Raising the issue of child weight in different situations
As a practitioner who has frequent contact with young children and families, you are in a good position to identify potential weight-related issues, raise the issue with parents/carers and support them to make lifestyle changes. Yet the thought of raising the issue of child weight with parents/carers (without them raising it first) may bring some discomfort.
Whilst difficult, this first step may be the crucial turning point in the child’s future.
By following the communication principles in the communicating with parents about child weight module, it is possible to raise weight issues in an informative, yet sensitive manner. For example, if you put yourself in the parent/carer’s shoes, adopt a non-judgemental approach and ask permission before jumping in with advice, parents/carers are more likely to open up with you.
One of the best ways to do this is to make it a routine part of your practice to discuss physical activity, diet and weight (and explain to the parents/carers this is the case). This way parents/carers don’t feel targeted and are less likely to feel defensive.
It is important also to look for opportunities to have conversations outside of routine practice. The following suggestions might be helpful for helping you start conversations about weight, physical activity and diet in different situations.
In health clinics: If a parent/carer brings a child to see you for a non-weight related reason, there are several potential ways you might raise the issue of weight sensitively (or related lifestyle issues in the first instance):
- It can be helpful to support your conversation with some objective information. As a health professional, perhaps the most useful approach is to weigh and measure the child (as part of a routine health check, e.g. “I’d like to weigh and measure you now to see how much you’re growing”) then plot them on the BMI centiles. You can then follow the guidance in the Assessing Weight in Young Children module to talk the parent/carer through the child’s measurements, before discussing physical activity and diet as appropriate.
- If it isn’t possible or doesn’t feel appropriate to measure the child, you might begin by saying something like “would it be ok if we talked a little about your child’s physical activity and/or diet?” You could then talk through lifestyle issues (and relate to the medical issue of concern if applicable), before setting an action plan and asking them to return to see you another time. Depending on the direction of the conversation, you might also ask something like “have you any concerns about your child’s weight?” and – if so - “would you like me to plot your child’s weight for you and we can have a look where s/he is?”
During visits to children’s houses: If you notice a lot of sugary snacks around the house or have concerns about the child’s physical activity levels (e.g. if they are sitting in front of screens every visit), this could raise concerns as a risk factor for future weight concerns. Rather than jumping in and asking about the direct behaviour you have observed (which could lead parents to be defensive), it might be an opportunity to say something like “would it be ok if we have a chat about his/her physical activity and/or diet?” Then continue with open questions exploring the parent’s perspective on the situation, e.g. “how active do you feel your child is?” “could you talk me through a typical day?” “Is there anything you are struggling with or would like more support with?”
At Children’s Centres: There might be situations when a child’s weight means they struggle in some of the activities, for example if they are struggling to keep up during a physical activity session or if they have helped themselves to another child’s food in a healthy eating session. These instances provide an opportunity to speak with the parent/carer and express your concerns about the child’s behaviour, being careful to ensure the parent/carer doesn’t feel judged in any way. For example, you might say something like “have you got 5 minutes, I wondered if we would be able to have a chat about [your child]?” Then…”the reason I ask is I noticed today that s/he was struggling to keep up in the exercise session, is this something you were aware of?” and perhaps “what do you feel might be causing this?”. You might then go on to ask something like “could I ask if you know much about children’s physical activity and why it is important?”, or ask the parent about anything they have tried and whether they would like any further support. For non-health professionals (e.g., Children’s Centre staff), it is important to refer parents/carers of children who you have concerns about to their health visitor and/or GP alongside any lifestyle support you provide.
Below is a short quiz to help you evaluate your learning from this module. You may take the quiz as many times as you like.
Roles and responsibilities
Start the quiz
1. Which professions could be the first point of contact for a child of unhealthy weight?
a) Children’s Centre staff
c) Health visitors
d) All of the above
2. If a parent isn’t concerned about their child’s weight, which of these is an effective strategy to bring this to their attention?
a) Plot the child on a growth chart and talk the parents through where their child sits
b) Tell the parent their child is overweight
c) Ask how active their child is
d) Tell the parent they need to reduce the amount of snacks their children eats
3. If a Children’s Centre staff member wishes to support a family with a pre-school child to address a weight issue, which of the following approaches would be appropriate?
a) Refer to a medical professional before taking any action
b) First found out about the family’s lifestyle and concerns, before considering the best action to take
c) Consider what you can do to help them and also whether they might need additional support from a medical professional
d) b and c
4. If a health visitor notices a child seems to be spending a lot of time in front of the TV, what might be the most appropriate way to raise this with parents?
a) Tell them their child is spending too much time in front of the TV
b) Ask permission to talk a little about their child’s activity levels
c) Best not to bring it up, as it might upset the parents
d) Explain to the parents the dangers of sedentary behaviour, without mentioning their own child
5. If a health visitor sees a child who is overweight and there are no medical concerns, but clear areas of physical activity and diet that could be improved, what would be the most appropriate action?
a) Set an action plan with the family and review progress a few months’ later
b) Set an action plan with the family but also refer to the GP for medical support
c) Refer to the GP for medical support, and take no action until you have heard back from them
d) Take no action, but review again in 3 months’ time
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