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Bright Futures in Practice: Nutrition

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Bright Futures in Practice: Nutrition. “ New Morbidities”of the 21st Century. Changing family structures Highly mobile populations Lack of access to health care Health disparities Deteriorating neighborhoods and communities - PowerPoint PPT Presentation

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  • Bright Futures in Practice: Nutrition

  • New Morbiditiesof the 21st CenturyChanging family structures Highly mobile populationsLack of access to health careHealth disparitiesDeteriorating neighborhoods and communitiesIntentional and unintentional injuries, substance abuse, depression, and HIV infection

  • Bright Futures Sponsors

  • Every Child Deserves a Bright Future!

  • The Mission of Bright FuturesTo promote and improve the health and well-being of infants, children, adolescents, families, and communities. Bright Futures is dedicated to developing educational materials for health professionals and families; implementing Bright Futures content, philosophy, and materials; and fostering partnerships and collaboration.

  • Bright FuturesAn Organized Structure for Health SupervisionBright Futures provides a framework to address thecurrent and emerging health needs of infants,children, adolescents, and their families.

  • Bright Futures GuidelinesCornerstone Document

  • Families Matter!Families as partners

    Families as caregivers

    Families as teachers

    Families as resources

  • ImmunizationsBack to SleepBike HelmetsFluoridationHealth Promotion/Prevention Works!

  • Partnerships Make a Difference

    Health professionalsFamiliesChild care professionalsSocial service professionalsSchools

    Local and state governmentCommunity groupsBusiness/industryFaith communitiesPayers

  • Bright Futures in Practice SeriesOral HealthNutrition Physical ActivityMental Health

  • Bright Futures in Practice: NutritionAdvances in Nutrition

    Optimal nutrition is important for sustenance, good health, and well-beingDiet and health is important for disease preventionLifelong eating behaviors often established in early childhood

  • Emphasis of Bright Futures in Practice: NutritionDevelopmental approachContextual approachPartnerships among health professionals, families, and communities

  • Vision and Goals of Bright Futures in Practice: NutritionImprove the nutrition status of infants, children, and adolescentsEncourage partnerships among health professionals, families, and communitiesEducate health professionals, families, and communities about nutrition

  • Organizations That Support Bright Futures in Practice: NutritionAmerican Academy of PediatricsAmerican Academy of Pediatric DentistryAmerican Dietetic AssociationAmerican Medical AssociationNational Association of Pediatric Nurse Associates and PractitionersAmerican School Health AssociationAmerican Public Health Association and many more

  • How the Guide is OrganizedIntroductionNutrition Supervision GuidelinesNutrition Issues and ConcernsNutrition Tools

  • IntroductionHealthy Eating and Physical ActivityNutrition in the CommunityCultural Awareness in Nutrition Counseling

  • NutritionSupervision GuidelinesMajor StagesInfancy 0-11 Months Early Childhood 1-4 YearsMiddle Childhood 5-10 Years Adolescence 11-21 Years

  • Nutrition Supervision Guidelines Chapter HighlightsGrowth and physical, social, and emotional developmentCommon nutrition concernsNutrition supervisionDesired outcomesFrequently asked questions

  • NutritionIssues and ConcernsBreastfeedingChildren and adolescents with special health care needsNutrition and sportsVegetarian eatingObesityPediatric undernutrition

  • Nutrition ToolsNutrition questionnaires Key indicators of nutrition riskTips for promoting food safetyTips for fostering a positive body imageFederal food assistance and nutrition programs

  • How the Guide Can Be UsedClinicalCommunityPolicyEducation and Training

  • How the Guide Can Be Used: ClinicalIncorporate into each nutrition supervision visitIncorporate into each health supervision visitDevelop nutrition programs and servicesDevelop standards of practice and protocolEducate and train health professionals

  • How the Guide Can Be Used: CommunityServe as a resource to provide anticipatory guidance to families on healthy eating practicesDevelop nutrition education programs and servicesHelp schools develop health curriculaDevelop standards of practice and protocol

