Predictors of shorter sleep in early childhood

The Joint Association of Small for Gestational Age and Nighttime Sleep with Blood Pressure in Childhood

Children born small for gestational age (SGA) are more likely to develop high blood pressure. In prior studies, longer sleep duration is associated with lower BP, and SGA is associated with shorter sleep duration in childhood. We investigated whether sleep duration in early childhood modifies the association between SGA and higher childhood SBP in 1178 children recruited at birth and followed up to age 9 years. We ascertained birthweight and gestational age from medical records. We derived child sleep duration from maternal questionnaire interview. We calculated child SBP percentile according to U.S. reference data. We defined elevated SBP as SBP ≥75^th percentile. In this sample, 154 (13.1%) children were born SGA. Children born SGA had higher SBP percentiles and higher risk of elevated SBP. Among children born SGA, those in the highest compared to the lowest tertile for sleep had a 12.28 lower (−22.00, −2.57) SBP percentile and 0.44 (0.25 to 0.79) times lower risk of developing elevated SBP. Our data are consistent with an interaction between SGA and sleep duration on childhood elevated SBP (P_interaction = 0.0056). In conclusion, in this prospective birth cohort, longer sleep duration in early childhood may mitigate the blood pressure-raising effect of being born small.

Night sleep duration trajectories and associated factors among preschool children from the EDEN cohort

OBJECTIVE

Sleep duration may vary both interindividually and intraindividually over time. We aimed to identify night-sleep duration (NSD) trajectories among preschoolers and to study associated factors.

METHODS

NSD was collected within the French birth-cohort study EDEN at ages 2, 3, and 5-6 years through parental questionnaires, and were used to model NSD trajectories among 1205 children. Familial socioeconomic factors, maternal sociodemographic, health and lifestyle characteristics, as well as child health, lifestyle, and sleep characteristics at birth and/or at age two years were investigated in association with NSD using multinomial logistic regressions.

RESULTS

Five distinct NSD trajectories were identified: short (SS, <10 h, 4.9%), medium-low (MLS, <11 h, 47.8%), medium-high (MHS, ≈11.5 h, 37.2%), long (LS, ≥11.5 h, 4.5%) and changing (CS, ie, ≥11.5 h then <11 h, 5.6%) NSD trajectories. Multivariable analyses showed in particular that compared to the MHS trajectory factors associated with increased risk for the SS trajectory were male gender, first child, maternal age and working status, night-waking, parental presence when falling asleep, television-viewing duration, as well as both "Processed and fast foods" and the "Baby food" dietary patterns at age two years. Factors positively associated with the CS trajectory were maternal smoking, feeding at night, and the Processed and fast foods dietary pattern at age two years, whereas child's activity and emotionality scores at age one year were negatively associated.

CONCLUSION

We identified distinct NSD trajectories among preschoolers and associated early life factors. Some of them may reflect less healthy lifestyles, providing cues for early multi-behavioral prevention interventions.

Sleep patterns and cardiometabolic risk in schoolchildren from Cuenca, Spain

Sleep seems to have a significant influence on the metabolic syndrome (MetS). However, results in this association are still inconsistent in children. The aim of this study was to examine the influence of sleep characteristics in the MetS (index and factors) in Spanish children. Cross-sectional study including a sample of 210 children aged 8-to-11-years belonging to 20 schools from the province of Cuenca, Spain was conducted. Cardiometabolic risk and actigraphy sleep patterns were determined and analysed using correlation coefficients, ANCOVA models and a propensity score derivation model. Overall, children in the lower time in bed category and those who went to bed later (> 23:15h) showed worse values in the cardiometabolic profile and risk index. Differences were observed when the total time in bed was below 9h 15mins. Our study shows that short sleep duration could be a risk factor for cardiometabolic risk in children, and bedtime may independently influence this risk. In addition, our data suggests that children’s sleep hygiene should be incorporated in parenting educational programs.

