Identifying elevated child weight from 3 to 24 months: Early transitions into nonparental care and to solid foods

BACKGROUND

Early entry into nonparental care (NPC) and introduction to solid foods (ITS) have been linked to elevated weight, however, little research exists on the combined influence of these transitions on child weight over time.

OBJECTIVES

Identify groups of children based on early NPC and ITS timing and examine whether NPC-ITS groups differentially affect child weight over time.

METHOD

Data were drawn from STRONG Kids2 (n = 468). Primary predictors include NPC (by 3M)-ITS (< or ≥6M) groups; outcome variables include child weight-for-length/height z-scores (WFL/WFHz) (3, 12, 18, and 24 months). Multilevel regression was used to examine the NPC-ITS groups as predictors of child WFL/WFHz.

RESULTS

Six groups were identified: 27% Parental Care-ITS before 6M, 31% Parental Care-ITS after 6M, 12% Daycare-ITS before 6M, 14% Daycare-ITS after 6M, 10% Kincare-ITS before 6M, and 7% Kincare-ITS after 6M. Children who were in daycare (regardless of ITS) or kincare-ITS before 6M demonstrated the highest WFL/WFHz over time, compared to their parental care counterparts.

CONCLUSIONS

NPC-ITS combinations on child WFL/WFHz across the first 2 years of life highlight the need for a partnership approach among parental and nonparental caregivers to support the feeding of infants throughout the transition to solid foods.

Association of Child Masking With COVID-19-Related Closures in US Childcare Programs

IMPORTANCE

It is not known how effective child masking is in childcare settings in preventing the transmission of SARS-CoV-2. This question is critical to inform health policy and safe childcare practices.

OBJECTIVE

To assess the association between masking children 2 years and older and subsequent childcare closure because of COVID-19.

DESIGN, SETTING, AND PARTICIPANTS

A prospective, 1-year, longitudinal electronic survey study of 6654 childcare professionals at home- and center-based childcare programs in all 50 states was conducted at baseline (May 22 to June 8, 2020) and follow-up (May 26 to June 23, 2021). Using a generalized linear model (log-binomial model) with robust SEs, this study evaluated the association between childcare program closure because of a confirmed or suspected COVID-19 case in either children or staff during the study period and child masking in both early adoption (endorsed at baseline) and continued masking (endorsed at baseline and follow-up), while controlling for physical distancing, other risk mitigation strategies, and program and community characteristics.

EXPOSURES

Child masking in childcare programs as reported by childcare professionals at baseline and both baseline and follow-up.

MAIN OUTCOMES AND MEASURES

Childcare program closure because of a suspected or confirmed COVID-19 case in either children or staff as reported in the May 26 to June 23, 2021, end survey.

RESULTS

This survey study of 6654 childcare professionals (mean [SD] age, 46.9 [11.3] years; 750 [11.3%] were African American, 57 [0.9%] American Indian/Alaska Native, 158 [2.4%] Asian, 860 [12.9%] Hispanic, 135 [2.0%] multiracial [anyone who selected >1 race on the survey], 18 [0.3%] Native Hawaiian/Pacific Islander, and 5020 [75.4%] White) found that early adoption (baseline) of child masking was associated with a 13% lower risk of childcare program closure because of a COVID-19 case (adjusted relative risk, 0.87; 95% CI, 0.77-0.99), and continued masking for 1 year was associated with a 14% lower risk (adjusted relative risk, 0.86; 95% CI, 0.74-1.00).

CONCLUSIONS AND RELEVANCE

This survey study of childcare professionals suggests that masking young children is associated with fewer childcare program closures, enabling in-person education. This finding has important public health policy implications for families that rely on childcare to sustain employment.

Surveillance of SARS-CoV-2 transmission in educational institutions, August to December 2020, Germany

This study aims at providing estimates on the transmission risk of SARS-CoV-2 in schools and day-care centres. We calculated secondary attack rates (SARs) using individual-level data from state-wide mandatory notification of index cases in educational institutions, followed by contact tracing and PCR-testing of high-risk contacts. From August to December 2020, every sixth of overall 784 independent index cases was associated with secondary cases in educational institutions. Monitoring of 14 594 institutional high-risk contacts (89% PCR-tested) of 441 index cases during quarantine revealed 196 secondary cases (SAR 1.34%, 0.99-1.78). SARS-CoV-2 infection among high-risk contacts was more likely around teacher-indexes compared to student-/child-indexes (incidence rate ratio (IRR) 3.17, 1.79-5.59), and in day-care centres compared to secondary schools (IRR 3.23, 1.76-5.91), mainly due to clusters around teacher-indexes in day-care containing a higher mean number of secondary cases per index case (142/113 = 1.26) than clusters around student-indexes in schools (82/474 = 0.17). In 2020, SARS-CoV-2 transmission risk in educational settings was low overall, but varied strongly between setting and role of the index case, indicating the chance for targeted intervention. Surveillance of SARS-CoV-2 transmission in educational institutions can powerfully inform public health policy and improve educational justice during the pandemic.

Connecting Families to Food Resources amid the COVID-19 Pandemic: A Cross-Sectional Survey of Early Care and Education Providers in Two U.S. States

Early care and education (ECE) settings are important avenues for reaching young children and their families with food and nutrition resources, including through the U.S. federally funded Child and Adult Care Food Program (CACFP). Researchers conducted a cross-sectional survey of ECE providers in two U.S. states in November 2020 to identify approaches used to connect families with food and nutrition resources amid the COVID-19 pandemic. Logistic regression models were used to estimate odds of sites reporting no approaches and adjusted Poisson models were used to estimate the incidence rate ratio of the mean number of approaches, comparing sites that participate in CACFP to those that did not. A total of 589 ECE sites provided responses. Of those, 43% (n = 255) participated in CACFP. CACFP participating sites were more likely to report using any approaches to connecting families to food resources and significantly more likely to report offering "grab and go" meals, providing meal delivery, distributing food boxes to families, and recommending community food resources than non-CACFP sites. This study suggests that CACFP sites may have greater capacity to connect families to food resources amid emergencies than non-CACFP participating sites.

Model-based projections for COVID-19 outbreak size and student-days lost to closure in Ontario childcare centres and primary schools

There is a pressing need for evidence-based scrutiny of plans to re-open childcare centres during the COVID-19 pandemic. Here we developed an agent-based model of SARS-CoV-2 transmission within a childcare centre and households. Scenarios varied the student-to-educator ratio (15:2, 8:2, 7:3), family clustering (siblings together versus random assignment) and time spent in class. We also evaluated a primary school setting (with student-educator ratios 30:1, 15:1 and 8:1), including cohorts that alternate weekly. In the childcare centre setting, grouping siblings significantly reduced outbreak size and student-days lost. We identify an intensification cascade specific to classroom outbreaks of respiratory viruses with presymptomatic infection. In both childcare and primary school settings, each doubling of class size from 8 to 15 to 30 more than doubled the outbreak size and student-days lost (increases by factors of 2-5, depending on the scenario. Proposals for childcare and primary school reopening could be enhanced for safety by switching to smaller class sizes and grouping siblings.

Hand-washing promotion for preventing diarrhoea

BACKGROUND

Diarrhoea accounts for 1.8 million deaths in children in low- and middle-income countries (LMICs). One of the identified strategies to prevent diarrhoea is hand washing.

OBJECTIVES

To assess the effects of hand-washing promotion interventions on diarrhoeal episodes in children and adults.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, nine other databases, the World Health Organization (WHO) International Clinical Trial Registry Platform (ICTRP), and metaRegister of Controlled Trials (mRCT) on 8 January 2020, together with reference checking, citation searching and contact with study authors to identify additional studies.

SELECTION CRITERIA

Individually-randomized controlled trials (RCTs) and cluster-RCTs that compared the effects of hand-washing interventions on diarrhoea episodes in children and adults with no intervention.

DATA COLLECTION AND ANALYSIS

Three review authors independently assessed trial eligibility, extracted data, and assessed risks of bias. We stratified the analyses for child day-care centres or schools, community, and hospital-based settings. Where appropriate, we pooled incidence rate ratios (IRRs) using the generic inverse variance method and a random-effects model with a 95% confidence interval (CI). We used the GRADE approach to assess the certainty of the evidence.

