1. Healthy Active Living and Balance
Introduce team members and Centre for Healthy Active Living
Dr. Annick Buchholz, C.Psych.
Dr. Laurie Clark, C.Psych.
Kelly Heffernan, RD

2. Tonight’s Agenda What is health? Balancing busy schedules
Health at Every Size
Balanced eating
Physical activity in our daily lives
Sleep
Body Image and Emotional Health
Speak to how this applies to children 6-9 years old

3. What Is Health?
Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity World Health Organization
So who is healthier? A child who has diabetes, but his diabetes is well controlled, he is physically active 60 minutes a day, and eats three well-balanced meals with snacks, and sleeps 10 hours a night
Versus
A child who does not have diabetes, who skips breakfast, has approx. 6 hours of screen time a day, and is sleeping 8 hours a night

4. What is a healthy lifestyle for a child ?
Balance
Basic health behaviours
Nutrition
Physical Activity, Sedentary Time
Sleep
Coping and Emotional Development
Daily living activities
School
Homework
Extra-curricular Activities
Time with family and friends
Chores
Nutrition – 3 meals and 2 snacks
PA – 60 min moderate to vigorous activity per day. 3 days of the week aim to be vigorous
DT – less than 2 hours of screen time
Sleep – 10 hours
Coping well – tantrums, irritability, oppositional behaviours, anxious behaviours, avoidance of acitivites
School
Homework -30 – 60 minutes/ day
Extra-curricular – 1-2 structured activity/sport
Time – making sure that kids have structure and unstructured play dates
Chores – emptying dishwasher, tidying room, setting table

5. What is a healthy lifestyle for a parent?
Balance
Basic health behaviours
Nutrition
Physical Activity, Sedentary Time
Sleep
Coping and Emotional Development
Daily living activities
Work
Chores
Extracurricular activities
Family needs
Time with family and friends
Sleep 7-9 hours of sleep

6. Key Ingredients to Balance
Schedules work
Do not over schedule
Parents self care and mental health count
Sleep matters
Setting ‘loving’ limits is important
1. We did very good time management skills to;
Organize and prepare home-cooked meals
To plan to sign our child up for soccer/hockey
To know when parent/time interviews are
To spend 20 minutes a day with each child, outside of doing homework with them
2. Many kids are overscheduled
If a school-aged child is involved in extracurriculars, they do not need more than 1 structued activity unless it includes the family

7. Health at Every Size Diets are harmful and don’t work
Focus on your child’s health behaviours and not their weight
Advocate for size diversity
Remember to provide children with genuine body image compliments
“You look great today”
We need to think if how this applies to balance or does it? If so we need to think of a segway into the topic.

8. Who is healthier? Person A Ht: 7 ‘1 Wt: 325 lbs BMI: 32 %BF: 12%
WC: 90 cm
BP: 114/72
Chol: High HDL, Low LDL, TG’s with in normal range
Person B
Ht: 5 ‘9
Wt: 138 lbs
BMI: 21
%BF: 10%
WC: 78 cm
BP: 122/84
Chol: Low HDL, High LDL and TG
Here we have Shaq at his peak as a Laker (before he played for the HEAT, SUNS, Cavs and finally as an anathema to all Laker fans the Celtics). and while Keith is exceptionally resilient most would agree that Shaq is living a more traditionally healthy lifestyle and has better overall global health. 8

9. Healthy life style versus weight
Here we have Shaq at his peak as a Laker (before he played for the HEAT, SUNS, Cavs and finally as an anathema to all Laker fans the Celtics). and while Keith is exceptionally resilient most would agree that Shaq is living a more traditionally healthy lifestyle and has better overall global health.
BMI= 32 kg/m2
obese
BMI= 21 kg/m2
normal weight 9

10. Balanced Healthy Eating10

11. Balanced Healthy Eating
Each Day, 6-9 year olds require:
5-6 Vegetables and Fruit
4-6 Grains
2-4 Milk and Alternatives
1-2 Meat and Alternatives
Fluid requirements based on weight, H20
For Optimal Nutrition, Growth and Development – how? 11

12. It’s a Balancing Act Meals 3-4 food groups Snacks 2-3 food groups
Eat every hours
Balance over the week 12

13. Balancing Healthy Eating & the Division of Responsibility
Parents provide structure, support and opportunities.
Children choose how much and whether to eat from what the parents provide.
Ellyn Satter 2011, 13

14. Balancing Healthy Eating
Food refusal is common for children
Vegetables
Food ‘Jags’ are normal
Reintroduction is key
Parents/caregivers, historically, in an effort to have a ‘healthy’ child will:
Feed frequently
Offer large portions
Offer preferred foods
Offer food in response to crying
Coerce with food when available
Reward with food 14 14 14

15. Balancing Healthy Eating
Traditional feeding and their outcomes:
Coercion to eat healthy food = Aversions/Dislikes 15 15 15

16. Balancing Healthy Eating
Traditional feeding and their outcomes:
Clean your plate = Attention to external cues

17. Balancing Healthy Eating
Traditional feeding and their outcomes:
Food restriction = Increased desire
E.g. Fisher and Birch (1999) preschool aged, allowed certain foods and restricted others. What was the response?

