Childhood obesity after spinal cord injury

Childhood obesity after spinal cord injury

Posted by AskNurseLinda on Dec 3, 2018 12:08 pm

b9c897e774cb8baf19d9b8c62fbcb2ad-huge-isWeight gain is a concern to individuals with spinal cord injury. As mobility becomes affected, it is more difficult to burn extra consumed calories. However, burning calories is not the only reason for weight gain. Over eating is the basic culprit. Finding the balance between calories taken in and calories used by the body is necessary. Less calories are used as a person becomes less mobile. Still an essential number of calories are required for the body to maintain life.

Looking at the growth chart the pediatrician uses to assess the height and weight of your child, you will notice that there is a range for each age. Some children are larger in general and some are naturally smaller. A quick look at the biological parents and you will be able to predict the general size of a child. Taller parents tend to have taller children, shorter parents have shorter children. A tall parent paired with a short parent will have a child somewhere in the middle. Genetics are fickle and sometimes, a mismatch occurs.

Children and adolescents with spinal cord injury need to take in calories for internal body function and energy expense. Just as every injury is different, the number of calories to maintain a healthy weight is different.

The type of spinal cord injury can affect calorie needs due to functional ability. For example, children or adolescents who utilize braces and walkers for mobility might use more calories in energy expenditure to move about. When at home, some children with arm movement might play by surfing the floor. Other children and adolescents might use less calories when they rely on powerchairs for movement.

Ability to eat and to feed yourself is another factor in calorie consumption. If you are able to choose your foods in the school cafeteria, you will be more likely to eat well because the presumption is that you will choose what looks good to you. However, this can have a down side if pizza, burgers, desserts and other high calorie, high fat and high carbohydrate foods are always chosen.

Getting children and adolescents to make good food choices is a challenge for any parent. Some school nurses have instituted a color-coding system for cafeteria foods. Green are overall healthy choices, yellow indicates not eating too many of certain foods and red means only have this food once or twice a week. Interestingly, in schools where this educational program is in place, the students are very aware of food choices. They are given the control to choose, but also information needed to make good choices by the color-coding system. Incorporating this plan at school or at home might reduce some control issues.

A unique issue is tube feeding. Some children and adolescents with spinal cord injury may need dietary supplementation by tube feeding. This is done so the child is provided with the nutrients needed for growth and development. However, the tube feeding solutions are pure nutrition. The nutrients are easily accessible to the body. Eaten food has to be processed by the body to obtain the nutrients but tube feeding solutions are readily digestable. Monitoring weight is important when using tube feedings to avoid a weight creep.

Therefore, children who receive some or all of their nutrition through a tube placed directly into the stomach can gain weight especially if they are not using calories through activity. The solutions are carefully calculated for the age of the child. This formula should not be altered by anyone but your healthcare professional. Discuss your concerns with your child’s healthcare provider to see if a change in formula can be made.

Physiologically, after spinal cord injury, a slow bowel might stall eating. If food is moving through the bowel at a slower transit time, eating is not appealing. If your stomach and bowel is already full, people do not want to put more into their system. Moving the body by rolling from side to side in bed or doing skin relief pressure releases can help move food through the bowel.

Adding fiber to the diet is also helpful. Children and adolescents might not like to drink fiber products. Choosing a flavored fiber drink or the fiber cookie version will help. Be sure to drink the recommended amount of water to moisten the fiber once eaten. Not drinking water with fiber will cause it to dry in the bowel which will clog it leading to an impaction.

Spasticity is another factor that affects nutrition. Spasticity can use a tremendous number of calories. It should not be used for diet control, but spasticity should be controlled for safety and skin integrity. Individuals who are managing their spasticity might also be using a lot of calorie resources.

Psychologically, food is sometimes used as a weapon for child, adolescent and parent. Children or adolescents might use eating or withholding eating as a means of control. What is put into their mouth is a way of controlling their bodies and life. On the other hand, parents or caregivers can be extremely forceful in getting their children to eat. Food should not be used as a reward or punishment. Don’t withhold food or push it in their bodies too fast. Finding a balance can be easily overlooked when in a rush to do all the things that have to be done.

