Parent awareness of young children's physical activity

Tummy Time Tracking: Examining Agreement Between Parent Recall and Direct Observation in Infants

IMPORTANCE

Parent recall is the primary method for measuring positioning practices such as tummy time in infants. Concerns regarding the accuracy of parent recall have been raised in the literature. To date, no study has examined the agreement of tummy time recall measures with gold-standard methods.

OBJECTIVE

To assess the agreement between parental recall versus direct observation of tummy time in infants, and to explore the impact of prematurity on this relationship.

DESIGN

Cross-sectional observational study, spanning 1 yr.

SETTING

Participants' homes Participants: Thirty-two infant-parent dyads (19 full-term, 13 preterm), with infants ages 3 to 6 mo and caregivers ages older than 18 yr.

OUTCOME AND MEASURES

Home-recorded videos of infant play across 3 days were used as a proxy for direct observation of tummy time and compared with a 12-item parent recall survey.

RESULTS

Parent recall had a significant moderate correlation (ρ = .54, p = .002) with direct observation in full-term infants but was not correlated (p = .23) with direct observation in preterm infants. On average, parents of preterm infants overestimated tummy time by 2.5 times per day compared with direct observation.

CONCLUSIONS AND RELEVANCE

For full-term infants, parent recall measures of tummy time exhibit an acceptable level of agreement with direct observation and can be reliably used over shorter periods. Parents of preterm infants may display a bias in recalling tummy time, leading to overestimations. To accurately assess tummy time in this population, a combination of subjective and objective measures should be explored. Plain-Language Summary: Tummy time is an essential movement experience for infants, especially for preterm infants, who are at a higher risk for motor delays. The most common way to track tummy time is through parent reports, or recall, versus a practitioner directly observing tummy time in the home. Despite the widespread use of parent recall to track tummy time, no study has examined the accuracy of parent recall versus direct observation in the home. Accurately assessing tummy time is crucial for improving and supporting health outcomes for infants. This study found that prematurity may affect the accuracy of parent recall for assessing tummy time in young infants. The authors discuss the implications of this finding and provide suggestions to guide the selection of appropriate methods to measure tummy time in clinical practice and research studies.

Physical activity and unexpected weight change in Ontario children and youth during the COVID-19 pandemic: A cross-sectional analysis of the Ontario Parent Survey 2

The objective of this study was to investigate the association between children's parent-reported physical activity levels and weight changes during the COVID-19 pandemic among children and youth in Ontario Canada. A cross-sectional online survey was conducted in parents of children 5-17 years living in Ontario from May to July 2021. Parents recalled their child's physical activity and weight change during the year prior to their completion of the survey. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using multinomial logistic regression for the association between physical activity and weight gain or loss, adjusted for child age and gender, parent ethnicity, current housing type, method of school delivery, and financial stability. Overall, 86.8% of children did not obtain 60 minutes of moderate-to-vigorous physical activity per day and 75.4% of parents were somewhat or very concerned about their child's physical activity levels. For all physical activity exposures (outdoor play, light physical activity, and moderate-to-vigorous physical activity), lower physical activity was consistently associated with increased odds of weight gain or loss. For example, the adjusted OR for the association between 0-1 days of moderate-to-vigorous physical activity versus 6-7 days and child weight gain was 5.81 (95% CI 4.47, 7.56). Parent concern about their child's physical activity was also strongly associated with child weight gain (OR 7.29; 95% CI 5.94, 8.94). No differences were observed between boys and girls. This study concludes that a high proportion of children in Ontario had low physical activity levels during the COVID-19 pandemic and that low physical activity was strongly associated with parent reports of both weight gain and loss among children.

Energy expenditure and weight-related behaviors in youth with Down syndrome: a protocol

Background

The consequences of obesity are ominous, yet healthcare professionals are not adequately preventing or treating obesity in youth with Down syndrome (DS). Total daily energy expenditure (TDEE) is the energy expended in 24 h through physical activity and life-sustaining physiologic processes. An individual's TDEE is essential for determining the daily caloric intake needed to maintain or change body weight. Successful prevention and treatment of obesity in youth with DS is severely compromised by the lack of data on TDEE and information on weight-related behaviors for this high-risk population. This manuscript describes the protocol for the federally funded study that is in process to determine daily energy expenditure in a large cohort of children with DS.

Methods

This observational cross-sectional study will include a national sample of 230 youth with DS, stratified by age (5-11 and 12-18 years of age) and sex. Doubly Labeled Water analysis will provide the criterion body fat%, fat-free mass, and TDEE. To increase accessibility and decrease the burden on participants, the entire study, including obtaining consent and data collection, is conducted virtually within the participant's home environment on weekdays and weekends. The study team supervises all data collection via a video conferencing platform, e.g., Zoom. This study will (1) examine and determine average TDEE based on age and sex, (2) develop a prediction equation based on measured TDEE to predict energy requirements with a best-fit model based on fat-free mass, sex, age, and height and/or weight, and (3) use 24-hour dietary recalls, a nutrition and physical activity screener, wearable devices, and sleep questionnaire to describe the patterns and quality of dietary intake, sleep, and physical activity status in youth with DS.

Discussion

The lack of accurate information on energy expenditure and weight-related behaviors in youth with DS significantly impedes the successful prevention and treatment of obesity for this vulnerable population. The findings of this study will provide a further understanding of weight-related behaviors as obesity risk factors, currently not well understood for this population. This study will advance the science of weight management in individuals with disabilities and shift clinical practice paradigms.

Direct Parent Engagement to Improve Fundamental Movement Skills in Children: A Systematic Review

Fundamental movement skills (FMS) are basic movements in children that represent the building blocks for more complex motor skill development and act as a prerequisite for enduring sport and physical activity (PA) engagement and positive health-related behaviours. The FMS proficiency is currently inadequate worldwide, and consequently there are alarming levels of inactivity and childhood obesity. However, parents are role models to their children and possess the power to influence their PA behaviour. This review investigated if parent-focused interventions could improve FMS in 2-7-year-old children and evaluated which setting and method of parent engagement was most impactful. Keyword searches were conducted via Scopus, Web of Science, SPORTDiscus, PubMed, Science Direct, and Google Scholar. Only nine articles met the inclusion criteria. No research originated from the United Kingdom, highlighting the urgent need for further FMS interventions involving parents. The FMS improved in all nine studies, with significant changes in seven of the articles (p < 0.05). Parent-child co-activity, the education and empowerment of parents, and the provision of clear FMS guidance, messaging, and structure can positively influence children's FMS. Recently, smartphone apps have increased the feasibility and accessibility of FMS practice at home and may be integral to future interventions. Further research with direct parental involvement is clearly warranted.

Neighborhood and Family Characteristics Associated with Adiposity and Physical Activity Engagement among Preschoolers in a Small Rural Community

The purpose of this study was to evaluate family and home/neighborhood characteristics associated with physical activity (PA) and adiposity among young children living in a small rural community.

METHODS

Participants were 30 parents and their youngest child aged 2-5 years. Children wore accelerometers for 7 days. Parents completed questionnaires about family lifestyle behaviors, parenting practices, and home/neighborhood characteristics.

