Outdoor Time, Space, and Restrictions Imposed on Children's Play in Australian Early Childhood Education and Care Settings during the COVID Pandemic: A Cross-Sectional Survey from Educators' Perspective.

The study aimed to investigate the impact of COVID-19 restrictions on children's access to the outdoors in early childhood education and care (ECEC) settings. An online survey comprised of a standardised scale and questions used in previous related studies was completed by 143 early childhood educators across Australia. Participants were asked to report children's time spent outdoors, access to outdoor space, and restrictions imposed on children's play during the pandemic compared to the pre-pandemic period. The survey responses were imported into SPSS for descriptive, correlation, and ordinal regression analyses. We examined the relationship between children's outdoor time, space, restrictions imposed on children's play, and educators' characteristics, such as qualifications, professional development, and tolerance of risk or staff-child ratios during the pandemic in Australia. Most educators reported that children's outdoor time and access to outdoor space remained the same compared to before the pandemic, while imposed restrictions on children's outdoor play increased. The results of ordinal regressions indicated that educators with a higher tolerance of risk were less likely to impose additional restrictions on children's outdoor play. The findings contribute to the understanding of how educators' tolerance of risk influences children's outdoor play opportunities and provide directions for future risk-reframing interventions.

Impacts of COVID-19 Restrictions on Young Children's Outdoor Activity: A Systematic Review.

We sought to identify and synthesise available evidence to aid the understanding of the impact that COVID-19 restrictions had on the outdoor activity of children aged from birth to 12 years. Seven databases (Education Research Complete, ERIC, MEDLINE, PsycINFO, SPORTDiscus, Psychology and Behavioural Sciences Collection, WHO COVID-19 Database) were searched for relevant journal articles in English published from 2020 on. Four qualitative and eleven quantitative studies were included after screening. JBI's Critical Appraisal Tools were used for quality assessment. All qualitative studies showed an increase in outdoor activity. Less than half of the quantitative studies indicated an increase. Family demography, home characteristics, access to outdoor spaces, and parental support/encouragement/co-play were influential factors. The evidence also supports the recommendation for educators to increase children's outdoor play time to adhere to the physical distancing guidance and sanitisation requirements. Limited evidence suggests that when COVID-19 restrictions led to decreased outdoor activity, it was associated with less peer socialisation. We identified significant gaps in understanding of the impact of COVID-19 restrictions on young children's outdoor activity.

Parent engagement with the New South Wales child health home-based record: A cross-sectional survey and a retrospective chart review.

BACKGROUND: In 2018, World Health Organization endorsed universal use of home-based records to improve care for mothers, pregnant women, newborns and children. New South Wales (NSW), Australia has had universal use of a child health home-based record since 1988, with the first major update in 2013. Since the update, limitedbelief is sufficient for constituting evidence has been collected about factors influencing parent use of the record. This study aims to examine parent engagement with the record and whether it is influenced by child's first-born status and Parent Evaluation of Development Status (PEDS) outcome. METHOD: A survey of 202 parent-child pairs and a review of 20 record books were conducted in NSW, Australia. Odds ratio (OR) at 95% confidence interval (CI) and .05 level of significance, bivariate and multivariate logistic regressions were conducted to examine the influence of first-born status, child's PEDS outcome and other parent-child characteristics on parent engagement with the record. RESULTS: Parents engaged with the home-based record by taking it for routine checks (80.7%), writing (74.8%) or reading (75.8%) information. Parents of first-born children were more than three times likely to take the record book for routine checks compared with parent of later-born children (adjusted OR [AOR] = 3.70, 95% CI 1.12-12.20). Similarly, parents of children with low PEDS level of risk were significantly less likely to read information in the record book compared with parents of children with high risk (AOR = 0.28, 95% CI 0.08-0.98). Parent record input through direct observation significantly decreased from 85% at 1-month to 60% at 12-month postnatal. Data about at least one vaccination event were recorded in all the record books examined, while 85% had all recommended vaccinations recorded. CONCLUSION: Parents valued/engaged regularly with a child health home-based record, and the record may be a useful tool for early detection and monitoring of child developmental concerns. Therefore, continued promotion of the use of child health home-based record appears to play an important role in improving child health and development.

