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Healthy kids

Everybody has a role to play

By Annie Young, D.O.

Every day, parents have to make choices about what is best for their children. This means making sure their choices will promote both optimal emotional and physical health so their children are better able to face life’s challenges and make good choices.

Parents, pediatricians, teachers and other specialists/clinicians all have a role and must work together to promote a child’s well-being. Based on a partnership of mutual responsibility and trust, clinicians can help the child and family focus on issues such as nutrition, safety, early literacy and mental health. In this way, the whole child, or total health, is considered. As a clinician seeing the challenges children face day in and day out, I invite you, parent or not, to play a role in shaping the futures of our kids. ¡Nos incumbe a todos! It’s everyone’s responsibility!

Here’s how:

  • Consider your pediatrician as a partner in your child’s overall success
  • Get to know and embrace the “medical home” concept
  • Get educated and empowered to ask questions of your medical professionals
  • Advocate for all of Arizona’s children by challenging schools, lawmakers and voters to review how we can make all of our systems more efficient and effective

Consider pediatricians partners in your child’s success. We are the “medical home” for all things related to health and wellness for a child. This is where evidence-based decisions are made – a one-stop shop of sorts that can coordinate all issues that may arise in childhood.

Start early. Children achieve 90 percent of their brain development in the first five years of life, so it is critical that parents actively engage early on, spending quality time together, reading and exploring, to ensure a high level of learning along with developing important relationship and communication skills that  serve to support self-esteem and other intrapersonal skills.

As medicine moves toward this integrated health-care model, pediatricians and clinicians are working as a team to address the entire scope of a child’s needs. Oftentimes, this means educating the parents on how to keep their child well or get them back on track. Cultural differences require different approaches or suggestions.

The only way to break down cultural barriers is for both the parent and physician to ask important questions and share how your family or culture might look at a particular health issue. Language barriers, education levels and inability of parents to fully explain what their concerns are can sometimes hinder a physician and other providers from offering optimal care. Physicians need to do their part to dig a little deeper, and the family needs to help the pediatrician understand so that he, or she, can get to the root of the problem. Otherwise, issues can be under-diagnosed or missed completely. 

Much is at stake because parents and clinicians alike have the ability to initiate healthy habits and practices in children during their formative years before the bad habits settle in. The entire family has to be on board. 

Parents with poor dietary and exercise habits contribute to unhealthy children, setting up a wide range of health issues and often life-long struggles. Strong role modeling on the part of parents and additional support from the schools to reinforce good habits are critical.

Most of my visits with families are spent discussing healthy meal options and alternatives that can be used every day. Eliminating liquid calories and switching to low-fat milk is one of my biggest battles. The discussion has to be tailored to focus on the nutritional habits specific to the family’s culture. For example, some cultures eat more carbohydrates, such as tortillas, beans, cactus (nopales) and rice. Others focus on higher-fat content with pork products, as well as rice, beans and bread. 

The parents’ daily decisions on what to feed their child or how to engage them in active recreation will have the most significant impact on their health and future well-being. A simple choice for the morning meal between eating a large bagel or some sugary cereal product versus opting for quality protein, such as scrambled eggs, can impact a child’s ability to learn and perform well in school and on tests.

Many pediatricians will affirm that parents are often the biggest obstacle;  they often do not accept that their child is overweight. Yet the statistics don’t lie; Arizona posted the biggest increase in the prevalence of childhood obesity of all states between 2003 and 2007.

Pediatricians are already seeing significant incidences of cardiovascular disease even in kids as young as 5 years old. Type-2 diabetes is showing up in children, the  kind of diabetes once called “adult-onset.” Children are being diagnosed as obese even before they step foot into kindergarten. The American Academy of Pediatrics (AAP) says that about 20 percent of obese four-year-olds will grow up to become obese adults. That figure rises to 80 percent among teenagers who are overweight. These children are more likely to have high blood pressure, joint problems and greater risk of death as their weight increases. 

The Arizona Chapter of AAP advocates parents follow the “5-2-1-0 rule.  This means getting kids to eat 5 servings of fruits and vegetables a day (a serving could mean a medium apple or a handful of mini-carrots); spend less than 2 hours in front of a screen including computers and video games; spend at least 1 hour a day being physically active; and limit sugary drinks to 0 a day. You can embrace this simple rule along with your kids and the entire family will benefit. More information is available at azwaytogo.org.

Just as quality foods play a role in a child’s health, so too do immunizations. There may not be any issue we advocate more for on any given day than immunizations. Recent outbreaks of polio, measles and epidemic rates of pertussis (also known as whooping cough, including one death in Arizona this past year) demonstrate that all children should be vaccinated according to the immunization schedule available at the CDC website (cdc.gov). 

Mental health and abuse problems are now more prevalent on our list of issues to address. Our offices are often making referrals for community resources and services to help a parent facing any number of needs – from abuse and bullying to access to food or dental care – all of which might keep a child from growing and performing well. While we know that our schools are focused on the education of our children, establishing good habits in early childhood sets kids up for success. 

Pediatricians are often the first and only professional a family sees or talks with before the child starts school. That’s why more than 800 Arizona pediatricians voluntarily incorporate AzAAP’s early literacy program, Reach Out and Read Arizona, at each well-child visit. This proven program involves the physician talking to parents about the importance of reading to their child daily to impart crucial language skills. Pediatricians supply children, aged six  months to five years old, with a free, developmentally-appropriate book to keep for a period of 10 well-child visits. Only 43 percent of Arizona parents read to their kids daily. 

Keeping your child physically safe is another component when considering the whole child. Pediatricians talk about booster seats, water safety, wearing sunscreen, firework safety, using helmets when out riding bikes – but we can’t be there when those things are happening. Parents must be diligent through all phases of their child’s life.

In Arizona, drowning continues to be a leading cause of injury-related death for children between the ages of one and five years old, according to the Drowning Prevention Coalition. Adult supervision is the best way to a prevent drowning. 

Being a good role model is another important factor. Are you showcasing how to treat all people with respect? It may start with “please” and “thank you,” but also include how you speak to, and about, those you disagree with. Bullying, which affects about 10 percent of our kids, is a significant issue in our schools when their focus should be on reading, writing and arithmetic. Parents can be models for critical relationship behaviors, as well as monitor their child’s online activities, which can impact both emotional and physical development. Visit stopbullying.gov for more information. 

Besides parents and pediatricians, teachers, lawmakers, grandparents and average citizens can make a difference in the lives of our children. Your understanding and investment in improving our state systems for effectiveness and efficiency is needed. As doctors, we invite you to learn more about the importance of the medical home, to increase your understanding of how you play a role in your, or any, child’s health and wellness, and to partner with your pediatrician to create a bright future for our kids.

Dr. Anne Young is an Arizona native and pediatrician at Valle del Sol in Central Phoenix. She completed medical school at Midwestern University in Glendale and residency in Savannah, Ga. She is a member of the Arizona Chapter of the American Academy of Pediatrics. Her interests include obesity and nutrition, autism and diabetes.

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This Article appears on the December 2012 issue of LPM under Health

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