Effects of Structured Physical Activity on Motor Fitness in Preschool Children.

The aim was to investigate the impact of a specific structured movement activities (SMA) program compared to free play activity (FRP) on the strength, speed, agility, coordination, and balance of motor fitness (MF) in 6-year-old boys and girls. A total of 53 children (24 boys, 29 girls) were randomly allocated to either the SMA group or the FRP group. Both group activities were administered three times a week over a 6-month period. MF variables were assessed before (pre-) and after (post-) using tests: the flamingo balance (FLA), the standing long jump (SLJ), plate tapping (PTT), the obstacle course backwards (OCB), and the shuttle run 4 × 5 m (SRT). At the post-test, the SMA program resulted in significant (p < 0.05) improvements in OCB, PTT, SLJ, and SRT tasks. For FRP, a noteworthy improvement was observed only in OCB (ES = 0.45, p < 0.05). An ANCOVA revealed a significant group × time interaction (F = 21.71-52.41, η2 = 0.258-0.512, p < 0.01) for OCB, PTT, and SRT, favoring SMA over FRP. The present findings suggest that SMA may be more effective than FRP when aiming to develop motor coordination, agility, and speed of movement in children.

Associations between outdoor play features and children's behavior and health: A systematic review.

The decline of children's opportunities to play outdoors raises a new concern about the quality of outdoor play environments, and their developmental and well-being benefits for children. This systematic review aims to synthesize the associations between outdoor play features and children's behavior and health. PRISMA guidelines were followed (2021). The inclusion criteria were studies with children aged between 5 and 12 (Population); that addressed presence, absence or disposition of equipment, natural elements, loose parts, resources availability, type of terrain and space modifications (Intervention or Exposure); in pre-post intervention or between groups (Comparison); related to health and behavior in different domains (Outcomes); with an experimental, observational, descriptive or longitudinal design (Study design). Indoor context, adult-led activities and structured activities were excluded. A literature search of five databases (PubMed, Web of Science, ERIC, Scopus, and PsycINFO) was concluded in March 2022. After identifying 28,772 records, duplicates and irrelevant titles were removed, and abstracts and full-text articles were screened in duplicate. The remaining 51 eligible articles (45 primary studies) were assessed for risk of bias with QualSyst. A narrative synthesis of the results was conducted. The most frequent behavioral or health outcome addressed was physical activity. Included studies focused on the following space features: fixed structures, space naturalness, floor markings, loose parts/equipment, area available, and the combination of factors. Although some positive effects were found, the heterogeneity between studies did not allow to draw firm conclusions on the effects of each environmental feature on primary children's health and behavior. Systematic review registration: PROSPERO CRD42020179501.

Exploring the key drivers of responsive parenting in mothers and fathers - observed and self-reported responsiveness.

BACKGROUND: This article explores parental responsiveness - the ability of a parent to react to a child's needs adequately, promptly, and with tenderness and synchrony. Parental responsiveness can be measured using observational and self-report scales. The purpose of this study was to explore whether individual differences in empathy and attachment in mothers and fathers and their satisfaction with their relationship are predictors of parental responsiveness toward infants. Moreover, self-report and observational measures of parental responsiveness were compared. PARTICIPANTS AND PROCEDURE: A total of 110 triads (mother, father, and child aged 6-10 months) took part in the free play procedure and parents' behaviors towards their children were assessed using the Ainsworth Sensitivity Scale. Moreover, they filled out a set of questionnaires measuring parental self-reported responsiveness, empathy, experiences in close relationships and romantic relationship satisfaction. RESULTS: Higher empathic concern was connected with higher responsiveness and this was seen in both individual and partner measures. At the individual level, measures of responsiveness (self-report and observational) were not congruent and probably depended on other variables. In couples, there were positive correlations in three aspects of their family functioning: observed and self-reported parental responsiveness as well as relationship satisfaction. CONCLUSIONS: This study revealed differences between self-reported and observational measures of parental responsiveness, indicating that their results may not always be congruent and could depend on other variables.

Investigating social inequalities in children's independent mobility, active transportation and outdoor free play in two Canadian cities.

