Child Health

Question 1

Contextualise child health issues, especially physical activity and nutrition, in relation to lifestyle factors.

Answer 1

Foetal nutrition + maternal physical activity → determines child weight​

1/5 young children (aged 4/5) are already overweight/obese​

Physical activity in children → improved cardiovascular fitness/sleep/weight​

Question 2

Contextualise child health issues, especially physical activity and nutrition, in relation to bevioural factors.

Answer 2

Inadequate foetal nutrition → irreversible delayed cognitive/motor development​

If more physically active in childhood → more likely as adult​

Children are less active than ever now​

Physical activity in children → improved learning/academic achievement/ executive functioning​

Physical activity in children → reduced anxiety/stress/ depression​

Question 3

Contextualise child health issues, especially physical activity and nutrition, in relation to social factors.

Answer 3

Diet/physical activity/relationships/sleep/stress/socio-economic status → school readiness​

If children engage in inclusive + positive + meaningful physical activity → develop physical literacy​

Physical activity in children → improved happiness/resilience/self-esteem/ confidence/trust of others​

Question 4

Contextualise child health issues, especially physical activity and nutrition, in relation to environmental factors.

Answer 4

Early interactions with parents/ caregivers → heavy influence on lifestyle behaviours​

Parental obesity = biggest risk factor for childhood obesity​

Question 5

What does ACE stand for?

Answer 5

ACE = adverse childhood experience

Question 6

Examples of ACEs?

Answer 6

Experiencing abuse: Physical, sexual, psychological or neglect​

Witnessing domestic abuse ​

Having a close family member or caregiver who misused drugs or alcohol ​

Having a close family member or caregiver with mental health problems​

Having a close family member or caregiver who served time in prison​

Experiencing parental separation or divorce on account of relationship breakdown​

Question 7

Impact of ACEs?

Answer 7

Strong associations with sexual risk taking, mental ill health, problematic alcohol use​

Strongest associations with problematic drug use, violence​

Excessive chronic activation of stress response → system dysregulation​

Childhood experiences affect epigenome and gene expression (temporarily/permanently)​

Question 8

What would a lifestyle medicine consultation with children and families focus on?

Answer 8

Nutrition

Physical Activity

Question 9

Practices to encourage in lifestyle medicine consultations with children and families?

Answer 9

Specific, short term goals​

Daily routine – more effective goals​

LEAP criteria activities (Local, Enjoyable And Practical)​

Question 10

How to approach lifestyle medicine consultations with children and families?

Answer 10

Be opportunistic​

Be sensitive​

Non-judgemental approach -many parents find it difficult to know if their child is growing healthily​

Strengths-based approach (positive affirmations)​

Focus on barriers that are particularly important to the child​ .e.g. benefits of physical activity on learning​ - Encourage children with long term conditions to be active (Moving Medicine)​

Relate to other children​ - ‘Do you mind if I share some ideas with you that helped other people your age?’​

Engage parents and families - Look at their strengths, needs, challenges and priorities​

Question 11

What is the National Child Measurement Programme​?

Answer 11

Measures height + weight in:​

Reception (ages 4 + 5)​

Year 6 (ages 10 + 11)​

Question 12

What are the effects of orexin (higher levels in those who don’t need much sleep)?

Answer 12

Arousal state! (cerebral cortex activation + involves LC neurons)​

Autonomic function​

Food intake​

Hormonal changes​

Glucose control​

Energy expenditure + metabolic rate​

Question 13

What are the effects of age on sleep?

Answer 13

Sleep time decreases​

Becomes more fragmented​

Changes in type​

From 2 months = circadian sleep (cycles every 24 hrs), infants = ultradian sleep (cycles within 24hrs)​

Circadian rhythm delays in adolescents (stay up later and sleep in later)​

Accompanied by increased light sensitivity (increased impact of screen time etc.)​

Post adolescence – circadian system advances (genetics, neuropeptide expression, lifestyle)​

Slowed melatonin production in elderly (unless remained in good health)​

Sleep disorders: insomnia and OSA most common​

In adolescence – sleep walking, night terrors, sleep paralysis, nocturnal enuresis​

Question 14

How many tiers of interventions are there for BMI?

Answer 14

4

Question 15

BMI criteria for Tier 1 interventions?

Answer 15

None - these interventions are for all

Question 16

BMI criteria for Tier 2 interventions?

Answer 16

≥ 91st centile

Question 17

BMI criteria for Tier 3 interventions?

Answer 17

≥ 99.6th centile​

Or​

≥ 91st centile + co-morbidities/complex needs

Question 18

BMI criteria for Tier 4 interventions?

Answer 18

Not available in children

Question 19

What are some Tier 1 interventions?

Answer 19

Universal prevention​

Consultation with frontline health professionals​

Public health approaches

Question 20

What are some Tier 2 interventions?

Answer 20

Intensive + community based​

Time-specific​

Public health approaches​

Question 21

What are some Tier 3 interventions?

Answer 21

Specialist MDT​

Weight management clinics​

Longer term follow up​

Question 22

What are some Tier 4 interventions?

Answer 22

Surgical options