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.

Infant temperament and mealtime distractions as predictors of preschool Children's bite speed during family mealtime.

Eating behaviors are shaped at an early age, persist into adulthood, and are implicated in the development of physical health outcomes, including obesity. Faster bite speed has been identified as an obesogenic eating behavior, prompting researchers to examine child and family factors associated with children's variability in bite speed. Child temperament, involving phenotypes of reactivity and regulation, and distractions in family food contexts are fruitful areas of investigation, but few studies have examined the interplay among these factors and their associations with bite speed. To address the gap in the literature, we examined relations between early child temperament, family mealtime distractions, and children's observed bite speed. Caregiver report of child temperament at 3 months was measured using the Infant Behavior Questionnaire Very Short Form - Revised. Child mealtime distractions and bite speed were assessed using family mealtime videos that were collected during home visits when children were 18-24 months of age (n = 109). Results revealed that children who were reported to be higher on orienting/regulation at 3 months, and who were more distracted during mealtimes at 18-24 months, had relatively slower bite speeds. No significant interactions were found. The findings from this correlational study inform further investigations into the implications of early temperament and food contexts for the development of eating behaviors implicated in obesity risk.

Influences of Child Temperament and Household Chaos on Preschoolers' Emotional Eating.

Background: Emotional eating has been linked to child temperament and family environment factors, such as household chaos. However, few studies have examined how child and home characteristics independently and together influence children's overeating and undereating in response to negative emotions. Objective: The current study examined associations among child temperament, household chaos, and emotional eating in children 18-24 months of age, and interaction effects were also tested. Methods: The study included an analysis sample of 371 families participating in the larger STRONG Kids2 longitudinal birth cohort study (N = 468). The Early Childhood Behavior Questionnaire was used to assess child temperament at 18 months, and the Confusion, Hubbub, and Order Scale was used to assess disorganization in the household at 24 months. Child emotional eating at 24 months was assessed using parental reports of the Child Eating Behavior Questionnaire. Results: Negative affectivity and household chaos were independently associated with child emotional overeating. Negative affectivity, effortful control, and household chaos were significantly associated with emotional undereating. No significant interactions were found. Conclusions: Child temperament and household environment independently influence emotional eating in young children, highlighting the need to consider these factors in early prevention. Longitudinal studies are warranted to determine mechanisms that may be involved in these relations.

Prospective Associations Between Fathers' Engagement in Infant Caregiving and Their Weight-Related Behaviors and Mental Health.

Fathers' engagement in infant caregiving is linked with positive social, emotional, and developmental outcomes in children; however, its relationship with fathers' own health is largely unknown. This longitudinal study examined associations between fathers' caregiving engagement with their 6-month-old infants and their physical activity, sugar-sweetened beverage (SSB) consumption, nighttime sleep duration, and depressive symptoms 6 months later when infants were 12 months old. Participants were 143 fathers of infants (62.7% non-Hispanic White, 82.3% with a bachelor's degree). Fathers reported their frequency of engagement in seven caregiving activities when infants were 6 months old. Fathers' physical activity, SSB consumption, nighttime sleep duration, and depressive symptoms were assessed when infants were 6 and 12 months old. Multivariate logistic regression analysis was used to assess if fathers who reported higher infant caregiving at 6 months had more positive health outcomes at 12 months, controlling for fathers' age, race/ethnicity, education, employment, household income, and the outcome at 6 months. Fathers who reported higher caregiving engagement when infants were 6 months old had increased odds of being sufficiently physically active 6 months later (unadjusted odds ratio [OR] = 1.19, 95% confidence interval [CI] = [1.00, 1.41]; adjusted OR = 1.47, 95% CI = [1.11, 1.96]). No links were identified between fathers' caregiving engagement and their SSB consumption, nighttime sleep duration, or depressive symptoms. In summary, fathers' engagement in infant caregiving may be beneficial to their physical activity in the first year after birth. There was insufficient evidence in this study that the benefits of caregiving engagement were experienced broadly across multiple health outcomes.

