Priorities, barriers, and facilitators for nutrition-related care for autistic children: a qualitative study comparing interdisciplinary health professional and parent perspectives

IntroductionChildren with autism spectrum disorder often face nutrition-related challenges, such as food selectivity, gastrointestinal issues, overweight and obesity, and inadequate nutrient intake. However, the role of routine nutrition-related screening or care by interdisciplinary health professionals is not well understood. This study aimed to compare the beliefs of health professionals with those of parents of autistic children regarding high-priority nutrition-related challenges, barriers and facilitators to care, and desired education and resources related to nutrition for autistic children.ParticipantsInterdisciplinary health professionals (n = 25) (i.e., pediatricians, occupational therapists, speech-language pathologists, board certified behavior analysts, registered dietitians) and parents of autistic children (n = 22).MethodsThe study used semi-structured phone interviews, which were recorded, transcribed, verified, and double-coded using the Framework Method.ResultsThematic analysis of transcripts revealed that while health professionals and parents of autistic children shared some perspectives on nutrition-related challenges and care, they also had distinct viewpoints. Parents emphasized the importance of addressing food selectivity, behavioral eating challenges, sensory issues, and sleep disturbances affecting appetite. Both groups acknowledged the need for tailored support, access to an interdisciplinary care team, and reasonable expectations. Some health professionals perceived parents as lacking motivation or the ability to make changes. In contrast, many parents felt that health professionals lacked the knowledge and motivation to take nutrition or growth concerns seriously. Health professionals acknowledged that their lack of knowledge or capacity to provide nutrition education or referrals was a common barrier to care, particularly given limited community resources.DiscussionHealth professionals who serve autistic children are motivated to address nutrition-related challenges but lack resources related to nutrition. To promote better health outcomes for autistic children, professionals should identify and support parent motivations around nutrition-related care. Both groups expressed interest in accessing autism-specific resources for education, referral, and screening guidance. Future research could explore the development of healthcare training models that improve the competency of health professionals in providing nutrition care and referral for autistic children

Assessing care providers’ perceptions and beliefs about physical activity in infants and toddlers: baseline findings from the Baby NAP SACC study

Background: As children now spend increasing amounts of time in out-of-home care, care providers play an important role in promoting positive health behaviors. Little is currently known about providers’ perceptions and beliefs about physical activity, particularly for very young children. This study describes providers’ perceptions and beliefs about infants’ and toddlers’ physical activity, and assesses their knowledge of physical activity guidelines, to establish if and where providers may need support to promote physical activity in child care settings. Methods: We analyzed baseline data from a pilot randomized-controlled trial conducted in 32 child care centers in Massachusetts, USA. Providers completed physical activity-related questionnaires from which we compared twenty perception and belief questions for infant and toddler care providers. Results: 203 care providers (96% female, mean ± SD age: 32.7 ± 11.2 years) from 29 centers completed questionnaires. A large proportion of providers (n = 114 (61.9%)) believed that infants should be active for 45 minutes or less each day, and only 56 providers (29.7%) perceived toddlers to require more than 90 minutes of activity per day. 97% of providers perceived it was their job to ensure children engaged in a healthy amount of physical activity and most (94.1%) perceived physical activity to be important to own their health, despite 13.3% finding it hard to find the energy to be physically active. Conclusions: This study is the first to assess the physical activity perceptions and attitudes of providers caring for infants and toddlers. Though all providers believed toddlers should engage in more physical activity than infants, most providers believed that young children require only a short amount of physical activity each day, below recommended guidelines. How provider perceptions influence children’s physical activity behavior requires investigation

Parenting around child snacking: development of a theoretically-guided, empirically informed conceptual model

BackgroundSnacking contributes to excessive energy intakes in children. Yet factors shaping child snacking are virtually unstudied. This study examines food parenting practices specific to child snacking among low-income caregivers.MethodsSemi-structured interviews were conducted in English or Spanish with 60 low-income caregivers of preschool-aged children (18 non-Hispanic white, 22 African American/Black, 20 Hispanic; 92% mothers). A structured interview guide was used to solicit caregivers’ definitions of snacking and strategies they use to decide what, when and how much snack their child eats. Interviews were audio-recorded, transcribed verbatim and analyzed using an iterative theory-based and grounded approach. A conceptual model of food parenting specific to child snacking was developed to summarize the findings and inform future research.ResultsCaregivers’ descriptions of food parenting practices specific to child snacking were consistent with previous models of food parenting developed based on expert opinion [1, 2]. A few noteworthy differences however emerged. More than half of participants mentioned permissive feeding approaches (e.g., my child is the boss when it comes to snacks). As a result, permissive feeding was included as a higher order feeding dimension in the resulting model. In addition, a number of novel feeding approaches specific to child snacking emerged including child-centered provision of snacks (i.e., responding to a child’s hunger cues when making decisions about snacks), parent unilateral decision making (i.e., making decisions about a child’s snacks without any input from the child), and excessive monitoring of snacks (i.e., monitoring all snacks provided to and consumed by the child). The resulting conceptual model includes four higher order feeding dimensions including autonomy support, coercive control, structure and permissiveness and 20 sub-dimensions. Conclusions: This study formulates a language around food parenting practices specific to child snacking, identifies dominant constructs, and proposes a conceptual framework to guide future research

