September 2008

How much is enough?

Is depression limiting lifestyle change?

Stay fit this fall

Is it really hypertension? 

Lakefront Mini-marathon: A great way to expose kids to running

How much is enough?

Jennifer Allen, RD, CD

Kids should eat from every food group to ensure they are getting adequate amounts of all necessary nutrients. The amount of nutrients kids need increases with age.

Refer to the chart below to find the specific amounts that kids need from each food group per day and what counts as a serving.

For toddlers, remind parents to offer children what may be viewed as a very small serving. Toddlers only need about 1 tablespoon of each type of food at a meal time. If they finish that, they always can have more.

Grains: What counts as an ounce equivalent? One slice of bread, 1 cup of ready-to-eat cereal, ½ cup of cooked rice, cooked pasta or cooked cereal.

Dairy: What counts as a cup? One cup of milk or yogurt, 1 ½ ounces of natural cheese, 2 ounces of processed cheese.

Meat/Beans: What counts as an ounce equivalent? One ounce of meat, poultry or fish, ¼ cup of cooked dry beans, 1 egg, 1 tablespoon of peanut butter, ½ ounce nuts or seeds.

Fruits: What counts as a cup? One cup of fresh fruit, 1 cup of 100-percent fruit juice, 1 cup canned fruit, ½ cup of dried fruit.

Vegetables: What counts as a cup? One cup of raw or cooked vegetables or vegetable juice, 2 cups of raw, leafy greens.

Oils: What counts as a teaspoon? Many foods eaten from this group are going to be made up of mostly oil. Thus, the amount eaten could equal multiple teaspoon servings. Example: 1 tablespoon of margarine is equivalent to 3 teaspoons of oil.

Learn more about how much is enough here.

Is depression limiting lifestyle change?

Brian Fidlin, PsyD

Depression and obesity often are linked in children. One study actually found that obese children were 5.5 times more likely to have an impaired quality of life in comparison to their "healthy-weighted peers."¹ This finding is similar to children undergoing chemotherapy treatment for cancer. Obese children experience a variety of physical, emotional, psychological, social and family impairments. Often, these impairments will lead to unhealthy behaviors, which can lead to increased weight.

When focusing on weight management with patients, develop a complete approach that recognizes all aspects of the individuals and their families. While assessing weight status can be straight-forward, assessing depression in children and adolescents can be more difficult. Below are a list of signs and symptoms that may suggest that a patient may benefit from a referral to a mental health provider.

• Sadness or hopelessness.
• Irritability, anger, hostility.
• Tearfulness or frequent crying.
• Withdrawal from friends and family.
• Loss of interest in activities.
• Changes in eating and sleeping habits.
• Restlessness and agitation.
• Feelings of worthlessness and guilt.
• Lack of enthusiasm and motivation.
• Fatigue or lack of energy.
• Difficulty concentrating.
• Thoughts of death or suicide.

You also should consider a referral to a mental health provider when a patient or family has attempted to make lifestyle changes and you recognize a lack of motivation or symptoms of depression are limiting progress.

If needed, encourage parents to contact their mental health insurance for guidance on providers within their networks. With proper mental health care, kids and their families are, oftentimes, more capable of engaging in the necessary behaviors that not only lead to improved weight status but an overall better quality of life.

¹The researchers reported their results in the Journal of the American Medical Association (Vol. 289, No. 14:1813-1819).

Stay fit this fall

Stefanie Reid, MPT

As the days get shorter and the nights get colder, we tend to find comfort indoors and spend less time outdoors, leading to more sedentary behaviors. Sedentary behavior is linked to obesity, several types of cancer, lower self-esteem and adolescent risk behaviors, including smoking, truancy and delinquency.

Encouraging your patients and families to get out and enjoy this colorful autumn season is important in order to improve and maintain fitness levels. Improving cardiovascular health and fitness through aerobic activities does not have to be boring or cost a lot of money.

Some of the known benefits of exercise include:

• Lowering low-density lipoprotein (LDL) cholesterol which decreases the risk of heart disease.
• Raising high-density lipoprotein (HDL) cholesterol.
• Increasing strength, muscle mass and cardiovascular fitness.

A state or local park, nature center or a backyard are all great places for families and children to enjoy the change of seasons while getting fit. Suggestions for family-friendly aerobic activities include:

• A trip to the local apple farm or orchard while enjoying a walk and the fruits of the harvest season.
• A game of hide-and-go-seek or a search for leaves in the backyard or park.
• Shooting hoops in the backyard or at a park.
• Raking or jumping into a pile of leaves.
• Organizing a flying disc or football game with the neighborhood children.
• Paddle boating at a local park.
• Taking a walking tour of the neighborhood.
• Hiking through a pumpkin patch.
• Performing litter patrol at a favorite park.

