Age of achievement of gross motor milestones in infancy and adiposity at age 3 years

Value of video-based education to enhance infant motor development

BACKGROUND

Parents play a vital role in promoting infant motor development and physical activity; however, there is little information available to parents on how to support healthy movement. Therefore, the purpose of this study was to assess the feasibility of implementing video-based education to improve infant physical activity and motor development.

METHODS

This multiple case study consisted of semi-structured interviews with mothers (n = 12) and early childhood experts (n = 5, e.g., pediatrician, home visitor). Participants watched pre-recorded videos and answered questions which were developed following Bowens and colleagues guide for designing feasibility studies. Data were analyzed using a directed content analysis approach.

RESULTS

Most mothers (91.7 %) reported they were highly likely to recommend the videos to others and said the best way to share these videos would be through an app or social media (83.3 %) or health care entities (e.g., hospital, pediatrician, 75 %). Half of mothers (50 %) reported they would be interested in seeing videos once a month or once every couple of months. Further, all experts agreed parents would be somewhat or highly likely to use the videos and a majority (80 %) stated they were highly likely to recommend and share videos like these. Experts' top suggestions for sharing the videos was through an app/social media (40 %) and credible websites (40 %).

DISCUSSION

Overall, the videos appear feasible for mothers. Both groups primarily suggested that videos be disseminated through social media, online, or through an app. Future research should engage parents and healthcare providers in developing videos.

Parental knowledge of children's motor development: A cross-sectional study in Saudi Arabia

BACKGROUND

This study was undertaken to explore parental knowledge of normal motor development. In addition, the association between parental knowledge and characteristics was investigated.

METHODS

A cross-sectional design was adopted for this study. An online survey was used to administer a four-part questionnaire designed for this study. The first part of the questionnaire focused on demographic information, such as age, age at birth of first child, and educational level. The second part consisted of questions about birth-related information sources, and the third part included questions about normal motor development. The fourth part was directed to participants who had children with DDs. The data were analysed descriptively and reported using absolute and relative frequencies. Linear regression was used to investigate the association between parental knowledge level and gender, age, education, age at first birth, number of children, and self-rated knowledge level.

RESULTS

A total of 4081 participants responded to the survey. Most participants were found to have low levels of parental knowledge, as 88.87% answered ≤ 50% of the developmental milestone questions correctly. Being a female and having a university education were significantly associated with high knowledge levels (p < 0.001 for both variables). Further, undergoing an awareness programme about normal child development was significantly associated with high knowledge levels (p = 0.02). No association was found between the factors of age, age at first birth, number of children, and knowledge rating and the level of parental knowledge about normal physical development.

CONCLUSION(S)

There is a lack of appropriate knowledge about normal motor development among parents in Saudi Arabia, which raises serious concerns about children's health in the country.

IMPLICATIONS

Effective health education programmes on normal developmental milestones should be implemented by the Ministry of Health to improve the developmental outcomes of children in Saudi Arabia.

Effects of Crawling before Walking: Network Interactions and Longitudinal Associations in 7-Year-Old Children

BACKGROUND

To study the impact of crawling before walking (CBW) on network interactions among body composition, the cardiovascular system, lung function, motor competence and physical fitness, at age 7, and to assess the longitudinal association between CBW and body composition, the cardiovascular system, lung function, motor competence, physical fitness and physical activity parameters, at age 7.

METHOD

CBW, body composition, cardiovascular system, lung function, motor competence, physical fitness and physical activity were assessed in seventy-seven healthy Caucasian children.

RESULTS

Network analyses revealed that the crawling group had a greater number of links among all the studied variables compared with the non-crawling group. In the longitudinal study, using multiple regression analyses, crawling was independently associated with fat mass (%), fat-to-muscle ratio and systolic blood pressure, with models explaining up to 56.3%, 56.7% and 29.9% of their variance, respectively.

CONCLUSIONS

CBW during child's development is a possible modulator in the network interactions between body systems and it could influence future metabolic and cardiovascular health.

Crack and motor development of babies living in an assistance shelter

Introduction: The baby motor development happens naturally with the complex interaction of the body, performing tasks in its context. When the body suffers negative external influence, such as the use of drugs by the mother during pregnancy, and develops in an environment different from home, such as shelters, it is questionable how the motor development would be. Objective: To evaluate the motor development of babies living in welfare shelters, children of crack users during pregnancy; to verify if there is an association of motor delay in these babies; and to describe the environment in which they were inserted. Methods: This is a cross-sectional study, with a convenience sample. There were 29 babies between three and 16 months old. Twenty-two of them were exposed to crack during pregnancy (Crack Group) and the remaining seven were not (Non-Crack Group). All were living in a specific shelter. To assess broad motor development, the Alberta Infant Motor Scale (AIMS) was used. The Affordances in the Home Environment for Motor Development - Infant Scale (AHEMD-IS) was used to assess home environment opportunities. Results: In the crack group, the developmental delay was confirmed in 36.4% cases and suspected in 18.2%. Most babies in the crack group were typical (45.5%). There was no statistically significant association between crack group and developmental delay, nor with age and sex. Conclusion: The development of babies in the crack group was similar to the non-crack group and the opportunities in the environment were reasonable for the baby development.

