only get worse if we do nothing. There is something truly upsetting seeing children who are obviously overweight and struggling with a range of health problems. And because of this need the report lists about 35 recommendations for government action, from more prenatal care and breastfeeding, to banning low-nutrient foods and sugary drinks to children under 12.

It also wants the Ontario government to provide incentives (read more money) to food growers to “support community-based food distribution programs” and all restaurants to list calories on all menu items — a program that didn’t work in New York City, and won’t work here in reducing obesity levels. And of course it calls for more spending, about $80 million annually to reduce childhood obesity levels.

To its credit, the report doesn’t recommend new taxes on selected food products and sugary drinks probably because the committee couldn’t agree on which foods to tax and whether those taxes would do much good.

On this point, most economists are in agreement. A wise decision, especially in light of Denmark’s disastrous experiment with a similar fat tax as consumers found endless ways to avoid it. After only 18 months, the Danes chucked the whole mess. But there are other problems with the report.

The charts in the report make it clear that childhood obesity rates have been rising for the past few decades, but the study doesn’t break down the data by income levels, ethnicity, education or whether there is a higher level of obesity among children from single parent families.

To read the full article…..Click here

Preventing Childhood Tooth Decay

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toothFrom Your Health Journal…..A short, yet important article I found recently on one of my favorite sites to promote called Health News Digest entitled Preventing Childhood Tooth Decay is as Easy as 2 Minutes, Twice a Day. Oral care in children is a hot topic, as so many children neglect to take care of their mouths properly. Dental decay is one of the most common chronic childhood diseases, with greater than 16 million children suffering from untreated tooth decay in the United States. The mouth is the highway to overall health, and an unhealthy mouth can be associated with obesity, diabetes and even heart disease. In the U.S., oral disease causes kids to miss 51 million school hours and their parents to lose 25 million work hours annually. I encourage all of you to visit the Health News Digest web site (link provided below) to read the complete article. It is very informative and well written. While there, browse through many of their quality, educational articles.”

From the article…..

Here’s health news you can sink your teeth into: Dental decay is the most common chronic childhood disease, with more than 16 million kids suffering from untreated tooth decay in the U.S. The mouth is the gateway to overall health, and an unhealthy mouth can be associated with obesity, diabetes and even heart disease. In the U.S., oral disease causes kids to miss 51 million school hours and their parents to lose 25 million work hours annually.

Nevertheless, a survey by the Ad Council found less than half of American parents report that their children brush their teeth twice a day or more.

A Solution

To remedy that, The Partnership for Healthy Mouths, Healthy Lives was formed. It’s a coalition of more than 35 leading dental health organizations and, with the Ad Council, they created the Kids’ Healthy Mouths campaign to teach parents, caregivers and children about the importance of oral health and simple ways to prevent oral disease.

Created pro bono by ad agencies Grey Group and Wing in New York, the campaign stresses the importance of brushing for 2 minutes, twice a day.

“The messages in this campaign may seem simple but their impact will be felt for years to come,” said Gary Price, Secretary and CEO of the Dental Trade Alliance Foundation. “Most mouth disease is preventable using steps that can easily become a part of every child’s life routine.”

To read the full article…..Click here