The Pica Perspective

My Last Word -- for Now -- on Childhood Obesity

Finally, some good news -- I hope. Reports this week have heralded the news that the childhood obesity crisis has leveled off. After 25 years of increasing, the percentage of American children who are overweight or obese appears to have held steady in 2003-2004 and 2005-2006.

However, as much as I want to believe this means things are turning around, I'm only cautiously optimistic. As some have pointed out, this could indicate a statistical flaw. And Dr. David Ludwig, director of the obesity clinic at Children's Hospital Boston (and whom I interviewed for BAM), points out that "the full impact of the childhood epidemic will continue to mount in coming years" because it can take many years for obesity-related complications to translate into life-threatening events, including heart attacks and kidney failure.

I'm going to take a wait-and-see attitude. As Dr. Ludwig said, the CDC's analysis of data for 2007-08, due next year, may be the best evidence for determining what direction children's rates are really heading. In the meantime, we should continue to do all we can to ensure children eat right and are physically active!

With that in mind, here's some interesting information about how many calories you and your children can burn doing simple, everyday things!

Activity/Calories Burned After 30 Minutes*
Watching TV	34
Office Work	51.5
Stroller Push	129.5 (17 minute mile)
Sandbox Digging	170.4
Catch	85.2
Jumping Rope	340.9
Soccer	238.6
Basketball	272.2
Gardening	136.3
Playing with children/baby	136.3
Cleaning House (light dusting/etc)	85.2
Dancing	153.2
Stretching	85.2
* For a 150-pound adult, from http://www.primusweb.com/cgi-bin/fpc/actcalc.pl

Childhood Obesity -- What's Responsible for It?

Following on the heels of my post concerning who is responsible for the childhood obesity crisis is a new study that's determined lack of physical activity doesn't play a role in reducing weight in overweight children. The subtitle of the article I read was:

Encouraging overweight children to exercise has no impact on weight loss and they should be encouraged instead to eat more healthily, according to new research.

The researchers, who studied 300 children over a five-year period, stated:

"The most cost-effective way of easing the problem would be to put all the money into getting kids to stop eating junk food rather than splitting it between that and getting them active.

"It is tempting to make kids more active but it doesn't produce the expected results."

The study found that being overweight influences activity more than activity influences being overweight, and argues that this is why attempts to promote physical activity as a way of combating childhood obesity have failed.

Naturally, as a children's physical activity specialist, I'm not happy to read such statements.

I understand, of course, that once a child is overweight, physical activity becomes a greater problem. Many of us have nightmarish recollections of trying to climb the rope, or being forced to run laps until overcome with nausea, during old-fashioned and developmentally inappropriate "gym" classes. Surely any kind of physical activity would feel equally nightmarish to an overweight child. Even if they're inclined to move, overweight children are often physically incompetent. According to an article at the website of the International Play Equipment Manufacturers Association, during one study approximately 120 children ages 3 to 10 were observed traversing an overhead ladder. The only children unable to cross the ladder successfully were obese. In another study it was determined that even children's walking patterns were affected by overweight, with obese children walking slower, asymmetrically, flat-footed, and with toes turned out. Over time these poor walking habits can result in structural deformities and damage to body tissue. And, of course, if even walking is a challenge, anything beyond that could be perceived as overwhelming.

Still, it frightens me to think that this study could be misconstrued and misapplied. The formula is: Energy in/energy out! That means we have to ensure the number of calories burned is equal to the number of calories consumed.

In fact, there have been studies both here and abroad that have indicated the greater problem lies with the second half of the equation: energy out. For example, in the United Kingdom, while the proportion of overweight or obese children remained the same between 1974 and 1984, there was a marked increase in the following decade. The research, reported in the British Medical Journal, determined the change was due not to increased energy (caloric) intake but rather to a decrease in energy output.

Studies in the United States have made the same determination. An increase in childhood obesity of 20% over the last decade has occurred despite a decrease in overall fat consumption and little change in caloric intake.