Using School Staff Members to Implement a Childhood Obesity Prevention Intervention in Low-Income School Districts: the Massachusetts Childhood Obesity Research Demonstration (MA-CORD Project), 2012–2014

Introduction: Although evidence-based interventions to prevent childhood obesity in school settings exist, few studies have identified factors that enhance school districts’ capacity to undertake such efforts. We describe the implementation of a school-based intervention using classroom lessons based on existing “Eat Well and Keep Moving” and “Planet Health” behavior change interventions and schoolwide activities to target 5,144 children in 4th through 7th grade in 2 low-income school districts. Methods: The intervention was part of the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project, a multisector community-based intervention implemented from 2012 through 2014. Using mixed methods, we operationalized key implementation outcomes, including acceptability, adoption, appropriateness, feasibility, implementation fidelity, perceived implementation cost, reach, and sustainability. Results: MA-CORD was adopted in 2 school districts that were facing resource limitations and competing priorities. Although strong leadership support existed in both communities at baseline, one district’s staff reported less schoolwide readiness and commitment. Consequently, fewer teachers reported engaging in training, teaching lessons, or planning to sustain the lessons after MA-CORD. Interviews showed that principal and superintendent turnover, statewide testing, and teacher burnout limited implementation; passionate wellness champions in schools appeared to offset implementation barriers. Conclusion: Future interventions should assess adoption readiness at both leadership and staff levels, offer curriculum training sessions during school hours, use school nurses or health teachers as wellness champions to support teachers, and offer incentives such as staff stipends or play equipment to encourage school participation and sustained intervention activities

Tamoxifen-Induced Cre-loxP Recombination Is Prolonged in Pancreatic Islets of Adult Mice

Tamoxifen (Tm)-inducible Cre recombinases are widely used to perform gene inactivation and lineage tracing studies in mice. Although the efficiency of inducible Cre-loxP recombination can be easily evaluated with reporter strains, the precise length of time that Tm induces nuclear translocation of CreERTm and subsequent recombination of a target allele is not well defined, and difficult to assess. To better understand the timeline of Tm activity in vivo, we developed a bioassay in which pancreatic islets with a Tm-inducible reporter (from Pdx1PB-CreERTm;R26RlacZ mice) were transplanted beneath the renal capsule of adult mice previously treated with three doses of 1 mg Tm, 8 mg Tm, or corn oil vehicle. Surprisingly, recombination in islet grafts, as assessed by expression of the β-galactosidase (β-gal) reporter, was observed days or weeks after Tm treatment, in a dose-dependent manner. Substantial recombination occurred in islet grafts long after administration of 3×8 mg Tm: in grafts transplanted 48 hours after the last Tm injection, 77.9±0.4% of β-cells were β-gal+; in β-cells placed after 1 week, 46.2±5.0% were β-gal+; after 2 weeks, 26.3±7.0% were β-gal+; and after 4 weeks, 1.9±0.9% were β-gal+. Islet grafts from mice given 3×1 mg Tm showed lower, but notable, recombination 48 hours (4.9±1.7%) and 1 week (4.5±1.9%) after Tm administration. These results show that Tm doses commonly used to induce Cre-loxP recombination may continue to label significant numbers of cells for weeks after Tm treatment, possibly confounding the interpretation of time-sensitive studies using Tm-dependent models. Therefore, investigators developing experimental approaches using Tm-inducible systems should consider both maximal recombination efficiency and the length of time that Tm-induced Cre-loxP recombination occurs

“I Just Try to Keep Her Quiet and Happy” The Role of Caregiver Feeding Practices in Early Childhood Obesity Prevention

