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When presented with an overweight child who has hypertension, collect a detailed history, including a 24-hour food-intake history.
Also assess the child's nutritional habits, such as number of fast-food items typically eaten per week and number of family dinners.
Ask about the fluids these children generally consume. For instance, do they drink any caloric beverages other than low-fat milk?
Take an exercise history. Inquire how many hours per day the child is exposed to television, video games, and other media.
Social interaction can be particularly important with an overweight child. Ask if the child has been teased or bullied at home, in school, or elsewhere in the community.
Next ask the parent(s) and patient what they know about high blood pressure. Also inquire about a family history of hypertension.
Confirm any elevation in the child's blood pressure during a physical examination. If the patient has severe hypertension, it is usually time to refer the child to a specialist.
If the child has hypertension for three consecutive monthly visits, further evaluation with blood work is appropriate. Order a complete metabolic panel, urinalysis, and fasting lipid panel. Urinalysis, for example, is useful as a screen for type 2 diabetes.
On a full review of systems, identify other morbidities associated with obesity and perform appropriate tests.
For instance, the child with daytime sleepiness and snoring may require a sleep study to identify obstructive sleep apnea.
In addition, if liver function tests are elevated, a pediatric ultrasound exam can identify a fatty liver.
You can also order an electrocardiogram to identify heart pathology and refer the child if the findings are abnormal.
Many families request thyroid testing for an overweight child. Full thyroid function tests are not cost effective and need not be done. A thyroid-stimulating hormone test should suffice.
As for behavioral counseling, at the Cleveland Clinic Children's Hospital, we recommend our “5 to GO!” messaging, in which children are told to eat 5-a-day fruits and veggies; give 4 compliments a day to anyone they encounter, including other kids, and get 4 compliments a day from anyone; consume 3 dairy products a day; engage in no more than 2 hours of media/TV time a day; drink 0 sugar-sweetened beverages, and go!
For teenagers, we aim for 4 dairy/calcium servings and 3 compliments a day (not that they need fewer compliments, but they do need more calcium than the under age 10 crowd).
The key is to follow patients monthly. Slow, steady change—with positive motivation tailored to each family—works better than trying to do everything at once.
Follow up, follow up, and follow up—with a lot of cheerleading!
Patient education is also essential. Help patients and their families figure out how to cook a no-added-salt diet, how to shop the periphery of a grocery store where the fresh produce is located, and how to build physical activity and exercise into the family's daily plan.
Consider a weight management program such as our Fit Youth Program. Patients and families who participate in this 12-week program at the Cleveland Clinic receive group counseling sessions led by a psychologist in combination with a pediatrician, a dietitian, and an exercise physiologist.
Multidisciplinary interventions such as this one can accomplish modest weight loss versus progression toward 30 pounds of weight gain per year, as occurs in many of our children who do not receive effective treatment.
When presented with an overweight child who has hypertension, collect a detailed history, including a 24-hour food-intake history.
Also assess the child's nutritional habits, such as number of fast-food items typically eaten per week and number of family dinners.
Ask about the fluids these children generally consume. For instance, do they drink any caloric beverages other than low-fat milk?
Take an exercise history. Inquire how many hours per day the child is exposed to television, video games, and other media.
Social interaction can be particularly important with an overweight child. Ask if the child has been teased or bullied at home, in school, or elsewhere in the community.
Next ask the parent(s) and patient what they know about high blood pressure. Also inquire about a family history of hypertension.
Confirm any elevation in the child's blood pressure during a physical examination. If the patient has severe hypertension, it is usually time to refer the child to a specialist.
If the child has hypertension for three consecutive monthly visits, further evaluation with blood work is appropriate. Order a complete metabolic panel, urinalysis, and fasting lipid panel. Urinalysis, for example, is useful as a screen for type 2 diabetes.
On a full review of systems, identify other morbidities associated with obesity and perform appropriate tests.
For instance, the child with daytime sleepiness and snoring may require a sleep study to identify obstructive sleep apnea.
In addition, if liver function tests are elevated, a pediatric ultrasound exam can identify a fatty liver.
You can also order an electrocardiogram to identify heart pathology and refer the child if the findings are abnormal.