Background: Active transportation (AT) and free play (FP) are the primary ways in which children engage in unstructured physical activity in cities, with independent mobility (IM) gaining increased attention as a potential precursor of AT and FP. However, current trends show that children are engaging in less FP and AT, and have less IM, than previous generations and it is not well understood how these practices, and their interrelatedness, differ by neighbourhood-level socio-economic stats (SES) and municipal contexts. Objectives: This study aims to address the gaps in knowledge by quantifying, comparing, and correlating IM, AT, and FP practices in high and low-SES neighbourhoods within and across the cities of Montreal and Kingston, Canada. Methods: 584 questionnaires were distributed among children in grades 1 to 5, living in low- and high-SES neighbourhoods of these two citiesResultsEngagement in the three practices was low in every study neighbourhood, though all three practices were higher in high-SES compared to low-SES neighbourhoods in both cities. Levels of FP were higher in Kingston compared to Montreal, while AT was higher in Montreal than in Kingston. Conclusion: This study revealed social inequalities in all three of these practices based on socioeconomic status and city. Since IM is likely a precursor to both independent FP and AT, more research is warranted into how our cities can become more conducive to IM in children, particularly in low SES neighbourhoods where children have less freedom of movement independently and otherwise.

Automated Video Tracking of Autistic Children's Movement During Caregiver-Child Interaction: An Exploratory Study.

Objective, quantitative measures of caregiver-child interaction during play are needed to complement caregiver or examiner ratings for clinical assessment and tracking intervention responses. In this exploratory study, we examined the feasibility of using automated video tracking, Noldus EthoVision XT, to measure 159 2-to-7-year-old autistic children's patterns of movement during play-based, caregiver-child interactions and examined their associations with standard clinical measures and human observational coding of caregiver-child joint engagement. Results revealed that autistic children who exhibited higher durations and velocity of movement were, on average, younger, had lower cognitive abilities, greater autism-related features, spent less time attending to the caregiver, and showed lower levels of joint engagement. After adjusting for age and nonverbal cognitive abilities, we found that children who remained in close proximity to their caregiver were more likely to engage in joint engagement that required support from the caregiver. These findings suggest that video tracking offers promise as a scalable, quantitative, and relevant measure of autism-related behaviors.

Factors associated with implemented teacher-led movement and physical activity in early childhood education and care.

Movement and physical activity (MoPA) is critical for children's development and health. This study aimed to explore early childhood education and care (ECEC) educators' reported frequency of implemented gross motor and physical activities (MoPA) among children in ECEC, as well as the educators' reported personal physical activity (PA) levels in leisure time. A cross-sectional survey was performed in 68 preschools in southern Sweden. Data were obtained from questionnaires completed by 359 ECEC educators. The participation rate was 61%. About two thirds offered MoPA once a week or more seldom, while one quarter offered MoPA at least every other day. Educators who reported personal PA three times or more per week, offered MoPA for the children at least every other day to a higher extent (37%) compared to colleagues who reported personal PA once or twice a week (26%) or colleagues who reported that they were never or seldom active (18%) (p = 0.034). The results from multiple logistic regression analysis showed that reported implemented MoPA among children in ECEC was significantly associated with the educators' perceptions that free play improved children's gross motor skills (OR 2.7), the educators' perceptions of needed curricular guidelines for MoPA (OR 2.1), the educators' own leisure PA level (OR 2.0) and the educators' perceptions that adequate gross motor skills were not learned at home (OR 0.4). Teacher-led MoPA occurs sparingly during the preschool day and the teachers believe that the children get sufficient MoPA in free play. The children are expected to develop their motor skills to a sufficient extent during the short moments of offered outdoor play. Teachers who are physically active in their leisure-time seem to offer gross motor training for the children to a higher extent than less active or inactive colleagues.

The impact of an e-newsletter or animated video to disseminate outdoor free-play information in relation to COVID-19 guidelines in New South Wales early childhood education and care services: a randomised controlled trial.