I have a friend who says you can find research pointing to either side of an argument, and I'm beginning to understand how true that is. My estimation is that lack of physical activity certainly contributes to children becoming overweight and obese -- and that once they're overweight or obese, children are less likely to be physically active. But would I suggest that all monies be appropriated toward the elimination of junk food? Not on your life!

Once again, my advice -- as it often is -- is to maintain a balance!

Childhood Obesity -- Whose Responsibility Is It?

This morning I came across something in the "what were they thinking" category that prompted this post.

Here's the description:

Spinning Cone
The answer for lazy lickers! This motorized ice cream cone will have your whole family fighting for them… so you’d better get one for everyone!

That's right -- a spinning ice cream cone, so your child doesn't even have to move her arm while consuming calories!

Now, I love ice cream as much as -- or maybe even more than -- the next guy. And I certainly wouldn't advise denying children the occasional scoop. But I would love to know why someone thought this was a good idea considering we've got a childhood obesity crisis on our hands!

It brought to mind a piece Brian Doherty wrote in the Los Angeles Times in 2001, in which he ridiculed former surgeon general David Satcher's "fat war." He called on taxpayer-funded agencies to think twice about spending Americans' money to lecture us on what he considers a matter of private health. He believes obesity is a condition "caused by freely chosen behavior" and maintains people can simply cure themselves of obesity by eating less and exercising more.

It would be wonderful to imagine that if everyone simply took personal responsibility for her or his own weight gain, we wouldn't have to spend $100 billion dealing with obesity. But David Satcher told us that this is "the most overweight, obese generation of children in our history." Exactly whose responsibility is that? Let's think about it.

Without even taking into consideration the $100,000 paid to schools by soft drink companies to fill our children's bodies with empty calories, there's still the issue of recess and physical education disappearing from the schools. Who's making the decisions to eliminate all physical activity from the school day (where children spend most of their waking hours) despite mounting evidence that children need to move -- for the health of both their bodies and their minds? Not the children. Given a choice, they'd happily decide to mix more movement into the day.

There's also the matter of loading children's days with activities that preclude exercising more. Given a choice -- and the opportunity -- children might well opt to spend more of their time running, jumping, and breathing hard. But they're not being allowed to "choose freely." Rather, adults are choosing for them.

Are the children responsible for the fact that 32% of 2- to 7-year-olds -- and 65% of 8- to 18-year-olds -- have TVs in their bedrooms? Is it their fault they're not born with self-limiting mechanisms -- and that too often parents have forgotten how to say no? If young children were able to set their own limits with regard to television viewing and computer and video use, they'd need parents only to provide food, clothing, and shelter.

The problem is, once a child is obese because of all these adult-made decisions, the odds are pretty much stacked against him. Not only are behavior patterns, like eating and physical activity habits, established in childhood (educational psychologist Benjamin Bloom contended that 90% of an individual's habits and traits are set by age 12), but long-term studies have also shown that excess body fat tends to persist throughout childhood and into adulthood.

So whose responsibility is the childhood obesity crisis? Among others, I'd say it's companies like the one making the spinning ice cream cone -- and anybody who buys one for a child!

Do You Treat Your Son & Daughter Differently?

This week's featured interview on Body, Mind and Child is with Dr. Lawrence Cohen, author of Playful Parenting. When I talked with Dr. Cohen, I honed in on his chapter on empowering girls and connecting boys to their feelings. I'm fascinated by the topic of gender differences -- especially as it concerns perceived differences, or differences created by society!

Dr. Cohen and I talked about what he calls the "tabletop experiments," in which participants were shown a baby, with some told the baby was a girl and some told the baby was a boy. Not unexpectedly (at least from my perspective), the participants treated the baby differently, depending on which gender they believed it to be.