Predictors of Parent Use of a Child Health Home-Based Record and Associations with Long-Term Child Health/Developmental Outcomes: Findings from the Longitudinal Study of Australian Children from 2004 to 2016.

PURPOSE: This study aims to examine predictors of parent use of a child health home-based record and associations with child health/developmental outcomes. DESIGN AND METHODS: Data for this study was obtained from a nationally representative study of Australian children from 2004 to 2016. The current study focuses on the kindergarten cohort of the Longitudinal Study of Australian Children, which enrolled children at the ages of 4-5 years. Logistic regression was used to analyse the data using Odds Ratio (OR) at 95% Confidence Interval (CI) and p-value of 0.05. RESULTS: A total of 4983 parent-child pairs participated at the beginning of the study in 2004, which reduced to 3089 (62%) by 2016. The most significant predictor of home-based record use was co-parenting, with single parents less likely to use the record (Adjusted OR = 0.633-95%CI:0.518-0.772). Similarly, child up-to-date immunisation was 31% higher among parents who used the record (OR = 1.313-95%CI:1.049-1.644). Children without a home-based record had increased odds of having various health/developmental concerns (p < 0.05). CONCLUSION: The findings suggest that using a home-based record may have a long-term impact on child health and development. It is also possible that home-based records are more likely to be used by parents of relatively healthy children. Further work is needed to consider if home-based records need to be modified for parents of children with health/development problems. PRACTICE IMPLICATIONS: Nurses and other primary care providers at forefront of family health should ensure proper use of child health home-based records as well as promote its use by parents and caregivers of children.

"How about We Give It a Go?": A Case Study on Supporting Breastfeeding Families in an Australian Child Care Centre.

The World Health Organization (WHO) recommends exclusive breastfeeding for six months and continuation of breastfeeding for up to two years. Formal child care has an important role in supporting breastfeeding, as many Australian infants commence care before two years of age. Currently, little is known about support or barriers in child care contexts. The present qualitative instrumental case study explores practices which protect, promote and support breastfeeding at a child care centre located in the Australian Capital Territory's outer suburbs. Extending from a previously published collective case study, a cultural-institutional focus of analysis was used to explore the roles of proximity, flexibility and communication in supporting breastfeeding within a child care centre located close to an infant's home. Interviews with centre staff and mothers, triangulated with observations of the centre environment and policy documents provide insight into the environment. Affirming the roles of flexibility in routine and staff rostering and two-way communication, findings suggest longer-term benefits may be derived from selecting a child care centre close to an infant's home, provided mothers can overcome barriers to breastmilk expression in the workplace. The study recognises the role of non-lactating caregivers in the transition to formal child care, and of the support culture for educators who breastfeed. This study extends the knowledge base of breastfeeding support interventions in the child care setting to inform future research and policy.

Is Parent Engagement with a Child Health Home-Based Record Associated with Parents Perceived Attitude towards Health Professionals and Satisfaction with the Record? A Cross-Sectional Survey of Parents in New South Wales, Australia.