BACKGROUND: State-based Guidelines were issued for Early Childhood Education and Care (ECEC) services (caring for children 0-6 years) recommending greater time outdoors and inclusion of indoor-outdoor programs to facilitate social distancing to reduce spread of COVID-19. The aim of this 3-arm randomised controlled trial (RCT) was to examine the impact of different dissemination strategies on increasing ECEC service intentions to adopt recommendations from the Guidelines. METHODS: This was a post-intervention only RCT. A sample of eligible ECEC services in New South Wales (n = 1026) were randomly allocated to one of three groups; (i) e-newsletter resource; (ii) animated video resource; or (iii) control (standard email). The intervention was designed to address key determinants of guideline adoption including awareness and knowledge. Following delivery of the intervention in September 2021, services were invited to participate in an online or telephone survey from October-December 2021. The primary trial outcome was the proportion of services intending to adopt the Guidelines, defined as intention to; (i) offer an indoor-outdoor program for the full day; or (ii) offer more outdoor play time. Secondary outcomes included awareness, reach, knowledge and implementation of the Guidelines. Barriers to Guideline implementation, cost of the dissemination strategies and analytic data to measure fidelity of intervention delivery were also captured. RESULTS: Of the 154 services that provided post-intervention data, 58 received the e-newsletter (37.7%), 50 received the animated video (32.5%), and 46 received the control (29.9%). Services who received the animated video had nearly five times the odds (OR: 4.91 [1.03, 23.34] p = 0.046) than those in the control group, to report having intentions to adopt the Guidelines. There were no statistically significant differences in awareness or knowledge of the Guidelines between either intervention or control services. Development costs were greatest for the animated video. The extent to which the dissemination strategy was viewed in full, were similar for both the e-newsletter and animated video. CONCLUSION: This study found potential for the inclusion of interactive strategies to disseminate policy and guideline information within the ECEC setting, in the context of the need for rapid communication. Further research should explore the added benefits of embedding such strategies within a multi-strategy intervention. TRIAL REGISTRATION: Retrospectively registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) on the 23/02/2023 (ACTRN 12,623,000,198,628).

Automated movement tracking of young autistic children during free play is correlated with clinical features associated with autism.

LAY ABSTRACT: Play-based observations allow researchers to observe autistic children across a wide range of ages and skills. We recorded autistic children playing with toys in the center of a room and at a corner table while a caregiver remained seated off to the side and used video tracking technology to track children's movement and location. We examined how time children spent in room regions and whether or not they approached each region during play related to their cognitive, social, communication, and adaptive skills to determine if tracking child movement and location can meaningfully demonstrate clinical variation among autistic children representing a range of ages and skills. One significant finding was that autistic children who spent more time in the toy-containing center of the room had higher cognitive and language abilities, whereas those who spent less time in the center had higher levels of autism-related behaviors. In contrast, children who spent more time in the caregiver region had lower daily living skills and those who were quicker to approach the caregiver had lower adaptive behavior and language skills. These findings support the use of movement tracking as a complementary method of measuring clinical differences among autistic children. Furthermore, over 90% of autistic children representing a range of ages and skills in this study provided analyzable play observation data, demonstrating that this method allows autistic children of all levels of support needs to participate in research and demonstrate their social, communication, and attention skills without wearing any devices.

Effects of Different Teaching Approaches on Proxy Measures of Physical Fitness of Italian Kindergarten Children.

Developing physical fitness (PF) behaviors early in life enhances physical development and facilitates sustained participation in physical activity and sports across childhood. This study addressed the effect of different teaching approaches on precursors of PF in kindergarten children. A total of 178 children (5.45 ± 0.40 years, female = 92) from 11 classes were organized into three groups. Group 1 (structured activity + free play) and Group 2 (only free play) attended the same playground (PrimoSport0246) for one hour/week for 10 weeks. Group 3 (structured activity + free play in kindergarten) followed their standard physical education curriculum at school. PF tests (standing long jump, medicine ball throw, and 20 m running speed) were administered pre- and post-intervention. Factorial ANOVA was implemented using a percentage change in PF performance (PFC) as the dependent variable, and teaching approaches, gender, and age as factors. Group 1 demonstrated significant improvements in fitness performance compared with Groups 2 and 3. Moderate to large effect sizes (Cohen's d range: 0.68-1.40) were noted in both males and females. Six-year-old demonstrated the greatest improvement in composite PFC compared to Groups 2 and 3. A structured teaching plan, even with a limited dose of once per week, supported the development of PF attributes in kindergarteners.

