Posts Tagged ‘ foster care ’

An Enlightening Story About Extreme Childhood Obesity: When It’s Not Just Parenting

Tuesday, November 29th, 2011

Yesterday, after I blogged about using foster care as an intervention of last resort for extreme childhood obesity, I spent the afternoon in a juvenile court. I was working with a judge and clinicians to help develop a platform for making family-centered interventions available for teens who are in need of services for a variety of issues (typically delinquency and substance use). We ended up talking about the obesity debate – and I heard a story that was an eye opener. Here it is. 

There was a child who was placed in foster care because of extreme obesity and the parents’ lack of compliance with medical recommendations. During the time in foster care, the child lost 60 pounds. He was then reunited with his parents. The parents were working with a nutritionist and made lots of changes to the child’s diet. Even though they had limited resources, they found ways to purchase fresh foods and made healthy meals at home, all under the guidance of the nutritionist.

Despite this, the child started to slowly gain back weight, and after a few months, had put back on 30 pounds (half of the weight that he lost in foster care). Everyone – including the nutritionist – was baffled. Then someone finally figured it out.

The cause? The meals provided by his school. Yep, it was primarily the school lunches that were putting the weight back on.

So in this one case, the foster care model (which I don’t favor) actually did work, and in-home intervention (which I do favor) actually did work – but these accomplishments were undermined by the school system.

If we trust schools to educate our children, shouldn’t we trust them to also feed them properly? I’ll state the obvious – the obesity epidemic in this country is not just about parenting.

Image: Double Cheeseburger via Shutterstock

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Obese Third Grader Placed In Foster Care: The Debate Continues

Monday, November 28th, 2011

Today there is a reported case of an obese third grader being placed in foster care. The rationale for this is that when a parent(s) ignores or doesn’t properly follow medical recommendations – and their child continues to suffer from extreme obesity – then the appropriate agency can petition a court and cite “medical neglect” as a rationale for temporary placement in foster care. 

I discussed this issue this summer in response to a thoughtful and provocative editorial published in the Journal of the American Medical Association. But now that we have a current news story in front of us, it seems appropriate to continue the debate.

To start, let’s be clear about one thing – a third grade boy who weighs over 200 pounds and is suffering from sleep apnea requires immediate intervention (we’re not talking about a kid who is a little heavy for his age). The health risks – both immediate and longer-term – are too great to be ignored. Let’s add to this that fundamental changes in the child’s caretaking are necessary (we’re not talking about occasionally eating too much junk food and not getting quite enough exercise) – especially since they have not happened despite medical advice.  And even if there is a medical basis (including rare but powerful genetic conditions) underlying the obesity, major lifestyle alterations will need to be made with respect to diet and activity. So the issue is how best to deliver an intervention that will be successful.

I continue to understand the frustrations of practitioners who are trying to (quite literally) save a child’s life, and watch as their suggestions are not followed. But I still disagree with the idea of taking the child away from the mother, especially since the goal is to return the child at a later time. Simply put, I think administering in-home intervention that will help teach the mom and her son how to break the extreme habits that have been formed would serve as the best platform for long-term change. As someone who is currently conducting research on family-centered interventions, I know first-hand that this is easier said than done. But to me there is much more potential for improving this family’s life – and this boy’s health – by keeping them together and devoting all the potential resources to deliver in-home care to get this family to make the changes they need to make. Sometimes families need help, and by bringing medical intervention to them in their home environment, perhaps we can make more progress in the fight against childhood obesity.

Image: Healthy Diet Via Shutterstock

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Kids In Foster Care Are Getting Prescribed Antipsychotic Cocktails At An Alarming Rate

Monday, November 21st, 2011

A new paper released in the journal Pediatrics adds new troubling findings to an emerging public health issue: the tendency to prescribe antipsychotic drugs to kids in foster care. What this new study shows is that kids in foster care – compared to kids in a program for needy families, and kids with diagnosed disorders such as autism or bipolar disorder – are more likely to be put on a regimen that combines antipsychotic drugs (known as antipsychotic cocktails). This practice is particularly dangerous for kids because it is known to lead to rapid weight gain and risk for metabolic problems – and it is not clear what other effects it may have on kids over time. And it also shows that they are not getting the psychological help that they need.

This study is influential because it uses a very strong design. Dr. Susan dosReis and colleagues examined Medicaid records of over 600,000 minors in a mid-Atlantic state – and combed through them to find 16,969 youths (younger than 20) who received some type of psychiatric diagnosis as well as evidence for a prescription for an antipsychotic drug. The big finding is that kids in foster care are more likely to be given antipsychotic cocktails (a combination of at least 2 drugs) than kids with diagnosed disabilities or kids in needy families – and they stay on them longer (particularly when compared to kids in needy families). Such objective evidence using these detailed comparisons shows a heavy bias – not supported in any way by clinical profile – to over-medicate kids in foster care.

It’s clear that kids in foster care can suffer from all kinds of problems due to the unfortunate and troubling issues that put them there in the first place. The big picture here is that our national ‘mental health mentality’ needs to change from trying to use drugs to control behavioral and emotional difficulties to investing in the harder and more expensive process of investing in psychosocial intervention. Even in the case of appropriate use of medication with kids who suffer from disorders such as autism or ADHD (and there are many kids who benefit from the rational and well-monitored use of prescription drugs), the best treatment incorporates legitimate behavioral intervention. Why should kids in foster care be deprived of this service? We have an obligation to invest in all youth, and to give them opportunities to develop into healthy and happy adults who will return the investment by becoming productive members of society. Simply zonking them out with antipsychotic cocktails doesn’t help them, or anyone else for that matter.

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