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March 2010: A Look Into Girls' Health and the Future Women of Tomorrow Girls Health Adolescence is a unique stage of development and a crucial time for today's young women. During these formative years, girls' attitudes, behaviors and experiences will shape their lives for years to come. There are four major issues that affect young women today, which are associated with a myriad of health consequences: nutrition, fitness, emotional needs, and sexuality. Nutrition and Fast Food The number one enemy of teen nutrition: Fast Food! Fast food and poor nutritional choices is tied to serious health risks. Eating frequent fast food meals causes teens and young adults to gain more weight and face an increased risk of developing insulin resistance according to the results of a study funded by the National Heart,Lung, and Blood Institute(NHLBI) and published in the January 1, 2005 issue of The Lancet.* After 15 years, those who ate at fast-food restaurants more than twice each week compared to less than once a week had gained an extra ten pounds and had a two-fold greater increase in insulin resistance, a risk factor for type 2 diabetes. Diabetes is a major risk factor for heart disease. “Obesity and diabetes are on the rise in this country and this important study highlights the value of healthy eating habits,” said NHLBI Acting Director Barbara Alving, M.D. Fast-food consumption has increased in the United States over the past three decades. “It’s extremely difficult to eat in a healthy way at a fast-food restaurant. Despite some of their recent healthful offerings, the menus still tend to include foods high in fat, sugar and calories and low in fiber and nutrients,” said lead author Mark Pereira, Ph.D., assistant professor of epidemiology at the University of Minnesota. People need to evaluate how often they eat meals at fast-food restaurants and think about cutting back, according to Pereira. One reason for the weight gain may be that a single meal from one of these restaurants often contains enough calories to satisfy a person’s caloric requirement for an entire day. Participants were asked during the physical examinations given as part of the study how often they ate breakfast, lunch or dinner at fast-food restaurants. Researchers found that the adverse impact on participants’ weight and insulin resistance was seen in both blacks and whites who ate frequently at fast-food restaurants, even after adjustment for other lifestyle habits. Study participants included 3,031 young black and white adults who were between the ages of 18 and 30 in 1985-1986. The participants, who were part of the Coronary Artery Risk Development in Young Adults (CARDIA) study, received dietary assessments over a 15-year period. CARDIA centers are located in Birmingham, AL, Chicago, IL, Minneapolis, MN, and Oakland, CA. According to the study, men visited fast-food restaurants more frequently than women and blacks more frequently than whites. Black men reported an average frequency of 2.3 visits per week in 2000-01. White women had the lowest frequency, at an average of 1.3 visits per week in 2000-01. “It is important to watch carefully what you eat, especially at a fast-food restaurant. Knowing the nutritional content is important. Consumers may want to ask for this information,” said NHLBI’s Gina Wei, M.D., project officer for CARDIA. Salads and grilled foods tend to be lower in fat than fried foods, she said. Keep portion sizes small, and ask that high-fat sauces and condiments, such as salad dressing and mayonnaise, be “on the side” and use them sparingly to reduce calories, Wei said. Fitness and Overall Physical Health You need 60 minutes of physical activity every day — and bone-strengthening activities at least three days a week. Check out the list of activities that are good for your bones. BadmintonWhat you'll need A racquet. Badminton racquets are different from tennis racquets — they're generally smaller and much lighter. Shuttlecock. Sometimes called a "birdie", this light object is hit back and forth over the net. Because the flight of the birdie is affected by wind, this activity is played indoors competitively. However, badminton is a great backyard activity that you can play with your entire family. Play it safeDon't let the ease of this backyard game fool you — it can be a great workout! Make sure you warm up your arms and shoulders and stretch before and after playing to avoid injury. To avoid injuring others, never throw your racquet or birdies. How to playBadminton has been played since ancient times. Though it is an Olympic sport, badminton is often played recreationally and is a great activity for people of all abilities and fitness levels. Badminton is played by either two opposing players (singles) or two opposing pairs (doubles), who take positions on opposite halves of a court (or yard) divided by a net. Players score points by striking the shuttlecock with their racquet so that it passes over the net and lands in their opponents' half of the court. A rally ends once the shuttlecock has struck the ground, and each side may only the shuttlecock strike once before it passes over the net. Basketball What you'll needA Basketball. Basketballs come in different sizes depending on your age and whether you're a girl or boy. Also, there are different basketballs for inside and outside use. Basketball can really make you work and help you build strong bones, but make sure you stretch and warm up before playing. Because of all of the quick moves and jumping, it can put a lot of wear and tear on your ankles, so protect them by wearing the right pair of shoes — medium or high tops do the best job of supporting your ankles. Protect those knees by learning how to cut, stop, and land a jump safely. And, make sure to eat lots of food with calcium to give your bones the strength