Write that prescription for "exercise"!

With obesity ranking as a major health threat for children today, pediatricians need to be involved in getting kids started in exercise and sports and keeping them involved, Jordan Metzl, MD, told a session at the American Academy of Pediatrics national conference today.

But just as with many other health conditions, the exercise prescription has to be tailored to the individual child and take into account such factors as body type and personality type, including how involved the child already is in sports, said Dr. Metzl, who is medical director of the Sport Medicine Institute for Young Athletes at the Hospital for Special Surgery in New York and Greenwich, Connecticut.

It's a prescription that involves setting goals for weight loss and fitness and looking for underlying medical or orthopedic issues, he explained. Key to the process is being sure the activity is fun for the child in order to get "buy-in" and keep the youngster engaged.

Dr. Metzl recommends martial arts as one possibility for obese children. That's because it's basically noncompetitive, and obese kids may not be as good at other, more traditional, sports as their peers, a fact that can discourage them.

On the other end of the spectrum is the child whose heavy involvement in sport may be causing problems. Dr. Metzl told the story of a talented 11-year-old gymnast who crippled her wrists and had to drop the sport because her high-powered coach told her to work through the pain. Discussions with these very athletic kids, he said, may be just as important as talks with those who are inactive. For the young person who is aspiring to be a ballet dancer, but is in pain, it may be up to the pediatrician to say, "Your hips just are not turned out enough for a ballet dancer." That intervention may be critical, explained Dr. Metzl, because the system will go on pushing the child.

For the moderately active child or teenager, the problem may be one of motivation. The task may involve looking at self-esteem issues, such as in cases where the child is not good enough to make the team or not as good as their sibling. Dr. Metzl noted a case of a 14-year-old skilled gymnast whose back problems ended her involvement in that sport. For her, the solution was finding another sport, such as diving or dance, that uses many of her skills.

The AAP and sports medicine organizations recommend strength training for kids. It's effective for children as young as age 7 or 8, and it can increase baseline strength by 30% to 40%, said Dr. Metzl. But, he cautioned, it needs to be supervised and safe.

One thing that is standard for most children is the need for positive reinforcement, because they will inevitably get discouraged at some point. Give gold stars on a chart or some system to keep a child's morale up, he says.