The Pediatric School of Health

The Pediatric School of Health, Department of Pediatrics, National University Hospital of Iceland

Topics

Structure, procedures and collaboration

Treatment and results

Treatment and results Pediatric School of

Health

The Pediatric School of Health is an outpatient department for children with obesity and their families

This service, in it’s current form started in 2011 and is provided at the pediatric outpatient department 21-E at the Department of Pediatrics, National University Hospital of Iceland. Over 200 children have attended the Pediatric School of Health and approximately half have attended group therapy.

Our clients are children with obesity from approximately 5 years of age to 18 years as well as their families. The cut-off is BMI 2,5 standard deviations from the mean according to a normal distribution, or a significant increase in a child’s weight over a short period of time.

Development and research: Our aim is to measure treatment effectiveness and improve our treatment materials. A key factor in this process is a strong collaboration with the University of Iceland.

Pediatric School of

Health

Transdisciplinary team Six professions

Anna Sigríður Ólafsdóttir, nutritionist Berglind Brynjólfsdóttir, psychologist Guðlaug M. Júlíusdóttir, social worker Ólöf Elsa Björnsdóttir, nurse and public health specialist Ragnar Bjarnason, chief physician Sigurlaug Hrefna Traustadóttir, social worker Tryggvi Helgason, pediatric physician Þórður Sævarsson, sports scientist

Pediatric School of

Health

Collaborators

Sidekick™

No

Yes

Workflow

Consultancy Information gathering Psychosocial information Overall health Exercise and eating behaviour Background informationBodily measurements Height and weight Blood pressure Circumference of waist and upper arm Blood tests

Referral sheet Parents Health professionals

Referral

Screeninginterview

Nurse(45minutes)

Doctor(45minutes)Psychologist

Furtherassessment?Socialworker

Typeoftreatment

Followupatthehealthclinic

NoFurther

treatmentneeded?

Yes Grouptherapy

Individualtherapy

Otherspecifictreatmentresources(pediatricpsychiatry,psychologicaltreatment)

TheSchoolofHealth’sworkflow

Assessment and resources for psychosocial issues

Treatment type

Details on the initial interview at the Pediatric School of Health, 2011-2013 (n=180)Initial Interview

Mean±SDorn(%)

Gendergirlsboys

101(56%)79(44%)

Age(years) 11,5±2,91

Height(cm) 153,5±16,1

Weight(kg) 74,8±24,95BMI(kg/m2) 30,7±5,26

BMI-SDS 3,5±0,80

Waistcircumference(cm)

102,1±14,1

Waistcircumference/height

0,66±0,06

Ásdís Eva Lárusdóttir, B.Sc. theses in Medical Science, 2013. The impact of anthropometric factors on metabolic aberrance in children and adolescents.

The average child

participant at the Pediatric

School of Health

Normal value

53%

Aberrance 47%

Aberrance in blood tests (n=54)

Hyper- insulinemia 15%

Fatty liver 7%

Other aberrances 78%

Blood test results Blood test results (n=116)

Ásdís Eva Lárusdóttir, B.Sc. theses in Medical Science, 2013. The impact of anthropometry on metabolic aberrance in children and adolescents.

Workflow

Consultancy Information gathering Psychosocial information Overall health Exercise and eating behaviour Background informationBodily measurements Height and weight Blood pressure Circumference of waist and upper arm Blood tests

Referral sheet Parents Health professional

Assessment and resources for psychosocial issues

Adolescents Individual treatment

Group therapy 8-12 years old

Family-based CBT Family-based Cognitive Behavior Therapy – the children and their parents are active participants

Information on healthy eating, the environmental impact on eating behavior and exercise, the relationship between thoughts, emotions and behavior and appetite awereness training.

Parents are taught about behavioral motivation in supporting their children to change their behavior by using self monitoring, goal setting, incentive systems (reward charts), observational learning and positive reinforcement.

DoasIsaybutnotasIdo–doesnotwork!

Treatment content

Log books Goal setting

Incentive System

–Dailymeetingsofparentandchild–Writeinthelogbook(atleast3daysaweek)–5aday-fruitsandvegetables–Maximum2hoursperdayforscreentime–1hourperdayexercise–1portionorlessofsweetsperday–1-3portionslowfatmilkproducts

Realisticexpectations

Realisticexpectations

The shaping of behavior –

exersice and eating

Complimentthechildwhenitchoosestobehaveinahealthyway

The Energy Equation (seesaw)

Weonlyhaveonebody-letstakegoodcareofit

The Magic Triangle

What you think Thought

How you feel

FeelingWhat you do

BehaviorHealthyhabitsarenotaboutleadingaperfectlyhealthylifestyle

Appetite Awareness

Let’sshowourselvesunderstanding,empathyandrespect

TheAppetiteAwareness,LindaCraighead

Group therapy for 7-12 years olds receiving family CBT at the Pediatric School of Health: Emotional wellbeing, quality of life and anthropometric factors. Bryndís Kristjánsdóttir, MPH public health specialist