RESULTS

None of the family lifestyle behaviors were associated with child BMI percentile. Backyard size was inversely associated with moderate to vigorous physical activity on weekday afternoons (rho = -0.488, p = 0.006), as was perception of neighborhood dangers (rho = -0.388, p = 0.034). Perceived neighborhood safety (rho = 0.453, p = 0.012), the presence of sidewalks (rho = 0.499, p = 0.012), and public playground use (rho = 0.406, p = 0.026) were each associated with higher weekday afternoon MVPA.

CONCLUSIONS

Findings suggest neighborhood safety, sidewalks, and use of public playgrounds are positively associated with MVPA among preschoolers, while backyard size and access to play equipment at home are not. These findings have implications for rural communities where space is plentiful but access to community space and sidewalks may be limited.

Physical Activity and Sedentary Behaviors in Primary School Children in Saudi Arabia during the COVID-19 Pandemic: Association with Parents' Behaviors

During the COVID-19 pandemic, a few studies used accelerometers to assess physical activity (PA) and sedentary behavior in the family context. This study aimed to assess children and parents' moderate and vigorous physical activity (MVPA) and sedentary time, as well as their relationship in MVPA and sedentary time. Data were collected from 30 parent-child dyads during the COVID-pandemic for seven days, using a hip-worn accelerometer. Children and parents engaged in 65.6 and 34.6 min/day in MVPA and 442.2 and 427.9 min/day sedentary, respectively. There was no evidence of gender difference in MVPA and sedentary between boys and girls. Male parent spent more time in MVPA than female parents. A total of 50% of children and 53.3% of parents met the recommended PA. Children's MVPA and sedentary time were both correlated with that of their parents. Adjusted linear regression showed that only child MVPA was negatively associated with their parents' MVPA. There is evidence that multi-level interventions involving parents and children are more effective than interventions focusing on a single group. This study also provides evidence to support the link between MVPA and sedentary time between parents and children. Generalization of the findings is difficult due to the bias of self-selection sample.

Validation of a Parent-Reported Physical Activity Questionnaire by Accelerometry in European Children Aged from 6 to 12 Years Old

Validated physical activity (PA) questionnaires are crucial for collecting information in large epidemiological studies during childhood. Thus, this study analyzed the validity of a parent-reported PA questionnaire based on the Children’s Leisure Activities Study Survey by accelerometry in European children aged from 6 to 12 years old. We used data from 230 children of the Human Early-Life Exposome and Infancia y Medio Ambiente projects. Mean differences between moderate-to-vigorous PA (MVPA) reported by the questionnaire and the accelerometer were calculated (min/day), and its associated factors were explored by multiple robust linear regression. The agreement between methods was examined using a Bland−Altman plot. The concurrent validity of assessing MVPA was analyzed by cohort-adjusted Spearman’s partial correlations. ROC curve analysis was also used to explore the questionnaire’s capability to identify active children based on the World Health Organization guidelines. A moderate correlation was found between parent-reported and accelerometer MVPA (rho = 0.41, p < 0.001). The child’s sex (girl) was statistically associated with the mean MVPA difference between methods. However, this questionnaire accurately identified physically active children (area under the curve = 83.8% and 82.7% for boys and girls, cut-points = 68.6 and 45.4 min/day in MVPA, respectively). Consequently, this questionnaire is suitable for classifying active children in order to monitor public health interventions regarding PA.

Parents’ Inadequate Estimate of Their Children’s Objectively Physical Activity Level

This study aimed to investigate parents’ estimation of their preschool children’s leisure-time physical activity (PA) and the correlation between parents’ reported participation in PA with their children in leisure time and their children’s PA levels. A total of 244 Norwegian preschool children aged 4–6 and their parents were enrolled in the study. According to standard protocols, the children’s PA level was measured with Actigraph GT1M accelerometers. The parents completed a questionnaire that provided information about their estimation of their children’s PA and their reported participation in their children’s PA. Correlation analyses and scatter plots showed no significant association between parents’ estimation of their children’s PA level at leisure time and the children’s objectively measured PA level. Only 5% of the parents estimated their children’s PA level correctly. In general, the parents overestimated their children’s PA levels by three times. Furthermore, the results found no significant correlation between children’s PA levels at leisure time and parents’ reported participation in PA with their children. Our findings indicate that parents’ self-estimation of their children’s PA is inaccurate, which is problematic. Considering that the PA levels of many children are too low to fulfill internationally established health recommendations, parents’ ‘wrong’ perception about their children’s PA urgently needs to be addressed and rectified.

Considerations for a Social Media Physical Activity Program: Exploratory Study

BACKGROUND

Social media may be a powerful platform to combat parents' and children's low physical activity levels.

OBJECTIVE

This study surveyed parents' beliefs about physical activity in order to expand the extant literature concerning the interest in and the design of an effective and feasible social media physical activity (SMPA) program.

METHODS

Primary caregivers (n=250; 215 [86%] mothers, 164 [65.6%] White) of children aged 6-12 years completed an online questionnaire. Interest was examined through responses on the questionnaire; beliefs (ie, perceptions, knowledge, and support) about physical activity were examined using Spearman correlations; and to support the SMPA program design, researchers examined a combination of multiple-choice and free-response questions. For the free-response questions, the researchers performed open coding related to perceived benefits, barriers, and motivators.

RESULTS

Parent respondents (n=215, 86%) were interested in a SMPA program tailored for families. Regarding beliefs, parents exhibited a monotonic relationship between 2 questions related to perceptions of physical activity levels in their children (r_s(250)=.310, P<.001), knowledge about physical activity and motor skills (r_s(250)=.328, P<.001), and support of physical activity and motor skills (r_s(250)=.385, P<.001). Parents perceived benefits of a SMPA program, highlighting family time and health. Barriers included time constraints, a lack of motivation, and environmental factors.

CONCLUSIONS

Parents are interested in supporting healthy family behaviors using a SMPA program. An effective program should emphasize motor skill activities, be fun and family oriented, and incorporate incentives, goal setting, and advice and tips. SMPA also needs to address identified barriers, such as those regarding time and environment.

Association Between Physical Activity, Screen Time and Sleep, and School Readiness in Canadian Children Aged 4 to 6 Years

OBJECTIVE

School readiness is strongly associated with a child's future school success and well-being. The primary objective of this study was to determine whether meeting 24-hour movement guidelines (national physical activity, sedentary behaviors, and sleep recommendations) was associated with school readiness measured with mean scores in each of the 5 developmental domains of the Early Development Instrument (EDI) in Canadian children aged 4 to 6 years. Secondary objectives include examining the following: (1) the association between meeting 24-hour movement guidelines and overall vulnerability in school readiness and (2) the association between meeting individual physical activity, screen use and sleep recommendations, and overall school readiness.

METHODS

A prospective cohort study was performed using data from children (aged 4-6 years) who participated in a large-scale primary care practice-based research network.

RESULTS

Of the 739 participants (aged 5.9 + 0.12 years) in this prospective cohort study, 18.2% met the 24-Hour Movement Guidelines. Linear regression models (adjusted for child/family demographic characteristics, number of siblings, immigration status, and annual household income) revealed no evidence of an association between meeting all 24-hour movement guidelines and any of the 5 domains of the EDI (p > 0.05). Adjusted linear regression models revealed evidence of an association between meeting screen use guidelines and the "language and cognitive development" (β = 0.16, p = 0.004) domain, and for the sleep guideline, there was a statistically significant association with the "physical health and well-being" (β = 0.23, p = 0.001), the "language and cognitive development" (β = 0.10, p = 0.003), and the "communication skills and general knowledge" (β = 0.18, p < 0.001) domain.

