The Rewards of Adaptive Bicycles for Children

Bicycle or tricycle riding is an important component of childhood. For certain children with medical complexities, there are special equipment that enable them to explore the world just like any other child.

When I was working as a physical therapist on the pediatric floor of a rehabilitation hospital, I encountered many children and families impacted by debilitating conditions and circumstances. From cerebral palsy and brain injury, to spinal injury, or cancer, many of the children I met proved that being physically and cognitively limited did not keep them from participating in stimulating play activities.

Adaptive tricycles are designed to provide less able-bodied children a way to exercise their limbs, practice their skills and encourage their participation. 

They often come with various features and accessories such as extra wide frames, trunk reinforcement, head support, leg straps, hand straps, steering assist, etc. They make it possible for children who have low muscle tone, motor control, coordination, or cognitive function to engage in locomotion.

How Can an Adaptive Bicycle Help?

For children with diagnoses that reduce their trunk control, adaptive bikes provide a safe environment where they can work on coordinating their limbs while having their back fully supported or strapped in.  For children who fatigue easily due to their medical conditions, adaptive bikes offer the option of having an adult help steer from behind.  For children who lack the motor control to alternately pedal their legs, foot straps and connected pedals make the reciprocal motion easier by putting muscles and joints through those much needed ranges. Depending on the type of bike, adaptive handles can also accommodate all kinds of grip. So when a child with upper body weakness has a hard time grasping or holding the handlebars to steer a regular bike, an adaptive bike allows them more control of their locomotion.

Durable wheels and a parking brake make adaptive bikes safe for children with a wide range of physical abilities and conditions.  Children with medical complexities who are restricted to a wheelchair can still benefit from rides in an adaptive bike.  Aerobic training and upright posture, as well as limb movements (facilitated or self-initiated), are an essential part of the growth and rehabilitation process for children of all different capabilities. All of this is made easy by special equipment such as the adaptive bike. Being outside and being able to participate in activities with other children promote emotional health and create positive environments for mental and physical growth.

The Rewards of Using Adaptive Bicycles

I have watched many children blossom behind the wheel of an adaptive bicycle. Taking part in that transition is such a rewarding process.  Children who were unable to move certain parts of their bodies after an injury were eventually able to transfer what they learned during cycling to standing and walking tasks. Toddlers who were never able to stand on their own were able to experience, for the first time, limb movements and self-propulsion locomotion. Seeing the smiles on their faces, and hearing the laughter of their parents and siblings… Those moments definitely made my job worthwhile.

Are Eggs Good for You?

Eggs seem to conjure quite a nutrition debate-the white, the yolk, the cholesterol, the omega-3s, the protein, cage-free, brown, white…  This simple, whole food has been put on the “bad” list as much as it’s on others’ “good” list. Whole eggs have been dissected and rearranged into liquid and powdered egg products. Brown eggs have been bleached white. And some eggs have been fortified. Which are healthiest?

As with many nutrition-related questions, I advocate for food in its whole, most natural form. When it comes to eggs, here are my nutrition bites:

Whole eggs are part of a healthy diet, in moderation.

Eggs are comprised of two things: protein and fat. Eggs are a great source of protein, containing approximately 7 grams per egg. All of the protein is in the egg white. All of the fat is in the egg yolk. If we learned anything from the fat-free craze of the 90s, it’s that not all fat is bad for you. In fact, some fat is essential for health (i.e. omega-3 fatty acids), and eliminating all fat does not result in sustainable health changes.

Regarding egg yolks…

The yolk of the egg contains many vital nutrients that would be used to nourish a new life (a baby chick, that is). In this way, it is one of nature’s perfect foods. Yes, there is cholesterol in the egg yolk, so eating more than two eggs every single day may inch up your blood cholesterol level (although exercise and fiber will inch it down, too).

Eggs are actually low in calories and very filling.

