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Why Pediatricians Are Being Urged to Write ‘Physical Activity Prescriptions’ for Children

Health + Wellness
Doctors report that only 1 in 4 children are getting the recommended 60 minutes of physical activity per day. Ronnie Kaufman / DigitalVision / Getty Images

By Dan Gray

Pediatricians are being urged to start writing "exercise prescriptions" for the children they see in their office.


That's the recommendation of a report published Sunday by the American Academy of Pediatrics (AAP) titled Physical Activity Assessment and Counseling in Pediatric Clinical Settings.

In it, AAP officials encourage pediatricians to go beyond simply recommending that kids get exercise and take the step of actually issuing a prescription for physical activity.

"Currently, most pediatricians recommend that children get 60 minutes per day of physical activity, but this is not commonly elaborated upon or provided as a prescription," Dr. Natalie D. Muth, a co-author of the clinical report who's also a pediatrician and registered dietitian in California, told Healthline.

"Additionally, there is an important opportunity to consider physical activity as a routine part of the treatment plan for many conditions, such as ADHD," she added.

Another pediatrician interviewed by Healthline agrees with the recommendations.

"In reading through the clinical report, what they do is recommend the prescription in the first 2 years," Dr. David Fagan, vice chair of the department of pediatrics at Cohen Children's Medical Center in New Hyde Park, New York, told Healthline.

"I think the reason they are going to that extreme is to promote the idea of physical literacy to impart on a family, even at that early age, the importance of being physically active," he said.

Fagan also notes the report represents a shift toward more directly confronting the rising rates of childhood obesity.

"Previously, we've focused on healthy nutrition in combating obesity and then focusing on kind of eliminating the sedentary behaviors — gaming and things like that," he said. "But this report states that we need to be more proactive in promoting activity."

Sedentary Lifestyles

The AAP points to a few statistics in their report.

For starters, only 1 in 4 children reports getting the recommended 60 minutes of physical activity per day.

Additionally, in their 2017 Youth Risk Behavior SurveillanceTrusted Source, the Centers for Disease Control and Prevention (CDC) found that only slightly more than a quarter of teens in the U.S. are getting the recommended amount of activity per day.

In addition, 15 percent of teens said they hadn't been physically active for even a single hour of the previous week.

The AAP also reports that the average preschooler is sedentary for more than 6 hours a day, and more than 40 percent of schoolchildren spend 3 or more hours in front of a television per school day.

In 2016, the AAP rolled out new guidelines that recommended minimal screen time for young kids and zero screen time for the first 18 months of life.

"Some people may say that it's extreme or not realistic in this day and age, but the emphasis of the message there is that we want children — infants and toddlers — to be on the floor, playing with toys, and moving around from an early age," Fagan said.

"That's what we're really imparting on families: the importance of being physically literate and understanding how vital physical activity is to the development of children," he added.

Academic pressures can also prevent children from getting the physical activity they need, says Muth.

"Physical activity in the school day has been compromised by a push toward more 'academic' subjects, even though we know well that physical activity in the school day improves concentration and attention, improves academic performance, improves behavior, and helps children and adolescents adopt habits for lifelong health," she said.

How Can Families Help?

As a pediatrician, Fagan says he tries to motivate his young patients by asking them what activities they like.

Sedentary activities, such as video games and social media, are a nonstarter.

"I ask, 'Besides video games, what do you like to do?' and then offer some suggestions. You have to find something that they like," he said.

"If you tell a child or teen that they need to be on a treadmill 60 minutes a day, 3 days a week, and it's not something they like, they're not going to do it. So I think it's critical to find out what the child or teenager enjoys doing in terms of physical activity. Even going out for a walk for 15 or 20 minutes is a step in the right direction," Fagan said.

The AAP notes in their report the importance of role models when it comes to physical activity.

Muth points out that kids who grow up in active households are more likely to be active themselves. She offers some suggestions for parental role modeling.