Father support for breastfeeding mothers who plan to utilize childcare: A qualitative look at Mothers' perspectives.

Breastfeeding exerts many health benefits for the infant and the benefit is affected by exclusivity and duration, however, most mothers in the U.S. breastfeed for a shorter duration than recommended. First-time mothers who return to work outside the home, utilize childcare, and pump to continue to provide human milk, all of which have been found to reduce breastfeeding duration individually, represent a subset of breastfeeding mothers facing several known barriers to breastfeeding continuation and at risk for early breastfeeding cessation. The aim of this study is to understand and describe the perceptions of first-time mothers with prenatal intentions to breastfeed and utilize childcare, of paternal support for the breastfeeding experience. A semi-structured interview guided data collection with 24 first-time breastfeeding mothers and responses were analyzed using thematic analysis. Two main themes from mothers' experiences highlight the perceptions of first-time mothers, who had prenatal intentions to breastfeed and utilize childcare, were shaped by the actions, behaviors, and beliefs of their partners throughout the breastfeeding process, as well as illustrate both mothers and fathers lack knowledge of how to optimally involve fathers in breastfeeding. Our findings extend evidence for two existing models of father support to promote breastfeeding as relevant to mothers who return to work outside the home and utilize childcare, and additionally identify an area of support not included in either model. Early and improved education that situates breastfeeding within the co-parenting relationship and includes paternal support for pumping has the potential to improve mothers' breastfeeding experience and breastfeeding duration through mothers' return to work and infants' transition to childcare.

Household Chaos, Maternal Emotional Responsiveness, and Child Eating Behavior: A Moderation Analysis.

OBJECTIVE: To address calls for a resilience-informed approach to understand the cause and prevention of childhood obesity, the current study aims to investigate the independent and interactive associations between household chaos, maternal emotional responsiveness, and eating behavior in early childhood. METHOD: A sample of (n = 108) families of 18- to 24-month-olds completed self-report surveys and consented to home visits as part of the larger STRONG Kids 2 (N = 468) study. Videotapes of family mealtimes were collected during home visits and coded for observed maternal emotional responsiveness. Mothers completed questionnaires assessing maternal emotional responsiveness, household chaos, and child eating behaviors. Moderation analyses assessed independent and interactive effects of chaos and emotional responsiveness on child appetite self-regulation. RESULTS: In moderation analyses controlling for demographic covariates, higher levels of chaos were associated with more emotional overeating and with more food responsiveness, but only among children of mothers observed engaging in low levels of responsiveness at mealtimes. There was no association between chaos and eating behavior among children of mothers observed engaging in high levels of emotional responsiveness at mealtimes. There was also no independent or interactive association between chaos and child eating behaviors characterized by food avoidance. CONCLUSION: Preliminary evidence suggests that maternal emotional responsiveness at mealtimes may attenuate the deleterious effects of chaos on child overeating and food responsiveness. Future research should prioritize using longitudinal designs, developing observational assessments of early childhood eating behaviors, and understanding these processes among families exposed to greater socioeconomic adversity.

Cross-sectional survey of factors associated with paternal involvement in the neonatal intensive care unit.