Sometimes, eating can become an activity just because there is nothing else to do. Eating can be a response to being bored, used to fill a void in your emotions or as a means of comforting. Being aware of these emotions for eating is difficult for children and adolescents to understand. Setting times for meals and a healthy snack can help structure the day.

Finding the right balance in letting children make choices is especially important when the situation changes as your child ages. Having the insight to see that perhaps the issue lies with the parent is difficult to understand. If you are having a struggle in making these decisions, it is time to talk with your child’s healthcare professional and seek counseling.

Obesity can lead to health problems today and especially over time. Pressure injury is of prime concern with extra weight. It is more difficult to move your body to transfer and to perform pressure releases to protect your skin. Pressure injury forms when a bone pushes on the inside of the skin causing an interruption in circulation in that area. Muscle helps pad the bone, to avoid pressure injury. If your muscles become thin from lack of use, there is less protection. Fat does not disperse pressure but constricts the area even more. For individuals with a higher body fat, the incidence of pressure injury is higher. Thin people also have a higher risk of pressure injury from lack of muscle tissue protection.

Transferring and mobility can become issues with obesity. Attempting to lift a heavier body is difficult and can even become impossible leading to increased pressure injury, more difficulty in catheterizing and hygiene and loss of functional ability.

Adult health issues are being seen in younger people. Children are developing hypertension or high blood pressure in adolescence and even in childhood due to extra body weight. Since individuals with spinal cord injury may have lower average blood pressures in general, this might not be noticed right away. An average blood pressure for age might be high for that individual with spinal cord injury.

Other consequences of obesity in children might include high cholesterol, fatty liver disease, heart disease, sleep apnea (especially due to extra weight in the neck) and diabetes. Individuals with spinal cord injury have a higher likelihood of acquiring type 2 diabetes due to immobility, weight and diet. This is also true for children.

There are other factors that contribute to obesity as well. A link has been reported between diabetes and BPA. BPA is a chemical that is found in tinted or hard plastic and aluminum as well as a variety of odd things such as cash register receipts. This chemical is well known in baby products and BPA has been eliminated from most of these items if manufactured in the USA.

A connection between using products such as water bottles containing BPA increases the risk for diabetes. Acid drinks such as juices or hot fluids such as coffee release the more BPA from plastic. Check your water bottles and storage containers to be sure they are BPA free. Do not heat food in plastic when using the microwave. The trend now is for households to become plastic free to reduce the risks. More research in this area is being conducted so we will need to follow the progress of these studies.

The best way to avoid obesity is to manage your weight from the start. Therefore, nutrition education is critical at early ages. Once you have gained weight, it is more difficult to eliminate it. Our bodies have developed over thousands of years which included periods of feasts and famines. Innately, we eat to excess to be sure we have some fat stores to carry us through the periods of famine. Today, we need to eat for health but our bodies have not yet learned that. Also, after spinal cord injury, it can be difficult to lose weight due to lack of movement.

There are some strategies to use to help control your diet. This includes eating in moderation for your age and energy needs. If you are not sure of a serving size for yourself or your child, check the website, My Plate. Pictures of serving sizes, what types of foods to eat and amounts for age groups are provided from children to seniors.

Use the color-coding system. Green for proteins and vegetables, yellow for grains, fruits and dairy, and red for sweets. Let the family join in by identifying the color code of the food. Children love to be the first to call out the correct answer.

Move your body. If you can, move it yourself, if not, have someone move it for you. Activity is critical to your health. Moving, even passively, burns calories and has numerous health effects such as avoiding pressure injury, blood clots and joint contractures. Movement can even help improve your breathing, bowel and bladder function. It can prevent the development of adult diseases in childhood.

Utilize your resources. Talk with your health professional about nutrition and diet. Most health plans allow for a yearly consultation with a dietician. Always have your child’s blood tested when recommended as this will indicate your nutritional status.

Developing good eating habits will keep your child healthy for a lifetime. As children’s brains and bodies are developing, they should not diet as adults might. Slow and steady wins the pediatric dietary race.

Nurse LindaI'm online in this community every Wednesday from 8-9 PM ET to answer your SCI and paralysis related questions.

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