Factors associated with shorter night-time sleep in toddlers: The Survey of Young Canadians

OBJECTIVES

Adequate sleep in childhood is important for healthy development. No information exists on the predictors of night-time sleep among toddlers in Canada. The aim of this study was to determine the prevalence of and to identify factors associated with sleeping &lt;11 consecutive hours per night among children aged 1-2 years in Canada.

METHODS

Data from the cross sectional Survey of Young Canadians (SYC) 2010 were used. The biological mother reported on toddlers' sleep duration at night. Based on cut-off values used in previous studies, shorter night-time sleep was defined as sleeping &lt;11 hours per night. Multivariable logistic regression was conducted to identify the associations between socio-demographic, maternal, sleep and child-related variables with shorter sleep at night.

RESULTS

Analysis of 3675 toddlers revealed that 57% slept &lt;11 hours per night. Results of the regression analysis showed that being from an immigrantfamily was significantly associated with shorter night-time sleep. Being from a higher income household, having a mother aged between 25 and 34 years at the time of the survey, and napping ≥2 hours during the day were significantly related to sleeping ≥11 hours per night. Other socio-demographic, maternal and child-related variables were not associated with night-time sleep.

CONCLUSION

This was the first population-based, nationally representative study to examine factors related to shorter night-time sleep in Canadian toddlers. Socio-demographic factors and nap duration were associated with night-time sleep duration. More adequate early childhood sleep hygiene awareness efforts are recommended, especially in vulnerable populations.

Short sleep and risk of proteinuria in 3-year-olds in Japan: a population-based cohort study

OBJECTIVE

To examine whether short sleep at 18 months of age is associated with risk of proteinuria at 3 years of age.

METHODS

A population-based cohort study using municipal health check-up data from 62,623 children born between March 1, 2004, and April 30, 2011, and followed to 3 years via questionnaire in Kobe City, Japan. Sleep duration was calculated from wake time and bedtime at the 18-month health check-up by standardized parent-reported questionnaires. Proteinuria, defined as dipstick urinary protein of ≥1+, was measured by dipstick urinalysis at 3 years. Multivariable logistic regression was used to generate adjusted olds ratios.

RESULTS

In total, 2253 (3.6%) children had short nighttime sleep (≤8 h) at 18 months. At 3 years, 765 (1.2%) children had proteinuria. The adjusted odds ratio for proteinuria among children with 8 h of sleep or less versus those with normal sleep of 10 h per night was 1.50 (95% confidence interval, 1.07-2.11; P = 0.02). Odds ratios of the same direction but weaker magnitude were observed for children with bedtime at 22:00 or later, and those with wake time at 6:00 or earlier.

CONCLUSIONS

Short sleep at 18 months was associated with risk of proteinuria at 3 years. Future research is warranted to examine whether sleep programs targeting early childhood may have additional potential health benefits for kidney development.

Systematic review of the relationships between sleep duration and health indicators in the early years (0-4 years)

Background

The objective of this systematic review was to examine for the first time the associations between sleep duration and a broad range of health indicators in children aged 0 to 4 years.

Methods

Electronic databases were searched with no limits on date or study design. Included studies (published in English or French) were peer-reviewed and met the a priori determined population (apparently healthy children aged 1 month to 4.99 years), intervention/exposure/comparator (various sleep durations), and outcome criteria (adiposity, emotional regulation, cognitive development, motor development, growth, cardiometabolic health, sedentary behaviour, physical activity, quality of life/well-being, and risks/injuries). The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Due to high levels of heterogeneity across studies, narrative syntheses were employed.

