Patient EducationHealth promotion strategies to encourage physical activity in infants, toddlers, and preschoolers
Section snippets
Background
Over the last two to three decades, the number of overweight children and adolescents in the United States has reached epidemic proportions, creating a significant public health problem. These children are at risk for developing immediate physical and psychological health problems, as well as the chronic comorbid conditions that affect obese adults (Eissa & Gunner 2004, Williams 2003). Research also has shown that children are unlikely to outgrow their overweight status through linear growth as
Why prevention?
The primary response by health care professionals to the obesity epidemic has been to treat the overweight child in an effort to reduce the child's risk of developing complications. This approach, like weight management programs for adults, has had limited success (Klish & Goodrick, 2003). Thus, the focus now has shifted from the management of overweight children to prevention of overweight (Klish & Goodrick 2003, Williams 2003). The goal is to develop health promotion strategies that emphasize
Contributing factors
Environmental risk factors associated with limited physical activity include: restricting children to infant seats, strollers, and small play spaces for long periods of time; television or video viewing for more than two hours per day; and lack of at least one hour of moderate physical activity per day (Dennison & Boyer 2004, National Association for Sport and Physical Education 2002). Barriers to physical activity include: 1) parental concern for safety in neighborhoods, 2) parental work
Guidelines and anticipatory guidance
Parents perceive the cost of weight management programs, equipment, and activities to be a significant barrier to increased family activity. However, the authors suggest the use of the guidelines developed by the National Association for Sport and Physical Education (BOX 1, BOX 2, BOX 3, BOX 4) as the framework to develop the following practical, inexpensive physical activity strategies (Figure). These strategies create an environment that fosters a parent's ability to support a growing child's
Parent guidelines: Birth—12 months (Box 2)
Infants and toddlers experiment with bodily sensations and motor movements with objects and people, a type of activity called sensorimotor play (Phillips, 1969). Infants need opportunities that will encourage large motor activity and increase mastery over body movements. Physical activity in a safe setting, particularly with encouragement from a parent or caretaker, allows time to acquire crucial skills for motor development and lays the foundation for critical neuronal connections (NASPE, 2002
Parent guidelines for toddlers: 12 months—36 months (Box 3)
Building on sensorimotor play, toddlers begin to understand the world in more symbolic terms (Phillips, 1969). They begin to perceive the function of objects and enjoy mimicking family activities. For instance, at this age they understand that they may use a baby bottle to feed a doll. Young children continue to expand their world and refine motor skills and movement (Dowshen & Walter, 2001). Toddlers often play side-by-side with peers in parallel play; however, solitary play is equally
Parent guidelines for preschoolers: 3 years—5 years (Box 4)
Preschoolers are ready to engage in the world of symbolic play where they substitute one object for another (Phillips, 1969). A preschooler may use a paper towel tube as a musical instrument or an empty box as a drum. In this process, 4-year-old to 5-year-old children infuse play with their experiences with family members and their immediate world. Children often play “school” or “house” with peers or friends, share play with parents or find solitary activities for brief periods (Dowshen &
Conclusion
Lifestyle changes and modern conveniences insidiously have created a more sedentary population. These sedentary changes affect children, starting with the infant, and have been linked to the surge of overweight children, adolescents and adults (National Association for Sport and Physical Education 2002, Neumark-Sztainer 2003). Once overweight is established, attempts at weight reduction are most often modestly successful for only a short time (Reilly & McDowell, 2002). The focus has shifted now
Acknowledgment
The authors would like to thank Robert J. Yetman, MD, for his assistance in the preparation of this article.
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Cited by (30)
Direct observations of active school transportation and stroller use in kindergarten children
2016, Preventive Medicine ReportsCitation Excerpt :It is suspected that many kindergarten children travel to school by sedentary means including motor vehicles and strollers or wagons. Stroller use is of particular interest for young children, as the American Academy of Pediatrics, Canadian Society for Exercise Physiology and the Institute of Medicine have recommended young children have limited use of strollers, which are considered sedentary devices that restrain movement and limit PA (Canadian Society for Exercise Physiology, 2011; McCambridge et al., 2006; Birch et al., 2011; Gunner et al., 2005). The AAP guidelines specifically recommend that stroller use be limited in kindergarten age children (ages 4–6) (McCambridge et al., 2006).
Barriers and Supports to Implementing a Nutrition and Physical Activity Intervention in Child Care: DIRECTORS' Perspectives
2014, Journal of Nutrition Education and BehaviorCitation Excerpt :Other research shows that child care providers often experience challenges with children's dislike of certain foods.7 Research indicates that the best way to engage children of this age is through experiential learning,19-21 and when related to consumption of new foods, through exposure in non-threatening forms such as healthy snack activities.21,22 In this study, hands-on activities with nutritious foods, such as making fun, healthy snacks or planting a school garden, were perceived by directors to pose no significant problems and effectively engaged children in healthy behaviors including being more receptive to eating new foods.
Opportunities for the Primary Prevention of Obesity during Infancy
2009, Advances in PediatricsCitation Excerpt :Although there is little debate that physical activity is important for obesity prevention, questions remain about how much and what types of physical activity during the infant and early toddler years is needed to prevent later obesity. In general, parents of infants should choose physical activities that are interactive, stimulating, easy to do, and incorporated into their daily routine, to reinforce the concept that physical activity is rewarding [213,215]. In addition, 2 existing programs offer possible blueprints for more extensive prevention efforts.
Physical activity in infants with Down syndrome receiving a treadmill intervention
2008, Infant Behavior and DevelopmentComparison of feeding behaviour in mothers of infants and young children from 0 to 36 months old
2007, Archives de PediatrieChildhood obesity: The infancy connection
2007, JOGNN - Journal of Obstetric, Gynecologic, and Neonatal NursingCitation Excerpt :Rapid weight gain in the first 4 months of life has been found to increase the risk of obesity in school‐age children (Stettler et al., 2002). Low birthweight has also been associated with central adiposity, metabolic syndrome, hypertension, cardiovascular disease, and type 2 diabetes in adults (Eriksson, Forsen, Tuomilehto, Osmond, & Barker, 2001; Eriksson, Forsen, Osmond, & Barker, 2003; Hales et al., 1991; Rich‐Edwards et al., 1999). Similarly, a longitudinal study examined the birthweight of male infants and their abdominal girth in adulthood.
Section Editor
Mary Margaret Gottesman, PhD, RN, CPNP
Ohio State University College of Nursing
Columbus, Ohio
- 1
Kathy B. Gunner is Pediatric Nurse Practitioner, Parkview Pediatric Clinic, Houston, Texas; and Assistant Professor of Pediatrics—Clinical, University of Texas, School of Nursing, Houston.
- 2
Paige M. Atkinson is Assistant Professor of Pediatrics—Clinical, University of Texas School of Nursing, Houston.
- 3
Julieana Nichols is Assistant Professor, Department of Pediatrics, University of Texas School of Medicine, Houston.
- 4
Mona A. Eissa is Assistant Professor, Department of Pediatrics, University of Texas School of Medicine, Houston.