January 2009

Prepare your office for patient success 

Get movin' with fun, family games, Part I

Help get your patients' portions under control

NEW Kids at the Y results: Small steps toward lifestyle change

Prepare your office for patient comfort

Michele Polfuss RN, MSN, APNP, Children's Hospital of Wisconsin

As medical providers, we know that childhood overweight is on the rise. But, have you ever asked yourself if your office is properly equipped to accommodate children who are overweight?

In our field, we are trained to be sensitive to the needs of patients with disabilities. Sometimes, we forget that patients who are overweight also have special needs. Our offices need to be equipped to provide comfort, accessibility and proper equipment to all of our patients.

Here are a few things to consider when designing an office that is welcoming to all patients:

• Staff: Since many staff members interact with patients, there should be an overall acceptance of all patients, regardless of size. Patients who are overweight usually are aware of their body sizes. Gestures, nonverbal cues, overheard comments and judgmental attitudes can be heard and felt.
• Office layout: Access from parking lot, stairs, narrow doors or hallways and cramped restrooms should be noted. When able to, you should attempt to change these situations.
• Waiting room: When designing a waiting room, consider:
  • Offering firm, high sofas
  • Providing sturdy armless chairs with at least 6 to 8 inches of space between them
  • Including healthy living messages such as hygiene, nutrition and physical activity. Avoid artwork and magazines that promote thinness.
• Weighing patients: Stepping on the scale can be a very emotional experience for some patients. The patient may feel embarrassed, ashamed or frustrated about his or her weight. When weighing patients:
  • Ask permission.
  • Weigh them in a private setting, away from other patients and staff. Sometimes, it also is helpful to weigh patients away from their parents.
  • Record weight silently and without comment.
  • If a discussion is needed, speak with patients in a private exam room.
• Equipment: To accurately obtain height, weight and blood pressure measurements, consider stocking the following equipment:
  • A wall-mounted sliding stadiometer for height.
  • At least one scale that measures above 350 pounds with a wide base and a handle that can be utilized for support, if needed.
  • Large adult arm and thigh blood pressure cuffs for accurate blood pressure measurements.
  • A sturdy step stool for climbing to and from exam tables.

This information was adapted from the American Medical Association's Roadmaps for Clinical Practice.

Get movin' with fun, family games, Part I

Stacy Stolzman, MPT, Children's Hospital of Wisconsin

While snow and ice offer fun winter activities such as sledding and ice skating, many families prefer to stay inside. Fortunately, a new breed of family games is available to keep families moving during the cold winter months.

Here are a few games worth mentioning to your patients:

• Twister Hopscotch allows kids to design their own hopscotch patterns using durable, non-slip rings. The game is designed for one or more players, ages 6 and older.

• IPlay Super Skipper features two telescoping, rotating poles that spin at different speeds. The Super Skipper is for one player, ages 3 and older.

• Hyper Dash is an electronic target-tagging racecourse with fun electronic commands set to a timer. The game is designed for one to eight players, ages 6 and older.

• DanceMaker is an electronic dance mat that encourages kids to step on light-up stars as they dance to one of three pre-programmed songs. DanceMaker is designed for one player, ages 5 and older.

These new games allow families to interact while raising heart rates. Most of these games can push participants to moderate levels of physical activity (3.5-6.0 METs), but the physical activity is not sustained for a long period of time. Vigorous physical activities (>6.0 METs) rarely are achieved with family games.

The physiologic affects on the body of increased heart rate, increased respiratory rate, and sweating are excellent indicators of the level of physical activity exerted. Family games can be a great place to start physical activity or add variety to the winter routine.

Watch next month's edition of NEW Kids News for more games designed to get families moving.

Help get your patients' portions under control

Jennifer Allen, RD, CD, Children's Hospital of Wisconsin

Sometimes, a child can be eating all of the right foods, but still gain weight. This is when you should examine portion control. From a young age, kids can become conditioned to eat all food in front of them, whether they're hungry or not. Providing appropriate portions for children helps them eat only what they need. Here is a general guideline about how much kids should be eating:

• Toddlers should eat approximately a quarter of adult portion sizes.
• Children ages 4 to 8 should eat one-third of adult portion sizes.

Even when portion sizes are in check, the ratio of food groups offered can lead to weight gain. According to the "plate method," one-half of a child's plate should be vegetables, one-quarter should be starchy sides (including corn, potatoes and peas), and one-quarter should be lean protein. A fruit and low-fat dairy serving may be added. If a child asks for seconds, parents should offer more vegetables.

Share this New Year's resolution with the patients you serve.

NEW Kids at the Y results: Small steps toward lifestyle change

Janet McMahon, association vice president, Healthy Lifestyles, YMCA of Metropolitan Milwaukee

NEW Kids at the Y was developed to help respond to the growing pediatric obesity crisis in our country. The success of this program must be measured in small steps toward lifestyle change that ultimately impact the family, as well as the child. These steps to success can take on many forms.

NEW Kids at the Y not only helps with nutrition and physical activity, but supports children who struggle with self-confidence, body image issues and other adolescent vulnerabilities. Acceptance is important for pre-teens and teens. Kari's story is a prime example.

Kari*, 13, is a bright yet cautious young teen who is self-conscious about her weight. At the start of her NEW Kids at the Y session she had difficulty making connections with other children in the group, most of whom were her same age. Kari always was on the periphery, observing the activities, but rarely participating. The other girls tried to coax her into their group but they soon gave up on her sulking and brooding.

Through careful group facilitation, some real change began to take place by the fourth week. Kari began to engage and participate in the program activities. She even initiated a friendship with one of the other girls. She learned that there were more effective ways to communicate than acting out. As a result, friendships bloomed and so did Kari. She became a happier teen, pleased with her small steps towards success that continued to build her confidence. Kari summarized it best, "I just didn't think I could do much, so why try? But I realized this group was different than other groups, and I wanted to be a part. I feel a lot better about myself now, too."

With a focus on spirit, mind and body, together in a safe and accepting group setting, families learn how to become more physically active and eat healthier.

Learn more about NEW Kids at the Y here.

*To protect her confidentiality and budding self-concept, Kari's real name was not used.