We examined parent views of health professionals and satisfaction toward use of a child health home-based record and the influence on parent engagement with the record. A cross-sectional survey of 202 parents was conducted across New South Wales (NSW), Australia. Bivariate and multivariate logistic regressions were conducted to identify predictors of parent engagement with the record book using odds ratio (OR) at 95% confidence interval (CI) and 0.05 significance level. Parents reported utilizing the record book regularly for routine health checks (63.4%), reading the record (37.2%), and writing information (40.1%). The majority of parents (91.6%) were satisfied with the record. Parents perceived nurses/midwives as most likely to use/refer to the record (59.4%) compared to pediatricians (34.1%), general practitioners (GP) (33.7%), or other professionals (7.9%). Parents were less likely to read the record book if they perceived the GP to have a lower commitment (Adjusted OR = 0.636, 95% CI 0.429-0.942). Parents who perceived nurses/midwives' willingness to use/refer to the record were more likely to take the record book for routine checks (Adjusted OR = 0.728, 95% CI 0.536-0.989). Both parent perceived professionals' attitude and satisfaction significantly influenced information input in the home-based record. The results indicate that improvements in parent engagement with a child health home-based record is strongly associated with health professionals' commitment to use/refer to the record during consultations/checks.

Is parent engagement with a child health home-based record influenced by early child development and first-born status? hypotheses from a high-income countries' perspective.

Home-based records for child health are widely used for documenting primary healthcare services including vaccinations and health screening. It serves as an educational tool for parents and promote continuity of care as well as communication between health professionals and parents. In our previous systematic review, we identified that parents in low- and middle-income countries and high-income countries value such a record and consider it important for childcare, yet questions were raised about its wide distribution and utilisation in high-income countries. We therefore aim to examine predictors that could be related to the use/usefulness of the record book in a high-income country, Australia. We hypothesize that parent engagement with the child health home-based record may be influenced by early child development (in-terms of age and hitting milestones) as measured by parent evaluation of developmental status (PEDS) tool and first-born status of the child (as compared to later-born). To test these hypotheses, we will be conducting a community-based survey and review of the record books across New South Wales state of Australia. This paper includes a summary of the findings of our previous review study that prompted the development of these hypotheses and the study protocol we will follow to test these hypotheses.

Creating play opportunities on the school playground: Educator experiences of the Sydney playground project.

INTRODUCTION: Children with disabilities often experience unsupportive environments that restrict their play opportunities and inclusion on the school playground. This exclusion can perpetuate inequities for children with disabilities, with lifelong implications. The Sydney Playground Project uses a simple, innovative intervention consisting of placing recycled materials on the playground and engaging parents and educators in risk reframing sessions to create increased playground choice, control, independence and inclusion for all children. METHODS: The purpose of this study was to learn from participants about the utility of the intervention for promoting choice and control among children with disability on the school playground. Data included evaluative interviews with 27 school staff (teaching assistants, teachers, therapists, school leadership) across five participating schools after completing of the intervention. Analysis was thematic and explored prominent ideas first within schools, and then between schools. RESULTS: Prior to the intervention, participating school staff focused on active supervision to support play and student needs. During the intervention, school staff experienced role shift and confusion as they allowed the children increased independence while using the recycled materials and learned to navigate how much independence to give the children. Children engaged in increased imaginative and social play, and school staff adopted higher expectations of children's capabilities. CONCLUSION: Interventions such as the Sydney Playground Project that collaboratively shift adult perceptions to focus on the capabilities of children with disabilities and increase the supportiveness of the physical environment have great promise in increasing play choice and inclusion on the school playground.

Construct Validity and Test-Retest Reliability of the Coping Inventory (CI) for Children With Developmental Disabilities.

OBJECTIVE: A reliable, valid, and readily usable method of measuring coping is essential for occupational therapy practitioners and researchers working with children with developmental disabilities. The aim of this study was to examine evidence for the construct validity and internal and test-retest reliability of the Coping Inventory (CI), a 48-item survey designed for use with children. METHOD: School staff (N = 39) completed CIs for 79 students with developmental disabilities age 5-13 yr (mean = 8.0, standard deviation = 2.0) who were primarily boys (n = 52; 68%) with autism spectrum disorder (n = 40 of 47 diagnoses provided). We used Rasch analysis to examine construct validity, internal reliability, and possible redundancy of items and intraclass correlations, Pearson correlations, Bland-Altman plots, and t tests were used to examine test-retest reliability. RESULTS: Rasch analysis provided evidence of construct validity: All items correlated positively with the overall measure; data from 94% of items conformed with Rasch expectations, and the items form a logical hierarchy. Intraclass correlations revealed an average coefficient of .96, providing evidence of test-retest reliability. CONCLUSION: The CI demonstrated good evidence for construct validity and internal and test-retest reliability. Redundancy of items suggests that some items could be eliminated after further research.

