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|Wednesday, June 20, 2012
|Kids, Friends, and Physical Activity—Unraveling the Connections
|by Pediatric Perspectives at 09:37 AM
By William Stratbucker, medical director, Healthy Weight Center, Grand Rapids, Michigan
We know that a child’s peer group influences their behavior, particularly teenagers. If adolescents hang out with kids who engage in risky behavior, they are more likely to engage in such behavior themselves. We also learned about the influence of social networks on adult obesity in a 2007 landmark study published in The New England Journal of Medicine. In that study, researchers found that an individual’s chance of obesity increased 57% if they had a friend who also became obese; with increased risks of 40% for someone with an obese sibling and 37% for someone with an obese spouse. It is almost as if obesity were spread like a flu virus.
Now comes evidence that similar relationships occur between school-aged children. Researchers from Vanderbilt University collected data from elementary-school aged children participating in after-school care (mean age 7.86), mapping their social networks and physical activity levels.
They found that children’s friendships “heavily” influenced their level of physical activity. In fact, it was the greatest influence on the amount of time children spent in moderate-to-vigorous physical activity during those after-school hours, with kids changing their own levels to match those of their friends. However, children did not end their friendships with children who did not match their own activity levels, nor did they deliberately choose friends whose activity levels matched their own.
I found this study fascinating. If you think about it, it suggests that if you put a physically active kid in with a group of sedentary children, the risk is that the majority rules and the active kid becomes sedentary. Conversely, if you put an inactive kid in with a group of active kids, you might see that child become more active. The problem is that if you have an active kid at home but put him/her in after-school care with a bunch of inactive friends, there is the risk that the child will not be active during that time. Thus, it becomes even more important for instructors/leaders and parents to promote physical activity in such programs.
As pediatricians, we are always looking for more behavioral strategies to use when counseling families about healthy lifestyles. So this is an important study to share with parents. They should understand the influence a child’s peer group has on his/her physical activity levels. For instance, if they have a sedentary child they might want to consider signing him/her up for a team sport, where the child can make friends who are more physically active.
The study also shows the importance of the after-school environment in kids’ activity levels. This is an incredibly important time for kids to engage in physical activity during the school week. If this “break” time is filled with inactivity like screen time followed by homework children end up with no time for activity.
As you know, screen time during the school week is an enormous problem. Estimates are that most children spend 1 to 3 hours a day watching TV, playing video games, or on their computers, and that the amount of screen time is directly related to the risk of obesity.1
Thus, encouraging parents who need to put their children into an after-school environment, that it be one that encourages physical activity, is an important message for community pediatricians to convey.
William Stratbucker is medical director of the Helen DeVos Children’s Hospital Healthy Weight Center in Grand Rapids, Michigan.
How do you think parents can encourage their children to develop activities with more physically active children?
1. Marshall SJ, Biddle SJ, Gorely T, Cameron N, Murdey I. Relationships between media use, body fatness, and physical activity in children and youth: a meta-analysis. Int J Obes Relat Metab Disord 2004;28(10):1238-46.
|Tuesday, June 12, 2012
|Moms Oblivious to Overweight Toddlers: What It Means for Pediatricians
|by Pediatric Perspectives at 08:21 AM
By Tom Peterson, MD, Executive Director, Safety, Quality and Community Health, Helen DeVos Children's Hospital in Grand Rapids, Michigan
There are so many reasons for the obesity crisis in our kids that it’s hard to know where to start. But a recent study in the Archives of Pediatric and Adolescent Medicine is worth highlighting because it suggests a significant role for community pediatricians in at least one of those factors.
The study, by researchers from the University of Maryland and Johns Hopkins, was a cross-sectional analysis of a sample of low-income mothers and their toddlers. Researchers showed 281 mothers of toddlers (mean age 20 months, 11.9 to 31.9) silhouette pictures of children from 0 to the 100th weight-for-length percentile, then asked them which picture looked most like their child and which picture they wanted their child to look like.
Just one-third of the mothers chose the silhouette that accurately depicted their child’s body size. Seventy-three percent of the mothers who were inaccurate had children who were overweight compared to 35% of the mothers who were accurate (P<0.001), making them 87% less likely to accurately assess their child’s size. In addition, 82% of mothers with overweight toddlers were satisfied with their child’s size compared to a third of mothers with healthy weight children.