CONCLUSION

Early lifestyle interventions targeting screen use and sleep may be beneficial for improving a child's readiness for school.

It doesn't hurt to TRY - Experiences of youths participating in a TRYathlon event series

ISSUE ADDRESSED

Running since 1999, the Sanitarium Weet-Bix Kids TRYathlon (SWKT) is the world's largest triathlon series for children and adolescents up to 16 years. This report seeks to describe participants of the TRYathlon and their perceptions of the event.

METHODS

An online survey was made available to Australian parents/guardians of participants enrolled in the 2020 SWKT. Organisational data was also employed to describe the reach of the SWKT since its inception.

RESULTS

Parents/guardians (n = 568) reported that the average child age was 9.12 (SD = 1.95, range = 6-16) and 58.6% were male. Parents/guardians identified 12 children as Aboriginal and/or Torres Strait Islander (2.0%) and 87 (14.6%) spoke a language other than English. The majority of parents/guardians rated their child's physical activity (PA) competencies as pretty good, or really good, for cycling (87.5%), swimming (80.9%) and running (79.5%). Most parents (66.0%) stated that their child was glowing with pride after completing the event, enjoyed or really enjoyed the event (98.8%), and thought their child would maintain their PA levels following the event (72.9%).

CONCLUSIONS

The SWKT series has demonstrated longevity and an ability to reach a large number of participants, providing opportunities to build health promotion awareness. Importantly the event instils a sense of confidence and pride related to PA competency in its participants; however, its long-term effectiveness requires further exploration. SO WHAT?: Mass participation events such as SWKT could be incorporated into larger health promotion strategies to encourage childhood PA and foster healthy physical and psychosocial development.

Gender Influences on Physical Activity Awareness of Adolescents and Their Parents

The imbalances between the actual physical activity (PA) of adolescents and the subjective perception both they and their parents have in this regard can play an important role in perpetuating inactive lifestyles. The aim of this study is to analyse these discrepancies by considering gender as a conditioning factor. The participants in the study were 1697 adolescents, 1244 mothers and 1052 fathers in the educational communities of 26 secondary schools located in urban environments of the Autonomous Community of Galicia (Spain). With regard to actual physical activity, a high prevalence of sedentarism (82.1%) was revealed, this being even more acute in girls (87.8%). However, the perceived levels of activity differed significantly from the actual ones with a clear general overestimation both by the adolescents and their parents. When further exploring the data, gender influences were also detected both in adolescent and parental perceptions, since the high rates of overestimation in sedentary individuals were lower in girls and, on the contrary, the low rates of underestimation in active individuals were higher in girls. Moreover, although the level of agreement between actual and perceived physical activity was low overall, with Cohen's kappa values ranging from 0.006 to 0.047, the lowest values were observed in the case of girls. In conclusion, both the adolescents and their parents were incapable of correctly assessing the actual physical activity of the former, so it seems that the general population lacks knowledge about the amount of physical activity that adolescents need to do to achieve a healthy lifestyle. Consequently, it would be advisable to implement health education campaigns and awareness-raising interventions directed to young people as well as to their parents and, in doing so, gender must be considered by establishing distinct program designs in terms of this variable.

Parents accurately perceive problematic eating behaviors but overestimate physical activity levels in preschool children

PURPOSE

The aim of this study is to examine the associations between parents' perceptions of their child's physical activity and eating behaviors to actual physical activity, body mass index percentage (BMI%), and body fat percentage (BF%). A secondary aim is to examine additional parental determinants to child's physical activity.

METHODS

Participants were preschool children (N = 114, 59 females, M_age= 4.06) from three University-sponsored centers and parents (N = 114, 107 mothers). Parents self-reported physical activity, perceptions of child's physical activity, and completed "The Child Eating Behavior Questionnaire". Children physical activity was collected with accelerometers.

RESULTS

Whereas 97% of the 68 parents with children meeting physical activity guidelines accurately identified their child as active, 93% of the 14 parents with children not meeting physical activity guidelines inaccurately identified their child as active (X²(1, N = 82) = 0.58, p = 0.446)). Regarding eating behaviors, child BMI% was moderately correlated with parent's perceptions of their child's Emotional Overeating (r(74) = 0.416, p < 0.001) and Food Responsiveness (r(74) = 0.543, p < 0.001). Parent's engagement in vigorous physical activity demonstrated a positive relationship to child's physical activity (r(78) = 0.297, p = 0.008).

CONCLUSION

Parents of inactive children have inaccurate perceptions of their child's physical activity. The association between children's BMI% and eating behaviors indicates parents can accurately perceive problematic eating behaviors. Parents, who accurately perceive their child's behaviors, may be in a better position to identify deficiency and seek early intervention. Additionally, parent's physical activity may have implications to children's physical activity.

LEVEL OF EVIDENCE

Level V: Descriptive cross-sectional study.

Association of Physical Activity and Cardiometabolic Risk in Children 3-12 Years

BACKGROUND

This study aimed to examine the association between physical activity (PA) and a total cardio metabolic risk (CMR) score in children aged 3-12 years. Secondary objectives were to examine the association between PA and individual CMR factors.

METHODS

A longitudinal study with repeated measures was conducted with participants from a large primary care practice-based research network in Toronto, Canada. Mixed effects models were used to examine the relationship between parent-reported physical activity and outcome variables (total CMR score, triglycerides, glucose, high-density lipoprotein cholesterol, systolic blood pressure, waist circumference, weight-to-height ratio, and non-high-density lipoprotein cholesterol).

RESULTS

Data from 1885 children (6.06 y, 54.4% male) with multiple visits (n = 2670) were included in the analyses. For every unit increase of 60 minutes of PA, there was no evidence of an association with total CMR score (adjusted: -0.02 [-0.014 to 0.004], P = .11]. For the individual CMR components, there was evidence of a weak association between PA and systolic blood pressure (-0.01 [-0.03 to -0.01], P < .001) and waist-to-height ratio (-0.81 [-1.62 to -0.003], P < .001).

CONCLUSION

Parent-reported PA among children aged 3-12 years was not statistically associated with total CMR, but was weakly associated with systolic blood pressure and waist-to-height ratio.

Parental Impact on Child Physical Activity and Sedentary Time in Appalachian North Carolina

Introduction

Physical activity has positive health benefits across the lifespan including reduced rates of chronic disease. Despite having ample availability of outdoor space for physical activity in the Appalachian Mountain region, there are low rates of physical activity along with high rates of sedentary time and increased prevalence of overweight individuals across all age groups. Therefore, there is a need to understand the factors that influence family's physical activity and sedentary time.

Purpose

To assess whether parental attitudes and behaviors influence children's physical activity and sedentary time.

Methods

The current study was a secondary analysis of the baseline data from a pilot study of a pediatrician prescription program for outdoor physical activity. Parents (N = 70) with children aged 5-13 years living in a county served by a single-pediatrician office completed surveys in the pediatrician's office during a well-child visit. The survey included questions related to parental attitudes toward children's physical activity and the physical activity and sedentary time performed by the parent and their child.

Results

Parent sedentary time was the only factor that had an impact on child sedentary time, with 18% of the variance in children's sedentary time being explained by parent sedentary time. No factors predicted children's physical activity.