  • How the Guide Can Be Used: PolicyObtain support for nutrition policies and programsProvide information on relevant nutrition issues and concerns

  • How the Guide Can Be Used: Education and TrainingEducate and train health professionalsEducate and train paraprofessionalsProvide in-service education and training to staffUse as a textbook or reference

  • Bright Futures Web Sitewww.brightfutures.orgResources for health professionals and familiesView, download and order publications

  • Bright Notes

  • To find out more about Bright Futures, contact:Bright Futures ProjectNational Center for Education in Maternal and Child HealthGeorgetown University2000 15th Street, North, Suite 701Arlington, VA 22201-2617Tel: (703) 524-7802Fax: (703) 524-9335E-mail: [email protected]

    This presentation will provide an overview of the Bright Futures project and the practice guide Bright Futures in Practice: Nutrition.Although advances in public health and medicine have improved the lives of many infants, children, and adolescents, todays families face new pressures. Often referred to as the new morbidities these challenges include:

    Changing family structures and the loss of extended family relationships.Highly mobile populations that often lack continuity of care.Health disparities in racial/ethnic groups.Deteriorating neighborhoods and communities.Lack of access to health care, especially in rural communities.Rising rate of intentional and unintentional injuries, substance abuse, depression, and HIV infection.Health professionals are challenged to respond to new morbidities and to coordinate care for families in a variety of settings. To meet these challenges, the Bright Futures project was initiated by the Health Resources and Services Administrations Maternal and Child Health Bureau, with additional support from the Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration).The Bright Futures project is based on the founding principles that every child and adolescent deserves to be healthy, experience joy, have self-esteem, have a nurturing family and caring friends, and believe that he or she can succeed in life.The mission of the Bright Futures project is to promote and improve the health and well-being of infants, children, adolescents, families, and communities. This is achieved through developing educational materials for health professionals, families, and communities; implementing Bright Futures content, philosophy, and materials; and through fostering partnerships and collaboration.Bright Futures provides an organized framework to address current and emerging health needs of infants, children, and adolescents. Bright Futures guidelines do not impose new mandates on health professionals; they reinforce a holistic approach to well-child care which many health professionals already embrace.

    Bright Futures is more than a set of guidelinesit is a unique approach to childrens health and health care. Bright Futures encourages health professionals to recognize the unique strengths and needs of each child and family and to provide health supervision within the context of family and community.The first task of the Bright Futures project was to develop a set of guidelines for health supervision, emphasizing health promotion and disease prevention in a developmental context. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents was published in 1994, and was updated in 2000 and 2002. The guidelines provide the foundation for a coordinated series of resource materials for health professionals, families, and communities.The Bright Futures guidelines are based on the belief that families matterfamilies as partners, as caregivers, as teachers, and as resources within the community. One of Bright Futures primary goals is to enhance families strengths while addressing their issues and concerns, to build parents confidence and competence in preventing illness and promoting health and safety at home and in their community.Central to the concept of health supervision is the knowledge that specific disease and injury prevention and health-promotion interventions improve childrens health outcomes. Examples of successful interventions include child safety seats, water fluoridation, immunization, the Back to Sleep campaign, bike helmets, and home safety practices.

    For example, the availability of fluoridated water has been the primary factor in reducing the prevalence of dental caries (tooth decay) by 30 to 40 percent among children in the United States.Health intervention not only occurs in clinics and hospitals, but also in homes, child care facilities, schools, and other community settings. Effective interventions require partnerships among health professionals, families, educators, community leaders, and many others.

    With the Bright Futures guidelines as the cornerstone document, a series of Bright Futures in Practice guides have been developed to provide health professionals with comprehensive guidance and practical tools in specific areas of health promotion and disease prevention.