Association Between Age of Achieving Gross Motor Development Milestones During Infancy and Body Fat Percentage at 6 to 7 Years of Age

OBJECTIVES

The later achievement of gross motor milestones during infancy is associated with adiposity in early childhood. However, the associations between gross motor development and adiposity after entering primary school are unclear. This study examined the associations between the ages at which six gross motor milestones were achieved and adiposity during early school years.

METHODS

This retrospective study was conducted in 2012 and 2013. Data were collected from 225 first-grade primary school children (mean age, 6.9 years; 39% girls). Adiposity was assessed using dual-energy X-ray absorptiometry and expressed as body fat percentage. Data describing the ages of achieving six gross motor milestones (holding head up, sitting, crawling, standing supported, walking supported, and independent walking) were obtained from the Maternal and Child Health Handbooks.

RESULTS

Mean body fat percentage was 21.7%. Multiple linear regression analyses revealed that later ages of achieving crawling (p < .001 [95% confidence interval: 0.33-1.16]), standing supported (p < .001 [95% confidence interval: 0.64-1.65]), and walking supported [p = .013 (95% confidence interval: 0.13-1.07)] were associated with increased fat. However, the ages of achieving holding head up (p = .053), sitting (p = .175), and independent walking (p = .736) were not statistically significant.

CONCLUSIONS

Achieving crawling, standing supported, and walking supported later predict increased body fat when aged 6-7 years. The practice of observing gross motor milestone achievements may allow early targeted interventions to optimize body composition before beginning school and thereby, potentially prevent childhood obesity.

Household Food Security and Infant Adiposity

OBJECTIVES

Food insecurity has been associated with obesity, but previous studies are inconsistent and few included infants. We examined associations between household food security and infant adiposity and assessed the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Supplemental Nutrition Assistance Program (SNAP) as effect modifiers. We hypothesized that infants from food-insecure households would have greater adiposity, with attenuation by WIC and SNAP.

METHODS

We repeatedly measured 666 infants from the southeastern United States in 2013-2017. We categorized households as high, marginal, low, or very low using the US Household Food Security Survey Module. Outcomes were BMI z score, subscapular and triceps skinfold-for-age z score, the sum of subscapular and triceps skinfolds, the ratio of subscapular and triceps skinfolds, and BMI z score ≥1 (at risk for overweight). We used covariate-adjusted repeated-measures linear and logistic regressions.

RESULTS

Of infants, 68.6% were Black and 60.5% had household incomes <$20 000. Interactions between food security and WIC and/or SNAP were not significant. Compared with infants from high food security households, infants from very low food security households had higher BMI z scores (0.18 U; 95% confidence interval [CI] 0.01 to 0.35), higher subscapular skinfold-for-age z scores (0.31 U; 95% CI 0.04 to 0.59), a higher sum of subscapular and triceps skinfolds (0.53 mm; 95% CI 0.002 to 1.07), and greater odds of being at risk for overweight (odds ratio 1.55; 95% CI 1.14 to 2.10). Infants from low food security households had greater odds of being at risk for overweight (odds ratio 1.72; 95% CI 1.17 to 2.10).

CONCLUSIONS

In larger and longer studies, researchers should examine food security and adiposity in young children.

A comparison between flow-regulated and adjustable valves used in hydrocephalus during infancy

INTRODUCTION

Ventriculoperitoneal shunt insertion during the neonatal period and early infancy is associated with a high rate of shunt failure when compared to the adult population. Furthermore, the function of flow-regulated valves and differential pressure valves may be different in neonatal hydrocephalus.

METHODS

A retrospective case series of all primary shunt procedures carried out during or immediately following the neonatal period, from August 2011 to February 2018 at Sheffield Children's Hospital. The total sample size was 55. This included 34 patients with adjustable valves (Miethke ProGav) and 21 with flow-regulated valves (Orbis-Sigma); however, only 53 had adequate follow-up.

RESULTS

The overall 1 year shunt survival was 34% (18/53), and there was no significant difference depending on which shunt valve was implanted. The primary shunt infection rate was 11% (6/53) with S. aureus being the most common causative organism. During the first year of life, clinical signs of shunt overdrainage were seen more frequently in patients with adjustable valves than in those with flow-regulated valves (59% [19/32] versus 24% [5/21], p = 0.02). Furthermore, 2 patients in the adjustable valve group developed sagittal craniosynostosis secondary to shunt overdrainage.

CONCLUSION

Shunt failure is high when inserted during or immediately following the neonatal period. Overdrainage may be less common in patients with flow-regulated valves. However, if overdrainage is observed, adjusting the setting of a differential pressure valve can effectively treat the overdrainage without the need for invasive shunt revision surgery.

Double Jeopardy in Contemporary China: Intersecting the Socioeconomic Gradient and Geographic Context on Early Childhood Development

Family socioeconomic status (SES) differences in early childhood development (ECD) are well documented, as are the neighborhood effects in early development outcomes. However, little is known about whether the SES gradient in ECD outcomes varies across geographic contexts by county-level variables in contemporary China. This study examines the effects of county-level socioeconomic background on inequalities in the developmental outcomes of young Chinese children. Individual-level child development data based on four early development milestones—taking a first step, first sentences, counting 10 objects, fully independent toileting—were combined with family- and county-level socioeconomic data from the China Family Panel Studies (CFPS). Using a hierarchical linear model (HLM) to examine how the broader socioeconomic context plays a role in the attainment of developmental milestones at expected times as young children grow and develop, we have found significant cross-level interaction effects between family SES and county-level variables in relation to developmental milestone attainment. The family SES gradient in the achievement of children’s developmental milestones is steeper for those in the under-developed regions than their counterparts in the more developed regions. Our findings suggest that low-SES children who are living in socioeconomically deprived regions suffer from a double disadvantage in terms of early development outcomes. Further research would be needed to contextualize the observed interactions and better explain the underlying mechanisms.