Implications

To decrease child sedentary time, interventions should focus on reducing parental and joint parent-child sedentary time.

Parent recommendations to support physical activity for families with young children: Results of interviews in deprived and affluent communities in South Wales (United Kingdom)

BACKGROUND

Physical inactivity is the fourth leading cause of mortality worldwide. Early childhood is a critical period when healthy behaviours can be instilled for a future active lifestyle. We explored community, societal and environmental factors affecting child and family physical activity and sought parent recommendations to support physical activity in families with young children.

METHODS

We interviewed 61 parents expecting a child or with a baby ≤12 months (35 mother and father paired interviews and 26 interviews with mothers only). We purposively sampled families for neighbourhood deprivation status (Townsend Index; 26 affluent; 35 deprived). We conducted thematic analysis of interview transcripts using Bronfenbrenner's socio-ecological framework to guide interpretation.

RESULTS

We identified four themes: work family-life balance; spaces for activity; beliefs and attitudes; and physical activity facilitators. We found that parents from deprived neighbourhoods were more likely to be underactive because of a complex web of community, social and personal factors which reduced motivation and hindered opportunity for physical activity. To increase knowledge and opportunity, respondents suggested 'help not tell' messages covering 'why', 'how' and 'where' information about physical activity, and using physical activity to support community engagement and social interaction.

CONCLUSIONS

Recommendations from parents highlight effective communication about the importance of early child and family physical activity and improved community access to safe facilities and opportunities. Both parents need to be engaged in designing interventions to support greater physical activity and healthy behaviours which are relevant and achievable in individuals' lives.

Using mixed methods to understand women's parenting practices related to their child's outdoor play and physical activity among families living in diverse neighborhood environments

A convergent parallel mixed methods design was used to understand parenting practices for outdoor play, their influence on adolescent's physical activity and outdoor play and the role of the neighborhood and child's sex. Adolescents (n = 263) and their parents completed questionnaires and wore accelerometers. Parents (n = 30) participated in in-depth interviews. Parenting practices were examined by neighborhood disadvantage and child's sex in quantitative (Chi-square and T-tests) and qualitative (comparative thematic analysis) samples. Multi-level linear mixed models examined the associations between parenting practices and two adolescent outcomes: physical activity and outdoor play. Parents in high disadvantage neighborhoods and of female adolescents imposed more restrictions on outdoor play. Restrictive parenting practices were negatively associated with outdoor play, but not physical activity. Policy and environment change that improves neighborhood conditions may be necessary to reduce parents' fear and lessen restrictions on outdoor play.

Effect of integrating a video intervention on parenting practices and related parental self-efficacy regarding health behaviours within the Feel4Diabetes-study in Belgian primary schoolchildren from vulnerable families: A cluster randomized trial

BACKGROUND

This study aimed to investigate the effect of integrating a video intervention "Movie Models" within the Feel4Diabetes-study on specific parenting practices and related parental self-efficacy regarding children's physical activity, screen-time and eating behaviour in vulnerable families (i.e. families living in low socioeconomic municipalities and at risk for developing type 2 diabetes). Additionally, there was examination of how the intervention was perceived by the parents.

METHODS

Within randomly selected low socioeconomic municipalities in Belgium, families were recruited through primary schools. Families at risk for developing type 2 diabetes were identified using the FINDRISC questionnaire (n = 457). Afterwards, the municipalities were randomly assigned to the intervention or control condition. At risk families assigned to the intervention group were invited to participate in six Feel4Diabetes counselling sessions in which families were encouraged to adopt a healthier lifestyle. The "Movie Models" videos were integrated within two sessions by using a face-to-face group discussion approach. Parenting-related factors were assessed before and after the integration of the videos, using a questionnaire. After integrating the videos, some extra evaluation questions were assessed. In total, 126 families were included in a per protocol evaluation and Repeated Measures ANOVAs were conducted to evaluate the potential intervention effects.

RESULTS

Some favourable intervention effects were found on parenting practices and related parental self-efficacy regarding children's eating behaviours, however almost no effects were found on parenting-related factors regarding children's physical activity and screen-time. In total, 60.0% of the participants indicated that they applied tips regarding parenting practices and 52.0% indicated that discussions with other participants regarding the videos were useful for them.

CONCLUSION

The integration of "Movie Models" within the Feel4Diabetes-study was effective in improving some parenting-related factors regarding children's health behaviours, however most parenting-related factors could not be improved. The implementation of "Movie Models" as a face-to-face group discussion approach was relatively well received and may be a promising way to improve parenting-related factors in vulnerable families.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02278809.

Reproducibility of a Short-Form, Multicomponent Dietary Questionnaire to Assess Food Frequency Consumption, Nutrition Knowledge, and Lifestyle (SF-FFQ4PolishChildren) in Polish Children and Adolescents

The aim of the study was to assess the reproducibility of a short-form, multicomponent dietary questionnaire (SF-FFQ4PolishChildren) in Polish children and adolescents. The study involved 437 children (6–10 years old) and 630 adolescents (11–15 years old) from rural and urban areas of Poland. The self-administered questionnaire was related to nutrition knowledge, dietary habits, active/sedentary lifestyle, self-reported weight and height, and socioeconomic data. The questionnaire was completed with a two-week interval—twice by parents for their children (test and retest for children), twice by adolescents themselves (adolescent’s test and retest) and once by adolescents’ parents (parent’s test). The strength of agreement measured using the kappa statistic was interpreted as follows: 0–0.20 slight, 0.21–0.40 fair, 0.41–0.60 moderate, 0.61–0.80 good, and 0.81–1.00 excellent. Regarding the frequency of consumption of food items and meals, kappa statistics were 0.46–0.81 (the lowest: fruit/mixed fruit and vegetable juices; the highest: Energy drinks) in test–retest for children, 0.30–0.54 (fruit/mixed fruit and vegetable juices; breakfast, respectively) in adolescent’s test–retest, 0.27–0.56 (the lowest: Sweets, fruit, dairy products; the highest: Breakfast) in adolescent’s test and parent’s test. Lower kappa statistics were found for more frequently consumed foods (juices, fruit, vegetables), higher kappa statistics were found for rarely consumed foods (energy drinks, fast food). Across study groups, kappa statistics for diet quality scores were 0.31–0.55 (pro-healthy diet index, pHDI) and 0.26–0.45 (non-healthy diet index, nHDI), for active/sedentary lifestyle items they were 0.31–0.72, for components of the Family Affluence Scale (FAS) they were 0.55–0.93, for BMI categories (based on self-reported weight and height) they were 0.64–0.67, for the nutrition knowledge (NK) of adolescents the kappa was 0.36, for the nutrition knowledge of children’s parents it was 0.62. The Spearman’s correlations for diet quality scores were 0.52–0.76 (pHDI) and 0.53–0.83 (nHDI), for screen time score they were 0.45–0.78, for physical activity score they were 0.51–0.77, for the FAS score they were 0.90–0.93, and for the NK score they were 0.68–0.80. The questionnaire can be recommended to evaluate dietary and lifestyle behaviors among children and adolescents.

