Exclusive breastfeeding of Swedish children and its possible influence on the development of obesity: a prospective cohort study

<p>Abstract</p> <p>Background</p> <p>Overweight and obesity are increasing among children all over the world. Socio-economic factors may influence the development of overweight and obesity in childhood, and it has been proposed that breastfeeding may protect against obesity. The aim of our study was to examine the relationship between exclusive breastfeeding and obesity when potential confounders, such as socioeconomic factors, are considered.</p> <p>Methods</p> <p>The data analyzed was from ABIS (All Babies in Southeast Sweden), a prospective cohort study. All parents with children born between October 1, 1997 and October 1, 1999 in Southeast Sweden (n = 21,700) were asked to participate. Parents were asked to answer periodic questionnaires from the time of the child's birth (n = 16,058) until he/she was five years of age (n = 7,356). Cutoffs for overweight and obesity were defined according to Cole et al, age and gender adjusted. Short-term exclusive breastfeeding was defined as < 4 months of exclusive breastfeeding. Multiple logistic regressions were used to identify variables that predict the child's BMI (Body Mass Index) at five years of age.</p> <p>Results</p> <p>At five years of age, 12.9% of the children in the study wereoverweight and 4.3% were obese. At the age of three months, 78.4% of the children were being breastfed exclusively. The median exclusive breastfeeding duration was four months. High maternal BMI > 30 (AOR = 1.07; CI = 1.05–1.09; P < 0.001), maternal smoking (AOR = 1.43; CI = 1.05–1.95; P = 0.023) and being a single parent (AOR = 2.10; CI = 1.43–3.09; P < 0.001) were associated with short-term exclusive breastfeeding (less than 4 months). Short-term exclusive breastfeeding was less common if one of the parents had a university degree (Mother: AOR = 0.74; CI = 0.61–0.90; P = 0.003 Father: AOR = 0.73; CI = 0.58–0.92; P = 0.008) or if the father was more than 37 years old (AOR = 0.74; CI = 0.55–0.99; P = 0.045). Short-term exclusive breastfeeding was associated with obesity in five-year-old children (simple logistic regression: OR = 1.44; CI = 1.00–2.07; P = 0.050), but when including other independent factors in the analysis, short-term exclusive breastfeeding did not attain statistical significance.</p> <p>Conclusion</p> <p>We cannot exclude the possibility that exclusive breastfeeding influences weight development, but it does not seem to protect against obesity at five years of age.</p

The awareness of primary caregivers in South Africa of the human rights of their children with intellectual disabilities

BACKGROUND : Besides the right to freedom, human rights can be seen as a basic requirement also for the maintenance of human dignity and the opportunity to thrive – particularly in the case of children with disabilities. It is imperative to explore primary caregivers‟ awareness of the human rights of their children with intellectual disabilities in view of the role they may play in either facilitating or restricting these rights. This paper explores the awareness of 219 primary caregivers of the human rights of their children with intellectual disabilities. METHOD : A descriptive survey design was used with a custom-designed questionnaire that employed a deductive content analysis based on the articles of the United Nations Convention on the Rights of a Child. Comparisons were drawn between the awareness of primary caregivers from urban and those from rural areas. RESULTS : The majority (85.5%) of participants agreed that their child with intellectual disability had rights. Three broad kinds of rights were mentioned (in descending order): provision rights, protection rights and participation rights. Participants from both urban and rural areas mentioned education (a provision right) most frequently. However, participants from urban areas were more aware of the different rights that existed than were their counterparts from rural areas. CONCLUSION : Primary caregivers in both rural and urban areas are aware of the rights of their children with disabilities, although there are significant differences between them.http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-22142017-11-30hb2016Centre for Augmentative and Alternative Communication (CAAC

Human rights of children with intellectual disabilities : comparing self-ratings and proxy ratings

