“Children are one third of our population and all of our future.”
Select Panel for the Promotion of Child Health, 1981
Lifestyle Medicine addresses the causative factors for chronic diseases and seeks to treat, sometimes reverse and especially prevent such disease states from developing. How wonderful it would be, if every child had the opportunity to be raised with optimal lifestyle factors: secure, low stress, continually active, nutritious food choices, loving relationships, refreshing sleep with meaning and purpose. As Lifestyle Medicine Practitioners we have an opportunity to invest in these young lives, to sow seeds for a healthy future and to work towards preventing the development of chronic disease.
Children need Lifestyle Medicine, just as much as adults do – maybe more so. Recent health data published by the US Centers for Disease Control and Prevention predicts that this generation of children will have shorter, less healthful lives than their parents.1 But as American abolitionist, Frederick Douglass said “It is easier to build strong children than to repair broken men.”
As Lifestyle Medicine Practitioners we need to use what influence we can to impact on long term health outcomes despite less than ideal time frames with individual patients. Certainly, a greater impact can be made at the macro level with Governmental health policies and legislation but for most of us who are consulting with individuals, we can use our Lifestyle Medicine skills to assess and prescribe lifestyle wherever possible with our youngest patients.
Last week an eight year old boy was brought in by his Mum to see me. The reason for their visit was Mum’s concern about anxiety behaviours. For the boy, he was concerned about his left eyelid twitching all the time but Mum described him as being incessantly restless, nail biting, hard to settle at night, always asking questions about what’s happening and checking the family schedule. These behaviours had been present for about six months and his teacher at school had also noticed them and they were considered so significant that it resulted in this doctor’s visit. Immediately apparent to me was another significant issue; this young man was extremely overweight for his eight young years.
For a General Practice consultation of 15 minutes, how could a paediatric Lifestyle Medicine frame of reference operate?
I have summarised the ‘vital signs’2 of Lifestyle Medicine under the acronym SHAPE3 and I use this for a lifestyle assessment and prescription. It works well in a paediatric and adult setting.
S for Sleep is a non-threatening way to begin a conversation around lifestyle. School age, preteen children need 9-11 hours sleep per night.4 This boy was struggling to fall asleep by 9:30pm and was the first child up in the morning so averaging at the lower end of this ideal.
Happiness determinants are the next vital signs to explore. For an adult this is emotional and mental wellness, relationships and stress: (personal, home and work). For a child this can be modified. We talked about his happiness and the areas, (personal, home and school), that he feels are difficult. No, he wasn’t hard on himself; he likes to talk to himself about rugby! (Especially when he can’t sleep). Home was his happy place he told me. He lives with his Mum, step dad, younger brother and six month old baby sister and felt safe at home. Direct questioning about family violence can be considered at this point also. Discussing school brought a frown and both he and Mum affirmed that he is a target for bullying and his friendships were fairly fluid.
Also peculiar to 2020, is the COVID19 pandemic, and I asked about the impact of societal lockdown that happened nationwide in New Zealand six months ago. Dad did school at home with him, he told me, as Mum was busy with the new baby. We discussed how he felt about all the changes that came with COVID19 pandemic restrictions and his new sibling but he didn’t seem to link it to his present symptoms. What did he do for fun? Drawing, listening to music, rugby and computer gaming, with Mum often allowing long periods of computer gaming to deal with the restless behaviour.
Alcohol/Tobacco/Substance Use hopefully isn’t a personal risk factor for children but they may be exposed to secondary harms with adult usage.
Physical Activity. Team sports have been disrupted in 2020 with the COVID19 restrictions and this young boy wasn’t undertaking physical activity on a regular basis at home; certainly not the one hour moderate to vigorous intensity activity recommended by NZ guidelines.5
Eating Habits. Family meals, eating vegetables most days, daily ultraprocessed foods.
Physical examination was brief: Height 148cm, Weight 82kg, BMI 37.4 (all measurements well above WHO growth charts)6. Ears, throat clear. Heart Sounds dual, chest clear.
