Obesity prevention and the primary care pediatrician's office.

Current Opinion in Pediatrics. 19(3):354-361, June 2007.

Perrin, Eliana M a; Finkle, Joanne P b; Benjamin, John T a
Abstract: Purpose of review: The obesity epidemic confronts the pediatrician every day in the office. Pediatricians should help curb the epidemic through prevention and the usual pediatric primary care tasks of screening, communication and anticipatory counseling. This review highlights findings from recent literature to guide office-based prevention of obesity in children.
Recent findings: More and more, children and society feel the effects of the obesity epidemic; prevention efforts need to begin earlier. Pediatricians' efforts to screen help identify at-risk children who may benefit from early lifestyle changes. The identification of overweight children also helps foster the appropriate work up of comorbidities. Pediatricians' communication of weight trajectories, which includes techniques like motivational interviewing, may help parents to adopt behavioral prescriptions. Pediatricians should focus on promoting breastfeeding, limiting television, increasing physical activity and reducing sugar-sweetened beverages. New tools used in the training setting show promising results.
Summary: Pediatricians must focus efforts on preventing childhood overweight, while awaiting effective treatment options for this chronic illness with its many associated morbidities. Such prevention involves sensitively communicating early body mass index screening results to parents and helping them to adopt key behavioral changes in diet and physical activity.

Amblyopia.

Doshi NR, Rodriguez MLF.

Am Fam Physician 2007; 75: 361-368.
Amblyopia, a decrease in visual acuity, is a major public health problem with a prevalence of 1 to 4 percent in the United States. It is thought to develop early in life during the critical period of visual development. Early recognition of amblyogenic risk factors such as strabismus, refractive errors, and anatomic obstructions can facilitate early treatment and increase the chance for recovery of visual acuity. Multiple medical organizations endorse screening for visual abnormalities in children and young adults, yet only 20 percent of school-age children have routine vision screening examinations. Any child with a visual acuity in either eye of 20/40 or worse at age three to five years or 20/30 or worse at age six years or older, or a two-line difference in acuity between eyes, should be referred to an ophthalmologist for further evaluation and definitive therapy. Treatment is started at the time of diagnosis and depends on the etiology. Treatment options for children with strabismus include patching and atropine drops. Children with refractive errors should be prescribed corrective lenses. Corneal lesions, cataracts, and ptosis require surgery. The success of therapy is highly dependent on treatment compliance. Patients and their parents should be educated about the need for regular follow-up and the risk of permanent vision loss.