Feasibility and Acceptability of a Self-Report Activity Diary in Families of Children With and Without Special Needs

This study was conducted to examine the feasibility and acceptability of a self-report activity diary completed by parents and older children to assess the child's daily activity in children with and without special needs. The study included 36 child/parent dyads stratified by child age and diagnosis. Parents (n = 36) and children ≥13 years (n = 12) were asked to report on the child's daily activity using an activity diary. Feasibility was determined based on successfully returned diaries and acceptability via post-study interview. Activity diaries were submitted by 94% of the parents and 100% of the children, with 83% and 80%, respectively, successfully completed. Comments provided post-study regarding the diaries were primarily on the format and were generally negative. The activity diary was feasible to use, but not well accepted within our sample of children with and without special needs or their parents. Further research is needed to create valid physical activity assessment measures that are population specific for individuals with special needs.

Protocol for Objective Measurement of Infants' Physical Activity using Accelerometry

PURPOSE

This study aimed to evaluate methods for infants' physical activity measurement based on accelerometry, including the minimum number of measurement days and placement of a wrist or ankle device. We also evaluated the acceptability of the device among infants and mothers.

METHODS

A cross-sectional mixed-methods study was conducted on a convenience sample of 90 infants. Physical activity was measured using the Actigraph GT3X+ accelerometer placed on the wrist and/or ankle for 7 consecutive days (worn for 24 h), and a qualitative interview was performed to verify acceptability. The intraclass correlation coefficient (ICC) method and the Bland and Altman's dispersion diagram were used to verify the minimum number of measurement days. All analyses were stratified by walking status.

RESULTS

The mean (SD) age was 12.9 (1.70) months; the mean acceleration varied between 25.8 mg (95% confidence interval (CI), 14.3-52.7) and 27.3 mg (95% CI, 17.9-44.5) using the wrist placement, and between 24.9 mg (95% CI, 10.6-48.4) and 26.2 mg (95% CI, 11.7-65.6) using the ankle placement. The ICC results showed a lower acceleration variability between days among infants incapable of walking; they achieved an ICC of 0.80 with 1 d of measurement in both placements. Among those capable of walking, the minimum number of days to achieve an ICC of 0.80 was 2 d measured at the wrist (0.85; 95% CI, 0.71-0.93) and 3 d measured at the ankle (0.92; 95% CI, 0.84-0.96). The qualitative results pointed to the wrist placement as the preferred placement among the overall sample.

CONCLUSIONS

Two and three measurement days with the accelerometer placed on the wrist and ankle, respectively, seemed to adequately represent a week of measurement. The accelerometer placed on the wrist had better acceptance by the infants and mothers.

Parents' Perceptions of the Challenges to Helping Their Children Maintain or Achieve a Healthy Weight

INTRODUCTION

Parents play a critical role in their children's weight. This paper examines parents' perceptions about the challenges to helping their kids maintain or achieve a healthy weight.

METHODS

We analyzed data in 2017 from a U.S. telephone poll conducted during October-November 2012 among parents or caregivers of children aged 2-17 years using a nationally representative sample of households. It included 667 White, 123 Black, and 167 Hispanic parents. Multiple logistic regressions were used to examine parent perceptions about the individual- and environmental-level challenges to helping their children maintain or achieve a healthy weight.

RESULTS

Overall, 45% of children have parents who reported challenges helping the child eat to maintain or achieve a healthy weight, and 35% have parents who reported challenges for exercise. According to parents, most children consumed snacks between 3 pm and bedtime during the school week (83%), and 63% of those children had an unhealthy snack. Parents did not express much concern about unhealthy snacks; 80% of children had parents who said that they did not mind since their child generally ate healthy food. Children with Hispanic and Black parents were more likely than those with White parents to have parents reporting environment challenges, such as unhealthy foods in schools.

CONCLUSIONS

Helping children maintain a healthy weight through diet is a problem for many parents, regardless of their race or ethnicity. Differences by race/ethnicity in parent perceptions of food environment challenges to helping their child maintain or achieve a healthy weight suggest possible areas for future interventions.

Extreme Preterm Infant Rates of Overweight and Obesity at School Age in the SUPPORT Neuroimaging and Neurodevelopmental Outcomes Cohort

OBJECTIVE

To identify rates of overweight (body mass index [BMI] ≥85th percentile) and obesity (BMI ≥95th percentile) at 6-7 years of age and associated risk factors among extremely preterm infants born at <28 weeks of gestation.

STUDY DESIGN

Anthropometrics, blood pressure, and active and sedentary activity levels were prospectively assessed. Three groups were compared, those with a BMI ≥85th percentile (overweight or obese for age, height, and sex) and ≥95th percentile (obese) vs <85th percentile. Multiple regression analyses estimated the relative risks of BMI ≥85th percentile and ≥95th percentile associated with perinatal and early childhood factors.

RESULTS

Of 388 children, 22% had a BMI of ≥85th percentile and 10% were obese. Children with obesity and overweight compared with normal weight children had higher body fat (subscapular skinfold and triceps skinfold >85th percentile), central fat (waist circumference >90th percentile), spent more time in sedentary activity (20.5 vs 18.2 vs 16.7 hours/week), and had either systolic and/or diastolic hypertension (24% vs 26% vs 14%), respectively. Postdischarge weight gain velocities from 36 weeks postmenstrual age to 18 months, and 18 months to 6-7 years were independently associated with a BMI of ≥85th percentile, whereas weight gain velocity from 18 months to 6-7 years was associated with obesity.

CONCLUSIONS

One in 5 former extremely preterm infants is overweight or obese and has central obesity at early school age. Postdischarge weight gain velocities were associated with overweight and obesity. These findings suggest the obesity epidemic is spreading to the most extremely preterm infants.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT00063063 and NCT0000.

Child Temperament, Maternal Feeding Practices, and Parenting Styles and Their Influence on Obesogenic Behaviors in Hispanic Preschool Children

Although obesogenic behaviors (physical activity and/or sedentary behavior and dietary intake) are known predictors of childhood weight status, little is known about mother and child behaviors contributing to obesogenic behaviors and obesity in Hispanic preschool children, whose obesity rate is higher than in non-Hispanic Whites and non-Hispanic Blacks. The purpose of this cross-sectional, descriptive study was to examine relationships among child temperament, maternal behaviors (feeding practices and parenting style), child obesogenic behaviors, and child weight status in 100 Hispanic preschool children. Results showed that higher scores on the negative affectivity dimension of child temperament were associated with higher scores on the dimension of permissive parenting, and permissive parenting was associated with less time spent in sedentary behaviors (B = -3.53, confidence interval [-7.52, -0.90]). Findings can guide school nurses in developing interventions that consider child temperament and parenting style to promote nonobesogenic behavior in Hispanic preschoolers.

Chronic Pain and Obesity Within a Pediatric Interdisciplinary Pain Clinic Setting: A Preliminary Examination of Current Relationships and Future Directions

OBJECTIVES

Pediatric obesity and chronic pain are 2 of the most significant public health crises affecting youth today. Despite the high number of youth experiencing both chronic pain and obesity, little research has been done examining their relationship. This study aims to both replicate and extend this research base.

METHODS

A retrospective chart review of 99 patients presenting for evaluation in a pediatric pain clinic was conducted. Demographic information, including patient weight status, and self-report measures completed by both patients and their parents, including the Pain Frequency-Severity-Duration scale, the Functional Disability Inventory, and the Pain Catastrophizing Scale were examined.

