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

A study on the correlation between physical fitness index and executive function in Chinese adolescents

OBJECTIVE

To explore the relationship between physical fitness index and executive function in Chinese adolescents, and to provide a reference for improving the development of executive function in Chinese adolescents.

METHODS

From September to December 2023, 5336 adolescents aged 13 to 18 years were selected by stratified whole cluster random sampling method in six regions of China for physical fitness and executive function tests. The relationship between adolescent physical fitness index and executive function was analyzed using t-test, ANOVA, Pearson's correlation, and logistic regression.

RESULTS

The correlation coefficients between adolescents' physical fitness index and inhibitory control reaction time were all 0.00094, p > 0.05; the correlation coefficients between adolescents' physical fitness index and working memory (1-back, 2-back) reaction time were -0.13 and -0.093, respectively, p < .05; the correlation coefficients between adolescents' physical fitness index and cognitive flexibility reaction time were -0.17 and -0.18, p < .05. Logistic regression analyses showed that 1-back, 2-back, and cognitive flexibility were significantly and positively correlated with physical fitness index in Models 1, 2, and 3 (all p values less than.01). The coefficients of inhibitory control were not significant in all three models (p > .05), and there was no significant relationship with physical fitness index.

CONCLUSION

The physical fitness index of Chinese adolescents has a significant positive correlation with working memory and cognitive flexibility, but not with inhibitory control, i.e. the higher the physical fitness index, the better the working memory and cognitive flexibility.

Emergence of locomotor behaviors: Associations with infant characteristics, developmental status, parental beliefs, and practices in typically developing Brazilian infants aged 5 to 15 months

Independent locomotion provides autonomy for infants, drastically changing their relationship with their surroundings. From a dynamic systems perspective, the interaction between environment, tasks, and organismic constraints leads to the emergence of new behaviors over time. This 6-month longitudinal study aimed to verify associations between the emergence of locomotor behaviors and infants' characteristics, developmental status, parental beliefs, and practices. This observational study remotely assessed 37 full-term Brazilian infants aged 5 to 15 months, divided into two groups (G1: 5 to 11 months, n = 19; and G2: 9 to 15 months, n = 18). The motor developmental status of infants was closely associated with the emergence of behaviors (p < 0.05). Infants in G2 whose parents agreed with the statement "In typically developing infants, motor development occurs naturally and there is no need to actively stimulate it" started to walk later than those whose parents disagreed. Infants whose parents expected them to walk around 10-11 months walked earlier compared to those expected to walk after 11 months (G2, p = 0.011). Infants in G2 with a high frequency of staying in the supine position started to walk, both with and without support, later than those with a low frequency (p < 0.05). For infants in G1 with a high frequency of playing on the floor, locomotion (p = 0.041) and crawling on hands-and-knees (p = 0.007) started sooner compared to those with a low frequency. Staying in the cradle more frequently was related to a later emergence of supported walk (p = 0.046) among infants in G2. The emergence of locomotor behaviors is associated with motor developmental status, the surfaces where the infant plays, and body position. Parental beliefs and expectations influence how infants are stimulated and, consequently, the emergence of independent walking.

Gross motor trajectories of pre-term and full-term infants under different parental educational approaches

This study aimed to explore motor trajectories of Brazilian pre-term and full-term infants from 3 to 12 months old whose parents participated in an educational program and had received guidance on gross motor development. Forty-eight Brazilian infants aged 3 months old were divided into Group 1 (full-term infants and their parents who received only verbal guidance, n = 14), Group 2 (full-term infants with parents who received an educative folder in addition to the same verbal guidance, n = 23), and Group 3 (preterm infants with parents who received the same verbal guidance and educative folder, n = 11). The folder had similar information to the verbal guidance; nonetheless, it helped to teach parents and allowed later consultation at home. We applied Alberta Infant Motor Scale, Affordances in Home Environment for Motor Development-Infant Scale, and a questionnaire about infants' information at 3-, 6-, 9-, and 12-months old. In longitudinal comparison, all groups showed a significant difference for AIMS variables on total score and subscales; all subitems of AHEMD-IS; and time spent in prone, supine, sitting, and standing positions. In general, no differences were found between groups. Motor trajectory, home opportunities, and parental positioning practices were similar between full-term and preterm infants with different guidance approaches.

