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
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
As I reflect on my last few months at Phebe Hospital in Bong County, Liberia, my thoughts are drawn to particular patients who are hard to forget, like:
The 6-year-old boy who burned his leg severely falling into a fire during a seizure. His family spent two months seeking care elsewhere; he spent another two months in the hospital recovering from surgery.
The developmentally delayed, severely malnourished 1-year-old, who weighed 4 kg (8.8 lbs; the average weight of a 2-week old) when I first met him one Wednesday afternoon.
The 4-year-old girl with malaria, treated in the hospital after experiencing fevers and seizures. She was covered in chalk after being treated with herbs in the village.
The 6-month-old girl who arrived in the emergency room with a florid full body rash. Her parents had been treating her with a cream of herbs mixed into zinc oxide.
It is amazing how quickly I adjusted to hearing stories like these, which would seem so far-fetched if heard in the Boston Children’s emergency room. However, an overriding theme that seemed to link a lot of my patients’ stories was shopping around for local remedies before coming to Phebe. …Read More
By now, most Americans know this dark and disturbing truth about our health care system: We spend more than any other industrialized country on health care, yet we have some of the worst health outcomes on a number of measures (including infant mortality, average lifespan, and death from preventable diseases).
Our current system focuses much more on treating illness than preventing it. So how does our usage, or the amount we spend on and utilize health care resources, relate to our outcomes, or how healthy we are overall? Better yet: What can we learn from comparing our country with one that has better health outcomes and a similar insurance system? …Read More