Results Research

Despitedifficulties,don’tgiveup–anopportunityforgrowth-let’sdobetternexttime

Table IV. Emotional wellbeing and quality of life before and after treatment´

**p<0.01 1Strengths and Difficulties Questionniare 2Pediatric Quality of life childs self-report 3Pediatric Quality of life parent report

Pre treatment Mean ± Standard dev

Post treatment Mean ± Standard dev

Difference in means (95% confidence interval)

1SDQ (n=22) 10.55 ± 5.88 9.59 ± 6.86 0.96 (0.7;2.5) 2PedsQL child (n=21)

70.55 ± 18.25 78.27 ± 16.00 -7.72(13.3;2.1)**

3PedsQL par.(n=21)

70.06 ± 16.39 76.86 ± 15.98 -6.80(-11.7;1.9)**

Table V. Emotional wellbeing and quality of life before treatment compared to 3, 6 and 12 months post treatment Pre treatment

mean ± standard deviation

3 months post treatm mean ± standard deviation

Difference in mean (95% conf interval)

1SDQ (n=10) 11,50 ± 4,30 9,10 ± 3,48 2,4 (1,2; 6,0) 2 Peds-QL child (n=10) 64,75 ± 21,44 85,44 ± 8,67 -20,7 (-5,5;-35,9)* 3 Peds-QL par. (n=9) 62,80 ± 19,46 83,07 ± 7,78 -20,3 (-33,5;-7,0)**

Pre treatment mean ± standard deviation



1SDQ (n=11) 11,55 ± 5,39 11,00 ± 7,24 0,6 (-3,3;3,3) 2Peds-QL child (n=10) 75,02 ± 16,43 80,40 ± 15,04 -5,4 (-17,1;6,3) 3Peds-QL par. (n=11) 69,05 ± 13,70 79,94 ± 15,48 -10,9 (-16,3;-5,5)**




1SDQ (n=16) 11,75 ± 5,62 11,12 ± 6,86 0,6 (-1,0; 2,3) 2Peds-QL child (n=16) 66,81 ± 23,61 75,63 ± 13,89 -8,8 (-20,2;2,6) 3 Peds-QL par. (n=16) 66,65 ± 18,51 73,91 ± 18,93 -7,3 (-16,3;1,8)

Table II. Standardized Body Mass Index before and after treatment

PretreatmentMean±standarddev

PosttreatmentMean±standarddev

Diffinmeans.(95%confinterval)

Children(n=31)

3,49±0,7 3,08±0,6 0,41(0,3;0,5)****

Boys(n=7) 3,80±0,6 3,09±0,4 0,71(0,5;0,9)***

Girls(n=24)

3,28±0,6 2,96±0,5 0,31(0,2;0,4)****

***p<0,001,****p<0,0001

Table III. Standardized Body Mass Index before treatment compared to 3, 6 and 12 months post treatment


3 mo post treatment mean ± standard deviation

Difference in means (95% conf interv)

Children (n=31) 3,40 ± 0,6 2,95 ± 0,6 0,45 (0,4;0,6) **** Boys (n=8) 3,84 ± 0,5 3,34 ± 0,6 0,50 (0,2; 0,8) ** Girls (n=23) 3,24 ± 0,6 2,82 ± 0,6 0,42 (0,3; 0,5)****




Children (n=24) 3,45± 0,6 2,98 ± 0,6 0,47 (0,4;0,6)**** Boys(n=5) 3,86 ± 0,6 3,19 ± 0,5 0,67 (0,5;0,8)*** Girls (n=19) 3,35 ± 0,6 2,93 ± 0,6 0,42 (0,3;0,5)****




Children (n=20) 3,36 ± 0,6 2,80 ± 0,4 0,55 (0,4;0,7)**** Boys (n=4) 3,79 ± 0,8 3,08 ± 0,4 0,80 (-0,1; 1,5) Girls (n=16) 3,25 ± 0,5 2,73 ± 0,4 0,52 (0,4; 0,7)****

Parent testimonials Happyaboutthecourse,veryinformative!

ThebestservicethatIhavereceived!

AchangedlifestyleisaboutUSINGwhatwelearnonthecourse–MOSTOFTHETIME!

Abrilliantcourse!

Abrilliantfeatherinthecap,theneedis

greatandwelearnedsomuchon

thecourse!

Weenjoyedthecourseanditwas

usefultoo!

Veryhappy!

ThePediatricSchoolofHealthdoesanexcellentjob!

PublishedwithpermissionfromÁsdísEvaLárusdóttir,medicalstudent

The Pediatric School of Health

Health & Medicine