One large egg has only about 70 calories, including the yolk that gets such a bad rap. The reason why eggs are filling is because both protein and fat take longer to digest, and help moderate sugar absorption and blood sugar levels. In other words, having an egg with a typical carbohydrate breakfast food will hold you over longer than if you were to eat just cereal, toast, or pancakes alone.

How the egg is produced and where it comes from matters.

When it comes to animal products, quality matters. A hen’s diet will dictate the nutrition quality of the eggs she produces. The better and healthier her diet and lifestyle are, the better and healthier her eggs will be. Chickens’ natural diet and environment includes roaming around pecking grass, seeds and bugs. Chickens who live and eat this way are often termed “free range” or “cage free”. Modern agriculture practices have tweaked chickens’ natural diet and environment to maximize production and revenue. These chickens live in very close quarters in cages and eat a diet of grain and corn. As you might expect, the yolks of free range-produced eggs have healthier fatty acid content, and these yolks naturally contain omega 3 fatty acids. Furthermore, organic eggs come from chickens that have not been given hormones, antibiotics, and who have been fed an organic diet. In my professional opinion, free-range, organic eggs are the best quality.

Brown vs white

Brown eggs come from brown hens and white eggs come from white hens. Given that all other production factors are equal (see above), brown and white eggs are no different in taste or quality.

I hope this was helpful in deciphering all the ideas out there about eggs. What are your opinions of eggs? What diet myths do you want to investigate further?

What Is the Difference Between Occupational and Physical Therapy for Children?

Many of the parents I meet often ask why very few occupational therapist work with infants, or why an occupational therapist (OT) is seeing their child for toe-walking as opposed to a physical therapist (PT). They often wonder why one child who has balance or coordination issues would see a physical therapist while another with similar limitations would see an occupational therapist instead. Some parents think that occupational therapists only work on fine motor skills while physical therapists only work on gross motor skills.  Physical and occupational therapists work in a variety of settings, including hospitals, neonatal intensive care units, skilled nursing homes, outpatient clinics, schools, rehabilitation centers, and doctor’s offices.  Physical therapist and occupational therapist roles differ depending on the setting they work in and the medical diagnoses they work with.

In the outpatient clinic, some of these roles may overlap.  While there are some similarities between PTs and OTs in each setting, there are a few fundamental differences between OTs and PTs in the pediatric setting.

Pediatric Physical Therapy:

In the pediatric outpatient setting, physical therapists are often musculoskeletal and movement specialists. Parents can seek out evaluations when their babies are as young as 1 month old. Physical therapists have in-depth knowledge about human musculoskeletal, neuromuscular, integumentary, and cardiovascular systems. Based on our background in stages of development and biomechanics, we help children with mobility difficulties; whether they are behind on their gross motor milestones, recovering from injury/surgery, or not keeping up with other children.

Through all kinds of hands-on or play techniques, pediatric physical therapist work with children on the following:

  • Gross motor skills
  • Strength
  • Endurance
  • Balance and coordination
  • Motor control and motor planning
  • Body awareness
  • Pain relief
  • Flexibility
  • Gait mechanics
  • Orthotics training
  • Wound care

Our focus is for children to be as mobile and as independent as possible, while training their caregivers on all aspects of a child’s physical development. This includes anything that may affect a child’s quality of movement, posture, alignment, and safety.

Pediatric Occupational Therapy

Outpatient pediatric occupational therapists are trained to improve the quality of children’s participation in their daily functional tasks.  A child’s job is to play and take part in activities at school and at home. These include important endeavors such as paying attention in class, hand writing, dressing, feeding and grooming themselves, and being able to engage in age-appropriate games. Occupational therapists are also trained to help children organize and interpret information from the environment so that they can just be kids. This may include taste aversions that limit their food intake, or texture aversions that affect their clothing tolerance, or sound aversions that affect their mood.