AIM AND OBJECTIVE: To describe factors associated with father involvement in the neonatal intensive care unit using the Heuristic model of the dynamic of parental behaviour and influence on children over time. BACKGROUND: Research shows that infants with involved fathers have better cognitive development, fewer crying episodes after caesarean birth, improved breastfeeding exclusivity and duration, and more regular sleep patterns. Preterm infants with involved fathers have improved cognitive development. DESIGN: This cross-sectional exploratory study used survey methodology to explore factors associated with father involvement in the neonatal intensive care unit. METHODS: The STROBE checklist for cross-sectional studies was used (see Appendix S2). Biological fathers of infants in a 97-bed neonatal intensive care unit in the southern USA completed a survey which asked about their involvement with their hospitalised infants and factors which affected that involvement. Eighty fathers completed the survey. RESULTS: Age ranged between 20-53 with 43% first-time fathers. Compared to less involved fathers, fathers who were more involved were younger, married or living with the mother, performed kangaroo care or fathers of multiple gestation. Fathers who had attended the delivery were more likely to bathe their infants than those who had not attended the delivery and fathers who performed kangaroo care felt more confident than those who did not. Compared to fathers who visited less often, fathers who visited more often were younger, had infants with a shorter hospitalisation time and lower acuity, and had fewer children in the family. CONCLUSIONS: Fathers are involved with their neonatal intensive care unit infants in many ways. Factors were identified that affect involvement in the neonatal intensive care unit. RELEVANCE TO CLINICAL PRACTICE: Results can help nurses in neonatal intensive care units worldwide facilitate father-infant interaction, identify fathers at risk for decreased involvement and advocate for institutional policy development for supporting neonatal intensive care unit father involvement.

An Exploratory Look at the Role of Childcare Providers as a Support and Resource for Breastfeeding Mothers.

Introduction: The childcare setting remains largely unexplored as a potential barrier to breastfeeding continuation and, therefore, the lack of interventions targeting childcare providers may be a missed opportunity for improved breastfeeding support. This article explores the perceptions of 25 first-time breastfeeding mothers on navigating the critical transition to childcare and the role of childcare providers regarding breastfeeding support. Methods: Mothers were selected if they indicated an intent to breastfeed on a prenatal questionnaire and had enrolled their child in childcare. Semistructured interviews guided by Bronfenbrenner's bioecological model were conducted to capture mothers' experiences. Responses were analyzed utilizing thematic analysis to generate themes rooted in mothers' experiences with childcare and breastfeeding. Results: A thematic analysis resulted in three key themes: Providers are not Critically Evaluated, A Stressful Transition, and Childcare as a Service, not Support. These themes indicated that although mothers intended to continue breastfeeding during and after the transition to childcare, they had not previously given much consideration to the childcare setting beyond that of a service provider. Conclusion: Findings illustrate new considerations to support modern breastfeeding mothers through the transition to work and childcare are needed such as basic and practical education and training to prepare childcare providers to support breastfeeding mothers in the way that best meets their needs, enhanced education for mothers on how to seek and evaluate providers for breastfeeding competence, and policy initiatives focused on fostering engagement between mothers and providers. By taking mothers' perceptions into consideration, researchers, practitioners, and policymakers can offer breastfeeding support that mothers will be receptive to and more likely to engage with, thereby advancing the health of both mothers and infants.

The STRONG Kids 2 Birth Cohort Study: A Cell-to-Society Approach to Dietary Habits and Weight Trajectories across the First 5 Years of Life.

BACKGROUND: Dietary habits formed during the first 5 y of life portend lifelong eating patterns. OBJECTIVE: The Synergistic Theory Research Obesity and Nutrition Group (STRONG) Kids 2 birth cohort study aimed to examine multilevel predictors of weight trajectories and dietary habits including individual biology, child socioemotional and behavioral characteristics, family environment, and child care environment over the first 5 y of life. This report describes recruitment strategies, an overview of survey measures, and basic descriptive statistics of the cohort. METHODS: The cohort includes 468 mothers and their offspring. A brief survey was completed at a 1-wk home visit including child's birth weight, intent to breastfeed, collection of an infant stool sample, and additional contact information should the family move. Mothers completed surveys including diet, child temperament, family environment, and child care when their child was 6 wk, 3, 12, 18, 24, 36, 48, and 60 mo of age. Height and weight of the mother and child were collected at each visit. Stool samples of the child were collected at each visit as well as saliva at 1 visit. RESULTS: Close to half of the mothers were either overweight (24.2%) or obese (25.2%) prepregnancy. At 6 wk of age, 32.9% of the children were overweight and 31.4% were obese based on direct measurement. CONCLUSIONS: The STRONG Kids 2 research team has adopted a socioecological model that accounts for multiple influences on children's health including biological, child social and behavioral, family household organization, and community factors. The study is limited by a relatively educated and nondiverse sample. However, variations in maternal and child weight may inform future prevention programs and policy aimed at improving the diet and health of children under the age of 5 y.This trial was registered at clinicaltrials.gov as NCT03341858.

