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.
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
The parents were asked about their confidence in their ability to make changes that would help reduce their child’s weight, or at least prevent further gains. These changes included:
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
But when the physician specifically asked parents about their level of concern about their child’s weight and their confidence level in making important changes to decrease obesity, parents reported feeling more confident to act. They also rated the quality of counseling about nutrition and physical activity as good or excellent, suggesting that parents welcome their doctor’s concern and help.
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.
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
Parents can also be helped to plan as specifically as possible how to achieve the goals for their unique family situation, and to learn how to break changes down into manageable steps, slowly introducing food changes, gradually substituting water for juice, finding enjoyable ways to get physical exercise, developing television guidelines that do not disintegrate when the child complains of boredom.
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.