Michele Polfuss

Developing Criteria for Pediatric/Adolescent Bariatric Surgery Programs

The prevalence of morbid obesity in adolescents is rising at an alarming rate. Comorbidities known to predispose to cardiovascular disease are increasingly being diagnosed in these children. Bariatric surgery has become an acceptable treatment alternative for morbidly obese adults, and criteria have been developed to establish center-of-excellence designation for adult bariatric surgery programs. Evidence suggests that bariatric surgical procedures are being performed with increasing numbers in adolescents. We have examined and compiled the current expert recommendations for guidelines and criteria that are needed to deliver safe and effective bariatric surgical care to adolescents.

Parenting and feeding behaviors associated with school-aged African American and White children.

Pediatric obesity is multifactorial and difficult to treat. Parenting and feeding behaviors have been shown to influence a child’s weight status. Most prior studies have focused on preschool-aged White children. Additional complicating factors include parents’ inability to accurately identify their child’s abnormal weight status. Parenting and feeding behaviors used by 176 African American and White parents of school-age children were examined. Assessment included (a) identifying what behaviors were reported when parent expressed concern with child’s weight and (b) the relationship of these behaviors on child’s body mass index percentile (BMI%), considering ethnicity, socioeconomic status (SES), and parent’s body mass index (BMI). Findings included African American parents and parents concerned about their child’s weight exhibited increased controlling/authoritarian parenting and feeding behaviors. Parents were able to accurately identify their child’s weight status. Parenting and feeding behaviors played a significant role in the children’s BMI% even when controlling for ethnicity, SES, and parent’s BMI.

Parenting Behaviors of African American and Caucasian Families: Parent and Child Perceptions, Associations With Child Weight, and Ability to Identify Abnormal Weight Status

This study examined the agreement between parent and child perceptions of parenting behaviors, the relationship of the behaviors with the childs weight status, and the ability of the parent to correctly identify weight status in 176 parent-child dyads (89 Caucasian and 87 African American). Correlational and regression analyses were used. Findings included moderate to weak correlations in child and parent assessments of parenting behaviors. Caucasian dyads had higher correlations than African American dyads. Most parents correctly identified their own and their childs weight status. Parents of overweight children used increased controlling behaviors, but the number of controlling behaviors decreased when the parent expressed concern with their childs weight.

Autism Spectrum Disorder and the Child's Weight–Related Behaviors: A Parents' Perspective

To explore parent perspectives of how the attributes of their childs autism spectrum disorder(ASD) impact nutrition, physical activity, screen time behaviors and risk for obesity. Secondarily, we examined the parents perception of the healthcare providers (HCP) influence on these weight-related behaviors. DESIGN AND METHOD We conducted and audio-recorded telephone interviews with parents of children with ASD (n=8) using a structured question guide. Data were transcribed and thematic analysis was conducted. Issues surrounding weight-related behaviors and parental strategies used were reported. RESULTS Two overarching themes with eight subthemes emerged: (1) Challenges related to features of ASD (subthemes included fixation on food, sensory issues/rigidity, developmental factors, impaired social skills, and medication effects) and (2) Challenges related to the care of children with ASD (subthemes included lack of individualized care planning, picking your battles and the impact of ASD on family). CONCLUSION Strategies extracted from the parent narratives promoted both healthy and unhealthy weight-related behaviors. The key finding in this study is that some parents did not follow HCP guidance when they perceived that the HCP did not understand their particular situation. PRACTICE IMPLICATIONS Implementation of healthy weight-related behaviors can be optimized when providers consider the childs challenging ASD behaviors, affirm the difficulties encountered by the family and provide guidance that builds on the individual child/family strengths.

Parental Feeding Behaviors and Weight-Related Concerns in Children With Special Needs:

Parental feeding behaviors and concern about child weight are associated with obesity among youth who are typically developing. Little is known about this relationship among parents of youth with special needs, despite these children having higher obesity risk. This study used an online survey to explore associations among parental feeding behaviors, parent weight concerns, demographics, and child weight status in a sample of 356 parents of children diagnosed with autism spectrum disorder, spina bifida, and Down syndrome. Specific parental feeding behaviors were significantly related to the child’s weight and intensified when the parent was concerned about the child’s weight. Child’s diagnosis, family income, parent age, and parent gender influenced select feeding behaviors. Obesity has significant health ramifications and negatively affects an individual’s ability to self-manage, which is crucial in individuals with special needs. These findings present an opportunity for the health care community to educate and promote healthy feeding practices in this vulnerable population.

Body Composition Measurement in Children with Cerebral Palsy, Spina Bifida and Spinal Cord Injury: A Systematic Review of the Literature

ABSTRACT Pediatric obesity is a major health concern that has an increased prevalence in children with special needs. In order to categorize a child’s weight, an assessment of body composition is needed. Obtaining an accurate body composition measurement in children with special needs has many challenges associated with it. This perplexing scenario limits the provider’s ability to screen, prevent and treat an abnormal weight status in this vulnerable population. This systematic review summarizes common methods of body composition measurements, their strengths and limitations and reviews the literature when measurements were used in children with cerebral palsy, spina bifida and spinal cord injury. Following PRISMA guidelines, 222 studies were identified. The application of the inclusion and exclusion criteria yielded a final sample of nine studies included in this review. Overall, articles reinforced the inconsistencies of body composition measurement and methodology when used with children with special needs. Concerns include small sample sizes, the need to validate prediction equations for this population, and the lack of controlled trials and reporting of measurement methodology. Healthcare providers need to be aware of the complexities associated with measuring body composition in children with special needs and advocate for further testing of these measurements. Additional studies addressing the reliability and validity of these measures are needed to facilitate appropriate health promotion in children.