Does premature birth affect Brazilian parents' practices related to infant positioning?

OBJECTIVE

To verify whether the time spent in prone, supine, or seated positions differed between term and preterm infants; and to determine whether a single verbal guidance session for parents changed the time spent in different positions, and, consequently, the motor development scores, after one month in preterm infants.

METHODS

Sixty-one infants from a full-term and preterm group from Brazil were included. Motor development was assessed by the Alberta Infant Motor Scale (AIMS) and the parents registered the time spent in each position on a 24-hour schedule. A month after verbal guidance, a second assessment was performed only on the preterm infants.

RESULTS

The positioning times awake determined for the full-term and preterm parents were similar. Preterm infants spent more time in the prone sleeping position (2.1 vs. 0.8 h; p=0.037) than full-term infants. The AIMS percentile scores did not differ significantly between the groups. For preterm infants, the time spent in all positions did not change during the second assessment (n=18).

CONCLUSIONS

The fact that some parents position their infants in the prone posture during sleeping periods reinforce the importance of parental education approaches for sudden infant death syndrome (SIDS) prevention during the first months of life. The verbal guidance provided to parents of preterm infants did not influence the AIMS percentile and time spent in various positions but increased preterm parents' confidence in placing their infants in a prone position to play.

Consensus statement on Singapore integrated 24-hour activity guide for early childhood

Introduction

Early childhood is a critical period for growth and development. Adopting healthy lifestyle behaviours during this period forms the foundation for future well-being and offers the best protection against non-communicable diseases. Singapore studies have shown that many young children are not achieving the recommendations on physical activity, sedentary behaviour and sleep. A workgroup was set up to develop recommendations for caregivers of infants, toddlers and preschoolers (aged <7 years) on how to integrate beneficial activities within a daily 24-hour period for optimal development and metabolic health.

Method

The Grading of Recommendations Assessment, Development and Evaluation (GRADE)- ADOLOPMENT approach was employed for adoption, adaption or de novo development of recommendations. International and national guidelines were used as references, and an update of the literature reviews up to September 2021 was conducted through an electronic search of PubMed, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) databases.

Results

Four consensus statements were developed for each age group: infants, toddlers and preschoolers. The statements focus on achieving good metabolic health through regular physical activity, limiting sedentary behaviour, achieving adequate sleep and positive eating habits. The 13th consensus statement recognises that integration of these activities within a 24-hour period can help obtain the best results.

Conclusion

This set of recommendations guides and encourages caregivers of Singapore infants, toddlers and preschoolers to adopt beneficial lifestyle activities within each 24-hour period.

Physical activity in infancy and early childhood: a narrative review of interventions for prevention of obesity and associated health outcomes

In the context of the childhood obesity epidemic, this narrative review aims to explore opportunities to promote physical activity (PA) between birth and age 5 years as well as the health outcomes associated with PA in early childhood. Although early childhood is an ideal time to promote healthy habits, guidelines for PA have often ignored early childhood given the limited evidence for children <5 years old. Herein we discuss and highlight infant, toddler and preschool age interventions to promote PA and prevent obesity both in the short and long-term. We describe novel and modified interventions to promote improved early childhood health outcomes, encompassing cardiorespiratory, muscle, and bone strengthening components necessary for short-term motor development and long-term health. We call for new research aimed at developing and testing innovative early childhood interventions that may be performed in home or childcare settings, monitored by parents or caregivers.

"I Am Afraid of Positioning my Baby in Prone": Beliefs and Knowledge about Tummy Time Practice

Objective

To identify beliefs and knowledge about tummy time (TT) practice and its repercussions on motor development.

Methods

Longitudinal study carried out with parents/caregivers of infants older than 30 days of life. Two assessments were performed. A structured interview was conducted, while the babies were between one and six months old to identify beliefs, knowledge about TT, and the motor milestone achievement expected for the age. At six to 12 months, the risk of motor development delay was tracked using the survey of well-being of young infant questionnaire (SWYC).

Results

41 families responded to the SWYC questionnaire (21 were allocated to the TT group). 31.70% reported that it was not important to put the infants in a prone position while awake, and 70.70% said they are afraid their babies would become breathless when positioned in a prone position. 85.70% of infants from the TT group showed typical development, while 55% of the control group showed atypical development for their age (p = 0.01). Only three infants from the control group were at risk of delayed motor development (p = 0.10).