they need to support your body. Basketball is fun to play in pick up games in the yard with your pals, or you can join an organized league. Different positions rely on different skills — point guards should focus on their dribbling and passing, while centers and forwards should be powerful rebounders and shooters. Outside guards need to be quick and strong to make those 3-point shots. Want some basics? What you need to wear depends on the type of dancing you will be doing — dance styles range from ballroom and ballet to hip hop and salsa. For ballet, you'll need a more specific uniform of leotard, tights, and ballet shoes. For others, wearing comfortable clothes you can move in easily is all you need. Play it safeDancing is an amazing workout! Make sure you stretch to help your muscles get stronger and more flexible. Focus on warming up your ankles and feet to avoid common dancing injuries like sprains and strains. Don't forget to cool down too. How to playDancing is as simple as moving in time to music. Practice at home by moving your feet and hips to the beat (you can usually pick up the beat by counting repeatedly to four. Make sure you move your arms around a bit as well. Let your body move as naturally as possible to the rhythm to help it look smooth, not jerky or stiff. If you lose the rhythm, just go back to counting the beats again. Sound complicated? Step-by-step instructions on dancing can be found in videos online or at your local library. But remember: Dancing is meant to be fun, so grab your BFFs and host a dance party in your den! Put on your favorite tunes and soon you'll be dancing with the best of them. Running What you'll needGood running shoes are key. A shoe store should be able to help you pick out the perfect pair for your feet. Look for a shoe with good cushioning, tread, and flexibility. Wear comfortable socks made of cotton or other sweat-wicking materials. Make sure you're aware of the miles adding up — you should replace your shoes every 500 miles. Running is a great bone-strengthening activity, but it can be hard on the joints, especially the knees. Make sure you stretch before and after your run and warm up by walking and then jogging slowly. It's never safe to run in the dark — morning or night, and it's a good idea to wear a reflective strip on your shoes or shirt no matter what time of day you run. Remember to run facing traffic and never wear headphones. Headphones are fine if you're running on a treadmill, but not on the open road or trail! This prevents you from hearing what's going on around you. Better yet, run with your BFF — she'll help keep you motivated and safe and make it more fun too! How to playStart out slowly to build your endurance. You can find a lot of training programs online or in books at your local library. Walking What you'll needShoes are the most important part of your walking gear. Good walking shoes are generally flat, but flexible, so your foot rolls with each step. They should fit well, but leave enough room for your feet to spread out while walking. Wear socks that are comfortable. Try socks made of cotton or other sweat-wicking materials — they will keep your feet drier and help prevent blisters. Running shoes are okay to use for walking. Don't forget to trade in the old shoes when the treads start wearing out — which is about 500 miles. Whew! It's always best to walk where you can avoid traffic — like parks or even the mall! Or try to find an area where there are sidewalks. If you have to walk on a street without sidewalks, walk close to the curb facing traffic. Remember to cross the street only at marked crosswalks or at corners, keep your ears and eyes open, and watch out for traffic in front and back of you. Wear bright-colored clothing or reflectors so drivers can see you. If you are walking alone, don't wear headphones — if they are too loud, they can keep you from hearing any oncoming traffic. How to play You've probably been walking for about as long as you've been talking. But walking isn't just a way to get from here to there; it's also a great bone-strengthening physical activity that can help you build strong bones! Walking doesn't require a lot of equipment, you can do it anywhere, it is always available by just walking out your front door, and it's a great way to relax and refresh. It's also something you can do alone or with your friends and family. Weight Lifting What you'll needThe weight room at your school should have all you need to get started, but you can also check out a local YMCA or gym. Make sure you start with a lighter weight and build up as you get stronger — a combination of 1-, 3-, and 5-pound weights should be enough in the beginning. If you're using machines, keep the weight at the lowest setting at first. Play it safeStrength training, or weightlifting, builds muscles of course but it also helps your bones. Strength training is a great way to build bone density. There's a difference, though, between strength training to build muscle and improve your health and powerlifting or bodybuilding (competitive weight lifting). Powerlifting and bodybuilding are not recommended for teens and can cause serious injuries to growing bones, muscles, and joints. Make sure you talk to your doctor first to make sure it's safe for you to lift weights. How to playAt a gym or weight room, you can often choose between free weights (barbells, dumbbells, and hand weights) or weight machines. Free weights usually work a group of muscles at the same time; weight machines typically are designed to help you isolate and work on a specific muscle. You can also use resistance bands to tone your muscles, or your own body weight (as in pushups or sit-ups). Whatever you decide, start out with a lighter weight and go slowly. Even if you don't feel anything right away, your muscles could be sore the next day if you've never lifted weights before.