MAIN RESULTS

We included 29 RCTs: 13 trials from child day-care centres or schools in mainly high-income countries (54,471 participants), 15 community-based trials in LMICs (29,347 participants), and one hospital-based trial among people with AIDS in a high-income country (148 participants). All the trials and follow-up assessments were of short-term duration. Hand-washing promotion (education activities, sometimes with provision of soap) at child day-care facilities or schools prevent around one-third of diarrhoea episodes in high-income countries (incidence rate ratio (IRR) 0.70, 95% CI 0.58 to 0.85; 9 trials, 4664 participants, high-certainty evidence) and may prevent a similar proportion in LMICs, but only two trials from urban Egypt and Kenya have evaluated this (IRR 0.66, 95% CI 0.43 to 0.99; 2 trials, 45,380 participants; low-certainty evidence). Only four trials reported measures of behaviour change, and the methods of data collection were susceptible to bias. In one trial from the USA hand-washing behaviour was reported to improve; and in the trial from Kenya that provided free soap, hand washing did not increase, but soap use did (data not pooled; 3 trials, 1845 participants; low-certainty evidence). Hand-washing promotion among communities in LMICs probably prevents around one-quarter of diarrhoea episodes (IRR 0.71, 95% CI 0.62 to 0.81; 9 trials, 15,950 participants; moderate-certainty evidence). However, six of these nine trials were from Asian settings, with only one trial from South America and two trials from sub-Saharan Africa. In seven trials, soap was provided free alongside hand-washing education, and the overall average effect size was larger than in the two trials which did not provide soap (soap provided: RR 0.66, 95% CI 0.58 to 0.75; 7 trials, 12,646 participants; education only: RR 0.84, 95% CI 0.67 to 1.05; 2 trials, 3304 participants). There was increased hand washing at major prompts (before eating or cooking, after visiting the toilet, or cleaning the baby's bottom) and increased compliance with hand-hygiene procedure (behavioural outcome) in the intervention groups compared with the control in community trials (data not pooled: 4 trials, 3591 participants; high-certainty evidence). Hand-washing promotion for the one trial conducted in a hospital among a high-risk population showed significant reduction in mean episodes of diarrhoea (1.68 fewer) in the intervention group (mean difference -1.68, 95% CI -1.93 to -1.43; 1 trial, 148 participants; moderate-certainty evidence). Hand-washing frequency increased to seven times a day in the intervention group versus three times a day in the control arm in this hospital trial (1 trial, 148 participants; moderate-certainty evidence). We found no trials evaluating the effects of hand-washing promotions on diarrhoea-related deaths or cost effectiveness.

AUTHORS' CONCLUSIONS

Hand-washing promotion probably reduces diarrhoea episodes in both child day-care centres in high-income countries and among communities living in LMICs by about 30%. The included trials do not provide evidence about the long-term impact of the interventions.

Using a Respectful Approach to Child-centred Healthcare (ReACH) in a paediatric clinical trial: A feasibility study

BACKGROUND

There is a growing momentum in paediatric ethics to develop respectful research and healthcare protocols. We developed, tested and refined our 'Respectful Approach to Child-centred Healthcare' (ReACH), to underpin respectful participant interactions in a clinical trial.

OBJECTIVE

To determine whether a ReACH-based approach is acceptable to children and parents, and effective in obtaining compliance with common healthcare assessments in a clinical trial of healthy 4-6-year-old children.

METHODS

ReACH-based child assessments were evaluated at two baseline clinics and one post-intervention, using mixed methods. Children (n = 49; 46.9% female; mean age = 5.24±0.88 years at baseline) and their parents provided independent evaluation, via customised 5-point Likert scales and qualitative feedback. A dedicated child researcher evaluated adherence to the study ReACH principles.

RESULTS

Children achieved compliance rates of 95% for body composition (BodPod) assessments; 89% for blood pressure measurements, and 92% (baseline) and 87% (post-intervention) for blood draws. Adherence to ReACH principles during clinic visits was positively associated with child compliance, significantly for baseline BodPod (p = 0.002) and blood test (p = 0.009) clinics. Satisfaction with BodPod protocols was positively associated with compliance, for children at baseline (p = 0.029) and for parents post-intervention (p <0.001). Parents rated the study itself very highly, with 91.7% satisfied at baseline and 100% post-intervention. Qualitative feedback reflected an enjoyable study experience for both parents and children.

CONCLUSIONS

Adherence to our emerging ReACH approach was associated with high child compliance rates for common healthcare assessments, although no causality can be inferred at this preliminary stage of development. Participants expressed satisfaction with all aspects of the study. Our use of child-centred methods throughout a research intervention appears feasible and acceptable to children and their parents.

Preschool environment and preschool teacher's physical activity and their association with children's activity levels at preschool

Objective

The aim of this study was to investigate the association between preschool playground size, formalized physical activity (PA) policies, time spent outdoors and preschool teacher’s levels of PA and children’s objectively assessed levels of PA and sedentary time (ST) during preschool hours.

Methods

In total, 369 children and 84 preschool teachers from 27 preschools in Södermalm municipally, Stockholm Sweden wore an Actigraph GT3X+ accelerometer during 7 consecutive days. Preschool environmental and structural characteristics were measured via the Environment and Policy Evaluation Self-Report (EPAO-SR) instrument and time in- and outdoors was recorded by preschool teachers during the PA measurements. Weight and height of children were measured via validated scales and parents filled out a questionnaire on demographical and descriptive variables. Linear mixed models, nested on preschool level, were used to assess the association between predictors and outcomes.

Results

The mean child age was 4.7 years (SD 0.8) and 45% were girls. We found that children were more active in preschools with a formalized PA policy, compared to preschools without such a policy, but not less sedentary. The association between policy and activity seemed to be more pronounced when accounting for other environmental factors. Similar associations were found in children spent most time outdoors (uppermost quartile) compared with children spent least time outdoors (Lowermost quartile). Preschool teachers’ light PA (LPA) (ß = 0.25, P = 0.004) and steps (ß = 0.52, P<0.001) were associated with children’s LPA and steps while the preschool playground size showed no association with PA in children, when accounting for other environmental factors.

Conclusion

The current study showed that preschool structural characteristics such as formalized PA policies and more time spent outdoors were positively associated with children’s PA. These findings suggest that formalized PA policies and time outdoors may be of importance for promoting children’s PA during preschool hours.

Changes in Child and Adult Care Food Program (CACFP) Practices at Participating Childcare and Education Centers in the United States Following Updated National Standards, 2017-2019

The U.S. Department of Agriculture's (USDA) Child and Adult Care Food Program (CACFP) updated meal pattern standards took effect in October 2017. The aim of this quasi-experimental, pre-post study is to identify changes in food and beverage practices of CACFP-participating centers due to implementation of updated CACFP meal patterns over a 21-month period. Eight hundred and fifty-eight centers located in 47 states and the District of Columbia completed a survey (primarily electronic) at both time points (67.6% follow-up response rate). Multivariable logistic regressions with robust standard errors assessed changes over time, accounting for repeated observations within each site. From baseline to follow-up, centers reported the increased familiarity and implementation, albeit with time, money, and staffing-related challenges. Significant improvements were seen in not serving sugary cereals or flavored milk, in serving 100% whole grains, and serving processed meats less than once a week. While CACFP-participating centers reported making significant progress in meeting the updated meal pattern standards and suggested best practices within 15-19 months of their effective date, reported compliance and adherence to the standards and best practices was not universal. USDA, state agencies, and technical assistance providers should work to provide centers with additional guidance to help them with implementation.

Infiltration of fine particles in urban daycares

Singapore is a tropical country with a high density of day-care facilities whose indoor environments may be adversely affected by outdoor fine particle (PM_2.5 ) air pollution. To reduce this problem requires effective, evidence-based exposure-reduction strategies. Little information is available on the penetration of outdoor PM_2.5 into day-care environments. Our study attempted to address the following objectives: to measure indoor infiltration factor (F_inf ) of PM_2.5 from outdoor PM_2.5 and to determine the building parameters that modify the indoor PM_2.5 . We collected indoor/outdoor 1-min PM_2.5 from 50 day-care classrooms. We noted mean F_inf  ± SD of 0.65 ± 0.22 in day-care rooms which are naturally ventilated and lower F_inf  ± SD values of 0.47 ± 0.18 for those that are air-conditioned: values which are lower than those reported in Singapore residences. The air exchange rates were higher in naturally ventilated rooms (1.47 vs 0.86 h^-1 ). However, fine particle deposition rates were lower for naturally ventilated rooms (0.67 ± 0.43 h^-1 ) compared with air-conditioned ones (1.03 ± 0.55 h^-1 ) presumably due to composite rates linked to the filters within the split unit air-conditioners, higher recirculation rates, and interior surfaces in the latter. Our findings indicate that children remaining indoor in daycares where air-conditioning is used can reduce their PM_2.5 exposures during outdoor pollution episodes.

