Recommendations for Weight Management in Children and Adolescents

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It is important you follow and are aware of your child’s yearly height and weight assessments. This allows a body mass index (BMI) to be calculated. If your child’s BMI is > 95% than he is severely over weight. Another term for this is obese but be cautious when this term is used. It is very important not to instill fear or a feeling of hopelessness when discussing weight issues. If he is between the 85% and the 95% he is overweight. If your child is in either of these categories an assessment by your pediatrician is needed and a decision must be made whether intervention is necessary.

The quality of every meal your child eats should be evaluated. Quantity and portion size are important but quality is just as important. Limit eating outside of your home, always eat breakfast, encourage family meals and avoid all sugar or artificially sweetened drinks. Eating whole fruit is much healthier than drinking juice. Make certain your child is eating a high fiber diet based on low caloric density that is high in fruits and vegetables. Avoid excessive consumption of foods that are high in energy density such as fat and protein.

Look at the environment your child lives in. Does it support a healthy dietary intake and an active lifestyle? Are there environmental or social barriers to physical activity? Is there excessive unbalanced media exposure to a diet high in unhealthy foods? Is adequate time spent every day away from sedentary activities such as television watching, video games and computer use?

Goals should include five or more servings per day of fruits and vegetables, less than two hours per day of screen time, one or more hours per day of moderately strenuous physical activity, no electronic devices in the bedroom and no sugar or artificially sweetened beverages.

A family history of obesity, heart disease, stroke and type 2 diabetes is important. If there is a history in your family of one or more of these then added attention to your child’s growth, activity level and dietary intake is essential. Special testing may also be required.

As a parent you must disengage from many of the minor food and activity decisions. Your child must be encouraged and allowed to self-regulate both food intake and daily exercise. This does not mean you do not discuss guidelines but rather establish a setting where success is easier to achieve and healthy choices become easier to make.

If routine interventions are unsuccessful then structured weight management protocols should be pursued under the direction and guidance of your pediatrician. This will include determination of the components of a healthy diet as well as structuring of daily meals and snacks. Activity time will also need to be supervised and screen time decreased to less than one hour per day. Structured behavior modification programs can also be used.

Room 101

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I had not thought about Room 101 for many years.  This room changed me.  The children who entered 101 every school day taught me how humility, acceptance and giving are our greatest gifts.  This past Easter weekend a teenage patient of mine who spoke with smiles and laugher passed away.  The joy of his life and the power of his resurrection made me think about Room 101.

In high school I volunteered and worked in a classroom for children with severe cerebral palsy. I became familiar with neuromuscular disorders and all types of assist devices. Tables, chairs, wheelchairs, standing boards, communication devices and all types of adapted feeding equipment became my stock and trade. What I learned most, however, was the power of touch.

We had many visitors to our room. College students often observed. Most visitors watched silently. A few asked questions and almost everyone smiled seemingly overwhelmed by the physical disabilities they saw. I remember one day someone asked me: “Is it hard to work with these children?” I shook my head and went back to feeding a snack to one of my friends.

As an aide my job was to run the changing room and keep all the children clean and dry. Throughout the day I changed diapers and after lunch and snack would spruce them up. I became a master of diapers and bibs.  When I told my friends what I did most would say: “I couldn’t do that.”

Throughout college and medical school I continued to work with special needs children. I supervised playgrounds, worked in a daycare and during my last year of medical school taught summer school in a class of special needs children. The children and parents I worked with during these many years taught me more than any book or teacher.

Children with special needs do come into the world wanting to bring sorrow or pity.  They do not want us to look away, talk softly and live in the past. They want us to laugh, dance, love and live life with them. I believe they are our greatest teachers and our greatest treasures.

The Crosswalk

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You could see how much he loved her.

One of my greatest teachers taught me parenting is about teaching by example and learning how to follow your child’s lead. I have read countless books about the importance of modeling and being attentive, responsive attuned and sensitive to the needs of your child. Yet, it took an encounter on a crosswalk for me to understand the real meaning of these words.

