www.rpped.com.br
REVISTA
PAULISTA
DE
PEDIATRIA
ORIGINAL
ARTICLE
Knowledge
of
pediatricians
regarding
physical
activity
in
childhood
and
adolescence
Alex
Pinheiro
Gordia
a,∗,
Teresa
Maria
Bianchini
de
Quadros
a,
Luciana
Rodrigues
Silva
b,
Gilton
Marques
dos
Santos
baUniversidadeFederaldoRecôncavodaBahia(UFRB),Amargosa,BA,Brazil bUniversidadeFederaldaBahia(UFBA),Salvador,BA,Brazil
Received2October2014;accepted8February2015 Availableonline28August2015
KEYWORDS
Motoractivity; Educationmedical; Pediatricobesity; Healthpromotion
Abstract
Objective: Toinvestigatetheknowledgeandguidancegivenbypediatriciansregardingphysical activityinchildhoodandadolescence.
Methods: Across-sectionalstudyinvolvingaconveniencesampleofpediatricians(n=210)who participatedinanationalpediatricscongressin2013.Sociodemographicandprofessionaldata anddataregardinghabitualphysicalactivityandpediatricians’knowledgeandinstructionsfor youngpeopleregardingphysicalactivitywerecollectedusingaquestionnaire.Absoluteand relativefrequenciesandmeansandstandarddeviationswerecalculated.
Results: Mostpediatricianswerefemales, hadgraduatedfrommedicalschoolmorethan15 yearsago,andhadresidencyinpediatrics.Morethan70%oftheparticipantsreportedtoinclude physicalactivityguidanceintheirprescriptions.Ontheotherhand,approximatelytwo-thirds ofthepediatriciansincorrectlyreportedthatchildrenshouldnotworkoutandlessthan15% answeredthequestionaboutphysicalactivitybarrierscorrectly.Withrespecttothetwo ques-tionsaboutphysicalactivitytotackleobesity,incorrectanswersweremarkedbymorethan50% ofthepediatricians.Mostparticipantsincorrectlyreportedthat30minshouldbetheminimum daily timeofphysicalactivityinyoungpeople. Lessthan40%ofthepediatricianscorrectly indicatedthemaximumtimeyoungpeopleshouldspendinfrontofascreen.
Conclusions: Ingeneral,thepediatriciansreportedthattheyrecommendphysicalactivityto their young patients, but specificknowledge of thistopic was limited. Programs providing adequateinformationareneeded.
©2015SociedadedePediatriadeS˜aoPaulo.PublishedbyElsevierEditoraLtda.Thisisanopen accessarticleundertheCCBY-license(https://creativecommons.org/licenses/by/4.0/).
DOIoforiginalarticle:http://dx.doi.org/10.1016/j.rpped.2015.02.001
∗Correspondingauthor.
E-mails:alexgordia@gmail.com,alexgordia@ufrb.edu.br(A.P.Gordia).
PALAVRAS-CHAVE
Atividademotora; Educac¸ãomédica; Obesidade pediátrica; Promoc¸ãodasaúde
Conhecimentodepediatrassobreaatividadefísicanainfânciaeadolescência
Resumo
Objetivo: Investigaroconhecimentodospediatrassobreaatividadefísicanainfânciae ado-lescênciaeaorientac¸ãodadaporeles.
Métodos: Estudotransversalfeitocomumaamostraconvenientedepediatras(n=210)que par-ticiparamdecongressosnacionaisdestinadosàespecialidadeem2013.Usou-seumquestionário paracoletar dadossociodemográficos,profissionais,dapráticahabitualdeatividadefísicae sobreoconhecimentoeorientac¸ãodopediatraemrelac¸ãoàatividadefísicadejovens.Foram calculadasfrequênciasabsolutaserelativas,médiaedesvio-padrão.
Resultados: Amaiorproporc¸ãodospediatraseradosexofeminino,estavaformadoem medi-cinahaviamaisde15anosetinharesidênciaempediatria.Maisde70%relataramincorporar aorientac¸ãodeatividadefísicaemsuasprescric¸ões.Poroutrolado,aproximadamentedois terc¸osrelataramincorretamentequecrianc¸asnãopodem fazermusculac¸ãoemenos de15% responderamcorretamente aquestãosobrebarreiraspara apráticadeatividadefísica.Em ambas asquestões sobreaprática de atividadefísica para enfrentamentoda obesidade as opc¸õesincorretasforammarcadaspor50%oumaisdospediatras.Amaioriarelatou, incorreta-mente,que30minutoséotempomínimodiárioparaapráticadeatividadefísicaparajovens. Menosde40%souberamrespondercorretamentequaléotempomáximoqueosjovenspodem passaremfrenteàstelas.
