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childhood obesity

Treating Childhood Obesity With Activity

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When talk focuses on childhood obesity in the United States, words like “critical” and “epidemic” are often used. The tried-and-true prescription of more exercise and better nutrition still holds true, but overweight children face unique challenges when it comes to weight loss.

Why Has Childhood Obesity Increased and What Are the Effects?
The statistics are disturbing. Not only are the overall obesity rates increasing, the heaviest kids are heavier than they were 30 years ago. Why is this happening? Experts who have studied childhood obesity attribute it to a change in lifestyle. The active lifestyle of the past—walking to school, playing outside, and engaging in after-school activities—has been replaced by a sedentary lifestyle of watching TV, playing video games, and using electronic devices like phones, computers, and tablets. Eating habits have changed noticeably, with convenience foods that are higher in fat and calories replacing fruits and vegetables.

The consequences of obesity are significant. A child who is obese may develop high blood pressure, high cholesterol, and type 2 diabetes. These conditions can increase the risk of cardiovascular disease such as a heart attack and stroke. In addition, older teens who are obese may have an increased risk of death during adulthood.

Obesity can also affect emotional health. A child who is obese may have emotional problems in school, and struggle with low self-esteem and depression.

What Is One of the Best Solutions?
Exercise is one of the main tools to fight childhood obesity. The US Department of Health and Human Services encourages children of all ages to be physically active. If your child is overweight, obese, or even of normal weight, recommendations to improve your child’s health include:

  • Encouraging your young child (aged 1-4 years old) to actively play daily in a safe environment
  • Encouraging your older child (aged 5 years and up) to participate in moderate to vigorous activity every day—Your child should aim for at least one hour per day of moderate to vigorous activity. At least 3 days out of the week should be vigorous activity.

Since children often engage in shorter bursts of activity throughout the day, it is okay to count these times as exercise.

Examples of different types of physical activity include:

Moderate-intensity: Brisk walking, hiking, skateboarding, baseball, rollerblading, and bike riding
Vigorous-intensity: Jumping rope, running, and playing sports like basketball, hockey or tennis

The main difference between moderate- and vigorous-intensity exercises is the demand on the body. Vigorous activities force the body to work harder. The heart beats faster and breathing becomes more rapid, but energy is used up faster.

  • Rollerblading
  • Learning karate
  • Playing organized sports (field hockey, soccer, football)
  • Swimming
  • Gymnastics
  • Strength training with weights
  • Rock climbing
  • Cross-country skiing

Before your child jumps into a new fitness routine, it is important that you work with your child’s doctor. Being obese can put a strain on muscles and bones, possibly causing back pain and foot or ankle problems. The doctor can assess your child’s overall health and recommend safe exercises.

What Else Can Be Done to Encourage Activity?
Another important piece to the puzzle is to focus on screen time. Screen time refers to how many hours per day your child spends in front of a screen—whether it be watching TV, playing video games, or using electronic devices. These are sedentary activities that contribute to obesity. The NHLBI recommends that screen time should be limited to less than 2 hours per day, which leaves more time for exercise. You can further encourage your child to be active by planning family outings, like going on a hike, riding bikes, or playing flag football. That way, the whole family can become healthier together.

by Patricia Kellicker, BSN and Rebecca J. Stahl, MA

RESOURCES:
American Council on Exercise
http://www.acefitness.org

Shape Up America
http://www.shapeupus.org

CANADIAN RESOURCES:
Health Canada
http://www.hc-sc.gc.ca

Healthy Alberta
http://www.healthyalberta.com

REFERENCES:
Aerobic, muscle, and bone-strengthening: What counts? Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/physicalactivity/basics/children/what_counts.htm. Updated June 5, 2015. Accessed March 2, 2016.

Chapter 3: Active children and adolescents. US Department of Health and Human Services website. Available at: http://www.health.gov/paguidelines/guidelines/chapter3.aspx. Accessed March 2, 2016.

How much physical activity do children need? Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/physicalactivity/basics/children/index.htm. Updated June 4, 2015. Accessed March 2, 2016.

Krul M, van der Wouden JC, Schellevis FG, van Suijlekom-Smit LW, Koes BW. Musculoskeletal problems in overweight and obese children. Ann Fam Med. 2009;7(4):352-356.

NCHBI integrated guidelines for pediatric cardiovascular risk reduction. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 12, 2013. Accessed March 2, 2016.

Obesity in children and adolescents. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 10, 2016. Accessed March 2, 2016.

Last reviewed March 2016 by Michael Woods, MD Last Updated: 3/2/2016

EBSCO Information Services is fully accredited by URAC. URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation.

Backpack Safety

Backpack Safety 101

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It’s that time of the year again when the kids are heading back to school. Learn the proper guidelines and precautions about backpack safety in this week’s PTandMe blog post.

