Parent involvement is important to help overweight children lose weight. However, parent readiness to make changes around child eating and physical activity (PA) behaviors can differ across domains. Using a cross-sectional design, our aim was to examine which factors were associated with parents being in the Action/Maintenance stage of change in each domain. From November 2008 to August 2009, parents of overweight/obese children (n=202) attending a tertiary care obesity clinic in Providence, RI, answered questions assessing their stage of change, beliefs about child health and weight, and provider behaviors. Separate multivariate logistic regression models were created to determine which factors were associated with parent readiness to make changes for child dietary and PA behaviors. Almost 62% of parents were in the Action stage of change for child dietary behaviors, but only 41% were in the Action stage of change for PA behaviors. Parents who believed their own weight was a health problem were less likely to be ready to make changes to their child's dietary behaviors. Physician discussion of strategies was related to readiness to make changes for child dietary behaviors, but not PA behaviors. In the PA domain, parents of younger children were more likely to be ready to make changes. Training health care providers to address PA readiness and be aware of factors influencing dietary and PA readiness may result in more effective conversations with parents and improve behavior change efforts for pediatric weight loss.

Background

Antibiotics are frequently prescribed to children, and may be an environmental influence that contributes to the increasing prevalence of childhood obesity. The aim of this study was to examine the effect of antibiotic use in the first year of life on child growth trajectories from birth to age 6 years including significant covariates.

Methods

Data from 586 children in the Infant Feeding Practices II (IFPS II) and 6 year follow-up study (6YFU) were included. Antibiotic exposures, weight and height measurements were collected from birth through the first 12 months, and then again at 6 years. Linear mixed effects growth modeling, controlling for exclusive breastfeeding, socio-demographic factors, smoking during pregnancy, gestational diabetes, and maternal pre-pregnancy weight status, was used to examine the association between antibiotic exposure and child growth trajectories through age 6 years.

Results

The majority of infants (60.58%) did not receive any antibiotics; 33.79% received 1-2 courses and 5.63% received 3 or more antibiotic courses during the first year. In the unadjusted model, children with 1-2 antibiotic exposures had a 0.17 (SE 0.08) higher rate of change in BMI z-score (BMIz) than children without any antibiotics, and children with ≥3 exposures had a 0.42 (SE 0.16) higher rate of change in BMIz (p = 0.009). Growth trajectory over time for those who had ≥3 antibiotics was greater than those without any antibiotics (p = 0.002).

Conclusions

Efforts to guide the judicious use of antibiotics should continue, particularly in the first year of life.

The health and nutritional status of women of reproductive age has tremendous impact on the health of future populations; therefore, special attention should be paid to promoting women's health, especially a healthy weight at this critical time period. The purpose of the paper is to provide information on the nutritional needs of women at various stages of the reproductive age spectrum, including preconception/interconception and during pregnancy to achieve and maintain a healthy weight. The Socio-Ecological Model (SEM) is presented to help practitioners understand the importance of intervening where women of reproductive age live, work, and frequent.

Objective

There is a need to address cultural beliefs and parenting practices regarding childhood obesity to design effective weight-control programmes for overweight/obese US Latino children. The purpose of the current study was to explore cultural beliefs about children's weight, understand parent perceptions on feeding their children, and explore barriers that interfere with a healthy lifestyle.

Design

Four focus groups were conducted in Spanish with forty-one Latino mothers of elementary school-age children from San Diego County, California between April and May 2011. Cultural viewpoints about overweight status among children and barriers to leading a healthy lifestyle were explored. Focus group discussions were analysed based on a priori and emergent themes.

Results

Three themes were identified: (i) mothers' cultural beliefs about health that are barriers to family health; (ii) mothers as primary caretakers of their family's health; and (iii) attitudes about targeting children's weight. Mothers acknowledged the idea that 'chubby is better' is a misperception, yet having a 'chubby' child was preferred and even accepted. Mothers described fatalistic beliefs that contradicted existing knowledge of chronic disease and daily demands of Western culture as barriers to practising healthy behaviours in the home as the family caretaker.

Conclusions

These findings may be used to inform more culturally appropriate research to address US Latino health. Increasing awareness of cultural beliefs and daily circumstance could help to address obesity more directly and thereby overcome some of the potential underlying barriers that might exist when involving the Latino immigrant families in obesity treatment and prevention.