OTs work with children on the following skills:

  • Sensory integration
  • Cognitive endurance
  • Fine motor skills
  • Hand function
  • Visual-spatial awareness
  • Hand-eye coordination
  • Attention
  • Social skills
  • Body awareness

Occupational therapists often educate parents and teachers on the best techniques to ensure children participate in learning, self-care, and play tasks.

Why do some children need both disciplines and some only need one?

So many factors can affect a child’s ability to participate in her daily life. A child may be experiencing frequent falls or may have trouble jumping due to a number of reasons.  No matter the diagnosis or underlying medical condition, any child who is having a hard time keeping up with his peers can benefit from a comprehensive evaluation by a pediatric specialist.

Digestive Issues: How to Help with Diet

Digestive issues are extremely common among kids and adults in our country. So common, in fact, that we often don’t give these issues much thought and accept these feelings as being sort of normal. As a registered dietitian, I can tell you that digestive issues are your body’s way of telling you that some changes need to be made to feel better.

Here are common digestive problems, along with causes and dietary cures:

Acid Reflux

Causes:  Overeating, making the stomach too full and as a result, the stomach contents push up into the esophagus. Reflux can also be caused by food sensitivities or allergies, especially in infants.
Diet Cures:  Eat smaller meals at regular intervals each day (3 meals and 2 snacks). Your stomach is about the size of your two hands cupped together (with two more hands on top to make a sphere), so try eating about this much at meals. Eliminate fried foods. Eat plenty of fruits, vegetables, whole grains and lean meats. Eliminate trigger foods such as caffeine, dairy, and other high fat foods (such as sausage pizza or “loaded” nachos). In infants, rule out food sensitivity or food allergy; common culprits related to reflux in infants are cow’s milk protein (dairy), soy, eggs, and wheat.

General Indigestion

Causes:  Overeating, poor quality of diet, chronic constipation, inflamed enterocytes (cells that line the gastrointestinal tract).
Diet Cures:  Eat smaller meals at regular intervals (see above). Reduce processed foods and focus on whole foods such as legumes, fruits, vegetables, whole grains and lean meats. Drink plenty of water (2+ liters/day). Vary your grain intake (often we eat some form of wheat at all meals and snacks throughout the day). Consume probiotics through quality food sources such as organic yogurt, fermented vegetables (sauerkraut, kimchi, etc), and kefir.

Chronic Constipation

Causes:  A diet that is high in refined carbs, low in fiber, and inadequate in fluids. Constipation worsens with inadequate physical activity and long sedentary periods. Kids may be constipated if they consume too much dairy.
Diet Cures:  Eat fresh fruit at least twice per day and vegetables at least 2-3 times per day. Replace refined grains with whole grains. Other foods high in fiber include legumes, nuts and seeds. Drink 2+ liters of water per day. Limit dairy to 12-24 oz per day. Engage in physical activity throughout the day; even walking and doing house chores are helpful.

Frequent Loose Stools

Causes:  Excessive intake of sugary beverages, including juice, as well as excessive intake of “diet sugars”. Can also be caused by food sensitivity/food allergy. Another cause may be imbalanced gut flora, which can occur after taking antibiotics or with prolonged poor quality of diet.
Diet Cures:  Eliminate sugary beverages and replace with water or milk (given dairy is tolerated). Limit diet beverages to 8 oz per day or less. Trial an elimination diet of common food allergens for two weeks to see if symptoms improve (dairy, wheat, soy, eggs, nuts, fish, shellfish). Consume quality probiotic food sources (see above), as well as soluble fiber which is found in foods such as bananas, oatmeal, applesauce, dried peas as in pea soup, carrots, cucumbers.

Stomach Pain, with Gas and Bloating

Causes:  Food intolerance, sensitivity or allergy. Also these symptoms occur with general overeating of unhealthy food choices.
Diet Cures:  Trial elimination of common culprits for two weeks, including lactose (in dairy), wheat, legumes including beans and nuts, eggs, and soy. Eliminate sugary beverages as well. If symptoms do not improve, investigate fructose intolerance by working with a registered dietitian. Eat smaller meals and regular intervals throughout the day reflecting the Healthy Plate Model.