    Four guides are available:Bright Futures in Practice: Oral Health published in 1996.Bright Futures in Practice: Nutrition published in 2000 and revised in 2002.Bright Futures in Practice: Physical Activity published in 2001.Bright Futures in Practice: Mental Health published in 2002.Optimal nutrition is important for sustenance, good health, and well-being throughout life. As the relationship among diet, health, and disease prevention have become clearer, nutrition and the promotion of healthy eating behaviors have received increased attention. Lifelong eating behaviors are often established in early childhood. Therefore, it is important for children and adolescents to build the foundation for good health by practicing healthy eating behaviors.

    Bright Futures in Practice: Nutrition provides comprehensive nutrition guidelines for health promotion and disease prevention from birth through adolescence.In developing the nutrition guidelines, three main concepts were integrated:

    A developmental approach, which is based on the unique social and psychological characteristics of each developmental period, is critical for understanding childrens and adolescents attitudes toward food and for encouraging healthy eating behaviors.A contextual approach emphasizes the promotion of positive attitudes toward food and healthy eating behaviors by providing children, adolescents, and their families with consistent nutrition messages.Encouraging healthy eating behaviors is a shared responsibility. Working together, health professionals, families, and communities can promote the nutrition status of infants, children, and adolescents.The vision and goals of Bright Futures in Practice: Nutrition are to:

    Improve the nutrition status of infants, children, and adolescentsEncourage partnerships among health professionals, families, and communitiesEducate health professionals, families, and communities about nutritionThe nutrition guide has been supported by numerous organizations representing medicine, nursing, nutrition, public health, school health, and related fields. Thirty-seven national organizations support Bright Futures in Practice: Nutrition.The nutrition guide is organized into four sections:

    IntroductionNutrition Developmental Chapterswhich provide an overview of the critical issues in infancy, early childhood, middle childhood, and adolescence.Issues and Concerns Chapterswhich provide an overview of 13 common pediatric topics.Tools a wide variety of nutrition screening tools, counseling strategies, and resources.Indexesdevelopmental and topic indexes and a listing of all the tools that appear in the guide.The first section of the guide includes three introductory chapters:

    The chapter Healthy Eating and Physical Activity includes several tools including the Dietary Guidelines for Americans, Food Guide Pyramid, and the Activity Pyramid developed to help individuals practice healthy eating and physical activity behaviors.The chapter Nutrition in the Community addresses building partnerships among health professionals, families, and communities to promote the nutrition status of infants, children, and adolescents. Activities of building partnerships include assessing the nutrition needs of the community and providing nutrition services. The chapter Cultural Awareness in Nutrition Counseling provides a framework for understanding how culture affects food choices and nutrition. Keys to good cross-cultural communication, such as learning and following cultural rules about touching, establishing rapport, respecting silence, and noticing how people make eye contact are provided.The four developmental chapters provide an overview of the critical issues in: infancy (birth through 11 months), early childhood (ages 1 through 4 years), middle childhood (ages 5 through 10 years), and adolescence (ages 11 through 21 years).

    Each chapter begins with a brief orientation to the developmental period. Topics discussed include growth and physical development, social and emotional development, healthy lifestyles, building partnerships and common concerns. Nutrition supervision includes key interview questions, recommended screening and assessment, and counseling to share with the family about the childs nutrition status.The developmental chapter lists desired outcomes that contribute to the overall health and physical activity status of the child, and the role of the family. These outcomes can be useful for evaluating the quality of programs or services provided.A vignette is included to show how the physical activity guide can be used in many settings and by different health professionals. Topics include helping new parents interact with their infant and providing opportunities to children and adolescents for developing motor skills.The chapter concludes with a list of frequently asked questions and provides practical strategies for promoting physical activity. The health professional can share the information with the family during the visit or use it as a handout. Example of questions includeWhen and how should I introduce solid foods?What should I do if my child seems overweight?The third section presents information on nutrition issues and concerns families may have when a child or adolescent has diabetes, an eating disorder, a food allergy, iron-deficiency anemia, or special health care needs. Each of the 13 chapters provides an overview of the issue or concern and identifies prevention, early recognition, and intervention strategies. Additional chapters include breastfeeding, nutrition and sports, vegetarian eating practices, obesity, and pediatric undernutrition.The final section of the guide includes tools that health professionals, families, and communities can use to promote nutrition. Tools include:

    Nutrition questionnaires for infants, children, and adolescents, which provide a starting point for identifying areas of nutrition concern and interpretation of each question.Key indicators of nutrition riskcharacteristics that are associated with an increased likelihood of poor nutrition status.Screening guidelines for elevated blood lead levels.Stages of change, a model to provide nutrition counseling to promote behavior change.Strategies for health professionals to promote healthy eating behaviors.Bright Futures in Practice: Nutrition can be used in community and clinical settings including health clinics, community health centers, nutrition education programs, and university-based training programs. It can also be used to to promote policy and to provide education and training.In clinical settings, the nutrition guide can be used to incorporate information into nutrition supervision visits and to develop standards of practice and protocol.

    For example, the Utah Department of Health incorporated information from the nutrition guide into staff training modules. New staff are required to complete a self-paced training module and pass a final exam before they can work in the clinic.In community settings, the nutrition guide can be used as a resource to provide anticipatory guidance to families and to develop nutrition education programs and services.

    In Kentucky, WIC has enhanced its nutrition education materials with information on folic acid, obesity, and physical activity from the nutrition guide.

    In Mohave County (Arizona), WIC has developed an online educational lesson, The Healthy Balance: Food and PlayMaintaining a Well-Balanced Diet from Childhood to Adulthood. At the end of the lesson, participants can identify 3 causes of obesity, 2 health consequences of obesity, 3 healthy eating tips, 2 benefits of physical activity, and know how to use BMI table. The lesson incorporated Tips for Fostering a Positive Body Image from the nutrition guide.

    In Maine, WIC has added frequently asked questions for health professionals and frequently asked questions for parents on their Web site. The nutrition guide served as a source for information on infant feeding.To promote policy, the guide can be used to provide information to policymakers, program administrators, and community leaders on relevant issues and concerns.

    For example, tools from the nutrition guide were incorporated into the New Mexico State Children's Health Insurance Program Screening and Risk-Reduction Initiative. This initiative will create a statewide population-based, public health prevention program if approved by the Center for Medicare and Medicaid Services.The nutrition guide can be used to provide education and training to health professionals and paraprofessionals and can be used as a textbook or reference.

    The USDA, Supplemental Food Programs Division purchased 3,000 copies of the nutrition guide to distribute to state and local WIC agencies for training staff. Trainings have been held in 25 states across the country.

    The University of Tennessee, in collaboration with the University of North Carolina, designed training program materials that introduced the nutrition guide. The materials provided information on planning, delivering, and evaluating nutrition services and meeting the needs of families and communities.

    In Kentucky, the Department of Public Health, Nutrition Services Branch used the nutrition guide to train nutritionists, nurses, and educators.Bright Futures materials, including the physical activity guide, are available on the Bright Futures Web site. The Web site offers an easy way for people to access, download, or order guidelines and other materials. On the Bright Futures home page, under special topic areas, click on nutrition.Bright Notes, the newsletter of the Bright Futures, highlights whats new and noteworthy with the initiative and showcases ways in which partners are using Bright Futures to make a difference in childrens lives. The newsletter features stories from the field, project updates, and descriptions of new resources.

    The spring 2001 issue features the release of the physical activity guide.

    The fall 2000 issue highlights some of the exciting and innovative ways the nutrition guide is being used around the country.These materials have been developed by the National Center for Education in Maternal and Child Health at Georgetown University in Arlington, Virginia. The center is funded by the Health Resources and Services Administrations Maternal and Child Health Bureau. It is our hope that the Bright Futures materials will help integrate current content and practice into programs and services to improve the health status of infants, children, and adolescents.