Conceptualization of Major Stakeholders in Emergency Management of Childcare Facilities

This study aims to conceptualize the key stakeholders in emergency management of childcare facilities for applicable nations by referring to the Korean case. Qualitative content analysis is the main methodology used. Unique features are gathered from the Korean literature on childcare facilities and then summarized; however, universal principles from the English language literature on international childcare facilities are emphasized. The analysis of five major stakeholders in Korean childcare facilities, namely, governments, community personnel, parents, childcare providers, and children, shows that their current efforts are directed only at general safety management. Multi-hazard management or an integrated approach in terms of social work is thus provided as an alternative for not only Korea but also other nations.

Child Care Sites Participating in the Federal Child and Adult Care Food Program Provide More Nutritious Foods and Beverages

OBJECTIVE

To compare food/beverage provisions between child care sites participating and not participating in the Child and Adult Care Food Program (CACFP).

DESIGN

Cross-sectional survey administered in 2016.

SETTING

Licensed child care centers and homes.

PARTICIPANTS

Child care providers (n = 2,400) randomly selected from California databases (30% responded). Respondents (n = 680) were primarily site directors (89%) at child care centers (83%) participating in CACFP (70%).

MAIN OUTCOME MEASURES

Meals/snacks served, and food/beverage provisions provided to children of age 1-5 years on the day before the survey.

ANALYSIS

Odds ratios unadjusted and adjusted for the number of meals/snacks using logistic regression.

RESULTS

Compared with CACFP sites, non-CACFP sites provided fewer meals/snacks; had lower odds of providing vegetables, meats/poultry/fish, eggs, whole grains, and milk; and had higher odds of providing candy, salty snacks, and sugary drinks. After adjusting for the number of meals/snacks, differences were attenuated but remained significant for meats/poultry/fish, milk, candy, salty snacks (centers only), and sugary drinks. Differences emerged in favor of CACFP for flavored/sugar-added yogurt, sweet cereals, frozen treats, and white grains.

CONCLUSIONS AND IMPLICATIONS

Child care sites participating in CACFP are more likely to provide nutritious foods/beverages compared with non-CACFP sites. Child care sites are encouraged to participate in or follow CACFP program guidelines.

Participation in the Child and Adult Care Food Program is associated with fewer barriers to serving healthier foods in early care and education

BACKGROUND

Early care and education (ECE) is an important setting for influencing young children's dietary intake. There are several factors associated with barriers to healthy eating in ECE, and recent evidence suggests that participation in the Child and Adult Care Food Program (CACFP), the primary national food assistance program in ECE, may be associated with fewer barriers to serving healthier foods. However, no prior studies have examined differences between CACFP participants and non-participants across a large, multi-state sample. This is the first study to examine the association between CACFP participation and barriers to serving healthier foods in ECE using a random sample of directors from two regions across the country.

METHODS

We conducted a cross-sectional survey among a random sample of child care center directors from four states (Massachusetts, North Carolina, Rhode Island, and South Carolina). We conducted logistic and Poisson regression to calculate the odds and incidence rate ratios of reporting 1) no barriers, 2) specific barriers (e.g., cost), and 3) the total number of barriers, by CACFP status, adjusting for covariates of interest.

RESULTS

We received 713 surveys (36% response rate). About half (55%) of centers participated in CACFP. The most prevalent reported barriers to serving healthier foods were cost (42%) and children's food preferences (19%). Directors from CACFP centers were twice as likely to report no barriers, compared to directors from non-CACFP centers (OR 2.03; 95% CI [1.36, 3.04]; p < 0.01). Directors from CACFP centers were less likely to report cost as a barrier (OR = 0.46; 95% [CI 0.31, 0.67]; p < 0.001), and reported fewer barriers overall (IRR = 0.77; 95% CI [0.64, 0.92]; p < 0.01), compared to directors from non-CACFP centers.

CONCLUSIONS

CACFP directors reported fewer barriers to serving healthier foods in child care centers. Still, cost and children's food preferences are persistent barriers to serving healthier foods in ECE. Future research should evaluate characteristics of CACFP participation that may alleviate these barriers, and whether barriers emerge or persist following 2017 rule changes to CACFP nutrition standards.

Implementation of Revised Nutrition Standards in US Department of Agriculture's Child and Adult Care Food Program

OBJECTIVE

In October 2017, substantial changes were made to improve the nutritional quality of meals served in the Child and Adult Care Food Program (CACFP). This study describes the experience of child care providers and sponsors during the first year of implementation.

METHODS

A 1-time survey was administered to CACFP sponsors in Delaware 1 year after implementation of the changes. Data analysis included frequencies and chi-square tests of independence.

RESULTS

Among respondents (n = 137), 21% faced moderate or significant challenges. Food cost (53.1%) and communicating with parents about changes (44.6%) were the most common challenges faced. The majority reported that parents supported the changes and that children and teachers generally ate the new food.

CONCLUSIONS AND IMPLICATIONS

A minority of providers in Delaware faced significant challenges, suggesting that broad changes to CACFP may be feasibly implemented across settings. Training focused on food cost and parent communication may be warranted.

Status of Beverages Served to Young Children in Child Care After Implementation of California Policy, 2012-2016

INTRODUCTION

Since 2012, licensed California child care centers and homes, per state policy, are required to serve only unflavored low-fat or nonfat milk to children aged 2 years or older, no more than one serving of 100% juice daily, and no beverages with added sweeteners, and they are required to ensure that drinking water is readily accessible throughout the day. We evaluated adherence to the policy after 4 years in comparison to the adherence evaluation conducted shortly after the policy went into effect.

METHODS

Licensed California child care sites were randomly selected in 2012 and 2016 and surveyed about beverage practices and provisions to children aged 1-5 years. We used logistic regression to analyze between-year differences for all sites combined and within-year differences by site type and participation in the federal Child and Adult Care Food Program (CACFP) in self-reported policy adherence and beverage provisions.

RESULTS

Respondents in 2016 (n = 680), compared with those in 2012 (n = 435), were more adherent to California's 2010 Healthy Beverages in Child Care Act overall (45.1% vs 27.2%, P < .001) and with individual provisions for milk (65.0% vs 41.4%, P < .001), 100% juice (91.2% vs 81.5%, P < .001), and sugar-sweetened beverages (97.4% vs 93.4%, P = .006). In 2016, centers compared with homes (48.5% vs 28.0%, P = .001) and CACFP sites compared with non-CACFP sites (51.6% vs 27.9%, P < .001) were more adherent to AB2084 overall.

DISCUSSION

Beverage policy adherence in California child care has improved since 2012 and is higher in CACFP sites and centers. Additional policy promotion and implementation support is encouraged for non-CACFP sites and homes. Other states should consider adopting such policies.

Program Directors' Perception of Pregnancy and Parenthood in Orthopedic Surgery Residency

Orthopedic surgery has one of the lowest percentages of women of all medical specialties. The purpose of this study was to determine the perception of pregnancy and parenthood during orthopedic surgery residency among program directors. An anonymous survey was distributed to all program directors who were members of the American Orthopaedic Association's Council of Orthopaedic Residency Directors. Twenty-six (53%) of 49 male program directors believed that pregnancy and parenthood negatively affected female residents' scholarly activities (P=.02), whereas 10 (83%) of 12 female program directors believed that it had no effect. Significantly more program directors believed that pregnancy and parenthood imposed a burden on fellow trainees for female residents than for male residents (77% vs 45.9%, respectively; P=.0004). This study demonstrated that orthopedic residency program directors perceive the effects of pregnancy and parenthood more negatively for female residents, especially related to scholarly activities and the burden placed on fellow residents. [Orthopedics. 2020; 43(2):e109-e113.].

Diet Quality in Early Care and Education Centers: A Comparison of Menu, Served, and Consumed Lunch Measures

OBJECTIVE

Assess if diet quality (DQ) differs among 3 lunch measures commonly used to assess DQ in early care and education (ECE) centers, which include what is listed on the menu, served, and consumed.

DESIGN

This quantitative observational study measured DQ of food and beverage items listed on the menu, what children were served, and what they consumed during one lunch meal.

SETTING

Alabama ECE centers.

PARTICIPANTS

ECE centers (n = 28) with attendance of ≥10 children ages 3 to 5 years and provided lunch daily.