Unlabelled

Objective To characterize bedtime routines (BR) and associations between reading at bedtime and sleep behaviors in a sample of Latino preschoolers.

Methods

A convenience sample of Latino parents of a 4-year-old child completed standardized questionnaires assessing BRs, bedtime reading frequency and other sleep variables. Family demographics and home environment were also assessed. Results Parents of 62 children completed questionnaires. A consistent BR was reported by 48%. Frequent reading at bedtime was reported in 42%. After controlling for key confounders, reading at bedtime was significantly associated with longer total nighttime sleep (P < .01), but not with other sleep behaviors. Conclusion Reading at bedtime was significantly associated with longer total nighttime sleep duration. This, together with the relatively low frequency of reading found in this sample, suggests that interventions aimed at increasing reading at bedtime among Latino preschoolers may improve overall sleep health.

Objectives

Increase parent/caregiver ability to correctly identify the attending in charge and define terminology of treatment team members (TTMs). We hypothesized that correct TTM identification would increase with use of an electronic communication tool. Secondary aims included assessing subjects' satisfaction with and trust of TTM and interest in computer activities during hospitalization.

Methods

Two similar groups of parents/legal guardians/primary caregivers of children admitted to the Pediatric Hospital Medicine teaching service with an unplanned first admission were surveyed before (Phase 1) and after (Phase 2) implementation of a novel electronic medical record (EMR)-based tool with names, photos, and definitions of TTMs. Physicians were also surveyed only during Phase 1. Surveys assessed TTM identification, satisfaction, trust, and computer use.

Results

More subjects in Phase 2 correctly identified attending physicians by name (71% vs. 28%, P < .001) and correctly defined terms intern, resident, and attending (P ≤ .03) compared with Phase 1. Almost all subjects (>79%) and TTMs (>87%) reported that subjects' ability to identify TTMs moderately or strongly impacted satisfaction and trust. The majority of subjects expressed interest in using computers to understand TTMs in each phase.

Conclusions

Subjects' ability to correctly identify attending physicians and define TTMs was significantly greater for those who used our tool. In our study, subjects reported that TTM identification impacted aspects of the TTM relationship, yet few could correctly identify TTMs before tool use. This pilot study showed early success in engaging subjects with the EMR in the hospital and suggests that families would engage in computer-based activities in this setting.

Background: Family-based behavioral treatment (FBT) is the most successful weight-loss treatment for children with overweight and obesity, however, long-term success is only achieved by a third of children over time. The use of foods that induce satiety, such as eggs, could improve adherence to calorically restricted diets in children and improve outcomes. This study explored the consumption of eggs (FBT+egg) or cereal (FBT+cereal) for breakfast as part of an FBT program, when breakfast foods were provided to families. Methods: Fifty 8-12-year-old children with overweight and obesity and their parents were randomized to a 4-month FBT+egg or FBT+cereal treatment program. Families were provided the ingredients for their assigned breakfast at each treatment session, and instructed to consume the breakfast a minimum of 5 days per week. Families attended assessments at baseline, post-treatment, and 4-months post-treatment. Results: Results showed that both treatments were well liked, FBT attendance was similar, and there was high compliance with consumption of the specified breakfast. Children experienced moderate weight loss at post-treatment [-0.11 standardized BMI (BMIz)] through 4-month follow-up (-0.09 BMIz), with no statistically significant differences (mean difference -0.05 BMIz, 95% confidence interval -0.19 to 0.09) observed between egg and cereal conditions across any anthropometric or appetitive measures. Conclusions: The use of eggs for breakfast in children enrolled in FBT was well tolerated, and future studies should include larger samples and longer follow-up periods to assess the potential differential effects of prescribed breakfasts on children's weight and eating behaviors.

Background

There is growing interest in the relationship between general parenting and childhood obesity. However, assessing general parenting via surveys can be difficult due to issues with self-report and differences in the underlying constructs being measured. As a result, different aspects of parenting have been associated with obesity risk. We developed a more objective tool to assess general parenting by using observational methods during a mealtime interaction.