Don't rely on strength training as your only form of exercise. You still need to get your heart and lungs working harder by doing some kind of additional aerobic exercise for a minimum of 20-30 minutes per session. Doctors recommend an hour a day of moderate to vigorous activity — so on days when you're not lifting weights, you may want to get more aerobic activity. Emotional Needs How's your child doing? Is she getting along with his friends? Is she a little down in the dumps and not telling you what's going on? Up and down, up and down…the teen years can seem like an endless emotional roller coaster. Your child might feel happy and confident in one moment, then sad or confused in the next. Why? Their body is changing, and their mind is very much a part of this change too. Just knowing that these highs and lows are normal can help get her through the tough times. The teenage years are a time of transition from childhood into adulthood. Teens often struggle with being dependent on their parents while having a strong desire to be independent. They may also feel overwhelmed by the emotional and physical changes they are going through. What can I do to help my teen? Communicating your love for your child is the single most important thing you can do. Children decide how they feel about themselves in large part by how their parents react to them. For this reason, it's important for parents to help their children feel good about themselves. It is also important to communicate your values and to set expectations and limits, such as insisting on honesty, self-control and respect for others, while still allowing teenagers to have their own space. The American Academy of Child and Adolescent Psychiatry (AACAP) suggests the following ways for parents to prepare for their child's teenage years:
What warning signs should I look for? Remember that your teen may experiment with his or her values, ideas, hairstyles and clothing in order to define him- or herself. This is typically normal behavior and you shouldn't be concerned. However, inappropriate or destructive behavior can be a sign of a problem.
What should I do if there is a problem? Work together to maintain open communication. If you suspect there is a problem, ask your teen about what is bothering him or her. Don't ignore a problem in the hopes that it will go away. It is easier to cope with problems when they are small. This also gives you and your teen the opportunity to learn how to work through problems together. Don't be afraid to ask for help with dealing with your teen. Many resources, including your family doctor, are available.Sexuality The subject of teen sex often scares parents of teenagers. Here you will learn how to talk to your teen about sex and teen sexuality. Why it's important to keep the lines of communication open when faced with the issues of teen sex. We also have resources and more information on teen sexuality including teen pregnancy, menstruation, puberty, AIDS and much more. Talking to your teen about sex Sex education basics may be covered in health class, but your teen might not hear — or understand — everything he or she needs to know to make tough choices about sex. That's where you come in. Awkward as it may be, sex education is a parent's responsibility. By reinforcing and supplementing what your teen learns in school, you can set the stage for a lifetime of healthy sexuality.