MAIN OUTCOME MEASURE(S)

DQ measured through Healthy Eating Index-2015 (HEI) scores, which were calculated for the menu, served, and consumed lunch measures.

ANALYSIS

Menu, served, and consumed HEI scores compared using either Kruskal-Wallis or ANOVA. Dunn Bonferroni or Duncan post hoc tests identified which group differed.

RESULTS

Total HEI scores were significantly higher among menus, compared with served and consumed (P = .001). Served and consumed total HEI scores were not different.

CONCLUSIONS AND IMPLICATIONS

Menu DQ differed from both the served and consumed lunch measures. These findings support the need for nutrition education on the importance of menu adherence in ECE centers.

Screen-Time Policies and Practices in Early Care and Education Centers in Relationship to Child Physical Activity

BACKGROUND

Few preschool children meet physical activity recommendations, whereas the majority exceeds screen-time recommendations. The purpose of this study was to examine the relationship of screen-time policies and practices with children's physical activity and sedentary time in early care and education (ECE) centers.

METHODS

We conducted a cross-sectional study of 104 children (3.3 ± 0.5 years; 50% girls) attending 10 ECE centers in the United States. Physical activity was measured by accelerometry. Screen-time practices were measured by classroom observation and director report. Mixed linear models were used to examine the relationship of screen-time practices with children's total physical activity (TPA) and moderate-to-vigorous physical activity (MVPA) and sedentary time, adjusting for child's age, sex, and BMI z-score and taking into account the clustering of children within each center. Models were repeated to include director-reported active play time as a covariate.

RESULTS

More limited/supervised screen-time (by observation) was related to higher TPA (p = 0.0003) and lower sedentary time (p = 0.0003). More limited/supervised screen-time (by director report) was related to higher TPA (p < 0.0001) and MVPA (p = 0.021) and lower sedentary time (p < 0.0001). Associations remained significant when active play time was included as a covariate. TPA was inversely related to computer access (p = 0.0015) and positively related to the use of educational screen-time compared with noneducational screen-time (p = 0.04).

CONCLUSIONS

Limiting computer usage and ensuring screen-time is educational, and integrated within the curriculum may benefit children's physical activity levels and reduce time spent sedentary.

Sugary Cereals at Early Childhood Education Centers Participating in the Child and Adult Care Food Program, 2017

The objective of this study was to describe the provision of sugary cereals by early childhood education (ECE) centers participating in the Child and Adult Care Food Program (CACFP) before required implementation of the updated CACFP meal pattern standards. We distributed a web-based survey, which included a question on breakfast cereals, to a random sample of 5,483 CACFP-participating ECE centers nationwide. Of the 1,343 centers that responded, 30% did not meet the updated requirement for cereal; 38% of independently owned or operated centers did not meet the requirement. Results indicate the need for additional training and technical assistance on the updated CACFP standards for sugar in cereal.

Association of early daycare attendance with allergic disorders in children: a longitudinal national survey in Japan

The association between early daycare attendance and risk of allergic diseases remains inconclusive. Therefore, we examined the association among Japanese children on a long-term basis using a nationwide longitudinal survey data. We estimated the association between daycare attendance at age 6 or 18 months and allergy development using information on outpatient visits for atopic dermatitis (AD), food allergy (FA), and asthma and admission for asthma up to 12 years of age as a proxy for developing these diseases, with multilevel logistic regression. Early daycare attendance was associated with increased odds of AD at ages 2.5-3.5 years: the adjusted odds ratio (OR) was 1.34 [95% CI: 1.21, 1.47]. The association with FA was equivocal. The odds of asthma was increased before age 3.5 years and afterwards decreased: the adjusted ORs were 1.60 [1.44, 1.77] for ages 1.5-2.5 years and 0.77 [0.69, 0.87] for ages 5.5-7 years. The effect of early daycare attendance depends on the type of allergies.

Social and Emotional Learning Associated With Universal Curriculum-Based Interventions in Early Childhood Education and Care Centers: A Systematic Review and Meta-analysis

Importance

Social-emotional competence in early childhood influences long-term mental health and well-being. Interest in the potential to improve child health and educational outcomes through social and emotional learning (SEL) programs in early childhood education and care (ECEC) settings is increasing.

Objective

To conduct a systematic review and meta-analysis of studies examining the social, emotional, and early learning outcomes associated with universal curriculum-based SEL programs delivered to children aged 2 to 6 years in center-based ECEC settings.

Data Sources

Keyword searches of Education Resources Information Center (ERIC), MEDLINE Complete, PsycINFO, and Proquest Dissertations and Theses Global databases were conducted to identify all relevant studies published from January 1, 1995, through December 31, 2017.

Study Selection

Studies included in this review examined universal curriculum-based SEL intervention delivered to children aged 2 to 6 years in a center-based ECEC setting. All assessed individual-level social and/or emotional skill after the SEL intervention and used an experimental or quasi-experimental design (ie, studies that did not or were not able to randomly allocate participants to intervention and control groups) with a control group.

Data Extraction and Synthesis

A total of 13 035 records were screened, of which 362 were identified for full-text review. A systematic literature review was conducted on 79 studies. Multilevel random-effects meta-analyses were conducted on 63 eligible studies from October 2 through 18, 2018.

Main Outcomes and Measures

Social competence, emotional competence, behavioral self-regulation, behavior and emotional challenges, and early learning outcomes.

Results

This review identified 79 unique experimental or quasi-experimental studies evaluating the effect of SEL interventions on preschooler outcomes, including a total of 18 292 unique participants. Sixty-three studies were included in this meta-analysis. Compared with control participants, children in intervention conditions showed significant improvement in social competence (Cohen d [SE], 0.30; [0.06]; 95% CI, 0.18-0.42; P < .001), emotional competence (Cohen d [SE], 0.54 [0.16]; 95% CI, 0.22-0.86; P < .001), behavioral self-regulation (Cohen d [SE], 0.28 [0.09]; 95% CI, 0.11-0.46; P < .001), and early learning skills (Cohen d [SE], 0.18 [0.08]; 95% CI, 0.02-0.33; P = .03) and reduced behavioral and emotional challenges (Cohen d [SE], 0.19 [0.04]; 95% CI, 0.11-0.28; P < .001). Several variables appeared to moderate program outcomes, including intervention leader, type of assessment, informant, child age, and study quality.

Conclusions and Relevance

According to results of this study, social and emotional learning programs appeared to deliver at a relatively low intensity may be an effective way to increase social competence, emotional competence, behavioral self-regulation, and early learning outcomes and reduce behavioral and emotional difficulties in children aged 2 to 6 years. Social and emotional learning programs appear to be particularly successful at increasing emotional knowledge, understanding, and regulation.

A Comparison of Preschoolers' Physical Activity Indoors versus Outdoors at Child Care

The aims of this study were to quantify and examine differences in preschoolers’ indoor and outdoor sedentary time and physical activity intensity at child care using GPS devices and accelerometers. We conducted an observational study of 46 children (mean age 4.5 years, 30 boys, 16 girls) from five child care centers who wore accelerometers and GPS devices around their waists for five days during regular child care hours. GPS signal-to-noise ratios were used to determine indoor vs. outdoor location. Accelerometer data were categorized by activity intensity. Children spent, on average, 24% of child care time outdoors (range 12–37% by site), averaging 74 min daily outdoors (range 30–119 min), with 54% of children spending ≥60 min/day outdoors. Mean accelerometer activity counts were more than twice as high outdoors compared to indoors (345 (95) vs. 159 (38), (p < 0.001)), for girls and boys. Children were significantly less sedentary (51% of time vs. 75%) and engaging in more light (18% vs. 13%) and moderate-to-vigorous (MVPA) (31% vs. 12%) activity when outdoors compared to indoors (p < 0.001). To achieve a minute of MVPA, a preschooler needed to spend 9.1 min indoors vs. 3.8 min outdoors. Every additional 10 min outdoors each day was associated with a 2.9 min increase in MVPA (2.7 min for girls, 3.0 min for boys). Preschool-age children are twice as active and less sedentary when outdoors compared to indoors in child care settings. To help preschoolers achieve MVPA recommendations and likely attain other benefits, one strategy is to increase the amount of time they spend outdoors and further study how best to structure it.

Predictors of Nutrition Quality in Early Child Education Settings in Connecticut

OBJECTIVE

This study assessed the dietary quality of lunches and feeding practices (family-style service, teacher role modeling) in Connecticut child care centers and made comparisons by center participation in the federal Child and Adult Care Food Program (CACFP).

