Fiber is an important part of a healthy diet and most kids are not getting enough of it on a daily basis. Fiber is a carbohydrate that is found in plants that we eat for food. Dietary fiber-found in vegetables, fruits, whole grains, seeds, and beans-helps with digestion and keeps our bowel movements regular. Dietary fiber includes soluble and insoluble fibers. Soluble fiber dissolves in water while insoluble fiber does not. Both of these remain undigested and aren't absorbed into the bloodstream and are excreted from the body. Insoluble fiber absorbs water to bulk up stool and helps move waste through the intestines to prevent constipation. Soluble fiber binds with fatty acids and helps to form a "Teflon coat" of sorts to also assist in digestion.

The prior rule of thumb for recommended fiber requirements for children over the age of 2 until 12 years of age was to take in the number of grams of fiber each day that equals their age plus 5. So, for example, a 7 year old would need to consume 12 grams of fiber. Nutritionists felt that this number was too low. The Food and Nutrition Board of the American Heart Association now recommends fiber intake as follows:

AGE	FIBER (grams)
1-3 years	19
4-8 years	25
9-13 years	Female- 26 / Male-31
14-18 years	Female-26 / Male- 38

Foods that contain over three grams of fiber are considered good sources of fiber while foods containing 5 grams or greater are considered excellent sources of fiber. Food labels list the fiber content on all packaged item and websites such as www.caloriecount.com is a great resource for finding fiber counts along with all other nutritional information.

Ways to add high fiber foods to your child's diet:

• Look for whole grain breads, cereals, and crackers. Be sure to check the label for the fiber content on breakfast cereals and look for one that has at least 3 grams of fiber.
• Use brown rice instead of white rice for cooking. Also shop for whole wheat pasta or whole wheat tortillas.
• Include vegetables or fruits in every snack. Be sure to keep the peel on to maximize the fiber intake.
• Add whole wheat or oat bran to muffin or pancake mix. Also shredded veggies such as carrots or squash can be added in the batter for an extra fiber boost.

Begin slowly since it does take time for the digestive system to adapt to the new intake and be sure to offer your child plenty of water to prevent any gas or bloating. Remember - fiber is not just for Grandma! Starting healthy eating habits early can lead to a lifetime of good food habits and healthy bowels.

By Jill Menefee, PT

I've done hundreds of Kegels. What else can I do to make my pelvic floor muscles strong?

Here are 16 ways to strengthen the pelvic floor & only ONE of them involves plain Kegels.
(These physical therapy treatments can also be used to treat: urinary and fecal incontinence, pain with intercourse, coccyx pain, pelvic organ prolapse, sacroiliac joint pain, pelvic pain, vulvodynia, endometriosis, interstitial cystitis, pudendal neuralgia)

The pelvic floor (PF) has 3 primary roles: maintenance of continence,¹ support of abdominal contents,¹ and sexual function.² The PF also assists in ventilation ³ (breathing), spinal stability,⁴ postural control,³ and stiffness of sacroiliac joint.^5,6 Your physical therapist at CTS will assess the health of your pelvic floor muscles as well as supporting systems. Here is a list of evidence based treatment options we use to support pelvic health.

Strengthen Pelvic Floor (PF) Muscles

CONCEPT: PF muscles are strongest when posture is good.^6,10

TREATMENT 1: Static posture and alignment corrections of spine, pelvis, hips, knees, and feet. ^6,10
TREATMENT 2: Dynamic posture corrections: Bend and lift technique

CONCEPT: PF muscles are short or overactive making them fatigued or weak and sometimes painful.

TREATMENT 1: Calming nervous system via relaxation exercises to decrease tone of PFM.
TREATMENT 2: Diaphragmatic breathing
TREATMENT 3: Biofeedback¹² to learn what it feels like to relax PF muscles
TREATMENT 4: Manual stretches, soft tissue massage, and trigger point release to PF muscles
TREATMENT 5: fascial release of hip and thigh muscles
TREATMENT 6: learn neutral lumbar alignment because neutral alignment decreases the tone on PF muscles.⁶

CONCEPT: PF muscles need simple strength training

TREATMENT 1: progressive "Kegels" including concentric and eccentric training
TREATMENT 2: Biofeedback¹² or electrical stimulation to "wake up" PF muscles.

CONCEPT: activation of transverse abdominal muscle (TA)^11,13 and obturator internus⁸ improves strength of PF muscles.

TREATMENT 1: strengthen TA11 muscle and hip muscle.⁸

CONCEPT: Timing and coordinating PF muscle contraction

TREATMENT 1: Learn to coordinate a "Pelvic Brace" to support organs during increases in intra-abdominal pressure (IAP)
TREATMENT 2: learn to contract the pelvic brace prior to and during a cough/laugh/sneeze/lift/start of a movement

CONCEPT: The PF muscles and diaphragm work together for optimal respiratory health and pelvic health via maintenance of intra-abdominal pressure.^7,9

TREATMENT 1: Learn correct diaphragmatic breath⁹
TREATMENT 2: release thoracic restrictions affecting diaphragm health¹⁴
TREATMENT 3: Diaphragm trigger point release

Crystal Hazelton, PT, OCS

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