Intervention Programs Target Childhood Chronic Disease

by Candi Helseth

As pediatric obesity rates have risen, the rate of children diagnosed with chronic diseases has also climbed. In response, more schools are offering educational nutrition and physical fitness programming. But some schools are moving even further into the medical realm, by screening students, diagnosing chronic conditions and referring students for follow up treatment in situations that used to be handled only in clinics or doctor’s offices. The role of school nurses is also expanding, as they are tasked with the responsibility of managing students with serious diseases that once were only diagnosed in adults.

“Children born in the year 2000 now have a one-in-three risk for developing Type 2 diabetes, a disease that used to occur in adulthood only,” said Kathy Brewer, a South Carolina Department of Health registered nurse and certified diabetes educator who provides leadership for a children’s school-based chronic disease management program in two rural SC counties. “Long-term complications can begin at an even younger age with children developing diabetes. That can be devastating.”

Overweight children also experience elevated cholesterol levels that can lead to cardiovascular disease. The CARDIAC Project (Coronary Artery Risk Detection in Appalachian Communities), based out of West Virginia University at Morgantown, is the nation’s first program to provide school-based surveillance, identification of children at risk and referral for treatment, according to founder and current director Dr. William Neal. CARDIAC began in three counties in 1998, has expanded to cover all 55 of West Virginia’s counties. West Virginia, the second most rural state, has a rate of heart disease 21 percent higher than the national average.

According to the American Academy of Pediatrics, overweight and obese children are also more likely to have high blood pressure, asthma, sleep apnea, skin infections and complaints of joint pain. Research also indicates that obese children have lower self-esteem, which has been linked to poor academic performance and depression.

Camp NEW You Renews

Camp NEW You

Children at Camp NEW You, a two-week camp run by the WV CARDIAC Project, enjoy an activity on the water.

Sarah Watkins was an overweight 11-year-old with a family history of heart disease when a CARDIAC Project screening at her West Virginia elementary school indicated Sarah already had elevated cholesterol levels. She was referred to Camp NEW You, an intensive year-long program targeted at improving physical health for overweight and obese children, one of several CARDIAC intervention programs (the NEW stands for “Nutrition, Exercise and Weight Management”). Today Sarah is a healthy 14-year-old who has maintained her weight loss and participates in sports 11 months of the year.

“Camp NEW You turned Sarah’s life around,” said Anita, Sarah’s mother. “Sarah has lots of friends now, is a 4.0 student and feels good about herself. Camp NEW You changed all of us. I shop different, cook different and stay active. Michael (Sarah’s father) lost weight and quit smoking.”

Funded by the state’s insurance providers, Camp NEW You meets needs of children ages 11-14 that have a BMI above the 95th percentile, said Eloise Elliott, CARDIAC Project associate director for interventions. Parents and the child must make a written commitment to participate. Family weekend retreats, telephone coaching, individualized physical activity programming and personal accountability mechanisms follow the initial two weeks of intensive therapy on the university campus.

“We have lifestyle coaches that help the whole family identify how to be healthier,” Elliott said. “Children depend on the guardian or parents to help them with lifestyle changes. There has to be home support, and that’s the hardest part.”

School Screenings Identify At-Risk Children

The CARDIAC Project identifies at-risk children through free, private, voluntary screenings at West Virginia schools that include height and weight, BMI (Body Mass Index), blood pressure, examinations for Acanthosis Nigricans (a possible indicator for Type 2 diabetes) and cholesterol testing. These are all done at the fifth-grade level; kindergarten and second-grade students are also screened for Acanthosis Nigricans. A comprehensive health report provided to the child’s family includes referral for additional services, if needed, and recommendations on how to maintain a healthy lifestyle.

Dr. William Neal

Dr. William Neal, founder and director of the CARDIAC Project in West Virginia, observes a WVU Medical student screening children for health risks.

“We’ve screened over 100,000 children in the last 13 years,” Dr. Neal said. “When we began doing this years ago, parents didn’t think children even had cholesterol, much less high cholesterol. CARDIAC raises awareness of risk factors for chronic disease in children. It identifies children at high risk and puts the appropriate interventions in place.”

CARDIAC first helps families implement lifestyle changes when a child has elevated cholesterol. If those changes aren’t sufficient, Dr. Neal said, the children are placed on cholesterol-lowering medications. CARDIAC also operates clinics in five counties and collaborates with school nurses to ensure that children with known heart-related problems and high cholesterol receive appropriate medical treatment.

Other CARDIAC intervention programs include Healthy Hearts 4 Kids and Take Charge, Be Healthy, which are Web-based, health-related instructional models offered at no charge to all West Virginia schools. In addition to learning better health habits using the interactive programs, children can enter their daily dietary intake and physical activity to receive suggestions for improvement. Software development underway will allow children to text daily data from their cell phones.

School Nurses Can Help Kids Stay in School

When health surveys in South Carolina’s Chester and Fairfield counties revealed that children with chronic diseases were absent or going home from school frequently, the Upper Midlands Rural Health Network (no longer available online) embarked on a campaign to keep these children in class by providing support systems for school nurses in sparsely populated counties.

“School health screenings identified students with hypertension and obesity even at the elementary level,” Brewer said. “Diabetes, hypertension and asthma were the most common chronic conditions in these children.”

Using funds from a Rural Health Network Development Planning and Rural Health Outreach grant, the Network sponsored educational workshops for school nurses in both counties on prevention and management of chronic diseases in the school setting. Network members initially worked directly with middle school nurses to enhance their skills in developing treatment plans, monitoring students with chronic disease and providing appropriate interventions when students became ill at school. Purchasing an electronic school health record system for all schools improved medical documentation.

“An informal review in one school showed that days where the school nurse was available to assess students seeking medical help, the majority of students who saw the school nurse and received treatment returned to the classroom and finished the day,” Brewer said.

The Network also used grant monies to help fund salaries to employ two nurses in middle schools that didn’t have nurses on staff. School districts continued these positions when the grant expired. “They saw the value,” Brewer said. “We know that healthy children learn better. School nurses are instrumental in that process.”

Results Prove Intervention Works

Neal says CARDIAC Project’s research throughout the years proves that a child’s fitness level translates into better school performance. “Our research shows that our actions have merit,” he said. “We’ve found a lot of parents don’t know their family history and they don’t recognize the serious nature of having a child who is morbidly obese. I think all children should be screened at some point, considering our high-risk population.”

When obese children return to a healthy weight and add regular physical activity to their lifestyle, conditions such as hypertension and prediabetes will disappear, Dr. Neal added. Meanwhile, chronic disease in children continues to increase as their weight increases. Ultimately, weight loss is the solution for returning America’s children to improved health.


NACRHHS Looks at Childhood Obesity

The forthcoming 2011 Annual Report from the National Advisory Committee on Rural Health and Human Services (NACRHHS) will include a chapter on childhood obesity in rural communities. In researching the topic, the Childhood Obesity in Rural Communities Subcommittee visited preventative programs in Iowa and South Carolina. Previously, the Committee looked at rural obesity in its 2005 Annual Report.

NACRHHS reports are available on its Reports and Recommendations website.


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