Are Parent-Held Child Health Records a Valuable Health Intervention? A Systematic Review and Meta-Analysis.

Parent-held child health record (PHCHR), a public health intervention for promoting access to preventive health services, have been in use in many developed and developing countries. This review aimed to evaluate the use of the records toward promoting child health/development. We searched PubMed, PsycINFO, CINAHL, Cochrane Library and Google Scholar to identify relevant articles, of which 32 studies met the inclusion criteria. Due to considerable heterogeneity, findings were narratively synthesised. Outcomes with sufficient data were meta-analysed using a random-effects model. Odds Ratio (OR) was used to compute the pooled effect sizes at 95% confidence interval (CI). The pooled effect of the PHCHR on the utilisation of child/maternal healthcare was not statistically significant (OR = 1.31, 95% CI 0.92⁻1.88). However, parents who use the record in low- and middle-income countries (LMIC) were approximately twice as likely to adhere to child vaccinations (OR = 1.93, 95% CI 1.01⁻3.70), utilise antenatal care (OR = 1.60, 95% CI 1.23⁻2.08), and better breastfeeding practice (OR = 2.82, 95%CI 1.02⁻7.82). Many parents (average-72%) perceived the PHCHR as useful/important and majority (average-84%) took it to child clinics. Health visitors and nurses/midwives were more likely to use the record than hospital doctors. It is concluded that parents generally valued the PHCHR, but its effect on child health-related outcomes have only been demonstrated in LMIC.

Sydney Playground Project: A Cluster-Randomized Trial to Increase Physical Activity, Play, and Social Skills.

BACKGROUND: We assessed the effectiveness of a simple intervention for increasing children's physical activity, play, perceived competence/social acceptance, and social skills. METHODS: A cluster-randomized controlled trial was conducted, in which schools were the clusters. Twelve Sydney (Australia) primary schools were randomly allocated to intervention or control conditions, with 226 children (5-7 years old) selected randomly to participate. Data were collected at baseline and after 13 weeks. The intervention consisted of introducing recycled materials without an obvious play purpose into school playgrounds and a risk-reframing workshop for parents and teachers. RESULTS: Children from the intervention schools increased physical activity and reduced sedentary time while control schools decreased physical activity and increased sedentary time. The intervention yielded increases in total accelerometer counts (ß = 9350 counts, 95% CI 3490-1522, p = .002), minutes of moderate/vigorous physical activity (MVPA) (ß = 1.8 min, 95% CI 0.52-3.12, p = .006), and reductions in sedentary time (ß = -2.1 min, 95% CI -3.77-(-0.51), p = .01). Although the changes in time spent in play and nonplay were not statistically different (p = .08) the effect size (d = .27) indicates clinical significance. CONCLUSIONS: This intervention was effective for increasing MVPA during recess and demonstrated capacity to improve play opportunities in school playgrounds.

The Sydney playground project--levelling the playing field: a cluster trial of a primary school-based intervention aiming to promote manageable risk-taking in children with disability.