When beginning any of the above activities, it is important to keep the following in mind:

• Biking can be strenuous exercise, especially on hills and rough terrain, so encourage your patients to drink plenty of water before biking and bring a bottle along for the ride.

• Stretching prior to exercising is important for children to warm up their muscles in order to prevent potential injury.

• Children should be encouraged to bend at the knees and hips and squat to pick up leaves. This movement pattern protects the protects the back from injury and helps strengthen quadriceps, hamstring and core muscle groups.

Resources

• Mayo Foundation for Medical Education and Research. Mayo Clinic The Total Heart 2.0. Accessed November 21, 1995.
• Howard RA, Freedman DM, Park Y, Hollenbock A, Schatzkin A, Leitzmann MF. Physical activity, sedentary behavior and the risk of colon and rectal cancers in the NIH-AARP diet and health study. Canc Causes Contr.
• Nelson MC, Gordon-Larsen, P. Physical activity and sedentary behavior patterns are associated with selected adolescent health risk behaviors. Pediatrics, 2006; 1281-1290.

Is it really hypertension?

Michele Polfuss MSN, RN, APNP

From a cardiovascular aspect pediatric obesity places children at an increased risk for hypertension. Approximately 13 percent of overweight children have elevated systolic blood pressure and about nine percent have an elevated diastolic blood pressure (Barlow, 2007). Acknowledging the seriousness of the diagnosis of hypertension, it is important to gather accurate information prior to diagnosing a child.

Medical providers often have a limited time frame to work with the family and depend on the information provided from support staff and office medical equipment. These factors can lead to inaccurate information even in the best settings. The wrong blood pressure cuff size or an anxious child can falsely elevate a child's blood pressure reading. This can lead to increasing concern of the child/family or possibly unnecessary consultation or additional testing.

The following are a few reminders to be shared with staff:

• Hypertension is defined as average systolic and/or diastolic blood pressure greater than or equal to the 95th percentile for age and sex on three or more occasions.

• Children older than 3 who are seen in medical care settings should have their blood pressure measured at their examinations.

• If possible, children should not have had stimulants (such as caffeine) prior to their appointments and should have time to sit quietly for 5-10 minutes before having blood pressure taken.

• When taking blood pressure, children should sit with their feet on floor and cubital fossa at heart level.

• The right upper arm is the extremity of choice due to possibility of coarctation of the aorta.

• The preferred method of measurement is manual auscultation with a standard clinical sphygmomanometer and stethoscope placed over the brachial artery.

  • Oscillometric devices measure the mean arterial blood pressure and then calculate systolic and diastolic values and do not always match manual readings.

• Appropriate cuff size is critical and can be difficult with an obese child's arm. To prevent this, it is recommended:

  • The inflatable bladder width is at least 40 percent of the arm circumference at the midway point between the olecranon and acromion.

  • This may mean using adult or even thigh cuffs for an obese adolescent.

  • When in doubt, use the measurements marked on the inside of the blood pressure cuffs for accuracy.

Blood pressure tables and additional information can be found here.

References

Barlow, SE and Expert Committee (2007). Expert committee recommendations regarding the prevention, assessment and treatment of child and adolescent overweight and obesity: Summary report. Pediatrics 120(Supplement 4), S164-S190.

National High Blood Pressure Education Program Working Group on Children and Adolescents. The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents. Retrieved from www.nhlbi.nih.gov/health/prof/heart/hbp/hbp_ped.htm

Lakefront Mini-marathon: A great way to expose kids to running

Sydney Hofer, YMCA of Metropolitan Milwaukee

The idea of running a marathon at any age can be intimidating. But participating in the Lakefront Mini-marathon is a great way for kids to learn about running. Running is a great sport because it is inexpensive, can be done almost anywhere and can result in a healthy, life-long hobby.

The Lakefront Mini-marathon is a shorter version of the Milwaukee Lakefront Marathon, scheduled for Sunday, Oct. 5, 2008. Kids train for several weeks, then on race day they run the last 1.2 miles of the Lakefront Marathon route. In the weeks leading up to the race, they learn about stretching and participate in drills to improve their running. Runners also learn how to create and follow a training plan.

Practices are lead by YMCA Youth Sports coordinators. Coaches and volunteers teach the young runners things they can do to improve their running and their overall health.

For more information about the Lakefront Mini-marathon, contact Phil Salter at the Southtown YMCA. psalter@ymcamke.org or (414) 817-9622.