Total Energy Expenditure and Body Composition of Children with Developmental Disabilities

BACKGROUND Obesity prevalence is increased in children with developmental disabilities, specifically in children with spina bifida and Down syndrome. Energy expenditure, a critical aspect of weight management, has been extensively studied in the typically developing population, but not adequately studied in children with developmental disabilities. OBJECTIVE Determine energy expenditure, fat-free mass and body fat percentile and the impact of these findings on recommended caloric intake in children with spina bifida and Down syndrome. METHODS/MEASURES This pilot study included 36 children, 18 with spina bifida, 9 with Down syndrome and 9 typically developing children. Half of the children with spina bifida were non-ambulatory. Doubly labeled water was used to measure energy expenditure and body composition. Descriptive statistics described the sample and MANOVA and ANOVA methods were used to evaluate differences between groups. RESULTS Energy expenditure was significantly less for children with spina bifida who primarily used a wheelchair (p = .001) and children with Down syndrome (p = .041) when compared to children without a disability when adjusted for fat-free mass. However, no significant difference was detected in children with spina bifida who ambulated without assistance (p = .072). CONCLUSIONS Children with spina bifida and Down syndrome have a significantly decreased energy expenditure which directly impacts recommended caloric intake. No significant difference was detected for children with spina bifida who ambulated, although the small sample size of this pilot study may have limited these findings. Validating these results in a larger study is integral to supporting successful weight management of these children.

The Relationship Between Hemoglobin A1C in Youth With Type 1 Diabetes and Chaos in the Family Household

Purpose The purpose of the study was to examine how physical and social environments, as measured by household chaos, affect the diabetes control (ie, A1C) in youth with type 1 diabetes (T1DM). Methods One hundred and four patients (53 male, 51 female) with T1DM (aged 1-13 years) and their caregivers were recruited from a diabetes clinic at a Midwestern children’s hospital. The caregivers completed a demographic questionnaire as well as a questionnaire pertaining to chaos in the household. A medical record review at baseline and 3- and 6-month follow-up was also conducted. Results Results found that above and beyond the demographic covariates, there still remained a significant relationship between household chaos and glycemic control. Those who scored more than 1 standard deviation above the mean Confusion, Hubbub, and Order Scale (CHAOS) measure score showed significantly worse glycemic control at 6-month follow-up. Conclusions This study demonstrated the relationship of family environment and glycemic control for youth with T1DM. The findings highlight the need to individually assess the youth’s home environment to promote diabetes management and care during clinic visits.

The measurement of body composition in children with spina bifida: Feasibility and preliminary findings

PURPOSE To assess the feasibility of obtaining and comparing various methods of height and body composition (BC) measurements in children with spina bifida (SB). METHODS Fifteen children (7M/8F) with SB (4-18 years old) underwent weight, four height measurements (arm span, wall-mounted stadiometer, segmental and recumbent length) and five BC measurements: (BMI; BodPod®; DEXA; Bioelectrical Impedance Analysis; and skinfold). Data collectors, parents, and study participants evaluated procedures. The four heights as paired with the BC measurements were compared to the gold standard DEXA measurements. RESULTS Procedures were successfully completed in 14 of 15 children. Skinfolds and segmental length had a midlevel ranking of comfort. While no measures substituted for the DEXA scan, preliminary findings suggest that an algorithm may estimate BC in this high-risk population. Currently, arm span used within BodPod® measurements provided the closest agreement with the DEXA scan. CONCLUSION Study protocol was feasible and provided necessary information, including recommended modifications, for successful implementation of the planned subsequent study.

Technology-Based Dietary Assessment in Youth with and Without Developmental Disabilities

Obesity prevalence is higher in children with developmental disabilities as compared to their typically developing peers. Research on dietary intake assessment methods in this vulnerable population is lacking. The objectives of this study were to assess the feasibility, acceptability, and compare the nutrient intakes of two technology-based dietary assessment methods in children with-and-without developmental disabilities. This cross-sectional feasibility study was an added aim to a larger pilot study. Children (n = 12; 8–18 years) diagnosed with spina bifida, Down syndrome, or without disability were recruited from the larger study sample, stratified by diagnosis. Participants were asked to complete six days of a mobile food record (mFR™), a 24-h dietary recall via FaceTime® (24 HR-FT), and a post-study survey. Analysis included descriptive statistics for survey results and a paired samples t-test for nutrient intakes. All participants successfully completed six days of dietary assessment using both methods and acceptability was high. Energy (kcal) and protein (g) intake was significantly higher for the mFR™ as compared to the 24 HR-FT (p = 0.041; p = 0.014, respectively). Each method had strengths and weaknesses. The two technology-based dietary assessment tools were well accepted and when combined could increase accuracy of self-reported dietary assessment in children with-and-without disability.