A Pilot Randomised Controlled Trial to Increase the Sustainment of an Indoor-Outdoor-Free-Play Program in Early Childhood Education and Care Services: A Study Protocol for the Sustaining Play, Sustaining Health (SPSH) Trial.

Early Childhood Education and Care (ECEC) settings are important environments to support children's physical activity (PA). In 2021, COVID-19 regulations recommended the provision of indoor-outdoor free-play programs in ECEC settings to reduce the transmission of COVID-19, resulting in an increased uptake of this practice. As the context has since changed, research suggests that ECEC services could cease the implementation of these practices. Therefore, this pilot randomised controlled trial (RCT) aims to examine the feasibility, acceptability, and impact of a sustainment strategy to ensure the ongoing implementation (sustainment) of ECEC-delivered indoor-outdoor free-play programs. Twenty ECEC services located in New South Wales, Australia that have implemented indoor-outdoor free-play programs since the release of COVID-19 guidelines will be recruited. The services will be randomly allocated either the sustainment strategy or usual care. The "Sustaining Play, Sustaining Health" program consists of eight strategies, developed to address key barriers against and facilitators of sustainment informed by the Integrated Sustainability Framework. The outcomes will be assessed via internal project records, staff surveys, and a self-reported measure of free play. This study will provide important data to support the performance of a fully powered trial within Australian ECEC settings and to inform the development of future sustainment strategies.

Mommy, Can I Play Outside? How Urban Design Influences Parental Attitudes on Play.

Although play results in physical, social, and cognitive benefits, there is a consensus that children's opportunities to play have been reduced, particularly for those who live in urban environments. What are the barriers to play, and how can we mitigate them? This review examines a critical factor in play opportunities: parents as the decision-makers with regard to children's play. Using perspectives from psychology, urban design, and cognitive science, we analyze the relationships between the design of built environments, parental attitudes and beliefs, and parental decisions on allowing children to play. For example, can a new implementation of children-centered urban design change parents' skeptical attitude toward play? By drawing from global studies, we chart (1) the three key beliefs of parents regarding play and built environments: play should benefit learning, be safe, and match the child's competence and (2) the design principles that can foster these beliefs: learning, social, and progressive challenge designs. By making the link between parents, urban design, and play explicit, this paper aims to inform parents, educators, policymakers, urban planners, and architects on the evidence-based measures for creating and increasing opportunities to play.

Playing at the Schoolyard: "The Who's, the What's and the How Long's" of Loose Parts.

Play has a key role in children psychomotor development, and the quality of play spaces can be a facilitator of the former. The physical properties of the environment, such as equipment or material available, can influence children's behavior. However, it is not clear how the provision of different loose parts impacts children's play patterns. This study aimed to analyze the influence of four types of loose parts on the time, frequency and number of children using them during free play sessions. We recorded the 1st, 5th and 10th sessions delivered by playworkers in a primary school, with 14 children (Mage = 9.96 years). The available loose parts were categorized, and four types of materials were chosen: tarpaulin/fabrics, cardboard boxes, plastic crates and plastic tubes. The influence of these materials on the time spent using them, frequency of use and number and sex of users (dependent variables) was analyzed. Some tendencies emerged, such as the popularity of tarpaulin/fabrics, but results showed no significant differences between materials. This could mean that the specific physical qualities of each loose part were not determiners of the behavioral domains analyzed. These findings suggest that all types of materials studied can be meaningful for children to engage with in diverse play opportunities.

Infants' behaviours elicit different verbal, nonverbal, and multimodal responses from caregivers during early play.