Results

A total of 69 articles/studies (62 unique samples) met inclusion criteria. Data across studies included 148,524 unique participants from 23 countries. The study designs were randomized trials (n = 3), non-randomized interventions (n = 1), longitudinal studies (n = 16), cross-sectional studies (n = 42), or longitudinal studies that also reported cross-sectional analyses (n = 7). Sleep duration was assessed by parental report in 70% of studies (n = 48) and was measured objectively (or both objectively and subjectively) in 30% of studies (n = 21). Overall, shorter sleep duration was associated with higher adiposity (20/31 studies), poorer emotional regulation (13/25 studies), impaired growth (2/2 studies), more screen time (5/5 studies), and higher risk of injuries (2/3 studies). The evidence related to cognitive development, motor development, physical activity, and quality of life/well-being was less clear, with no indicator showing consistent associations. No studies examined the association between sleep duration and cardiometabolic biomarkers in children aged 0 to 4 years. The quality of evidence ranged from “very low” to “high” across study designs and health indicators.

Conclusions

Despite important limitations in the available evidence, longer sleep duration was generally associated with better body composition, emotional regulation, and growth in children aged 0 to 4 years. Shorter sleep duration was also associated with longer screen time use and more injuries. Better-quality studies with stronger research designs that can provide information on dose-response relationships are needed to inform contemporary sleep duration recommendations.

Electronic supplementary material

The online version of this article (10.1186/s12889-017-4850-2) contains supplementary material, which is available to authorized users.

Sleep Duration and Adiposity in Early Childhood: Evidence for Bidirectional Associations from the Born in Bradford Study

Study Objectives:

To examine independent associations of sleep duration with total and abdominal adiposity, and the bidirectionality of these associations, in a young biethnic sample of children from a disadvantaged location.

Methods:

Child sleep duration (h/day) was parent-reported by questionnaire and indices of total (body weight, body mass index, percent body fat (%BF), sum of skinfolds) and abdominal adiposity (waist circumference) were measured using standard anthropometric procedures at approximately 12, 18, 24, and 36 months of age in 1,338 children (58% South Asian; 42% White). Mixed effects models were used to quantify independent associations (expressed as standardised β-coefficients (95% confidence interval (CI)) of sleep duration with adiposity indices using data from all four time-points. Factors considered for adjustment in models included basic demographics, pregnancy and birth characteristics, and lifestyle behaviours.

Results:

With the exception of the sum of skinfolds, sleep duration was inversely and independently associated with indices of total and abdominal adiposity in South Asian children. For example, one standard deviation (SD) higher sleep duration was associated with reduced %BF by -0.029 (95% CI: −0.053, −0.0043) SDs. Higher adiposity was also independently associated with shorter sleep duration in South Asian children (for example, %BF: β = -0.10 (-0.16, -0.028) SDs). There were no significant associations in White children.

Conclusions:

Associations between sleep duration and adiposity are bidirectional and independent among South Asian children from a disadvantaged location. The results highlight the importance of considering adiposity as both a determinant of decreased sleep and a potential consequence.

A different rhythm of life: sleep patterns in the first 4 years of life and associated sociodemographic characteristics in a large Brazilian birth cohort

Objective

Sleep is an important marker of healthy development and has been associated with emotional, behavioral, and cognitive development. There is limited longitudinal data on children's sleep with only a few reports from low- and middle-income countries (LMICs). We investigate sleep parameters and associated sociodemographic characteristics in a population-based longitudinal study in Pelotas, Brazil.

Methods

Data from the Pelotas 2004 Birth Cohort were used (N = 3842). Infant sleep was collected through maternal report at 3, 12, 24, and 48 months: sleep duration, bed and wake time, nighttime awakenings, co-sleeping and sleep disturbances (24 and 48 months).

Results

Compared to children in high-income countries (HICs), children in Brazil showed a substantial shift in rhythms with later bed and wake times by approximately 2 hours. These remain stable throughout the first 4 years of life. This population also shows high levels of co-sleeping which remain stable throughout (49.0–52.2%). Later bedtime was associated with higher maternal education and family income. Higher rates of co-sleeping were seen in families with lower income and maternal education and for children who were breastfed. All other sleep parameters were broadly similar to data previously reported from HICs.