RESULTS

Abdominal pain was the most frequently reported primary pain diagnosis category, with headache, diffuse musculoskeletal, localized musculoskeletal, and back pain categories reported from greatest to least frequency. Results show that 29% of our sample was obese. Age was related to weight status such that older children were more likely to have a higher body mass index. Among school-aged children, a higher body mass index percentile was associated with greater parent-reported pain catastrophizing. Obese youth had higher parent-reported Functional Disability Inventory scores than those in the normal weight group. Post hoc comparisons identified that this finding was only significant for girls. Further, obese youth were more likely to have a longer pain duration than those classified as normal weight.

DISCUSSION

The results of this study add to the growing literature regarding the importance of taking weight status into account when intervening with youth with chronic pain.

The impact of daycare attendance on outdoor free play in young children

Background

Outdoor free play is important for healthy growth and development in early childhood. Recent studies suggest that the majority of time spent in daycare is sedentary. The objective of this study was to determine whether there was an association between daycare attendance and parent-reported outdoor free play.

Methods

Healthy children aged 1-5 years recruited to The Applied Research Group for Kids! (TARGet Kids!), a primary care research network, were included. Parents reported daycare use, outdoor free play and potential confounding variables. Multivariable linear regression was used to determine the association between daycare attendance and outdoor free play, adjusted for age, sex, maternal ethnicity, maternal education, neighborhood income and season.

Results

There were 2810 children included in this study. Children aged 1 to <3 years (n = 1388) and ≥3 to 5 years (n = 1284) who attended daycare had 14.70 min less (95% CI -20.52, -8.87; P < 0.01) and 9.44 min less (95% CI -13.67, -5.20; P < 0.01) per day of outdoor free play compared with children who did not attend daycare, respectively.

Conclusions

Children who spend more time in daycare have less parent-reported outdoor free play. Parents may be relying on daycare to provide opportunity for outdoor free play and interventions to promote increased active play opportunities outside of daycare are needed.

Total energy expenditure and body composition of children with developmental disabilities

BACKGROUND

Obesity prevalence is increased in children with developmental disabilities, specifically in children with spina bifida and Down syndrome. Energy expenditure, a critical aspect of weight management, has been extensively studied in the typically developing population, but not adequately studied in children with developmental disabilities.

OBJECTIVE

Determine energy expenditure, fat-free mass and body fat percentile and the impact of these findings on recommended caloric intake in children with spina bifida and Down syndrome.

METHODS/MEASURES

This pilot study included 36 children, 18 with spina bifida, 9 with Down syndrome and 9 typically developing children. Half of the children with spina bifida were non-ambulatory. Doubly labeled water was used to measure energy expenditure and body composition. Descriptive statistics described the sample and MANOVA and ANOVA methods were used to evaluate differences between groups.

RESULTS

Energy expenditure was significantly less for children with spina bifida who primarily used a wheelchair (p = .001) and children with Down syndrome (p = .041) when compared to children without a disability when adjusted for fat-free mass. However, no significant difference was detected in children with spina bifida who ambulated without assistance (p = .072).

CONCLUSIONS

Children with spina bifida and Down syndrome have a significantly decreased energy expenditure which directly impacts recommended caloric intake. No significant difference was detected for children with spina bifida who ambulated, although the small sample size of this pilot study may have limited these findings. Validating these results in a larger study is integral to supporting successful weight management of these children.

Preschool children's context-specific sedentary behaviours and parental socioeconomic status in Finland: a cross-sectional study

OBJECTIVES

This study examined the associations of parental socioeconomic status (SES) with preschoolers' objectively measured sedentary time (SED) over the course of a week and with parent-reported children's screen and reading times at home as indicators of sedentary behaviours (SB).

DESIGN

Cross-sectional.

SETTING

In years 2015 and 2016 in Finland.

PARTICIPANTS

864 children, aged 3-6 years, with their parents.

OUTCOME MEASURES

Children's accelerometer data were transformed into average SED minutes per hour in different contexts (preschool, home during preschool days, weekend and total). Parent-reported children's screen and reading times were expressed as average daily minutes. The SES indicators (maternal and paternal education and relative household income) were grouped into three categories. Linear or logistic regression analyses were used, with municipality, season, and children's gender and age as covariates. CIs were adjusted for clustering at the preschool group level.

RESULTS

Children with low maternal (β=17.21, 95% CI: 8.71 to 25.71) and paternal (β=10.54, 95% CI: 0.77 to 20.30) education had more overall screen time at home than their more advantaged counterparts. SES differences in overall screen time were mostly explained by TV viewing. Children with low as opposed to high maternal education (β=-2.66, 95% CI: -4.95 to -0.38) had less reading time at home. Children whose fathers were on the middle (β=-1.15, 95% CI: -2.01 to -0.29) educational level had less weekend SED than those with high paternal education. Otherwise, parental SES was not related to objectively measured SED.

CONCLUSIONS

The results of this study highlight the fact that the associations between parental SES and preschoolers' SB are dependent on the indicators of SES and SBs, and vary between different contexts. Generally, parental SES was not associated with SED, whereas some SES differences existed in screen time and reading time at home. Interventions aiming to diminish SES differences in children's SB should focus on home hours.

TRIAL REGISTRATION NUMBER

ISRCTN57165350.

Effects of the Healthy Start randomized intervention trial on physical activity among normal weight preschool children predisposed to overweight and obesity

BACKGROUND

There is limited evidence to support the effectiveness of primary interventions aiming to prevent excess weight gain among young children. Evaluating behavioral changes, such as physical activity (PA), may add to future development of efficient interventions. The objective was to evaluate the effect on PA outcomes of the 15 month Healthy Start intervention that focused on changing diet, PA, sleep and stress management among normal weight but obesity-prone preschool children. Children were defined as obesity-prone if they had a birth weight > 4,000 g, mothers with a pre-pregnancy body mass index of > 28 kg/m2, or mothers with ≤ 10 years of schooling.

METHOD

From a baseline study population of 635 normal weight 2-6 year old preschool children from the greater Copenhagen area, parents of 307 children had given information on PA at both the baseline and follow-up examinations. PA was obtained from a 7 days recording in the Children's Physical Activity Questionnaire. Time used for sport activities were combined with outdoor playing time to achieve a proxy of total PA level of moderate to vigorous intensity.

RESULTS

Linear regression analyses revealed that at follow-up the intervention group spent more time on sports and outdoor activities combined per week than the control group (ITT analyses: intervention: 400 min/week; 95% confidence interval (CI): 341, 459 versus control: 321 min/week; 95% CI: 277, 366; p = 0.02), although no significant intervention effects were seen for each of the subcategories, e.g. sports participation, outdoor activities, screen time, or commuting frequency.

CONCLUSION

Our results suggest that the overall time spent on sports and outdoor activities combined was increased at follow-up among normal weight obesity-prone children, as a result of the Healthy Start intervention.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01583335.

The Influence of Fathers on Children's Physical Activity and Dietary Behaviors: Insights, Recommendations and Future Directions

PURPOSE OF REVIEW

Although fathers have an important influence on their children's well-being, their unique influence on child lifestyle behaviors has been largely overlooked in the literature. To inform and encourage future research, this paper provides an overview of existing studies that have examined the influence of fathers on the physical activity and dietary behaviors of their children.

RECENT FINDINGS

While the available data indicate that fathers' behaviors and parenting practices likely play an important role in promoting healthy behaviors in children, the evidence base is limited by a reliance on observational designs and small, ungeneralizable samples. This paper also provides a summary of the methods, research findings, and experiential insights we have gained while conducting the "Healthy Dads, Healthy Kids" randomized controlled trials, which tested the efficacy and effectiveness of a socio-culturally targeted program that engages fathers to improve their own health and the health of their children. The paper concludes with a series of recommendations for recruiting and engaging fathers and a summary of directions for future research.

