Rewards badges from Zamzee

The Health Resources and Services Administration at HHS is working on a new texting initiative, based on the successful public health texting initiative Text4Baby, called TXT4Tots. The department is soliciting via the Federal Registry for ways to distribute their library of text messages designed to promote wellness, nutrition and exercise for parents of children under five.

But the government isn't the only one looking for ways to leverage digital health solutions to promote kids' health and wellness.

Even as the players solidify in the burgeoning adult health tracking space, a growing number of companies is looking to apply digital health and self-tracking lessons to the problem of childhood obesity, and the challenge of getting kids to be more active. First Lady Michelle Obama's high-profile Let's Move initiative even acknowledges the role digital health can play in getting kids active: the initiative included an Apps for Healthy Kids contest on challenge.gov. The winner was Smash Your Food, from Food N' Me, a game that builds kids' awareness of the fat, sugar and oil content of different foods by letting them guess those numbers and then check their guess through a simulation of smashing the food in a compressor. A similar app from Medtronic uses an animal avatar called Lenny the Lion to teach kids with diabetes about carb counting.

Getting kids moving: Zamzee, GeoPalz, and Sqord

One prominent emerging solution is web and mobile platforms with accompanying activity trackers that use social and gaming mechanics to spur kids to activity. One of the earliest entrants is Zamzee, a platform that spun out of HopeLab in 2010.

"In terms of where kids are spending their time, the engagement with digital technology is increasingly pervasive," said Richard Tate, VP of Communications and Marketing at HopeLab. "It's a lot of time with technology. A lot of people have pointed to that as part of the 'problem' that has led to sedentary behavior. We were interested in turning that on its head, seeing if digital technology could be part of the solution."

In Zamzee's system, kids wear a Zamzee Activity Monitor, a plastic tracker with a customizable skin. The device tracks their movement, not just steps, the company says, but intensity of activity: whether or not it fits into the "moderate or vigorous" categories considered to be most beneficial to kids. When kids plug the device's USB slider into a computer, they gain "Pointz" based on how much they've moved, which they can use to buy prizes like skins for their Tracker, big ticket items like iPods, or even donations to a charity (a surprisingly popular choice, a Zamzee rep told MobiHealthNews). HopeLab recently released an efficacy study which showed Zamzee got kids to move 60 percent more than non-users over a six month period.

Another system, which MobiHealthNews mentioned in our CES 2013 slideshow, is GeoPalz (their forthcoming mobile-based system is called iBitz). GeoPalz markets their product to parents at Whole Foods and REI stores. They provide a pedometer, worn on the hip or shoe and shaped like, for instance, a lady bug or a soccer ball, and a web and mobile portal. With GeoPalz, kids read their steps taken off a screen on the pedometer and manually enter that number into a website, which converts the steps into points they can use to buy goods selected and priced by their parents. The system has as back-end that allows parents to select appropriate gifts from Amazon.com and set a number of points for each product they think is appropriate.

GeoPalz also partners with game makers (like online flash game maker Nitrome) to license versions of their games on the GeoPalz site. The number of activity points a child has collected during the day will buy a corresponding number of minutes playing a game - once they expire, it's locked until the kid moves some more. iBitz, which also syncs steps automatically, will take that one step further -- partnered game developers have created versions of their games where kids can use activity points to buy in-game goods like secret items and achievements.

A third, burgeoning digital health for kids platform, Sqord, just completed a crowdfunding campaign on Indiegogo. Sqord offers a wristworn tracker which syncs wirelessly, and the company is focused on the social aspect at the classroom or neighborhood level. Competition is the main motivator in Sqord's platform, rather than rewards. Sqord, which won a Technology Innovator award from Tufts-based nonprofit ChildObesity180, has been in beta with limited pilot trials in classrooms since June 2011. Sqord "is powered in part by" the Fitbit Ultra hardware and API, according to the company's website.

"Our belief is that, at its core, active play is still a lot of fun for kids, it’s just gotten crowded out by other interests. If you build a platform based around active play and grab that interest, you can get them back in," Sqord CEO Coleman Greene told MobiHealthNews.

The Sqord hub and PowerBand.

What makes tracking for kids different?

But what does it take to sell digital health to parents and kids? Some of the devices available suggest that adapting self-tracking for a younger audience involves a number of tweaks in approach.