Conclusions

Most of the families feel insecure about proning their babies and fear breathlessness when positioned. Acquisition of motor milestones prevailed in the TT group, suggesting an association between TT practice and motor milestone achievement.

Characteristics of tummy time and dose-response relationships with development in infants

This study aimed to examine change in tummy time patterns and preferences in the first 6 months of life, as well as dose-response relationships between tummy time duration and development at 2, 4, and 6 months. Participants were parents of infants from the Early Movers project in Edmonton, Canada (baseline: n = 411). At 2, 4, and 6 months, infant tummy time duration and preference (i.e., 1 = really likes to 5 = really dislikes) and development (i.e., Ages & Stages Questionnaire (ASQ-3) communication, fine motor, gross motor, problem-solving, personal-social) were measured by a parental questionnaire. In a subsample (n = 127), tummy time patterns (i.e., bout frequency, mean and median bout length) were measured using a 3-day time-use diary. Tummy time bout frequency, bout length, and preference significantly increased over time. Linear dose-response relationships between tummy time duration and development outcomes were observed at 4 (gross motor) and 6 months (all development outcomes). Moreover, at 2 months, 30-44 min/day of tummy time was associated with a higher total development score (vs. < 15 min/day; B = 11.14; 95%CI: 1.60, 20.68). At 6 months, 61-120 min/day (vs. < 30 min/day; B = 27.12; 95%CI: 11.93, 42.32) and > 120 min/day (vs. < 30 min/day; B = 33.80; 95%CI: 18.90, 48.70) of tummy time were associated with higher total development scores. Differences in threshold doses between some developmental outcomes were observed. Conclusion: In the first 6 months of life, increases were observed in tummy time preference as well as tummy time bout frequent and length. This finding may explain why the optimal amount of tummy time needed for more advanced development appeared to increase with age. What is Known: • Tummy time is a type of physical activity in infancy. International and national guidelines recommend at least 30 minutes of tummy time per day for infants who are not yet mobile. What is New: • In the first six months of life, preference for tummy time as well as tummy time bout frequency and length increased. • Tummy time duration had dose-response associations with several development outcomes, and the optimal amount of tummy time needed for more advanced development appeared to increase with age.

Asia-Pacific consensus statement on integrated 24-hour activity guidelines for the early years

Background

Early childhood is a vital period for development and growth. Promoting beneficial lifestyle behaviours in early childhood can help optimise children's health, development and learning, shape their behaviours in adulthood and offer the best protection against future non-communicable diseases (NCDs). In the Asia-Pacific region, NCDs are significant causes of healthcare burden and mortality. Furthermore, there is also a high prevalence of adverse metabolic risk factors and unhealthy lifestyle behaviours among these children.

Method

Representatives from 19 Asia-Pacific nations and/or jurisdictions developed a consensus statement on integrated 24-hour activity guidelines for the early years using the GRADE-ADOLOPMENT framework.

Findings

These guidelines apply to all infants, toddlers and pre-schoolers below 5 years of age. The guidelines aim to provide a holistic and practical approach to lifestyle activities by framing physical activity, sedentary behaviour and sleep within a 24-hour period. Dietary patterns were included as they play an integral role in metabolic health and energy balance.

Interpretation

Aligned with the World Health Organization's Global Action Plan for the Prevention and Control of NCDs through health promotion interventions in early life, through cultivating healthy lifestyle behaviours in the children's early years, we aim to provide children with the best start in life and reduce the burden of future NCDs in the Asia-Pacific region.

Funding

Funded by Integrated platform for research in advancing metabolic health outcomes of women and children.

Racial and Ethnic Differences in Maternal Social Support and Relationship to Mother-Infant Health Behaviors

OBJECTIVE

To examine racial and ethnic differences in maternal social support in infancy and the relationship between social support and mother-infant health behaviors.

METHODS

Secondary analysis of baseline data from a multisite obesity prevention trial that enrolled mothers and their 2-month-old infants. Behavioral and social support data were collected via questionnaire. We used modified Poisson regression to determine association between health behaviors and financial and emotional social support, adjusted for sociodemographic characteristics.

