Primary prevention of childhood obesity, second edition.

Primary prevention of childhood obesity, second edition.

Registered Nurses' Association of Ontario (RNAO). Primary prevention of childhood obesity, second edition. Toronto (ON): Registered Nurses' Association of Ontario (RNAO); 2014 May. 140 p. [265 references]

Major Recommendations

The levels of evidence supporting the recommendations (Ia, Ib, IIa, IIb, III, IV) are defined at the end of the "Major Recommendations" field.

Practice Recommendations

Assessment

Recommendation 1.1

Routinely assess children's nutrition, physical activity, sedentary behaviour, and growth according to established guidelines, beginning as early as possible in a child's lifespan.

(Level of Evidence = IV)

Recommendation 1.2

Assess the family environment for factors (e.g., parenting/primary caregiver influences and socio-cultural factors) that may increase children's risk of obesity.

(Level of Evidence = IV)

Recommendation 1.3

Collaborate with school leaders to assess elementary-school environments for risk and protective conditions that influence childhood obesity, including:

• Student demographics
• School policies
• Food and physical activity environments

(Level of Evidence = IV)

Recommendation 1.4

Assess neighbourhoods for community-level risk and protective conditions that influence childhood obesity.

(Level of Evidence = IV)

Planning

Recommendation 2.1

Engage community stakeholders when planning primary-prevention interventions for childhood obesity.

(Level of Evidence = IIb)

Recommendation 2.2

Develop interventions that are:

• Universally applied, as early as possible (Level of Evidence = IV)
• Targeted toward multiple behaviours (Level of Evidence = IV)
• Implemented using multiple approaches (Level of Evidence = IIa)
• Inclusive of parents/primary caregivers and the family (Level of Evidence = IIa), and
• Implemented simultaneously in multiple settings (Level of Evidence = IIa)

Implementation

Recommendation 3.1

Support exclusive breastfeeding for the first six months of life followed by breastfeeding and complementary feeding up to two years of age or beyond.

(Level of Evidence = III)

Recommendation 3.2

Provide education and social support to help parents/primary caregivers to promote healthy eating and physical activity in infants and toddlers.

(Level of Evidence = Ib)

Recommendation 3.3

Collaborate with parents/primary caregivers, educators and support staff (e.g., teachers, child care providers, school leaders) to promote healthy eating and physical activity in all settings where preschool children gather.

(Level of Evidence = Ib)

Recommendation 3.4

Collaborate with school communities to promote regular physical activity among elementary-school children.

(Level of Evidence = IIb)

Recommendation 3.5

Facilitate and support the integration of health and nutrition education into elementary-school programs and support the improvement of the school food environment.

(Level of Evidence = IIa–III)

Evaluation

Recommendation 4.1

Monitor and evaluate the effectiveness of the family's approach to healthy eating and physical activity.

(Level of Evidence = IV)

Recommendation 4.2

Evaluate the effectiveness and sustainability of school- and community-based primary-prevention initiatives.

(Level of Evidence = IV)

Recommendation 4.3

Advocate and support the evaluation of an organization's compliance with healthy public policies, and the impact of such policies on childhood eating behaviours and physical activity.

(Level of Evidence = III)

Education Recommendations

Recommendation 5.1

Incorporate foundational primary-prevention curricula based on this Guideline into the undergraduate education of nurses and other health-care providers.

(Level of Evidence = IV)

Recommendation 5.2

Health-care professionals should participate in continuing education to enhance their ability to support the positive behavioural and environmental changes for children, families, and communities recommended in this Guideline.

(Level of Evidence = IV)

.../...

Dental interventions to prevent caries in children. A national clinical guideline

