Overweight and Obesity - a Real Emerging Childhood Concern .

 

        India has the second highest number of obese children in the world, according to a new study published in The New England Journal of Medicine. While India has 14.4 million of them, China tops the chart with 15.3 million obese children.

Preventing kids from becoming overweight means making choices in the way your family eats and exercises, and how you spend time together. Helping kids lead healthy lifestyles begins with parents who lead by example.

What Health Problems Can Obesity Cause?

        Obesity puts kids at risk for medical problems that can affect their health now and in the future. These include serious conditions like type 2 diabetes, high blood pressure, and high cholesterol — all once considered adult diseases.

Overweight and obese kids are also at risk for:

• bone and joint problems 
• shortness of breath that makes exercise, sports, or any physical activity more difficult. This also can make asthma symptoms worse or lead kids to develop asthma.
• restless sleep or breathing problems at night, such as obstructive sleep apnea
• a tendency to mature earlier. Overweight kids may be taller and more sexually mature than their peers, raising expectations that they should act as old as they look, not as old as they are. Overweight girls may have irregular menstrual cycles and fertility problems in adulthood.
• liver and gallbladder disease.

Cardiovascular risk factors (including high blood pressure, high cholesterol, and diabetes) that develop in childhood can lead to heart disease, heart failure, and stroke in adulthood. Preventing or treating overweight and obesity in kids may help protect them from these problems as they get older.

Obese kids also might have emotional issues to deal with (such as low self-esteem), and may be teased, bullied, or rejected by peers. Kids who are unhappy with their weight can be at risk for:

• unhealthy dieting and eating disorders
• depression
• substance abuse

How Are Overweight and Obesity Defined?

        Body mass index (BMI) uses height and weight measurements to estimate a person's body fat. But calculating BMI on your own can be complicated. An easier way is to use a BMI calculator.

On a standard BMI chart, kids ages 2 to 19 fall into one of four categories:

• underweight: BMI below the 5th percentile 
• normal weight: BMI at the 5th and less than the 85th percentile 
• overweight: BMI at the 85th and below 95th percentiles 
• obese: BMI at or above 95th percentile

For kids younger than 2 years old, doctors use weight-for-length charts instead of BMI to determine how a baby's weight compares with his or her length. Any child under 2 who falls at or above the 95th percentile may be considered overweight.

BMI is not a perfect measure of body fat and can be misleading in some cases. For example, a muscular person may have a high BMI without being overweight (extra muscle adds to body weight — but not fatness). Also, BMI might be hard to interpret during puberty when kids have periods of fast growth. Remember, BMI is usually a good indicator of body fat, but it's not a direct measurement.

If you're worried, take your child or teen to see the doctor. The doctor will ask about eating and activity habits and make suggestions on how to make positive changes. The doctor also may order blood tests to look for some of the medical problems associated with obesity.

Depending on your child's BMI (or weight-for-length measurement) and health, the doctor may refer you to a registered dietitian or a weight management program.

Why Do Kids Become Overweight or Obese?

    A number of things contribute to a person becoming overweight. Diet habits, lack of exercise, genetics, or a combination of these can be involved. In some instances, too much weight gain may be due to an endocrine problem, genetic syndrome , or some medicines.

Diet and Life style

     Much of what we eat is quick and easy — from fat-filled fast food to processed and prepackaged meals. Daily schedules are so busy that there's little time to make healthier meals or to squeeze in some exercise. Portion sizes, in the home and out, are too large.

Plus, modern life is sedentary. Kids spend more time playing with electronic devices than actively playing outside. Kids who watch TV more than 4 hours a day are more likely to be overweight compared with kids who watch 2 hours or less. And kids who have a TV in the bedroom also are more likely to be overweight.

Exercise and Physical Activity;

     Many kids don't get enough physical activity. Older kids and teens should get 1 hour or more of moderate to vigorous exercise every day, including aerobic and muscle- and bone-strengthening activities. Kids ages 2 to 5 years should play actively several times each day. 

Genetics

     Genetics can play a role in what kids weigh. Our genes help determine body type and how the body stores and burns fat. But genes alone can't explain the current obesity crisis. Because both genes and habits are passed down from one generation to the next, multiple members of a family may struggle with weight.

People in the same family tend to have similar eating patterns, levels of physical activity, and attitudes toward being overweight. A child's chances of being overweight increase if one or both parent is overweight or obese.

How Can We Prevent Overweight and Obesity?

        The key to keeping kids of all ages at a healthy weight is taking a whole-family approach. Make healthy eating and exercise a family affair. Get your kids involved by letting them help you plan and prepare healthy meals. Take them along when you go grocery shopping. Teach them how to make good food choices.