18. Balancing Healthy Eating
How can we incorporate treat foods?

19. Balanced Eating & Sugary Sweetened Beverages
Sugary beverages include:
Sports drinks, energy drinks fruit juice, pop, iced coffee, specialty coffees, others
Consumption has been gradually increasing over the past few decades
20% of caloric intake for 4-18 year olds
30% of caloric intake for 1-3 year olds
Hassink, Seminarts Ped Surg (2009), 18, 19 19 19

20. Balanced Eating & Sugary Sweetened Beverages
One of the main contributors to increased energy intake for kids
AAP recommends:
4-6 oz ( mL)/day for 1-6 year olds
8-12 oz ( mL)/day > 6 year olds
Seach et al, Int J Obes, 34(10)1475-9, 2010 20 20 20

21. Tips to help with Balanced Eating
Provide Structure
Eat at a table with no screen on
Have family meals more often
Make meal time enjoyable and fun
Involve kids
Encourage variety
Healthy plate
Allow treats
Limit eating out to 1x/week
Role model 21 21

22. Physical Activity
Is movement that increases our heart rate and our breathing – and requires muscles to use energy.

23. Physical Activity: Its Rewards
Enhances healthy growth and development
Promotes coordination and balance
Improved sleep
Increased concentration
Better academic scores
Improved self esteem
Learn social skills – cooperation, teamwork, listening

24. Physical Activity Guidelines Children 5-11 years 24

25. Intensity Talk 1 10
5-6
7-8 25

26. Sedentary Behaviour Guidelines
Review what recreational screen time is – non-school related time spent in front of a TV, computer, ipod, DS 26

27. Leaves little time to be active!
Screen Time
Children and screen time:
6 hrs/day on weekdays
7 hrs/day on weekend days*
In 1971, average age a child started watching TV was 4 years; today, it is 5 months**
Canadian children spent 62% of their waking hours being sedentary***
Leaves little time to be active!
*2010 Active Healthy Kids Canada Report Card
**Zimmerman et al. Arch Pediatr Adolesc Med. 2007
***CSEP Sedentary Behaviour Guidelines 27

28. We tell our children to be active…
When they’re “easy and natural” choice of being active is removed/not there, what is left as the easy and natural thing? (second click reveals circle around the answer!)
But have we forgotten that in order for kids to be active, it needs to be easy and natural for them? 28

29. What can parents do to increase Physical Activity
Start early in life
Role modeling
Balance screen time with active time
Variety
Dress for success
Schedule It!
Start Early in Life: Take children to playgrounds and parks and encourage them to climb, swing and play, arrange to meet up with friends so its fun, active and social for everyone. Make use of programs and facilities offered at your local community centre and have your child try different sports in age-appropriate classes such as entry level soccer, baseball, skating, dance, swimming, gymnastics, racquet sports, non-contact martial arts.
Role Modeling: Be a good role model – your kids are watching you even when you’re watching TV! It’s important that your child sees you running, walking and playing sports. Display a positive attitude that being active if fun and feels good. Teach your kids to make the active choice – avoid the escalator at the mall and the elevator in your apartment building, and walk places rather than drive as often as possible. Participate as a family team in a charity run, walk or car wash. We know that increased adult participation in PA = increased child participation.
Balance screen and active time: remove screens from room, set limits, choose active gaming to replace sedentary activities as long as your child is actually moving – more on this on the next slide
Variety: expose your child to a wide-range of different activity experiences – builds confidence, avoids boredom, helps acquire motor skills that are the building blocks for future more complicated movements/activities. Provide both time for structure activity (organized sport) and free-play (kids getting together and going to the park to play).
Dress for Success: send children to school in clothes and footwear that promotes safe PA and free play – allows for free mobility, appropriate seasonal outdoor clothing and informal clothing rather than outfits that need to be kept clean
Schedule it: Easier not to miss if it’s scheduled in!