Size
• Should Not Extend Above Shoulders
• Should Rest In Contour Of Low Back (Not Sag Down Toward Buttocks)
• Should Sit Evenly In Middle Of Back

Fit
• Shoulder Straps Should Rest Comfortably On Shoulders And Underarms, With Arms Free To Move – Tighten Shoulder Straps To Achieve This Fit
• Tighten Hip And Waist Straps To Hold Pack Near Body
• Padded Straps Help Even Pressure Over The Shoulders

Weight Of Pack
• Should Never Exceed 15% Of The Child’s Weight To Avoid Excess Loads On The Spine

backpack

Lifting Of Pack
• Proper Lifting Is Done By Bending The Knees, Squatting To Pack Level, And Keeping Pack Close To Body To Lift First To Waist Level And Then Up To Shoulders

Carrying The Pack
• Keep Both Shoulder Straps In Place And Pack Centered
• Spinal Forces Increase With Distance From The Body’s Center

Posture
• Uneven Stresses On The Spine Can Cause Muscle Imbalances. This Can Lead To Pain And Possibly Functional Scoliosis.

Juvenile Rheumatoid Arthritis

Juvenile Rheumatoid Arthritis

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Definition

Juvenile rheumatoid arthritis (JRA), also known as juvenile idiopathic arthritis, is a disease of the joints in children. It can affect a child over a long period of time. JRA often starts before the child is 16 years old.

In Juvenile rheumatoid arthritis, the joint becomes swollen. It will make the joint painful and difficult to move. JRA can also lead to long term damage to the joint. For some, JRA can interfere with the child’s growth and development.

There are 5 major types of juvenile rheumatoid arthritis:
• Pauciarticular JRA—4 or less joints are affected in the first 6 months of illness
• Polyarticular JRA—5 or more joints are affected in the first 6 months of illness
• Enthesitis associated arthritis—swelling of the tendon at the bone
• Psoriatic arthritis—associated with a skin disease called psoriasis
• Systemic onset JRA (also called Stills disease)—affects the entire body, least common type of JRA

Causes

Juvenile rheumatoid arthritis is caused by a problem of the immune system. The normal job of the immune system is to find and destroy items that should not be in the body, like viruses. With JRA, the immune system attacks the healthy tissue in the joint. It is not clear why this happens. The immune system problems may be caused by genetics and/or factors in the environment.

People of Hispanic American, Asian American, Pacific Islander, Native American, or African American descent are at higher risk.
Having prediabetes means that you are at high risk for developing diabetes and may already be experiencing adverse effects of elevated blood sugar levels.

Risk Factors

Girls are more likely to get JRA than boys.

There are no clear risk factors for JRA. Factors that may be associated with some types of JRA include:
• Family history of:
• Anterior uveitis with eye pain
• Inflammatory back arthritis (ankylosing spondylitis)
Inflammatory bowel disease

kids toes

Symptoms

• Symptoms may include:
• Joint stiffness, especially in the morning or after periods of rest
• Pain, swelling, tenderness, or weakness in the joints
• Fever
• Weight loss
• Fatigue or irritability
• Swelling in the eye—especially associated with eye pain, redness, or sensitivity to light
• Swollen lymph nodes
• Growth problems, such as:
• Growth that is too fast or too slow in one joint (may cause one leg or arm to be longer than the other)
• Joints grow unevenly, off to one side
• Overall growth may be slowed

Some symptoms are specific to each type of juvenile rheumatoid arthritis . For example:
• Symptoms common with pauciarticular JRA include:
• Problems most often found in large joints. These joints include knees, ankles, wrists, and elbows.
• If the left-side joint is affected, then the right-side similar joint will not be affected. For example, if the right knee is affected, then the left knee will be healthy.
• May also have swelling and pain at on the tendons and ligaments attached to the bone

• Symptoms common with polyarticular JRA include:
• Problems found most often in small joints of the fingers and hands. May also affect weight-bearing joints like the knees, hips, ankles, and feet.
• Joints on both sides of the body are affected. For example, if the left hand is affected, then the right hand will also be affected.
• May also have a blood disorder called anemia. This is an abnormally low number of red blood cells.
• One type of polyarticular JRA may occur with:
• A low-grade fever
• Nodules—bumps on parts of body that receive a lot of pressure such as elbows

• Symptoms common with systemic onset JRA include:
• Some of the first signs may be a high fever, chills, and a rash on the thighs and chest. May appear on and off for weeks or months
• May have swelling in the heart, lungs, and surrounding tissues
• The lymph nodes, liver and/or spleen may become enlarged
• Children with enthesitis arthritis often have tenderness over the joint where the pelvis and spine meet.
• Children with psoriatic arthritis often have finger or toe swelling. There may also be damage on fingernails.

Often, there are remissions and flare-ups. Remission is a time when the symptoms improve or disappear. Flare-ups are times when symptoms become worse.

Diagnosis

You will be asked about your child’s symptoms. You will also be asked about your family medical history. A physical exam will be done. An eye examination may also be done to check for swelling in the eye. Your child may be referred to a specialist if JRA is suspected. The specialist is a doctor that focuses on diseases of the joints.

