AAP issues interim guidance for nutrition in the pandemic

The disruption to life caused by the COVID-19 pandemic has been all-encompassing. Millions have lost their jobs; those still employed have had to make their homes their new offices; and millions of children have transitioned to a virtual learning environment. These changes have created economic and other hardships for many families. Additionally, children have not been visiting their pediatrician as often as they have in the past, which can make assessing nutrition and physical activity more difficult. The American Academy of Pediatrics has issued interim guidance to help address these concerns as the pandemic continues.¹

The guidance first addresses the main negative consequences of the pandemic. With the turn to virtual, half-day, or hybrid learning, a number of children and teenagers no longer have access to nutritious foods that they would normally be able to get through school breakfast and lunch. Additionally, families may have turned to snack foods; nonperishable processed foods acquired during the early panicked days of the pandemic; and increased consumption of food and sugar-sweetened beverages. As many may note through conversation with friends, families may increase consumption to assuage boredom or to manage negative emotions. Unfortunately as food consumption may be changing for the worse, the opportunity to engage in physical activity has decreased, with many gyms and parks closing or offering limited access, and school sports reduced or cancelled entirely .

Pediatricians are urged to help children and families overcome the current barriers to a healthy lifestyle, but they should be prepared to acknowledge the ways that the pandemic has made having such a lifestyle more difficult. The guidance also has recommendations for assessing and screening, which include:

• Assess and screen for disruptions in nutrition and physical activity that are connected to the pandemic at every well visit
• Screen for obesity onset or worsening

When assessing nutrition:

- Ask about access to fresh food and evaluate food insecurity

- Ask about the family’s eating routines and patterns

- Look for disordered eating habits linked to the pandemic, which can include scarcity of food, stress, and trauma

When assessing physical activity:

- Ask about the child’s physical activity, how much and what it is.

- Ask about what may prevent the child from engaging in physical activity

- Ask about the child’s sedentary time and how much they are using an electronic device for recreation

- Conduct an obesity assessment at every visit

It’s also important to give families positive strategies that can use the familial strengths to engage in a healthy lifestyle. When counseling patients and families, the clinician should ensure all advice is appropriate for the child’s developmental stage as well as sensitive to the socioeconomic, cultural, and psychological characteristics of the family. To effectively help families, clinicians should be familiar with how nutrition and activity levels can connect with excessive weight gain as well as how those can change in the pandemic.

Reference

1. American Academy of Pediatrics. Supporting healthy nutrition and physical activity during the COVID-19 pandemic. Services.aap.org. Updated December 9, 2020. Accessed December 11, 2020. https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/supporting-healthy-nutrition-and-physical-activity-during-the-covid-19-pandemic/.