In another study about which I've written, parents -- especially fathers -- described girls as "softer, finer-featured, smaller, weaker, and more delicate" than boys. Other studies, in which infants were disguised in cross-gender clothing, demonstrated that parents brought trucks to the supposed boy babies and dolls to those they considered girls.

As children get older, parents tend to talk more to their daughters, encourage them to help others, and discourage autonomy. Boys, on the other hand, are encouraged to be fearless. One study, which I referenced in my interview with Dr. Cohen, used videotapes of children on a playground to prove this. The tapes showed that mothers of daughters were more likely to see danger in their activity, and they intervened more quickly and more often that did mothers of sons. Mothers of daughters also issued more statements of caution, while mothers of sons offered more words encouraging risk taking. Similarly, one researcher points out that, when a baby boy falls down, parents make light of it, encouraging the child to get up and try again. On the other hand, when a baby girl takes a tumble, we race over to pick her up and make sure she's OK.

Of course parents aren't the only ones in our society promoting gender stereotyping and inequality. Children are bombarded daily with television images marketing what they conceive to be the "norm": boys playing with cars, trucks, and action figures and girls playing with dolls. "Pink" aisles in the toy stores feature dolls, makeup, and miniature appliances, while "blue" aisles offer vehicles and war toys. "Boys'" toys tend to promote problem solving and exploration, which in turn help develop confidence and competence. "Girls'" toys, by contrast, limit exploration and discourage independence and problem solving.

One result of this media pressure is that, regardless of what they may have asked for, boys more often receive activity-oriented toys and games, while girls are given stuffed animals, toy houses, kitchen sets, and dress-up outfits. Researchers have found that no matter what toys are on the children's lists, parents and others give them gender-specific toys. Girls are then praised for playing with dolls -- and boys are ignored when displaying nurturing behavior. Girls are also more often praised for how they look, while boys are praised for what they do.

Are there differences between boys and girls? Dr. Cohen says there are but that they're not as great as we might imagine. Society, he contends, magnifies the differences that do exist and this does a great disservice to both girls and boys.

Digital Media & Kids

Obviously, as the author of a blog and the host of a podcast, I'm a fan of "new media." And every time I feel like cursing technology for one reason or another, I remind myself that if it weren't for technology, much of what I do these days wouldn't be possible. Does that mean I'm a fan of digital media for children? Not so much, no.

I won't get into a whole dialog concerning authentic learning versus that offered by computers, etc. For now I'd just like to point out that when a child sits in front of a computer or TV screen, even if in the company of others, there's little or no interaction taking place, meaning relationships are not being fostered. It also means fewer opportunities for speaking. As a result, a child may not as readily enunciate her words, formulate her thoughts, expand her vocabulary, or effectively express herself.

According to a new national poll from Common Sense Media and the Joan Ganz Cooney Center, American parents agreed by a wide margin that digital media skills are important to kids' success in the 21st century, but they also expressed skepticism about whether digital media could contribute to the development of skills such as communicating, working with others, and establishing civic responsibility.

To this I say "hallelujah." But the people who conducted the survey have a different take. They say, "The results suggest that tech-savvy school leaders might need to reach out to parents and demonstrate how their children's use of digital media in classrooms can contribute to these skills."

Sorry, but I'm not buying it. Yes, digital media has much to offer children. I'm even partnering with one site dedicated to the use of digital media. It's called Woogi World and, according to its founders, it's "a fun, engaging, and interactive virtual social network site that promotes balance and builds character. Through its academically sound and value-based games and activities, children are encouraged to get out of the virtual world and into the real world using their time, talents, and energies to connect with family, explore interests, engage in play, and serve in their communities." CEO Scott Dow adds, "We promote online learning and offline doing."

Did you read that last quote -- and the part about getting out of the virtual world and into the real world? That's what made me agree to work with them! They understand that there's only so much the virtual world can offer children -- that it takes getting out into the "real world" for them to succeed in life.

