Friday, September 24, 2010

Obesity Part II: Early Prevention (Prenatal through Preschool)

Is there anything you can do to prevent obesity in your child? YES, YES, YES!

First, look at your child's risk factors. Family history is important. One study showed that a child born to an obese parent (or parents) has an 80% chance of becoming obese herself. There could also be diseases in the family which are influenced by obesity. These would include diabetes, high blood pressure, cardiovascular disease, and stroke.

Conditions during pregnancy, such as gestational diabetes and maternal smoking, may contribute to a child's difficulty maintaining a normal weight. Babies born small for gestational age may have a predisposition to glucose intolerance. Breastfeeding may help reduce the chance of obesity.

By assessing risk factors I don't mean to introduce more guilt in your life as a parent. We all have a family history, we all have our own health issues, complications occur in pregnancies, and not everyone can breast feed their baby! I know all of this. However, in preventing obesity and its related diseases from happening it is important to know what the risk is from the beginning.

Early in infancy it is important to feed your baby when he is hungry, and allow him to stop when he is full. Watch for signs of hunger such as rooting and crying. Listen for the cry that means hunger, versus the cry that means irritability or sleepiness. Feed your baby "on demand." If the baby just ate and seems to be acting hungry again try cuddling, soothing, swaddling, or a pacifier before offering another feeding. If your baby is bottle feeding, watch closely for signs of her being full. Don't try to get her to just finish that last ounce. If she stops sucking, lets milk pour out of her mouth, or pulls away and turns her head, recognize these as signs she has had enough. Hold your baby when you feed her a bottle. Never prop a bottle for a baby.

As your baby gets older and learns to smile and interact socially, you can try toys and other distractions to keep her happy when she is fussy but not really hungry. The more you interact with your baby, the more you will get to know her and understand what she needs. Often it will be hunger, but sometimes it will be boredom, fatigue, or loneliness that needs to be addressed.

TV is a very poor substitute for interaction with you. Children grow up in the presence of lots of media. They learn to be entertained, rather than to entertain themselves. They learn to be inactive, and to stop using their brains. Developing minds and bodies do not need TV. It does not benefit young children at all. Yes, babies will watch videos, and appear mesmerized and happy, but they aren't learning anything that will help them later. Instead they are learning from an early age to be what we all don't want to be--couch potatoes! Add snacks and beverages consumed while watching TV and we are thoroughly indoctrinating them into the inactive lifestyle led by many Americans. No TV at all until age 2 or older is the best way to go.

In the toddler years trouble spots for weight control seem to center around excessive juice, excessive milk, and "grazing." Grazing is allowing your child to nibble on things throughout the day. Usually these are foods like fishy crackers, cereal, fruit snacks, puffs, pretzels, and other foods that are mostly made up of carbohydrates. Sippy cups allow toddlers to walk around all day sipping on milk or juice. These practices cause lots of eating problems. Children can get too many calories from this constant sipping and nibbling. They never feel hungry, so then they don't eat well and are very picky at meal times. As soon as they are the slightest bit hungry they whine and cry about wanting food. To top it off, they even are learning to treat boredom (and possibly negative emotions) with food.

You can help your toddler control his weight, be less picky, and be hungry for meals by feeding three meals and two or three quality snacks ONLY per day. At other times the kitchen is CLOSED! Also, limiting milk to 16-20 oz. per day, and juice to 4-6 oz per day will help your cause. Make snacks count--serve fruits, cheese, yogurt sweetened with applesauce or fruit, vegetables, hard-boiled eggs, and more at snack time. Don't give your child anything else to drink other than milk, water, and a tiny bit of juice. Pop? Do you have to ask?

Allow your child to become hungry before meals, then serve the stuff that's good for him first! My sister-in-law always dished out big bites of broccoli to her kids and mine while they complained of hunger and the rest of the meal wasn't quite ready. Guess what? The broccoli (or peas, green beans, or carrots) was devoured by many picky little people who were also quite hungry!

Save the empty calories (fruit snacks, fishy crackers) for an occasional little treat, or a difficult part of the week (the check-out line at the grocery store). Allow your child to freely drink water from their sippy cup, and give the milk and juice at meal and snack time. Teach your child to drink milk and juice from a regular cup and ditch the sippy cup as soon as possible.

As your child gets older--into the preschool years--keep up the practice of three meals a day, and two snacks. Make your child what she likes to eat at breakfast and lunch. Then, at dinner (if this is your family meal) serve one meal to your family. Do not make your child a separate meal. A few items in your meal should be kid-friendly. You can always set out some fruit, or a bowl of applesauce. At first, aim for good table manners--no saying "yuck" or throwing or pushing the food off the plate. Your first goal is to get your child to tolerate the presence of the food in front of him. Then you work towards a taste of everything, and then a few bites (cut them very small and ask for three bites from a three year old, four bites from a four year old...) of a less desirable food. If your child leaves the table hungry, there is always tomorrow and a good breakfast around the corner. No guilt here--you served the food, it was your child's choice not to eat it.

Please consider avoiding fast food restaurants. If you can get the food at the drive through window I would really question its nutritional value. Watch the video Super Size Me. I have not taken my own kids to that fast food restaurant (and most others) since I watched that movie! Most toddlers (and definitely preschoolers) recognize the golden arches, and will happily eat a meal consisting of chicken nuggets and fries. But why develop those taste buds when you could be working on the taste buds that some day will hopefully enjoy salad, whole grains, fruits, and vegetables? Why cultivate a taste for fatty, high calorie, high salt food that is low in nutritional value?

Encourage free outdoor play. Allow your young child to run, climb, dig, race, throw and kick balls, twirl, swing, slide, swim, and be free outdoors. Limit time in front of the TV or any media screen to one hour a day on most days, and definitely no more than two hours a day. Try to have twice as much outdoor play time as time in front of the TV. Children under the age of two should not watch TV.
Children should have a minimum of one hour a day of very active play.

Take care of yourself, too. Are you eating healthy food? Exercising? Limiting your time in front of the TV? It is much easier to help your child be healthy if you are also living a healthy lifestyle.

I am trying to give you ideas to help keep your child at a healthy weight with a good level of fitness, to minimize the risk of obesity related diseases, and to promote better self-esteem and enjoyment in life. All of us are a work in progress, and this goal is something to work toward. I hope I have given you something to think about, and some practical ideas you can put to use. As always, the advice in my blog is quite general, and is not meant to substitute for more specifically tailored instructions from your own personal pediatrician! Good luck.

As far as resources I used--the same ones I sourced in my first Obesity blog (Part I) were used here, as well relying heavily on my own experience as a pediatrician in general practice.

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