Cumulative family risks across income levels predict deterioration of children's general health during childhood and adolescence

Family is considered an important agent in the health development of children. This process is significant but quite complex because the prevalence of potential risk factors in the family can hinder children’s health. This study examined if multiple family risks might have cumulative effect on children and youth’s health across various levels of household income. The data in this study were drawn from the 2011–2012 U.S. National Survey of Children’s Health (N = 79,601). A cumulative family risk (CFR) index was developed, which included such constructs as single-parenthood, unstable employment, large family, parenting stress, poor maternal education, poor maternal general health and poor maternal mental health. Multiple logistic regression analyses showed that CFR level was significantly related to children and youth’s poor health outcome (p < .001). When poverty levels were considered, however, the impact of CFRs on children and youth’s health was attenuated. The impact of CFRs was higher on children and youth from affluent families than on those from poor families. Overall there was a consistent pattern of trend in the point estimate as well as confidence limits as levels of affluence and numbers of family risk increased although some of the confidence intervals overlapped. Living in disadvantaged families might serve as a protective factor against CFRs possibly through repeated exposure to hardships and subsequent formation of resilience among some of the disadvantaged children.

Children's Physical Activity Awareness among Mothers in a Saudi Arabian Health Center

INTRODUCTION

Physical inactivity is a major contributor to the increasing levels of obesity and other serious medical conditions among children and adolescents worldwide. A major factor in this increase is lack of awareness of mothers' regarding the Physical Activity (PA) of their children.

AIM

The current study aimed to identify the degree of knowledge and awareness of Saudi mothers' regarding their children's physical activities, which will be useful for improving physical education, health programs, and eventually children's health care.

MATERIALS AND METHODS

A total of 342 mothers attending a vaccination clinic, well-baby, or women's health clinic participated in the study, in which questionnaire was used to assess the awareness regarding PA.

RESULTS

The majority of mothers agreed that they have a crucial role in motivating their children to engage in PA, but was not aware of current recommendations.

CONCLUSION

Awareness of Saudi mothers' regarding their children's PA was exceedingly low. Creating awareness of children's PA is essential.

The Relationship Between Parental and Child Physical Activity in a Rural Community

This study examined the relationship between parental and child physical activity (PA) in a rural community. Forty-one children and at least 1 parent wore pedometers to measure step count over the course of 4 days. Parents also completed a PA survey assessing parental support for PA, parental enjoyment for PA, perceived importance of PA, and their own PA levels. Parental PA level and mothers' support for PA were moderately associated with their child's PA levels. Thus, future PA promotion efforts could focus on encouraging parents, primarily mothers, to be more active to help improve their child's PA levels.

Treating Obesity in Preschoolers: A Review and Recommendations for Addressing Critical Gaps

Developing interventions targeting obesity reduction in preschoolers is an emergent area. Although intensive, multicomponent interventions seem a promising approach to preschool obesity reduction, this review identifies and discusses approaches to 3 critical gaps (poor reach to families from low-income and minority backgrounds, lack of sufficient evidence to determine the most effective and efficient treatment components and approaches to treating obesity in early childhood, and lack of consensus on how best to discern intervention effectiveness) that need to be addressed to advance the preschool obesity literature.

Pediatric Obesity in Early Childhood: A Physician Screening Tool

Obesity is a public health crisis and continues to affect youth of increasingly younger ages. With significant medical and psychosocial comorbidities, it is critical that front-line providers feel confident in their abilities to assess, and appropriately refer, children and families to subspecialties to aid in weight management treatment. This article describes the development and utility of a 1-page screening tool for pediatricians and other providers. Utilizing research, clinical experience, and consensus opinion, a brief tool was developed that could be incorporated into medical visits to facilitate medical care decisions and management of pediatric obesity.

Health and happiness is more important than weight': a qualitative investigation of the views of parents receiving written feedback on their child's weight as part of the National Child Measurement Programme

BACKGROUND

The present study aimed to explore parental perceptions of overweight children and associated health risks after receiving National Child Measurement Programme (NCMP) weight feedback.

METHODS

Fifty-two parents of overweight and obese children aged 4-5 years and 10-11 years enrolled in the NCMP programme in England in 2010-2011 participated in qualitative, semi-structured interviews about their perceptions of their child's weight and health risk after receiving weight feedback. Interviews were audio tape recorded and were conducted either by telephone (n = 9) or in the respondents' homes (n = 41). Interviews were transcribed verbatim and analysed using interpretative thematic analysis.

RESULTS

Parents who received NCMP written feedback informing them that their child was overweight disregarded the results because they viewed 'health and happiness as being more important than weight'. The feedback was viewed as less credible because it did not consider the individual child's lifestyle.'Broad definitions of healthy' were described that did not include weight,such as reference to the child having good emotional and physical health and a healthy diet. Parents attributed weight to 'inherited/acquired factors' such as genetics or puppy fat, or did not regard their child's 'appearance' as reflecting being overweight. 'Cultural influence' also meant that being overweight was not viewed negatively by some non-white parents.

CONCLUSIONS

After receiving written weight feedback, parents use methods other than actual weight when evaluating their child's weight status and health risks. Parents' conceptions of health and weight should be considered when communicating with parents, with the aim of bridging the gap between parental recognition of being overweight and subsequent behaviour change.

Understanding the Accuracy of Parental Perceptions of Child Physical Activity: A Mixed Methods Analysis

BACKGROUND

Interventions to increase children's physical activity (PA) have achieved limited success. This may be attributed to inaccurate parental perceptions of their children's PA and a lack of recognition of a need to change activity levels.

METHODS

Fifty-three parents participated in semistructured interviews to determine perceptions of child PA. Perceptions were compared with children's measured MVPA (classified as meeting or not meeting UK guidelines) to produce 3 categories: "accurate," "over-estimate," and "under-estimate." Deductive content analysis was performed to understand the accuracy of parental perceptions.

RESULTS

All parents of children meeting the PA guidelines accurately perceived their child's PA; while the majority of parents whose child did not meet the guidelines overestimated their PA. Most parents were unconcerned about their child's PA level, viewing them as naturally active and willing to be active. Qualitative explanations for perceptions of insufficient activity included children having health problems and preferences for inactive pursuits, and parents having difficulty facilitating PA in poor weather and not always observing their child's PA level. Social comparisons also influenced parental perceptions.

CONCLUSIONS

Strategies to improve parental awareness of child PA are needed. Perceptions of child PA may be informed by child "busyness," being unaware of activity levels, and social comparisons.

Feasibility and acceptability of an early childhood obesity prevention intervention: results from the healthy homes, healthy families pilot study

BACKGROUND

This study examined the feasibility and acceptability of a home-based early childhood obesity prevention intervention designed to empower low-income racially/ethnically diverse parents to modify their children's health behaviors.

METHODS

We used a prospective design with pre-/posttest evaluation of 50 parent-child pairs (children aged 2 to 5 years) to examine potential changes in dietary, physical activity, and sedentary behaviors among children at baseline and four-month follow-up.

