A 12-year-old sees her pediatrician for a well check. On the pre-visit questionnaire, she says she eats fruits and vegetables one time per day, never gets 60 minutes per day of physical activity, struggles to fall asleep, spends six hours per day on media and has been feeling anxious. Her pediatrician notes that while her height for age is tracking consistently at the 50th percentile on the growth chart, her body mass index (BMI) has increased from the 80th to the 90th percentile. How can her pediatrician support her in optimizing health and well-being?
Many children and adolescents struggle to meet recommended guidelines for nutrition, physical activity, sleep or screen use for a variety of reasons. As a result, they are at risk for poor physical and mental health.
An updated AAP clinical report provides guidance on how pediatricians can support patients and their families in optimizing health and wellness.
The report The Role of the Pediatrician in the Promotion of Healthy, Active Living, from the Section on Obesity and Committee on Nutrition, addresses behavioral patterns that support high-quality nutrition, physical activity, adequate sleep, a positive approach to screen use and social-emotional wellness. It is available at https://doi.org/10.1542/peds.2023-065480 and will be published in the March issue of Pediatrics.
The report replaces the 2015 AAP clinical report The Role of the Pediatrician in the Primary Prevention of Obesity.
Domains influencing healthy, active living
Several factors affect whether children and families can meet recommendations for nutrition, physical activity, sleep and screen use. These domains of influence include:
- public policies that regulate practices for disease prevention and control, and impact social determinants of health such as poverty and structural racism;
- community factors like neighborhood safety and access to healthy food;
- institutional factors like child care and school environments;
- interpersonal factors like the home environment, parenting approaches and family relationships; and
- individual characteristics such as age, knowledge, skills and motivation.
Pediatricians can recognize variables influencing a child’s health status and behaviors, and take steps to promote healthy, active living. As leaders of the patient-centered medical home, pediatricians can promote the prevention and early identification of health conditions affected by lifestyle factors.
Outside the clinical setting, pediatricians can be role models and advocates for changes that help promote a healthier environment for children and adolescents to live, grow and thrive.
Recommendations
Following are recommendations outlined in the report to help pediatricians promote healthy, active living among all infants, children and adolescents:
- Assess social determinants of health such as poverty, food insecurity, exposure to racism, trauma and toxic stress, and the built environment.
- Assess parenting practices and baseline nutrition, physical activity, sleep and screen use. When a gap exists between recommended and reported behaviors, assess a patient’s and family’s readiness to make a change and work together to develop a change plan, when appropriate.
- Use respectful, nonstigmatizing language when addressing weight, behaviors or need for behavioral change.
- Learn and implement communication approaches for behavioral change such as motivational interviewing.
- Be a role model for healthy patterns around nutrition, physical activity, sleep, screen use and self-care.
- Refer children and adolescents to community resources.
- Support policies to eradicate racism, address social determinants of health, improve nutrition, decrease intake of sugary drinks and increase physical activity.
- Advocate for adequate payment for preventive care service and team-based care to support guidance for healthy, active living.
The pediatrician in the vignette above used a patient questionnaire to obtain baseline information about health behaviors, which aligns with recommendations in the report. The pediatrician then can ask the adolescent and family for permission to discuss the responses to the questionnaire. The pediatrician should review the growth chart with the patient and family sensitively and nonjudgmentally, noting the recent change in BMI percentile. Using motivational interviewing, the pediatrician can work with the patient and family to identify areas of highest priority or interest to make a change, help them set goals consistent with their values and cultural practices, and connect them to additional resources as needed.
Dr. Muth is a lead author of the clinical report and a member of the AAP Section on Obesity.
Resources
- The AAP Institute for Healthy Childhood Weight has information for pediatricians on how to promote healthy, active living, responsive feeding tools, and obesity prevention and treatment resources.
- Information for parents on healthy, active living is available from HealthyChildren.org
- Additional resources can be found in the clinical report
