Another Reason to Offer Pediatric Nutrition Counseling

Parents often struggle with knowing what 'proper nutrition' really means for their children. This can be especially confusing for the parent who has had a personal history of unhealthy eating. Since the Center for Disease Control and Prevention (CDC) estimates that 1 in 5 children is clinically obese, this is a public health epidemic that continues to manifest itself in pediatric examination rooms every day.

As was noted in this comprehensive overview on the importance of including nutritional counseling in a pediatric practice, unhealthy eating can result in children:

  • Being overweight or underweight
  • Having Irritable Bowel Syndrome or Irritable Bowel Disease
  • Experiencing eating disorders and picky eating
  • Contracting Diabetes Type 1 and Type 2
  • Experiencing weight loss due to ADHD medication

An excellent consumer- focused book on this subject was written by well-known pediatrician and spokesperson for the American Academy of Pediatrics (AAP), Dr. Tanya Altmann. As the mother of three boys, she has clinical and personal experience on the value of good nutrition for healthy kids.

In What to Feed Your Baby, Dr. Altmann provides the latest nutritional recommendations and best practices for feeding babies and young children. The simple program focuses on serving eleven foundation foods: eggs, prunes, avocado, fish, yogurt/cheese/milk, nuts, chicken/beans, fruit, green veggies, whole grains, and water. This book helps parents set their children up for a lifetime of healthy choices and is an excellent reference tool for new parents.

New Report on Food Additives: Another Red Flag Goes Up

Unfortunately, childhood obesity is not the only reason for concern about childhood nutrition.

According to the statement in the August 2018 Pediatrics, "Food Additives and Child Health," some currently allowed chemicals may best be avoided - especially for children.

The report notes that “an Increasing number of studies suggest some food additives can interfere with a child's hormones, growth and development, according to the policy statement and accompanying technical report. Some may also increase the risk of childhood obesity, rates of which have tripled since the 1970s.

“The United States allows the use of more than 10,000 additives to preserve, package or modify the taste, appearance, texture, or nutrients in foods. Many were grandfathered in for approval during the 1950s, and roughly 1,000 additives are used under a ‘Generally Recognized as Safe’ designation process that doesn't require U.S.Food and Drug Administration (FDA) approval.”

The report further states that some additives are put directly in foods, while indirect additives may include chemicals from plastic, glues, dyes, paper, cardboard, and different types of coatings used for processing and packaging. The additives of most concern, based on rising research evidence cited in the report, include:

  • Bisphenols, such as BPA, used to harden plastic containers and line metal cans, can act like estrogen in the body and potentially change the timing of puberty, decrease fertility, increase body fat, and affect the nervous and immune systems. BPA is now banned in baby bottles and “sippy cups.”

  • Phthalates, which makes plastic and vinyl tubes used in industrial food production flexible, may affect male genital development, increase childhood obesity, and contribute to cardiovascular disease. In 2017, the Consumer Product Safety Commission banned the use of some phthalates in child-care products such as teething rings.

  • Perfluoroalkyl chemicals (PFCs), used in grease-proof paper and cardboard food packaging, may reduce immunity, birth weight, and fertility. Research also shows PFCs may affect the thyroid system, key to metabolism, digestion, muscle control, brain development, and bone strength.

  • Perchlorate, added to some dry food packaging to control static electricity, is known to disrupt thyroid function, early life brain development and growth.

  • Artificial food colors, common in children's food products, may be associated with worsened attention-deficit/hyperactivity disorder (ADHD) symptoms. Studies cited in the report found a significant number of children who cut synthetic food colorings from their diets showed decreased ADHD symptoms.

  • Nitrates/nitrites are used to preserve food and enhance color, especially in cured and processed meats. These chemicals can interfere with thyroid hormone production and the blood's ability to deliver oxygen in the body. Nitrates and nitrites also have been linked with gastrointestinal and nervous system cancers.

Potentially harmful effects of food additives are of special concern for children, according to the AAP. Children are more sensitive to chemical exposures because they eat and drink more, relative to body weight, than adults do, and are still growing and developing.

According to the report, the chemicals that affect the endocrine system, for example, can have lasting effects on a child since hormones coordinate complex functions throughout the body. Even small disruptions at key moments during development can have lifelong consequences. Annual estimated health-care costs tied to endocrine disrupting chemicals are estimated to be roughly $340 billion.

Among its recommendations, the AAP calls for a more rigorous and transparent "Generally Recognized as Safe" designation process, including new requirements for toxicity testing before use in the marketplace and re-testing previously-approved chemicals.

Nutrition Counseling: Preventive Care and Good Business

This new concern about food additives is another excellent reason that pediatricians should consider offering nutrition counseling to young parents as an ancillary service of the practice. As our earlier post suggests, pediatricians can “do good while doing well” with this valuable service.

It was noted that “many insurance plans provide coverage for healthy eating, called ‘Dietary Surveillance and Counseling'. Policies vary by state and plan, but often allow for three nutrition sessions per year with no referral necessary. When sessions are not preventive in nature and are related to an eating disorder, some insurance plans grant unlimited sessions with prior approval. Medicaid varies by state as well, and in some states it provides unlimited nutrition sessions per year.” The correct CPT codes are listed in this earlier post.

“Our pediatric-focused electronic health records (EHR) platform can greatly enhance this type of preventative service,” said Chip Hart, the director of PCC’s Pediatric Solutions consulting group and author of the popular blog Confessions of a Pediatric Practice Consultant.

“Nutrition counseling is another way for a smart pediatrician to differentiate his or her practice from the the retail clinics. It helps build a bridge to the young parents who might be struggling with what to do about proper nutrition.”  

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Tags: patient advocacy, patient engagement, nutrition