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INTRODUCTION

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  • How do I work with a caregiver of a preschooler with obesity or a preteen depressed about the way she looks?

  • When can I consult specialists and when can healthy lifestyle counseling remain in the primary care office?

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This chapter will address the following American College of Graduate Medical Education competencies: patient care, interpersonal and communication skills, professionalism, and systems-based care.

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Patient Care: It has been established that early intervention has a significant impact in establishing positive lifestyle habits.1 This chapter will help the pediatric health care provider understand the emotional, behavioral, and developmental factors impacting obesity, identify developmentally appropriate care, and practice in a culturally sensitive manner taking into consideration the availability of resources within families enabling them to deliver individualized care for their patients.

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Interpersonal and Communication Skills: Effective communication with patients and caregivers is key to preventing and/or treating pediatric obesity. This chapter will help pediatric health care providers clearly address and effectively engage families around the complex issues promoting healthy habits to ensure the best patient care.2

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Professionalism: This chapter will help the pediatric health care provider develop a compassionate and understanding approach to the patient with obesity and their family without judgment regarding weight.

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Systems-Based Care: This chapter will increase the pediatric health care provider’s understanding of the system or context in which a patient lives which is essential to evaluating risk and accessing resources for lifestyle change.

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UNDERSTANDING CHILD DEVELOPMENT FROM PRESCHOOL TO PRETEEN

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Cognitive development

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Cognitive processes used to monitor and regulate thoughts and goal-directed behaviors (executive function) have been strongly linked with academic performance, social functioning, and emotional stability.3, 4, 5, 6, 7 A recent review has shown that children with obesity performed significantly worse on tasks requiring executive functioning such as exercising inhibitory control (suppression of inappropriate behaviors or those that interfere with goal-directed behavior) compared to healthy weight children.8 Limited studies preclude being able to determine causality,8 but this association adds to the importance of family-based interventions that support the child struggling with obesity.

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In early childhood assessment, instruments and treatment recommendations are aimed primarily at adult caregivers. Specifically, managing dietary intake and creating opportunities for active play and physical activity largely depend on caregiver decision-making for younger children. For example, it is not appropriate to expect young children to make dietary choices such as what to pack for school lunch independent of adult supervision. Pediatric health care providers should educate caregivers on the cognitive limitations that make such dietary decisions difficult to achieve for younger children.

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As children transition from preschool to grade school, executive functioning components, such as working memory, and other cognitive processes develop and should allow for more direct interventions to occur with grade school children. At ...

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