RESULTS

39 (78%) parent-child pairs completed evaluation data at 4-month follow-up. Vegetable intake among children significantly increased at follow-up (0.54 cups at 4 months compared to 0.28 cups at baseline, P = 0.001) and ounces of fruit juice decreased at follow-up (11.9 ounces at 4 months compared to 16.0 ounces at baseline, P = 0.036). Sedentary behaviors also improved. Children significantly decreased time spent watching TV on weekdays (P < 0.01) and also reduced weekend TV time. In addition, the number of homes with TV sets in the child's bedroom also decreased (P < 0.0013).

CONCLUSIONS

The findings indicate that a home-based early childhood obesity prevention intervention is feasible, acceptable and demonstrates short-term effects on dietary and sedentary behaviors of low-income racially/ethnically diverse children.

Top 10 research questions related to exercise deficit disorder (EDD) in youth

Exercise deficit disorder (EDD) is a pediatric medical condition characterized by reduced levels of moderate-to-vigorous physical activity (MVPA) that are below current recommendations and inconsistent with positive health outcomes. At present, a majority of children and adolescents meet the diagnostic criteria for EDD because they are not accumulating minimum thresholds of daily MVPA. The purpose of this article is to highlight 10 important research questions related to EDD in youth. The critical research needs to better define the clinical spectrum of EDD to include an assessment of physical activity behaviors to determine the age or stage of maturation at which EDD first emerges; an examination of the kinesiogenesis of movement skills and physical abilities; and an evaluation of lifestyle factors that can influence the MVPA trajectory in youth. Research questions about interventions and policies to treat EDD include evaluating the education and training of health care providers on the importance of exercise medicine; determining the effectiveness of strategies to identify and treat youth with EDD in clinical practice; developing sensitive, specific, and cost-effective methods to diagnose youth with EDD; and assessing methods to promote health care reimbursement for the treatment of this condition. Without future research to optimize identification, treatment, and management strategies for youth with EDD, new health care concerns with significant biomedical, psychosocial, economic, and political ramifications will continue to emerge.

Primary caregiver knowledge of paediatric physical activity recommendations in the United Kingdom and its association with caregiver behaviour: an observational study

Background

Most children in affluent developed countries do not meet basic physical activity recommendations. This study assessed primary caregiver knowledge of the UK recommendations on physical activity for children and examined the relationship between knowledge and components of parental support and modelling of physical activity.

Methods

Data were from a large, community-based twin birth cohort. Primary caregivers were invited to take part in a telephone interview on the home food and activity environment that included a question on knowledge of the minimum amount of physical activity recommended in UK child guidelines. Socio-demographic variables (maternal age, BMI, education, ethnicity and presence of co-habiting partner) were available from previously completed questionnaires. Parental support and modelling of physical activity variables were assessed during the telephone interview. Binary logistic regression analyses examined the relationship between knowledge and socio-demographic variables and components of parental support and modelling of physical activity.

Results

1,113 families took part in the interview. Only 21% of participants knew the recommended amount of physical activity for children. Higher maternal education was associated with knowledge of the recommendation (Odds Ratio (OR) 2.82; 95% Confidence Interval (CI) 1.66, 4.79, p < 0.001). Knowledge of the recommendation was associated with communicating positive messages about physical activity to child (OR 1.52; 95% CI 1.12, 2.06, p = 0.008), watching the child participating in physical activity (OR 1.69; 95% CI 1.11, 2.55,p = 0.013) and showing the child they enjoyed physical activity themselves (OR 1.51; 95% CI 1.08, 2.12,p = 0.016) but not associated with encouraging the child to be active, doing physical activity with the child, being active in front of the child or showing enthusiasm about being active.

Conclusions

Most primary caregivers in the UK do not know how much physical activity is recommended for children but those who do may be more supportive of physical activity for their child. Wider dissemination of the guidelines could be an important step in increasing population levels of physical activity.

Maternal awareness of young children's physical activity: levels and cross-sectional correlates of overestimation

BACKGROUND

Factors associated with parental awareness of children's physical activity (PA) levels have not been explored in preschool-aged children. This paper investigates maternal awareness of preschool-aged children's PA levels and determined correlates associated with maternal overestimation of PA.

METHODS

Data from the Southampton Women's Survey, a UK population-based study, were collected March 2006 through June 2009. Daily minutes of moderate-to-vigorous PA (MVPA) were derived using accelerometry in 478 4-year-old children. Mothers who were realistic or overestimated their child's PA were identified. Log-binomial regression was used to analyse correlates of maternal overestimation of PA levels in children whose mothers perceived them to be active (n = 438).

RESULTS

40.8% of children were classified as inactive: 89.7% of these were perceived to be active by their mothers (over-estimators). These mothers were more likely to think their child sometimes lacked skills required to be physically active (RR (95% CI) = 1.29(1.03-1.63)) and their child was more likely to attend nursery full-time (RR = 1.53(1.14-2.04)). They were less likely to have older children at home (RR = 0.71(0.56-0.90)).

CONCLUSIONS

Almost 90% of mothers of inactive preschool-aged children perceive their child to be active. Nursery-school attendance and having older siblings at home may be important to consider when designing behavioural interventions to increase PA in preschool children.

Bridging animal and human models of exercise-induced brain plasticity

Significant progress has been made in understanding the neurobiological mechanisms through which exercise protects and restores the brain. In this feature review, we integrate animal and human research, examining physical activity effects across multiple levels of description (neurons up to inter-regional pathways). We evaluate the influence of exercise on hippocampal structure and function, addressing common themes such as spatial memory and pattern separation, brain structure and plasticity, neurotrophic factors, and vasculature. Areas of research focused more within species, such as hippocampal neurogenesis in rodents, also provide crucial insight into the protective role of physical activity. Overall, converging evidence suggests exercise benefits brain function and cognition across the mammalian lifespan, which may translate into reduced risk for Alzheimer's disease (AD) in humans.

Predicting weight status stability and change from fifth grade to eighth grade: the significant role of adolescents' social-emotional well-being

PURPOSE

The primary objective of this study was to predict weight status stability and change across the transition to adolescence using parent reports of child and household routines and teacher and child self-reports of social-emotional development.

METHODS

Data were from the Early Childhood Longitudinal Study-Kindergarten Cohort (ECLS-K), a nationally representative sample of children who entered kindergarten during 1998-1999 and were followed through eighth grade. At fifth grade, parents reported on child and household routines and the study child and his/her primary classroom teacher reported on the child's social-emotional functioning. At fifth and eighth grade, children were directly weighed and measured at school. Nine mutually-exclusive weight trajectory groups were created to capture stability or change in weight status from fifth to eighth grade: (1) stable obese (ObeSta); (2) obese to overweight (ObePos1); (3) obese to healthy (ObePos2); (4) stable overweight (OverSta); (5) overweight to healthy (OverPos); (6) overweight to obese (OverNeg); (7) stable healthy (HelSta); (8) healthy to overweight (HelNeg1); and (9) healthy to obese (HelNeg2).

RESULTS

Except for breakfast consumption at home, school-provided lunches, nighttime sleep duration, household and child routines did not predict stability or change in weight status. Instead, weight status trajectory across the transition to adolescence was significantly predicted by measures of social-emotional functioning at fifth grade.

CONCLUSIONS

Assessing children's social-emotional well-being in addition to their lifestyle routines during the transition to adolescence is a noteworthy direction for adolescent obesity prevention and intervention.