Many families request thyroid testing for an overweight child. Full thyroid function tests are not cost effective and need not be done. A thyroid-stimulating hormone test should suffice.
As for behavioral counseling, at the Cleveland Clinic Children's Hospital, we recommend our “5 to GO!” messaging, in which children are told to eat 5-a-day fruits and veggies; give 4 compliments a day to anyone they encounter, including other kids, and get 4 compliments a day from anyone; consume 3 dairy products a day; engage in no more than 2 hours of media/TV time a day; drink 0 sugar-sweetened beverages, and go!
For teenagers, we aim for 4 dairy/calcium servings and 3 compliments a day (not that they need fewer compliments, but they do need more calcium than the under age 10 crowd).
The key is to follow patients monthly. Slow, steady change—with positive motivation tailored to each family—works better than trying to do everything at once.
Follow up, follow up, and follow up—with a lot of cheerleading!
Patient education is also essential. Help patients and their families figure out how to cook a no-added-salt diet, how to shop the periphery of a grocery store where the fresh produce is located, and how to build physical activity and exercise into the family's daily plan.
Consider a weight management program such as our Fit Youth Program. Patients and families who participate in this 12-week program at the Cleveland Clinic receive group counseling sessions led by a psychologist in combination with a pediatrician, a dietitian, and an exercise physiologist.
Multidisciplinary interventions such as this one can accomplish modest weight loss versus progression toward 30 pounds of weight gain per year, as occurs in many of our children who do not receive effective treatment.
When presented with an overweight child who has hypertension, collect a detailed history, including a 24-hour food-intake history.
Also assess the child's nutritional habits, such as number of fast-food items typically eaten per week and number of family dinners.
Ask about the fluids these children generally consume. For instance, do they drink any caloric beverages other than low-fat milk?
Take an exercise history. Inquire how many hours per day the child is exposed to television, video games, and other media.
Social interaction can be particularly important with an overweight child. Ask if the child has been teased or bullied at home, in school, or elsewhere in the community.
Next ask the parent(s) and patient what they know about high blood pressure. Also inquire about a family history of hypertension.
Confirm any elevation in the child's blood pressure during a physical examination. If the patient has severe hypertension, it is usually time to refer the child to a specialist.
If the child has hypertension for three consecutive monthly visits, further evaluation with blood work is appropriate. Order a complete metabolic panel, urinalysis, and fasting lipid panel. Urinalysis, for example, is useful as a screen for type 2 diabetes.
On a full review of systems, identify other morbidities associated with obesity and perform appropriate tests.
For instance, the child with daytime sleepiness and snoring may require a sleep study to identify obstructive sleep apnea.
In addition, if liver function tests are elevated, a pediatric ultrasound exam can identify a fatty liver.
You can also order an electrocardiogram to identify heart pathology and refer the child if the findings are abnormal.
Many families request thyroid testing for an overweight child. Full thyroid function tests are not cost effective and need not be done. A thyroid-stimulating hormone test should suffice.
As for behavioral counseling, at the Cleveland Clinic Children's Hospital, we recommend our “5 to GO!” messaging, in which children are told to eat 5-a-day fruits and veggies; give 4 compliments a day to anyone they encounter, including other kids, and get 4 compliments a day from anyone; consume 3 dairy products a day; engage in no more than 2 hours of media/TV time a day; drink 0 sugar-sweetened beverages, and go!
For teenagers, we aim for 4 dairy/calcium servings and 3 compliments a day (not that they need fewer compliments, but they do need more calcium than the under age 10 crowd).
The key is to follow patients monthly. Slow, steady change—with positive motivation tailored to each family—works better than trying to do everything at once.
Follow up, follow up, and follow up—with a lot of cheerleading!
Patient education is also essential. Help patients and their families figure out how to cook a no-added-salt diet, how to shop the periphery of a grocery store where the fresh produce is located, and how to build physical activity and exercise into the family's daily plan.
Consider a weight management program such as our Fit Youth Program. Patients and families who participate in this 12-week program at the Cleveland Clinic receive group counseling sessions led by a psychologist in combination with a pediatrician, a dietitian, and an exercise physiologist.
Multidisciplinary interventions such as this one can accomplish modest weight loss versus progression toward 30 pounds of weight gain per year, as occurs in many of our children who do not receive effective treatment.