http://www.sign.ac.uk/pdf/SIGN138.pdf

Scottish Intercollegiate Guidelines Network (SIGN). Dental interventions to prevent caries in children. A national clinical guideline. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN); 2014 Mar. 45 p. Acceso a texto completo Major Recommendations Note from the Scottish Intercollegiate Guidelines Network (SIGN) and National Guideline Clearinghouse (NGC): In addition to these evidence-based recommendations, the guideline development group also identifies points of best clinical practice in the full-text guideline document. The grades of recommendations (A-D) and levels of evidence (1++, 1+, 1-, 2++, 2+, 2-, 3, 4) are defined at the end of the "Major Recommendations" field. Predicting Caries Risk Carries Risk Assessment C - The following factors should be considered when assessing caries risk: Clinical evidence of previous disease Dietary habits, especially frequency of sugary food and drink consumption Social history, especially socioeconomic status Use of fluoride Plaque control Saliva Medical history D - Specialist child healthcare professionals should consider carrying out a caries risk assessment of children in their first year as part of the child's overall health assessment. D - Children whose families live in a deprived area should be considered as at increased risk of early childhood caries when developing preventive programmes. Delivery of Dental Brief Interventions in the Practice Setting Effectiveness of Dental Brief Interventions B - Oral health promotion interventions should facilitate daily toothbrushing with fluoride toothpaste. Format of Dental Brief Interventions B - Oral health promotion interventions should be based on recognised health behaviour theory and models such as motivational interviewing. Social Determinants of Oral Health C - As part of the patient assessment, a social history should be taken which will contribute to dental brief interventions being specific to individuals and tailored to their particular needs and circumstances. Toothbrushing with Fluoride Toothpaste Concentration of Fluoride Toothpaste A - Following risk assessment, children and young people up to the age of 18 years who are at standard risk of developing dental caries should be advised to use toothpastes in the range 1,000 to 1,500 parts per million fluoride (ppmF). A - Following risk assessment, children aged from 10 to 16 years who are at increased risk of developing dental caries should be advised to use toothpastes at a concentration of 2,800 ppmF. Frequency and Duration of Brushing Frequency of Toothbrushing A - Toothbrushing with fluoride toothpaste should take place at least twice daily. Supervised Toothbrushing A - Supervision of toothbrushing with fluoride toothpaste is recommended as an effective caries prevention measure. Toothbrushing Practice A - Children should be encouraged to spit out excess toothpaste and not rinse with water after brushing. Topical Anticaries Interventions Topical Fluoride Varnish A - Fluoride varnish should be applied at least twice yearly in all children. Sealants Use of Sealants A - Resin-based fissure sealants should be applied to the permanent molars of all children as early after eruption as possible.

Well-Child Care Clinical Practice Redesign for Serving Low-Income Children

Coker TR(1), Moreno C(2), Shekelle PG(3), Schuster MA(4), Chung PJ(5).

Pediatrics. 2014 Jul;134(1):e229-39. doi: 10.1542/peds.2013-3775. Epub 2014 Jun

Our objective was to conduct a rigorous, structured process to create a new model of well-child care (WCC) in collaboration with a multisite community health center and 2 small,   independent practices serving predominantly Medicaid-insured children. Working groups of clinicians, staff, and parents (called “Community Advisory Boards” [CABs]) used (1) perspectives of WCC stakeholders and (2) a literature review of WCC practice redesign to create 4 comprehensive WCC models for children ages 0 to 3 years. An expert panel, following a modified version of the Rand/UCLA Appropriateness Method, rated each model for potential effectiveness on 4 domains: (1) receipt of recommended services, (2) family-centeredness, (3) timely and appropriate follow-up, and (4) feasibility and efficiency. Results were provided to the CABs for selection of a final model to implement. The newly developed models rely heavily on a health educator for anticipatory guidance and developmental, behavioral, and psychosocial surveillance and screening. Each model allots a small amount of time with the pediatrician to perform a brief physical examination and to address parents' physical health concerns. A secure Web-based tool customizes the visit to parents' needs and facilitates previsit screening. Scheduled, non–face-to-face methods (text, phone) for parent communication with the health care team are also critical to these new models of care. A structured process that engages small community practices and community health centers in clinical practice redesign can produce comprehensive, site-specific, and innovative models for delivery of WCC. This process, as well as the models developed, may be applicable to other small practices and clinics interested in practice redesign.

Brief Approaches to Developmental-Behavioral Promotion inPrimary Care: Updates on Methods and Technology.

Glascoe FP, Trimm F. Brief Approaches to Developmental-Behavioral Promotion inPrimary Care: Updates on Methods and Technology. Pediatrics. 2014 Apr 28. [Epubahead of print] PubMed PMID: 24777220.

Well-child visits are a critical opportunity to promote learning and development,

encourage positive parenting practices, help children acquire behavioral
self-control, enhance the development and well-being of children and their
families, identify problems not amenable to brief in-office counseling, and refer
for services when needed. This article outlines the communication skills,
instructional methods, and resource options that enable clinicians to best assist
families. Also covered is how to monitor progress and outcomes. A total of 239
articles and 52 Web sites on parent/patient education were reviewed for this
study. Providers require a veritable armamentarium of instructional methods.
Skills in nonverbal and verbal communication are needed to elicit the
parent/patient agenda, winnow topics to a manageable subset, and create the
"teachable moment." Verbal suggestions, with or without standardized spoken
instructions, are useful for conveying simple messages. However, for complex
issues, such as discipline, it is necessary to use a combination of verbal
advice, written information, and "teach-back," aided by role-playing/modeling or 
multimedia approaches. Selecting the approaches most likely to be effective
depends on the topic and family characteristics (eg, parental literacy and
language skills, family psychosocial risk and resilience factors, children's
developmental-behavioral status). When providers collaborate well (with parents, 
patients, and other service providers) and select appropriate educational
methods, families are better able to act on advice, leading to improvements in
children's well-being, health, and developmental-behavioral outcomes. Provided
are descriptions of methods, links to parenting resources such as cell phone
applications, Web sites (in multiple languages), interactive technology, and
parent training courses.

PMID: 24777220  [PubMed - as supplied by publisher]