BACKGROUND: Providing children and adults with opportunities to engage in manageable risk taking may be a stepping stone toward closing the gap in life conditions currently experienced by young people with disabilities. We aim to demonstrate the effectiveness of a simple, innovative program for 1) changing the way parents and teachers view manageable risk-taking for children with disabilities and 2) increasing the level of responsibility that children take for their own actions, as seen on the school playground. METHODS/DESIGN: We will employ a cluster repeated measures trial with six Sydney-area primary-school-based programs for children with disabilities. The intervention comprises two arms. 1) Risk-reframing--teachers and parents will participate together in small group intervention sessions focusing on the benefits of manageable risk-taking; 2) Introduction of play materials--materials without a defined purpose and facilitative of social cooperation will be introduced to the school playground for children to use at all break times. A control period will be undertaken first for two school terms, followed by two terms of the intervention period. Outcome measures will include playground observations, The Coping Inventory, qualitative field notes, and The Tolerance of Risk in Play Scale. DISCUSSION: New national programs, such as Australia's National Disability Insurance Scheme, will place increasing demands on young people with disabilities to assume responsibility for difficult decisions regarding procuring services. Innovative approaches, commencing early in life, are required to prepare young people and their carers for this level of responsibility. This research offers innovative intervention strategies for promoting autonomy in children with disabilities and their carers. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registration Number ACTRN12614000549628 (registered 22/5/2014).

Young children's after-school activities - there's more to it than screen time: a cross-sectional study of young primary school children.

BACKGROUND: Children can spend substantial amounts of leisure time in sedentary activities, dominated by TV/screen time. However, objective real-time measurement of activities after school among young school children is seldom described. METHODS: School children (n = 246, 5-7 years old, mean 6.0) and their parents were recruited by random selection from 14 schools across Sydney, Australia. Parents used a real-time objective measure (Experience Sampling Method, ESM) to record children's activities and whether they were indoors or outdoors at 3 random times each day after school. Data were collected across 4 weekdays in 1 week and then, 13 weeks later, another 4 weekdays in 1 week. RESULTS: Results were based on 2940 responses from 214 child-parent dyads showed that 25% of behavior involved physical activity, 51% was spent in sedentary activities, and 22% was TV/screen time. Most instances (81%) occurred indoors. CONCLUSION: Despite a high proportion of TV/screen time, children were also engaged in a range of other sedentary and physically active pursuits after school. Hence TV/screen time is not a suitable proxy for all sedentary behavior, and it is important to gather information on other non-screen-based sedentary and physically active behaviors. Future research is warranted to further investigate after-school activities in young primary school children.

Understanding Patterns of Young Children's Physical Activity After School--It's all About Context: A Cross-Sectional Study.

BACKGROUND: To promote healthy lifestyles, we need to understand more about the patterns of children's activities after school. METHODS: Twenty 5- to 7-year-old children and their parents participated in this study. Parents used 'real-time' diaries to report children's activities and contextual information at 3 randomly selected times per day, over 4 week days. Reporting was repeated after 13 weeks. Simultaneously children wore Actical accelerometers. RESULTS: Approximately 300 simultaneous accelerometer measurements and diary entries were compared. Mean physical activity levels were highest when children engaged in activities generally considered as "active" and lowest for doing "nothing." However, the range within activities was very large; some children who reported TV/screen time accumulated high accelerometry counts and conversely, some children were practically sedentary during organized sports. Children spent most (78%) of their after school time indoors, but the children were significantly more active outdoors than indoors [t(74.8) = 5.0, P < .001]. CONCLUSIONS: Accelerometer data in conjunction with real-time diaries provide a more complete understanding of the value of outdoor play in increasing movement opportunities for children's after school activities.

Increasing physical activity in young primary school children--it's child's play: a cluster randomised controlled trial.

OBJECTIVE: To explore the effects of an innovative school-based intervention for increasing physical activity. METHODS: 226 children (5-7 years old) randomly selected from 12 Australian primary schools were recruited to a cluster randomised trial with schools randomly allocated to intervention or control conditions. The 13-week intervention comprised: (1) altering the school playground by introducing loose materials and (2) a teacher-parent intervention exploring perceptions of risk associated with children's free play. The primary outcomes were total accelerometer counts and moderate-vigorous physical activity during break times. Testing took place in Sydney, 2009-2010. RESULTS: 221 participants were tested at baseline. Mixed-effect multilevel regression revealed a small but significant increase from the intervention on total counts (9400 counts, 95% CI 3.5-15.2, p=0.002) and minutes of MVPA (1.8 min, 95% CI 0.5-3.1, p=0.006); and a decrease in sedentary activity (2.1 min, 95% CI 0.5-3.8, p=0.01) during break times. We retested children in one intervention school after 2 years; they maintained the gains. CONCLUSIONS: Capturing children's intrinsic motivations to play while simultaneously helping adults reconsider views of free play as risky provided increases in physical activity during break times. Using accelerometry as the sole measure of physical activity may underestimate the effect. TRIAL REGISTRATION: ACTRN12611000089932.