Associations between father availability, mealtime distractions and routines, and maternal feeding responsiveness: An observational study.

Responsive feeding and frequency of family mealtimes are related to healthier eating behaviors and weight outcomes in children and adolescents. Distractions at mealtimes are related to greater intake of unhealthy food and a less positive mealtime emotional climate. However, there is little understanding of the effects of routines and father availability on distractions at family meals, and there is limited research investigating the effects of distractions among all family members on maternal feeding practices in toddlerhood. This study aims to characterize distractions at family mealtimes and examine associations between father availability, distractions, and observed responsive feeding. Descriptive analyses, nonlinear mixed models, and path analyses were conducted using observational (home-based family mealtimes) and self-report data collected from a subsample of families (n = 109) of 18- to 24-month-old children in the larger STRONG Kids 2 Study (N = 468). Between fathers, mothers, and children, families spent almost half of the mealtime distracted. Fathers and mothers engaged in about equal amounts of distractions, and children engaged in more technology-related distractions than parents. Fathers' absence at the mealtime was associated with more child distractions and less maternal feeding responsiveness. Lower paternal total distractions, maternal non-technology-object-related distractions, and higher household income were significantly associated with more observed maternal feeding responsiveness. Future research should investigate how father availability and family mealtime distractions may be associated directly and indirectly with children's eating behaviors and weight outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Sources of Information and Support for Breastfeeding: Alignment with Centers for Disease Control and Prevention Strategies.

BACKGROUND AND OBJECTIVES: Research consistently supports health benefits of breastfeeding; however, rates in the United States remain below Healthy People 2020 goals. To increase breastfeeding, information and support are needed from multiple sources. Given differences in breastfeeding rates by demographic characteristics, sources of information and support may also differ. In addition, recent research suggests potential differences in health outcomes related to feeding method (direct breastfeeding only, feeding expressed human milk, combination-feeding with formula). This study examined (1) information and support received within Centers for Disease Control and Prevention (CDC)-defined strategies for supporting breastfeeding mothers, (2) differences in rates of information and support received by demographics, and (3) associations with feeding method at 6 weeks postpartum. MATERIALS AND METHODS: A sample of 447 women participating in the Synergistic Theory Research Obesity and Nutrition Group (STRONG) Kids 2 study completed surveys with questions from the CDC Survey on Infant Feeding Practices II related to sources of information and support for breastfeeding and breast pump use, and about demographics and feeding method at 6 weeks postpartum. RESULTS: Frequencies of supports received within each category indicate that professional supports were the most pervasive, followed by support from friends and relatives. However, women at greater risk for breastfeeding cessation (lower education, Women, Infants, and Children participants, single mothers) received information and support at lower rates. Education and information support was the only source significantly associated with feeding method. CONCLUSION: New approaches are needed to increase efficacy of information delivery, especially for at-risk populations, to better meet CDC recommendations.

Providers perspectives on self-regulation impact their use of responsive feeding practices in child care.

Supporting children's self-regulation in eating through caregivers' practice of responsive feeding is paramount to obesity prevention, and while much attention has been given to supporting children's self-regulation in eating through parents' responsive feeding practices in the home setting, little attention has been given to this issue in childcare settings. This qualitative study examines childcare providers' perspectives on using responsive feeding practices with young children (2-5years). Individual semi-structured interviews were conducted with providers until saturation was reached. Data was analyzed using thematic analysis. The final sample included 18 providers who were employed full-time in Head Start or state-licensed center-based childcare programs, cared for children (2-5y), and were directly responsible for serving meals and snacks. Providers were primarily (67%) employed in childcare programs that served children from low-income families and received reimbursement for meals and snacks from the US Department of Agriculture's Child and Adult Care Food Program. Three factors emerged that shaped childcare providers' experiences using responsive feeding practices: the providers' perspectives about whether or not young children can self-regulate food intake, their understanding of Child and Adult Care Food Program (CACFP) portion size regulations, and the availability of food at the center where they worked. Future research should examine how childcare providers' understanding of children's ability to self-regulate their food intake, the appropriate use of the CACFP regulations in relationship to serving sizes, and having food available to offer seconds promotes providers' use of responsive feeding practices in center-based childcare programs and children's dietary behaviors.

