Practical Paediatrics Webinar Module 1 Handouts...4/12 ©Practical Paediatrics Anthropometry-at 3, 3.5 and 4 years Weight Height BMI ©Practical Paediatrics. 15/06/2016 14 Diet History

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Weight Management for Toddlers & Preschool Children

Christina Meade

Niamh Kelly

©Practical Paediatrics

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


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Discussing the topic of weight management

Parent Engagement

Acknowledge Fear


Centile charts

Positive Language

Change



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Engagement

Acknowledge Fear

Centile charts

Positive Language

Change



Discussing Weight Management

Useful Resources


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Poll Question 1

How many children under 5 years old have you seen for weight management in the last 6 months?

Possible answers:

• 0 – 5

• 5 -10

• > 10


Assessment

Background

Anthropometry Diet

Lifestyle

Nutritional Concerns

Goals


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Assessment: Background

Early feeding practices

Where do they spend most of their day?

Who are the main carers?

? Historical overfeeding

Social History


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


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Growth Charts – 0 to 4 years

UK WHO Growth Charts


Growth Charts – 2 to 18 years


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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


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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


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Mealtime

Shopping / Cooking

Meal pattern

Who is present

Screens / toysClean

Plate Policy/

Seconds

Access

Childcare

Play dates / parties


DrinksTypical 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


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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


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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


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Summary

Supportive non-judgemental approach - compliance

Anthropometry

Diet and mealtime environment

Focus on drinks and portion sizes


Case Study: 3 year old girl


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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

Weight Height

BMI


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Diet History

Breakfast (at home) Weetabix x 2 + sugar + low fat milk +/- toast + Juice

Mid morning (child-minders): Cheese strings + blueberries /choc covered raisins+ Water

Lunch (child-minders) Brown bread x 2 + butter + cheese + ham+ apple + yogurt

Mid afternoon (child-minders) Sweets + juice

Mid pm (child-minders) Sausage roll + toast + beans

Dinner (at home) Chicken curry + rice/ chicken breast + pasta + cheese+/‐ second portion

Before bed Toast + chocolate spread + juice

Daily treat x1 in child-minders – sweets

Daily treat x1 at home – ice cream \ biscuits


LifestylePhysical 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”


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Agreed Goals

↓portion sizes

↑ physical activity levels

List of healthy snacks provided

Food diary to highlight number of meals/snacks per day

Mum reports ↑ mo va on1. Daily walks with mum2. ↓por on sizes3. ½ portion of dinner in pm at home4. No second helpings at meals5. 5 day meal plan for child‐minder6. Treat 1/7 not everyday

Mum reported difficulty making changes 1. Christmas holidays2. Trip to Disneyland


Useful ResourcesAnthropometry Video clips

• http://www.hse.ie/eng/health/child/growthmonitoring

Communication and language

• http://www.hse.ie/eng/health/child/healthyeating/healthprofessionals/healthprofs.pdf

• David Coleman article

Portion sizes

• Food for young children: https://www.healthpromotion.ie/hp-files/docs/HPM00383.pdf

• An Bord Bia Nutrition for two to fives

When Sammy met Sally: www.safefood.eu


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Questions & Answers


Thank you for joining today’s Practical Paediatrics Webinar

A survey will follow shortly: we value your feedback

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Don’t forget to register for next webinar

Register at www.abbottnutrition.ie


Documents

Practical Paediatrics Webinar Module 1 Handouts...4/12 ©Practical Paediatrics Anthropometry-at 3, 3.5 and 4 years Weight Height BMI ©Practical Paediatrics. 15/06/2016 14 Diet History