Conclusion

The shift in biological rhythms in this representative community sample of children in Brazil challenges our understanding of optimal sleep routine and recommendations.

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Biological rhythms are shifted with later bedtime by approximately 2 h (22.18 hours).

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Later bedtime is associated with higher maternal education and family income.

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High levels of co-sleeping are prevalent until 4 years of age (49% at 3 months to 52% at 4 years).

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Co-sleeping was more prevalent in families with lower income and maternal education.

Association Between Night Waking and Child Health During the First 3 Years of Life

OBJECTIVE

Night awakening is a common concern for parents and professionals in early childhood and a risk factor for child growth and development. This study examined the concurrent and longitudinal associations of night awakening with child health and illness during the first 3 years of life.

METHODS

Longitudinal data from 1364 infants in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development were used in this study. At ages 6, 15, 24, and 36 months, mothers reported on the frequency of their child's night awakening in the past week, overall health, and occurrences of illness. Information on demographic factors, including child sex and ethnicity/race, maternal education, and family income as well as child breastfeeding status was obtained at 1 month. Structural equation modeling, including latent growth curve modeling, was performed.

RESULTS

Age-related changes in weekly frequency of night awakening and overall child health were characterized by curvilinear patterns between 6 and 36 months. Although more frequent night awakenings were associated with poorer health at 6 months, a faster decline in night awakenings was associated with a slowed health decline over time. Furthermore, more frequent night awakenings were concurrently associated with more occurrences of illness at ages 6, 15, and 24 months. The association between night awakening and illness dissipated by 36 months.

CONCLUSION

Night awakening is concurrently and longitudinally associated with poorer health and more illnesses in early childhood.

Increased Screen Time: Implications for Early Childhood Development and Behavior

The authors review trends in adoption of new digital technologies (eg, mobile and interactive media) by families with young children (ages 0-8 years), continued use of television and video games, and the evidence for learning from digital versus hands-on play. The authors also discuss continued concerns about health and developmental/behavioral risks of excessive media use for child cognitive, language, literacy, and social-emotional development. This evidence is then applied to clinical care in terms of the screening questions providers can use, tools available to providers and parents, and changes in anticipatory guidance.

Bedtime in Preschool-Aged Children and Risk for Adolescent Obesity

OBJECTIVE

To determine whether preschool-aged children with earlier bedtimes have a lower risk for adolescent obesity and whether this risk reduction is modified by maternal sensitivity.

STUDY DESIGN

Data from 977 of 1364 participants in the Study of Early Child Care and Youth Development were analyzed. Healthy singleton-births at 10 US sites in 1991 were eligible for enrollment. In 1995-1996, mothers reported their preschool-aged (mean = 4.7 years) child's typical weekday bedtime, and mother-child interaction was observed to assess maternal sensitivity. At a mean age of 15 years, height and weight were measured and adolescent obesity defined as a sex-specific body-mass-index-for-age ≥95th percentile of the US reference.

RESULTS

One-quarter of preschool-aged children had early bedtimes (8:00 p.m. or earlier), one-half had bedtimes after 8:00 p.m. but by 9:00 p.m., and one-quarter had late bedtimes (after 9:00 p.m.). Children's bedtimes were similar regardless of maternal sensitivity (P = .2). The prevalence of adolescent obesity was 10%, 16%, and 23%, respectively, across early to late bedtime groups. The multivariable-adjusted relative risk (95% CI) for adolescent obesity was 0.48 (0.29, 0.82) for preschoolers with early bedtimes compared with preschoolers with late bedtimes. This risk was not modified by maternal sensitivity (P = .99).

CONCLUSIONS

Preschool-aged children with early weekday bedtimes were one-half as likely as children with late bedtimes to be obese as adolescents. Bedtimes are a modifiable routine that may help to prevent obesity.