Infant Motor Milestones and Childhood Overweight: Trends over Two Decades in A Large Twin Cohort

BACKGROUND

Poor motor skill competence may influence energy balance with childhood overweight as a result. Our aim was to investigate whether the age of motor milestone achievement has changed over the past decades and whether this change may contribute to the increasing trend observed in childhood overweight.

METHODS

Motor skill competence was assessed in children from the Young Netherlands Twin Register born between 1987 and 2007. Follow-up ranged from 4 up to 10 years. Weight and height were assessed at birth, 6 months, 14 months, and 2, 4, 7, and 10 years.

RESULTS

Babies born in later cohorts achieved their motor milestones 'crawling', 'standing', and 'walking unassisted' later compared to babies born in earlier cohorts (N = 18,514, p < 0.001). The prevalence of overweight at age 10 was higher in later cohorts (p = 0.033). The increase in overweight at age 10 was not explained by achieving motor milestones at a later age and this persisted after adjusting for gestational age, sex, and socioeconomic status.

CONCLUSION

Comparing children born in 1987 to those born in 2007, we conclude that children nowadays achieve their motor milestones at a later age. This does not however, explain the increasing trend in childhood overweight.

Exploring gender differences in infant motor development related to parent's promotion of play

This study explored how parents' promotion of play may impact gender differences in motor development of six-nine month old infants. Twenty-nine infants between six-nine months of age and their primary caregivers took part in assessments of anthropometry, motor development, video observations of play and a qualitative interview. Results revealed females had significantly higher scores for fine motor skills and significantly higher incidence of touching toys in an individual play scenario compared to males. Males had a higher intensity level of play during both play scenarios. Qualitative explorations found that parents perceived other adults such as surrounding family and friends to promote gender differences but not themselves; however, parents' verbal interactions with infants did appear to differ by gender. Parents of males more frequently made statements to promote gross motor skills while parents of females more frequently made statements to promote fine motor skills. While biological influences are suggested to play a role on gender differences of motor development early in life, environmental explanations related to socialization, gender-differentiated expectations and experiences amplify these differences to a greater degree than may have been previously considered during this time period.

Physical Activity and Adiposity in a Racially Diverse Cohort of US Infants

OBJECTIVE

Early life physical activity may help prevent obesity, but objective quantification in infants is challenging.

METHODS

A total of 506 infants were examined from 2013 to 2016. Infants wore accelerometers for 4 days at ages 3, 6, 9, and 12 months. Daily log-transformed physical activity counts were computed, averaged, and standardized across assessments. A linear mixed model was used to examine trends in standardized physical activity counts as well as associations between physical activity and BMI z score, sum of subscapular and triceps skinfold thickness for overall adiposity (SS+TR), and their ratio for central adiposity (SS:TR).

RESULTS

Among infants, 66% were black and 50% were female. For each additional visit, standardized physical activity counts increased by 0.23 (CI: 0.18 to 0.27; P < 0.0001). This translates to 126.3 unadjusted physical activity counts or a 4% increase for each visit beyond 3 months. In addition, a 1-SD increase in standardized physical activity counts (550 unadjusted physical activity counts) was associated with a 0.01-mm lower SS:TR (95% CI: -0.02 to -0.001; P = 0.03). However, standardized physical activity counts were not associated with BMI z score or SS+TR.

CONCLUSIONS

Physical activity increased over infancy and was associated with central adiposity. Despite limitations, researchers should consider objective measurement in infants.

Modifiable factors which predict children's gross motor competence: a prospective cohort study

Background

Fundamental motor skills (FMS) are important for physical activity and healthy weight status in children, yet it is unclear which early childhood factors facilitate subsequent motor skill. The aim of this prospective study was to investigate which modifiable family and home environment factors in the early years predict children’s FMS at age five.

Methods

Mothers from the Melbourne InFANT program (registered with the International Standard Randomised Controlled Trial Number Register (ISRCTN81847050)) completed questionnaires when child was aged 4, 9, 19 months old, and 3.5 years old on factors hypothesised to predict motor skills. Some factors were grouped in tertiles (high, medium, low) due to the nature of the distribution. At 5 years old children were assessed on 6 locomotor and 6 object control skills (Test of Gross Motor Development-2). Eight regression models examined the association between factors at each time-point and children’s skills (object control and locomotor) at 5 years old.