Implementing the Academy of Nutrition and Dietetics Benchmarks for Nutrition Education for Children: Child-Care Providers' Perspectives.

BACKGROUND: National childhood obesity prevention policies recommend that child-care providers educate young children about nutrition to improve their nutrition knowledge and eating habits. Yet, the provision of nutrition education (NE) to children in child-care settings is limited. OBJECTIVE: Using the 2011 Academy of Nutrition and Dietetics benchmarks for NE in child care as a guiding framework, researchers assessed child-care providers' perspectives regarding delivery of NE through books, posters, mealtime conversations, hands-on learning, and sensory exploration of foods to young children (aged 2 to 5 years). DESIGN: Using a qualitative design (realist method), individual, semistructured interviews were conducted until saturation was reached. PARTICIPANTS/SETTING: The study was conducted during 2012-2013 and used purposive sampling to select providers. Final sample included 18 providers employed full-time in Head Start or state-licensed center-based child-care programs in Central Illinois. MAIN OUTCOME MEASURE: Child-care providers' perspectives regarding implementation of NE. STATISTICAL ANALYSES PERFORMED: Thematic analysis to derive themes using NVivo software. RESULTS: Three overarching themes emerged, including providers' motivators, barriers, and facilitators for delivering NE to children. Motivators for delivering NE included that NE encourages children to try new foods, NE improves children's knowledge of healthy and unhealthy foods, and NE is consistent with children's tendency for exploration. Barriers for delivering NE included that limited funding and resources for hands-on experiences and restrictive policies. Facilitators for delivering NE included providers obtain access to feasible, low-cost resources and community partners, providers work around restrictive policies to accommodate NE, and mealtime conversations are a feasible avenue to deliver NE. Providers integrated mealtime conversations with NE concepts such as food-based sensory exploration and health benefits of foods. CONCLUSIONS: Present study findings offer insights regarding providers' perspectives on implementing NE in child care. Drawing from these perspectives, registered dietitian nutritionists can train providers about the importance of NE for encouraging healthy eating in children, integrating NE with mealtime conversations, and practicing low-cost, hands-on NE activities that meet the food safety standards for state licensing. Such strategies may improve providers' ability to deliver NE in child-care settings.

"Great Job Cleaning Your Plate Today!" Determinants of Child-Care Providers' Use of Controlling Feeding Practices: An Exploratory Examination.

BACKGROUND: National early childhood obesity prevention policies recommend that child-care providers avoid controlling feeding practices (CFP) (eg, pressure-to-eat, food as reward, and praising children for cleaning their plates) with children to prevent unhealthy child eating behaviors and childhood obesity. However, evidence suggests that providers frequently use CFP during mealtimes. OBJECTIVE: Using the Academy of Nutrition and Dietetics (2011) benchmarks for nutrition in child care as a framework, researchers assessed child-care providers' perspectives regarding their use of mealtime CFP with young children (aged 2 to 5 years). DESIGN: Using a qualitative design, individual, face-to-face, semi-structured interviews were conducted with providers until saturation was reached. PARTICIPANTS/SETTING: Providers were selected using maximum variation purposive sampling from varying child-care contexts (Head Start, Child and Adult Care Food Program [CACFP]-funded centers, non-CACFP programs). All providers were employed full-time in Head Start or state-licensed center-based child-care programs, cared for children (aged 2 to 5 years), and were directly responsible for serving meals and snacks. MAIN OUTCOME MEASURE: Child-care providers' perspectives regarding CFP. STATISTICAL ANALYSES PERFORMED: Thematic analysis using NVivo (version 9, 2010, QSR International Pty Ltd) to derive themes. RESULTS: Providers' perspectives showed barriers, motivators, and facilitators regarding their use of mealtime CFP. Providers reported barriers to avoiding CFP such as CFP were effective for encouraging desired behaviors, misconceptions that providers were encouraging but not controlling children's eating, and fear of parents' negative reaction if their child did not eat. Providers who did not practice CFP were motivated to avoid CFP because they were unnecessary for encouraging children to eat, and they resulted in negative child outcomes and obesity. Facilitators as an alternative to CFP included practicing healthful feeding practices such as role modeling, peer modeling, and sensory exploration of foods. CONCLUSIONS: Training providers about negative child outcomes associated with CFP, children's ability to self-regulate energy intake, and differentiating between controlling and healthful feeding strategies may help providers to avoid CFP.

