Kindergarten and Weight: How to Handle the Discussion?

Most pediatric providers enjoy sharing in the rite of passage known as the pre-kindergarten physical where even the temporary discomfort of the shots and pokes cannot overcome the innocent excitement and enthusiasm of these eager young children ready to enter the formal school setting.

This visit, usually taking place between 4 1/2 to 6 years of age, just became even more intriguing with a recent report indicating that fewer than 20% of children in at-risk weight categories overcame weight issues by 5th grade, with the majority of those who returned to normal weights made the correction by 1st grade.

While the concurrent good news is that 70% of children with healthy weight in kindergarten maintained that weight classification as they grew older, the above findings are a sobering indicator that at a relatively young age, weight patterns are mostly ingrained and difficult to correct, especially after 1st grade. 

So does this portend the evolution of fad diets and aggressive weight management programs targeting the pre-school set and their families/caregivers? Are we going to amplify the angst of young families already struggling with selective eaters and worries of creating life-long body image issues?

There aren't clear answers to some of these concerns, but most importantly, this should be a reminder that those of us who take care of pre-school age children must be diligent about providing anticipatory guidance about healthy habits including meal planning, food choices/amounts, and obtaining a minimum of 45 minutes of daily vigorous physical play.  

Often the popular thought is that "children will grow into their weights" but if we heed this data, like it or not, there is a time sensitivity on appropriate weight discussion and management during those first 5-6 years of life. 

Is this data robust enough to influence how you view weight concerns in the first few years of life, and will it make you more aggressive in weight control recommendations and measures? Or do you think it will place undue guilt and pressure upon young families? Is more study needed?

Cheering for Cheerleading to be Classified as a Sport

Add the American Medical Association to the growing list of prominent medical groups advocating for cheerleading to be formally classified as a sport.

This policy adoption at the annual AMA meeting this week in Chicago recognizes the rigors and risks of cheerleading to be as demanding as many other high school and collegiate level sports. The AMA statements reinforces the findings of a well-documented American Academy of Pediatrics Council on Sports Medicine and Fitness Policy Statement that describes the epidemiology of cheerleading injuries and provides sensible recommendations for injury prevention. (Full disclosure: I was on the committee that reviewed this paper and approved the findings and recommendations).

As a sports medicine professional who sees a fair number of bases, flyers, spotters, and tumblers, the designation of cheerleading as a sport would have a multitude of benefits:

• Cheerleaders would have better and essential access to certified athletic trainers (ATC) for injury prevention and evaluation along with assistance in return to activity progression. Deciding how to return any athlete or performer can be a difficult and individualized concern, but doing it without an on-site medical professional such as the school-based ATC is even more overwhelming.
• Requiring cheerleaders to have pre-participation athletic screening exams affords the opportunity to identify medical and orthopedic concerns and develop comprehensive management plans before these issues become major problems. A timely pre-participation exam could tag team with starting an appropriate strength and conditioning program focusing on common shoulder, back, wrist, knee, and ankle issues.
• A sport designation would hopefully lead to safer facilities including use of mats and not inappropriate types of flooring, higher ceilings, and institution of emergency action plans in the event of injury.
• Encouraging coaches to follow rules for execution of technical skills set forth by national cheerleading governing bodies
• Including cheerleading injuries in national injury monitoring programs to increase information on the type, frequency, and severity of cheerleading-specific injuries at the high school and collegiate levels.

Today's cheerleaders often start well before high school and participate on competitive cheer teams in addition (or in many cases, in place of) to cheering for particular schools and teams. The high level of skill and training asked of these performers places them at risk for both acute and overuse injuries often at similar levels to contadt or collision sport athletes. Denying cheerleaders the right to appropriate medical care and supervision only increases the chance for catastrophic outcomes.

That would be something no one would cheer about...

Click here for more information about cheerleading safety and injury prevention.