Childhood Obesity: An emerging epidemic

Is deficiency of the growth the only worrisome problem in the childhood?

Every parent has got a similar refrain that my child is not eating well or growing well. But in the real time scenario, where we follow one or two child policy in most households, parents in their attempts to feed the child will agree to unreasonable demands of children and would give child anything to eat when the child does not eat the good home-made food. And that is leading to another problem - Obesity. Obesity is the root cause of majority of the lifestyle diseases like diabetes, cardio-vascular problems, hypertension and even stroke. And in the present scenario with our junk food friendly diets, obesity is gaining epidemic proportions.

Obesity in children and adolescents is a common phenomenon now-a-days. Childhood obesity can lead to a variety of diseases. Because of obesity,  type 2 diabetes (usually associated with older adults) accounts for 30% of newly diagnosed cases of diabetes in teenagers now. Also associated with obesity are sleep apnea (temporary interruptions of breathing during sleep), raised blood pressure, high cholesterol, bone and joint problems, and depression.

When to say that the child is obese?

Defining childhood overweight and obesity is difficult. Body mass index used to define obesity in adults varies with age and hence should be used only after correction for age. 

A BMI-for-age higher than that of 85% of children of similar age indicates overweight; a BMI-for-age higher than that of 95% indicates obesity. 

Childhood obesity is a serious matter. Having excess fat should not be dismissed as a condition the child will grow out of, something “in the genes,” or a merely cosmetic concern. Obese children become obese adults.

It is good to follow up with your endocrinologist to rule out any hormonal disturbance. Doctor would assess your child for overall health and may some test might be required to rule out incident diabetes or thyroid disorder.

What can I do to manage obesity in my child?

Lifestyle changes, in form of diet and physical activity, form the cornerstone of therapy for childhood obesity. Healthy eating habits would include:

1.     Controlling caloric intake through portion control

2.     Avoiding the consumption of calorie-dense, nutrient-poor foods (e.g., sweetened drinks (such as soda, juice and sports drinks ), most “fast food,” and high-calorie snacks such as chips and candy)

3.      Increasing dietary fiber, fruits, and vegetables

4.     Eating regular meals, particularly breakfast, and avoiding “grazing” after school.

What is the role of exercise in controlling obesity?

Energy intake (calories) is only half of the equation governing weight gain; the other half is energy output (physical activity). 

• Children should engage daily in 60 minutes of vigorous physical activity, and should not spend more than 1 to 2 hours daily watching television, playing video games, talking or texting on cell phones, or using the computer for fun.
• Family as a unit should be part of lifestyle change. For example, it is important for parent to be an example of these healthy lifestyles, avoid overly strict dieting, avoid use of food as a reward or punishment, and try to build children's self-esteem. 

A positive approach works best. Parents should encourage healthy eating and regular exercise without developing a fear of food. This is the first step in establishing the behaviours essential to long-term success.

Contributed by:

Dr Rajiv Singla

Consultant Endocrinology & Metabolism

MD,DM Endocrinology.

Has my child got short height/ Stature? Physical aspect of child development…

Physical growth of a child is another issue where parents tend to spend a lot of time and energy worrying about its adequecy. Physical growth in children is result of concerted optimal functioning of hormonal, nutritional and psychosocial milieu. If a child is growing well physically in stature, it reassures us about endocrine/hormonal and nutritional wellbeing. It is important that parents maintain health records of their children regularly and recording of height and weight is an integral and essential part of this.

How do I know if my child is shorter than normal?

This can be answered by comparing your child’s height to the height of other children who are the same age and sex. This comparison is done with help of standard charts that are available with your doctor. It is advisable to use Indian growth charts for our children. If your child is much shorter than other children of the same age and sex, doctors call it “short stature.”

If my child is short, does it mean he or she has a medical problem?

Not essentially. Children who are short may be healthy and may not have any medical problem. Reasons for short stature in these children can be:

1. One or both of their parents are short. If a child’s parents are short, chances are good that he or she will be short, too.

2. They are growing more slowly than usual i.e. they have “growth delay.” These children are short because they have their growth spurt delayed than other children. But these children will grow to a normal height as adults.

Some children who are short do have a medical problem. Some of these include:

1. Very low body weight

2. Long-term diseases affecting the digestive system, heart, lungs, kidneys, or blood.

3.“Growth-hormone deficiency”.  Growth hormone is a hormone made in the pituitary gland in brain that helps children grow normally. Children with this condition have too little growth hormone in their body to have normal physical growth.

4. Other hormonal diseases like thyroid problem, pituitary abnormality etc.

5. Problems that babies are born with, for example  abnormal genes

Will my child need some investigations?

Perhaps. First step is to confirm whether your child is short. A physical exam followed by measurements of height, weight, arm and leg length is the next step to diagnosis. These will be followed by questions about family history, which will give clues to whether the short stature could be the result of an inherited condition.  If any of the above medical condition is suspected in your child then we might also do some blood tests to check for different conditions, including growth hormone deficiency and x-rays of 1 of your child’s hands and wrists – these X-rays to help tell how tall your child will grow.

Will my child need treatment?

Treatment of short stature depends on the underlying cause. For example, if the cause is a chronic disease such as diabetes or sickle cell anemia, these conditions should be treated first.

Is growth hormone treatment ever used for children without growth hormone 

deficiency?