Ethnic differences in sleep duration at 5 years, and its relationship with overweight and blood pressure

BACKGROUND

Studies on adult population indicate shorter sleep duration in ethnic minority groups than host populations. We examined ethnic differences in sleep duration and its relationship with overweight and blood pressure (BP) among children living in Amsterdam.

METHODS

Participants include 2384 children (aged 5 years) and their mothers from the Amsterdam-based longitudinal study. Sleep was categorised into short sleep (<10 h/night) and normal sleep (10-11 h/night). Linear regressions ( Β: were used to study association between sleep duration and systolic BP (SBP) and diastolic BP (DBP). Prevalence ratios (PRs) were used to study ethnic differences in sleep duration and its association with overweight and raised BP.

RESULTS

Minority groups reported shorter sleep duration compared to native Dutch, with prevalence ranging from 11.3% in Dutch to 53.1% in Ghanaians. Age-adjusted PRs ranged from 3.38 (95%CI 2.63-4.34) in Moroccans to 4.78 (95%CI 3.36-6.82) in Ghanaian compared with Dutch children. Increased prevalence of overweight was observed among children with short sleep in Dutch and Moroccans only, but this risk was no longer statistically significant after further adjustment for socioeconomic status. Short sleep was not related to SBP and DBP in all groups. No relationship was observed between short sleep and raised BP except for African Surinamese (3.65, 95% CI 1.23-10.8).

CONCLUSION

Like adults, children from ethnic minority populations sleep less hours than Dutch children. Efforts to improve ethnic inequalities in sleep hygiene should also include children at younger age. Associations as reported in adults with overweight and BP could not consistently be replicated in children, however.

Subjective - Objective Sleep Comparisons and Discrepancies Among Clinically-Anxious and Healthy Children

We compared subjective and objective sleep patterns and problems, and examined cross-method correspondence across parent reports, child reports, and actigraphy-derived sleep variables in clinically-anxious children and healthy controls. In a multi-site, cross-sectional study, 75 pre-adolescent children (6 to 11 years; M = 8.7 years; SD = 1.4; n = 39/52 % female) were examined including 39 with a diagnosis of primary generalized anxiety disorder (GAD) and 36 controls recruited from university-based clinics in Houston, TX and Washington, DC. Structured interviews, validated sleep questionnaires, and 1 week of actigraphy data were utilized. Despite subjective reports of significantly greater sleep problems among anxious children, actigraphy data revealed no significant differences between the groups. All parents estimated earlier bedtimes and greater total sleep duration relative to actigraphy, and all children endorsed more sleep problems than parents. With few exceptions, subjective reports exhibited low and non-significant correspondence with actigraphy-based sleep patterns and problems. Our findings suggest that high rates of sleep complaints found among children with GAD (and their parents) are not corroborated by objective sleep abnormalities, with the exception of marginally prolonged sleep onset latency compared to controls. Objective-subjective sleep discrepancies were observed in both groups but more apparent overall in the GAD group. Frequent complaints of sleep problems and daytime tiredness among anxious youth might more accurately reflect difficulties prior to the actual sleep period, cognitive-affective biases associated with sleep, and/or poor sleep quality. Findings highlight the importance of considering sleep from multiple perspectives.

Changes in sleep duration in Spanish children aged 2-14 years from 1987 to 2011

OBJECTIVE

Historical decreases in sleep duration in children have been documented worldwide; however, there is sparse information on sleep duration in differing cultural regions. We assess sleep duration and its trends for children in Spain from 1987 to 2011 and associated sociodemographic characteristics.

METHODS

Data from eight Spanish National Health Surveys, from 1987 to 2011, were collected on parent-reported sleep duration and associated socio-demographic characteristics including age, sex, parental level of education, child body mass index (BMI), and physical activity. A total of 24,867 children aged 2-14 years were included in the final sample.