When children play together, they learn to navigate the two-way street that is communication. Through play, they also learn to cooperate, take turns, share, resolve conflict, handle their emotions, and take another's perspective. Children aren't born with these abilities, any more than they're born with the ability to multiply and divide.

It takes a great deal more than information to be successful. If personal and social awareness weren't necessary for success and happiness in life, only great test-takers would be triumphant. But the great test-takers don't usually end up as successful or as satisfied with their lives as those possessing great social and emotional skills. And no matter what the media companies think, social and emotional skills can't be acquired via digital means.

How soon should children begin schooling?

Like most controversial topics, the subject of universal preschool and even schooling during the first three years has supporters firmly on both sides. The good news is that everyone finally seems to understand the importance of early childhood. The bad news is that we have a tendency in this country to go overboard with our "solutions."

A recent article in the Chicago Tribune explored the topic of how early early education should begin. There are those who feel that because children's brains "change more between conception and kindergarten than at any other time," waiting to start schooling at age 4 or 5 is too late. The article cites neuroscientist Peter Huttenlocher's studies showing that connections in most brain areas peak by age three and then decline gradually as experiences mold the brain's wiring.

My question is: Just because the brain has more connections during the first three years, does that mean we have to stuff as much information as possible into it? After all, the pruning of synapses is part of nature's plan. It's about survival of the fittest. We aren't necessarily meant to have as many synapses as possible; we're supposed to have the most important, most useful synapses. (That's a rather simplistic explanation, but you get the idea.)

The article made many good points concerning the value of early intervention for infants and toddlers from low-income families. A University of Kansas study determined that children from upper-income backgrounds hear 30 million more words by age 3 than those from welfare families. So, if early intervention strategies can help low-income parents interact with and engage their children, I'd say that's money well spent. But considering how poorly we're doing with the early childhood education we currently offer, in terms of the developmentally inappropriate practice that the politicians and policy makers are demanding, the idea of "formal schooling" for children under age 4 makes me very nervous indeed.

My feeling is that as long as children have parents who interact with them -- love them, talk to them, read to them, and play with them -- they're getting all the education they need! You'll remember, too, that I'm a huge fan of what Finland is doing in terms of education; and Finnish children don't begin formal schooling until age 7. Before then they learn through play. And considering they're number-one in the world in literacy and numeracy, I'd say they're onto something.

What do you think?

Speaking of your thoughts, I'm happy to announce a new feature at Body, Mind and Child. It's called "Parenting Gossip," and it's a place for you to exchange parenting tips, talk about the program guests and topics, make product recommendations, or just gossip about the ups, downs, challenges and joys of being a parent. I hope you'll visit and help get the dialog started! Just click on the above link and then on the tab marked "Parent Gossip." I look forward to the exchange!

Ready or Not, Here Come Sports

With spring here, I thought it appropriate to write about young children and sports. First up: why readiness matters.

Participation in organized sports, if developmentally appropriate, can offer children an opportunity for physical activity and social interaction -- both of which are critical to a child's development. But when the requirements and expectations of organized sports go beyond a child's level of readiness and maturation (when it's developmentally inappropriate), the experience will have more negative than positive results.

What determines readiness? Well, it's important to remember that every child develops at his or her own pace. Still, there are certain "givens" where young children are concerned. One is that they're still growing. Their bones haven't completely calcified, their muscles have not reached their peak volume, and their organs are not fully developed. Additionally, their bodies don't possess the mechanisms needed to relieve their bodies of heat; their visual perception is a long way from mature; and their eye-hand and eye-foot coordination won't be entirely developed for another several years!

In a nutshell, children are not just short adults. Among other things, expecting them to play adult games with adult rules and adult-sized equipment puts them in harm's way physically. Doctors advise against high-impact sports like hockey and football for children under the age of 8 because of the immaturity of their organs and skeletal structures. Soccer, which is thought to be safe for children of both genders, actually has a high rate of injury among young children. Even among professional players, almost one-third suffer at least one injury every season.

