Practical Paediatrics. Awareness of approaches to discussing weight management with parents

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1 Weight Management for Toddlers & Preschool Children Christina Meade Niamh Kelly Learning Outcomes Awareness of approaches to discussing weight management with parents Build on your skills collecting, plotting, interpreting and explaining anthropometry Understand the key areas to focus on for weight management in this age group 1

2 Discussing the topic of weight management Parent Engagement Acknowledge Fear Discussing the topic of weight management Centile charts Positive Language Change 2

3 Engagement Discussing the topic of weight management Acknowledge Fear Centile charts Positive Language Change Discussing Weight Management Useful Resources 3

4 Poll Question 1 How many children under 5 years old have you seen for weight management in the last 6 months? Possible answers: > 10 Assessment Anthropometry Diet Background Nutritional Concerns Lifestyle Goals 4

5 Assessment: Background Early feeding practices? Historical overfeeding Social History Where do they spend most of their day? Who are the main carers? Assessment: Anthropometry <2years old: Nude Baby scales for weight Supine length on measuring mat > 2 years old: Light indoor clothing, no shoes, remove hair accessories Weight on electronic calibrated scales Height on appropriate stadiometer 5

6 Growth Charts 0 to 4 years UK WHO Growth Charts Growth Charts 2 to 18 years 6

7 Growth Charts - Castlemeade BMI Charts For children < 2 years - serial measurements For children > 2years calculate the BMI Overweight (on BMI chart ): 91st 98th centile Obesity (on BMI chart ): > 98th centile Waist Circumference 7

8 Poll Question 2 Do you routinely measure waist circumference in children? Possible answers Yes No Assessment - Diet Diet history Food frequency questionnaire Specific questions Weekends Takeaways Snacks Total milk intake Total juice intake Other drinks Treats Supplements 8

9 Shopping / Cooking Play dates / parties Meal pattern Childcare Mealtime Who is present Access Clean Plate Policy/ Seconds Screens / toys Drinks Typical drinks in this age group Juice, Flavoured milk, Capri Sun limited nutritional value appetite for other foods contribute to excessive weight gain preference for sweet tastes contribute to tooth decay. Practical tips Know the sugar content of the common drinks Model the sugar content of drinks Existing resources Simple resources 9

10 Portion Sizes No consensus for <5yrs Portions should be individualised for the child Demonstrate portion sizes Pictures - Use existing resources Use child sized plate Weigh out a portion size Coloured Plate Use a disposable plastic cup Plastic food models Assessment - Lifestyle Physical Activity Key Q s - Do parents consider their child to be physically active? - Are there planned activities? - How do they get to crèche, pre-school etc - How many minutes activity per day? Screen Time Explain that it - Displaces activity - Disturbs sleep - Lead to passive over-consumption of calories 10

11 Nutritional Priorities Support growth and development Calcium Iron Vitamin D Micronutrients Goals Motivators SMART A couple of goals diet /mealtime environment, activity, screens Provide individualised meal plans Family goal setting and self monitoring Contract 11

12 Summary Supportive non-judgemental approach - compliance Anthropometry Diet and mealtime environment Focus on drinks and portion sizes Case Study: 3 year old girl 12

13 Background Family History Hypertension Diabetes Obesity Birth History Born 38/40 Birth weight 3.2kg No early feeding issues Social History At home with parents 1 x sister 4 years old Comorbidities Breathlessness Previously attended PHN regarding increased weight at 4/12 Anthropometry- at 3, 3.5 and 4 years BMI Weight Height 13

14 Diet History Breakfast (at home) Mid morning (child-minders): Lunch (child-minders) Mid afternoon (child-minders) Mid pm (child-minders) Dinner (at home) Before bed Weetabix x 2 + sugar + low fat milk +/- toast + Juice Cheese strings + blueberries /choc covered raisins+ Water Brown bread x 2 + butter + cheese + ham+ apple + yogurt Sweets + juice Sausage roll + toast + beans Chicken curry + rice/ chicken breast + pasta + cheese +/ second portion Toast + chocolate spread + juice Daily treat x1 in child-minders sweets Daily treat x1 at home ice cream \ biscuits Lifestyle Physical activity Parents report child to be physically active No planned activities < 60 minutes physical activity per day Refuses to walk Requests the buggy Needs encouragement when out playing Screen Time Daily screen time ~ 1.5 hours at home + at child-minders Described as Would watch TV all day if she was allowed 14

15 Agreed Goals portion sizes physical activity levels List of healthy snacks provided Food diary to highlight number of meals/snacks per day Mum reported difficulty making changes 1. Christmas holidays 2. Trip to Disneyland Mum reports mo va on 1. Daily walks with mum 2. por on sizes 3. ½ portion of dinner in pm at home 4. No second helpings at meals 5. 5 day meal plan for child minder 6. Treat 1/7 not everyday Useful Resources Anthropometry Video clips Communication and language hprofs.pdf David Coleman article Portion sizes Food for young children: An Bord Bia Nutrition for two to fives When Sammy met Sally: 15

16 Questions & Answers Thank you for joining today s Practical Paediatrics Webinar A survey will follow shortly: we value your feedback 16

17 Don t forget to register for next webinar Register at 17

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