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?

At least not yet, but both school districts are considering adopting a policy and Dallas ISD could have one by the end of the day.

That news makes Kim Mangham, M.D., a Cook Children’s pediatrician in Keller, both relieved and happy. Dr. Mangham focuses on nutrition and activity with her patient families and she believes this is a good start for area schools to get kids moving.

As early as January 2007, A Clinical Report in the Journal of Pediatrics emphasized the benefits of free play for children, “but since that time it seems we have drifted farther and farther away from this concept,” Dr. Mangham said. “Kindergarten and even preschool curriculums are emphasizing academics over social and emotional development, and kids are presenting at younger ages with anxiety and depression due to academic pressures.”

For all children, especially those with ADHD, Dr. Mangham said it is vital that they are offered unstructured free time to allow them to process the information they have learned and to get their exercise. Only then can they return to the classroom and focus.

Children have an innate need to be outside and run and play, according to Dr. Mangham. This helps them to connect socially with their peers and allows them to settle back down in the classroom and learn again.

“I hear from so many of my parents that their children do so much better with homework if they are allowed to play outside after school,” Dr. Mangham said. “Kids are so worn out by the end of the day, they need to decompress and let their brains rest before they can focus again on school work. I tell my parents that if they want well behaved children, to let them run and play outside and to burn off all of their energy. “

Why not focus on the things that are free from side effects and cost nothing? We have so much to gain, says Dr. Mangham.

Children have so much adult-directed time – in the classroom, with sports, with extracurricular activities and with chores in the home. Adults even try to interfere with free play. Children need that free time to learn to share, play nicely, make up games, follow rules, get along and just enjoy friends.

As reported in December 2015 by KERA news and a recent segment on the Today show, schools are starting to see the benefits of recess.

Cook Children’s offers Go Noodle to 18 ISDs (including public, private and charter elementary schools in Cook Children’s six-county region) and 515 schools. The 120,619 students and 4,918 teachers have logged over 35 million aggregate minutes of physical activity.

“My 12 year old daughter started sixth grade this year,” Dr. Mangham said. “Her biggest complaint is not being able to be outside all day. Their only break is the four minute transition time between classes and lunch. “She says, ‘I miss being outside and seeing the sky and the trees.’ My 8 year old son loves climbing trees. The reflection and relaxation he gets while sitting in the top of his tree is just as important as the exercise he gets while climbing.”

About the source

Kim Mangham, M.D., is a Cook Children's pediatrician at 1601 Keller Parkway in Keller, Texas. She earned her medical degree at University of Texas Southwestern Medical School in Dallas. She completed the pediatric residency program at University of Oklahoma Health Sciences Center in Oklahoma City. Her interests include breastfeeding education as well as disease and injury prevention. Dr. Mangham is board certified in pediatrics.

When author Dan Buettner and fellow staff members looked at areas of the world where people lived longer - they circled it with a blue sharpie on the map - that is how those areas became known as The Blue Zones. Some of the areas with longevity that Dan studied were Sardinia, Italy, Okinawa, Japan, and Loma Linda, California. He learned that the people in these communities didn't choose longevity. Longevity happened to them. Environment is the key to a healthy life, not necessarily personal will power. 

Cook Childrens is a proud sponsor of the Blue Zones Project and Fort Worth is the only city in the south participating. I recently attended the Fort Worth kickoff event for the Blue Zones Project. Dan discussed the common threads that he found in the communities he studied.

Here are some of his suggestions for longevity and a life free from chronic illness:

1. Stay active.

2. Wake up with purpose each day.

3. Find down time daily.

4. Eat mindfully. Eat more fruits and vegetables.

5. Belong. Make time for family, friends, and fellowship.

As a pediatrician, parents come to me with questions about how to care for their children. They depend on my advice to help them raise healthy kids, safe from the burdens of chronic diseases like obesity, hypertension, diabetes and heart disease. Providing a medical home truly is a partnership. It is up to all of us: the parents, the doctors, and the kids. We are a team.

In the upcoming weeks, I will give you tips on how to create a Blue Zone in your home. We can do this together.

For more information about blue zones, see www.bluezones.com and check out the vitality compass.

Ensure school-age children know when to wash - before eating and after playing on a playground at recess, using the restroom, and coming into contact wiht friends and classmates. Teach kids that it's important not to chew their fingernails or touch their faces.

"Hand-to-mouth transmission is a major way children are infected by viruses," said Vanessa Charette, M.D., a Cook Children's pediatrician in Fort Worth. "Keeping hands out of the mouth is a difficult behavior for certain children to master, but it's important that they do."

Little hands can pick up a lot of germs. At any given time, you have close to 150 different bacteria living on your hands, and 80 percent of illnesses are spread by direct human contact. For kids, stomach bugs, strep throat and other bacterial illnesses can spread quickly, particularly in environments such as schools and day cares.

"I also tell young children to keep their hands below their neck. They don't rub their eyes, such their fingers or pick their nose," said Kim Mangham, M.D. a Cook Children's pediatrician in Keller. "Kids can have all the germs in the world living on their hands, but they don't put their hands in their mouth, nose or eyes, they won't get sick."

Having trouble convincing your children to get with the hand hygiene program? Let them know that fighting the spread of germs can be pretty cool. A recent study published in the American Journal of Infection Control concluded that fist bumping transmits far few bacteria than handshaking.

We moved into a new home about three weeks ago. Amid the chaos of boxes and a not quite finished remodel job, I hear the laughter of my kids upstairs. I head up to check on them and realize they are “playing nicely.”  What is interesting is that we have had no access to TV for three weeks. Could there be a connection between my kids getting along and no TV?  What are the results of being unplugged?

The American Academy of Pediatrics recommends no TV for kids under 2 and less than 2 hours per day of media time for kids older than 2 years of age. Why? Because too much media is associated with aggression, inattention, anxiety, depression, sleep problems and obesity in our kids.

We call it TV head at my house. It is a lazy Saturday morning. The kids lounge in front of the TV for a few hours watching a movie. The next thing I know there is fighting, yelling and disagreement between my children. My son never quite recovers the rest of the day. He is a little “fuzzy headed” and a little grumpy.

Many of my patients have found harmony at home by decreasing media time. My parents have returned with true amazement at the difference in their kids once they have unplugged, especially in the evenings. They have reported healthier and happier kids. A number of my families have decided to unplug for the summer, which in all honesty, is probably the hardest time to do so, especially when it is hot outside and not much to do inside. Enter Mrs. Aubrey Conklin, one of the most fun and down to earth moms I have ever met.  I discussed the benefits of decreased media with her at the recent well-child exams for her three children. She is open minded enough to try it, and kind enough to let us join her on this journey.

Watch for Aubrey’s blogs this summer. She will be reporting in on how she and her family are doing cutting back on screen time.