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Tuesday, 13 August 2013

Little and often

This week, my thoughts are on being a mom of a child with movement difficulties: not a therapist or an educator, but a mom.

Parents of children who have movement difficulties are often worried about their child's lack of interest in physical activity, sport, ball games and even "incidental" exercise, like walking to the shops, or playing tag or hide and seek with the neighbours. I have often felt that I am not doing my job as a mom properly, because my little girl didn't want to play in the park or go for a cycle. Being a medical professional, I recognised the fact that a child will often say they don't like doing something (or in my daughter's case, it was "boring"), rather than saying they find it hard or tricky, or that they are embarrassed that they keep falling over or bump into their friends, or they can't hop or skip. Thus, the cycle of avoidance of physical activity begins. I knew all of this. However, how could I stop this cycle? If I couldn't do it, how could I expect other parents to do it?

Now, I could go into all the research that is exploring what motivates children to participate in physical activity (and there is lots out there-refer to the research of Australians, Jeff Wakely and Tony Okeley, Dylan Cliff and Lisa Barnett or Cheryl Missiuna and her team at McMaster University and Can Child in Canada and Helene Polatajko's (University of Toronto) fantastic work with the CO-OP approach), but instead, I am going to blog about my experiences as a mom. In retrospect, I think the experience would have been exactly the same whether I knew about the research or not, but it is interesting to read the research and realise that it ties in with the reality of having a child with movement difficulties.

So, back to my quandary of how did I encourage my daughter to  be physically active? The first task was to "get in quick"-before she realised that she did things in a different way to her peers; also before her fears started creeping in-about falling, bumping, embarrassing herself. I tried to give her opportunities in stress free situations to practise things-walking along the white painted line on the pavement, the low brick wall, jumping off things, bouncing on the  bed-playing, playing and more playing. I asked her about what she wanted to "get good at". Being a little girl, she really wanted to learn how to skip and gallop in ballet and she hated tennis groups at school because she couldn't hit a ball. She didn't mind if she wasn't the best, but she didn't want to stand out as the one who couldn't do anything. She also wanted to join in with hopscotch and ball games in the playground. My daughter told me what the "tasks" were and together we embarked on a journey of learning and mastering them. However, it was always in her own time and I only ever gave her something achievable to work on-we practised little and often-whilst walking to the shops or to our neighbour, never for more than 5 minutes at a time, as she would get cross and frustrated. I have emphasised over and over again, that it takes time and effort to get good at things and constantly reward both my daughters for the effort they put into practising things that they are not good at. Both my daughters are starting to recognise that some people are just good at things-without trying or putting effort into them, but that does not mean that, because they, themselves, need to practise something, they cannot achieve the skill. Practise really does make perfect (well, not so perfect, sometimes, but nevertheless, the CAN learn to DO IT!).

Regarding the ball skills- the key for my daughter was having access to all my physio equipment that happened to be lying around the house. So, (nothing to do with me), she found my big gym balls (which are slower and bigger than normal balls, therefore easier) and started bouncing them, rolling them and throwing them. Everyday whenever she came into the dining room (which is where they were being stored), she would give it a go - little and often - most of the time, all by herself. Initially, we spoke it through and I demonstrated often by showing her with my hands over her hands, we spoke about how the ball moves and used imagery regarding the ball- "imagine it is a fairy and you want to push her gently to the ground for as long as you can keep your hands on her"- but once she had the idea, she just practised on her own. the more she practised, the better she became and now it is one of her favourite activities. It seems to be a cycle: the more a child learns to use the mechanics of their body, the more they get a feeling of success, and the more they experience success, the more they are motivated to keep practising.