BACKGROUND : A child rights-based approach to research articulates well with Article 12 of the United Nations Convention on the Rights of the Child (CRC) and highlights the importance and value of including children’s own views about aspects that concern them. The aim of this study is to compare children with intellectual disability’s own ratings (as self-raters) to those of their primary caregivers (as proxy raters) regarding human rights of children. The study also aims to establish whether there is an inter-rater agreement between the self-raters and proxy raters concerning Maslow’s hierarchy of needs. METHOD : This study is nested in a larger study examining the human rights of children with intellectual disability in South Africa. In total, 162 children with intellectual disability from 11 schools across three provinces and their primary caregivers participated by answering parts of a Children’s Rights Questionnaire (CRQ) developed by the researchers based on the United Nation’s CRC.We compared the answers for six questions in the questionnaire that were addressed to self-raters (children) and proxy raters (primary caregivers) in the same way. RESULTS : Questions regarding basic needs, such as access to clean water or whether the child had food to eat at home, were answered similarly by self-raters and proxy raters. Larger differences were found when self-raters and proxy raters were asked about whether the child had things or friends to play with at home. Socio-economic variables seemed to affect whether self-raters and proxy raters answered similarly. CONCLUSION : The results underscore the importance of promoting children’s rights to express themselves by considering the opinions of both the children as self-raters and their primary caregivers as proxy raters – not only the latter. The results indicate that it is especially important to include children’s own voices when more complex needs are surveyed. Agreement between selfand proxy ratings could be affected by socio-economic circumstances.http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-22142016-11-30hb201

Children in South Africa with and without intellectual disabilities’ rating of their frequency of participation in everyday activities

In a low-and middle-income country (LMIC) such as South Africa, not much is known about how children with intellectual disabilities (ID) participate in everyday activities, as no studies to date have compared their participation to peers without ID from the same background. Using a newly developed, contextually valid measure of participation, Picture my Participation (PmP), 106 children with (73) and without ID (33), rated their frequency of participation in activities of daily living. Previous international research has established that children with ID tend to participate less frequently than children without ID in everyday activities outside of the school setting. However, much of this research is based on proxy ratings from caregivers rather than children with ID themselves. There is a growing body of evidence that suggests children with disabilities have uniquely different views of their own participation than their caregivers. The existing research evidence is also delimited to studies conducted predominantly in high income contexts (HICSs). Since it is universally acknowledged that participation patterns are affected by the environment, it is important to evaluate the generalizability of the current evidence to LMICs. The current study found that there were many similar patterns of participation between the two groups although significant differences were noted in social, community, leisure and self-care activities. We compare these results to findings from studies conducted in HICs and find that there are similarities but also differences across contexts. This study highlights the importance of gaining a child’s perspective of participation and understanding how intellectual disability can affect participation relative to peers without ID in LMICS.The National Research Foundation (NRF), South Africa and the Swedish Foundation for International Cooperation in Research and Higher Education (STINT).http://www.mdpi.com/journal/ijerphpm2021Centre for Augmentative and Alternative Communication (CAAC

Agreement between children with long-term health conditions and their primary caregivers on reports of perceived participation

BackgroundThere is limited knowledge regarding the perceived participation of children with long-term health conditions in everyday activities. Children may have perceptions that differ from those of their primary caregivers. It is unclear whether children and caregivers rate their participation in everyday situations in the same way.ObjectivesWe aimed to explore the level of agreement pertaining to perceived participation (attendance and involvement) and examine whether differences exist in the rank order of activities selected as the three most important between reports from children with long-term health conditions and their primary caregivers.MethodsThe simplified Chinese version of the Picture My Participation (PMP-C; Simplified) was used in an interview with children with long-term health conditions; meanwhile, their primary caregivers finished the questionnaire independently. Data were analyzed using Wilcoxon tests, weighted kappa values, and Spearman's rank order correlation.ResultsChildren with long-term health conditions reported significantly lower attendance scores for six activity items (p &lt; 0.05) and higher involvement scores for two activity items (p &lt; 0.05) than their primary caregivers did. An overall slight to fair agreement in perceived participation was found at the child–caregiver dyad level, though differences in dyads were observed. A strong correlation was identified between the rank order of the most important activities for both groups (r = 0.81).ConclusionsDifferences may exist between the perceived participation of children with long-term health conditions, as reported by primary caregivers and the children themselves. The findings highlight that children with long-term health conditions exhibit unique views with respect to their perceived participation and have to be asked regarding their perceptions themselves