Conclusões: Emgeral,ospediatrasrelataramrecomendaraatividadefísicaparaseuspacientes jovens, porém o conhecimento específico sobre o assunto foi limitado. Há necessidadede programascominformac¸õesadequadasparaospediatras.
©2015SociedadedePediatriadeS˜aoPaulo.PublicadoporElsevierEditoraLtda.Esteéumartigo OpenAccesssobalicençaCCBY(https://creativecommons.org/licenses/by/4.0/deed.pt).
Introduction
Obesity in childhood and adolescence has been consid-ered a pandemic,with highcosts for health care systems worldwide.1 Young obese individuals are more likely to
develop cardiometabolic risk factors, diabetes, hyperten-sion, liver disease, joint disease, asthma, oral health problems, anxiety, depression, attention deficit disorders withhyperactivity,sleepproblemsandnegativeperception ofqualityoflife.2Obesityduringchildhoodandadolescence
hasadverseeffectsonearlymortalityandphysicalmorbidity inadulthoodintheshortandlongterms.3
Evidenceindicatesthatphysicalactivityduringchildhood andadolescencemaycontributetofightobesityinatleast three ways: (1) the practiceof physical activity in child-hoodandadolescencehelpsmaintainingtheenergybalance and,consequently,aidsinthepreventionandtreatmentof obesity and obesity-related diseases in this stage of life; (2)activeyoungindividualstend tobecomeactiveadults, increasingenergyexpenditurethroughoutthelifecycle,and (3)activeyoung individualsarelesslikelytodevelop obe-sityandobesity-relateddiseases inadulthood.4,5However,
whilephysicalactivityrepresentsanimportantcomponent ofhealth promotionanddiseaseprevention inchildren,5,6
thereisahighprevalenceofsedentarybehaviorand insuf-ficientphysicalactivityinthispopulation.7,8
Pediatricians are the health professionals more often presentinyoungindividuals’lives,accompanyingthemfrom birth tolate adolescence.In this sense,pediatricians are veryimportanttofighttheobesitypandemicinchildrenwith
a focus on health promotion, protection, prevention and health education.Parents believe that pediatricians have acentralroleincontrollingthebodyweightoftheir chil-dren, including the suggestion of diet plans and physical activity.9Asthefamilyistheprimarysourceofinformation
andsupporttothepediatricpatient,providingpatientand family-centeredcare is essential for the success of pedi-atric practice.10 There is evidence that young individuals
whohave parental support for physical activity aremore active,aswellasthatmoreactiveparentshavemoreactive children.11Thus,sporadicinformationaboutphysical
activ-itygivenbythepediatrician,bothtothepatientandtotheir parents,maybeapromisingstrategyforadherencetothis practiceatanearlyage.
However,thereisstilllittleinformationaboutthe train-ingand therole of the pediatrician asa physical activity promoter.Therefore,theaimofthisstudywastoinvestigate theknowledgeandinformationprovidedbypediatricianson physicalactivityduringchildhoodandadolescence.
Method
emPediatria.Allphysicians registered intheconferences receivedaquestionnaireintheirfolders.Ontwooccasions duringthe conferences,participants received information aboutthestudyandwereaskedtocompletethe question-naire.Attheendofeachactivitycarriedoutattheevents, therewasaresearcherresponsibleforcollectingthefilled outquestionnaires.Althoughnotallinvestigatedphysicians haddoneresidencyinPediatrics,inthisstudywechoseto callallofthem‘‘pediatricians’’becauseoftheirpractical workinthisarea.
As an evaluation tool, a questionnaire that was for-mulated by two teachers of physical education and a pediatricianwasused.The toolconsistedof20 questions, dividedinto twoparts. The first part,consisting of seven questions,investigatedtheinformationaboutgender,time sincegraduationfromthemedicalschool,residencyin Pedi-atrics, time working in Pediatrics, workplace (outpatient clinic/private clinic, hospital ward, emergency room and morethanonelocation)andemploymentsector(only pub-lic, only privateor both sectors). Stillin the firstpart of thequestionnaire,theparticipantswereaskedabouttheir usual physical activity practice with the following ques-tion:‘‘On average, how much timein a typical week do you dedicate to physical activity?’’ The second part was structuredintwoother parts: (1)knowledge about physi-calactivity inchildhoodand adolescence(ten questions), and(2) guidelines/recommendations for children, adoles-centsandparentsaboutphysicalactivity(threequestions). Thetoolwasdeveloped basedontheAmericanCollegeof SportsMedicineguidelines12 andotherclassicalreferences
ofthearea.13---15
Data were analyzed using SPSS statistical software, version 20.0. Absolute and relative frequencies, mean and standard deviation (SD) were calculated. Prior to participation in the study, pediatricians were informed about the research objectives and voluntarily agreed to participate.The present studywasapproved bythe Insti-tutional Review Board of Faculdade Maria Milza (process #126/2011).