Not usually. That’s because growth hormone treatment doesn’t always make these children grow. The treatment costs a lot of money and is not easy. Children usually need to take an injection every day for many years.

Is there anything I can do on my own to help my child?

Yes. You can make sure your child gets enough food and eats a healthy diet. If you need help changing your child’s diet, ask the doctor or nurse. Help your child feel good about him or herself. Try to point out your child’s strengths and not focus too much on his or her height.

Contributed by:

Dr Rajiv Singla

Consultant Endocrinology & Metabolism

MD, DM Endocrinology

 

Developmental Disorder: Cerebral Palsy a common cause.

A normal child will follow a more or less typical pattern of development both mentally and physically. A common refrain that might be heard amongst parents is my child is not catching up, that might  be in terms of mental development, academically, physically. It might be a benign concern coming from a parent who expects children to win all the possible ways in this big race called life. But when should we suspect that there is actually wrong with my child. We commonly use milestones that should be reached for particular age groups. Skills such as taking a first step, smiling for the first time, and waving “bye-bye” are called developmental milestones. Children reach milestones in how they play, learn, speak, behave, and move (for example, crawling and walking). A brief overview of the common milestones that are monitored is given below. A pediatrician or a neurologist should examine any child who is lagging behind in these milestones.

 

                 image courtesy : www.cdc.gov 

When do we know that is not keeping up and when does the parents should meet their healthcare provider. There are few red flags that indicate child is not developing well:

1.      If child is lagging on milestone chart
2.      If is unable to attend to task given
3.      If child is hyperactive
4.      If child has any seizure
5.      Has difficulty in sensory perception, progressive decreased vision and decreased hearing.

If there is any of the above symptoms, we should suspect Developmental disorder in the child and take medical help as soon as possible.  

What cause developmental disorders? Most of developmental disorders are caused by a mix of factors genetics; parental health and behaviors (such as smoking and drinking) during pregnancy; complications during birth; infections the mother might have during pregnancy or the baby might have very early in life; and exposure of the mother or child to high levels of environmental toxins, such as lead. For some developmental disabilities, such as fetal alcohol syndrome, which is caused by drinking alcohol during pregnancy, we know the cause. But for most, we don’t.
  

Can my child be affected? 

Developmental disabilities occur among all racial, ethnic, and socioeconomic groups. 

What are the common Developmental disorders? 

Common developmental disorders include:
1. Cerebral Palsy
2. Autism and austic spectrum disorder
3. ADHD
4. Hearing Loss
5. Vision Loss
6. Miscellaneous – including specific genetic syndromes.
  

What is cerebral palsy (CP)? 

Cerebral palsy is a group of disorders that affect a person’s ability to move and keep their balance and posture which may occur because of brain injury or abnormal brain development. The cause of the palsy may begin before or as is more common during and immediately post birth. Cerebral palsy causes different types of disabilities in each child. A child may simply be a little clumsy or awkward, or unable to walk at all. 

How does CP present ? 

Presenatation of CP vary greatly because there are many different types and levels of disability. The main sign that your child might have cerebral palsy is a delay reaching the motor or movement milestones. CP might be suspected if child do not attain the below mentioned milestoenes at the ages mentioned aside them.A child at: 

2 months cannot control head or has stiff legs that cross or “scissor”.
6 months continues to have a hard time controlling head when picked up or reach with only one hand while keeping the other in a fist.
10 months crawls by pushing off with one hand and leg while dragging the opposite hand and leg and not sit by himself or herself.
12 months not crawl and not be able to stand with support.
24 months not be able to walk or to push a toy with wheels. 

Are there any other symptoms that the child with CP have? 

Apart from motor symptoms, child might have associated seizures, speech problems, ,  clumsiness in doing work, eating problems, skeletal problems, sensory impairments, intellectual disability, learning disabilities, urinary incontinence, fecal incontinence, and/or behavioural disorders. Pain because of stiffness in the muscles is another disabling complaint in these children. 

What causes CP? 

CP is caused by damage to the motor centers of the developing brain which may occur during pregnancy, during childbirth, or after birth up to about age three. Upto 2% of all cerebral palsy cases are believed to be due to a genetic cause. 

In a case of suspected cerebral palsy, Please seek the help of a specialist such as a developmental pediatrician or child neurologist, who might after evaluating the child might guide on the path to its management.  

Contributed by:
Dr Sweta Singla
MD, DM Neurology 

Consultant Neurology & Sleep Disorder.

Child development - the key for the better future

“A child is the seed that we sow to create the future; the future that remains unseen”

A child is like a new beginning, with limitless possibilities that may emerge out of him. While raising a child, a lot many questions come to our mind. What should I do to provide my child the best possible environment so that she/he grows to achieve the best of his potential? What food should I give him? What kind of mental stimulus should I expose her to? Is her physical growth adequate? Why is my child not the best amongst all? Is there any thing else that I should do? This and many more doubts come to our mind as a parent when we are doing this tremendous job of raising a child.

Though, endless discussions can take place on such topics, what we shall try here, is to give you in a nutshell, the normal development on the brain and physical aspects of the body of a child and when should we suspect any discrepancy in the same.

We may start the discussion with normal brain development during the early childhood. Followed by common conditions that may hamper the development of the brain. The most common of these is cerebral palsy. Also mental health is important and so comes the discussion on autism spectrum disorders and ADHD. Lastly we will discuss the physical aspects of the growth and the growth disorders.