One last thought, and that is to do with exposure. Children who are exposed to physical activity, more out of neccessity, rather than choice, the ones who perhaps do not have access to stationary leisure activities, like TV- from a young age- no matter what they baseline ability is; I wonder if they create their own opportunities for task perfection and taking the time to work out how to do things. I am thinking of my nephew who lives on a farm with no TV. He has a learning difficulty and poor core stability, balance and coordination, yet he is the most active child I know. He has learnt his way around his difficulties and compensated in other ways that did not neccessarily use all the perfect fundamental motor skills-yet he managed to achieve the task at hand. In his case, this was being able to play outside with his brother and cousin on the farm-climbing trees, driving tractors, swimming and cycling. The intrinsic (inner) motivation was there. If he didn't work out his own way of achieving these tasks, he would have been left out of the game and bored stiff! If only we all lived in paradise though...

Monday, 5 August 2013

Sugar and children

I read this article today by Annette Noray (see link above) and found her explanation of what is actually happening in the body when we eat processed sugar very helpful.

I am all about balance-maybe that is because I am a Libran!! Whatever, or whyever, I strongly believe that we, as parents, therapists and educators need to form a decision about how we want to bring our children up with regards to their eating habits. This is easier said than done and I am still on a quest to learn more about this subject.  One thing I am trying to bear in mind is that much of the research into disease (diabetes, heart disease, obesity) is done on adults. There is just not enough information out there yet that is based on randomised controlled trials (or meta analyses) in children. Therefore, we do not know, for certain, whether or not sugar addiction or carbohydrate resistance exists in children, whether or not obesity in children is due to highly processed sugar diets and or highly processed carbohydrate diets, but the scientists are working on it and I hope that soon, this information will be available to us.

However, what I do know is that there is a recommended daily allowance (RDA) for added sugar for adults and children and this is something we need to be aware of. Awareness and knowledge is the first step towards health and we need to educate ourselves about how much sugar we are consuming. Obviously, we know exactly how much added sugar we are having when we sprinkle some onto our cereal or in our coffees. However, it is the ubiquitous sugar that we need to be aware of. Thus, we need to read the labels of our breakfast cereals, yoghurts, bread and drinks. Most of the extra sugar in the diet comes from drinking sugar-sweetened beverages.This includes carbonated soft drinks, fruit drinks, punches, sports drinks, coffee and tea with sugar added and milk products that are flavored. Sugar is also found in cake, ice cream, jelly, cookies, fruit packed in syrup and baked goods. Other sources include tomato sauce, pasta sauce, barbecue sauce, applesauce, jello, pudding, granola bars, breakfast cereals and many more. Be careful with foods that are labeled as fat free because they may be loaded with sugar instead. The best bet, I think, is to read the nutrition label. This has been a very educational process for me, I must say and I am astonished by how much added sugar we were having as a family.

The American Heart Association (AHA) recommends that adults should not consume, on average, more than about 6 (women) to 9 (men) teaspoons, or 25 to 37.5 grams, of sugar a day. Preschoolers with a daily caloric intake of 1,200 to 1,400 calories shouldn't consume any more than 170 calories, or about 4 teaspoons, of added sugar a day. Children ages 4-8 with a daily caloric intake of 1,600 calories should consume no more than 130 calories, or about 3 teaspoons a day.

Now for the statistics:

A can of soda has 8-10 teaspoons of sugar in it, half a cup of ice cream has 4 teaspoons in it, a bowl of chocolate flavoured puffed rice can have 2 teaspoons of sugar in it and we won't talk about the caffeine content here!

A study conducted by the AHA found children as young as 1-3 years already bypass the daily recommendations, and typically consume around 12 teaspoons of sugar a day. By the time a child is 4-8 years old, his sugar consumption skyrockets to an average of 21 teaspoons a day. The same study found 14-18 year old children intake the most sugar on a daily basis, averaging about 34.3 teaspoons.

So, I guess my summary is that we need to start off by being aware of how much added sugar our children are consuming (without realising, as it has been added to the product) and secondly to teach our children to make healthy choices when it comes to snack time, drinking time and breakfast time. If we can start off by eating our calories and not drinking them, that would be a fine start, I think!