Weight Mangement in Down Syndrome : The School Age and Adolescent Years
by Joan E. Medlen, R.D.
The first article in this series focussed on weight management in the early childhood years. The emphasis during those early years is on establishing the feeding relationship and setting boundaries that promote a healthy lifestyle. This article focuses broadly on the school age and adolescent years.
Parents of children with Down syndrome have a multitude of hopes and dreams for their children as adults, including living independently, cooking healthy meals, being active, and making smart lifestyle choices. As parents, we want our kids to have it all. In the past, many of the skills needed to accomplish these goals were taught in the special education or life-skills classes. For instance, a unit in a life-skills course often covers grocery shopping, menu planning, some cooking skills, and leisure plans. However, as more children are included in regular education classrooms, these skills are not routinely taught. Children with Down syndrome will receive the same quick, fragmented nutrition education as other students, leaving them to try to decode confusing and often inaccurate messages from commercials, movies, and their friends.
In a perfect world, successful and realistic weight management for persons with Down syndrome is preventive in nature. Research and observation show that children with Down syndrome are at a greater risk to become obese. Their bodies use fewer calories to do the same activities as their same-age peers. Preventing obesity or limiting weight gain through the foundation of a healthy lifestyle is the only reasonable option. However, weight management and healthy lifestyles do not happen magically; they are learned. That means that this foundation to a healthy lifestyle must be strategically presented in a way that is meaningful and lasting.
Fortunately, families are not limited to what occurs in the classroom or on the playground to encourage healthy lifestyles. Parents can make a significant difference in the lives of everyone in the family by creating an environment that promotes healthy lifestyles. Some key elements to consider are:
An attitude of complete acceptance. This is especially important if your child is overweight. Do not be obsessed with your child’s weight, food choices, or the negative consequences of being overweight. Children with Down syndrome need to know that relationships are not contingent on how much they weigh or what they eat. It is important to discuss your concerns without becoming "the food police." Model the expected behavior. Children with Down syndrome learn by watching those around them. The most powerful tool available to parents to influence children’s choices is being healthy and active themselves. Allow your child to make choices. Do not ignore your child’s food preferences in the pursuit of good nutrition. Provide an array of choices that have something everyone likes along with new foods to experiment with. Create a win-win situation at mealtime as often as possible. The more a child with Down syndrome feels they are in control of successful situations, the more they will continue to make similar choices when on their own.
Create opportunities for successful independence. Whenever possible, set up situations that allow for independence in food activity.
With these attitudes and strategies in mind, there are countless areas parents can work on to teach the skills and build the confidence a child with Down syndrome need to independently make smart choices. The examples in this article focus on three areas: snack choices, menu writing, and routine activity schedules.
Similar to the early childhood years, school-age children and adolescents with Down syndrome (ages 7-16) need the security of boundaries regarding food choices. These boundaries, established by the feeding relationship, create opportunities for success and independence.
Building confidence and independence in food choices is best done through practice, the earlier the better. Start by creating a list of each person’s favorite foods (see Table 1). This list, arranged by food groups, becomes a tool for structuring menu planning and snack choices. Update the list periodically to allow for changing tastes and fads. There are a variety of ways to use this information that provide practice for making smart food choices.
| Breakfast | Lunch and Dinner | Fruits | Vegetables | Bread, Cereal & Grain | Snacks and Sometimes Foods |
| pancakes french toast corn flakes muffins toast hot chocolate orange juice |
meatballs pizza stir fry mac & cheese PB & J soup lasagna chili lentils |
pears (canned) banana grapes oranges star fruit kiwi berries |
raw: broccoli carrots celery jicama peas snow peas cooked: broccoli corn green beans |
bagels dumplings stuffing homemade rolls french bread barley biscuits |
pretzels popcorn popcorn cakes chips nachos ice cream reg. soda granola bars candy cookies |
Set up a snack choice system. Using a collection of foods from the family favorites list, provide an array of healthy and not-so-healthy snacks (no one is healthy all the time). After school, your child may choose one snack choice. Take time to discuss the available choices, food groups, and the appropriate serving sizes with her.
Encourage appropriate serving sizes and food budgeting. Stock the snack shelf or drawer with a one-week supply. Be available to discuss your child’s choice at first, slowly lessening your involvement. If the snacks run out before the end of the week, she must wait for the snack options to be replaced the next week.
Let your child help create the snack menu from the list of family favorites. Highlight the foods on the list that are snack foods. Be sure to add new foods to the list of possibilities. Have her choose a specific number of snack foods from each food group to emphasize the importance of balance in food choices.
Involve older children in menu planning. This is usually harder on the parents than the kids. A nutritionally balanced meal includes at least three of the five food groups (the "sometimes" group is excluded) from the food guide pyramid. For instance, a meat and bean burrito with a tossed salad uses the grain, vegetable and meat groups. It is nutritionally balanced. Remind your child to include foods equally from other family members’ favorites, not just their own.
Focussing discussions on an understanding of food groups and using a variety of foods for good health encourages wise food choices. The Food Guide Pyramid is a useful teaching tool for promoting balance, encouraging independence, and avoiding the "good food vs. bad food" theme. There are also many inexpensive nutrition-related games available that may be helpful.
