Treating rural pediatric obesity through telemedicine: outcomes from a small randomized controlled trial.

OBJECTIVE: The objective of the current study was to examine the effectiveness of a multidisciplinary weekly family-based behavioral group delivered via telemedicine to rural areas, compared with a standard physician visit intervention. METHODS: A randomized controlled trial was conducted with 58 rural children and their families comparing a family-based behavioral intervention delivered via telemedicine to a structured physician visit condition. Outcome measures included child body mass index z-score (BMIz), 24-hr dietary recalls, accelerometer data, Child Behavior Checklist, Behavioral Pediatrics Feeding Assessment Scale, and feasibility and fidelity. RESULTS: Child BMIz outcomes were not statistically different between the 2 groups (F = 0.023, p = .881). Improvements in BMIz, nutrition, and physical activity were seen for both groups. CONCLUSIONS: Both telemedicine and structured physician visit may be feasible and acceptable methods of delivering pediatric obesity treatment to rural children.

Obesity and related health behaviors among urban and rural children in the United States: data from the National Health And Nutrition Examination Survey 2003-2004 and 2005-2006.

OBJECTIVE: To assess rates of overweight/obesity and related health behaviors among rural and urban children using data from the National Health and Nutrition Examination Survey (NHANES). METHODS: Data were drawn from the 2003-2004 and 2005-2006 NHANES surveys regarding demographic characteristics, weight status, dietary behaviors and physical activity behaviors. RESULTS: Significantly more rural children were found to be obese than urban children. Health behavior differences to explain this differential obesity rate were primarily not significant, but multivariate analyses indicate that for rural children meeting physical activity recommendations is protective and engaging in more than 2 hr/day of electronic entertainment promotes obesity. CONCLUSIONS: There are modifiable health behavior differences between rural and urban children which may account for the significantly higher obesity rates among rural children.

Treating rural pediatric obesity through telemedicine: baseline data from a randomized controlled trial.

OBJECTIVE: To describe baseline characteristics of participants in a pediatric obesity intervention tailored specifically to rural families delivered via telemedicine. METHODS: Randomized-control trial comparing a family-based behavioral intervention to a usual care condition. Participants Fifty-eight first through fifth graders and their parents from the rural Midwest. Measures Demographic, body mass index (BMI), Actigraph activity monitor information, 24-h dietary recalls, Child Behavior Checklist, Behavioral Pediatrics Feeding Assessment Scale. RESULTS: Child mean BMI was in the 94th percentile for weight. Average daily dietary intake exceeded 2,000 kcal and children consumed over eight servings of high-calorie, low-nutrient-dense foods. Children are engaged in approximately 65 min of moderate, 12 min of vigorous and over 300 min of sedentary physical activity daily. CONCLUSIONS: Baseline data suggest children in rural areas may engage in adequate physical activity but eat many daily servings of energy-dense foods. Rural families may benefit from a comprehensive, rurally tailored obesity-related health behavior intervention.

The use of TeleMedicine in the treatment of paediatric obesity: feasibility and acceptability.

To assess the feasibility of conducting empirically supported family-based paediatric obesity group treatment via TeleMedicine. Seventeen families were randomly assigned to one of two conditions (physician visit, TeleMedicine). Measures included feasibility, satisfaction and intervention outcome measures such as BMI percentile, and nutrition and activity behaviours. Measures were completed at baseline, post-treatment and at 1-year follow-up. Analyses indicate that both feasibility and satisfaction data regarding the TeleMedicine intervention were positive. Intervention outcome indicates no change in BMI percentile or nutrition and activity behaviours for either treatment group. A behavioural family-based weight loss intervention delivered via TeleMedicine was well received by both parents and providers. Due to the small sample size, null findings regarding intervention outcome should be interpreted with caution. Future research should focus on methods to increase the impact of this intervention on key outcome variables.

Empirically supported treatments for feeding difficulties in young children.

Pediatric feeding problems are common among children and present severe issues for families. Unfortunately, treatment outcome studies with this population are sparse. The current study reviews the literature regarding treatment studies of children with severe feeding issues, provides an overview of empirically supported treatments for children who do eat orally, and finally summarizes interventions that attempt to reintroduce oral feeding to children who have been fed by gastrostomy tube or other non-oral feeding route.

Moving from tube to oral feeding in medically fragile nonverbal toddlers.

The current article describes a 14-week outpatient protocol for transitioning from gastrostomy tube to oral feeding in toddlers with medical complications. The team ensured that eating skills were mastered before treating patients for 8 weeks with continuous gastrojejunal drip tube feedings and low-dose tricyclic antidepressant and/or gabapentin. We prescribed 6 weeks of megestrol for hunger provocation while withdrawing tube feedings. A chart review after treatment demonstrated 9 subjects were eating exclusively orally and 1 was eating 50% orally.

Interdisciplinary Strategies for Treating Oral Aversions in Children.

Oral aversion is a frequent diagnosis in the pediatric population. For a minority of children, feeding challenges rise to the level of requiring clinical evaluation and intervention. Determining the best evaluation and treatment plan can be challenging, but there is a consensus that treatment for children with a severe oral aversion involves an interdisciplinary approach. Within the team model, multiple strategies have demonstrated effectiveness, including sensorimotor skill building, behavioral modification, hunger provocation, and sensory integration therapy. This tutorial reviews the diagnostic and treatment process for a child with oral aversion, including identification of an underlying etiology, the medical and behavioral evaluation, and formulation of a treatment plan.

