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  • How do I work with a family to assess and set nutritional goals for their young child?

  • What evidence-based nutritional interventions are most likely to be helpful in addressing overweight and obesity in the young child?

  • How do I help families who are struggling with meeting their lifestyle goals?

  • What are the next steps to take if the family is unable to reduce their child’s body mass index (BMI)?

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

Patient Care: This chapter will help the pediatric health care provider deliver patient care that is individualized, evidence based, compassionate, and family centered by helping them understand the implementation of evidence-based nutritional interventions within the context of family readiness. In addition, this chapter will also help the pediatric health care provider develop an understanding of the environment and resources available in order to deliver individualized care for their patients.

Interpersonal and Communication Skills: This chapter will help the pediatric health care provider understand nutritional interventions based on accurate and sensitive assessment of a family’s behaviors and beliefs about food and feeding and use this understanding to communicate compassionately and effectively with the family.

Although the rapid growth rates of infancy and the toddler years slow during the preschool period, adequate and varied nutritional intake continues to be essential for proper growth and prevention of obesity. The preschool and school-age years can be a window of opportunity to encourage food acceptance and increase dietary variety, following the neophobic toddler years. Adequate and thorough nutritional assessment and review of dietary history by the pediatric health care provider are critical components of evaluating a child’s overall health status. This assessment is key to the formation and provision of appropriate anticipatory guidance to parents or caregivers about healthy nutrition and informs the prevention or identification of pediatric overweight or obesity. In this chapter, nutritional guidelines and anticipatory guidance for nutrition including tips for management of overweight and obesity will be provided. Primary care providers will learn to manage overweight and obesity for children between 3 and 12 years of age through the use of nutritional assessment and counseling, motivational interview, and stepwise evaluation and treatment recommended by the Expert Committee.1


Close monitoring of growth by continuing to plot BMI is important in order to prevent and/or respond to significant rapid weight accelerations often indicated by crossing BMI percentiles. Parents may also need reassurance during this period, that is, it is normal for growth to slow with a corresponding decrease in appetite and intake that may vary greatly day to day. Children who have overweight or obesity during the preschool- and school-age period have a greater likelihood of becoming adults with obesity. This risk is increased in girls ...

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