DESIGN

Plate waste methods and visual observation of lunches served and consumed.

SETTING

A total of 97 randomly selected licensed Connecticut child care centers (53 CACFP and 44 non-CACFP).

PARTICIPANTS

A total of 838 preschool-aged children.

MAIN OUTCOME MEASURES

Total energy intake, macronutrient intake, and intake by CACFP meal component as well as use of family-style dining, management of additional helpings, and whether and what teachers consumed in view of children.

ANALYSIS

Child dietary intake at lunch was compared with dietary and CACFP recommendations using a mixed linear regression model.

RESULTS

The CACFP centers were more likely to offer family-style service and have staff eat the same foods as the children. Children in non-CACFP centers consumed more saturated fat (4.1 vs 2.7 g; P < .001) and trans fats (0.1 vs 0.1 g; P = .02) and less milk (3.5 vs 2.7 oz; P < .001) than did children in CACFP centers. Caloric intake and dietary fiber were below recommendations in both groups. Participation in CACFP was a significant predictor of low-fat milk consumption.

CONCLUSIONS AND IMPLICATIONS

The CACFP-participating centers confer some nutritional advantages in terms of provider behavior during meals, characteristics of food offerings, and child intake. Current feeding practices in child care settings require further exploration in the context of serving children at risk for food insecurity and in light of recent work on responsive feeding.

Ultrafine, fine, and black carbon particle concentrations in California child-care facilities

Although many U.S. children spend time in child care, little information exists on exposures to airborne particulate matter (PM) in this environment, even though PM may be associated with asthma and other respiratory illness, which is a key concern for young children. To address this data gap, we measured ultrafine particles (UFP), PM_2.5 , PM₁₀ , and black carbon in 40 California child-care facilities and examined associations with potential determinants. We also tested a low-cost optical particle measuring device (Dylos monitor). Median (interquartile range) concentrations for indoor UFP, gravimetric PM_2.5 , real-time PM_2.5 , gravimetric PM₁₀ , and black carbon over the course of a child-care day were 14 000 (11 000-29 000) particles/cm³ , 15 (9.6-21) μg/m³ , 15 (11-23) μg/m³ , 48 (33-73) μg/m³ , and 0.43 (0.25-0.65) ng/m³ , respectively. Indoor black carbon concentrations were inversely associated with air exchange rate (Spearman's rho = -.36) and positively associated with the sum of all Gaussian-adjusted traffic volume within a one-kilometer radius (Spearman's rho = .45) (P-values <.05). Finally, the Dylos may be a valid low-cost alternative to monitor PM levels indoors in future studies. Overall, results indicate the need for additional studies examining particle levels, potential health risks, and mitigation strategies in child-care facilities.

Web-Based Surveillance of Illness in Childcare Centers

School absenteeism is an inefficient and unspecific metric for measuring community illness and does not provide surveillance during summertime. Web-based biosurveillance of childcare centers may represent a novel way to efficiently monitor illness outbreaks year-round. A web-based biosurveillance program ( sickchildcare.org ) was created and implemented in 4 childcare centers in a single Michigan county. Childcare providers were trained to report sick children who required exclusion or had parent-reported absences due to illness. Deidentified data on age range, number of illnesses, and illness categories were collected. Weekly electronic reports were sent to the county public health department. Data for reports were gathered beginning in December 2013 and were summarized using descriptive statistics. A total of 385 individual episodes of illness occurred during the study period. Children with reported illness were infants (16%, n = 61), toddlers (38%, n = 148), and preschoolers (46%, n = 176). Illness categories included: fever (30%, n = 116), gastroenteritis (30%, n = 115), influenzalike illness (8%, n = 32), cold without fever (13%, n = 51), rash (7%, n = 26), conjunctivitis (1%, n = 3), ear infection (1%, n = 5), and other (10%, n = 37). The majority of reports were center exclusions (55%, n = 214); others were absences (45%, n = 171). The detection of a gastroenteritis outbreak by web-based surveillance during winter 2013-14 preceded county health reports by 3 weeks; an additional outbreak of hand-foot-mouth disease was detected during June 2014 when standard school-based surveillance was not available. Web-based biosurveillance of illness in childcare centers represents a novel and feasible method to detect disease trends earlier and year-round compared to standard school-based disease surveillance.

Age at introduction of ultra-processed food among preschool children attending day-care centers

OBJECTIVE

To identify the age of introduction of ultra-processed food and its associated factors among preschool children.

METHODS

Cross-sectional study carried out from March to June 2014 with 359 preschool children aged 17 to 63 months attending day-care centers. Time until ultra-processed food introduction (outcome variable) was described by the Kaplan-Meier analysis, and the log-rank test was used to compare the survival functions of independent variables. Factors associated with ultra-processed food introduction were investigated using the multivariate Cox proportional hazards model. The results were shown as hazard ratios with their respective 95% confidence intervals.

RESULTS

The median time until ultra-processed food introduction was six months. Between the 3rd and 6th months, there is a significant increase in the probability of introducing ultra-processed food in the children's diet; and while the probability in the 3rd month varies from 0.15 to 0.25, at six months the variation ranges from 0.6 to 1.0. The final Cox proportional hazards model showed that unplanned pregnancy (1.32 [1.05-1.65]), absence of prenatal care (2.50 [1.02-6.16]), and income >2 minimum wages (1, 50 [1.09-2.06]) were independent risk factors for the introduction of ultra-processed food.

CONCLUSION

Up to the 6th month of life, approximately 75% of preschool children had received one or more ultra-processed food in their diet. In addition, it was observed that the poorest families, as well as unfavorable prenatal factors, were associated with early introduction of ultra-processed food.

Education of staff in preschool aged classrooms in child care centers and child outcomes: A meta-analysis and systematic review

Staff education is considered key to quality of early childhood education and care (ECEC) programs. However, findings about associations between staff education and children's outcomes have been inconsistent. We conducted a systematic review and meta-analysis of associations between ECEC staff education and child outcomes. Searches of Medline, PsycINFO, and ERIC, websites of large datasets and reference sections of all retrieved articles were conducted. Eligible studies provided a statistical link between staff education and child outcomes for preschool-aged children in ECEC programs. Titles, abstracts and paper reviews as well as all data extraction were conducted by two independent raters. Of the 823 studies reviewed for eligibility, 39 met our inclusion criteria. Research in this area is observational in nature and subject to the inherent biases of that research design. Results from our systematic review were hampered by heterogeneity in how staff education was defined, variability in whose education was measured and the child outcomes that were assessed. However, overall the qualitative summary indicates that associations between staff education and childhood outcomes are non-existent to very borderline positive. In our meta-analysis of more homogeneous studies we identified certain positive, albeit very weak, associations between staff education and children's language outcomes (specifically, vocabulary and letter word identification) and no significant association with a mathematics outcome (WJ Applied Problems). Thus, our findings suggest that within the range of education levels found in the existing literature, education is not a key driver of child outcomes. However, since we only explored levels of education that were reported in the literature, our findings cannot be used to argue for lowering education standards in ECEC settings.

What Can Be Learned from Existing Investigations of Weight-Related Practices and Policies with the Potential to Impact Disparities in US Child-Care Settings? A Narrative Review and Call for Surveillance and Evaluation Efforts

Child-care settings and the combination of policies and regulations under which they operate may reduce or perpetuate disparities in weight-related health, depending on the environmental supports they provide for healthy eating and activity. The objectives of this review are to summarize research on state and local policies germane to weight-related health equity among young children in the United States and on how federal policies and regulations may provide supports for child-care providers serving families with the most limited resources. In addition, a third objective is to comprehensively review studies of whether there are differences in practices and policies within US child-care facilities according to the location or demographics of providers and children. The review found there is growing evidence addressing disparities in the social and physical child-care environments provided for young children, but scientific gaps are present in the current understanding of how resources should best be allocated and policies designed to promote health equity. Additional research is needed to address limitations of prior studies relating to the measurement of supports for weight-related health; complexities of categorizing socioeconomic position, ethnicity/race, and urban and rural areas; exclusion of legally nonlicensed care settings from most research; and the cross-sectional nature of most study designs. There is a particularly great need for the development of strong surveillance systems to allow for better monitoring and evaluation of state policies that may impact weight-related aspects of child-care environments, implementation at the program level, and needed implementation supports.