RESULTS

Overall, short sleep duration increased to 44.7% from 29.8% in 1987. Decreasing sleep duration trends were found in all demographic groups, decreasing by around 20 minutes in 24 hours from 1987 to 2011; decreasing to 10 hours 16 minutes in 2- to 5-year olds, 9 hours 31 minutes in 6- to 9-year-olds, and 8 hours 52 minutes in 10- to 14-year-olds. No difference in sleep duration was found between girls and boys. Sleep duration was associated with year of survey, age, level of parental education, obesity, and exercise.

CONCLUSIONS

Almost 45% of children in Spain are not sleeping the recommended amount. Regional differences in sleep attitudes and duration alongside a lack of consistency in cut-offs for age-appropriate ideal sleep in literature is a barrier for international comparison and highlights the need for research in physiological sleep requirements. With the association of short sleep duration with many different health outcomes, sleep should be considered as a modifiable lifestyle factor and a public health issue.

Evaluation of actigraphy-measured sleep patterns among children with disabilities and associations with caregivers' educational attainment: results from a cross-sectional study

OBJECTIVES

To use wrist-actrigrphy to collect objective measures of sleep and to characterise actigraphy-measured sleep patterns among children with disabilities. We also assessed the extent to which, if at all, caregivers' education is associated with children's sleep disturbances.

DESIGN

Cross-sectional study.

SETTING

A rehabilitation centre in the Patagonia region, Chile.

METHODS

This study was conducted among 125 children aged 6-12 years with disabilities (boys: 55.2%) and their primary caregivers in Chile. Children wore ActiSleep monitors for 7 days. A general linear model was fitted to generate least-square means and SEs of sleep efficiency (proportion of the sleep period spent asleep) across caregivers' education levels adjusting for children's age, sex, disability type, caregiver-child relationship and caregivers' age. Multivariable logistic regression analyses were conducted to estimate ORs and 95% CIs of longer sleep latency (≥ 30 min) and longer wake after sleep onset (WASO) (≥ 90 min) (a measure of sleep fragmentation) in relation to caregivers' educational attainment.

RESULTS

Median sleep latency was 27.3 min, WASO 88.1 min and sleep duration 8.0 h. Mean sleep efficiency was 80.0%. Caregivers' education was positively and significantly associated with children's sleep efficiency (p trend<0.001). Adjusted mean sleep efficiency was 75.7% (SE=1.4) among children of caregivers high school education. Compared to children whose caregivers had >high school, children of caregivers with

CONCLUSIONS

Children with disabilities experience difficulties initiating sleep (prolonged sleep latency) and maintaining sleep (long WASO, low sleep efficiency). Among children with disabilities, lower level of caregivers' education is associated with more sleep disturbances.

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Key Words

• EPIDEMIOLOGY
• PUBLIC HEALTH
• SLEEP MEDICINE

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MESH Headings

• Actigraphy/instrumentation
• Actigraphy/methods
• Adult
• Caregivers/education
• Caregivers/psychology
• Child
• Chile/epidemiology
• Cross-Sectional Studies
• Disabled Children/psychology
• Educational Status
• Female
• Humans
• Male
• Sleep Wake Disorders/epidemiology
• Sleep Wake Disorders/etiology
• Sleep Wake Disorders/psychology
• Surveys and Questionnaires

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Grants

• T37 MD001449 NIMHD NIH HHS
• UL1 TR000170 NCATS NIH HHS
• 8UL1TR000170-07 NCATS NIH HHS
• T37-MD001449 NIMHD NIH HHS

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Affiliation(s)

Xiaoli Chen Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
Juan Carlos Velez Centro de Rehabilitación Club de Leones Cruz del Sur, Punta Arenas, Chile
Clarita Barbosa Centro de Rehabilitación Club de Leones Cruz del Sur, Punta Arenas, Chile
Micah Pepper Centro de Rehabilitación Club de Leones Cruz del Sur, Punta Arenas, Chile
Bizu Gelaye Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
Susan Redline Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts, USA Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
Michelle A Williams Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA

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Sleep and nighttime energy consumption in early childhood: a population-based cohort study

BACKGROUND

Shorter sleep is a risk factor for weight gain in young children. Experimental studies show that sleep deprivation is associated with higher nighttime energy intake, but no studies have examined the patterning of energy intake in relation to nighttime sleep duration in young children.