The role of multiple-group measurement invariance in family psychology research.

Measurement invariance (MI) is a property of measurement that is often implicitly assumed, but in many cases, not tested. When the assumption of MI is tested, it generally involves determining if the measurement holds longitudinally or cross-culturally. A growing literature shows that other groupings can, and should, be considered as well. Additionally, it is noted that the standard techniques for investigating MI have been focused almost exclusively on the case of 2 groups, with very little work on the case of more than 2 groups, even though the need for such techniques is apparent in many fields of research. This paper introduces and illustrates a model building technique to investigating MI for more than 2 groups. This technique is an extension of the already-existing hierarchy for testing MI introduced by Meredith (1993). An example using data on father involvement in 5 different groups of families of children with and without developmental disabilities from the Early Childhood Longitudinal Study-Birth Cohort dataset will be given. We show that without considering the possible differential functioning of the measurements on multiple developmental groups, the differences present between the groups in terms of the measurements may be obscured. This could lead to incorrect conclusions.

Father involvement and maternal depressive symptoms in families of children with disabilities or delays.

This study examined the longitudinal association between fathers' early involvement in routine caregiving, literacy, play, and responsive caregiving activities at 9 months and maternal depressive symptoms at 4 years. Data for 3,550 children and their biological parents were drawn from the Early Childhood Longitudinal Study-Birth Cohort data set. Analyses in a structural equation modeling framework examined whether the association between father involvement and maternal depressive symptoms differed for families of children with autism spectrum disorder (ASD) and for families of children with other disabilities or delays from families of children who were typically developing. Results indicated that father literacy and responsive caregiving involvement were associated with lower levels of depressive symptoms for mothers of children with ASD. These findings indicate that greater father involvement may benefit families of children with ASD and highlight the need to support and encourage service providers to work with fathers.

Predictors of head start and child-care providers' healthful and controlling feeding practices with children aged 2 to 5 years.

Few child-care providers meet the national recommendations for healthful feeding practices. Effective strategies are needed to address this disparity, but research examining influences on child-care providers' feeding practices is limited. The purpose of this study was to identify determinants of child-care providers' healthful and controlling feeding practices for children aged 2 to 5 years. In this cross-sectional study, child-care providers (n=118) from 24 center-based programs (six Head Start [HS], 11 Child and Adult Care Food Program [CACFP] funded, and seven non-CACFP) completed self-administered surveys during 2011-2012. Multilevel multivariate linear regression models were used to predict seven feeding practices. Working in an HS center predicted teaching children about nutrition and modeling healthy eating; that may be attributed to the HS performance standards that require HS providers to practice healthful feeding. Providers who reported being concerned about children's weight, being responsible for feeding children, and had an authoritarian feeding style were more likely to pressure children to eat, restrict intake, and control food intake to decrease or maintain children's weight. Providers with nonwhite race, who were trying to lose weight, who perceived nutrition as important in their own diet, and who had a greater number of nutrition training opportunities were more likely to use restrictive feeding practices. These findings suggest that individual- and child-care-level factors, particularly provider race, education, training, feeding attitudes and styles, and the child-care context may influence providers' feeding practices with young children. Considering these factors when developing interventions for providers to meet feeding practice recommendations may add to the efficacy of childhood obesity prevention programs.