From the parent’s point of view, letting kids be inactive is the easiest thing to do. It requires little planning, time, or money. After a long day of work, dealing with friends and family, pulling together meals, and completing household chores, the easiest choice is to let kids entertain themselves. Most likely, they will fill up their time with television, computer games, homework, and free time.
However, children with Down syndrome need to be taught how to use their time in a constructive and healthful manner. After school activities, team sports, and Special Olympics can fill some of their time, but it is limited to the season and other schedules. One solution is to build an after school routine that has structure and limits sedentary activity. These after school routines provide a framework that helps children use time wisely, discourages long periods of sedentary activity (watching television or playing computer games), and encourages families to spend time together.
For parents of children with Down syndrome, these after school routines will require planning and time by parents and caregivers. Careful thought must be given to providing support and encouragement. Children who go home directly after school will have slightly different options than children who go to after school care. It may be helpful for parents of children who come directly home to hire a high school or college student to help once a system is in place. Weekends are a good time for activities that everyone can be involved in: hiking, walking, biking, and so on.
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After School Schedule: Kids in After-School Care |
After School Schedule: Kids in After-School Care
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All of these suggestions for food and activity choices look wonderful on paper. Parents of kids with Down syndrome lead busy and sometimes stress-filled lives as they deal with the usual parenting concerns along with private therapies and managing their child’s I.E.P. However, those I.E.P. meetings come in handy. As you plan for changes within your family, take advantage of the information you have learned from teachers and therapists at I.E.P. meetings and private therapy. For instance, if your child needs a picture system, many of the menu planning and food choice ideas can be done with simple drawings. Or, if your child needs some cues for setting the table, there are placemats that have the position for each item printed on them or you can mark where things go on the table with masking tape.
Most important, focus on improvements everyone has made rather than the imperfections of food and activity choices. Creating a healthy lifestyle does not mean a perfect lifestyle. Continue building on your successes and the successes of your family one step at a time. Set goals for changes that are important, yet small and easy to accomplish. Remember to reward yourself and your children in ways that are supportive of a healthy and active lifestyle , such as exercise clothes, books, or music. Most importantly, keep in mind that healthy lifestyles don’t just happen; they are taught. If kids with Down syndrome learn healthy habits in the school age and adolescent years, there will be less to re-learn as they prepare to live on their own. Every step, no matter how small, is a step toward building healthy habits and healthier futures.
Satyr, E. How to Get Your Kid to Eat But Not Too Much, Bull Publishing, 1987. Medlen., J. "Looking At Metabolism." Disability Solutions, Vol 1:3, 1996, 10-11.
Epstein, L.H. "Family Based Behavioural Intervention for Obese Children." International Journal of Obesity Related and Metabolic Disorders, Vol 20, 1996, 514-521.
Fick, D., Goff, S.J. "Blending Exercise Into Family Life." The Physician and Sports Medicine, Vol 24:2, 1996.
Pyramid Explorer: Nutrition Adventures. Oregon Dairy Council-Nutrition Education Services, 1997. CD-ROM software (PC & Mac). Available from the Oregon Dairy Council, 10505 S.W. Barbur Blvd., Portland, OR 97219. 503-229-5033. $49.00
Pyramid Explorer is a CD-ROM with four fun, game-like modules to teach nutrition-related concepts. The CD-ROM package comes with a teacher/leader booklet to help guide activities.
Mealtime Game. Oregon Dairy Council-Nutrition Education Services, 1995. Available from the Oregon Dairy Council, 10505 S.W. Barbur Blvd., Portland, OR 97219. 503-229-5033.
This game gives families ideas for new traditions, easy games, and conversations to enjoy while sharing meals. They can be done as a family, or as a group activity at school or with after-school groups.
How to Teach Nutrition to Kids: An Integrated, Creative Approach to Nutrition Education for Children Ages 6-10. Connie Liakos Evers, MS, RD. Published by 24 Carrot Press, 1995. ISBN 0-9647970-3-8. $18.00
How to Teach Nutrition to Kids is written for classroom and school foodservice personnel. There are many activities for group education that reinforce sound nutrition as well as writing, math, reading, and other skills. It is a good book for after-school care programs wanting to provide enriching nutrition-related activities for kids. Activities will need adaptation for the student with Down syndrome.
The Presidential Sports Award Program. P.O. Box 68207, Indianapolis, IN 46268. 317-872-2900. $6.00
The Presidential Sports Award Program is a self-motivated program of regular exercise chosen by the participant. After meeting the criterion for one of many categories of activities (walking, running, biking, hiking, swimming, and so on), participants mail in a log detailing their efforts along with $6.00 to receive a patch, luggage tag, certificate of achievement signed by the president, and a letter of congratulations from Arnold Schwarzenegger. For some, this is a handy motivation tool for increasing activity.
Reprinted from Disability Solutions.
The article above is reproduced from the Down Syndrome Guide disseminated by the Down Syndrome Clinic at Kennedy Krieger Institute. In accordance with federal copyright restrictions, the contents of this booklet may not be reproduced by photocopying or any other means without written permission from the copyright holder. © 1999 George Capone, M.D.
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