The Sydney playground project: popping the bubblewrap--unleashing the power of play: a cluster randomized controlled trial of a primary school playground-based intervention aiming to increase children's physical activity and social skills.

BACKGROUND: In the Westernised world, numerous children are overweight and have problems with bullying and mental health. One of the underlying causes for all three is postulated to be a decrease in outdoor free play. The aim of the Sydney Playground Project is to demonstrate the effectiveness of two simple interventions aimed to increase children's physical activity and social skills. METHODS/DESIGN: This study protocol describes the design of a 3-year cluster randomised controlled trial (CRCT), in which schools are the clusters. The study consists of a 13-week intervention and 1 week each of pre-and post-testing. We are recruiting 12 schools (6 control; 6 intervention), with 18 randomly chosen participants aged 5 to 7 years in each school. The two intervention strategies are: (1) Child-based intervention: Unstructured materials with no obvious play value introduced to the playground; and (2) Adult-based intervention: Risk reframing sessions held with parents and teachers with the aim of exploring the benefits of allowing children to engage in activities with uncertain outcomes. The primary outcome of the study, physical activity as measured by accelerometer counts, is assessed at baseline and post-intervention. Additional assessments include social skills and interactions, self-concept, after school time use and anthropometric data. Qualitative data (i.e., transcriptions of audio recordings from the risk reframing sessions and of interviews with selected teacher and parent volunteers) are analysed to understand their perceptions of risk in play. The control schools have recess as usual. In addition to outcome evaluation, regular process evaluation sessions are held to monitor fidelity to the treatment. DISCUSSION: These simple interventions, which could be adopted in every primary school, have the potential of initiating a self-sustaining cycle of prevention for childhood obesity, bullying and mental ill health. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registration Number ACTRN12611000089932.

Effects of targeted reading instruction on phonological awareness and phonic decoding in children with down syndrome.

This research evaluated the effectiveness of reading instruction targeting oral reading and phonological awareness for children with Down syndrome (affecting chromosome 21). The participants were 7 children ranging in age from 2 years, 11 months to 10 years, 8 months. Each child acted as his/her own control, with assessments of language, cognition, phonological awareness, word and short-passage comprehension, and oral reading ability conducted on four occasions (initially, preintervention, postintervention and delayed postintervention) over approximately a 12-month period. The intervention was conducted over 10 weekly sessions and involved individual instruction. The postintervention assessment results provided evidence that phonic reading instruction was generally effective in improving reading skills and phonological awareness of children with Down syndrome.

Playful interaction: occupational therapy for all children on the school playground.

We examined the impact of an intervention on the playfulness of 5- to 7-year-old children who are developing typically. Materials that had no defined purpose were placed on a school playground for 11 weeks. The Test of Playfulness (ToP) was used to compare videotaped play segments pre- and postintervention. Teachers who did playground duty were interviewed regarding changes in play. ToP data were analyzed using a Wilcoxon signed-ranks test. Interview data were analyzed for themes. ToP scores were significantly higher after intervention (Z= -1.94; p = .025, one-tailed; Cohen's d = 0.55). Teachers reported that children were more social, creative, and resilient when the materials were on the playground. Children who were creative, rather than very physically capable, became leaders in activity. Our results revealed a potential role for occupational therapists with typically developing children in schools. This finding has clear implications for children with disability.