"Parents can be self-motivated just by giving themselves a goal -- measurability and self-reporting, that's parents motivation," said Zan O'Leary, co-founder of GeoPalz. "Kids are completely different. Kids are motivated by prizes, by rewards. They don't care how many steps they take because it's never been put to their attention."

"Kids don't necessarily work out or exercise, per se, for extended periods of time," said Zamzee's Tate. "Kids tend to move in short bursts of activity. They play. And we were very interested in tracking even those short bursts, because over time that's good for you."

A lot of parents would think twice about giving a child a $100 Fitbit device, for instance. Kids' trackers need to be something parents can feel good about giving to children who could lose them or subject them to some harsh treatment while playing. Sqord's PowerBand is waterproof and nearly indestructible, Greene claims, and O'Leary says the steel GeoPalz tracker is water-resistant and robust. Zamzee says their device is pretty tough, too, but they also offer a generous replacement policy for lost or broken trackers. As for the price point, Zamzee trackers are $29.99, GeoPalz charges $25.00 for their classic and $40.00 to pre-order the iBitz PowerKey, and Sqord is looking to charge around $20, according to Greene. All three companies stressed the importance of a fashionable, personalized tracker for getting kids engaged.

One final challenge to building a platform for kids, especially kids under 13, is greater privacy considerations. Kids digital health companies want to provide a social experience also, but it's important they do so in a way that's compliant with COPPA, the Children's Online Privacy Protection Act. GeoPalz largely shies away from social features because of COPPA, O'Leary said. So the sharing that happens with GeoPalz is limited to the family unit, within which parents and siblings can share data. But Tate told MobiHealthNews that Zamzee saw an opportunity to make their social features more creative instead.

Zamzee users create online profile with made up names and they can share their tracking data and enter into competitions with other users anonymously. There's no free chat, which would compromise security, but there is a feature called "Whamz" which Zamzee Content and Social Media Manager Nina Gannes described as status updates crossed with Mad Libs. Kids choose from drop down menus to create statuses like "Walking the dog on the moon and making it epic" that they can share on the site.

By selling their platform to organizations, Sqord can focus on social motivators without running up against COPPA problems. Kids are only interacting on the site with known peers.

"Our platform is more fun the more people you have, kind of like with any game," said Greene. "Really the schools and the youth organizations are where we’ve spent most of our time today."

Kids can track weight, blood sugar, and, soon, allergens

The forthcoming iBitz PowerKey from GeoPalz

Last month, health peripheral maker Withings released their Smart Kid Scale, a version of their flagship connected weight scale product aimed specifically at parents. The scale is equipped with a basket so it can be used as a baby scale, but the basket is removable so it can continue to track weight up to age 8. The connected app also lets parents track height, to keep a record of a child's growth.

“With the Smart Kid Scale, we’re hoping to bring the same positive outcomes we’ve seen in adults with weight tracking to the adults of the future," Withings co-founder Cedric Hutchings said in a statement. "We’ve made it very simple for parents to track the weight progress of their children and therefore giving them a tool that will assist in turning their children into healthy adults.”

Although fighting obesity and promoting activity is one of the most obvious mass market opportunities for kid's digital health, there are also some chronic diseases that affect children, and some companies are leveraging mobile and digital health solutions to help kids manage these conditions.

Ayogo's Monster Manor app uses progressively unlockable games, similar to GeoPalz, to encourage kids with diabetes to check their blood sugar regularly. The app is synced with an app on the parent's phone, so when kids check their blood sugar, their parents can see the results right away. The parents can even customize the in-game incentives to meet their child's needs, and the whole system is designed to be done in 10-minute spurts, so kids aren't kept away from their classrooms throughout the day.

Just like with fitness tracking, one factor that's at play here is habit formation, and it stands to reason that habits formed at a young age will persist into adulthood, whether the habit is working out or carefully and regularly checking one's blood glucose.

Another chronic condition afflicting kids, moreso than adults even, is food allergies and intolerances, which are inexplicably on the rise. As MobiHealthNews reported in mid-December, a UCLA researcher is working on technology that will turn smartphones into mobile labs to test foods for particular allergens.

One more company is leveraging gamification and tracking to keep kids honest with brushing their teeth. The FDA-cleared Beam Brush is a smart toothbrush that uploads data on how much and how often kids brush to an app their parents can track. They just partnered with Kiip to offer rewards to kids who meet their dental hygiene goals.