Evaluation of a Physical Activity Regulation for Child Care in Massachusetts

OBJECTIVES

A number of states have enacted regulations to increase physical activity in children attending child care, but most were not evaluated. In 2010, Massachusetts (MA) enacted a new regulation requiring 60 minutes of light, moderate, and vigorous physical activity (LMVPA) for children in child care; we conducted a prospective evaluation. We hypothesized that MA centers would comply with the regulation at follow-up, resulting in increases in children's LMVPA.

METHODS

We evaluated compliance with the regulation in MA using Rhode Island (RI) as the comparison. We measured physical activity in a longitudinal sample of 20 centers and cross-sectional samples of 180 children per state three times before and three times after the regulation took effect. We assessed physical activity using the Observation System for Recording Activity in Preschoolers. We conducted difference-in-differences tests to evaluate changes in LMVPA in MA compared with RI from baseline to follow-up.

RESULTS

Children were active for at least 60 minutes of LMVPA in over 80% of centers at baseline and follow-up in MA and RI. Nevertheless, LMVPA increased in both states. In multivariable adjusted regressions, LMVPA increased from baseline to follow-up [MA estimate 38.1 minutes; confidence interval (CI): 28.6, 47.5; p ≤ 0.0001; and RI estimate 42.7 minutes; CI: 35.2, 50.1; p ≤ 0.0001]. The average difference-in-differences estimate indicated no difference in MA compared with RI (estimate -4.6 minutes; CI: -16.6, 7.5; p = 0.46) since LMVPA increased comparably in both states.

CONCLUSIONS

Although LMVPA increased in MA, we observed similar changes in RI. Thus, other factors could have influenced children's physical activity.

Tribally Affiliated Child-Care Center Environment and Obesogenic Behaviors in Young Children

BACKGROUND

Child-care centers are an integral part of life for many families with young children. American Indian children are at elevated health risk because of higher levels of obesity and associated health behaviors.

OBJECTIVE

Our aim was to assess the child-care environment and children's physical activity (PA) and dietary intake in young children attending tribally affiliated child care.

DESIGN

We conducted a cross-sectional study.

PARTICIPANTS/SETTING

Participants were from 11 tribally affiliated child-care centers across Oklahoma and included 82 children aged 3 to 5 years old.

MAIN OUTCOME MEASURES

Classroom observations were conducted using the Environmental and Policy Assessment Observation to measure PA and nutrition environments. Children wore an ActiGraph GT3X accelerometer and lunchtime plate waste was observed.

STATISTICAL ANALYSES

Descriptive statistics, including mean±standard deviation and frequencies, were calculated for the children's behaviors and environment.

RESULTS

The total environment score was 23.9±5.2 (maximum=43). The nutrition score was 12.5±3.1 (maximum=21). The PA score was 11.7±2.2 (maximum=22). The participants were 3.8±0.1 years old, 55% were male, 67% were American Indian, and 38% were overweight or obese. Accelerometers were worn for 5.9±1.7 hours, excluding naptime. Children accumulated 4.3±2.2 min/h of moderate to vigorous PA, 4,294±1,883 steps/day, and 12.1±3.7 steps/min. At lunch, children were served 510±241 kcal, and consumed 387±239 kcal. Lunches consisted of 47% carbohydrate, 20% protein, and 33% fat. Total number of F/V served was 2.9±1.9 and consumed was 2.3±1.8, while whole grains served and consumed were 0.3±0.4 and 0.2±0.4, respectively, and lean proteins served and consumed were 0.3±0.4 and 0.2±0.4, respectively.

CONCLUSIONS

This study describes obesogenic aspects of the child-care environment and identifies areas for improvement. Children did not accumulate adequate PA or consume calories or fat excessively. Children consumed multiple F/V; however, more whole grains and lean proteins could be provided. Future research might investigate how the healthfulness of the child-care environment can be improved by counseling providers on nutrition and PA strategies to prevent obesity.

Characteristics of child daycare centres associated with clustering of major enteropathogens

Insights into transmission dynamics of enteropathogens in children attending daycare are limited. Here we aimed at identifying daycare centre (DCC) characteristics associated with time-clustered occurrence of enteropathogens in DCC-attending children. For this purpose, we used the KIzSS network, which comprises 43 DCCs that participated in infectious disease surveillance in The Netherlands during February 2010-February 2013. Space-time scan statistics were used to identify clusters of rotavirus, norovirus, astrovirus, Giardia lamblia and Cryptosporidium spp. in a two-dimensional DCC characteristic space constructed using canonical correlation analysis. Logistic regression models were then used to further identify DCC characteristics associated with increased or decreased odds for clustering of enteropathogens. Factors associated with increased odds for enteropathogen clustering in DCCs were having indoor/outdoor paddling pools or sandpits, owning animals, high numbers of attending children, and reporting outbreaks to local health authorities. Factors associated with decreased odds for enteropathogen clustering in DCCs were cleaning child potties in designated waste disposal stations, cleaning vomit with chlorine-based products, daily cleaning of toys, extra cleaning of toys during a suspected outbreak, and excluding children with gastroenteritis. These factors provide targets for reducing the burden of gastrointestinal morbidity associated with time-clustered occurrence of major enteropathogens in DCC attendees.

Entering out-of-home care during childhood: Cumulative incidence study in Canada and Australia

Cumulative incidence provides a more accurate indicator than annual incidence rates of the number of children who experience out-of-home care during childhood. The study utilises a cohort of all children born in Western Australia (WA) 1994-2005 and Manitoba 1998-2008 using de-identified linked data. Life tables were used to calculate the age-specific cumulative incidence over time and for at-risk groups. Cox regression was used to compare risk factors for entry to care. Manitoba had a larger proportion of children entering care compared to WA (9.4% vs 1.5% by age 12). Over time children entered care at a younger age in both WA (HR=1.5, CI:1.4-1.5) and Manitoba (HR=1.5, CI:1.5-1.6). Similar factors were associated with earlier age care entries in both countries including: socioeconomic disadvantage, young maternal age, maternal hospital admissions for mental health issues, substance misuse and assault. Supplementary analysis for WA showed a time trend with young children (<3years of age) who entered care spending an increasing proportion of their early years in care. Whilst Manitoba had a larger proportion of children entering care, over time in Western Australia children have been entering care at a younger age and spending more time in care. These latter factors contribute to an increased burden on the out-of-home care system. Manitoba had over five times greater cumulative incidence than WA, however risk factors for entry to out-of-home care were consistent in both countries. Knowledge of the risk factors for entry to out-of-home care can inform targeted support and prevention programs.

Organophosphate esters in dust samples collected from Danish homes and daycare centers

Organophosphates are used in a wide range of materials and consumer products and are ubiquitous in indoor environments. Certain organophosphates have been associated with various adverse health effects. The present paper reports mass fractions of organophosphates in dust samples collected from 500 bedrooms and 151 daycare centers of children living in Odense, Denmark. The identified compounds include: tris(isobutyl) phosphate (TIBP), tri-n-butyl phosphate (TNBP), tris(2-chloroethyl) phosphate (TCEP), tris(2-chloroisopropyl) phosphate (TCIPP), tris(1,3-dichloroisopropyl) phosphate (TDCIPP), tris(2-butoxyethyl) phosphate (TBOEP), triphenylphosphate (TPHP), 2-ethylhexyl-diphenyl phosphate (EHDPP), tris(2-ethylhexyl) phosphate (TEHP) and tris(methylphenyl) phosphate (TMPP). Both the number of organophosphates with median values above the limit of detection and the median values were higher for samples from daycare centers than for samples from homes. Organophosphates with median mass fractions above the limit of detection were: TCEP from homes (6.9 μg g(-1)), and TCEP (16 μg g(-1)), TCIPP (5.6 μg g(-1)), TDCIPP (7.1 μg g(-1)), TBOEP (26 μg g(-1)), TPHP (2.0 μg g(-1)) and EHDPP (2.1 μg g(-1)) from daycare centers. When present, TBOEP was typically the most abundant of the identified OPs. The sum of the organophosphate dust mass fractions measured in this study was roughly in the mid-range of summed mass fractions reported for dust samples collected in other countries. On a global scale, the geographical distribution of organophosphates in indoor dust is quite variable, with higher concentrations in industrialized countries. This trend differs from that for phthalate esters, whose geographic distribution is more homogeneous. Exposure to organophosphates via dust ingestion is relatively low, although there is considerable uncertainly in this assessment.