Images may be taken of your child’s bodily structures. This can be done with x-rays.

Your child’s bodily fluids may be tested. This can be done with:
• Blood tests
• Urine tests
• Tests of joint fluid

Treatment

Talk with your doctor about the best plan for your child. The plan will work to control swelling, relieve pain, and control joint damage. The goal is to keep a high level of physical and social function. This will help keep a good quality of life. Treatment options include the following:

Medication

There are several types of medication that may be used:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)—to help swelling and pain
• Disease-modifying antirheumatic drugs (DMARDs)—to slow the progression of the disease
• Tumor necrosis factor (TNF) blockers—to decrease swelling, pain, and joint stiffness
• Interleukin inhibitors—to reduces disease activity
• Corticosteroids through IV or by mouth—for swelling
• Steroid injections into the joint—may help relieve swelling and pain in some children

Polyarticular JRA may become inactive in children who begin medications within 2 years of onset.

Physical Therapy

Exercise is done to strengthen muscles and to help manage pain. Strong nearby muscles will support the joint. It also helps to recover the range of motion of the joints. Normal daily activities are encouraged. Non-contact sports and recreational activities may be good options. Physical activities can also help boost a child’s confidence in their physical abilities.

Physical therapy may be needed. This will help to make the muscles strong and keep the joints moving well.

Maintenance Devices

Splints and other devices may be recommended. They may be worn to keep bone and joint growth normal. Some joints may get stuck in a bent position. These devices can help prevent this.

Prevention

There is no known way to prevent JRA.

by Jacquelyn Rudis

RESOURCES:
American College of Rheumatology
http://www.rheumatology.org

Arthritis Foundation
http://www.arthritis.org

CANADIAN RESOURCES:
The Arthritis Society
http://www.arthritis.ca

Health Canada
http://www.hc-sc.gc.ca

REFERENCES:

Hofer MF, Mouy R, et al. Juvenile idiopathic arthritides evaluated prospectively in a single center according to the Durban criteria. J Rheumatol. 2001. 28:1083.

Juvenile idiopathic arthritis (JIA) enthesitis related. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 16, 2015. Accessed December 21, 2015.

Juvenile idiopathic arthritis (JIA) oligoarticular. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 16, 2015. Accessed December 21, 2015.

Juvenile idiopathic arthritis (JIA) polyarticular. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 16, 2015. Accessed December 21, 2015.

Juvenile idiopathic arthritis (JIA) systemic-onset. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 16, 2015. Accessed December 21, 2015.

JAMA Patient Page. Juvenile idiopathic arthritis. JAMA. 2005;294:1722.

Petty RE, Southwood TR, et al. Revision of the proposed classification criteria for juvenile idiopathic arthritis: Durban, 1997. J Rheumatol.1998; 25:1991.

2/5/2013 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed: De Benedetti F, Brunner HI, Ruperto N, et al. Randomized trial of tocilizumab in systemic juvenile idiopathic arthritis. N Eng J Med. 2012;367(25):2385-95.

2/24/2014 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Limenis E, Grosbein HA, et al. The relationship between physical activity levels and pain in children with juvenile idiopathic arthritis. J Rheumatol. 2014 Feb;41(2):345-351.

9/2/2014 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Guzman J, Oen K, et al. The outcomes of juvenile idiopathic arthritis in children managed with contemporary treatments: results from the ReACCh-Out cohort. Ann Rheum Dis. 2014 May 19.

Last reviewed December 2015 by Kari Kassir, MD Last Updated: 12/20/2014

EBSCO Information Services is fully accredited by URAC. URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation.

kids with arthritis

Can Physical Therapy Help Kids with Arthritis?

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Did you know that physical therapy can help kids with arthritis? Juvenile Rheumatoid Arthritis (JRA), also called Stills disease, is the most common form of arthritis seen in children and young adults.Children commonly complain of joint pain and stiffness, along with an occasional fever.

JRA can impact fine movements and overall mobility if left untreated. While medical therapy is the mainstay of treatment, physical therapy and rehabilitation are essential to restoring full movement and quality of life.

superhero_girl

How does physical therapy help?
Physical therapists are trained experts at delivering a variety of treatments to help reduce pain and improve joint movement. A child experiencing pain and dysfunction can feel isolated and left out, unable to participate in group activities with other children. A physical therapist can help the child to improve muscle tone, strength and reduce joint inflammation. This helps children regain the quality of life they deserve; allowing them to live with less pain and enjoy the benefits of unrestricted movement.

This information was written by Oregon Spine and Physical Therapy, a physical therapy group located in Eugene, Oregon. At Oregon Spine & Physical Therapy, your care begins with a comprehensive evaluation of your condition by your physical therapist. This initial assessment will allow the physical therapist to accurately reach a diagnosis and then prepare your appropriate, personal treatment plan. For more information click here.