2 things toddlers do right, but we get wrong

When I discuss normal newborn sleep patterns with parents at their first several visits, I usually end up with a 4 month old who sleeps through the night. But I have trouble fixing sleep problems in a 2 year old.

When I advise my 3 year old patients to wear helmets on their tricycles, then I end up with 10 year old patients who wear their helmets. It’s near impossible to convince my 10 year olds to START wearing a helmet.

Why do you think so many ED doctors end up advocating for car seat safety? They see the results of horrible car accidents that could have been prevented.

That’s how I feel about obesity prevention. Far and away, poor diet and a sedentary lifestyle wreak havoc on the mental and physical health of my patients – from young to old – those with poor lifestyle choices have a decreased quality of life. They come to see me with more illnesses, more headaches and most certainly more abdominal pain.

When I start talking to my families about diet, I try to give anticipatory guidance about offering fruits and vegetables and limiting processed foods. Toddlers and young children do two things really well – they don’t eat when they are not hungry and they stop eating when they are full.

We as parents, and grandparents, mess up their satiety cues by trying to get them to eat when they are not hungry and trying to get them to keep eating when they are full. Allowing children to control the amount of food they eat leads to a long term healthy relationship with food. Parents have control over what is offered but should not try to control how much is eaten.

Along those same lines, children are naturally conditioned to be outside and to be active. We as parents mess that up by keeping them inside in front of an iPad or video game. We have control over their media time.

I think focusing on healthy behaviors rather than BMI is a positive way to talk to parents. Most parents are doing 1 or more things right in the 5-2-1-0 recommendations. Kids are motivated to follow these recommendations, but they need their parents to create an environment at home that allows them to do so. This goes along with the thinking of the Blue Zones.

I do think there is value for using BMI as a tool. I usually show growth charts to families as an objective measurement of what is happening and then we turn to talking about healthy behaviors. But I do see a flattening of BMI with improved diet/activity choices. It is also not uncommon for me to see an increase in BMI and ask what has changed, and families are usually able to say – oh yeah, he quit playing soccer, or he doesn’t have PE this year….etc.

When you look at guidelines for treatment of obesity, the first thing you must have is motivation for change. If that is not there, you really can’t go forward. What if we don’t have to motivate people to change because they have been feeding their children correctly from the beginning?