(5 of 6)
Recognizing this, the AAP also changed the guidelines it offers practitioners, recommending that they include advice about drugs like statins for children as young as 8 if they have elevated cholesterol levels and show signs of heading toward heart disease. The fact that we've arrived at a place where the AAP and AARP are starting to offer similar medical advice is something parents and pediatricians are struggling to accept.
It Takes a Village
The paradox of treating prematurely aging kids is that varied as their problems are, there tends to be a one-stop-shopping strategy to address them all--with everything starting in the pediatrician's office. But doctors are learning to stress physical activity and healthy eating and measure a child's body mass index, or BMI, during checkups. In New York State, doctors are urged to document BMI in children as young as 2 or 3. "It helps pediatricians to point out that a child's weight may be trending in an unhealthy direction," says McInerny of the AAP.
Growing numbers of pediatricians are also starting to expand their skill set by learning about adult diseases such as fatty liver and hypertension. "We were trained in [them] but not in as much detail as family physicians," says Dr. Wendy Slusser, medical director of the Fit for Healthy Weight program at Mattel Children's Hospital at UCLA. "We're all having to learn more."
In her program, Slusser relies heavily on a team approach. Doctors, nurses, dietitians, psychologists and exercise specialists, as well as family members, are all recruited as part of treatment. The core of her program, however, involves communicating with kids in a style known as motivational interviewing. Instead of dictating advice, doctors try to get patients to articulate by themselves how they can change their behavior. A statement like "You could ride your bike for an hour instead of sitting at the computer" will never have as much impact as asking the child what activities they like to do and figuring out how to help them do those activities more often. It's more time-consuming, but the payoff is worth it.
"I always have to sit on my hands. And it takes a little bit of patience to wait an extra minute for someone to answer your question," says Slusser. So far, in a pilot group of 115 patients, she and her colleagues have brought down blood pressure enough to help those with high blood pressure avoid taking antihypertensive drugs. Overall, those in the treatment group have either lost weight or at least stayed stable over three months.
A number of schools have begun to measure students' BMI and send the data home to parents. Not all parents support the move, but the AAP stands by it. In some school districts in Texas, nurses are also alerting parents to what's known as acanthosis nigricans, a darkening and thickening of the skin in the back of the neck that can signal prediabetes. Children with this symptom are sent home with a letter, just as they would be if they had lice.