RESULTS

Eight hundred and twenty-six mother-infant dyads (27.3% non-Hispanic Black, 18.0% Non-Hispanic White, 50.1% Hispanic and 4.6% Non-Hispanic Other). Half of mothers were born in the United States; 87% were Medicaid-insured. There were no racial/ethnic differences in social support controlling for maternal nativity. US-born mothers were more likely to have emotional and financial support (rate ratio [RR] 1.14 95% confidence interval [CI]: 1.07, 1.21 and RR 1.23 95% CI: 1.11, 1.37, respectively) versus mothers born outside the United States. Mothers with financial support were less likely to exclusively feed with breast milk (RR 0.62; 95% CI: 0.45, 0.87) yet more likely to have tummy time ≥12min (RR 1.28; 95% CI: 1.02, 1.59) versus mothers without financial support. Mothers with emotional support were less likely to report feeding with breast milk (RR 0.82; 95% CI: 0.69, 0.97) versus mothers without emotional support.

CONCLUSIONS

Nativity, not race or ethnicity, is a significant determinant of maternal social support. Greater social support was not universally associated with healthy behaviors. Interventions may wish to consider the complex nature of social support and population-specific social support needs.

Pediatric Assessments for Preschool Children in Digital Physical Therapy Practice: Results From a Scoping Review

PURPOSE

To examine and map the extent and scope of pediatric physical therapy assessments previously used in the digital context.

METHODS

A 6-step evidence-based scoping methodological framework was used. Articles containing assessments conducted by a physical therapist using technology to assess a child aged 0 to 5 years were included and synthesized using descriptive statistics and thematic analysis.

RESULTS

Eighteen studies identifying 25 assessments were eligible. Asynchronous observational developmental instruments administered in the child's natural environment to those at risk or presenting with neurodevelopmental conditions were the most common. There is a need for detailed procedures and training for caregivers and clinicians.

CONCLUSION

Limited research exists on the use of pediatric physical therapy assessments for young children with musculoskeletal and cardiorespiratory conditions in a digital context. The development of new instruments or modifications of existing ones should be considered and be accompanied by detailed administration protocols and user guides.

Pediatrician's Beliefs and Practices Around Rapid Infant Weight Gain: A Qualitative Study

Rapid infant weight gain is a risk factor for later obesity. The objective of this study was to examine primary care pediatricians’ beliefs and practices around rapid infant weight gain. Primary care pediatricians (N = 16) participated in a semi-structured interview about infant growth. Interviews were transcribed, analyzed for themes using the grounded theory and the constant comparative method then reliably coded for the presence of each theme. Three themes were identified, pediatricians (1) are uncertain about the concept, definition, and implications of excessive or rapid infant weight gain (N = 16, 100%), (2) are more comfortable with management of inadequate versus excessive or rapid weight gain (N = 10, 62.5%), and (3) perceive the primary cause of excessive or rapid infant weight gain to be overfeeding (N = 10, 62.5%). In conclusion, pediatricians are uncertain about the concept, definition, management, and long-term risks of rapid infant weight gain. Interventions to increase awareness and pediatrician sense of competence in management of rapid infant weight gain are needed.

The process of culturally adapting the Healthy Beginnings early obesity prevention program for Arabic and Chinese mothers in Australia

Background

Behavioural interventions for the early prevention of childhood obesity mostly focus on English-speaking populations in high-income countries. Cultural adaptation is an emerging strategy for implementing evidence-based interventions among different populations and regions. This paper describes the initial process of culturally adapting Healthy Beginnings, an evidence-based early childhood obesity prevention program, for Arabic and Chinese speaking migrant mothers and infants in Sydney, Australia.

Methods

The cultural adaptation process followed the Stages of Cultural Adaptation theoretical model and is reported using the Framework for Reporting Adaptations and Modifications-Enhanced. We first established the adaptation rationale, then considered program underpinnings and the core components for effectiveness. To inform adaptations, we reviewed the scientific literature and engaged stakeholders. Consultations included focus groups with 24 Arabic and 22 Chinese speaking migrant mothers and interviews with 20 health professionals. With input from project partners, bi-cultural staff and community organisations, findings informed cultural adaptations to the content and delivery features of the Healthy Beginnings program.