Where baseball and softball are concerned, the possibilities are even more frightening. These sports were recently determined to be the leading cause of sports-related eye injuries in children, with the highest incidence occurring in children between the ages of 5 and 14. Even scarier, during a seven-year period in the 1990s there were 40 baseball- or softball-related deaths of children in that same age span. The primary causes of death were blows to the head, neck, and chest.

Among the reasons for these horrific statistics are the facts that:

• young pitchers can't yet throw accurately
• young children don't possess the reaction time needed to instantly evade a fast-approaching ball
• the chest walls of young children are thinner than those of teenagers and adults
• figure-ground perception -- the ability to distinguish an object from its surroundings -- doesn't reach maturity until 8 to 12 years old
• depth perception -- the ability to judge distance in relation to oneself -- isn't usually mature until about age 12

According to the American College of Sports Medicine, more than three-quarters of a million children under the age of 14 are treated in emergency rooms for sports-related injuries each year. It's frightening and ironic, considering that concern about children's safety is one of the reasons parents enroll them in organized sports.

Then, too, there's the potential for psychological harm. Though not as devastating as the possibility of physical injury or death, it's still very real and can also be life-altering. Many adults harbor continuing feelings of inadequacy resulting from early failures in sports and other physical activities. Since children have sports-related perceptions of their ability by first grade, we can see that these beliefs persist over quite a few years.

Finally, there's another reason why readiness matters: the very real possibility that children who are asked to perform tasks for which they're not ready will develop bad habits. For example, the child who doesn't yet know how to throw correctly isn't going to learn to throw correctly because he's pitching a couple of games a week. The child who runs with his feet pronated (feet rolling in with baby toes comign up off the ground) won't learn to run correctly simply by running. Rather, the chances are that these bad habits will become more ingrained over time, making it probable that the child will be unable to continue pitching or running.

But, you're thinking, don't the coaches teach the children how to perform these skills? Unfortunately, the answer is almost never. Many well-meaning coaches, after all, are simply parent volunteers who don't know the correct mechanics of the motor skills involved. Other coaches are so intent on winning games that they focus exclusively on the skilled players, leaving the less-skilled kids to fend for themselves. Either way, it's almost always the game that matters -- not fundamental skill development.

One of the great misconceptions about youth sports is the belief that children who are enrolled in organized programs are taught the skills needed to play -- or to become physically capable people. More often than not, children are instead thrust into playing situations, given instructions that make little sense to them, and expected to go to it. It's rather like taking a child who can't yet walk and trying to teach him to skip first.

These kinds of negative experiences can affect a child for years -- if not a lifetime -- whether we're talking about injury, perception of ability, or poor skill development. All of these possibilities are likely to produce a child who may have begun sports participation with the greatest of enthusiasm but soon is unable or unwilling to take part in any physical activity at all.

What Keeps Kids Inside

Well, I knew fear and competition from electronics were keeping kids indoors; but I never suspected flip-flops, mulch, and no coats as culprits! But that's exactly what a new study has found...

Because I want to do this study justice (it's really important that we give this issue some thought), I'm going to simply reprint the entire press release here. I'd love to get your thoughts on this!

CINCINNATI, April 30 /PRNewswire/ -- At a time when over half of US
children (aged 3-6) are in child care centers, and growing concern over
childhood obesity has led physicians to focus on whether children are
getting enough physical activity, a new study of outdoor physical activity
at child care centers, conducted by researchers at Cincinnati Children's
Hospital Medical Center, has identified some surprising reasons why the
kids may be staying inside. The study, will be presented May 5 at the
annual meeting of the Pediatric Academic Societies in Honolulu, Hawaii.

    "It's things we never expected, from flip flops, mulch near the
playground, children who come to child care without a coat on chilly days,
to teachers talking or texting on cell phones while they were supposed to
be supervising the children," according to Kristen Copeland, M.D., lead
author of the study which was funded by the National Heart, Lung and Blood
Institute. She noted that because there are so many benefits of physical
activity for children -- from prevention of obesity, to better
concentration and development of gross motor skills -- it's important to
know what barriers to physical activity may exist at child-care centers.