Results
The study included 210 pediatricians(145 in theevent in Salvador,BA,and65inPortoAlegre,RS).Therewasa sam-plelossof356pediatricians,with111intheeventheldin Salvador,BAand245intheeventheldinPortoAlegre,RS. Pediatricians reported practicing 105.5 (SD=60.8)minutes ofphysicalactivityonatypicalweek.Thedemographicand professionaldataoftheassessedpediatriciansareshownin
Table1. Mostof themwere females, hadgraduated from medicalschoolmore than 15years before,haddone res-idency in Pediatrics and worked withPediatrics for more than15years.The majority ofpediatriciansworkedin an outpatientclinic/privateclinicoratmorethanonelocation, andmorethanhalfworked inboththepublicandprivate sectors.
Morethan90%ofrespondentsgaveacorrectanswerin thatphysicalactivityrecommendationsforchildrenshould not be similar to those for adults, and that recreational activities are more suitable than competitive activities for children. On the other hand, more than two thirds
Table1 Demographic andprofessionalcharacteristicsof theinterviewedpediatricians.
Characteristic n(Total) %
Gender
Male 62(206) 20.4 Female 164(206) 79.6
TimesinceMedicalSchoolgraduation(years)
≤5 35(205) 17.1
6---15 36(205) 17.6 16---25 48(205) 23.3
≥26 86(205) 42.0 MedicalresidencyinPediatrics
Yes 168(203) 82.8 No 35(203) 17.2
TimeworkinginPediatrics(years)
≤5 43(194) 22.2
6---15 32(194) 16.5 16---15 52(194) 26.8
≥26 67(194) 34.5 Placeofemployment
OutpatientClinic/privatepractice 84(198) 42.5 Nursingward 3(198) 1.5 EmergencyRoom 22(198) 11.1 Morethanoneplaceofemployment 89(198) 44.9
WorkSector
Onlypublicsector 44(194) 22.7 Onlyprivatesector 42(194) 21.6 Bothsectors 108(194) 55.7
incorrectlyreportedthatchildrencannotperformstrength training,andlessthan15%correctlyansweredthequestion aboutimpedimentstophysicalactivity.Manyoftheassessed pediatriciansreportedthattheydidnotknowtheAmerican CollegeofSportsMedicine’srecommendationsforphysical activityinthepediatricpopulation(Table2).
Inbothquestionsonphysicalactivitytofightobesityin childhood and adolescence, at least half of pediatricians indicated incorrect alternatives. Many respondents would recommendthepracticeof isolatedaerobicactivities and walkingasthemostappropriatephysicalactivityforobese youngindividuals(Table3).
Mostofthe assessed pediatriciansincorrectly reported that 30min is the minimumdaily time for physical activ-ityforchildrenandadolescents.Inaddition,lessthan40% wereable tocorrectlyanswer whatis themaximum time that young individuals can spend in front of screens, and almosthalf didnotidentifyactivevideogamesashelpers inincreasingthe levelofphysical activityinthe pediatric population(Table4).
Table2 Frequencyofanswers onthegeneralaspectsof physicalactivityinchildhoodandadolescence.
Questions/answers n(Total) %
DoyouknowtheAmericanCollegeofSportsMedicine’s recommendationsforthepracticeofphysicalactivitiesof childrenandadolescents?
Yes 32(197) 16.2 No 165(197) 83.8
Consideringphysiologicalaspectssuchasthermoregulation, aerobicandanaerobicmetabolism,shouldthe
recommendationsforpracticeofphysicalactivitiesby childrenbesimilartotherecommendationsforadults?
Yes 5(191) 2.6
Noa 186(191) 97.4
Whatactivitiesaremoreadequateforchildren?
Competitive 11(187) 5.9 Recreationala 176(187) 94.1
Canchildrenandadolescentsdostrengthtraining?
