Obesity has important implications for the physical and psychosocial health of children. Boys and girls who view themselves as different from the "norm" often have poor self-esteem. Significant depression in overweight children has also been diagnosed. The most serious consequence of childhood obesity is the fact that 80% of obese children become obese adults and hence are at risk for early adult cardiovascular death.
Research has shown that dietary habits and lifestyle patterns are established in early childhood. Published data from the National Institutes of Health (NIH) suggest a relationship between physical activity, hours of televisions viewing, a high-fat diet, and BMI. Obesity is significantly related to a sedentary lifestyle and a high-fat diet. Encouraging physical activity needs to be emphasized. A study of over 400 children age 8–16 years showed that only 20% exercised vigorously twice or less per week. Today, many children spend a great deal of time being inactive. The average child watches approximately 24 hours of TV per week. It appears that TV viewing has replaced physical activity and is thus considered a linkage to obesity.
If there is a family history of early cardiovascular disease, such as stroke or heart attack under the age of 55 (this includes parents or grandparents), your child should be screened for familial hyperlipidemia. This is performed by a fasting blood test. The American Academy of Pediatrics recommends treating children over the age of 10 years with elevated cholesterol values especially if there is a positive family history of early cardiovascular disease, such as stroke or heart attack under the age of 55 years.
So, should you worry if your child is obese? The answer is "yes," and your physician can help you develop a treatment plan. First, discuss your concern further with your healthcare provider. Consider introducing not only your child but also your entire family to well-balanced meals rather than placing the child on a "diet," which sounds punitive. Remember that children are a reflection of their parents and thus will model their family's eating patterns. Busy lifestyles of many families leave little time for the traditional "family dinner"each evening. The alternative has become the fast food restaurant/drive-through for a quick, often high-fat, meal. This cultural change is partly to blame for the dramatic increase in obesity over the last 2 decades.
Enroll your child in an after-school activity, such as basketball, soccer, swimming or tennis, which will provide him or her aerobic exercise. Lead by example. If your child sees that you are physically active and are having fun, he or she will be more apt to become active as well. Schedule "family time" that includes doing a fun physical activity into your weekends or after dinner. Making this lifestyle change as an entire family will be much more successful than focusing on the family member with the health risk. Be sensitive to your child's needs. Choose a physical activity your child will enjoy rather than be embarrassed trying to perform. And, of course, limit not only the amount of time your child spends watching TV but also the time he or she spends on the computer, on the cell phone, or playing video games.
My daughter fainted this morning while I was combing her hair. I remember fainting as a teenager while having my blood drawn. Should I call her physician?
Syncope, which is the medical term for fainting, is defined as a complete loss of consciousness as well as muscle tone for a very short period of time followed by a rapid, complete recovery. Syncope is common, affecting up to 15% of children and adolescents.
Fainting can be divided into 2 categories: cardiac and noncardiac. The noncardiac cause of syncope can be thought of as the "common fainting episode" and is often benign or not worrisome. It is more common than the other form of syncope, which is due to a serious cardiac abnormality. The physiological basis for simple fainting is the decreased blood flow return to the heart, which stimulates nerve fibers that produce a drop in heart rate, blood pressure, or both.
There are many triggers of fainting, but the most common is a period of prolonged standing, such as a bridesmaid standing at the altar during the wedding ceremony. Pain, fear, the sight of blood, dehydration, illness, and even temper tantrums may also provoke syncope, as seen in the toddler who has breath-holding spells. Another common childhood presentation of syncope may result from hair grooming. The pain experienced due to scalp stimulation is a well-described cause of passing out.
Sometimes children may describe episodes of near fainting or significant dizziness. A common trigger in this case is often quick changes in position, especially in the morning hours when the child has had nothing to eat or drink for many hours.
The true heart causes of fainting are due to decreased blood flow from the heart or perhaps from a serious rhythm abnormality. In both instances, sudden death may be the result. In these patients, a history of prior fainting, especially with exercise, is common. Also, there may be other members of the family who have had fainting spells or even sudden death. If there is a history of a known underlying structural heart problem or a rhythm abnormality in a patient with syncope, immediate medical attention should be sought. Also, children who have strong family histories of sudden death or syncope should be evaluated for inherited cardiac conditions, such as long QT syndrome or a heart muscle disease known as a cardiomyopathy.
Your physician may consult with a pediatric cardiologist for further evaluation of your child's syncope. Special tests may be ordered, such as an electrocardiogram, which assesses the heart rhythm. For the common faint, the treatment strategy is aimed at increasing fluid and salt intake as well as educating the child on situations that may provoke the spells, such as avoiding getting up too quickly from supine positions and dehydration. As importantly, if the child begins to feel light-headed or dizzy, he or she should sit or preferably lie down quickly to avoid an episode of syncope. Many state driving laws do not allow an individual to drive if he or she has a recent history of syncope for the obvious reason of potential injury avoidance. Hence, it is important to be compliant with the treatment plan provided by your doctor for syncope. If conservative management fails, additive therapy of certain medications can be prescribed. Typically, common syncope is a self-limited problem that improves gradually over time.
Our daughter was recently diagnosed with Kawasaki's disease. Will this lead to serious long-term heart problems?
Kawasaki's disease, also known as mucocutaneous lymph node syndrome, is primarily a childhood illness diagnosed not by a single lab test but by history and clinical examination.
Children in the acute stages of Kawasaki's disease are irritable and difficult to console.They have high fevers that last more than 5 days, a rash, swelling of the hands and feet with eventual peeling of the skin, red bloodshot eyes (conjunctivitis), swollen lymph nodes in the neck, and red, swollen mouth, lips, and throat. Long-term cardiac complications of the disease can occur, especially if the diagnosis is not made promptly and thus treatment is delayed.
A Japanese pediatrician, Dr. Tomisaku Kawasaki, originally identified the disease in 1961. It is more frequent in Asian-American children but can occur in any racial group. In the United States, 6,000 children are affected each year. The average age of diagnosis is 2 years, and 80% of cases occur in children less than 5 years of age. Boys are affected almost twice as often as girls.
The cause of Kawasaki's disease is unknown. There is no evidence that the disease is transmitted from person to person. It is an intense inflammatory disease that can affect the coronary arteries (the blood vessels that supply blood to the heart muscle) as well as the heart muscle itself. The coronary arteries can weaken, and aneurysms or discrete swelling of the arteries may develop, which, if not treated appropriately, may be life threatening.
Though a single blood test cannot diagnose Kawasaki's disease, various blood tests primarily are performed to eliminate other diseases that mimic Kawasaki's disease. An echocardiogram (ultrasound of the heart) is performed within the first few days following diagnosis to assess for heart function and the anatomy of the coronary arteries, specifically to determine if coronary artery aneurysms have developed. A follow-up echocardiogram is performed approximately 6 weeks after the initial echocardiogram to screen for any late-developing cardiac involvement.
Standard treatment includes a brief hospital stay with administration of a special intravenous medication known as gamma globulin. This medication has been proven to decrease the incidence of the life-threatening, long-term heart problems with the coronary arteries, which can occur in the child with Kawasaki's disease. Children with Kawasaki's disease are also treated with high-dose aspirin therapy until the fever has completely resolved. The majority of children who are treated with gamma globulin during the first 10 days of illness recover completely.
