While you might think there isn’t much overlap between the goals of a family medicine physician and a pediatric dentist, we have a shared understanding about the harmful effects of sugar-sweetened beverages (SSB) on the health of young children. We have both witnessed first-hand the increase in SSB-related poor health outcomes, especially during the COVID-19 pandemic. Our patients consumed higher than usual SSBs that coupled with experiencing a lack of access to physical activity, not surprisingly, increased the cases of obesity and/or dental caries in our practices.

When looking at BMI among San Diego school children, nearly 1 out of every 3 children were overweight or obese in the 2017-18 school year.¹ In terms of their oral health, according to data from the Oral Health Assessment 2017-18, 27% of kindergartners and first graders already experienced tooth decay or restorations, and 21% had visible decay with 4% needing urgent dental services.² These numbers were pre-pandemic and already shocking. Here are our personal experiences treating patients during the pandemic:

Dr. Campos:

As a family medicine physician working in the South Bay of San Diego at San Ysidro Health, I have seen a dramatic increase in pediatric obesity during my well-child visits. Many times, due to a variety of factors exacerbated by COVID-19, families find juice and soda to be the easiest drink to give to their children.

One of my patients, Laura, is twelve years old; she is being raised by a single mother who works two jobs to pay the rent. As the youngest, Laura is often left alone with her older sisters for most of the day after school. She typically grabs a fast breakfast of granola bars and juice since her mother doesn’t have time to cook. When Laura returns from school, dinner is usually whatever fast food her mother can pick up on the way home from work, and Laura washes it down with soda. Laura has not been able to maintain a healthy weight, and this has only become more challenging during the pandemic, exacerbated by disruptions she experienced in access to physical activity. She now has signs of fatty liver disease, which happens when too much fat accumulates in the liver and triggers an inflammatory process that injures liver cells. While this is a complication more often seen in adults, in my personal practice, I am diagnosing more of my pediatric and adolescent patients with fatty liver disease.

Dr. Whyte:

I’ve seen equally shocking situations in my dental practice at San Ysidro Health.

Lucy is a five-year-old girl with Down Syndrome who I began seeing in my dental clinic when she was 18-months-old. At that time, she had severe early childhood caries, but was being managed with caries arresting medication, fluoride varnish, diet and oral hygiene counseling, and frequent recall visits. Her last dental appointment was in March 2020. Due to the pandemic, and its long-lasting negative impact on children’s access to medical and dental preventative care, she was lost to follow up, not returning to see me until February 2022. At that time, she had been to the emergency room for facial swelling secondary to dental decay and her mom reported Lucy was in pain. When Lucy’s mask was removed, dry blood was inside her mask. The mom reported that her teeth caused the bleeding.

Lucy’s oral exam showed that her teeth were in such poor condition that blood could be seen coming from some of the teeth and the remainder of her baby teeth were so decayed that only roots remained. Her four adult molars, which had only been in her mouth a few months were already extensively decayed. Upon further discussion with mom, the mom shared that Lucy mainly drinks “Capri Sun and Sunny Delight” at home. The result was that Lucy had 18 baby teeth extracted under general anesthesia leaving her with only four permanent molars in the back of her mouth.

It was these experiences that led us to tackle SSBs on a higher level beyond our clinical work and one-on-one patient encounters. We decided to come together and combat both childhood obesity and early childhood caries in one program at our Federally Qualified Health Center (FQHC).

Utilizing a multi-generational and multi-cultural video from the UCSF LatinX Center of Excellence, we plan to educate parents of children being seen by one of our physicians or dentists about the detrimental effects of SSBs. We developed an accompanying flier with facts about SSBs and their association with obesity and dental decay. Parents can scan a QR code on the flier and watch the video, in English or Spanish, on their own electronic devices, allowing them to view the video anytime and share with friends and relatives. In the medical clinic, parents will also be given recipe cards for healthy drink substitutes. In the dental clinic, the parents will be given a follow up survey to assess their perception and perceived benefit of the video. Our goal is to create a sustainable education program that can be utilized in other community clinics.

Addressing the harmful impacts of SSBs on childrens’ health requires a comprehensive and interdisciplinary approach. We hope that our model for collaboration can inspire others to come together with a shared vision for promoting better and equitable outcomes for all children.

References:

1. California Department of Education. (2018). FITNESSGRAM® body composition test. Data for 5th, 7th and 9th grade students enrolled in San Diego County’s 42 public school districts in school year 2017-2018. Retrieved from https://data1.cde.ca.gov/ dataquest/
2. Finlayson, T., Zapata, R., & Institute for Public Health School of Public Health San Diego State University, Available Local Oral Health Data Summary Report 1–70 (2019). San Diego, CA.