Yesa 52(188) 27.7
No 136(188) 72.3
Whichofthefollowingoptionsisnotasignificant impedimenttophysicalactivityinchildrenand adolescents?Checkonlyone.
Lackoftime 61(184) 33.2 Lackoffamilysupport 17(184) 9.3 Fearofhurtingoneselfa 26(184) 14.1
Lackofopportunity 21(184) 11.4
Laziness 47(184) 25.5
Lackofsafety 12(184) 6.5
a Correctanswer.
Table 3 Frequency of answers on practice of physical activitiestofightobesityinchildhoodandadolescence. Questions/answers n(Total) %
Forobesechildrenandadolescents,whatphysicalactivity wouldyourecommendtohelpweightloss?
Aerobicactivities 102(191) 53.4 Anaerobicactivities 11(191) 5.8
Botha 78(191) 40.8
Forobesechildrenandadolescents,consideringthemost appropriatetypeofphysicalactivity,whichoptionwould yourecommendthemost?Checkonlyone.
Walking 81(186) 43.5
Running 8(186) 4.3
Swimminga 93(186) 50.0
Volleyball 0(186) 0
Soccer 4(186) 2.2
a Correctanswer.
Discussion
Theincrease intheregularpracticeof physicalactivityin childhoodandadolescencehasbeenreportedasaneffective andpromisingstrategytofightobesityand,consequently,to decrease chronic, noncommunicablediseases in adults.4---6
Table 4 Frequency of answers on active and sedentary behaviorinchildhoodandadolescence.
Questions/answers n(Total) %
Whatshouldbetheminimumdailydurationoftimespent onphysicalactivityforchildrenandadolescentsaccording totheAmericanCollegeofSportsMedicine’s
recommendations?
30min 109(177) 61.6 45min 25(177) 14.1 60mina 38(177) 21.5
75min 0(177) 0
90min 5(177) 2.8
Whatshouldbethemaximumdailydurationoftimespent bychildrenandadolescentsinfrontofscreens(TV,video gameandcomputer)accordingtothecurrent
recommendations?
15min 2(183) 1.1
30min 28(183) 15.3
60min 73(183) 39.9
90min 9(183) 4.9
120mina 71(183) 38.8
Canactivevideogames(suchasNintendoWii)helpto increasethephysicalactivityofchildrenandadolescents?
Yesa 101(185) 54.6
No 84(185) 45.4
a Correctanswer.
Table5 Frequencyofanswersoninformationand recom-mendationsbypediatriciansforphysicalactivityinchildhood andadolescence.
Questions/answers n(Total) %
Doyouincorporatetherecommendationsofphysical activityinyoursystematicprescriptions?
Yes 137(187) 73.3 No 50(187) 26.7 Onlyforobesechildren 0(187) 0
Inyourpractice,doyouhavethehabitofmaking recommendationstotheparentsofyoungobesepatients abouttheimportanceoflifestylechangesinthewhole family?
Yes 185(190) 97.4 No 5(190) 2.6
Inyourpractice,doyourecommendthatyoungpatients seekaphysicaleducationprofessionalforthepracticeof specificphysicalactivities?
Yes 121(190) 63.7 No 69(190) 36.3
duringtheirclinicalpractice.However,theassed pediatri-cians usuallyhad limited knowledgeon the subject. Most ofthemmistookrecommendationsfortheadultpopulation asadequateforchildren,reportedthatchildrencannotdo strengthtraining,wereunawareofthecurrent recommen-dationsonthemaximumdailytimeallowedforchildrenin frontofscreensanderroneouslyindicatedthemost appro-priateactivitiesforobesechildrenandadolescents.
Recommendations and guidelines for the practice of physical activity in children and adolescents should take intoaccountspecificphysiologicalresponsesthatoccur dur-ingexercise,especiallyinthethermoregulationandenergy productionsystems.16---18Childrenhavelesssweatoutputby
gland, and thus absorb more heat during exercise under heat stress, a characteristic that can lead them to have symptomsofhyperthermia.16 Additionally, childrenhavea
higher body surface per unit of body mass than adults, whichincreasesthespeedofheatexchangewiththe envi-ronment,accelerating both the heat gain in hotclimates (greater risk for hyperthermia) and heat loss in cold cli-mates (higher risk for hypothermia).16,18 Therefore, it is
important that young individuals exercise in thermoneu-tralenvironmentsandareproperlyhydratedbefore,during and after practice.12 Regarding energy production, when
comparedtoadults,children havelower levelsof lactate dehydrogenase and phosphofructokinase enzymes, which limit the performance of anaerobic activities, and have lowersystolicvolumeandcardiacoutput,whichreducethe capacitytoperformaerobicactivities.16,17Thisimmaturity
ofthermoregulationandenergyproductionsystemsis evi-dentinprepubertalindividualsandtendstodecreaseduring puberty. Thus, from a physiological point of view, at the endofadolescencetherecommendationsandguidelinesfor thepracticeofphysicalactivitymaybesimilartothoseof adults.