"Parents can help kids build activity into their day, whether that's walking or biking to school when possible, taking family walks together after dinner, and helping kids get to sports or active hobbies. The key is to help kids find physical activities that they enjoy doing," she said.

With childhood obesity rates on the rise, it's more critical than ever to encourage kids to get active — and a formal prescription, rather than a recommendation, may help spur them into action.

"I think the importance of this clinical report is giving the pediatrician the tools to dive deeper, so we can offer more specific recommendations in terms of how much moderate to vigorous physical activity a child should achieve," Fagan said.

"This can be promoted through referral to community-based organizations and providing families with lists of resources in the community, whether it's parks or recreation centers," he added.

Reposted with permission from Healthline.

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Guillain-Barre syndrome occurs when the body's own immune system attacks and injures the nerves outside of the spinal cord or brain – the peripheral nervous system. Niq Steele / Getty Images

By Sherry H-Y. Chou, Aarti Sarwal and Neha S. Dangayach

The patient in the case report (let's call him Tom) was 54 and in good health. For two days in May, he felt unwell and was too weak to get out of bed. When his family finally brought him to the hospital, doctors found that he had a fever and signs of a severe infection, or sepsis. He tested positive for SARS-CoV-2, the virus that causes COVID-19 infection. In addition to symptoms of COVID-19, he was also too weak to move his legs.

When a neurologist examined him, Tom was diagnosed with Guillain-Barre Syndrome, an autoimmune disease that causes abnormal sensation and weakness due to delays in sending signals through the nerves. Usually reversible, in severe cases it can cause prolonged paralysis involving breathing muscles, require ventilator support and sometimes leave permanent neurological deficits. Early recognition by expert neurologists is key to proper treatment.

We are neurologists specializing in intensive care and leading studies related to neurological complications from COVID-19. Given the occurrence of Guillain-Barre Syndrome in prior pandemics with other corona viruses like SARS and MERS, we are investigating a possible link between Guillain-Barre Syndrome and COVID-19 and tracking published reports to see if there is any link between Guillain-Barre Syndrome and COVID-19.

Some patients may not seek timely medical care for neurological symptoms like prolonged headache, vision loss and new muscle weakness due to fear of getting exposed to virus in the emergency setting. People need to know that medical facilities have taken full precautions to protect patients. Seeking timely medical evaluation for neurological symptoms can help treat many of these diseases.

What Is Guillain-Barre Syndrome?

Guillain-Barre syndrome occurs when the body's own immune system attacks and injures the nerves outside of the spinal cord or brain – the peripheral nervous system. Most commonly, the injury involves the protective sheath, or myelin, that wraps nerves and is essential to nerve function.

Without the myelin sheath, signals that go through a nerve are slowed or lost, which causes the nerve to malfunction.

To diagnose Guillain-Barre Syndrome, neurologists perform a detailed neurological exam. Due to the nerve injury, patients often may have loss of reflexes on examination. Doctors often need to perform a lumbar puncture, otherwise known as spinal tap, to sample spinal fluid and look for signs of inflammation and abnormal antibodies.

Studies have shown that giving patients an infusion of antibodies derived from donated blood or plasma exchange – a process that cleans patients' blood of harmful antibodies - can speed up recovery. A very small subset of patients may need these therapies long-term.

The majority of Guillain-Barre Syndrome patients improve within a few weeks and eventually can make a full recovery. However, some patients with Guillain-Barre Syndrome have lingering symptoms including weakness and abnormal sensations in arms and/or legs; rarely patients may be bedridden or disabled long-term.

Guillain-Barre Syndrome and Pandemics

As the COVID-19 pandemic sweeps across the globe, many neurologic specialists have been on the lookout for potentially serious nervous system complications such as Guillain-Barre Syndrome.

Though Guillain-Barre Syndrome is rare, it is well known to emerge following bacterial infections, such as Campylobacter jejuni, a common cause of food poisoning, and a multitude of viral infections including the flu virus, Zika virus and other coronaviruses.