Caregivers use a range of verbal and nonverbal behaviours when responding to their infants. Previous studies have typically focused on the role of the caregiver in providing verbal responses, while communication is inherently multimodal (involving audio and visual information) and bidirectional (exchange of information between infant and caregiver). In this paper, we present a comprehensive study of caregivers' verbal, nonverbal, and multimodal responses to 10-month-old infants' vocalisations and gestures during free play. A new coding scheme was used to annotate 2036 infant vocalisations and gestures of which 87.1 % received a caregiver response. Most caregiver responses were verbal, but 39.7 % of all responses were multimodal. We also examined whether different infant behaviours elicited different responses from caregivers. Infant bimodal (i.e., vocal-gestural combination) behaviours elicited high rates of verbal responses and high rates of multimodal responses, while infant gestures elicited high rates of nonverbal responses. We also found that the types of verbal and nonverbal responses differed as a function of infant behaviour. The results indicate that infants influence the rates and types of responses they receive from caregivers. When examining caregiver-child interactions, analysing caregivers' verbal responses alone undermines the multimodal richness and bidirectionality of early communication.

Quality early childhood education and care in a time of COVID-19.

Contextual approaches to high quality Early Childhood Education and Care (ECEC) seek to capture the complexity of children's lives, developing pedagogical approaches that are responsive to children's needs and interests. In 2020, the COVID-19 pandemic provided a complex layer to the question of what constitutes quality ECEC. A mixed methods appreciative inquiry of educators' and parents' views of quality in one ECEC setting in England, became an unexpected ethnographic exploration of quality ECEC in the time of a global pandemic. The findings indicate how features of quality, such as offering a range of learning environments and structuring the pedagogic environment to offer free-flowing play, had to be adapted to prevent the spread of COVID-19. The focus on quality shifted, prioritising the health and safety of families and staff, over the quality and variety of the curriculum. Greater emphasis was also placed on children's social and emotional well-being to support their ability to understand and manage the changes to routines in response to the pandemic. The findings demonstrate that the early years workforce remains central to understanding and supporting quality, concluding that quality ECEC is shaped by adaptability - adapting to the needs of children, families, staff, and the unprecedented context of COVID-19. The focus on adaptability seeks to highlight how educators frequently respond to unique contexts in juggling concepts of quality ECEC. Consequently, a recommendation is made for future educator training to consider the importance of adaptability, in providing a useful framework for reimaging quality ECEC post COVID-19.

Resonance Effects in Variable Practice for Handball, Basketball, and Volleyball Skills: A Study on Contextual Interference and Differential Learning.

Effective sports training should be attuned to the athlete's specific conditionings and characteristics. In motor learning research, two often neglected factors that influence this resonance are the learner's athletic background and the structural diversity of exercises (e.g., relative similarity). In the setting of real-word training with higher external validity, this study examines the effects of three learning approaches (i.e., contextual interference (CI), differential learning (DL), and free-play control condition (CO)) on the parallel learning of handball (HB), volleyball (VB), and basketball (BB) skills, considering participants' prior sport backgrounds. Forty-five males (15 HB, 15 VB, and 15 BB players) with a mean age of 22 ± 1.4 years and at least 6 years of experience in the mastered discipline voluntarily participated in this study. A pre-post-retention test design including a 6-week-intervention program was employed. During the intervention period, participants engaged in three training sessions a week, with each one lasting approximately 80 min. Each of the three test sessions involved the execution of ten attempts of BB free-throw shooting, HB three-step goal throwing, and VB underarm passing following a blocked order. In terms of short-term (pre-post) gain, only the DL group significantly improved their performance in both non-mastered disciplines (p = 0.03, ES = 1.58 for the BB free-throw and p = 0.05, ES = 0.9 for the HB shooting tests), with a trend (ES = 0.53) towards an improvement in the performance of the mastered VB underarm-pass skill. In terms of relatively permanent gains, the CI group significantly improved their performances from pre- to retention test only in the non-mastered BB free-throw skill (p = 0.018, ES = 1.17). In contrast, the DL group significantly improved their performance at retention compared to the pre-test in both non-mastered BB (p = 0.004, ES = 1.65) and HB (p = 0.003, ES = 2.15) skills, with a trend (ES = 0.4) towards improvement in the mastered VB test. In both the short-term and relatively long-term, higher composite score gains were observed in DL compared to CI (p = 0.006, ES = 1.11 and 0.049, ES = 1.01) and CO (p = 0.001, ES = 1.73 and <0.0001, ES = 2.67). In conclusion, the present findings provide additional support for the potential advantages of the DL model over those of CI. These findings can serve as the basis for tailored training and intervention strategies and provide a new perspective for addressing various issues related to individual and situational learning.