Given that parental perceptions of their child’s weight can be a key factor in the lifestyle choices they make for their family early in life, choices that that can contribute to child’s feeding behavior (such as exhorting children of a healthy weight to eat more), this study should raise our awareness of importance of parental perceptions of their child’s weight.
Plus, as the authors noted, it is hardly the first to document parental misperceptions of their child’s weight. However, it is the first to measure perceptions of parents of such young children. As you may know, there is good evidence that toddler weight predicts later weight.1
However, let’s not only blame parents for misperceptions of weight; pediatricians do it, too.2
This study and others like it highlight the need for objective data on the size of very young children and documentation at every well-child visit, rather than relying only on weight or only on appearance. The American Academy of Pediatrics recommends precisely this—assessing BMI in children 2 and older, and weight-for-length in younger children.
The study also highlights the need to share this information with parents and engage them in conversations about healthy lifestyles and diet, even those with very young children. Such discussions could improve the accuracy of parental perceptions of their child’s weight, as well as help parents identify opportunities to support a healthy weight in their children.
How do you routinely assess children’s body size/weight in your practice?
Tom Peterson, MD, is executive director of Safety, Quality and Community Health at Helen DeVos Children's Hospital in Grand Rapids, Michigan
1. Reilly JJ, Armstrong J, Dorosty AR, et al. Early life risk factors for obesity in childhood: cohort study. BMJ. 2005;330(7504):1357.
2. O'Brien SH, Holubkov R, Reis EC. Identification, evaluation, and management of obesity in an academic primary care center. Pediatrics. 2004;114(2):e154-159.
|Monday, June 04, 2012
|Making CT Scans Safer for Kids
|by Pediatric Perspectives at 10:24 AM
By Heather L. Borders, MD, pediatric radiologist, Helen DeVos Children’s Hospital, Grand Rapids, Michigan
There’s been a lot of concern lately about the amount of radiation received from CT scans. The issue is particularly concerning when it comes to children, however, because their brains and bodies are still developing.
We just published an article in the Journal of the American College of Radiology that highlights opportunities for children’s hospitals to make CT scans safer for children. I hope all pediatric radiologists and pediatricians will read it, and that you, as a community pediatrician, will bring it to the attention of your own pediatric imaging center.
The study began with a project I initiated as a pediatric radiologist here at Helen DeVos. I knew about studies highlighting high levels of radiation with CT scans, so I started collecting information on the CT dosage and outcomes in our imaging center. Back then, pediatric and adult radiology shared a facility as well as the radiology technicians.
When we moved into the new children’s hospital in 2011 and began working in our own dedicated pediatric imaging facility, I continued collecting that information on CT dosage. We had also reconvened our ALARA (As Low As Reasonably Achievable) committee, charged with monitoring the radiation dose in pediatric radiology to ensure the use of the safest possible amount; developing ways to reduce the dose even further; and educating healthcare professionals, patients and families about the importance of keeping the dose as low as possible.
The study we published compares radiation exposure before and after we moved into the new hospital. While the best amount of radiation is no radiation at all, we were surprised (and gratified) to find that the radiation dose in the new hospital was substantially lower than that provided in the old hospital. In fact, it was often equal to or even lower than the background radiation children are regularly exposed to each year. The dosages were also much more consistent than those used under the old set up in the shared facility.
We think the difference is due to the fact that we now have a dedicated pediatric imaging department with dedicated pediatric CT technologists. This has led to better compliance with pediatric protocols and consistently lower radiation doses.
This study raises several issues, however. One is that adult and pediatric imaging departments should re-evaluate their existing protocols for pediatric imaging and provide appropriate training to ensure adherence.
Another is that just because imaging centers can get the dosage so low doesn’t mean more kids should be imaged. It is very important that pediatricians first consider why they are ordering scans and how it will affect their management of the child. If there is any question, I urge you to call a pediatric radiologist and discuss it with them. There may be other tests that could provide similar information without exposing the child to any radiation.
We’re not resting on our laurels. Here at Helen DeVos we continue to track radiation dosages and protocol adherence every month to make sure we are doing the best job possible and exposing our kids to the lowest radiation dosage possible.
What protocols do you have in place for pediatric CT scans? Have you evaluated your dosages over time?
Heather L. Borders, MD, is a pediatric radiologist at Helen DeVos Children’s Hospital in Grand Rapids, Michigan