Results

Program structure and delivery mode were retained to preserve fidelity (i.e. staged nurse calls with key program messages addressing modifiable obesity-related behaviours: infant feeding, active play, sedentary behaviours and sleep). Qualitative analysis of focus group and interview data resulted in descriptive themes concerning cultural practices and beliefs related to infant obesity-related behaviours and perceptions of child weight among Arabic and Chinese speaking mothers. Based on the literature and local study findings, cultural adaptations were made to recruitment approaches, staffing (bi-cultural nurses and project staff) and program content (modified call scripts and culturally adapted written health promotion materials).

Conclusions

This cultural adaptation of Healthy Beginnings followed an established process model and resulted in a program with enhanced relevance and accessibility among Arabic and Chinese speaking migrant mothers. This work will inform the future cultural adaptation stages: testing, refining, and trialling the culturally adapted Healthy Beginnings program to assess acceptability, feasibility and effectiveness.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10270-5.

Perspectives of infant active play: a qualitative comparison of working versus stay-at-home parents

BACKGROUND

Parents play a key role in infant's development through their interactions and the type of environment they provide to promote active play. The amount of time parents are able to spend with their infant is dependent on their working status, yet few studies have explored parent perception of their infant's active play by working status. The purpose of this study was to explore parent perception of active play and compare responses between working and stay-at-home parents.

METHODS

Twenty-nine parents participated in this qualitative study by completing a one-time, in-person semi-structured interview based on the Theory of Planned Behavior. Themes were developed and compared based on parental working status using a directed content analysis approach.

RESULTS

All parents believed active play could have a positive effect on their child's development through physical, social and emotional, cognitive, and/or language and communication development. However, stay-at-home parents reported a broader impact of active play across these domains; whereas working parents most often referenced active play as impacting infant's physical development. Social and emotional interactions were the highest reported form of active play among all parents. Additionally, all parents described similar barriers to increasing the time for active play. The most commonly reported barrier for all parents was time or schedule followed by care needs of the infant, environmental concerns, and need for restrictive devices (e.g., car seats). More stay-at-home parents than working parents reported the care needs of the infant as being a barrier. Recommendations for active play were not widely known amongst all parents, with a higher percentage of working parents reporting they would desire advice from a healthcare provider.

CONCLUSIONS

Working status of parents appears to have implications on perceptions of active play which in turn may influence infants' development. Future studies should objectively assess the impact of parents' working status on infant development and explore how gender of the parent may serve as a confounding variable.

Effects of Telephone and Short Message Service Support on Infant Feeding Practices, "Tummy Time," and Screen Time at 6 and 12 Months of Child Age: A 3-Group Randomized Clinical Trial

Importance

There is limited information as to whether telephone or short message service (SMS) support is effective in improving infant feeding practices and tummy time and reducing screen time.

Objective

To determine the effectiveness of either nurse-led telephone or SMS support in improving infant feeding practices and tummy time and reducing screen time.

Design, Setting, and Participants

This study was part of a 2-year, 3-group parallel, randomized clinical trial conducted from February 23, 2017, to November 30, 2018, among 1155 women in the third trimester of pregnancy in New South Wales, Australia. It reports the main outcomes at 6 and 12 months of child age. All analyses were conducted on an intention-to-treat principle.

Interventions

The intervention consisted of staged information booklets mailed to the intervention groups, each followed by either a nurse-led telephone support session or SMS intervention, antenatally and at 1, 3, 5, 7, and 10 months after birth.

Main Outcomes and Measures

The primary outcomes were infant feeding practices at both 6 and 12 months and tummy time at 6 months. The secondary outcome was screen time at 12 months.

Results

Of 1155 mothers, 947 (82%; mean [SD] age, 32.5 [5.0] years) completed follow-up surveys at 6 months; 920 mothers (80%) completed follow-up surveys at 12 months. Compared with the control group, telephone support led to higher odds of appropriate timing of introducing solid foods (adjusted odds ratio [AOR], 1.68 [95% CI, 1.22-2.32]), cup use (AOR, 1.54 [95% CI, 1.12-2.13]), and early-start tummy time (AOR, 1.63 [95% CI, 1.18-2.25]) at 6 months and higher odds of having no screen time (AOR, 1.80 [95% CI, 1.28-2.53]) and no bottle at bedtime (AOR, 1.73 [95% CI, 1.23-2.42]) at 12 months. Use of SMS also led to higher odds than the control group of having no screen time (AOR, 1.28 [95% CI, 1.08-1.52]) and having no bottle at bedtime (AOR, 1.29 [95% CI, 1.10-1.51]) at 12 months. No significant differences were found in breastfeeding rates between the telephone support, SMS support, and control groups.