Addressing tough topics Sex education for teens includes abstinence, date rape, homosexuality and other tough topics. Be prepared for questions like these:
Talk to your teen about alcohol and drugs. Alcohol and other drug use is linked to risky sexual behavior and poses significant threats to the health of adolescents. Substance abuse may impair adolescents' ability to make judgments about sex and contraception, placing them at increased risk for unplanned pregnancy, sexual assault, or becoming infected with a sexually transmitted disease (STD), including HIV/AIDS. We know the AIDS virus can be transmitted through sharing hypodermic needles. Less is known about the dangerous role of alcohol and other drugs in sexual behavior that may lead to STDs and HIV/AIDS. To compound matters, there is also considerable evidence that alcohol and other drugs weaken the immune system, thereby increasing susceptibility to infection and disease. Consider the following statistics:
According to the Centers for Disease Control and Prevention, HIV/AIDS has been the sixth leading cause of death among 15- to 20-year-olds in the United States for over three years. One in five of the new AIDS cases diagnosed is in the 20 to 29 year age group, meaning that HIV transmission occurred during the teen years. Additionally, more than half of new cases of HIV infection in 1994 were related to drug use. There is still much to be learned about the relationship between alcohol and other drugs and sexual behavior. During the past decade, teens reported higher levels of sexual activity at earlier ages, experienced more unplanned pregnancies, and suffered higher rates of sexually transmitted diseases. To reduce the incidence of these problems in the future, prevention of alcohol and other drug abuse must be a top priority. Additional Health Information/Resources from Girls' Health Alcohol addiction Tips for Teens: The Truth About Alcohol Alcohol (Copyright © Freevibe.com) Drinking: It Can Spin Your World Around: Facts for Teens (Copyright © AAFP) Girl Talk: Choices and Consequences of Underage Drinking Students Against Destructive Decisions AllergiesOn the Teen Scene: Cosmetics and Reality Teen Worker Safety in Restaurants: Latex Allergy Food Allergies in the Real World Food Allergy News for Kids and Teens (Copyright © Food Allergy and Anaphylaxis Network) Just for Kids (Copyright © AAAAI) Milk Allergy: A Guide for Teens (Copyright © CYWH) Alopecia areataHair Loss- Information for Teens Kids Konnect for Teens (Copyright © NAAF) Amputation Anxiety disordersAnxiety (Copyright © The Annenberg Foundation Trust at Sunnylands) Anxiety Disorders (Copyright © University of Connecticut Health Center) ArthritisJuvenile Arthritis (Copyright © Arthritis Foundation) Asperger syndromeKids' Quest on Disability and Health AsthmaMeeting the Challenge: Don’t Let Asthma Keep You out of the Game Just for Kids (Copyright © AAAAI) Quest for the Code: Asthma Game (Copyright © Starlight Starbright) Teens and Asthma: What You Really Need to Know (Copyright © ALA) The Asthma Wizard (Copyright © National Jewish Medical and Research Center) Attention deficit hyperactivity disorder (ADHD - ADD)AD/HD and Driving (Copyright © CHADD) Attention Deficit Hyperactivity Disorder (Copyright © Children’s Hospital and Health Center) Autism and autism spectrum disordersKids' Quest on Disability and Health Bipolar disorderBipolar Disorder (Copyright © The Annenberg Foundation Trust at Sunnylands) Bleeding disordersUnderstanding von Willebrand Disease Blindness and visual impairmentsBlindness – Written for Kids (Copyright © MCWDN) National Federation of the Blind: Students (Copyright © NFB) The Braille Bug (Copyright © AFB) Brain injuryKids Corner (Copyright © Brain Injury Association of America) ThinkFirst! For Teens (Copyright © ThinkFirst) Burn injuryTeen Worker Safety in Restaurants: Cooking Burns The X-Men in: Life Lessons Comic Book (Copyright © Starlight Starbright) Cancer2bMe (Copyright © CTFA Foundation) Coping With Chemo (Copyright © The Starlight Starbright Children's Foundation) CureSearch: For Patients (Copyright © CureSearch) For Teens Only (Copyright © Memorial Sloan-Kettering Cancer Center) Teens Living with Cancer (Copyright © Melissa’s Living