High quality nutrition, physical activity, and adequate sleep are a few of the ingredients necessary to promote children’s best health, along with a positive approach to screen use and social-emotional wellness.
But for many families, the environment throws up obstacles – whether it’s a challenge to find nutritious foods, a lack of green space or sidewalks, or the constant lure of social media. The American Academy of Pediatrics offers practical strategies for pediatricians and families to help children adopt healthy behaviors and overcome challenges within a clinical report, “The Role of the Pediatrician in the Promotion of Healthy, Active Living.” The report, published online earlier this year, updates recommendations last made in 2015 and overviews ways to lower risks of illnesses such as obesity or disordered eating.
Clinical reports created by AAP are written by medical experts, reflect the latest evidence in the field, and go through several rounds of peer review before being approved by the AAP Board of Directors and published in Pediatrics. In the report, the AAP notes that practical strategies to promote healthy, active living are urgently needed, as few children and adolescents meet the recommendations for nutrition and activity. It proposes a model of care that considers the environment in which a child lives – and how it can be made healthier as well as interpersonal and individual factors that influence a child’s health.
“Pediatricians can advocate for all children to have a healthier environment, including access to good nutrition, safe spaces for physical activity, preventive health care and other things we know children need to thrive,” said Natalie D. Muth, MD, RDN, MPH, FAAP, FACSM, a lead author of the clinical report, written by the AAP Section on Obesity and AAP Committee on Nutrition.
The AAP report provides charts that list optimal amounts of sleep and physical activity needed according to age group, as well as guidance on screen time and what and how to eat. The clinical report complements the 2023 “Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity,” with a focus on prevention. The most effective approach for pediatricians is to offer guidance in a nonjudgmental manner, knowing the many social drivers underlying family life, according to AAP. Families and social media may also harbor myths or misinterpret definitions of “healthy.” Pediatricians and other primary pediatric health care providers have a crucial role in helping to promote lifestyle factors bene cial for the health of children of all weights, shapes, and sizes.
“Research tells us a lot about how to improve a child’s health,” said Christopher Bolling, MD, FAAP, a co-author of the report. “We know that families reap great benefits by eating together three times a week. We also have evidence that physical activity improves mental health and wellbeing. Once we identify a need, we can brainstorm practical ways that, as it turns out, benefit the whole family and not just children.”
Pediatricians are encouraged to not only track a child’s growth measurements and growth trends, but also review them in a family-centered and nonstigmatizing way to identify areas of potential concern. Healthy behaviors are also associated with a parenting style in which the parent or caregiver demonstrates high respect for the child and emotional responsiveness — as well as high control and clear and strict boundaries. This authoritative approach includes offering a structure and consistency to meal and snack times and supports a child’s use of hunger and fullness cues to guide their own intake.
The AAP recommends that pediatricians:
• Assess social determinants of health such as poverty, food insecurity, exposure to racism, trauma and toxic stress, and the built environment.
• Assess parenting practices and baseline nutrition, physical activity, sleep, and screen use. When a gap exists between recommended and reported behaviors, consider a patient’s and family’s readiness to make a change and work together to develop a plan, when appropriate.
• Use respectful, nonstigmatizing language when addressing weight, behaviors or need for behavioral change.
• Learn and implement communication approaches for behavioral change such as motivational interviewing.
• Be a role model for healthy patterns around nutrition, physical activity, sleep, screen use and self-care.
• Refer children and adolescents to community resources.
• Support policies to eradicate racism, address social determinants of health, improve nutrition, decrease intake of sugary drinks and increase physical activity.
• Advocate for adequate payment for preventive care service and team-based care to support guidance for healthy, active living.
The AAP focuses on the need to support a healthier generation of children, and work to prevent diseases that stem from a complex constellation of genetic, environmental and social drivers.
“Pediatricians work with children from infancy throughout young adulthood, and so they are in a great position to help identify gaps and support families working toward healthier lifestyles,” Dr. Muth said. “We can also partner with parents and role model healthy patterns around nutrition, physical activity, sleep, and screen use. Even when we don’t realize it, children are watching and take their cues from us.”
Learn more at aap.org.