If you didn’t see your digestive issues listed above, or for more specific questions, leave a comment in the section below. For more guidance on helping your family overcome digestive issues, make an appointment with a registered dietitian at North Shore Pediatric Therapy.

Baby Food Pouches: Bad for Baby’s Health?

A recent statement from the American Academy of Pediatric Dentistry warns parents of the possible side effects to prolonged usage of baby food pouches. They compare the squeeze pouches to that of giving babies juice in sippy cups and bottles, and they indicate that tooth decay may develop if babies are given frequent access to the pouches.

What Harm Can Baby Food Pouches Cause?

The squeeze pouches, while convenient for families on the go, often contain sugary fruit blends which can reek havoc on developing teeth. Over time, the constant exposure of the foods directly to the teeth may begin to break down tooth enamel. However, further research will determine if there is a true correlation between the squeeze pouches and cavities in young children. It is indicated that if parents do allow for their children to eat from the pouches, that they continue to follow the recommendation  of brushing their children’s teeth 2x per day and giving them water and milk to drink instead of juice.

Should I Allow My Child to Use Baby Food Pouches?

While the jury is still out on the actual effects of the pouches on little teeth, the old adage of “everything in moderation” holds true. Busy parents should not be discouraged from using the pouches in a pinch, but spoon feedings are still preferred. Feeding your child from a spoon not only contributes to functional oral motor development, but increases the social aspects of mealtimes. Parents are able to connect with their children during meals and if children are allowed access to constant drinking from the pouches, they are missing out on opportunities to practice developmental feeding skills when fed via spoon.

Click here to read more about oral motor and feeding difficulties in children.

My Child Is Tongue Tied: What Does This Mean?

What is Tongue Tie (Ankyloglossia)?

Ankyloglossia, or more commonly referred to as Tongue Tie, occurs when the lingual frenulum (the thin band of tissue that connects the bottom of the tongue to the mouth) is too short and tight. Reports on the prevalence of tongue tie in newborns is conflicting, though current research indicates that this occurs in approximately 1-4% of newborns. Tongue tie may interfere with breastfeeding, and your newborn my present with significant challenges latching, remaining on the nipple when feeding, and fussiness during feeds. Nursing mothers may also experience significant pain when breastfeeding, even after repositioning.  You may notice that your baby has difficulty sticking their tongue out and the tongue shape may resemble a heart, as observed by a “V” indentation in the tip.  If tongue movement is restricted, tongue elevation, lateralization, and protrusion may be negatively impacted.  Tongue tie is not commonly identified at birth, however if you do have concerns, you should speak with a lactation consultant, speech-language pathologist, or your pediatrician.

What are the effects of my baby having Ankyloglossia?

However, it is presumed that long-term effects are not commonly seen in children with tongue tie. As an infant continues to grow, the frenulum in turn stretches and allows for increased tongue movement.  In rare cases, speech development may be negatively impacted by the severity of the tongue tie, as the tongue is unable to coordinate specific movements to produce targeted sounds. In cases where tongue range-of- motion are profoundly impacted by the tongue tie, the child may undergo a frenotomy or  frenulectomy in which the lingual frenulum is clipped to increase tongue movement.  There is continued debate about whether it is beneficial to “clip or not to clip”, as many healthcare professionals disagree on the effectiveness and supposed outcomes of the surgery. Each case is unique however, therefore an extensive oral-motor and feeding evaluation should be completed in order to assess the severity of the tongue tie, in order to determine the best plan of care for the child.

The Sleep Discrepancy: How Much Sleep We Need and What We Actually Get

Sleep is incredibly vital to our everyday health.  The questions of why we sleep and in the manner we do (consolidated to approximately eight hours) has been accumulating and theories surround its “cleansing” and “restoring” properties have been coming to light.

