During the recent admission of a pediatric patient in the ED, Veronica Winters encountered what more nurses in her field are facing every day.
As a certified emergency nurse, Winters, RN, BSN, who has practiced for 24 years at Northern Duchess Hospital in Rhinebeck, N.Y., was gathering the standard measurements for the 13-year-old girl, such as height and weight, routinely asking the girls mother for the necessary details before confirming with her own scale and measurement chart.
The mother told me her 13-year-old daughter was around 180 pounds, which is a problem, says Winters, who has been a nurse for 32 years. But to make the situation even worse, when I had her step on the scale, she was actually 230 pounds, which makes the matter even more disconcerting. Now, I have a child who is in the ED for some other problem, but suddenly, we are also dealing with an important discussion about weight, which is not an easy or welcomed subject for many parents to address.
As reported in the most recent findings by the CDC, children are increasingly being diagnosed with obesity and type 2 diabetes, the latter especially alarming since this condition has been referred to in the past as adult-onset diabetes. Today, more children, typically between 10 and 19 years old and obese, are being diagnosed and usually have a family history of the disease and are insulin resistant, and typically, they have poor glycemic control.
Because of the future health complications related to diabetes, Winters and other ED nurses are challenged with beginning the discussion with parents and their at-risk children about how they can improve future health.Dawn Hagerty, RN
Its not easy, but this trip to the ED is often the first time these parents and children are suddenly being made aware of just how much is at stake by not changing diet and lifestyle before everything becomes even worse in the situation, Winters says. We have a nutritionist we can refer them to for further resources and information. But honestly, right beside that [obese] child is an [obese] parent, and they dont want to hear what’s being said because this is still a sensitive area.
Winters says she and other nurses unfortunately are seeing more and more cases of childhood obesity and childhood type 2 diabetes.
Im supposed to be seeing a 5-year-old child in the ED for a broken leg, and what Im often also seeing is a 5-year-old child who is 80 pounds, with a broken leg. Its appalling, Winters says. When we see these cases, I think it should be considered just as serious as a case when you see a starving child which is categorized as child neglect. How is this any different?
Dawn Hagerty, RN, a certified diabetes educator at State University of New York Downstate Medical Center in Brooklyn, said in her 12 years in nursing, she also has seen a dramatic increase in both childhood obesity and children with type 2 diabetes.
Im in my 40s and this is a growing concern thats especially troubling for me because its not something that was around when I was growing up, and certainly not to this degree, Hagerty says. But its because of how sedentary so many people are today, instead of moving around and [getting] regular exercise. And add to that the increasing serving sizes, poor menu choices and access to so many more sugary beverages.Laurie Porcaro, RN
Hagerty, like Winters, also finds many parents do take exception to discussions about dietary warnings and their childrens excessive weight.
We have clinical guidelines we follow as nurses and diabetes educators, and as soon as parents hear the word diabetes, its devastating, because no one wants to hear their children have to live with this, and then comes resistance and denial, Hagerty says.
Besides obesity being a warning sign of potential risk for developing type 2 diabetes, Hagerty said signs of childhood type 2 diabetes can include the following: excessive thirst and urination, bed-wetting, darkening of the skin folds around the neck, fatigue and constant hunger.
Hagerty says its important to emphasize the positive about advancements for living with diabetes. By definition, type 2 diabetes is a condition that affects the way the body metabolizes sugar and the body becomes resistant to the effects of insulin or the body doesnt produce enough insulin to maintain a normal glucose level, Hagerty says. The good news is this is something that can be managed and even prevented before resulting in medication or insulin therapy.
She also reminds parents about the importance of including the entire family when making changes to menus and activities.Ann Courtney, RN
Rather than having separate foods in the house just for the child with type 2 diabetes, its better that the entire family share in the experience of acquiring healthier habits and a better diet, she said. Learning strategies are different for children, just as they are for working with adolescents with this diagnosis and adults. But the plan for a better way of living is still the same.
Hagerty said she would like to see schools and government become more involved in assisting with encouraging better lifestyle habits for children.
If fruits and vegetables were subsidized and made more affordable and accessible, families would adopt better menus, she says. Because so many parents both work, when children come home from school, they are often encouraged to stay inside rather than going outside to play because of safety concerns. This is where better park programs, after-school activity options and involvement with a local YMCA can help.
At SUNY Downstate, Hagerty is proud of the 4 Oclock Wednesdays program, a weekly support group that educates and counsels children with type 1 or type 2 diabetes. She also praises the Healthy Downstate Fitness and Nutrition Program, which addresses the physical health issues from type 2 diabetes and the psychological impact, since many obese children face depression and low self-esteem.
For these six- to eight-week programs, its always important to remind [participants] how vital it is to not only make necessary changes in lifestyles and diet, but also to maintain these changes, Hagerty says.
Laurie Porcaro, RN, BS, a certified diabetes educator for Orange Regional Medical Center in Middletown, N.Y., is a diabetes clinical coordinator for the facilitys Dunkelman Diabetes Treatment Center with a decade of experience helping children understand diabetes.
The Dunkelman Center provides comprehensive education and support for children, adolescents and adults with diabetes and pre-diabetes conditions.
It starts with a childs day-to-day habits, says Porcaro, who has been a nurse for 18 years. When I was growing up, as soon as we got home from school, children changed into play clothes and went outside. Today, as a society, we have to tell parents that the CDC says children need to have an hour of exercise every day. TV and hand-held game devices have replaced hopscotch and stickball and, as a result, we have more obese children.
Porcaro says poor diet choices, from more fast food to unrealistic portions, are adding to the problem of increased cases of diabetes in children.
Too many children drink sugary beverages, and not just soda, but also juice by the glass throughout the day, and that wasnt the case years ago, she says. It used to be juice was consumed at breakfast, and it would be in a 4-ounce glass. Today, parents make juice an option for their children throughout the day, when everyone should just be drinking more water.
Porcaro says she explains to parents and children that everyone is born with a finite amount of insulin in the body. She said that while a healthy body might be producing a reduced amount of insulin by age 50, some of the pediatric patients she sees are already at that same level by the time they are diagnosed.
Id like to see more detailed health screenings required for children when they start kindergarten, such as not only weight, but also body mass, Porcaro says.
Ann Courtney, RN, MS, a certified pediatric nurse practitioner and certified diabetes educator at Stony Brook (N.Y.) Long Island Children’s Hospital, said what once was called juvenile diabetes, referring to children with type 1 diabetes, has now become another emerging category since children are being diagnosed with type 2 diabetes at such a young age.
If a family doesnt have a history of diabetes or know of relatives with it, I dont think theres much education and awareness about the signs or what to do, says Courtney, whose youngest child is 7 and has type 2 diabetes. Losing weight and reducing the amount of processed food eaten is a start and, of course, more exercise.
Courtney says the risks for type 2 diabetes can go away in children with lifestyle modification, which is important not only for the young patient, but also the parents and the rest of the family, sharing a common goal for better living.
We have a great pediatric cardiology program at our hospital called Fit Kids for Life, she says. It helps create a foundation for better living and making the right choices. Education and awareness are the first, and very important step, for the decisions children will be making for the rest of their lives.