The flux and flow of free-play and paradox.

This paper addresses the centrality of play and paradox for the emergence of symbol formation in the liminal space "between" the opposites that offer constraint on the analytic dyad. Complex Adaptive Systems theory is interwoven with Jungian ideas to consider the importance and, sadly, the diminishment of 'free play' globally. The possible relationship between the state of mind needed for 'free play' as similar to the state while in REM dream sleep is described. A clinical sandtray case provides grounding for the way that the implicit, procedural domain is relevant for shaping the interactions and patterns that emerge in the present moment that reflect both the past and the unfolding future. Amplification related to the patient's cultural background opened an understanding of imaginative engagement with family and friends in her history that revealed attachment alternatives. Further, Greek Hermes as a symbol of connection and paradox is offered along with Egyptian Nut and Seb who represent the need for space and the necessary differentiation that opens room for the flux and flow of creative energy within a system.

Cet article s'occupe de la place centrale du jeu et du paradoxe pour l'émergence de la formation du symbole dans l'espace intermédiaire, « entre ¼ les opposés, et qui offre une contrainte à la dyade analytique. La théorie des Systèmes Complexes Adaptifs est entrecroisée avec les idées Jungiennes pour considérer globalement l'importance - et tristement la diminution - du jeu libre. L'article décrit la relation entre deux états d'esprit similaires : celui requis pour le jeu libre et celui du sommeil paradoxal. Un cas de thérapie par le jeu de sable fournit les bases pour comprendre la façon dont le domaine lié à la mémoire implicite et procédurale est pertinent pour donner forme aux interactions et aux schémas qui émergent dans le moment présent et qui reflètent à la fois le passé et le futur en train d'apparaitre. L'amplification en lien avec le « background ¼ culturel du patient a aidé à comprendre que l'implication imaginative avec la famille et les amis soutient le jeu d'imagination très nécessaire et les choix d'attachement. De plus, le dieu grec Hermès en tant que symbole de lien et de paradoxe est proposé aux côtés des dieux égyptiens Nut et Seb qui représentent la différentiation nécessaire qui ouvre de l'espace pour le flux de l'énergie créative à l'intérieur d'un système.

El presente trabajo trata acerca de la centralidad del juego y de la paradoja para el emerger de la formación de símbolos en el espacio liminal ´entre´ los opuestos que presentan restricciones en la díada analítica. La teoría de Los Sistemas Adaptativos Complejos se interrelaciona con ideas Junguianas para considerar la importancia, y tristemente, la disminución del 'juego libre' globalmente. Se describe el estado de la mente necesario para el 'juego libre' como similar al estado REM durante el sueño. Un caso clínico de caja de arena brinda el fundamento para el modo en que el dominio procedural, implícito es relevante para dar forma a las interacciones y patrones que emergen en el momento presente y que reflejan ambos, el pasado y el futuro desplegándose. Amplificaciones vinculadas al contexto cultural del paciente ayudaron a expandir la comprensión respecto a que la participación imaginativa con amigos y familiares ayudó al juego con la imaginación tan necesitado y también con alternativas de apego. A su vez, el dios griego Hermes, como símbolo de la conexión y paradoja es ofrecido junto a los dioses egipcios Nut y Seb, quienes representan la necesaria diferenciación que abre espacio para el flujo y el fluir de la energía creativa dentro del sistema.

Maternal mind-mindedness and communicative functions in free-play and mealtime contexts: Stability, continuity and relations with child language at 16 months.