Theories on Why We Sleep:

One theory suggests that sleep helps to clear our brains of unwanted toxins (Xie, L., Kang, H., Xu, Q., Chen, M., Liao, Y., Thiyagarajan, M., O’Donnell, J., Christensen, D.J., Nicholson, C., Iliff, J.J., Takano, T., Deane, R., & Nedergaard, M., 2013).

An additional theory hypothesizes that our brains have a limited capacity based on a 24-cycle which can only be restored through sleep (Nauert, 2010).  So, if we fall short an hour or two every night, you can imagine the cumulative effect on our cognitive functioning!

Why Are We Sleeping Less Than Before?

Nonetheless, the fact remains that we are all getting fewer hours of sleep than in generations before. Why?  Reasons can be explained by our longer work days that often continue well beyond the time we arrive home, easy access to distracting (albeit entertaining) modes of technology, more events and activities to attend, and an increasing academic workload for junior high and high school students, to name a few.

How Much Sleep Do We Really Need and How Much Are We Actually Getting?

In the school years (6-12), the recommended duration of sleep is between 11 to 12 hours.  Yet the incidence of sleep problems may be as common as 30-40% in children at any one time (Fricke-Oerkermann, L., Pluck, J., Schredl, M., Heinz, K., Mitschke, A., Wiater, A., & Lehmkuhl, G., 2007).  While likely to be transient and not in need of professional care, when the problem is persistent and clearly interferes with the child’s functioning, intervention is warranted.  It is best to begin with your pediatrician who can determine whether Melatonin (an over-the-counter supplement with sleep-enhancing properties), cognitive-behavior therapy, and/or a sleep study to rule-out medical conditions are warranted.

What About Teens and Sleep?

As I have mentioned in my previous blog: Teens and Sleep-How Technology Plays a Role in Restless Nights, adolescents are notorious for their poor sleeping habits and insufficient sleep.  While it is recommended that teens get 9 to 9.25 hours of sleep per night, the reality is closer to 7 hours on weekdays and 8.5 hours on weekends.  Clearly, these teens are not “catching up” on non-school days, creating an ever-increasing cumulative deficiency.  If you suspect that your teen is struggling with optimal sleep and is being negatively impacted as a result, first consider whether environmental factors (e.g., late-night cell phone use, late-night homework and study sessions, overscheduled nighttime activities, etc.) may be contributing and could be adjusted to make sleep a priority.  When this is not successful, recommendations are similar to those for school-age children and include speaking with your pediatrician about effective treatment options (Melatonin or other sleep-enhancing agents, cognitive-behavior therapy, and/or a sleep study to rule-out medical conditions).

To Summarize:

The fact is that our society is one that values hard work, grueling academic schedules, and an abundance of extra-curricular activities, which ultimately end up harming us when it comes to sleep.  It is time for the focus to be placed on sleep once again so that we are in a position to raise healthy adults who will pass on this wisdom.

Need help getting your family’s sleep on track?  Meet with our sleep specialist.

The 411 on Infant Rolling

Around the 4th or 5th month of a baby’s development, he will roll over from being on his tummy to his back. This is often purely accidental; he does not have the ability to control his weight-shifting on his tummy and often tips over as a result.  Around the 5th or 6th month, a baby will have the abdominal strength to lift up his feet and roll over from his back to his tummy. Many of the kids I see are infants and toddlers who somehow missed this important step, or who didn’t start rolling until after the 9th month.  Many of the parents I talk to didn’t give this a second thought until they noticed delays in other skills later on in their children’s growth.

Why is rolling so important?

A healthy, typically developing infant is constantly moving. Like the rest of his body, his musculoskeletal and nervous systems are constantly maturing. As he gains strength in all his big muscle groups, he is also learning how to control his limbs. Motor control is an important aspect of a baby’s neuromuscular growth. Rolling encourages postural muscle recruitment (including the back extensors, hip flexor/extensors, the obliques, and the abdominals). The muscles need to be strong before a baby can learn to crawl, stand, or walk.