Methods

The General Parenting Observational Scale (GPOS) was based on prior work of Baumrind, Maccoby and Martin, Barber, and Slater and Power. Ten dimensions of parenting were included; 4 were classified in the emotional dimension of parenting (warmth and affection, support and sensitivity, negative affect, detachment), and 6 were classified in the behavioral dimension of parenting (firm discipline and structure, demands for maturity, psychological control, physical control, permissiveness, neglect). Overweight children age 8-12 years old and their parent (n = 44 dyads) entering a weight control program were videotaped eating a family meal. Parents were coded for their general parenting behaviors. The Mealtime Family Interaction Coding System (MICS) and several self-report measures of general parenting were also used to assess the parent-child interaction. Spearman's correlations were used to assess correlation between measures.

Results

The emotional dimensions of warmth/affection and support/sensitivity, and the behavioral dimension of firm discipline/structure were robustly captured during the family meals. Warmth/affection and support/sensitivity were significantly correlated with affect management, interpersonal involvement, and communication from the MICS. Firm discipline/structure was inversely correlated with affect management, behavior control, and task accomplishment. Parents who were older, with higher educational status, and lower BMIs were more likely to display warmth/affection and support/sensitivity.

Conclusion

Several general parenting dimensions from the GPOS were highly correlated with similar family functioning constructs from the MICS. This new observational tool appears to be a valid means of assessing general parenting behaviors during mealtimes and adds to our ability to measure parent-level factors affecting child weight-related outcomes. Future evaluation of this tool in a broader range of the population and other family settings should be conducted.

Background

Current guidelines for nutritional rehabilitation in hospitalized restrictive eating disorder patients recommend a cautious approach to refeeding. Several studies suggest that higher calorie diets may be safe and effective, but have traditionally excluded severely malnourished patients. The goal of this study was to evaluate the safety of a higher calorie nutritional rehabilitation protocol (NRP) in a broad sample of inpatients with restrictive eating disorders, including those who were severely malnourished.

Methods

A retrospective chart review was conducted among eating disorder inpatients between January 2015 and March 2016. Patients were started on a lower calorie diet (≤1500 kcals/day) or higher calorie diet (≥1500 kcals/day). Calorie prescription on admission was based on physician clinical judgement. The sample included patients aged 8-20 years with any DSM-5 restrictive eating disorder. Those who were severely malnourished (<75% expected body weight [EBW]) or required tube feeding during admission were included. Multivariable regression models were used to determine whether level of nutritional rehabilitation was associated with hypophosphatemia, hypomagnesemia, or hypokalemia.

Results

The sample included 87 patients; mean age was 14.4 years (S.D. 32.7); 29% were <75% EBW. The majority (75.8%) was started on higher calorie diets (mean 1781 kcal/day). Controlling for rate of calorie change, initial %EBW, age, race/ethnicity, insurance, diagnosis, and NG/NJ tube placement, higher calorie diets were not associated with hypophosphatemia, hypomagnesemia, or hypokalemia on admission or within the first 72 h. Increased risk of hypophosphatemia on admission was associated with lower baseline %EBW.

Conclusion

A higher calorie NRP was tolerated in this broad population of inpatients with restrictive eating disorders. Lower %EBW on admission was a more important predictor of hypophosphatemia than initial calorie level. Larger studies are required to demonstrate the safety of higher calorie diets in severely malnourished patients.

Universal lipid screening (ULS) is recommended for all 9- to 11-year-old children. We investigated ULS outcomes and long-term pediatrician management of children with dyslipidemia using a retrospective chart review of well-child visits between 2014 and 2016. Descriptive statistics summarized demographics, ULS results, and follow-up visits/testing. Pearson χ² test examined differences between those with and without an abnormal screen. A total of 1039 children aged 9 to 11 years were seen for a well-child visit; only 33.3% (343/1039) completed screening. Of children screened, 18.1% (62/343) had abnormal screen results and were more likely to have an elevated body mass index (P < .001), though 30.1% (19/62) had no risk factors. A total of 10.2% (35/343) had dyslipidemia. A total of 77.1% of children with dyslipidemia received nutrition/exercise counseling and 57.1% received dietitian referrals; only 68.6% had a follow-up visit and 31.4% had repeat lipid testing. Pediatricians would benefit from more practical strategies for universal testing such as point-of-care testing and long-term management to ensure ULS is an effective screening tool.