Author: Susan Laster, MD

Managing childhood obesity in primary care: The BMI conversation

obese child on monkey bars childhood obesity
(Rob Hainer/Shutterstock)

When a previously healthy-weight child comes in with a high body mass index (BMI) — especially above the 85 percentile — the ensuing discussion can be one of the most delicate conversations we have with our families. We need to open a dialog in a way that won’t alienate the parent or child so they will feel comfortable returning for this problem.

If this is the first conversation about a BMI problem, my main goal is to identify why the child’s weight has increased (Change in diet? Change in exercise?) and suggest changes in ways that encourage the patient to return in a month. I try to balance the conversation with information, understanding and hope, pointing out that making some changes over the next month may make a difference.

But how do you find an opening to get the conversation started? …Read More

Preventing childhood obesity is all about communication

childhood obesity warning sign conversation
(Gustavo Frazao/Shutterstock)

Much of pediatric care focuses on prevention. Pediatricians generally understand how to prevent communicable diseases (by vaccinating) and injuries (periodic guidance around safety). But current pediatric practice also demands prevention of more chronic diseases. Some, like asthma, have good prevention guidelines. But one chronic disease that seems hard to prevent is obesity.

Childhood obesity is a multi-factorial disease that is poorly understood and has different etiologies in different children. Seen through another lens, however, obesity prevention is a matter of understanding how a person takes in energy (eats) and uses up energy (exercise and activity) and running a household that promotes healthy “energy” habits. Obviously, if that were easy to do, we would all do it. So, as pediatricians we must strive to help families create homes that promote healthy eating and exercise.

But, how can a pediatrician help a parent prevent childhood obesity? I have struggled with this question for many years and my solutions are a work in progress. However you go about it, it’s important to set all families up for success by promoting weight-healthy behaviors from the very beginning. Here are some of the approaches I have come upon as this health crisis has become more and more widespread. …Read More

Expert’s Corner: Getting the most out of a pediatric well visit

baby newborn stethoscope well visit Susan Laster

As every general pediatrician, family practitioner and nurse practitioner knows, the pediatric well visit is a rich, full 15-20 minute encounter. It is during this time that we hope to address all aspects of a child’s health and well being, with the ultimate goal of being able to “launch” that child into adulthood as physically, cognitively and emotionally healthy as possible. A few years ago, I realized I wasn’t just taking care of the child in front of me; I was also trying to care for the 25-year-old adult that child will become. No small task!

Luckily, we are not in it alone. …Read More

Clinical Consult: “Treatment resistant” head lice

head lice treatment resistant
(D. Kucharski & K. Kucharska/Shutterstock)

Lice are back in the news, and—with children back in school—are soon to be back in your office. While pediatricians generally view lice as a nuisance with no true medical consequences, families see lice as a time-consuming, worrisome health issue. One of the bigger concerns for parents is that if their child is diagnosed with lice, they will have to stay home from school or daycare.

Here are three important facts to keep in mind when discussing head lice with parents.

No. 1
Lice remain treatable.

The quickest, most efficient way to treat lice is to use one of the two ovicidal prescription creams, malathion or spinosad. In our practice we consider this pretty much a “one and done,” and sometimes a “two and done” (meaning the parent might have to repeat the cream treatment a week later).

Although it was initially considered ovicidal, recent studies have suggested that ivermectin is not completely so, in that it doesn’t kill the unhatched eggs (nits) but seems to kill the newly hatched nymphs. This may require a second treatment if live lice are seen a week after treatment.

Parents may bring up recent news suggesting that over the counter lice treatment products are no longer effective. Keep in mind that the study behind that news was funded by a manufacturer of prescription lice treatment products. …Read More