Results

The sample varied by time-point (178 to 259 children). Maternal physical activity optimism (4 months; β = 2.43), home physical activity equipment (9 months; β = 0.82), time outdoors – middle (9 months; β = 2.50) and highest tertile (9 months; β = 2.86), time free to move about - highest tertile (19 months; β = 2.41), time with older children - middle (19 months; β = 3.15) and highest tertile (3.5 years; β = 3.00) were predictive of better locomotor scores. Mothers’ own physical activity (9 months; β = − 0.01) and time active with mum – highest tertile (3.5 years; β = − 3.73) were negatively associated with locomotor skill. Time with older children - highest (4 months; β = 2.27) and middle tertile (19 months; β = 2.97), time free to move about – middle (19 months; β = 2.55) and highest tertile (19 months; β = 2.47), and more home equipment (9 months; β = 0.83); (3.5 years; β = 0.17) were predictive of better object control skills. Maternal physical activity knowledge (3.5 years; β = − 3.05) was negatively associated with object control skill.

Conclusions

Providing a supportive environment with older children and equipment, and allowing toddlers’ freedom to move, appears important. Opportunities exist to educate parents on their important role in developing children’s motor skills. Clinicians could advise parents that the home environment can make a difference to their child’s FMS starting from infancy.

Later achievement of infant motor milestones is related to lower levels of physical activity during childhood: the GECKO Drenthe cohort

BACKGROUND

The aim of this study is to investigate whether age of infant motor milestone achievement is related to levels of physical activity (PA), weight status and blood pressure at age 4-7 years of age.

METHODS

In the Dutch GECKO (Groningen Expert Center of Kids with Obesity) Drenthe cohort, the age of achieving the motor milestone 'walking without support' was reported by parents. Weight status and blood pressure were assessed by trained health nurses and PA was measured using the Actigraph GT3X between age 4 and 7 years.

RESULTS

Adjusted for children's age, sex and the mother's education level, infants who achieved walking without support at a later age, spent more time in sedentary behaviour during childhood and less time in moderate-to-vigorous PA. Later motor milestones achievement was not related to higher BMI Z-score, waist circumference Z-score, diastolic or systolic blood pressure.

CONCLUSION

The results of this study indicate that a later age of achieving motor milestone within the normal range have a weak relation to lower PA levels at later age. It is not likely that this will have consequences for weight status or blood pressure at 4-7 years of age.

A multivariate discrete failure time model for the analysis of infant motor development

We develop a multivariate discrete failure time model for the analysis of infant motor development. We use the model to jointly evaluate the time (in months) to achievement of three well-established motor milestones: sitting up, crawling, and walking. The model includes a subject-specific latent factor that reflects underlying heterogeneity in the population and accounts for within-subject dependence across the milestones. The factor loadings and covariate effects are allowed to vary flexibly across milestones, and the milestones are permitted to have unique at-risk intervals corresponding to different developmental windows. We adopt a Bayesian inferential approach and develop a convenient data-augmented Gibbs sampler for posterior computation. We conduct simulation studies to illustrate key features of the model and use the model to analyze data from the Nurture study, a birth cohort examining infant health and development during the first year of life.

Factors associated with nutritional status and motor development among young children

This study was conducted to investigate the nutritional status and gross motor development of children in a suburban area of northeast China and the factors influencing these issues. A total of 189 children aged 1-3 years and their mothers participated. Child and maternal length/height and weight were measured. Information was collected on basic characteristics, household monthly income, child's age at achievement of six gross motor milestones, and feeding practices by interviewing the mothers/caregivers. The prevalence of overweight (using World Health Organization growth standards) and delayed achievement of walking alone among the children was 27% and 12.7%, respectively. The independent predictors of increased odds for being overweight were middle household income and high dietary diversity score. Exclusive breastfeeding was associated with lower odds of children being overweight. Delayed solid feeding initiation was associated with increased odds of delay in walking alone for the children. Breastfeeding predicted reduced odds of this issue. These findings suggest that nutritional intervention and childcare education, such as breastfeeding promotion, improved diet quality, and the timely introduction of solid food, could improve growth and development among young children in suburban northeast China.

Longitudinal associations of gross motor development, motor milestone achievement and weight-for-length z score in a racially diverse cohort of US infants

OBJECTIVES

To investigate longitudinal associations between gross motor development, motor milestone achievement and weight-for-length z scores in a sample of infants. In a secondary aim, we explored potential bidirectional relationships, as higher weight-for-length z scores may impede motor development, and poor motor development may lead to obesity.

DESIGN

The design was an observational birth cohort.

SETTING

We used data from the Nurture study, a birth cohort of predominately black women and their infants residing in the Southeastern USA.

PARTICIPANTS

666 women enrolled their infants in Nurture. We excluded infants with missing data on exposure, outcome or main covariates, leaving a total analytic sample of 425 infants.

PRIMARY OUTCOME

The outcome was weight-for-length z score, measured when infants were 3, 6, 9 12 months.

RESULTS

Among infants, 64.7% were black, 18.8% were white and 16.9% were other/multiple race. Mean (SD) breastfeeding duration was 17.6 (19.7) weeks. Just over one-third (38.5%) had an annual household income of < $20 000. After adjusting for potential confounders, higher motor development score was associated with lower weight-for-length z score (-0.004; 95% CI -0.001 to -0.007; p=0.01), mainly driven by associations among boys (-0.007; 95% CI -0.014 to -0.001; p=0.03) and not girls (0.001; 95% CI -0.005 to 0.008; p=0.62). Earlier crawling was the only milestone associated with a lower weight-for-length z score at 12 months (-0.328; 95% CI -0.585 to 0.072; p=0.012). However, this association appeared to be driven by male infants only (-0.461; 95% CI -0.825 to -0.096; p=0.01). Weight-for-length z score was unrelated to subsequent motor development score and was thus not bidirectional in our sample.