Agreement between participation ratings of children with intellectual disabilities and their primary caregivers

BACKGROUND : Participation of children with ID it is argued must be understood in relation to the fit with the environment. Since caregivers are a vital factor within the close environment of a child with intellectual disability, their perceptions are unequivocally important. AIMS : The main aim of this study is to describe the self-reported participation of children with ID and the perceptions of their primary caregivers. Both frequency of attendance and perceived importance of activity was measured with self-reported and proxy-reports. METHODS AND & PROCEDURES : A custom developed Picture my Participation (PmP) survey was utilised in an interview format with children with intellectual disability whilst their primary caregivers completed the survey independently. RESULTS : Overall, the perceptions of children with intellectual disabilities and of primary caregivers showed similarities regarding attendance and activities considered important. On group level, both children and primary caregivers perceived the child to have a high level of attendance of Formal learning in school, Family mealtime, Interacting with family and Celebrations. An overall poor agreement in perceived frequency of attendance was found. However, in child-primary cargiver-dyads poor agreement in perceived frequency of attendance was found. CONCLUSIONS : While primary caregivers and children’s ratings of attendance and selection of the most important activities appeared somewhat similar, there was a noted difference, in that primary caregivers’ were uniform in their selection, whilst there was a diversity in the selection of activities amongst children.The South African National Research Foundation (NRF) (101566) and the Swedish Foundation for International Cooperation in Research and Higher Education (STINT) (SA2015-6253).https://www.elsevier.com/locate/redevdis2021-09-01hj2021Centre for Augmentative and Alternative Communication (CAAC

Voices of children with intellectual disabilities on participation in daily activities

BACKGROUND : Participation in daily activities is expressed as a human right. Full participation of children with disabilities in daily activities creates optimal opportunities for learning and development. Previous studies have focused primarily on proxy ratings of participation of children with intellectual disabilities in daily activities. However, little is known about how the children rate barriers and facilitators to their participation in everyday activities. OBJECTIVES : To identify barriers to and facilitators for everyday activities as experienced by children with intellectual disabilities from low- and middle-income countries and high-income countries. The research questions were as follows: ‘what barriers to participation do children with disabilities experience in everyday activities?’ and ‘what facilitators to participation do children with disabilities experience in everyday activities?’ METHOD : A qualitative content analyses was used in this study, and individual interviews were conducted with 49 children with intellectual disabilities. The interviews were performed using pictures. The children also selected the most important activities and described in their own words the facilitators and barriers relevant to being able to perform the activities. RESULTS : The most important activities were organised leisure activities, formal learning at school, taking care of other family members and family mealtimes. Self-reported barriers identified were personal functioning, social exclusion and lack of resources. The identified facilitators included satisfaction, personal capability, being included and having access to resources. CONCLUSION : These findings provide important knowledge about the factors to consider in the development of interventions, aimed at improving the participation of children with intellectual disabilities.The National Research Foundation (NRF) and Swedish Foundation for International Cooperation in Research and Higher Education (STINT).http://www.ajod.orgpm2021Centre for Augmentative and Alternative Communication (CAAC

Children's voices-differentiating a child perspective from a child's perspective

OBJECTIVE : The aim of this paper was to discuss differences between having a child perspective and taking the child's perspective based on the problem being investigated. METHODS : Conceptual paper based on narrative review. RESULTS : The child's perspective in research concerning children that need additional support are important. The difference between having a child perspective and taking the child's perspective in conjunction with the need to know children's opinions has been discussed in the literature. From an ideological perspective the difference between the two perspectives seems self-evident, but the perspectives might be better seen as different ends on a continuum solely from an adult's view of children to solely the perspective of children themselves. Depending on the research question, the design of the study may benefit from taking either perspective. In this article, we discuss the difference between the perspectives based on the problem being investigated, children's capacity to express opinions, environmental adaptations and the degree of interpretation needed to understand children's opinions. CONCLUSION : The examples provided indicate that children's opinions can be regarded in most research, although to different degrees.http://informahealthcare.com/journal/pdr2016-06-30hb201