The present study aimed at investigating the contextual stability, the contextual continuity and the concurrent associations between maternal measures (general language, communicative functions and mind-mindedness) and child measures (total number of word types and tokens) in two different contexts, free-play and mealtime. To this purpose, the interactions occurring between 25 mothers and their 16-month-old children in each context were video-recorded, transcribed and later coded for the selected measures. Significant contextual stability was observed in the mothers' production of general language measures (total number of utterances, total number of words and MLU), in the children's production of word types and tokens, and in some communicative functions (Tutorial, Control and Asynchronous). No contextual stability was found for the mothers' production of attuned mind-related comments. For continuity, both mothers and children produced more utterances and words in the free-play than in the mealtime context; the production of attuned mind-related comments and the use of the Control function were also more frequent in the free-play context. Lastly, the analysis of the concurrent correlations indicated that, especially in the mealtime context, the number of words produced by children was positively associated with the number of words produced by mothers and by their use of the Tutorial and Didactic functions, but negatively associated with their use of the Control function. The mothers' production of attuned mind-related comments bore no relation with children's expressive language. Similarities and differences with previous findings are discussed.

A randomised controlled trial of an implementation strategy delivered at scale to increase outdoor free play opportunities in early childhood education and care (ECEC) services: a study protocol for the get outside get active (GOGA) trial.

BACKGROUND: Increased outdoor play time in young children is associated with many health and developmental benefits. This study aims to evaluate the impact of a multi-strategy implementation strategy delivered at scale, to increase opportunities for outdoor free play in Early Childhood Education and Care (ECEC) services. METHODS: The study will employ a parallel-group randomised controlled trial design. One hundred ECEC services in the Hunter New England region of New South Wales, Australia, will be recruited and randomised to receive either a 6-month implementation strategy or usual care. The trial will seek to increase the implementation of an indoor-outdoor routine (whereby children are allowed to move freely between indoor and outdoor spaces during periods of free play), to increase their opportunity to engage in outdoor free play. Development of the strategy was informed by the Behaviour Change Wheel to address determinants identified in the Theoretical Domains Framework. ECEC services allocated to the control group will receive 'usual' implementation support delivered as part of state-wide obesity prevention programs. The primary trial outcome is the mean minutes/day (calculated across 5 consecutive days) of outdoor free play opportunities provided in ECEC services measured at baseline, 6-months (primary end point) and 18-months post baseline. Analyses will be performed using an intention-to-treat approach with ECEC services as the unit of analysis, using a linear mixed effects regression model to assess between-group differences. A sensitivity analysis will be undertaken, adjusting for service characteristics that appear imbalanced between groups at baseline, and a subgroup analysis examining potential intervention effect among services with the lowest baseline outdoor free play opportunities. DISCUSSION: Identifying effective strategies to support the implementation of indoor-outdoor routines in the ECEC setting at scale is essential to improve child population health. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ( ACTRN12621000987864 ). Prospectively registered 27th July 2021, ANZCTR - Registration.

Examining the Relationship between Infant Weight Status and Parent-Infant Interactions within a Food and Nonfood Context.

Background: Most observational research examining factors in the home environment that contribute to child adiposity has focused on feeding and physical activity, although aspects of one's nonfood home environment such as parent-child interactions can also impact body weight. The main objectives of this study were to determine if parent-infant interactions under different contexts provide a unique contribution to infants' concurrent adiposity after accounting for known obesity-related covariates. Methods: This was a cross-sectional analysis of 121 9- to 15-month-old infants using data collected at the baseline visit of an ongoing intervention study. Mother-infant interactions during a feeding episode and a free-play task were recorded and coded. Anthropometrics of infants were measured by trained research staff. We used two-step hierarchical multivariable regression models to examine the unique contribution of mother-infant interactions to weight status after accounting for known obesity-related covariates (i.e., maternal age, BMI, education, parity, and gestational age, child sex, breastfeeding duration, age of solid food introduction, and birthweight). Results: Maternal intrusiveness, child negative affect, and child responsiveness during free-play, but not feeding were significantly associated with z-weight-for-length. For every 1-U increase in maternal intrusiveness and child negative affect there was a 0.321 (p = 0.011) and 0.415 (p = 0.028) unit increase in z-weight-for-length, respectively, whereas for every 1-U increase in child responsiveness there was a decrease of 0.386 U in z-weight-for-length (p = 0.025). Conclusion: This research contributes new findings support the idea that parent-child interactions outside of the feeding context may relate to obesity. Clinical Trial Registration Number NCT02936284.