Canadian paediatricians encouraged to promote active, healthy living for all children

July 2005 –

 Vancouver hosted the 82nd annual meeting of the Canadian Paediatric Society in late June. More than 750 physicians, nurses, and other health care professionals attended the meeting. Keynote addresses, symposia, workshops, and oral and poster presentations of recent research spanned the spectrum of contemporary health issues for Canadian children. Topics ranged from those affecting critically ill newborns, through the common and not so common health problems encountered by infants and children, to the unique health issues faced by teenagers. There were also sessions that focused on the health of the world’s children, notably the opening address delivered by Stephen Lewis, the United Nations Secretary-General’s Special Envoy for HIV/AIDS in Africa.

Fries, donuts, and elevators

The Healthy Eating and Lifestyles Team at the IWK Health Centre, Halifax, Nova Scotia, challenged Canadian paediatricians to become community leaders in health promotion through the simple actions of “stop the talking” and “start acting.” Noncommunicable chronic diseases are the number one health problem in the world today according to the World Health Organization. These diseases are related to preventable risk factors that include smoking, increasing rates of sedentary lifestyles and poor eating habits, and the current epidemic of obesity in adults and children.

The Healthy Eating and Lifestyles Team at the IWK is a group of paediatricians, residents, medical students, a physiotherapist, and intermittently other health or hospital professionals, who are concerned about childhood obesity and the promotion of healthy lifestyles and eating habits in children and families in the Maritimes. The team’s goal is to promote a culture within the IWK in which health modelling and promotion are prominent and valued throughout the organization. Within the IWK, the team is working with the administration and staff to:

1. Examine the foods that are available for children, parents, visitors, and staff.
2. Promote activity levels for children, parents, visitors, and staff.
3. Improve the monitoring and interpretation of height, weight, and body mass index (BMI) in all areas of the Health Centre, and educate colleagues regarding the use of the BMI.
4. Develop educational tools for children and their families, the community, and staff regarding healthy eating and activity as well as interpretation of growth and activity parameters.

The team has developed a conceptual framework for health care providers that links the importance of healthy eating, healthy activity, and BMI. The framework defines a desired “Green Zone” and two undesirable “Red Zones.” The green zone, the target zone, is characterized as follows:

• Nutrition: variety from Canada’s Food Guide, appropriate portion size
• Activity: 90 minutes daily (14,000 steps) AND no more than 90 minutes screen time (TV, video, video games, recreational computer) daily
• BMI: 5th to 85th percentile for age

The team plans to adapt this tool for use by parents and teachers and to enter into partnerships with other institutions and businesses to promote the concept of healthy lifestyles and eating habits in children and families within the community at large.

Migraine prophylaxis

Migraine is a condition that may also be influenced by relatively simple lifestyle changes. The condition affects 3% of children aged three to seven years, 4% to 11% of children aged seven to 11 years, and 8% to 23% of children aged 11 to 15 years. Migraine prophylaxis was recommended for those children whose recurrent headaches met the International Headache Society’s criteria for paediatric migraine:

• five or more episodes with the following features
• headache that last between one and 72 hours
• at least two of these features: pulsating or throbbing quality, moderate to severe intensity, located on one or both sides of the head toward the front of the head, and aggravation by routine physical activity
• at least one of these features: nausea and/or vomiting, irritation by light and/or noise

The goals of migraine prophylaxis are to reduce the frequency, severity, and duration of subsequent migraine attacks; improve the benefits of acute headache treatment; and improve quality of life and reduce missed school days. Migraine prophylaxis is effective but it will never provide 100% headache relief.

In children, drug-free or non-pharmacological approaches are as effective as drug therapies. As stress is the dominant trigger for recurrent or frequent migraines, drug therapy will never be truly effective until the stress is reduced or eliminated. Adequate sleep, regular meals, regular exercise, and modification of extracurricular activities are important lifestyle changes. Other non-pharmacological approaches include cognitive and behavioural techniques, relaxation training, meditation, acupuncture, and massage therapy. Vitamins and herbal preparations may be beneficial for some children.

Drugs used for migraine prophylaxis include anticonvulsants, antihypertensives, and antidepressants. All pharmacological approaches should be used with caution as all drugs have side effects, some of which may make a child quite ill.

Andrew James, MBChB, FRACP, FRCPC, Chief Medical Editor, AboutKidsHealth