What about our daughters? Women's health begins in childhood

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In addition to urging a girl to substitute an apple for that bag of chips as an after-school snack, there are other important aspects of managing her health. The goal is to give her the best start on becoming a healthy woman and habits to maintain that health throughout her lifespan.Establish a medical home

“We are training pediatricians now to provide medical home services for children,” said Julie Byerley, MD, MPH, a pediatrician and director of the pediatric residency training program at the University of North Carolina at Chapel Hill School of Medicine.

“A medical home provides care that is comprehensive, patient-centered and culturally appropriate for an individual patient and family. It’s important that kids have access to that care and continuity with their provider and an ongoing relationship so that the family and child are well known.”While it is more important to get vaccinated than not, it is ideal for a vaccination or sports physical to occur within the context of a check-up at a girl’s medical home, Byerley said. A check-up there can be more comprehensive in examining the girl’s overall health than could a clinic devoted solely to administering sports physicals or shots.

Byerly emphasizes that a medical home provider has an opportunity to know the family and the girl’s history, build a relationship, anticipate questions about growth and development, and answer questions the girl or her family might have.

“That way, if a girl needs anything in the future, she feels comfortable returning to that relationship,” Byerly said.

Build healthy bones

Beyond establishing a medical home, other specific aspects of a girl’s health warrant consideration and may differ from the needs of a boy. One is bone health.

The first line of prevention of osteoporosis is to build strong bones early in life. According to the National Osteoporosis Foundation, 85 percent of adult bone mass is acquired by age 18 in girls (by age 20 in boys). Peak bone density for women is achieved by their mid-20s. After that, women lose about 0.4 percent of their bone density per year, with a much faster rate of loss once they enter menopause.

“We are now considering osteoporosis a pediatric concern, not just something to think about for postmenopausal women,” said Michael Evers, MD, assistant professor of obstetrics and gynecology in the UNC School of Medicine.

“I tell my residents that no matter why a teen is in for an appointment, she should hear the lecture on getting enough calcium- and vitamin D-rich foods. It’s during her teen years that she potentially can make the biggest impact on her bone health – with something as simple as attention to diet or taking a supplement.”The Institute of Medicine issued a report in 2010 updating recommendations for daily levels of calcium and vitamin D. Girls ages 9 to 18 should consume 1,300 mg./day of calcium and 600 mg./day of vitamin D, or the equivalent of two cups of milk.

Prevent cardiovascular disease

Cardiovascular health begins in childhood. Even an active girl or teen of healthy weight can have elevated cholesterol levels. Genetics may contribute, as well as eating habits.Pediatrics always has been very focused on prevention, said Mike Steiner, MD, chief of the division of pediatrics and adolescent medicine and medical director of outpatient clinics at UNC’s medical school.

“I think pediatricians are probably getting an increasing appreciation for things that can be done in childhood to improve the life of adult women,” he said.

The jury is still out, Steiner believes, on how aggressive pediatricians should be in screening for or identifying traditional cardiovascular risk factors, such as through cholesterol screening.

However, he noted, “There’s pretty good evidence that it’s beneficial to screen for high blood pressure. And there’s good evidence that it’s beneficial to screen for and treat tobacco abuse, which are two important cardiovascular risk factors in adulthood.”Prevent cervical cancer

Each year, 12,000 women in the U.S. are diagnosed with cervical cancer. Nearly 4,000 of those die from an advanced stage of this fully preventable and treatable disease. About half who die did not receive a regular Pap test, which detects abnormal cells that can lead to cervical cancer. African-American women and Latinas are disproportionately affected and the least likely to be screened.”In a wealthy nation like the United States, it is unforgivable to have women dying from cervical cancer, a fully preventable disease,” said Noel Brewer, PhD, director of Cervical Cancer-Free North Carolina and associate professor of health behavior and health education at UNC Gillings School of Global Public Health. “We can do better for our daughters, mothers, sisters and friends. We have to.”

His initiative and others promote Cervical Health Awareness Month every January.There are two lines of defense in the war on cervical cancer. One is vaccination against the human papillomavirus (HPV), in three doses when girls are 11 to 12 years old. The other is regular screening with a Pap test.

Evers, who says he also encourages and supports immunization for boys, notes that “Immunization does not negate the need for a young woman to participate in routine pap smears starting at age 21, but it can go a long way in reducing her risk of developing cervical cancer.”

Elizabeth Witherspoon, PhD, a health and science writer in Durham, N.C., compiled this information.

UNC Gillings School of Global Public Health contact: Ramona DuBose, director of communications, (919) 966-7467 or ramona_dubose@unc.edu.