Feasibility, utility and impact of a national dental epidemiological survey of three-year-old children in England 2013

Dental epidemiological surveys of children often focus on caries levels of five-year-olds as they are accessible and amenable to examination. Standardised surveys of this age group have been successfully carried out in the UK for many years. If improvements to caries level at age five are to be made then it is important to know when caries develops in the preceding years and what the likely causes are. This paper reports on the feasibility, utility and impact of a standardised survey of three-year-old children which took place in England.

METHOD

Standardised examinations were carried out on consented three-year-olds attending child care sites which had been randomly sampled using a method described in a national protocol. Feasibility was assessed by compliance results, utility from examples of use of the data and impact by a count of media responses at the time of publication.

RESULTS

Data from 53,814 examinations provided caries level estimates for 88% of lower tier local authorities, this number representing 8% of the population of this age cohort. Of the children for whom parental consent was provided, 8% refused to be examined at school and 9% were absent. The arising information was used in a variety of ways by local authorities and health planners. The media response was strong with coverage by TV, radio, printed press and online reporting.

CONCLUSION

This national survey of the oral health of three year olds was feasible but more labour intensive than surveys of school age children and the information derived has good utility and impact.

Knowledge and practices of nutritional care among day care staff in selected preschools in Ibadan North Local Government Area, Oyo State, Nigeria

BACKGROUND

Studies have established that growth of children usually falters during the preschool age when the child is usually left in the hands of other care givers; as parents go to work. Feeding of the preschool children is sometimes solely under the care of Day Care Staff (DCS) whoselevel of knowledge and practice of nutritional care is unknown. Knowledge and practices of nutritional care among DCS in selected preschools were investigated.

METHOD

A descriptive cross-sectional study design was used and 400 DCS were randomly selected for interview. A validated questionnaire with 50-point knowledge scale was used to collect information from the target population and this was complemented with observational checklist to assess the level of practice of nutritional care and environmental hygiene. Data obtained were analysed using both univariate and bivariate analyses including Chi-square test at p=0.05 level of significance.

RESULTS

Most of the DCS were female (97.5%) and 47.5% specialised in child education. Few (28.8% and 25.0%) of the DCS had ever received training on child nutritional care during pre-service and in- service training, respectively. Only 20.0% of DCS had good knowledge of nutritional care, which reflected in the activities observed. Age was significantly associated with knowledge of preschool nutritional care..

CONCLUSION

Knowledge of day care staff on nutritional care of preschool children was found to be poorer as the age of staff increases. This may also contribute to the poor practices observed. Training on nutritional care among day care staff, especially the older ones is suggested.

Prevalence of stunting and overweight/obesity among Brazilian children according to different epidemiological scenarios: systematic review and meta-analysis

CONTEXT AND OBJECTIVE

Within the Brazilian nutritional panorama, coexistence of antagonistic nutritional disorders can be seen, especially the increasing prevalence of overweight and the persistence of significant rates of chronic malnutrition in vulnerable groups of the population. Because these are major public health problems, this study aimed to ascertain the prevalence of stunting and overweight/obesity among Brazilian children according to different epidemiological scenarios.

DESIGN AND SETTING

This was a systematic review of prevalence studies, developed at the State University of Paraíba.

METHODS

The SciELO, Lilacs and PubMed databases were searched for articles, using specific keywords. Articles published between 2006 and 2014 were selected. The review was conducted by two reviewers who worked independently. A systematic review with meta-analysis was conducted, for which the studies were grouped within different epidemiological settings.

RESULTS

Among the 33 articles recovered, 9 involved samples from daycare centers, 4 had samples from public healthcare services or social registers, 5 related to populations in situations of social inequity and 15 were population-based. Higher chances of stunting were found in populations in situations of social inequity and in those at public healthcare services or on social registers, in relation to reference populations. For overweight/obesity, none of the scenarios had a higher chance than the reference.

CONCLUSION

Among Brazilian children, stunting continues to be a socially determined public health problem that mainly affects marginalized populations. This problem coexists with significant rates of overweight/obesity affecting all social groups.

Ventilation in day care centers and sick leave among nursery children

Several studies have reported poor indoor air quality (IAQ) in day care centers (DCCs), and other studies have shown that children attending them have an increased risk of respiratory and gastrointestinal infections. The aim of this study was to investigate whether there is an association between ventilation in DCCs and sick leave among nursery children. Data on child sick leave within an 11-week period were obtained for 635 children attending 20 DCCs. Ventilation measurements included three proxies of ventilation: air exchange rate (ACR) measured with the decay method, ACR measured by the perfluorocarbon tracer gas (PFT) method, and CO2 concentration measured over a 1-week period. All but two DCCs had balanced mechanical ventilation system, which could explain the low CO2 levels measured. The mean concentration of CO2 was 643 ppm, exceeding 1000 ppm in only one DCC. A statistically significant inverse relationship between the number of sick days and ACR measured with the decay method was found for crude and adjusted analysis, with a 12% decrease in number of sick days per hour increase in ACR measured with the decay method. This study suggests a relationship between sick leave among nursery children and ventilation in DCCs, as measured with the decay method.

Frequency of nutritional disorders and their risk factors among children attending 13 nurseries in São Paulo, Brazil. A cross-sectional study

CONTEXT AND OBJECTIVE

Nutritional disorders are associated with health problems earlier in life. The objective here was to estimate the frequency of nutritional disorders and their risk factors among children.

DESIGN AND SETTING

Cross-sectional study in nurseries at 13 day-care centers in São Paulo, Brazil.

METHODS

The mothers of 482 children were interviewed, with anthropometry on these children. Children whose anthropometric indices for weight and height were greater than two standard deviations were considered to have nutritional disorders.

RESULTS

Children in families with lower per capita income (odds ratio [OR]: 2.25; 95% confidence interval, CI: 1.08-4.67) and who presented neonatal risk (OR 8.08; 95% CI: 2.29-28.74), had incomplete vaccinations (OR 3.44; 95% CI: 1.15-10.31) or were male (OR 3.73; 95% CI: 1.63-8.56) were more likely to be malnourished. Children in families with lower per capita income were also less likely to be overnourished (OR 0.40; 95% CI: 0.19-0.88). Children who were exclusively breastfed for less than two months (OR 2.95; 95% CI: 1.35-6.44) or who were male (OR 2.18; 95% CI: 1.02-4.65) were also at greater risk of being overnourished. Children who presented neonatal risk (OR 3.41; 95% CI: 1.04-11.23), had incomplete vaccinations (OR 3.18; 95% CI: 1.307.76), or were male (OR 2.76; 95% CI: 1.56-4.90) were more likely to have a nutritional disorder.

CONCLUSIONS

Nutritional disorders remain present in children attending nurseries in São Paulo. Actions should focus on boys, children who were exclusively breastfed for less than two months and those without up-to-date vaccinations.

Childhood acute lymphoblastic leukemia and indicators of early immune stimulation: a Childhood Leukemia International Consortium study

The associations between childhood acute lymphoblastic leukemia (ALL) and several proxies of early stimulation of the immune system, that is, day-care center attendance, birth order, maternally reported common infections in infancy, and breastfeeding, were investigated by using data from 11 case-control studies participating in the Childhood Leukemia International Consortium (enrollment period: 1980-2010). The sample included 7,399 ALL cases and 11,181 controls aged 2-14 years. The data were collected by questionnaires administered to the parents. Pooled odds ratios and 95% confidence intervals were estimated by unconditional logistic regression adjusted for age, sex, study, maternal education, and maternal age. Day-care center attendance in the first year of life was associated with a reduced risk of ALL (odds ratio = 0.77, 95% confidence interval: 0.71, 0.84), with a marked inverse trend with earlier age at start (P < 0.0001). An inverse association was also observed with breastfeeding duration of 6 months or more (odds ratio = 0.86, 95% confidence interval: 0.79, 0.94). No significant relationship with a history of common infections in infancy was observed even though the odds ratio was less than 1 for more than 3 infections. The findings of this large pooled analysis reinforce the hypothesis that day-care center attendance in infancy and prolonged breastfeeding are associated with a decreased risk of ALL.

Evaluation of the Children's Environmental Health Network's environmental stewardship checklist responses

Children are subject to multiple hazards on a daily basis, including in child care facilities. Research has shown that children in the child care setting may be exposed to lead, radon, pesticides, and multiple chemicals that are associated with known or suspected adverse health effects. The authors' study used an existing environmental health endorsement program to describe current practices of child care facilities as related to environmental health and safety. The facilities varied greatly in size and were located mainly in the U.S. with a few from Canada and Australia. A few checklist items had nearly a 100% positive response rate; however, some of the items had more than 10% of the facilities answer "false" or "don't know." Although many areas exist in which these sampled child care facilities are being environmentally responsible, further education is needed, particularly as related to the use of wall-to-wall carpeting, radon testing, aerosols, and air fresheners.