The segmental volitional rolling that babies learn to do also encourages trunk dissociation. Through rolling, they learn to separate the movement of their limbs from the movement of their head and trunk. Through these transitional positions, they learn to balance the muscles on the front of their body with the muscles on the back and sides. When they roll to one side of their body, they are elongating that side and contracting the other. It is through this unilateral segmented use that children develop their sequential motor skills – crawling, walking, and most other locomotion skills require the ability to separate one side from the other and separate limb movements from trunk movements.

How can parents help encourage rolling?

  1. Start early. This is similar advice I give to parents about increasing infant tummy time: get down on the floor and play with him. Encourage him and motivate him with toys, sounds, lights, and faces. Start as early as you can. Babies have certain built-in reflexes that help them roll to their side if they just turn their head (the neck-righting reflex).
  2. Ease in.  The more a baby rolls, the more input he receives from his environment to his big muscle groups. Our job is to introduce him to his environment and help him tolerate each new position. His own maturation process will take it from there. Play with him when he is on his tummy or back, then help him to his side and play with him there.
  3. Engage your child, step-by step. With your baby on his back, place a toy just out of reach. Help lift one of his legs and bend his hip to 90 degrees or higher. Slowly cross his leg over the other hip. Wait for him to turn his upper body and kick in his trunk muscles. Your pressure across his hips should be firm, but gentle.
  4. Practice. Practice. Practice. And repeat.

When should I seek a pediatric physical therapy evaluation?

What I often look for is initiation.  The lack of initiation by 6 months is a good indicator that your baby may need a little push from a pediatric physical therapist.  If your baby is not picking up his feet and rolling easily from side to side while on his back by 6 months, bring him in for an evaluation.

Understanding Your Child’s Growth Chart

Growth charts are tools that medical professionals use to track trends in your child’s growth. They are also used to diagnose conditions that indicate growth issues, such as obesity or failure to thrive. For more information about how growth charts are used and interpreted, read on.

Understanding when to use which growth chart:

The Centers for Disease Control and Prevention’s website provides growth charts used for the majority of typically developing kids. It is important that medical professionals use the right growth chart for their patient.

  • For kids < 2 years old:  The growth charts labeled 0-2 years old from the World Health Organization should be used until age two. Recently, growth charts for this age were updated using data that is representative of a wider range of ethnicities and primarily breastfed babies.
  • The “Birth-36 months” growth charts:  These should be used when the child’s length is measured recumbently (lying down). If the practitioner is able to get repeatedly accurate standing height measurements of the child age 24-36 months, then the “2-20 years old” growth chart would be used to plot height and BMI. Weight-for-length is plotted using recumbent length, and BMI is calculated and plotted using standing height.
  • The “2-20” growth charts: These are used for typically developing kids in this age range, and for kids ages 2-3 if their height has been measured standing up. These are also used for kids with special needs or specific diagnoses, such as Down Syndrome and Cerebral Palsy, according to recent recommendations. However, it is imperative that a trained medical professional interpret growth of kids with special needs on standard growth charts. I find it useful to use both standard growth charts and growth charts designed for kids with specific diagnoses as multiple pieces of information in overall growth assessment.

BMI Measurements:

  • Weight for Length and BMI. This single data point is very important, as opposed to the other growth measurements where the overall trend is more important. These growth charts are used diagnostically as follows:
  • Weight-for-length or BMI < 5th percentile. This is considered “underweight”, which means that the infant or child does not have adequate body mass for how long he or she is. Kids who are underweight may be at higher risk for nutrient deficiencies, compromised immune function, lethargy, impaired cognitive development, and more. These cases should be referred to a pediatric dietitian. If underweight status worsens over time or is a chronic issue, the child may be diagnosed failure to thrive.
  • BMI 85th – 94th percentile. This is diagnosed as overweight. Weight loss is not recommended for these kids, but rather weight maintenance. Then as their heightcontinues to increase, the BMI will normalize.
  • BMI > 95th percentile. This is diagnosed as obese. These kids should be referred to a pediatric dietitian for assessment and a weight management plan.
  • Note, children under 2 years old are not diagnosed overweight and obese. This is because growth patterns are very different in infants than older kids. Many factors should be taken into consideration by the trained medical professional for infants who have weight-for-length > 95th percentile before changes to their diet intake are made.