OBJECTIVES

The objectives of the study were to test the hypothesis that shorter-sleeping children would show higher nighttime energy intake and to examine whether the additional calories were from drinks, snacks or meals.

METHODS

Participants were 1278 families from the Gemini twin cohort, using data from one child per family selected at random to avoid clustering effects. Nighttime sleep duration was measured at 16 months of age using the Brief Infant Sleep Questionnaire. Energy intake by time of day and eating episode (meal, snack, drink) were derived from 3-day diet diaries completed when children were 21 months.

RESULTS

Consistent with our hypothesis, shorter-sleeping children consumed more calories at night only (linear trend P < 0.001), with those sleeping <10 h consuming on average 120 calories (15.2% of daily intake) more at night than those sleeping ≥13 h. The majority of nighttime intake was from milk drinks. Associations remained after adjusting for age, sex, birth weight, gestational age, maternal education, weight and daytime sleep.

CONCLUSIONS

Shorter-sleeping, young children consume more calories, predominantly at night, and from milk drinks. Parents should be aware that providing milk drinks at night may contribute to excess intake. This provides a clear target for intervention that may help address associations between sleep and weight observed in later childhood.

A Review of the Relationship Between Socioeconomic Position and the Early-Life Predictors of Obesity

A range of important early-life predictors of later obesity have been identified. Children of lower socioeconomic position (SEP) have a steeper weight gain trajectory from birth with a strong socioeconomic gradient in child and adult obesity prevalence. An assessment of the association between SEP and the early-life predictors of obesity has been lacking. The review involved a two-stage process: Part 1, using previously published systematic reviews, we developed a list of the potentially modifiable determinants of obesity observable in the pre-natal, peri-natal or post-natal (pre-school) periods; and part 2, conducting a literature review of evidence for socioeconomic patterning in the determinants identified in part 1. Strong evidence was found for an inverse relationship between SEP and (1) pre-natal risk factors (pre-pregnancy maternal body mass index (BMI), diabetes and pre-pregnancy diet), (2) antenatal/peri natal risk factors (smoking during pregnancy and low birth weight) and (3) early-life nutrition (including breastfeeding initiation and duration, early introduction of solids, maternal and infant diet quality, and some aspects of the home food environment), and television viewing in young children. Less strong evidence (because of a lack of studies for some factors) was found for paternal BMI, maternal weight gain during pregnancy, child sleep duration, high birth weight and lack of physical activity in young children. A strong socioeconomic gradient exists for the majority of the early-life predictors of obesity suggesting that the die is cast very early in life (even pre-conception). Lifestyle interventions targeting disadvantaged women at or before child-bearing age may therefore be particularly important in reducing inequality. Given the likely challenges of reaching this target population, it may be that during pregnancy and their child's early years are more feasible windows for engagement.

Risk Factors Associated With Abscess Formation in Children 5 Years of Age and Younger

From 1997 to 2009, hospitalization rates have doubled for pediatric patients with soft tissue abscesses requiring incision and drainage. Despite this increasing national burden, few studies have been conducted to identify the risk factors associated with abscess formation. Our study evaluates a collection of physiological and lifestyle parameters that may serve as risk factors for abscess formation among pediatric patients 5 years of age or younger. Our results indicate family history and age 2 years and younger are associated with higher risk of abscess formation. Furthermore, methicillin-resistant Staphylococcus aureus and methicillin-susceptible Staphylococcus aureus were prevalent pathogens associated with abscess in our study group. Pediatricians may employ these novel parameters to educate parents and/or guardians of high-risk groups on preventing abscess formation to alleviate the burden of incision & dragining requiring abscess on health care costs.