The use of telemedicine in pediatric psychology: research review and current applications.

Several novel technologies have long been used in pediatric psychology. From using electronic pill-count bottles to track child adherence to pill-taking regimens to using bed alarms for night time enuresis, psychologists have relied on technology in their work with children who are ill. Much of the recent technology literature in pediatric psychology has focused on the use of the Internet and other Web-based technologies. This article thoroughly reviews the literature regarding telehealth in the field of pediatric psychology, more specifically the application of televideo or teleconferencing in various populations of children and adolescents with chronic illnesses, followed by the authors' clinical and research applications of telehealth in pediatric psychology. The review concludes with a summary of study findings and future directions in the field for clinicians and researchers alike.

Competitive foods in schools: availability and purchasing in predominately rural small and large high schools.

OBJECTIVES: Schools have an important role to play in obesity prevention, but little is known about the food environment in small, predominately rural schools. The primary purpose of this study was to compare the availability and student purchasing of foods sold outside of the reimbursable meals program through à la carte or vending (ie, competitive foods) in small (n=7) and large (n=6) Kansas high schools. METHODS: A cross-sectional observational study design was used to capture the number of à la carte and vending items available and purchased, and the fat and energy content of all available and purchased items on a single school day between January and May 2005. RESULTS: Small schools had significantly fewer vending machines than large schools (median 3.0 [range 2.0 to 5.0] vs 6.5 [range 4.0 to 8.0], P<0.01]. Vending and à la carte items at small schools contained a median of 2.3 fewer fat grams per item (P< or =0.05), whereas vending products contained a median of 25 kcal fewer per item (P< or =0.05) than at large schools. Significantly less fat (median -15.4 g/student) and less energy (median -306.8 kcal/student) were purchased per student from all competitive food sources and from à la carte (median -12.9 g fat and -323.3 kcal/student) by students in small schools compared to students in large schools (P< or =0.05). CONCLUSIONS: The findings, which highlight less availability and lower energy content from competitive foods at small compared to large schools, have implications for understanding how small schools support their foodservice programs with limited dependence on competitive foods and the influence that food and nutrition professionals can have on school environments by providing more oversight into the nutritional quality of foods available.

Effectiveness of teaching cardiac auscultation to residents during an elective pediatric cardiology rotation.

This study aimed to assess the effectiveness of randomized tracks of prerecorded cardiac sounds as a teaching tool for cardiac auscultation. The study focused on recognizing murmurs when present, distinguishing functional from organic murmurs, and detecting heart disease by auscultation. At both pre- and posttesting, 26 residents listened to 15 randomized tracks of live-recorded cardiac sounds and identified key features. The results indicate that the residents improved at detecting any murmur (66% vs 76%, p = 0.007) and functional murmur (37% vs 54%, p = 0.048), and marginally improved at detecting organic murmur (75% vs 84%, p = 0.129). Detection of absence of murmur declined slightly (69% vs 62%, p = 0.723). The posttest difference in identifying organic versus functional murmurs was striking (84% vs 54%, p < 0.001). Detection of heart disease (sensitivity) improved significantly (76% to 86%, p = 0.016), but there was scant improvement in detecting no disease (specificity) (55% vs 59%, p = 0.601). The residents increased in their ability to detect heart disease when present. However, the false-positive rate for a diagnosis of heart disease remained quite high. To ensure that appropriate referrals will be made, teaching should specifically target the confident recognition of functional murmurs.

Pediatric obesity attitudes, services, and information among rural parents: a qualitative study.

The objective of this study was to learn more about the attitudes concerning pediatric obesity among rural parents, the barriers these parents face in trying to help their children attain a healthy weight status, and the pediatric weight loss services currently available in small rural communities. A series of eight qualitative focus groups were conducted with 21 parents of overweight rural children in third through fifth grade. Eight saturated themes resulted indicating that parents (i) believe overweight children are lazy, (ii) are concerned about the weight of their children, (iii) believe that some individuals will be overweight no matter what they do, and (iv) have tried a variety of techniques to help their children lose weight. Barriers to helping their children lose weight unique to their rural status included lack of weight loss resources in their community, lack of exercise facilities, and lack of low-fat or low-calorie options in grocery stores. Rural families of overweight children encounter many barriers to healthier living, some of which are unique to their rural status.

A randomized clinical trial of dietary calcium to improve bone accretion in children with juvenile rheumatoid arthritis.

OBJECTIVE: To examine a behavioral intervention (BI) to increase calcium intake in children with juvenile rheumatoid arthritis (JRA) on calcium intake and bone mass 6 and 12 months after treatment. STUDY DESIGN: A randomized trial compared a 6-session BI to a 3-session enhanced standard of care (ESC) with 49 children ages 4 to 10 years with JRA. Calcium intake was assessed via 3-day diet diaries. Total body bone mineral content (BMC), arms and legs BMC, and lumbar spine bone mineral density were assessed by dual energy x-ray absorptiometry. RESULTS: BI maintained an average calcium intake of 1500 mg/d at 6- and 12-month follow-up. This was greater than their baseline level of 972 mg/d, but not greater than the intake of 1300 mg/day maintained by ESC (P=.09). The BI had a 4% and 2.9% greater gain in total body bone mineral content than ESC at 6 and 12 months, respectively (P=.005), and a 7.1% and 5.3% greater gain in arms and legs BMC at 6 and 12 months than ESC (P=.0007). CONCLUSIONS: BI is effective in increasing calcium intake and BMC in children with JRA over a 12-month period.