“Within Normal Limits”

This phrase describes the percentiles of the growth chart that are considered to be within a normal range of growth for kids that age. The normal range concept applies mostly to the BMI growth chart and the Weight-for-Length growth chart. BMI is within normal limits if it falls between the 5th and 85th percentiles.

It’s all about the trend.

When it comes to weight and length or height, in most cases, the bigger picture is more important than individual measurements. This means that as long as your child’s growth is “tracking along its usual curve”, his or her growth is probably normal for them. If weight or length/height drop or increase more than two growth channels over a span of 6 months, this is cause for concern and needs further evaluation by the pediatrician and dietitian.

Click here for strategies to talk to your kids about weight and healthy eating.

Get the Family Healthy in 2014, Part 2 of 2

Last week, I discussed three New Year’s resolutions to help get your family healthier in 2014. Here are some more ideas. Like I said in last week’s post, adopt as many of these as you think are realistic for your family. Or pick one change to implement each month as the year goes on. By summer, you will see some real changes!

More Fixes for Healthy Family Eating:

1. Eliminate sugary beverages, including juice. This change is pretty simple and can have a huge impact. Sugary beverages are problematic because it’s easy to quickly consume a lot of calories without feeling full. Juice and sports drinks are not ideal drink choices either, as they are just as calorie-dense as other sugary beverages like soda. It is better to get the vitamin C and electrolytes from healthy food choices. Kids rarely need sports drinks to replace electrolytes during or after physical activity unless they are involved in multiple hours of continuous physical activity and are sweating a lot. Chocolate milk is also considered a sugary beverage, and should be replaced with plain milk. If you are wondering how much sugar is in some of your family’s favorite drinks, measure out one teaspoon of table sugar for every 4 grams of sugar in the “Total Sugar” content on the Nutrition Facts Label. Be sure to look at what the serving size is and how many servings your family member is consuming. I have done this experiment with many families, and they are always shocked since no one (not even the kids) would consider drinking that heap of table sugar.

2. Do something active for at least 60 minutes, every day. Encourage your child to be active by having plenty of outlets for physical activity all year round. For days the weather is not conducive for outdoor play, have a bin filled with things like jump ropes, hula hoops, balls, and other toys. Encourage your child to participate in sports or other hobbies that involve physical activity. Be a good example. Find ways to be physically active as a family, such as walking places within a mile or so instead of driving. This is possible even in cold winter months as long as you dress warmly. If your child is resistant to doing fun physical activities, then offer another option— house chores.

3. Limit screen time to less than 2 hours per day. When you think about how many hours your child spends sitting at school, then how many hours they spend sitting doing homework, then how many hours they spend sitting watching TV or playing on the computer—it adds up to a pretty sedentary lifestyle. This is one of the biggest implications of childhood obesity in our culture today. We have transitioned from a society that relied on physical labor to complete daily tasks, to a society that relies on convenience. Kids used to play outdoor games and sports for fun, and now they play video games. I have had some school-age kids tell me that they just don’t know how to play. Set boundaries around screen time. One idea is to have the kids earn screen time by doing 60+ minutes of physical activity and completing homework.

Any of these New Year’s resolutions will make a healthy impact on your family, especially if the whole family is on-board and participating together. The resolutions described are all simple changes, but can be challenging to implement and sustain without commitment. For more personalized planning and troubleshooting, make an appointment with a registered dietitian at North Shore Pediatric Therapy.

Click here if you missed part 1 of this series, Get Your Family Healthy in 2014.