30. Tips to Tame the Screen Set basic rules & weekly plans
e.g. no screen time before homework or chores are done
e.g. let your child choose 2 shows or computer/video games they can watch/play each day
No watching TV, playing with ipod during mealtimes
Choose specific shows to watch – avoid TV on as constant background
Share expectations with caregivers
Childhood Obesity Resource: Obesity Society
Participation

31. Sleep Hygiene The promotion of regular sleep
Age
Sleep Needs (Per 24 Hour Period)
Newborns (1-2 mo.)
hours
Infants (3-11 mo.)
9-12 hours at night +
0.5 – 2 hour naps, 1-4x per day
Toddlers (1-3 yrs)
12-14 hours
Pre-schoolers (3-5 yrs)
11-13 hours
School-aged Children (5-12 yrs)
10-11 hours
Teenagers (12-17 yrs)
hours
Adapted from Early childhood obesity prevention policies. Institute of Medicine. 2011 31

32. Sleep Hygiene: Tips for Promoting Sleep
Create environments that ensure restful sleep
No screen/media where children sleep
Low noise and light levels
Create a bedtime routine
Relaxing activities & tasks before bed
E.g. Bath
Brush teeth
Story/Quiet Time
Lights out
Routine, Routine, Routine!

33. Going beyond Health Behaviours: Emotional Health
We want kids to feel good about themselves
What is Body Image?
How we think and feel about our bodies
How we treat our bodies
It is a core component of Self Esteem for people of all ages, including kids
What is Body Image?
How we see our body – size & shape, realistic vs. distorted, etc.
What we think about our body – it’s abilities, how is looks
How we feel about our body
What our body does – movement, aches & pains, etc.
How we treat out body
What Influences Body Image?
 Family  Friends & Peers The Media  Community & Culture 

34. Body Image: Where does it come from?
Influences:
Family – what we say & do, how we treat our own bodies
Friends & Peers – group norms,
Community and culture – school climate, community celebration of diversity
The media – a powerful influence & pressure on our youth today
Body image messages are ever present and typically state:
Thin women are beautiful, successful, and happy
Muscular men are handsome and successful

35. Women: The Thin Ideal

36. Men: Muscle, Muscle, Muscle………

37. Educate children and youth about how societies “image” of ideal beauty changes across the years.

38. It’s not just teens and adults
Discuss how this kind of advertising is sexualizing children. Use La Senza Giril as an example as well.
It’s not just teens and adults

39. The Media also Sends Messages about Nutrition
Our kids are being targeted by a powerful machine

40. Mixed Messages in the Media around Food40

41. Putting It all together: The Balancing Act
6-9 Year Olds
Kids are NOT mini adults
They are concrete thinkers
They have not developed insight or good self-regulation (“I am tired so I think I will go to bed now”)
Our messages to them need to be tailored to their level of understanding
Kids LOVE structure

42. Putting It all together: The Balancing Act
Kids need to move but they also need downtime
We don’t want to over-schedule our kids
Time to recharge
Learning emotion regulation and self-soothing skills
Unstructured Play is just as important as structured play
Fosters creativity and social development
Self determination
Schedule in downtime and unstructured play as you would structured activities.

43. Talking to Kids about Nutrition, Physical Activity and Health
Remember Kids often think in Black & White
Place the key on BALANCE
Avoid referring to foods or activities as being either “good” or “bad”
Focus on the positive – kids respond to positive reinforcement more than to punishment
Health is not an all or nothing thing
Remember to say – all food is good food in moderation

44. Make the Switch Promoting Health Messages to Avoid Nutrition
Colourful plates
All FOODS FIT
Labelling foods as “good”
or “bad”
Counting calories, fat, etc.
Physical
Activity
Physical Activity is…
For fun,
To connect with friends & family
To feel good
Physical Activity to “work
off” food
Physical Activity to change
body shape

45. Make the Switch: Positive Body Image
Don’t…
Keep glossy diet fitness & fashion magazines around
Criticize your own appearance or clothes in front of children
Comment on child’s weight/shape
Do…
Teach children to be critical of the media & its messages
Focus on the Instrumental, not the Ornamental
Provide Opportunities to build self-esteem
Body Image dissatisfaction can make weight loss efforts more challenging 45

46. We Need to Walk the Walk: Parents as Role Models
Our own health behaviors
Engage in activity yourself and limit your own screen time
Make Family time Active time
Start with Small Changes & build routine
Walk to school (even if only part of the way) with your kids
A Saturday walk and then a movie
Work at Consistency