Assessing care providers' perceptions and beliefs about physical activity in infants and toddlers: baseline findings from the Baby NAP SACC study

BACKGROUND

As children now spend increasing amounts of time in out-of-home care, care providers play an important role in promoting positive health behaviors. Little is currently known about providers' perceptions and beliefs about physical activity, particularly for very young children. This study describes providers' perceptions and beliefs about infants' and toddlers' physical activity, and assesses their knowledge of physical activity guidelines, to establish if and where providers may need support to promote physical activity in child care settings.

METHODS

We analyzed baseline data from a pilot randomized-controlled trial conducted in 32 child care centers in Massachusetts, USA. Providers completed physical activity-related questionnaires from which we compared twenty perception and belief questions for infant and toddler care providers.

RESULTS

203 care providers (96% female, mean ± SD age: 32.7 ± 11.2 years) from 29 centers completed questionnaires. A large proportion of providers (n = 114 (61.9%)) believed that infants should be active for 45 minutes or less each day, and only 56 providers (29.7%) perceived toddlers to require more than 90 minutes of activity per day. 97% of providers perceived it was their job to ensure children engaged in a healthy amount of physical activity and most (94.1%) perceived physical activity to be important to own their health, despite 13.3% finding it hard to find the energy to be physically active.

CONCLUSIONS

This study is the first to assess the physical activity perceptions and attitudes of providers caring for infants and toddlers. Though all providers believed toddlers should engage in more physical activity than infants, most providers believed that young children require only a short amount of physical activity each day, below recommended guidelines. How provider perceptions influence children's physical activity behavior requires investigation.

Milk- and solid-feeding practices and daycare attendance are associated with differences in bacterial diversity, predominant communities, and metabolic and immune function of the infant gut microbiome

The development of the infant intestinal microbiome in response to dietary and other exposures may shape long-term metabolic and immune function. We examined differences in the community structure and function of the intestinal microbiome between four feeding groups, exclusively breastfed infants before introduction of solid foods (EBF), non-exclusively breastfed infants before introduction of solid foods (non-EBF), EBF infants after introduction of solid foods (EBF+S), and non-EBF infants after introduction of solid foods (non-EBF+S), and tested whether out-of-home daycare attendance was associated with differences in relative abundance of gut bacteria. Bacterial 16S rRNA amplicon sequencing was performed on 49 stool samples collected longitudinally from a cohort of 9 infants (5 male, 4 female). PICRUSt metabolic inference analysis was used to identify metabolic impacts of feeding practices on the infant gut microbiome. Sequencing data identified significant differences across groups defined by feeding and daycare attendance. Non-EBF and daycare-attending infants had higher diversity and species richness than EBF and non-daycare attending infants. The gut microbiome of EBF infants showed increased proportions of Bifidobacterium and lower abundance of Bacteroidetes and Clostridiales than non-EBF infants. PICRUSt analysis indicated that introduction of solid foods had a marginal impact on the microbiome of EBF infants (24 enzymes overrepresented in EBF+S infants). In contrast, over 200 bacterial gene categories were overrepresented in non-EBF+S compared to non-EBF infants including several bacterial methyl-accepting chemotaxis proteins (MCP) involved in signal transduction. The identified differences between EBF and non-EBF infants suggest that breast milk may provide the gut microbiome with a greater plasticity (despite having a lower phylogenetic diversity) that eases the transition into solid foods.

The Amsterdam Sexual Abuse Case (ASAC)-study in day care centers: longitudinal effects of sexual abuse on infants and very young children and their parents, and the consequences of the persistence of abusive images on the internet

BACKGROUND

Little research has been done on the signs of child sexual abuse (CSA) in infants and very young children, or on the consequences that such abuse - including the persistence of the abusive pornographic images on the internet - might have for the children and their parents. The effects of CSA can be severe, and a variety of risk- and protective factors, may influence those effects. CSA may affect the psychosocial-, emotional-, cognitive-, and physical development of children, their relationships with their parent(s), and the relations between parents. In the so called 'the Amsterdam sexual abuse case' (ASAC), infants and very young children were victimized by a day-care employee and most of the victims were boys. Research involving the children and their parents would enable recognition of the signs of CSA in very young children and understanding the consequences the abuse might have on the long term.

METHODS/DESIGN

The proposed research project consists of three components: (I) An initial assessment to identify physical- or psychological signs of CSA in infants and very young children who are thought to have been sexually abused (n = 130); (II) A cross-sequential longitudinal study of children who have experienced sexual abuse, or for whom there are strong suspicions; (III) A qualitative study in which interviews are conducted with parents (n = 25) and with therapists treating children from the ASAC. Parents will be interviewed on the perceived condition of their child and family situation, their experiences with the service responses to the abuse, the effects of legal proceedings and media attention, and the impact of knowing that pornographic material has been disseminated on the internet. Therapists will be interviewed on their clinical experiences in treating children and parents. The assessments will extend over a period of several years. The outcome measures will be symptoms of posttraumatic stress disorder (PTSD), dissociative symptoms, age-inappropriate sexual behaviors and knowledge, behavioral problems, attachment disturbances, the quality of parent-child interaction, parental PTSD, parental partner relation, and biological outcomes (BMI and DNA).

DISCUSSION

The ASAC-project would facilitate early detection of symptoms and prompt therapeutic intervention when CSA is suspected in very young children.

Organophosphate flame retardants and plasticizers in the air and dust in German daycare centers and human biomonitoring in visiting children (LUPE 3)

Organophosphate (OP) flame retardants and plasticizers are chemicals that have been used in large quantities in diverse consumer and building-related products for decades. In the present study, OPs were measured in paired indoor air and dust samples from 63 daycare centers in Germany. Moreover, the urine of 312 children between 22 and 80 months old who attend these facilities was analyzed for the presence of eight OP metabolites. Tri-(2-butoxyethyl)-phosphate (TBEP), tris-(2-chloroisopropyl) phosphate (TCPP), and tri-n-butyl-phosphate (TnBP) were present in low concentrations in indoor air, with median values of 49 ng/m(3), 2.7 ng/m(3), and 2.2 ng/m(3), respectively. In dust, median values of 225 mg/kg for TBEP, 2.7 mg/kg for TCPP, 1.1mg/kg for diphenyl(2-ethylhexyl) phosphate, and 0.5mg/kg for tri-phenyl-phosphate (TPhP) were found. In the urine samples, the metabolites di-phenyl-phosphate, di-n-butyl-phosphate, and di-(2-butoxyethyl)-phosphate had median values (95th percentiles) of 0.8 μg/l (4.0 μg/l), 0.2 μg/l (0.9 μg/l), and 2.0 μg/l (10.7 μg/l), respectively. A significant correlation was found between the dust and air samples in the levels of TnBP, tris(2-chloroethyl) phosphate (TCEP), and TBEP. For TCEP and TBEP, significant correlations were also observed between the levels in dust and the respective metabolite levels in urine. For TCEP, there was also a significant correlation between the concentration in indoor air and metabolite levels in urine. Based on the 95th percentile in dust and air in our study and data from residences in a previously published study, the daily intake of the most abundant OP (TBEP) is high (i.e., 3.2 μg/kg b.w.). This level is approximately 6.4% of the reference dose (RfD) established by the NSF, U.S.A. Overall, our study shows that daycare centers are indoor environments that contribute to OP exposure.

Physical activity levels among children attending family day care

OBJECTIVE

To objectively measure the physical activity (PA) levels of children attending family day care programs.

METHODS

A total of 114 children from 47 family day care centers wore an accelerometer for the duration of their time in care. Time in moderate-to-vigorous PA (MVPA) and total PA was calculated using previously validated cut points.

RESULTS

Children accumulated 5.8 ± 3.2 minutes of MVPA and 10.4 ± 4.4 minutes of total PA per hour of attendance. Boys exhibited significantly higher levels of PA than girls. Among healthy weight children, 4- and 5-year-olds exhibited significantly higher levels of PA than 2- and 3-year-olds. Overweight and obese 4- and 5-year-olds exhibited significantly lower levels of PA than their healthy weight counterparts.

CONCLUSIONS AND IMPLICATIONS

Children attending family day care participate in low levels of PA during the child care day. The results highlight the need for effective programs to promote PA in family day care.