Legacy Foundation) Celiac diseaseRecipes for Teens with Celiac Disease Kids Network (Copyright © CSA) Visiting the Doctor (Copyright © CSA) Cerebral palsy Charcot-Marie-Tooth diseaseCMTA Kids' Page (Copyright © CMTA) Facts About Charcot-Marie-Tooth Disease and Dejerine-Sottas Disease (Copyright © MDA) Chronic fatigue syndromeA Guidebook by and for Young People with CFIDS (Copyright © CFIDS Association of America) Tips from a Teen for Self-Advocacy at School (Copyright © The Pediatric Network) Youth Voices (Copyright © The Pediatric Network) Chronic illnessDealing with a Health Condition Impact of Chronic Illness on College Planning: A Guide for Teens (Copyright © CYWH) Information for Teens and Young Adults (Copyright © AHTP) ZigaWhat! (Copyright © NICHCY) Cleft lip and palateDealing with Cleft Lip and Palate Cleft Palate Foundation (Copyright © CPF) Crohn's diseaseCrohn's Disease and Ulcerative Colitis: A Guide for Children and Teens (Copyright © CCFA) UC and Crohn’s (Copyright © CCFA) Cystic fibrosisCystic Fibrosis: Diet and Nutrition Recipes for Teens with Cystic Fibrosis Nutrition for Teens with Cystic Fibrosis (Copyright © CFF) (PDF - 132KB) Deafness and hearing impairmentHearing Impairment: Advice from Kristin Growing Up Without Hearing (Copyright © Gallaudet University) Hear Our Voices (Copyright © AG Bell Association for the Deaf and Hard of Hearing) Listen To Your Buds! (Copyright © ASHA) Stories from Deaf Kids and Adults (Copyright © The Children's Hospital of Philadelphia) World Around You (Copyright © Galludet University) DepressionDepression (Copyright © The Annenberg Foundation Trust at Sunnylands) Depression: A Guide for Teens (Copyright © CYWH) DiabetesTips for a Healthy Weight (PDF - 560KB) Tips for Being Active (PDF - 1.2MB) Tips for Healthy Eating (PDF - 297KB) Tips for Kids with Type 2 Diabetes (PDF - 781KB) Tips for Teens with Diabetes: Dealing With the Ups and Downs of Diabetes (PDF - 198KB) Diabetes: A Guide for Teens (Copyright © CYWH) Diabetes Information For Teens (Copyright © ADA) Kids Online (Copyright © JDRF) Down syndrome Drug abuse and addictionHeads Up: Real News about Drugs and Your Body My friend thinks I have a drinking and drug problem National Institute on Drug Abuse for Teens Check Yourself (Copyright © Partnership for a Drug-Free America) DwarfismLittle People of America: Frequently Asked Questions (Copyright © Little People of America, Inc.) Eating disordersI Think My Friend May Have an Eating Disorder. What Should I do? Eating Disorders: A General Guide for Teens (Copyright © CYWH) Eating Disorders: Facts For Teens (Copyright © AAFP) EndometriosisEndometriosis: A Guide for Teens (Copyright © CYWH) Family/Teen Program (Copyright © The Endometriosis Association) EpilepsyFor Teens (Copyright © Epilepsy Foundation) Information for Teens (Copyright © Epilepsy.com) Special Concerns for Teenage Girls (Copyright © Epilepsy Foundation) Teen Chat Group (Copyright © Epilepsy Foundation) Eczema Fetal alcohol syndromeNational Organization on Fetal Alcohol Syndrome FibromyalgiaIncreasing Your Independence (Copyright © The Pediatric Network) Youth Voices (Copyright © The Pediatric Network) GERD (Gastroesophageal reflux disease)Children's Digestive Health and Nutrition Foundation Growth hormone deficiencyThe Magic Foundation Kids Club (Copyright © The Magic Foundation) Heart diseasesHugo Kids Club Headquarters (Copyright © AHA) The Bad Fats Brothers (Copyright © American Heart Association) HIV infection and AIDSHealthy Youth: Sexual Risk Behaviors AIDS, Sex, and Teens (Copyright © AVERT) HIV Infection: Get the Facts (Copyright © Advocates for Youth) Voices of Youth (Copyright © UNICEF) Youthink! 