According tothe current literature,12,19,20 children and
adolescentsshouldbeurgedtopracticeatleast60minof moderateto vigorousphysical activity a day, whereas for adults,itisrecommendedaminimumof30minaday.12The
adultrecommendationwasestablishednearly20yearsago21
and,sincethen,ithasbeenwidelydisseminatedbythemass media.Inthisstudy,over60%oftheassessedpediatricians indicatedthesuggested30minadayforadultsasthe min-imumamountof physical activitytobe recommendedfor childrenandadolescents.Thisfindingisofconcern,because youngindividuals can beencouragedtoperformonly half oftherecommendeddailytimeofphysicalactivity,witha significantreductioninhealthbenefits.Publicpoliciesand civilsociety campaignsaimedat increasingthe dissemina-tionofrecommendations forphysicalactivity inchildhood andadolescence,bothforhealthprofessionalsandforthe generalpopulation,maybeusefultopromotethisbehavior inchildren,emphasizingthattheidealdurationofphysical activityisatleast60minaday,everydayoftheweek.
Physical activities for children and adolescents should beniceandappropriateforgrowth/developmentandmay include walking, active play/games, dance, sports and activitiestostrengthenmusclesandbones.12Another
impor-tant aspect about the prescription and physical activity information for young individuals are the factors that hinder or create difficulties for the practice. Evidence indicates that‘‘lack of time’’, ‘‘lack of familysupport,’’
‘‘lack of company of friends’’, ‘‘lack of opportunity’’, ‘‘prefertodootherthings,’’‘‘laziness’’,‘‘donothave any-one totake me’’, ‘‘lack of space’’ and ‘‘lack of safety’’ havebeenconsideredimpedimentstophysicalactivity dur-ingchildhoodandadolescence.15,22Theknowledgeofthese
impedimentsby pediatriciansand theattempttopropose strategiesforyoungindividualstotryovercomingthemmay berelevanttoincreasingphysicalactivity.
Although there is a consensus in the literature that activities aiming at muscle strength/endurance gaining, such asresistancetraining,are beneficialtochildren and adolescents,23 thispracticeis stillseen withalotof
prej-udiceor synonymousof an exclusivelyadult activity.This bias emerged in the 1970s and 1980s, when a survey in the US on the number of lesions in young practitioners of strength/resistanceactivities wasperformed.However, the lesions were related to problems in the equipment ergonomics, lack ofsupervision andplanning by atrained professional and excess workload.23 Current studies on
strength training/muscularenduranceindicatethat, when anappropriateplanisfollowed,thispracticecanbesafe, effective, enjoyable and with low risk of injury.12,19,20,23
According to the American College of Sports Medicine12
and other guidelines,19,20 children andadolescents should
perform strength/resistance activities for the major mus-cle groups 2---3 times aweek, with2---4 seriesper session and 8---15 repetitions per series, with moderate workload and focus on improvement of the motor gesture. Muscu-lar strength/endurance activities, if properly prescribed andsupervised, besidesofferingless riskof osteoarticular lesionsinchildrenthancontactsports,18providesignificant
gain in bone density and mineral content.19,23
Addition-ally, muscular strength/muscular resistance activities can help in the improvement of cardiorespiratory fitness and bodycompositionand,therefore,reducecardiovascularrisk factors.23
Physical activity plays an important role in obesity prevention and treatment in the pediatric population.4,5
A systematic review of meta-analyzes demonstrated that regularphysicalactivitywaseffectiveinreducingthe per-centageofbodyfatinobeseyoungindividuals.5Bothaerobic
(e.g. cycling,walking and swimming) and anaerobic (e.g. strength training) activities areimportant for the obesity treatment.Aerobicactivitiesarerecommendedforweight loss in obese individuals due to the high energy expendi-ture and fat metabolism stimulation, whereas anaerobic activities are suggested toassistin maintaining the basal metabolicratebypreservingleanmassduringbodyweight loss.24,25However,itisimportanttobearinmindthatobese
youngindividualsfeelmorepainintheknees,havegreater impairmentofmobilityandhigherprevalenceoffractures andjointandmusculoskeletaldiscomfort,comparedto indi-vidualswithnormalweight.26Inthissense,physicalactivity