    "With so many American preschool-aged children in child care centers,
and previous reports that the amount of physical activity children get
varies widely across different centers, we wanted to explore what some of
the barriers to physical activity at these centers might be," said Dr.
Copeland, a physician scientist and Assistant Professor of Pediatrics in
the Division of General and Community Pediatrics at Cincinnati Children's.
According to the most recent statistics 74% of US children aged 3-6 years
are in some form of non-parental child care. 56% percent of 3-6 year old
children spend time in centers, including child care centers and
preschools. Her team began by exploring child-care center staff members'
perceptions of barriers to children's physical activity. They conducted
focus groups with 49 staff members from 34 child-care centers in the
Cincinnati area (including Montessori, Head Start and centers in the inner
city and suburban areas) as the first of several studies on this subject.

    "We found several previously unreported barriers that meant kids had to
stay inside, including inappropriate footwear such as flip flops and
inappropriate clothing for the weather," said Dr. Copeland. In some child
care centers, if one child in the group shows up without a coat on a chilly
day, she noted, that means the whole group has to stay inside. Even more
surprising to the researchers was the fact that the child-care staff
members said some parents appear to intentionally keep their children's
coats (or send children without coats) so they'd have to stay inside, which
staff attributed to parents' concerns about the child getting injured or
dirty, or a having a cold that may be exacerbated by cold weather.

    Teachers said they also felt pressure from some parents who were more
concerned with children spending time on cognitive skills, such as reading
and writing, than on the gross motor and socio-emotional skills (such as
kicking a ball or negotiating with another child for a turn on the slide)
that are best learned on the playground.

    Then there was the mulch factor. "The staff members who participated in
the groups were really concerned about mulch in the play area," said Dr.
Copeland. "Many said that the kids eat the mulch, or use it as weapons, or
it gets caught in their shoes. It also requires constant upkeep. It's
certainly not something that we had anticipated as an issue, but judging by
the amount of and intensity of the discussions among child care teachers,
it really is."

    Dr. Copeland said the child-care center staff recognized that they
themselves could sometimes serve as a barrier to children's physical
activity. "We heard reports of teachers talking or texting on cell phones
instead of interacting with the children while on the playground," said Dr.
Copeland. She continued, "We found that a staff member who doesn't like
going outside -- maybe she's not a cold-weather person, or she thinks it's
too much work to bundle up and unbundle the children on a cold day -- could
act as a gatekeeper to the playground." In some cases, staff reported that
their own issues with being overweight prevented them from encouraging
children's physical activity.

    "This initial qualitative research has identified a number of issues
that we will be exploring in subsequent studies," noted Dr.Copeland.
"Clearly this is a complex issue -- but finding out what the barriers are
is the first step in addressing the problem and getting more kids involved
in more much-needed physical activity."

    The PAS meeting, sponsored by the American Academy of Pediatrics, the
American Pediatric Society, the Society for Pediatric Research and the
Ambulatory Pediatric Association, is the largest international meeting to
focus on research in child health.

    Cincinnati Children's Hospital Medical Center, one of the leading
pediatric research institutions in the nation, is dedicated to changing the
outcome for children throughout the world. Cincinnati Children's ranks
second among all pediatric institutions in the United States in grants from
the National Institutes of Health. It has an established tradition of
research excellence, with discoveries including the Sabin oral polio
vaccine, the surfactant preparation that saves the lives of thousands of
premature infants each year, and a rotavirus vaccine that saves the lives
of hundreds of thousands of infants around the world each year. Current
strategic directions include the translation of basic laboratory research
into the development of novel therapeutics for the treatment of disease,
and furthering the development of personalized and predictive medicine.
Additional information can be found at http://www.cincinnatichildrens.org.