My wife and I were driving into town this week to go dancing. We were talking about dance leads and how we communicate our various dance moves through touch and hand movements.  Lady Gaga was playing on the car stereo while we were stopped at a light. I looked ahead and there they were, father and daughter. A tall muscular man with broad shoulders was holding his daughter’s hand as they crossed the street.  They smiled, laughed and looked at one another. In the car our music played and the winter wind blew but I swear I heard them squeal with delight. Their eyes gleamed as they shook their heads back and forth as if saying “no I am right” to one another.

It was not so much the gentle way his large hand carefully encased and caressed hers or how his arm stretched and his knees bent to allow their hands to meet. Rather, it was the way the world compacted into a small container of two beings, he and his daughter. Certainly, he was aware of the stop-light, the cars, the blowing wind and the upcoming curb but all of these were transient and disappeared within his daughters grasp.

He looked at her and she at him. They talked, giggled and danced across the street almost floating until she hopped up on the curb. Just then he turned and gave me a thankful nod for giving them extra time to cross. As he smiled so did I while watching them hand in hand dance away.

As a parent you will have countless opportunities to tell your child what to do, when to do it and why to do it. Yet, no matter how numerous these opportunities are they always come to an end. Each of us must replace this telling with listening and showing just as this father did. In this way lessons learned by your example, your voice, your touch, your patience and your loving support will never end.

Parenthood is a dance. As my wife and I pulled away from that street corner and a new song came on the stereo I realized each of us dance best when we remember how our leads change forever the lives of the children we touch.

Parent Self-Care

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When a child is born all eyes focus on him. His beautiful eyes, the softness of his skin, the curls in his hair and the warmth of his embrace. When your infant snuggles into the crook of your neck the world disappears and all you see and hear is your child. Whether a product of our genes or emotional drives this focus drives a parent to protect a child who is unable to protect or nourish themselves. Without your love, affection and attention he could not survive. This is one of the reasons why he responds to your care and love. He not only wants you he needs you.

From the moment of birth your infant’s behavior shapes your life.  Your drives and their behavior force you to attend and respond to them.  This is good.  As parent you want to feel attached and needed by your newborn. A problem arises, however, when you allow this desire to override the respect you have for yourself and the pursuit of your own needs.

As a new parent you must learn to recognize, understand and respond to the needs of your infant. By doing so, you will allow him to begin his lifelong journey of self-discovery.  During his life your encouragement will allow him to develop a sense of self, a sense of others and eventually pursue the question of who he is and what he can do.  This passionate pursuit of what inspires him can only happen, however, if he is taught to be recognized and pursue his own needs.

Parents usually neglect their own and their spouse’s needs while caring for their new child. This places them at risk to undermine the goal they seek. Every parent wants their child to grow up with the self-awareness and strength to find their own place in the world. To have the ability to maintain relationships built out of mutual cooperation and respect. As an infant your child learns how to interact with all the people and things around him. Just as he is preparing himself for the future so to must you. As he moves into the toddler years he will begin to assert his own decision making and you must be there ready to help him with guidance and teaching. To set an example for him you must not allow your own self-care to evaporate under the heat of his needs. You must not neglect your needs or you will be unable to provide the independence and self-care modeling necessary for your toddler and his later years.  Your child learns most from watching you. He must from the earliest age believe that you provide him safety and security without losing yourself within the life of another.

You and your spouse must continue to chase your passions. You both deserve this.  Seek what inspires you beyond the touch, sight and sound of your infant. To do less results in a sense of loss and anger.  This anger cannot be directed at your new infant and so it is redirected to oneself or someone else, including your spouse.  When a parent stops performing self-care she justifies it as a necessary requirement of parenthood .  Yet, deep within, they mourn at the loss of self. Mothers and fathers often feel selfish when they think about the independence they have given up. This remorse is normal and expected. What you cannot do is stop your pursuit of self-care. Every parent must continue to seek the time and the opportunities to continue their own life journey. Look to the arts and to nature to help you see the magnificence of the world around you. Rent a video and make yourself your favorite dinner. Read a new book or start a new hobby. Call an old friend, go for a walk in the park, start a scrapbook or take up a new sport. Eat healthy, stay physically active, get your sleep and find someone to talk to who will listen to you non-judgmentally.

Parent self-care is best for both you and your child.