Children at risk

THE best health care today focusses on prevention. Unfortunately, that message does not seem to apply to children. "Healthwise, children are where adults were 20 years ago, before we understood the connection between lifestyle and disease," says Joseph Mirro, M.D., chief medical officer at St. Jude Children's Research Hospital, in Memphis. Without smart habits that will last through adulthood, children face serious health risks that could be prevented.

Super-sized children

"Obesity is the most common and most dangerous health problem," says Jay Cohen, M.D., F.A.C.E., F.A.A.P., endocrinologist at the Endocrine Clinic P.C., in Memphis. For children, as for adults, the condition increases the risk of coronary-artery disease, high blood pressure, diabetes and certain cancers. In the last two decades, the number of children who are obese has doubled and related health complications, which were once confined to adults, are striking at younger ages.

"These diseases start when you are three, four or five years old," says Avery Faigenbaum, Ed.D., professor of exercise physiology at the University of Massachusetts, in Boston. In a recent survey of preschoolers at New York Head Start Centres, overweight children as young as three had elevated blood pressure and cholesterol. For teens, the problem could be even worse: A Cleveland Clinic study last year found significant atherosclerosis, the dangerous buildup of fat and cholesterol in the arteries that can lead to heart attack and stroke, in 16 per cent of teenage heart donors.

Childhood obesity has triggered another health phenomenon. Type II diabetes, once known as "adult onset" diabetes, and typically diagnosed after age 30, is now turning up in the preteen set. The condition, in which the body develops a resistance to insulin, now accounts for up to 50 per cent of diabetes cases in children compared to less than one per cent 20 years ago, according to Cohen. Type II diabetes can be easily overlooked, since the only early symptoms may be thirst and frequent urination. But it can lead to stroke, heart attack, kidney disease, blindness and nerve damage.

"It can take 15 years for complications from diabetes to arise, so if you get this disease at 65, you may never see them," says Daniel Hale, M.D., paediatric endocrinologist at the University of Texas Health Science Centre, in San Antonio. "But when you get diabetes at age 13, blindness, kidney failure or amputations could be problems in your thirties."

Parents are a crucial part of obesity prevention, but sometimes they fail to recognise how serious the problem is. One study of low-income families found that eight per cent of parents considered their obese child underweight, and more than half thought their child was a healthy weight. To help determine which children are at risk, the Centres for Disease Control and Prevention (CDC), in Atlanta, recently revised paediatric growth charts for the first time since 1977. The new charts track body mass index (BMI), a height-weight ratio that helps assess the risk for heart disease, diabetes and high blood pressure, on a growth curve to see if a child is obese or at risk for becoming overweight.

Based on the new charts, 14 per cent of children aged six to 11 are overweight, according to the National Centre for Health Statistics. That means about six million children face health risks due to their weight, and five million more are on their way to becoming overweight. But some say the statistics are too conservative. The National Health and Nutrition Examination Survey III, a study of more than 30,000 children, found that 22 per cent were overweight and 11 per cent were obese.

What is to blame for the obesity epidemic? Although genetics play a part, experts agree that children are getting heavier because they are increasingly sedentary. While many children now have easy access to fast food and high-calorie snacks in schools, few are getting daily exercise. Only one State in the country, Illinois, requires daily gym class; school recess is now a daily routine only in Virginia.

Seventy-five per cent of teens who are obese will be dangerously overweight as adults, so it is important for parents to make lifestyle changes early. Although they should not constantly criticise a child's weight, which could lead to eating disorders, parents can help a child be more active and choose healthier foods. Since children, on average, rack up about six sedentary hours each day outside of school, a family walk or a game of soccer can make all the difference.

Too tired to learn

Teens need about nine hours of sleep each night, yet only 15 per cent of adolescents reported sleeping more than eight and a half hours on school nights, according to a study published by the National Sleep Foundation (NSF). In fact, 26 per cent of students reported typically sleeping six and a half hours or less. Whether they are staying up late to watch TV or even to study, sleep deprivation has serious consequences. Lack of sleep can lead to low grades and poor school performance. High-school students who are earning C's or below report later bedtimes and less sleep than students with higher grades. And a fatigued teen should not drive: Falling asleep at the wheel may kill more young adults than alcohol-related accidents.

Among younger children, sleep deprivation can trigger hyperactivity, short attention span, difficulty concentrating and moodiness - all symptoms of attention deficit hyperactivity disorder (ADHD). "Over the past five years, sleep researchers have realised that children with sleep deprivation are getting misdiagnosed for ADHD," says Gray Montgomery, M.D., director of the Centre of Sleep Disorders at Children's Health Care of Atlanta.

At least 40 per cent of all children have sleep problems, Montgomery estimates, but they are easily overlooked since parents might expect tired children to be wiped out instead of hyper. "Children fight sleepiness by increasing their activity," says Mark Mahowald, M.D., director of the Minnesota Regional Sleep Director Centre in Minneapolis.

Sleepy children are not only unable to concentrate in school, they are also more irritable - which can lead to violence. Minneapolis high schools that adopted later start times reported fewer behaviour problems. Getting extra sleep has been shown to soothe younger children, too. In one study of preschoolers, children were better behaved when their nap time was increased, says Montgomery.

Sleep is essential for children in other ways, too. Researchers suspect that the brain "sorts and files" new information during sleep, a process that is essential for memory formation and learning. Getting enough shut-eye is also essential for growth. "It is during deep sleep - stage 4 - that the growth hormone spurt occurs. If children are sleep-deprived, then they might miss out on some of that hormone spurt," says Montgomery.

Most commonly caused by swollen tonsils and adenoids or obesity, obstructive sleep apnea, in which blocked air passages force a child to wake up several times each night, affects about two per cent of children. Experts also point to overbooked schedules, which force children to go to bed later or get up earlier. "We all want to do more, and we cut back on sleep to do it, but sleepiness carries a big price tag," says Mahowald. "Parents need to say 'enough already'."

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