Obesity Prevention in the Early Years:

[Guest guest]

Obesity Prevention in the Early Years:

An Expert Interview With Anita Berry, MSN,CNP, APN

Laurie Barclay, MD

April 27, 2010 — Editor's note: Obesity prevention should begin in the early

years, according to a study presented at the National Association of Pediatric

Nurse Practitioners 31st Annual Conference of Pediatric Health Care. The

conference, entitled Achieving Vision: Pediatric Health Care Beyond the

Millennium, was held in Chicago, Illinois from April 15 to 18.

To learn more about the cues that children give parents and caregivers regarding

hunger and satiation, and about how nurses can counsel parents to help reduce

at-risk eating and activity patterns in their children, Medscape Nurses

interviewed presenter Anita Berry, MSN,CNP,APN, director of the Healthy Steps

for Young Children Program at Advocate Health Care in Park Ridge, Illinois.

Medscape: How important are eating patterns established in childhood to the

development of obesity in later life?

Ms. Berry: Adults find that if they were told to " clean their plate " as a child,

because children in some other country were starving, and even if they

understand now that that particular food will never get to those starving

children, they still feel compelled to clean their plates. This shows how

important eating patterns are in early childhood.

In fact, during pregnancy, an unborn fetus can taste the variety of foods the

mother eats when swallowing the amniotic fluid. If they never taste vegetables,

they will be less likely to easily accept vegetables during their infancy. So

the importance of healthy eating really starts much earlier than early

childhood; it actually starts during the prenatal period. Most people are not

aware of this important information.

Medscape: How prevalent is childhood obesity, and what are its demographics?

Ms. Berry: Obesity has emerged as the number 1 health problem in the United

States. Data from the 1999–2002 National Health and Nutrition Examination Survey

(NHANES) showed that among children and teens aged 6 to 19, 16% (over 9 million)

were overweight, or triple what the proportion was in 1980. In 1970, 5% of

children aged 6 to 11 were overweight. Another 15% are considered at risk of

becoming overweight.

By ethnicity, overweight affects 22% of Mexican-American children, 20% of

non-Hispanic blacks, and 14% of non-Hispanic whites.

In the city of Chicago, the rates are much higher. Compared with national,

regional, and state rates, there are 2 to 3 times more obese children in Chicago

public schools at kindergarten entry.

Medscape: What cues do infants, toddlers, and preschoolers give parents and

caregivers regarding hunger and satiation?

Ms. Berry: Infants, toddlers, and preschoolers are always giving us cues — some

easy to pick up, and some more difficult. An infant's first language is through

baby cues. Each child has their own cues to signal hunger. In a child with

special needs, it may only be licking their lips. Another child might cry

loudly. Another might only fuss softly.

Depending on the parent/caregiver perception, they may respond to the child

differently. The child who cries loudly could be fed more frequently, whereas

the child who merely licks his lips may develop failure to thrive if his cues

are not responded to as often. Some universal signs are licking the lips,

sucking, opening the mouth wide, and trying to reach for food when they are

older. Some preschoolers are able to help themselves to what is in cabinets and

refrigerators.

When infants and toddlers are full, they generally spit food out, push it off

their tray, bang on their high chair tray, and turn their heads away from the

food. Parents and caregivers often still encourage " 1 more bite " or " 3 more

bites because you are 3. "

Many books tell parents that if your child cries, feed them. They don't suggest

that they look to see what else might be going on or to see when was the last

time that they ate. The child may need a diaper or position change or they may

want to be held. All of these things make a big difference in later outcomes.

Medscape: How can parents and caregivers best respond to these cues?

Ms. Berry: We need to learn to do a really good job of looking for the cues and

then listening to them as if the child already had a voice. We should understand

that their stomachs are very tiny, about the size of their own fist, and large

portions are not something they can handle. Toddlers often eat 1 good meal a

day. All their food needs to be nutritious, and if they are hungry, they will

eat whatever is served to them.

We also need to understand that we all have different temperaments. One child

may be able to sit at the table with the family for 20 minutes and another only

for 5 minutes. The child who sits for 20 minutes does not need to be eating that

entire time; they can enjoy just being with the family. The child who can sit

for only 5 minutes needs to get into their high chair after the food is totally

prepared and ready to eat.

Medscape: What are the warning signs of at-risk eating patterns?

Ms. Berry: Many cultures look at fat babies as healthy babies. This is not the

case. Children born into families that are struggling with being overweight or

who are obese have a more likely chance of having a problem. Families who eat a

lot of fast foods and are not cooking family meals at home are likely to have a

problem. How the family cooks can be problematic, [for example,] if they are

used to preparing a lot of fatty, fried foods.

The family's failure to recognize the child is having a problem by saying

something like " he is just stocky and he will grow out of it " is [also

problematic]. Skipping breakfast is a [bad idea] because children will be much

hungrier later and fill up. Having a lot of junk foods or foods with empty

calories around is a problem when they are accessible to children. Generally, it

is the parents' eating, shopping, and cooking habits that will make a huge

difference in the outcomes. Many families worry about the texture, color, taste,

and aroma of food, rather than nutritional value.

Medscape: How should pediatric nurses counsel parents regarding the detection

and management of at-risk eating patterns?

Ms. Berry: They should talk with all families and ask them if they have concerns

about their child's nutrition and weight. Nutrition should be a topic discussed

at each well-child visit, even when there is not a concern for obesity.

Pediatric nurses and nurse practitioners can make a huge difference in the lives

of children by giving parents anticipatory guidance on what they can expect a

young child to eat.

For example, tell the parent to give the child a nickel-sized amount of each

type of food (they will likely be given a quarter-sized amount) at a meal, and

when the child finishes all of that, then offer more. Often, the amounts of food

given to children are overwhelming for them.

Medscape: This has been tremendously informative. Is there anything else you

would like to add?

Ms. Berry: Most people are focusing on treating obesity. It is so important to

focus on preventing it because, as with anything, change is difficult and food

is a big issue in most people's lives. Meals are one of the areas where parents

struggle most. They should follow the simple rule that it is the parent's or

caregiver's job to offer timely, nutritious meals to young children. It is the

child's job to determine what and how much they will eat. When offered very

small amounts of a variety of foods, children will likely ask for more. Parents

should be aware not to get into power struggles over food.

Ms. Berry has disclosed no relevant financial relationships.