4Kids: AIDS/HIV (Copyright © The World Bank Group) Huntington’s diseaseAfraid: A book for children "at risk" for Huntington's Disease (Copyright © HD Lighthouse) Juvenile HD (Copyright © HOPES) Inflammatory bowel diseaseCrohn's Disease and Ulcerative Colitis: A Guide for Children and Teens (Copyright © CCFA) UC and Crohn’s (Copyright © CCFA) Juvenile rheumatoid arthritisArthritis in Children (Copyright © American College of Rheumatology) Juvenile Arthritis (Copyright © AAOS) Kidney diseaseInformation for Kids and Teens (Copyright © National Kidney Foundation) Learn About Your Organs (Copyright © National Kidney Foundation) Lactose intoleranceLactose Intolerance: A Guide for Teens (Copyright © CYWH) Learning disabilitiesLDOnline’s KidZone (Copyright © WETA) Living With LD: For Teens (Copyright © National Center for Learning Disabilities) SparkTop.org (Copyright © Charles and Helen Schwab Foundation) Teen Place (Copyright © Learning Disabilities Worldwide) LupusAbout Lupus: For Children, Teens and Young Adults (Copyright © Lupus Foundation of America) Systemic Lupus Erythematosus (Lupus) in Children and Adolescents (Copyright © Arthritis Foundation) Mental healthChange Your Mind About Mental Health (Copyright © APA) CopeCareDeal (Copyright © The Annenberg Foundation Trust at Sunnylands) Create a Personal Stress Management Guide (Copyright © AAP) National Runaway Switchboard: Youth & Teens (Copyright © National Runaway Switchboard) www.talklisten.org (Copyright © Boston Public Health Commision) Mental retardationIntellectual Disability (formerly Mental Retardation) (Copyright © NICHCY) MigraineHeadache Headstart for Young Sufferers (Copyright © National Headache Foundation) Mono (Mononucleosis)Can a person get mono more than once? What is Mononucleosis (Copyright © AAFP) Multiple sclerosisKeep S’myelin: A Fun Resource for Kids about MS (Copyright © National Multiple Sclerosis Society) Someone You Know Has MS: A Book for Families (Copyright © National Multiple Sclerosis Society) Teen InsideMS (Copyright © National Multiple Sclerosis Society) When A Parent Has MS: A Teenager’s Guide (Copyright © National Multiple Sclerosis Society) Muscular dystrophyGrowing up, Staying Healthy, and Taking Charge (Copyright © MDA) With a Little Help From Your Friends (Copyright © MDA) NarcolepsyNeuroscience for Kids: Narcolepsy (Copyright © Eric H. Chudler) ObesityTake Charge of Your Health: A Teenager’s Guide to Better Health When Being Overweight is a Health Problem Healthy Eating: A Guide for Teens (Copyright © CYWH) The Bad Fats Brothers (Copyright © American Heart Association) Obsessive compulsive disorder (OCD) Polycystic ovary syndrome (PCOS)Polycystic Ovary Syndrome (PCOS): A Guide for Teens (Copyright © CYWH) Preparing for Your Oral Glucose Tolerance Test: A Guide for Teens with PCOS (Copyright © CYWH) Posttraumatic stress disorderCrime, Teens, and Trauma (Copyright © NCVC) (PDF - 145KB) PsoriasisCoping with Psoriasis (Copyright © National Psoriasis Foundation) Facts about Psoriasis (Copyright © National Psoriasis Foundation) National Psoriasis Foundation: For Teens (Copyright © National Psoriasis Foundation) Psoriasis and Dating (Copyright © National Psoriasis Foundation) Rett syndromeIntro to Adult Years (Copyright © IRSF) Rett Syndrome (Copyright © Autism Speaks) SchizophreniaChildhood Schizophrenia (Copyright © NARSAD) Schizophrenia (Copyright © The Annenberg Foundation Trust at Sunnylands) SclerodermaJuvenile Scleroderma (Copyright © Scleroderma Foundation) ScoliosisJust for Teens (Copyright © Adolescent Scoliosis Society of North America) Scoliosis: A Guide for Teens (Copyright © CYWH) What to Expect: Before and After Surgery (Copyright © Long Island Spine Specialists) Sickle cell anemiaSickle Cell Kids (Copyright © Grady Health System) Sickle Cell Slime-o-rama (Copyright © The Starlight Starbright Children's Foundation) Speech and language disordersiStutter (Copyright © La Trobe University) The Stuttering Foundation: Teens (Copyright © The Stuttering Foundation) Spina bifidaSpina bifida information for teens and young adults (Copyright © Children's Memorial Hospital) SPINAbilities: A Young Person’s Guide to Spina Bifida! (Copyright © SBA) Spinal cord injuryGoing Back to School: A Guide for Recently Injured Teens (Copyright © Shepherd Center) (PDF - 168KB) Zigawhat! (Copyright © NICHCY) StrokeHip Hop Stroke (Copyright © NSA) Neuroscience for Kids: The Blood Supply of the Brain (Copyright © Eric H. Chudler) Thyroid disease Tourette syndromeMatthew and the Tics (Copyright © TSA) Planet Tic! (Copyright © Danya International, Inc.) Tourette Syndrome Association for Young People Turner syndrome Ulcerative colitisCrohn's Disease and Ulcerative Colitis: A Guide for Children and Teens (Copyright © CCFA) UC and Crohn’s (Copyright © CCFA) Ulcers Williams syndrome |