CONCLUSIONS

Higher motor development score and earlier crawling were associated with lower subsequent weight-for-length z score. However, this was primary true for male infants only. These findings contribute to the growing body of evidence suggesting that delayed motor development may be associated with later obesity.

Examining Childhood Obesity From Infancy: The Relationship Between Tummy Time, Infant BMI-z, Weight Gain, and Motor Development-An Exploratory Study

INTRODUCTION

This exploratory study investigated the infant time spent in tummy time (TT) in relation to body mass index z score (BMI-z), weight gain, and motor development in infants from birth to 4 months.

METHOD

Mothers and their infants were telephone surveyed at 2 and 4 months. Mother demographics; TT; feeding practices; and infant length, and height, and development were collected each time.

RESULTS

Results from Cochran-Mantel-Haenszel and single logistic regression showed a significant association between development, level of BMI-z, and time spent in TT at 2 months of age (p < .0001). The threshold model showed there was a decline in BMI-z at 4 months as daily time in TT increases past the threshold value of approximately 12 minutes per day. Mother education and TT at 2 months were significant predictors of BMI-z at 4 months.

DISCUSSION

Study outcomes suggest that infant positioning and time in TT promote infant motor development and may moderate rapid infant weight gain.

Gross Motor Development in Children Aged 3-5 Years, United States 2012

Objective Gross motor development in early childhood is important in fostering greater interaction with the environment. The purpose of this study is to describe gross motor skills among US children aged 3-5 years using the Test of Gross Motor Development (TGMD-2). Methods We used 2012 NHANES National Youth Fitness Survey (NNYFS) data, which included TGMD-2 scores obtained according to an established protocol. Outcome measures included locomotor and object control raw and age-standardized scores. Means and standard errors were calculated for demographic and weight status with SUDAAN using sample weights to calculate nationally representative estimates, and survey design variables to account for the complex sampling methods. Results The sample included 339 children aged 3-5 years. As expected, locomotor and object control raw scores increased with age. Overall mean standardized scores for locomotor and object control were similar to the mean value previously determined using a normative sample. Girls had a higher mean locomotor, but not mean object control, standardized score than boys (p < 0.05). However, the mean locomotor standardized scores for both boys and girls fell into the range categorized as "average." There were no other differences by age, race/Hispanic origin, weight status, or income in either of the subtest standardized scores (p > 0.05). Conclusions In a nationally representative sample of US children aged 3-5 years, TGMD-2 mean locomotor and object control standardized scores were similar to the established mean. These results suggest that standardized gross motor development among young children generally did not differ by demographic or weight status.

He's just content to sit: a qualitative study of mothers' perceptions of infant obesity and physical activity

Background

Rates of obesity among children ages zero to five are rapidly increasing. Greater efforts are needed to promote healthy behaviors of young children. Mothers are especially important targets for promoting health as mothers’ views play a vital role in helping their children foster healthy habits from an early age. Research has found parents’ views of infants’ weight may influence their feeding practices; however, limited research has explored mothers’ view of infants’ weight in relation to the promotion of physical activity. Therefore, the purpose of this study was to explore the perceptions of mothers of normal weight infants and overweight infants about their infant’s weight and physical activity.

Methods

Semi-structured interviews were conducted with mothers of normal weight (n = 18) and of overweight (n = 11) infants (6.5 ± 0.5 month) in a Midwestern city in the United States. A thematic analysis was used to analyze the data.

Results

A majority of mothers thought infants could be overweight. However, no mothers referenced their own infant as overweight. Mothers most commonly noted infants could be overweight only if they were formula fed and/or were overfed, not if they were breastfed. Mothers views were not negatively influenced by others who mentioned that their child was either “big” or “small” and only one mother had been told her infant was overweight. A majority of mothers thought an infant could be physically active. When discussing infant activity, mothers primarily referred to it in terms of general mobility and a few thought activity level was related to a personality characteristic. Mothers intended to promote physical activity in the future either through outdoor play or specific organized activities such as sports. Despite a majority of mothers stating they were currently physically active themselves, only a few talked about interacting with their infant to promote their infant’s physical activity.

Conclusions

Efforts are needed by healthcare professionals and other public health professionals to inform mothers about the dangers of increased weight during infancy as well as the importance of interacting with infants to promote physical activity.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4503-5) contains supplementary material, which is available to authorized users.

Postural control strategies differ in normal weight and overweight infants

BACKGROUND

Evidence suggests obesity can have a negative influence on a child's motor development and postural control behavior. Little research has examined the impact of infant weight on gross motor behavior, particularly postural control at the onset of sitting.

OBJECTIVE

The purpose of this study was to determine whether normal weight and overweight infants differed in their postural control strategies at the onset of sitting and one-month post onset of sitting.

METHODS

29 infants (n=19 normal weight, n=10 overweight) were recruited to participate in this study. Infant's length and weight were measured at 3 months of age (visit 1). Infant's center of pressure (COP) was measured on an AMTI force platform at the onset of sitting (visit 2) and one-month post onset (visit 3). Data were analyzed using linear measures (range and RMS for the anterior/posterior (AP) and medial/lateral (ML) directions, sway path) and nonlinear measures (Sample Entropy in AP and ML directions).

