Unwrapping our cotton wool kids

Addressing parental fear is the new frontier in the fight against childhood obesity – but how to do it? Neil Bramwell looks at some exciting new initiatives.

A 13-YEAR-OLD Michael Fasher liked nothing better than to jump on his bike on a Saturday morning, ride over the Sydney Harbour Bridge from his home in Newtown to stay with a friend at Avalon in the Northern Beaches and then cycle home on Sunday evening.

Wind the clock forward and allowing a comparable trip for Hugh Fasher, the 13-year-old son of Dr Michael, has become unthinkable due to the increase in traffic in Sydney during the intervening years.

That’s not to say Hugh falls into the category of cotton-wool kids – children who are cosseted by their parents against every conceivable misfortune. Far from it. 

Just a couple of years further on and Hugh asked dad for permission to join his mates on a seemingly risky caper near their home, just over the Hawkesbury River from Windsor in the western suburbs.

“There was a gang of them heading out to use their climbing equipment to swing from bridges. I remember the thought process well – was I was going to stop this or not? 

“I decided not to because I thought that it was important for him to establish a place among his male peers, the tough boys of the western suburbs, and build his self-esteem. He came home safely and everything worked out for the best,” said Dr Fasher, now chair of the RACGP’s National Faculty of Specific Interests, Child and Young Persons Health Network.

Not all parents would have made the same decision, but those who repeatedly opt for caution create another risk – of allowing their children to fall into the trap of obesity. 

It’s a phenomenon that a recent initiative by VicHealth and the Parenting Research Council is aiming to address with a $600,000 three-year study into parental fear as a barrier to physical activity for their children.

Central to the study is an understanding of why fewer children make their own way to school, previously a key component of a child’s daily exercise, with more being ferried small distances by car.

Previous VicHealth research has found that parents’ perceptions of stranger danger, traffic concerns and crime are the most common reasons behind kids not walking or riding to school. 

So, with one in four children now classed as obese, compared to just one in 20 during the 1960s, the focus has switched to addressing the fears of ‘helicopter parents’, who constantly hover over their children’s every move.

There is little question that a child needs exposure to acceptable risk in order to learn how to respond when serious hazards do occur. Conversely, there is no doubt that the world is a more dangerous place, on many levels. 

Figures from Kidsafe, the Child Accident Prevention Foundation of Australia, show that accidental injury is one of the leading causes of death and hospitalisation for Victorian children aged 0–14, with approximately 29 children killed each year and a further 81,000 treated in hospital for unintentional injuries. 

If the assessment of these risks is difficult for the parent, the dilemma confronting professionals such as doctors and teachers is equally daunting. The task of telling a protective parent  their child is overweight can be a minefield for a GP. Imagine the repercussions if a doctor’s advice to encourage the child to walk to school was closely followed by a newsworthy incident involving that child. Not even the experts in child safety are convinced that unsupervised travel to and from school is the preferred solution to the child obesity issue.

Melanie Courtney, Kidsafe Victoria state manager, says: “In the case of younger children, supervision plays a critical role in the prevention of injury, as does appropriate role modelling by parents and carers, for example wearing a helmet when riding a bike. In these circumstances, Kidsafe would not be supportive of children travelling unaccompanied to school. There are many alternative options to encourage children to become and remain active.”

One such initiative, the Nature Play project in Western Australia, not only offers an alternative for parents, but is also working on a solution for GPs. Nature Play’s various founding partners are all linked by a common aim to attack the cotton-wool kids phenomenon. Their website promotes unstructured, unsupervised play by providing families with ideas to encourage their children to take up outdoor activity instead of spending sedentary time in front of the television.

There is also recognition by Nature Play that GPs often do not have the capacity for one-to-one counselling. This has led to an agreement between Nature Play and two of its founding members, the AMA and the Royal Australian College of Physicians (RACP), to pursue the pilot of an initiative called Green Scripts, previously rolled out in the US and New Zealand.

The US model was simplistic and under-funded, relying on printed chits with which the doctor would convey messages about a healthy lifestyle, such as ‘limit screen time to two hours per day’, or ‘exercise for one hour per day’.

The NZ model involved four hours of training for GPs on motivational interviewing and physical activity advice, targeting less active parents, setting goals with the patient, providing electronic links to local sports foundations with follow-up calls, and feedback from GP staff. This trial proved too expensive and so the Nature Play team is seeking a happy medium for their pilot, assuming funding is secured.

Nature Play’s chairman, Dr David Roberts, also the paediatric chair of the RACP, explains their vision. “Parents welcome defined strategies so GPs would be able to access our website and download ideas for out-of-door exercise, or help plan routes to school using public transport,” he says.

“Green Scripts would also provide GPs with a tool to track whether their advice is being acted upon. If the doctor recommends that the child joins a football club, then the Department of Sport and Recreation would pay a proportion of the fees and the child’s attendance is fed back through to the GP’s screen. So, at the next consultation, the doctor can ask how the hand-passing is coming along.”

Until such programs become more widespread, Dr Fasher has some simple, practical advice. 

“Overweight children often reflect the family culture of eating and exercise, and the art of general practice is to look at other risk factors and assess where the parents are on the cycle of change,” he says.

Pre-contemplators need to be nudged around the cycle, in the same way as heavy drinkers or smokers. Those who are already contemplating change need to know that it is a family exercise and not an opportunity to scapegoat the child. And those who are ready to change need to be helped to problem-solve. 

“While the promotion of activity is good, the degree needs to be determined by where the family is on the cycle of change. There can be no prescription – it’s a crazy world to be bringing up children in.”