At Children's Hospital of Philadelphia (CHOP), we're seeing an increase in body mass index (BMI) among many of our patients. We believe that's largely due to three factors, largely related to the ongoing impact of the COVID-19 pandemic on children and teens:
- Disrupted or altered sleep schedules
- Change in nutritional level of food and lack of structured meal times
- Lack of structured physical activity
Impacts of disrupted routines
COVID-19 disrupted daily routines for many families. Instead of families leaving home to attend work, school and daycare; they remained home – working, learning, relaxing and socializing. Children and teens began going to bed later, and getting up later – disrupting their "normal" schedules.
The impact of late nights is compounded daily and affects other aspects of children's lives – such as meals, nutrition and physical activity. Late-to-bed children and teens are more likely to eat alone and gorge on comfort foods like carbohydrates (chips, cookies, etc.), which gives a short energy burst that leads them to stay up later but ultimately leaves them feeling sluggish, still hungry and gaining unhealthy weight.
It's a self-defeating cycle – one that's hard to stop without family intervention. Public health officials advocate a "we're in this together" mantra for the family. Consider telling your kids, "let's come up with a healthy routine as a family."
Reinforce healthy sleep habits
One way to change your child's metabolism and motivation is to ensure your child receives enough sleep – at night. Elementary school children should be preparing for bed or reading by 8 p.m. Sunday through Thursday nights (i.e. school nights). Teens may stay up until 10 or 10:30 p.m., but they too need time to decompress and relax their minds and bodies.
Keep electronics (i.e. cell phones, tablets and computers) out of the bedroom (or turned off) when your child is trying to fall asleep or sleeping. The beeping and ringing from calls, texts or alerts can disrupt critical phases of your child's sleep cycle. For optimal sleep, ask your child to put electronic devices away at least 30 minutes before bed.
Make no mistake: You will hear grumbling about these changes from your kids. But after a few weeks on the new schedule, your child will be immersed in their new schedule along with their school friends … and may even thank you for the push to return to some semblance of normalcy.
Eat the right foods, at the right times
Eating the right foods at the right time during the day can make a huge impact on weight gain or loss – especially for growing kids and teens. We recommend all children eat three meals a day, plus one or two snacks. See ChooseMyPlate.gov for balanced diet suggestions.
Meals shouldn't be huge – just a balanced mix of food groups, with limited to no sugar, ensuring the carbohydrates offered are whole grain, as well as fruits, vegetables and lean proteins. Drinks should be water or low-fat milk.
Combining or skipping meals is not recommended as it sets up a dangerous cycle of spikes (energy) and valleys (tiredness) throughout the day. Be mindful of what your child drinks. There are tons of calories in soda, energy and fruit drinks. Offer your child water, water infused with fruit, or seltzer water if your child misses the bubbles found in soda.
Make meals a family affair
Consider getting kids involved with meal and snack preparation. Some families find it helpful to discuss meals for the week so family members know what to expect and can help prepare the meals they enjoy most. Meal preparation can be a great way to spend quality 1:1 time with your child. You can discuss the food you are preparing, how to make the meal healthier (i.e. using cauliflower as a partial substitute in mashed potatoes, decreasing the pasta in macaroni and cheese), or other topics you or your child wants to address. Encourage your child to eat a fruit or vegetable at every meal.
Make meals a social event. Discourage children and teens from eating alone. Eat at least one meal a day as a family. This will help every member of the family to slow down, enjoy the food and company. Talking about the highs and lows of the day can have an added benefit of helping family members express their feelings, and develop new potential solutions.
Prioritize physical activity
Find time to get active. You or your child may not have time for a long, concentrated workout. Instead, find pockets of time throughout the day to perform physical exercise. It could be a short walk after school, tossing a ball with a sibling or neighbor, or climbing the stairs five times in a row.
Some activities can be done alone, while others may be better with an "activity buddy." Exercising with others builds accountability and increases the chances you or your child will stick with the activity. You can track your activity – or compete with family members or friends - with fitness apps or online trackers.
Don't be afraid to get creative:
- Who can do the most jumping jacks in three minutes?
- Who can walk the farthest in a day/week/month?
- Which team (adults vs. kids or mixed) can successfully pass a water balloon the most times?
- Who can perform the most complex yoga move?
Consider writing a list of proposed activities – for inside or outside – with your child/ren and choosing a different one each day. Your kids may quickly develop favorites – leading to long-term enjoyment and activity.
If it's not safe to walk around your neighborhood, go to a public park or participate in a structured activity in your community. Make sure your kids (and you) stand in the sunlight – even for as few as five minutes - as many days as possible. Sunlight doesn't cost anything, doesn't put on pounds, and yet can noticeably boost your mood.
Small changes can make a big impact, so take it one step at a time and set goals together to get your family back on a healthy track. We can get through these trying times together and get healthier too!
If you are concerned about your child's recent weight gain, talk to your child's pediatrician or contact CHOP's Healthy Weight Program.
Saba Khan, MD, is an attending physician with the Healthy Weight Program at Children's Hospital of Philadelphia and the CHOP Care Network. She is also director of CHOP's Food Pharmacy.