RESULTS

Overweight infants had significantly greater RMS values in the ML direction at visit 2 and reduced Sway Path values in comparison to normal weight infants at visits 2 and 3. Further, there was a significant difference in Sample Entropy as overweight infants increased Sample Entropy from visit 2 to 3 while normal weight infants decreased Sample Entropy values during this time period.

CONCLUSIONS

These findings suggest that overweight infants adopt a different postural control strategy. This altered strategy may limit exploration early in development. More research is needed to determine if longitudinal differences continue to emerge.

Randomized controlled trial of an early child obesity prevention intervention: Impacts on infant tummy time

OBJECTIVE

To describe infant activity at 3 months old and to test the efficacy of a primary care-based child obesity prevention intervention on promoting infant activity in low-income Hispanic families.

METHODS

This study was a randomized controlled trial (n = 533) comparing a control group of mother-infant dyads receiving standard prenatal and pediatric primary care with an intervention group receiving "Starting Early," with individual nutrition counseling and nutrition and parenting support groups coordinated with prenatal and pediatric visits. Outcomes included infant activity (tummy time, unrestrained floor time, time in movement-restricting devices). Health literacy was assessed using the Newest Vital Sign.

RESULTS

Four hundred fifty-six mothers completed 3-month assessments. Infant activity results were: 82.6% ever practiced tummy time; 32.0% practiced tummy time on the floor; 34.4% reported unrestrained floor time; 56.4% reported ≥1 h/d in movement-restricting devices. Inadequate health literacy was associated with reduced tummy time and unrestrained floor time. The intervention group reported more floor tummy time (OR 2.16, 95% CI 1.44-3.23) and unrestrained floor time (OR 1.69, 95% CI 1.14-2.49) compared to controls. No difference in the time spent in movement-restricting devices was found.

CONCLUSIONS

Tummy time and unrestrained floor time were low. Primary care-based obesity prevention programs have potential to promote these activities.

Association between obesity-related biomarkers and cognitive and motor development in infants

BACKGROUND

This study aimed to verify the association between obesity-related biomarkers and cognitive and motor development in infants between 6 and 24 months of age.

METHODS

A cross-sectional study was conducted with 50 infants and plasma levels of leptin, adiponectin, resistin, soluble tumor necrosis factor receptors 1 and 2 (sTNFR1 and sTNFR2), chemokines, brain-derived neurotrophic factor (BDNF), serum cortisol and redox status were measured. The Bayley-III test was utilized to evaluate cognitive and motor development, and multiple linear stepwise regression models were performed to verify the association between selected biomarkers and cognitive and motor development.

RESULTS

A significant association was found among plasma leptin and sTNFR1 levels with cognitive composite scores, and these two independents variables together explained 37% of the variability of cognitive composite scores (p=0.001). Only plasma sTNFR1 levels were associated and explained 24% of the variability of motor composite scores (p=0.003).

CONCLUSIONS

Plasma levels of sTNFR1 were associated with the increase in cognitive and motor development scores in infants between 6 and 24 months of age through a mechanism not directly related to excess body weight. Moreover, increase in plasma levels of leptin reduced the cognitive development in this age range.

Cohort profile for the Nurture Observational Study examining associations of multiple caregivers on infant growth in the Southeastern USA

PURPOSE

Childcare has been associated with obesity in children in cross-sectional and longitudinal studies, although some observed no association. Few studies have focused on care during infancy, a period when children may be especially vulnerable.

PARTICIPANTS

The Nurture Study is an observational birth cohort designed to assess longitudinal associations of childcare and the presence of multiple caregivers on infant adiposity and weight trajectories throughout the first year of life. We examine as potential mediators feeding, physical activity, sleep and stress. We completed recruitment in 2015. Of the 860 women who enrolled during pregnancy, 799 delivered a single live infant who met our inclusion criteria. Of those, 666 mothers (77.4%) agreed to participate in the study for themselves and their infants.

FINDINGS TO DATE

Among the 666 women in the study, 472 (71%) identified as black, 127 (19%) as white, 7 (1%) as Asian or Asian American, 6 (1%) as Native American and 49 (7%) as other race or more than one race; 43 (7%) identified as Hispanic/Latina. Just under half (48%) had a high school diploma or less, 61% had household incomes <$20 000/year and 59% were married or living with a partner. The mean (SD) infant gestational age was 41.28 weeks (2.29) and birth weight for gestational age z-score was -0.31 (0.93). Just under half (49%) of infants were females, 69% received some human milk and 40% were exclusively breast fed at hospital discharge. Data collection began in 2013, is currently underway, and is scheduled to conclude in late 2016.

FUTURE PLANS

Results will help assess the magnitude of associations between childcare in infancy and subsequent obesity. Findings will also inform intervention and policy efforts to improve childcare environments and help prevent obesity in settings where many infants spend time.

TRIAL REGISTRATION NUMBER

Clinicaltrials.gov, NCT01788644.