Children’s diet is a key driver of childhood obesity, and thus understanding the role of caregivers in mediating the frequency and content of foods offered to children is critical to developing population-based interventions to support healthy behaviors. The main objective of this thesis is to describe multi-ethnic caregiver feeding practices in the context of childhood feeding recommendations through three studies. The first study presents cross-sectional survey data on the feeding practices of n=166 infant/toddler child care providers serving minority children in Boston, examining their adherence to current feeding guidelines. In multivariable analysis, center Child and Adult Care Food Program (CACFP) participation was associated with providers sitting with children at meals (OR=5.2; 95% CI 1.2-21.7), offering fruits and vegetables (OR=3.3; 95% CI 1.7-6.2), and limiting fast food (OR=3.5; 95% CI 1.8-6.7). These findings suggest that CACFP participation may encourage positive feeding behaviors among child care providers. Next, using qualitative in-depth interview data (n=47) low-income multi-ethnic caregivers’ conceptualizations of preschoolers’ snacking in the context of television (TV) viewing are described. Using schema theory to frame data analysis, interview transcripts were coded using the constant comparative method and emergent themes identified. TV viewing was an important component of caregivers’ schemas around child snacking, as they were aware of and accommodated preschoolers’ snacking and TV viewing which was described as routine, positive, and useful for non-nutritive purposes such as family bonding and managing children’s behavior. Finally, cross-sectional survey data from n=271 low-income parents of multi-ethnic children (2-12 years) is presented to identify both reasons and frequency that children receive snacks and the association between these reasons and children’s diet. Using multivariate logistic regression, children were significantly less likely to adhere to dietary recommendations (e.g. soda, fruit/vegetable consumption) when parents offered snacks for non-nutritive reasons like rewarding behavior (OR=0.83; 95% CI 0.70-0.99), celebrating events/holidays (OR=0.72; 95% CI 0.52-0.99), or achievements (OR=0.82; 95% CI 0.68-0.98). For caregivers/parents, public health messages should encourage “screen free” snacking, healthy snack options, and guidance for managing children’s behavior without using snacks or TV. Future research should explore ways to promote child-centered feeding practices both in child care and at home.Nutritio

Food parenting and child snacking: a systematic review

Background: While the role of parenting in children’s eating behaviors has been studied extensively, less attention has been given to its potential association with children’s snacking habits. To address this gap, we conducted a systematic review to describe associations between food parenting and child snacking, or consuming energy dense foods/foods in between meals. Methods: Six electronic databases were searched using standardized language to identify quantitative studies describing associations of general and feeding-specific parenting styles as well as food parenting practices with snacking behaviors of children aged 2–18 years. Eligible peer-reviewed journal articles published between 1980 and 2017 were included. Data were extracted using a standard protocol by three coders; all items were double coded to ensure consistency. Results: Forty-seven studies met inclusion criteria. Few studies focused on general feeding (n = 3) or parenting styles (n = 10). Most studies focused on controlling food parenting practices (n = 39) that were not specific to snacking. Parental restriction of food was positively associated with child snack intake in 13/23 studies, while pressure to eat and monitoring yielded inconsistent results. Home availability of unhealthy foods was positively associated with snack intake in 10/11 studies. Findings related to positive parent behaviors (e.g. role modeling) were limited and yielded mixed results (n = 9). Snacking was often assessed using food frequency items and defined post-hoc based on nutritional characteristics (e.g. energy-dense, sugary foods, unhealthy, etc.). Timing was rarely included in the definition of a snack (i.e. chips eaten between meals vs. with lunch). Conclusions: Restrictive feeding and home access to unhealthy foods were most consistently associated with snacking among young children. Research is needed to identify positive parenting behaviors around child snacking that may be used as targets for health promotion. Detailed definitions of snacking that address food type, context, and purpose are needed to advance findings within the field. We provide suggested standardized terminology for future research. Electronic supplementary material The online version of this article (10.1186/s12966-017-0593-9) contains supplementary material, which is available to authorized users

Student perspectives on multimodal composing in the L2 classroom: tensions with audience, media, learning and sharing

Purpose: Multimodal composing is often romanticized as a flexible approach suitable for all learners. There is a lack of research that critically examines students’ perspectives and the constraints of multimodal composing across academic contexts. This study aims to address this need by exploring high school learners’ perspectives and experiences enacting multimodal learning in an L2 classroom. More specifically, this study presents key tensions between students’ experiences of multimodal composing and teacher/researchers’ use of multimodal composition in an L2 classroom setting. Design/methodology/approach: The paper focuses on two multimodal composing projects developed within a design-based implementation research approach and implemented in a high school French class. Multiple data sources were used: observations; interviews; written reflections; and multimodal compositions. Data were analyzed using the critical incident technique (CIT). A critical incident is one that is unplanned and that stimulates reflection on teaching and learning. Methodologically, CIT was enacted through iterative coding to identify critical incidents and collaborative analysis. Findings: Using illustrative examples from multiple data sources, this study discusses four tensions between students’ experiences of multimodal composing and teacher/researchers’ use of multimodal composition in a classroom setting: the primary audience of student projects, the media leveraged in student projects, expectations of learning in school and the role of a public viewing of student work. Originality/value: This paper problematizes basic assumptions and benefits of multimodal composing and offers ideas on how to re-center multimodal composing on student voices. © 2021, Emerald Publishing Limited.This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]