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At Children's Hospital of Philadelphia (CHOP), we're seeing an increase in body mass index (BMI) among many of our patients. We believe that's largely due to three factors, largely related to the ongoing impact of the COVID-19 pandemic on children and teens:
- Disrupted or altered sleep schedules
- Change in nutritional level of food and lack of structured meal times
- Lack of structured physical activity
Impacts of disrupted routines
COVID-19 disrupted daily routines for many families. Instead of families leaving home to attend work, school and daycare; they remained home – working, learning, relaxing and socializing. Children and teens began going to bed later, and getting up later – disrupting their "normal" schedules.
The impact of late nights is compounded daily and affects other aspects of children's lives – such as meals, nutrition and physical activity. Late-to-bed children and teens are more likely to eat alone and gorge on comfort foods like carbohydrates (chips, cookies, etc.), which gives a short energy burst that leads them to stay up later but ultimately leaves them feeling sluggish, still hungry and gaining unhealthy weight.
It's a self-defeating cycle – one that's hard to stop without family intervention. Public health officials advocate a "we're in this together" mantra for the family. Consider telling your kids, "let's come up with a healthy routine as a family."
Reinforce healthy sleep habits
One way to change your child's metabolism and motivation is to ensure your child receives enough sleep – at night. Elementary school children should be preparing for bed or reading by 8 p.m. Sunday through Thursday nights (i.e. school nights). Teens may stay up until 10 or 10:30 p.m., but they too need time to decompress and relax their minds and bodies.
Keep electronics (i.e. cell phones, tablets and computers) out of the bedroom (or turned off) when your child is trying to fall asleep or sleeping. The beeping and ringing from calls, texts or alerts can disrupt critical phases of your child's sleep cycle. For optimal sleep, ask your child to put electronic devices away at least 30 minutes before bed.
Make no mistake: You will hear grumbling about these changes from your kids. But after a few weeks on the new schedule, your child will be immersed in their new schedule along with their school friends … and may even thank you for the push to return to some semblance of normalcy.
Eat the right foods, at the right times
Eating the right foods at the right time during the day can make a huge impact on weight gain or loss – especially for growing kids and teens. We recommend all children eat three meals a day, plus one or two snacks. See ChooseMyPlate.gov for balanced diet suggestions.
Meals shouldn't be huge – just a balanced mix of food groups, with limited to no sugar, ensuring the carbohydrates offered are whole grain, as well as fruits, vegetables and lean proteins. Drinks should be water or low-fat milk.
Combining or skipping meals is not recommended as it sets up a dangerous cycle of spikes (energy) and valleys (tiredness) throughout the day. Be mindful of what your child drinks. There are tons of calories in soda, energy and fruit drinks. Offer your child water, water infused with fruit, or seltzer water if your child misses the bubbles found in soda.
Make meals a family affair
Consider getting kids involved with meal and snack preparation. Some families find it helpful to discuss meals for the week so family members know what to expect and can help prepare the meals they enjoy most. Meal preparation can be a great way to spend quality 1:1 time with your child. You can discuss the food you are preparing, how to make the meal healthier (i.e. using cauliflower as a partial substitute in mashed potatoes, decreasing the pasta in macaroni and cheese), or other topics you or your child wants to address. Encourage your child to eat a fruit or vegetable at every meal.
Make meals a social event. Discourage children and teens from eating alone. Eat at least one meal a day as a family. This will help every member of the family to slow down, enjoy the food and company. Talking about the highs and lows of the day can have an added benefit of helping family members express their feelings, and develop new potential solutions.
Prioritize physical activity
Find time to get active. You or your child may not have time for a long, concentrated workout. Instead, find pockets of time throughout the day to perform physical exercise. It could be a short walk after school, tossing a ball with a sibling or neighbor, or climbing the stairs five times in a row.
Some activities can be done alone, while others may be better with an "activity buddy." Exercising with others builds accountability and increases the chances you or your child will stick with the activity. You can track your activity – or compete with family members or friends - with fitness apps or online trackers.
Don't be afraid to get creative:
- Who can do the most jumping jacks in three minutes?
- Who can walk the farthest in a day/week/month?
- Which team (adults vs. kids or mixed) can successfully pass a water balloon the most times?
- Who can perform the most complex yoga move?
Consider writing a list of proposed activities – for inside or outside – with your child/ren and choosing a different one each day. Your kids may quickly develop favorites – leading to long-term enjoyment and activity.
If it's not safe to walk around your neighborhood, go to a public park or participate in a structured activity in your community. Make sure your kids (and you) stand in the sunlight – even for as few as five minutes - as many days as possible. Sunlight doesn't cost anything, doesn't put on pounds, and yet can noticeably boost your mood.
Small changes can make a big impact, so take it one step at a time and set goals together to get your family back on a healthy track. We can get through these trying times together and get healthier too!
If you are concerned about your child's recent weight gain, talk to your child's pediatrician or contact CHOP's Healthy Weight Program.
Saba Khan, MD, is an attending physician with the Healthy Weight Program at Children's Hospital of Philadelphia and the CHOP Care Network. She is also director of CHOP's Food Pharmacy.
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