programs for this part of the population should include exercisesthatrequirelittleor nojointimpact.The Amer-icanCollegeofSportsMedicine12 suggeststhattrainingfor
nice/attractive environment(water), by showingrelevant adherencebyobeseyoungindividuals, becauseofthelow riskoflesionsandbecausetheyallowtheactivationof mus-clegroupsintheupperandlowerlimbsandtrunk.27,28
Sedentary behavior may be a risk factor for adverse effectsonhealth evenin youngindividuals whomeet the recommendations for physical activity.29 It is suggested
that children and adolescents do not exceed 2h a day in sedentary activities, in order to prevent obesity and cardiovascular risk factors.13 The access of the pediatric
populationtotelevision,cellphones,videogamesand com-putershasincreasedinrecentyearsand,withthat,many young individuals spend a long time in front of screens.8
On the other hand, technologicaladvances can alsohelp toincrease thephysicalactivitypracticeofyoung individ-ualsthroughactive video games.Asystematic review has shownthatthesegamescanincreaselevelsofphysical activ-ity,energyexpenditure,maximumoxygenconsumptionand heartrate,anddecreasewaistcircumferenceandsedentary timeinfrontofscreens.30Consideringthatelectronicmedia
tend tobeincreasingly present inthedaily livesofyoung individuals,itissuggestedthatthepediatrician’s informa-tiontothepatientaimtolimitat2-hadaythetimespentby youngindividualsinsedentaryactivitiesinfrontofscreens, andstronglyencouragetheuseofactivevideogamesasa strategytoincreasephysicalactivity.
The present study has limitations, including the con-venient sample of physicianswho participated inthe two pediatric update events, as well as the sampling loss of 62.9%ofthestudypopulation.Therefore,thestudy’s exter-nal validityand extrapolation offindings become limited. Regarding the internal validity of the study, the absence ofsample calculation andsamplingstrategycanbea lim-itation, considering the high sample loss. However, the questionnaireusedasatoolfordatacollectionwasnot vali-datedandmightnotdeterminethetruesignificanceofwhat weproposedtomeasure.Theevaluationoftheknowledge and information provided by the pediatricians participat-ingintheconferencesexclusivelythroughaquestionnaire makes it impossible to determine if what was reported is what actually happens in the daily clinical practiceof those professionals in outpatient clinics and offices, dur-ingshort-timeconsultations.Despitetheseissues,thisstudy demonstratesthattheknowledgeandinformationprovided bypediatriciansstillneedimprovementregardingthe appro-priatephysicalactivityforchildrenandadolescents.
Ingeneral,theassessedpediatriciansreportedthey rec-ommendphysicalactivityfortheiryoungpatients,butthe specificknowledgeonthesubjectwaslimited.Therefore, theroleofthepediatricianasafacilitatorfortheadherence ofyoungindividualstophysicalactivityiscompromised.In additiontosupportingphysical activity,especiallytofight obesity,pediatricians,duetotheirprivilegedcontactwith youngindividualsandtheirfamilies,havealsobeen asked togiveadviceonhealthyeating,oralhealth,mentalhealth, vaccination, among others. Based on this context, three questions seem toarise: (1)Are pediatriciansresponsible forinformingtheirpatientsonallaspectsrelatedtohealth promotion of children and adolescents?; (2) Do graduate coursesinmedicineandPediatricresidencyhavecurricula withtheoreticalandpracticalbasis toprovide supportfor pediatricianstosafelyincludetheseguidelinesintheir
clin-icalpractice?,and(3)Isthereaneffectiveopportunityfor thepediatrician’sinteractionwithotherprimaryhealthcare professionals,suchasphysicaleducators,nutritionists, den-tists and psychologists, in the comprehensive care given tochildrenandadolescents?Thereflection,discussionand developmentofresearchbasedonthesequestionsmayhave consequences that will help in the development of poli-ciesbasedonnewmodelsof trainingand performanceof pediatriciansandotherprofessionalswhoparticipateinthe monitoringprocessofyoungindividuals’health,andin pro-vidingadequateinformationonhealthylifehabits.
Funding
GrantfromFundac¸ãode Amparo àPesquisa doEstado da Bahia(FAPESB).
Conflicts
of
interest
Theauthorsdeclarenoconflictsofinterest.
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