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Helping Parents Change Children's Health Habits
Having confidence in your ability to change behavior even in the face of obstacles is a critical asset for an effective parent. At pediatric visits, parents are given lots of advice and guidelines about what to do to improve the health of their children. Better nutrition, more exercise, less television viewing are among the most common themes. However, translating advice into action outside the physician’s office is often more challenging than anticipated. Unless a parent is specifically counseled about how to bring about change they are often unsuccessful in following through on their good intentions.
A recent study in the July issue of Pediatrics looked specifically at how confident parents were in their ability to change behaviors at home, and how much help their physicians gave them. The researchers were interested in which types of clinical encounters with physicians best helped raise parents’ confidence about making changes at home. Focusing on behaviors associated with obesity, the researchers surveyed parents of significantly overweight children, ages 2−13 years old. One week after the child had a primary care visit, researchers interviewed the parents by phone and sent their healthcare providers a questionnaire. About 300 parents and 89 clinicians completed the study.
Parents’ Actions and Concerns
Parents were also asked if their doctor had asked if they were concerned about their child’s weight and how confident they felt about their ability to make changes at home. They were also asked to rate the quality of the advice their doctor gave them about their child’s nutrition and physical activity.
Parents felt least confident in their ability to remove the television from their children’s rooms and in limiting television and video viewing. Those who were closer to healthful weights themselves were more confident than overweight or obese parents about making these changes. The more education a parent had, the more confident they tended to be about making these changes. The more time a child spent watching TV and eating fast food, the less confident their parents tended to be about reducing these behaviors.
What Doctors Can Do
When the children’s doctors were asked about their level of confidence in counseling parents about reducing their children’s intake of sugar sweetened beverages and fast food, reducing television viewing time, removing the television from child’s bedroom, and increasing their child’s physical activity, they reported feeling least confident in counseling to encourage physical activity, limit television viewing and remove the television from the bedroom.
Because behaviors that lead to obesity often have their roots in early childhood habits, counseling for prevention must begin early in the child’s life. By the time the child is school age, eating patterns, physical activity level, and television and video viewing have become habits of the entire family.
It is easy to see how these problems arise. Tired parents rely on the television to entertain their children and on fast food to tempt the picky eater, so it is hard to modify these practices later on. Efforts to substitute water for sweetened beverages and to get their children to get off the internet or TV and be more active are often met with antrums and obstinacy. Allowing children to have televisions in the bedroom which are often not turned off until after the child falls asleep creates a nightly bedtime battle and a sleep deprived child when the television is finally removed. Often parents do not have the stamina to cope with the stresses that reversing long standing behaviors requires. Parents who are overweight may find it difficult to ask their children to accept activity and eating patterns that they have struggled with unsuccessfully themselves. Families who are undergoing financial, marital, economic, or health−related stress may not be able to marshal the energy to take on one more difficult challenge.
Done properly, when health care providers present parents with advice parents are better able to work on these issues. Both parents and doctors must avoid rote delivery and half−hearted acceptance of advice by asking enough questions to paint a clear picture of the needs, obstacles, and paths to change for the patient and family.
Be Specific and Make Small, Incremental Changes
The child’s doctor needs to take into account complicating circumstances such as opinionated or poorly motivated childcare providers and relatives, parental work schedules, siblings sharing bedrooms, and the economic realities of grocery shopping.
It is important that parents truly understand what is at stake if the child and his or family are able to make these changes and what is at stake if they don’t. The potential health benefits and risks are enormous and motivating.
August 7, 2009
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