Conclusions and Relevance

Both the nurse-led telephone support and SMS interventions were effective in reducing screen time and bottle use at bedtime. Telephone support was also effective in promoting the appropriate timing of the introduction of solid foods, early-start tummy time, and cup use.

Trial Registration

http://anzctr.org.au Identifier: ACTRN12616001470482.

Tummy Time and Infant Health Outcomes: A Systematic Review

CONTEXT

The World Health Organization recommends tummy time for infants because of the benefits of improved motor development and reduced likelihood of plagiocephaly. Because of poor uptake of these recommendations, the association of tummy time with other health outcomes requires further investigation.

OBJECTIVE

To review existing evidence regarding the association of tummy time with a broad and specific range of infant health outcomes.

DATA SOURCES

Electronic databases were searched between June 2018 and April 2019.

STUDY SELECTION

Peer-reviewed English-language articles were included if they investigated a population of healthy infants (0 to 12 months), using an observational or experimental study design containing an objective or subjective measure of tummy time which examined the association with a health outcome (adiposity, motor development, psychosocial health, cognitive development, fitness, cardiometabolic health, or risks/harms).

DATA EXTRACTION

Two reviewers independently extracted data and assessed their quality.

RESULTS

Sixteen articles representing 4237 participants from 8 countries were included. Tummy time was positively associated with gross motor and total development, a reduction in the BMI-z score, prevention of brachycephaly, and the ability to move while prone, supine, crawling, and rolling. An indeterminate association was found for social and cognitive domains, plagiocephaly, walking, standing, and sitting. No association was found for fine motor development and communication.

LIMITATIONS

Most studies were observational in design and lacked the robustness of a randomized controlled trial. High selection and performance bias were also present.

CONCLUSIONS

These findings guide the prioritization of interventions aimed at assisting parents meet the global and national physical activity guidelines.

Delayed Motor Development and Infant Obesity as Risk Factors for Severe Deformational Plagiocephaly: A Matched Case-Control Study

The prevalence of deformational plagiocephaly (DP) has increased since the recommendation of positioning infants to their back during sleeping and is affected by various biological and environmental factors. This study aimed to investigate associations between DP and perinatal or infant characteristics, including obesity. This case-control study included 135 infants (81 males) aged 2-12 months who were diagnosed with DP using calculated cranial vault asymmetric index and cranial index and 135 age- and sex-matched controls. Motor development was evaluated using the Alberta Infant Motor Scale, and obesity was defined by body mass index. Univariate and multivariate logistic regression models were used to assess potential risk factors for DP and its severity. One hundred thirty-five infants with DP were divided into the following three subgroups according to severity indicated by the cranial vault asymmetry index: mild to moderate group (n = 87, 64.4%), severe group (n = 48, 35.6%), and a combined plagiocephaly and brachycephaly group (n = 79, 58.5%). Independent risk factors significantly associated with development of DP were bottle-only feeding (adjusted odds ratio (aOR) = 4.65; 95% CI: 2.70-8.00), little tummy time when awake (aOR = 3.51, 95% CI: 1.71-7.21), delay of motor development (aOR = 2.85, 95% CI: 1.08-7.49), and obesity at diagnosis (aOR = 2.45, 95% CI: 1.02-5.90). Among these risk factors, delay of motor development (aOR = 4.91, 95% CI: 1.46-16.51) and obesity at diagnosis (aOR = 4.10, 95% CI: 1.42-11.90) were particularly related to severe DP. In conclusion, this study confirms that DP risk is positively associated with bottle-only feeding, infrequent tummy time, and delayed development of motor milestones. Notably, this study demonstrates infant obesity as a new risk factor for DP. Our findings suggest that obesity should be identified early and managed comprehensively in infants with DP.