Try to avoid these common traps:

• Don't reward kids for good behavior or try to stop bad behavior with sweets or treats. Find other ways to change behavior.
• Don't have a clean-plate policy. Even babies turn away from the bottle or breast to send signals that they're full. If kids are satisfied, don't force them to keep eating. Reinforce the idea that they should only eat when they're hungry.
• Don't talk about "bad foods" or completely ban all sweets and favorite snacks. Kids may rebel and overeat forbidden foods outside the home or sneak them in on their own. Serve healthy foods most of the time and offer treats once in a while.

Recommendations by Age 

Additional recommendations for kids of all ages:

• Birth to age 1: Besides its many health benefits, breastfeeding may help prevent excessive weight gain.
• Ages 1 to 5: Start good habits early. Help shape food preferences by offering a variety of healthy foods. Encourage kids' natural tendency to be active and help them build on developing skills.
• Ages 6 to 12: Encourage kids to be physically active every day, whether through an organized sports team or a pick-up game of soccer during recess. Keep your kids active at home with everyday activities like playing outside or going for a family walk. Let them be more involved in making good food choices, such as packing lunch.
• Ages 13 to 18: Teach teens how to prepare healthy meals and snacks at home. Encourage them to make healthy choices when outside the home and to be active every day.
• All ages: Cut down on TV, phone, computer, and video game time and discourage eating in front of a screen (TV or otherwise). Serve a variety of healthy foods and eat family meals together as often as possible. Encourage kids to eat breakfast every day, have at least five servings of fruits and vegetables daily, and limit sugar-sweetened beverages.

Talk to kids about the importance of eating well and being active. Be a role model by eating well, exercising regularly, and building healthy habits into your own daily life. Make it a family affair that will become second nature for everyone.

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Fevers-When to Alarm.

        All kids get a fever from time to time. A fever itself usually causes no harm and can actually be a good thing — it's often a sign that the body is fighting an infection.

But when your child wakes in the middle of the night flushed, hot, and sweaty, it's easy to be unsure of what to do next. Should you get out the thermometer? Call the doctor?Here's more about fevers, including when to contact your doctor.

What Is a Fever?

        Fever happens when the body's internal "thermostat" raises the body temperature above its normal level.Most people's body temperatures change a little bit during the course of the day: It's usually a little lower in the morning and a little higher in the evening and can vary as kids run around, play, and exercise.

What Causes Fevers?

      It's important to remember that fever by itself is not an illness — it's usually a sign or symptom of another problem.

Fevers can be caused by a few things, including:

Infection:  

       Most fevers are caused by infection or other illness. A fever helps the body fight infections by stimulating natural defense mechanisms.

Overdressing:  

        Infants, especially newborns, may get fevers if they're overbundled or in a hot environment because they don't regulate their body temperature as well as older kids. But because fevers in newborns can indicate a serious infection, even infants who are overdressed must be checked by a doctor if they have a fever.

Immunizations:      

        Babies and kids sometimes get a low-grade fever after getting vaccinated.Although teething may cause a slight rise in body temperature, it's probably not the cause if a child's temperature is higher than 100°F (37.8°C).

When Is a Fever a Sign of Something Serious?

        In healthy kids, not all fevers need to be treated. High fever, though, can make a child uncomfortable and make problems (such as dehydration) worse.

Doctors decide on whether to treat a fever by considering both the temperature and a child's overall condition.

        Kids whose temperatures are lower than 102°F (38.9°C) often don't need medicine unless they're uncomfortable. There's one important exception: If an infant 3 months or younger has a  temperature of 100.4°F (38°C) or higher, call your doctor or go to the emergency department immediately. Even a slight fever can be a sign of a potentially serious infection in very young babies.

        If your child is between 3 months and 3 years old and has a fever of 102.2°F (39°C) or higher, call to see if your doctor needs to see your child. For older kids, take behavior and activity level into account. Watching how your child behaves will give you a pretty good idea of whether a minor illness is the cause or if your child should be seen by a doctor. 

The illness is probably not serious if your child:

• is still interested in playing
• is eating and drinking well 
• is alert and smiling at you 
• has a normal skin color 
• looks well when his or her temperature comes down 

And don't worry too much about a child with a fever who doesn't want to eat. This is very common with infections that cause fever. For kids who still drink and urinate (pee) normally, not eating as much as usual is OK. 

Is it a Fever?

        A gentle kiss on the forehead or a hand placed lightly on the skin is often enough to give you a hint that your child has a fever. However, this method of taking a temperature (called tactile temperature) won't give an accurate measurement.