Studies showed an increase in Guillain-Barre Syndrome cases following the 2009 H1N1 flu pandemic, suggesting a possible connection. The presumed cause for this link is that the body's own immune response to fight the infection turns on itself and attacks the peripheral nerves. This is called an "autoimmune" condition. When a pandemic affects as many people as our current COVID-19 crisis, even a rare complication can become a significant public health problem. That is especially true for one that causes neurological dysfunction where the recovery takes a long time and may be incomplete.

The first reports of Guillain-Barre Syndrome in COVID-19 pandemic originated from Italy, Spain and China, where the pandemic surged before the U.S. crisis.

Though there is clear clinical suspicion that COVID-19 can lead to Guillain-Barre Syndrome, many important questions remain. What are the chances that someone gets Guillain-Barre Syndrome during or following a COVID-19 infection? Does Guillain-Barre Syndrome happen more often in those who have been infected with COVID-19 compared to other types of infections, such as the flu?

The only way to get answers is through a prospective study where doctors perform systematic surveillance and collect data on a large group of patients. There are ongoing large research consortia hard at work to figure out answers to these questions.

Understanding the Association Between COVID-19 and Guillain-Barre Syndrome

While large research studies are underway, overall it appears that Guillain-Barre Syndrome is a rare but serious phenomenon possibly linked to COVID-19. Given that more than 10.7 million cases have been reported for COVID-19, there have been 10 reported cases of COVID-19 patients with Guillain-Barre Syndrome so far – only two reported cases in the U.S., five in Italy, two cases in Iran and one from Wuhan, China.

It is certainly possible that there are other cases that have not been reported. The Global Consortium Study of Neurological Dysfunctions in COVID-19 is actively underway to find out how often neurological problems like Guillain-Barre Syndrome is seen in hospitalized COVID-19 patients. Also, just because Guillain-Barre Syndrome occurs in a patient diagnosed with COVID-19, that does not imply that it was caused by the virus; this still may be a coincident occurrence. More research is needed to understand how the two events are related.

Due to the pandemic and infection-containment considerations, diagnostic tests, such as a nerve conduction study that used to be routine for patients with suspected Guillain-Barre Syndrome, are more difficult to do. In both U.S. cases, the initial diagnosis and treatment were all based on clinical examination by a neurological experts rather than any tests. Both patients survived but with significant residual weakness at the time these case reports came out, but that is not uncommon for Guillain-Barre Syndrome patients. The road to recovery may sometimes be long, but many patients can make a full recovery with time.

Though the reported cases of Guillain-Barre Syndrome so far all have severe symptoms, this is not uncommon in a pandemic situation where the less sick patients may stay home and not present for medical care for fear of being exposed to the virus. This, plus the limited COVID-19 testing capability across the U.S., may skew our current detection of Guillain-Barre Syndrome cases toward the sicker patients who have to go to a hospital. In general, the majority of Guillain-Barre Syndrome patients do recover, given enough time. We do not yet know whether this is true for COVID-19-related cases at this stage of the pandemic. We and colleagues around the world are working around the clock to find answers to these critical questions.

Sherry H-Y. Chou is an Associate Professor of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh.

Aarti Sarwal is an Associate Professor, Neurology, Wake Forest University.

Neha S. Dangayach is an Assistant Professor of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai.

Disclosure statement: Sherry H-Y. Chou receives funding from The University of Pittsburgh Clinical Translational Science Institute (CTSI), the National Institute of Health, and the University of Pittsburgh School of Medicine Dean's Faculty Advancement Award. Sherry H-Y. Chou is a member of Board of Directors for the Neurocritical Care Society. Neha S. Dangayach receives funding from the Bee Foundation, the Friedman Brain Institute, the Neurocritical Care Society, InCHIP-UConn Center for mHealth and Social Media Seed Grant. She is faculty for emcrit.org and for AiSinai. Aarti Sarwal does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Reposted with permission from The Conversation.