Body composition and the monitoring of non-communicable chronic disease risk

There is a need for simple proxies of health status, in order to improve monitoring of chronic disease risk within and between populations, and to assess the efficacy of public health interventions as well as clinical management. This review discusses how, building on recent research findings, body composition outcomes may contribute to this effort. Traditionally, body mass index has been widely used as the primary index of nutritional status in children and adults, but it has several limitations. We propose that combining information on two generic traits, indexing both the ‘metabolic load’ that increases chronic non-communicable disease risk, and the homeostatic ‘metabolic capacity’ that protects against these diseases, offers a new opportunity to improve assessment of disease risk. Importantly, this approach may improve the ability to take into account ethnic variability in chronic disease risk. This approach could be applied using simple measurements readily carried out in the home or community, making it ideal for M-health and E-health monitoring strategies.

Windows of opportunity for physical activity in the prevention of obesity

Tackling increasing rates of obesity is likely to be a defining feature of health care over the next several decades. Adult obesity is a persistent and treatment-resistant problem. Consequently, an emerging theme in the literature is to commence prevention efforts earlier in the developmental time course. This view is based primarily on epidemiological data demonstrating a link between traits manifesting early during development and increased obesity risk in adulthood. Physical activity is a perennial factor in discussions of obesity prevention. However, the optimal timing and type of physical activity interventions to commence remains unclear. Critical developmental windows of plasticity may afford time-limited opportunities to shape body composition across the life course; however, physical activity has not been explicitly considered in these discussions. Although animal models suggest that physical activity commenced earlier in development has differential effects on obesity onset compared to physical activity commenced in adulthood, human research is lacking. In this conceptual review, we consider physical activity during critical developmental periods as a way to mitigate obesity risk later in life.

Prevention of obesity in infancy and early childhood: a National Institutes of Health workshop

Addressing the childhood obesity epidemic continues to be a challenge. Given that once obesity develops it is likely to persist, there has been an increasing focus on prevention at earlier stages of the life course. Research to develop and implement effective prevention and intervention strategies in the first 2 years after birth has been limited. In fall 2013, the National Institute of Diabetes and Digestive and Kidney Diseases convened a multidisciplinary workshop to summarize the current state of knowledge regarding the prevention of infant and early childhood obesity and to identify research gaps and opportunities. The questions addressed included (1) "What is known regarding risk for excess weight gain in infancy and early childhood?" (2) "What is known regarding interventions that are promising or have been shown to be efficacious?" and (3) "What are the challenges and opportunities in implementing and evaluating behavioral interventions for parents and other caregivers and their young children?"

Body mass index (BMI) trajectories in infancy differ by population ancestry and may presage disparities in early childhood obesity

CONTEXT

No consensus definition exists for excess adiposity during infancy. After age 2 years, high body mass index (BMI) is related to adverse cardiometabolic outcomes. Before age 2 years, the utility of BMI as a metric of excess adiposity is unknown.

OBJECTIVES

The objective of the study was to characterize infant BMI trajectories in a diverse, longitudinal cohort and investigate the relationship between the infancy BMI trajectory and childhood obesity.

SUBJECTS

Healthy, nonpreterm infants (n = 2114) in the Genetic Causes for Complex Pediatric Disorders study (The Children's Hospital of Philadelphia) with six or more BMI measurements in the first 13.5 months participated in the study.

DESIGN

For each infant, the BMI trajectory was modeled using polynomial regression. Independent effects of clinical factors on magnitude and timing of peak BMI were assessed. The relationship between infancy BMI and early childhood BMI (age 4 y) was examined (n = 1075).

RESULTS

The cohort was 53% male and 61% African-American. Peak BMI was 18.6 ± 1.7 kg/m(2) and occurred at 8.6 ± 1.4 months. In multivariate analysis, boys had a higher (0.50 kg/m(2), P < .001) peak BMI than girls. The peak was higher (0.53 kg/m(2), P ≤ .001) and occurred earlier (by 12 d, P < .001) in African-American vs white children. The odds of obesity at age 4 years increased among children with higher (odds ratio 2.02; P < .001) and later (odds ratio 1.26; P = .02) infancy peak BMI.

CONCLUSIONS

We demonstrate sex- and ancestry-specific differences in infancy BMI and an association of infancy peak BMI with childhood BMI. These findings support the potential utility of infancy BMI to identify children younger than age 2 years with increased risk for later obesity.

Maternal prepregnancy obesity and achievement of infant motor developmental milestones in the upstate KIDS study

OBJECTIVE

Maternal prepregnancy obesity is associated with several poor infant health outcomes; however, studies that investigated motor development have been inconsistent. Thus, maternal prepregnancy weight status and infants' gross motor development were examined.

METHODS

Participants consisted of 4,901 mother-infant pairs from the Upstate KIDS study, a longitudinal cohort in New York. Mothers indicated dates when infants achieved each of six gross motor milestones when infants were 4, 8, 12, 18, and 24 months old. Failure time modeling under a Weibull distribution was utilized to compare time to achievement across three levels of maternal prepregnancy BMI. Hazard ratios (HR) below one indicate a lower "risk" of achieving the milestone and translate to later achievement.

RESULTS

Compared to infants born to thin and normal-weight mothers (BMI < 25), infants born to mothers with obesity (BMI > 30) were slower to sit without support (HR = 0.91, P = 0.03) and crawl on hands and knees (HR = 0.86, P < 0.001), after adjusting for maternal and birth characteristics. Increased gestational age was associated with faster achievement of all milestones, but additional adjustment did not impact results.

CONCLUSIONS

Maternal prepregnancy obesity was associated with a slightly longer time for infant to sit and crawl, potentially due to a compromised intrauterine environment or reduced physically active play.