Use a reliable digital thermometer to confirm a fever. It's a fever when a child's temperature is at or above one of these levels:

• measured orally (in the mouth): 100°F (37.8°C)
• measured rectally (in the bottom): 100.4°F (38°C)
• measured in an axillary position (under the arm): 99°F (37.2°C)

        But how high a fever is doesn't tell you much about how sick your child is. A simple cold or other viral infection can sometimes cause a rather high fever (in the 102°–104°F/38.9°–40°C range), but this doesn't usually mean there's a serious problem. In fact, a serious infection, especially in infants, might cause no fever or even a low body temperature (below 97°F or 36.1°C).

           Because fevers can rise and fall, a child might have chills as the body's temperature begins to rise. The child may sweat to release extra heat as the temperature starts to drop.

        Sometimes kids with a fever breathe faster than usual and may have a faster heart rate. Call the doctor if your child has trouble breathing, is breathing faster than normal, or is still breathing fast after the fever comes down.

How Can I Help My Child Feel Better?

        Again, not all fevers need to be treated. In most cases, a fever should be treated only if it's causing a child discomfort.

Here are ways to ease symptoms that often accompany a fever:

Medicines;

        If your child is fussy or uncomfortable, you can give acetaminophen(paracetamol) or ibuprofen based on the package recommendations for age or weight. (Unless instructed by a doctor, never give aspirin to a child due to its association with Reye syndrome, a rare but potentially fatal disease.) If you don't know the recommended dose or your child is younger than 2 years old, call the doctor to find out how much to give.

        Infants younger than 2 months old should not be given any medicine for fever without being checked by a doctor. If your child has any medical problems, check with the doctor to see which medicine is best to use. Remember that fever medicine can temporarily bring a temperature down, but usually won't return it to normal — and it won't treat the underlying reason for the fever.

Home Comfort Measures;

         Dress your child in lightweight clothing and cover with a light sheet or blanket. Overdressing and over bundling can prevent body heat from escaping and can cause the temperature to rise.

Make sure your child's bedroom is a comfortable temperature — not too hot or too cold.

While some parents use lukewarm sponge baths to lower fever, this method only helps temporarily, if at all. In fact, sponge baths can make kids uncomfortable. Never use rubbing alcohol (it can cause poisoning when absorbed through the skin) or ice packs/cold baths (they can cause chills that can raise body temperature).

Food and Drinks;

         Offer plenty of fluids to avoid dehydration because fevers make kids lose fluids more rapidly than usual. Water, soup, ice pops, and flavored gelatin are all good choices. Avoid drinks with caffeine, including colas and tea, because they can make dehydration worse by increasing urination (peeing).

If your child also is vomiting and/or has diarrhea, ask the doctor if you should give an electrolyte (rehydration) solution made especially for kids. You can find these at drugstores and supermarkets. Don't offer sports drinks — they're not made for younger children and the added sugars can make diarrhea worse. Also, limit your child's intake of fruits and apple juice.

In general, let kids eat what they want (in reasonable amounts), but don't force it if they don't feel like it.

Taking it Easy;

         Make sure your child gets plenty of rest. Staying in bed all day isn't necessary, but a sick child should take it easy.

It's best to keep a child with a fever home from school or childcare. Most doctors feel that it's safe to return when the temperature has been normal for 24 hours.

When Should I Call the Doctor?

        The exact temperature that should trigger a call to the doctor depends on a child's age, the illness, and whether there are other symptoms with the fever.

Call your doctor if you have an:

• infant younger than 3 months old with a  temperature of 100.4°F (38°C) or higher 
• older child with a temperature of higher than 102.2°F (39°C)
• refuses fluids or seems too ill to drink adequately 
• has lasting diarrhea or repeated vomiting 
• has any signs of dehydration (peeing less than usual, not having tears when crying, less alert and less active than usual)
• has a specific complaint (like a sore throat or earache)
• still has a fever after 24 hours (in kids younger than 2 years old) or 72 hours (in kids 2 years or older)
• is getting fevers a lot, even if they only last a few hours each night
• has a chronic medical problem, such as heart disease, cancer, lupus, or sickle cell disease
• has a rash
• has pain while peeing

Get emergency care if your child shows any of these signs:

• crying that won't stop
• extreme irritability or fussiness
• sluggishness and trouble waking up
• a rash or purple spots that look like bruises on the skin (that were not there before your child got sick)
• blue lips, tongue, or nails
• infant's soft spot on the head seems to be bulging out or sunken in
• stiff neck
• severe headache
• limpness or refusal to move
• trouble breathing that doesn't get better when the nose is cleared
• leaning forward and drooling
• seizure
• moderate to severe belly pain

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