Nursing students

Raising the issue of child weight in different situations

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As a practitioner who has frequent contact with pre-school children, you are in a prime position to identify potential weight-related issues (see module on identifying unhealthy weight), raise the issue with parents and support them to make some lifestyle changes.   Yet the thought of raising the issue of child weight with parents (without them first bringing it up) 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’s shoes, adopt a non-judgemental approach and ask permission before jumping in with advice, parents are more likely to open up with you.  Below are example situations in which different professions might come across child weight issues and some ideas to help you broach the subject if parents themselves do not raise it.

In health clinics: If a parent 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 medical professional, perhaps the most useful approach is to weigh and measure the child yourself (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 module on identifying unhealthy weight to talk the parent through the child’s measurements, before discussing physical activity and diet as appropriate. 
  • If it is not possible or does not feel appropriate to measure the child at the time, 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 issues.  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 and express your concerns about the child’s behaviour, but this needs to be raised in a non-judgemental manner so the parent doesn’t feel you are “attacking” them. 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’s activity?”  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-medically qualified children’s centre staff, you might suggest parents see their health visitor and/or GP alongside any lifestyle support you provide.