A review of state regulations to promote infant physical activity in child care

BACKGROUND

The purpose of this study was to review state regulations promoting increased physical activity and decreased sedentary behaviors in infants in child care and to assess consistency with recent Institute of Medicine (IOM) recommendations.

METHODS

We compared existing state and territory licensing and administrative regulations to recent IOM recommendations to promote physical activity and decrease sedentary time in very young children attending out-of-home child care (both child care centers and family child care homes). Three independent reviewers searched two sources (a publicly available website and WestlawNext™) and compared regulations with five IOM recommendations: 1) providing daily opportunities for infants to move, 2) engaging with infants on the ground, 3) providing daily tummy time for infants less than six months of age, 4) using cribs, car seats and high chairs for their primary purpose, and 5) limiting the use of restrictive equipment for holding infants while they are awake. We used Pearson chi-square tests to assess associations between geographic region, year of last update, and number of state regulations consistent with the IOM recommendations.

RESULTS

The mean (SD) number of regulations for states was 1.9 (1.3) for centers and 1.6 (1.2) for homes out of a possible 5.0. Two states had regulations for all five recommendations, Arizona for centers and Virginia for homes. Six states and territories had zero regulations for child care centers and seven states and territories had zero regulations for family child care homes. There were no significant associations between geographic region and number of regulations consistent with IOM recommendations.

CONCLUSIONS

Out-of-home child care settings are important targets for optimal early child health interventions. While most states had some regulations related to the promotion of physical activity among infants, few states had regulations for more than three of the five IOM recommendations. Enhancing state regulations in child care facilities could aid in early childhood obesity prevention efforts.

Timing of motor milestones achievement and development of overweight in childhood: a study within the Danish National Birth Cohort

BACKGROUND

Overweight may hinder achievement of gross motor milestones and delayed achievement of milestones may increase the risk of later overweight for reasons involving physical activity and the building of lean body mass.

OBJECTIVE

To investigate whether increased birth weight and body mass index (BMI) at 5 months is associated with the achievement of the ability to sit up and walk and whether delayed achievement of these milestones is associated with overweight at age 7 years.

METHODS

We used data from the Danish National Birth Cohort on 25,148 children born between 1998 and 2003. Follow-up took place from 2003 to 2010. Mean age at follow-up was 7.04 years. We used logistic and linear regression analyses.

RESULTS

Birth weight and BMI at 5 months were marginally associated with earlier achievement of the ability to sit up and walk (regression coefficients between -0.027 months; [CI -0.042; -0.013] and -0.092 months [CI -0.118; -0.066]). Age in months of sitting and walking were not associated with overweight at age 7 years (ORs between 0.97 [CI 0.95-1.00] and 1.00 [CI 0.96-1.04]). Later achievement of sitting and walking predicted lower BMI at age 7 years (ln-BMI -z-scores between -0.023 [CI -0.029; -0.017] and -0.005 [CI -0.015; 0.005)).

CONCLUSIONS

All observed associations were of negligible magnitude and we conclude that birth weight or BMI at age 5 months and motor milestones appear largely independent of each other and that timing of achievement of motor milestones seems not to be associated with later overweight or increased BMI.

The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study

Background

Because early life growth has long-lasting metabolic and behavioral consequences, intervention during this period of developmental plasticity may alter long-term obesity risk. While modifiable factors during infancy have been identified, until recently, preventive interventions had not been tested. The Intervention Nurses Starting Infants Growing on Healthy Trajectories (INSIGHT). Study is a longitudinal, randomized, controlled trial evaluating a responsive parenting intervention designed for the primary prevention of obesity. This “parenting” intervention is being compared with a home safety control among first-born infants and their parents. INSIGHT’s central hypothesis is that responsive parenting and specifically responsive feeding promotes self-regulation and shared parent–child responsibility for feeding, reducing subsequent risk for overeating and overweight.

Methods/Design

316 first-time mothers and their full-term newborns were enrolled from one maternity ward. Two weeks following delivery, dyads were randomly assigned to the “parenting” or “safety” groups. Subsequently, research nurses conduct study visits for both groups consisting of home visits at infant age 3–4, 16, 28, and 40 weeks, followed by annual clinic-based visits at 1, 2, and 3 years. Both groups receive intervention components framed around four behavior states: Sleeping, Fussy, Alert and Calm, and Drowsy. The main study outcome is BMI z-score at age 3 years; additional outcomes include those related to patterns of infant weight gain, infant sleep hygiene and duration, maternal responsiveness and soothing strategies for infant/toddler distress and fussiness, maternal feeding style and infant dietary content and physical activity. Maternal outcomes related to weight status, diet, mental health, and parenting sense of competence are being collected. Infant temperament will be explored as a moderator of parenting effects, and blood is collected to obtain genetic predictors of weight status. Finally, second-born siblings of INSIGHT participants will be enrolled in an observation-only study to explore parenting differences between siblings, their effect on weight outcomes, and carryover effects of INSIGHT interventions to subsequent siblings.

Discussion

With increasing evidence suggesting the importance of early life experiences on long-term health trajectories, the INSIGHT trial has the ability to inform future obesity prevention efforts in clinical settings.

Trial registration

NCT01167270. Registered 21 July 2010.