Baby Steps

I knocked briskly on the exam room door and slowly cracked it open to avoid potentially colliding with a child on the other side. My caution is unnecessary, though. There were no other kids in the room besides Chelsea, and she was not a typical 8 year old. She sat perched on the edge of the exam table, right where a patient is supposed to be.

Chelsea smiled brightly at me, swinging her pink-stockinged feet. She threw her hands up in the air. “It’s my doctor!” she said so enthusiastically that for a moment I had to check my own excitement.

Chelsea wore a frayed, well-loved green dress that I knew she picked out just for her well-child check up. Her pigtails were askew. Her stockings had holes in the knees. Still, I admired her effort.

Chelsea’s mother smiled up at me with tired eyes.

“Where is everyone?” I asked the precocious child in front of me. I had made the mistake in the past of directing my questions to her mother, which Chelsea took as an insult to her maturity.

“Dad took the boys and grandma has the baby,” Chelsea answered. I glanced over at her mother. Dad had been out of the picture for a while. Her mother stared stony faced at the hands in her lap.

I looked back to Chelsea whose rounded cheeks were as rosy as if she just came in from a bike ride. I was pretty sure she didn’t own a bike.

“Any complaints today?” I asked. Chelsea’s mother shook her head as Chelsea listed her concerns. “I have a bug bite on my arm. It could have been a tick – yuck! I also scraped my knee and sometimes my belly hurts after dinner. I grew an inch and grandma said I should get a flu shot because mommy is having a baby!”

I looked to her mother, surprised. “Congratulations! Maybe you should make an appointment on your way out so we can catch up?” I suggested. She nodded.

Chelsea’s exam was entirely normal, except for her BMI. She slipped from overweight to obese since her last exam. While her soft rolls and chunky thighs were endearing as a baby, her weight had become a health threat. Obese kids were much more likely to become diabetics and were at higher risk for a number of other potentially lethal diseases.

I also I knew that as Chelsea got older her peers would tease her about her weight, eroding away the sweet confidence and self-esteem that made her so charming.

It was a delicate subject to broach but an even more difficult one to treat. Chelsea’s mother was also obese, as were all of her siblings. The only skinny one in the family was grandma, who chain smoked and enjoyed her high-balls in the afternoon.

“Looking over Chelsea’s growth chart has me concerned,” I started tentatively. Chelsea tilted her head and squinted her eyes at me inquisitively. Her mother looked at me blankly.

I tried a slightly more direct approach. “Her weight is too much for her height.”

Her mother sat up and snapped, “I know! I told her to lay off the soda and chips or she’ll be fat. I told her she should be on a diet.” I didn’t want to lose the battle with her mother by immediately confronting her with the obvious. At 8, Chelsea didn’t have the means to purchase those things herself.

“With kids, it’s better to focus on being more active and choosing healthier foods than to actually ‘diet’,” I explained to mom. I elaborated on the ways she might help Chelsea become more active such as limiting screen time to 2 hours a day, encouraging her to play outside and letting her join in extracurricular sports.

“I wanted to play softball, but mommy wouldn’t let me!” Chelsea said crossing her arms over her chest and glaring at her mother.

“I can’t get her to the field,” countered her mother, “and I can’t expect her little brothers to sit on the sidelines for hours.”

I knew that Chelsea’s mom struggled just to put gas in her tank. I knew she couldn’t afford a babysitter and that sometimes the TV and iPad probably served as one so she could have a little break herself.

There were no parks near Chelsea’s house out in the country.  She didn’t get much exercise at school either since gym classes were scaled back with budget cuts.

“I would love to see Chelsea increase her fruits and vegetables and limit the junk food,” I said.

“I love fruit!” Chelsea shouted. “Mommy never buys it!”

“They don’t give that stuff out at the food pantry,” her mother said. “I can’t afford those expensive things.” I can’t argue that. The cheapest way to feed a hungry family is pre-packaged carbohydrate-rich foods. It’s also the easiest way for an exhausted parent to feed picky kids.

“Maybe the best we can do right now is to focus on the things that aren’t so hard to change,” I suggested. I looked at Chelsea, “Except for maybe on special occasions, I’d like you to stop drinking sugary drinks like soda and juice.” Chelsea pouted a little, but nodded her head in agreement.

I looked at Chelsea’s mom. “This would be much easier for her if you didn’t buy them at all,” I said gently. I added, “It would work best if the whole family changed a few things.”

I looked at Chelsea, who was listening intently. “Do you have any other ideas about being healthy?” I asked.

“I could play tag with my brothers?” she asked. I nodded, encouraging her to continue. “Maybe I could not sneak cookies upstairs?” Her mother’s eyebrows raised.

“Yes,” I agreed.  And maybe mom could stop buying them.

I would have loved to encouraged Chelsea and her mother to start a walking program together. I could see Chelsea proudly pushing her baby sister in a stroller with her two brothers tumbling behind her, climbing in and out of a wagon pulled by mom.

I would also love to be able to offer them a healthy cooking class on a cheap budget. In an ideal world, they could pick up vegetables at the food pantry. Chelsea could track her steps with a pedometer and keep a journal of what she ate to show a dietician who would help her make healthy choices.

I settled for eliminating soda and spending more time outside.

Maybe next time I would encourage them to start a little garden on the porch.

Baby steps.