All of the above took about ten minutes and I had already come to the conclusion that the anxiety distress was significant enough to warrant a referral for psychological support. There seemed to be a number of contributing factors to his anxiety e.g. a new sibling, societal disruption due to COVID19, negative school dynamics and less than optimal lifestyle. Mum was happy with this approach and also with my offer to provide her and her son with ‘self-help’ lifestyle advice.
My Lifestyle Medicine prescription was as follows:
- Use sleep radio to help settle him to sleep at night.7
- Use physical activity to ‘burn off stress’ and settle the agitation. Mum could easily make the connection with how excessive screen time was probably impacting sleep and feeding the restlessness. Earn computer time by equivalent physical activity time each day preferably in the outdoors.
- Encourage a drawing activity prior computer gaming.
- Two extra serves of fruit and vegetables per day. We had the briefest discussion around food and mood and how I wished I had Felice Jacka’s “There’s a Zoo in Your Poo”8 to give out!
This consultation took 15 minutes, the referral was extra, but this young boy left with a lifestyle medicine prescription that will not only help his anxiety disorder but also his other major long term health risk connected with diabesity.9 As GP’s we also have the opportunity for reinforcing lifestyle medicine messages with follow up appointments also.
Children are not mini-adults and there are particular lifestyle issues pertinent to them. They are actively growing and developing and their nutritional, energy and sleep needs are greater than adults. To thrive they need a safe, nurturing, stimulating environment.
Whether we like it or not, this present generation is being raised well connected – digitally. We have all experienced the young baby, not able to sit up even, holding Mum’s iPhone and watching a screen to help pacify them. Screens are the dummies of old. The health consequences of this is well documented10 and contributes to the increased rate of childhood obesity, poor food choices, sedentariness, anxiety/depression, Internet/Video Gaming Addiction, sleep disturbance, poor school performance and behavioural issues. Also concerning, is the reduced outside time with subsequent development of early myopia and risk of long term blindness.
There are now more technological devices in the world than there are people. The digital learning environment is here to stay and has been accelerated given the restrictions around the current worldwide pandemic. Parents need awareness and guidance around their children’s use of technology.11
Examples are as follows:
- Avoid all digital media for under two year olds except video chat.
- Preschool age/Primary School age time restrict digital media and ensure daily outdoors physical activity. An easy way to monitor this is to set a timer – all devices have them and little ones can do this easily. (“Hey Siri set the timer for 30 minutes…!”)
- Teenagers transitioning into young adulthood are more challenging as their use of technology seems to be as natural as breathing. Fostering family routines, e.g. mealtimes, that are technology free times from childhood, is shown to be protective.12
One final comment about influencing our children and future generations: What are we role modelling ourselves? Novelist James Baldwin said it best: “Children have never been very good at listening to their elders, but they have never failed to imitate them.”
- Ludwig D. S. Lifespan Weighed Down By Diet. JAMA. 2016;315(21):2269-2270.
- https://www.lifestylemedicine.org/ACLM/About/What_is_Lifestyle_Medicine_/Lifestyle_Medicine.aspx
- https://www.lifestylemedicine.org.au/content/proactive-health-screening-and-the-opportunity-for-lifestyle-medicine/
- https://www.sleepfoundation.org/children-and-sleep/how-much-sleep-do-kids-need
- https://www.health.govt.nz/our-work/preventative-health-wellness/physical-activity
- https://www.albertahealthservices.ca/assets/info/hp/cgm/if-hp-cgm-who-boys.pdf
- https://www.sleepradio.co.nz/
- https://www.goodreads.com/book/show/53332352-there-s-a-zoo-in-my-poo
- Kalra S Diabesity. J Pak Med Assoc 2013 Apr;63(4):532-4
- Dresp-Langley B. Children’s Health in the Digital Age. Int J Environ Res Public Health. 2020 May; 17(9): 3240.
- https://www.apa.org/topics/healthy-technology-use-children
- Berge J. M et al, Childhood Obesity and Interpersonal Dynamics During Family Meals. Pediatrics. 2014 Nov;134(5):923-32.
This article has been written for the Australasian Society of Lifestyle Medicine (ASLM) by the documented original author. The views and opinions expressed in this article are solely those of the original author and do not necessarily represent the views and opinions of the ASLM or its Board.