Risk factors for overweight/obesity in preschool children: an ecological approach.

BACKGROUND: Identification of risk factors is critical to preventing the childhood obesity epidemic. Risk factors that contribute to obesity are multifactorial. However, limited research has focused on identifying obesity risk factors using an ecological approach. METHODS: Baseline self-report survey data from the STRONG Kids program were used. The sample consisted of 329 parent-child dyads recruited from childcare programs in east-central Illinois. Child height and weight were measured and converted to age- and sex-specific z-scores using standard growth charts. An ecological model provided the theoretical framework for the selection of 22 previously reported childhood obesity risk factors. Multiple logistic regression analyses were used to identify risk factors. RESULTS: Of 22 potential risk factors, three were found to be significantly associated with child overweight/obesity. These included child nighttime sleep duration (χ(2)=8.56; p=0.003), parent BMI (χ(2)=5.62; p=0.01), and parental restrictive feeding for weight control (χ(2)=4.77; p=0.02). Children who slept for 8 hours and less were 2.2 times more likely to be overweight/obese [95% confidence interval (CI): 1.3-3.7), whereas children with an overweight/obese parent were 1.9 times more likely to be overweight/obese (95% CI: 1.12-3.2). Finally, children whose parents used restrictive feeding practices were 1.75 times more likely to be overweight/obese (95% CI: 1.06-2.9). CONCLUSIONS: Using an ecological approach, we conclude that childhood obesity prevention efforts may benefit from targeting the key risk factors of child sleep duration, parent BMI, and parental restrictive feeding practices as focus areas for obesity prevention.

Academy of Nutrition and Dietetics benchmarks for nutrition in child care 2011: are child-care providers across contexts meeting recommendations?

The Academy of Nutrition and Dietetics (Academy) recommends feeding practices for child-care providers to establish nutrition habits in early childhood to prevent obesity. With >12 million US children in child care, little is known about child-care providers' feeding practices. The purpose of this study was to examine child-care providers' feeding practices to assess whether providers met the Academy's benchmarks and whether attainment of benchmarks varied across child-care contexts (Head Start, Child and Adult Care Food Program [CACFP], and non-CACFP). Cross-sectional data was collected in 2011 and 2012 from 118 child-care providers who completed self-administered surveys regarding their feeding practices for 2- to 5-year-old children. χ(2) tests and analysis of variance were used to determine variation across contexts. Head Start providers sat more frequently with children during meals (P=0.01), ate the same foods as children (P=0.001), and served meals family style (P<0.0001) more often compared with CACFP and non-CACFP providers. Head Start providers (P=0.002), parents (P=0.001), and children (P=0.01) received more nutrition-education opportunities compared with CACFP and non-CACFP. Head Start providers encouraged more balance and variety of foods (P<0.05), offered healthier foods (P<0.05), modeled healthy eating (P<0.001), and taught children about nutrition (P<0.001) compared with CACFP and non-CACFP providers. Providers across all three contexts used significantly more non-internal than internal mealtime verbal comments (P<0.0001). Head Start providers had greater compliance with the Academy's benchmarks compared with CACFP and non-CACFP providers. Possible reasons for this compliance might be attributed to Head Start nutrition performance standards and increased nutrition-training opportunities for Head Start staff. Head Start programs can serve as a model in implementing the Academy's benchmarks.

Childhood obesity prevention from cell to society.

Nearly 40% of US children are overweight or obese. We propose that a cell-to-society integrative approach is needed that takes into account biology, early child development, home and childcare environments, and public policy. This approach requires researchers, families, and policy makers to work together to develop preventative strategies and interventions that benefit the nutrition and wellbeing of young children and their families, and ultimately the health of the nation.