Weight gain in children : possible relation to the development of diabetes

Background: The prevalence of overweight and obesity among children has increased the last decades and is now defined as a global epidemic disease by the World Health Organization. Also the incidence of type 1 diabetes has increased and there are some hypothesises that argue there is a connection between overweight/obesity and type 1 diabetes. Aim: The general aim of this thesis was to study factors contributing to the development of overweight and obesity among children and to study possible relations to the development of diabetes. Method: All Babies in Southeast Sweden, ABIS, is a prospective cohort study. The study includes all babies who were born in southeast Sweden between Oct 1st 1997 until Oct1st 1999 and the design was to follow them up to school age in ABIS I and to follow them until 14 years in ABIS II, of the eligible 74 % entered the study. The families have answered questionnaires and biological samples were taken mainly from the children at the different time points: birth, 1 year, 2.5 years, 5 years and 8-9 years. In this thesis studies have been made including the whole cohort, but some studies have also been made involving only a part of the children. Results: The prevalence of overweight and obesity among children in the ABIS study was 12.9% overweight and 2.5 % obese at 5 years of age. One risk factor which appeared to have a great impact on the development of overweight and obesity at 5 years of age was the child’s own BMI at an early age and also the heredity for overweight/ obesity and the heredity for type 2 diabetes. If the father had a university degree, the child was less likely to be obese at 5 years of age. Other factors, such as the parents´ age, if the child had any siblings, and if the child lived with a single parent, did not show any significant correlation to the child’s BMI at 5 years of age. Early nutrition has been studied and no correlation could be found between breastfeeding less than 4 months and the development of overweight/obesity at 5 years of age. The parents answered questions about how frequent the child ate different food at 2.5 years and at 5 years. Intake of sweet lemonade was the only single food which was correlated to a higher BMI in 5 years old children. Porridge seemed to be protective against overweight/ obesity. In one of the studies the physical activity was measured by a step counter. The fewer steps the children were taking, the higher BMI and waist circumference they had. Low physical activity was also associated with a higher C-peptide value and decreased insulin sensitivity. Children who spent more time in front of TV/video had a higher fasting blood glucose value. Conclusions: A strong factor for the development of overweight and obesity among children is the child’s own BMI at an early age and also its heredity for overweight/ obesity and the heredity for type 2 diabetes. Early nutrition did not show any obvious correlations with overweight and obesity at 5 year old children. Low physical activity was associated with higher fasting C-peptide value and decreased insulin sensitivity. Low physical activity may cause β-cell stress which might contribute to an autoimmune process in individuals genetically predisposed to autoimmunity and, thereby, to the increasing incidence of Type 1 diabetes in children.Bakgrund: Förekomsten av övervikt och fetma bland barn har ökat under de senaste decennierna och klassas av Världshälsoorganisationen (WHO) som en global epidemi. Antalet barn som insjuknar i typ 1 diabetes har också ökat och det finns en del hypoteser som argumenterar för att det finns en koppling mellan övervikt/fetma och typ 1 diabetes. Syfte: Den här avhandlingens syfte var att studera faktorer som bidrar till utvecklingen av övervikt och fetma hos barn och att studera om det möjligen finns en relation till utvecklingen av typ 1 diabetes. Metod: Alla Barn I Sydöstra Sverige, ABIS, är en prospektiv kohort studie. Alla barn, som föddes mellan 1:a oktober 1997 till 1:a oktober 1999 i sydöstra Sverige, erbjöds delta. Barnen följdes sedan upp till skolåldern i ABIS I och till 14 års ålder i ABIS II. Från starten valde 74% av de tillfrågade familjerna att gå med i studien. Familjerna har besvarat frågeformulär, och biologiska prover är tagna huvudsakligen från barnen vid de olika åldrarna: födseln, 1 år, 2.5 år, 5 år och 8-9år. I avhandlingen ingår dels studier med hela ABIS kohorten, men i två av studierna deltar endast en del av barnen. Resultat: Hos de barn som igår i ABIS studien var 12,9% överviktiga vid 5 års ålder och 2,5% var feta. En faktor som visade sig ha betydelse för utvecklingen av övervikt och fetma hos 5 år gamla barn var barnets eget BMI vid tidig ålder samt hereditet för övervikt/fetma och hereditet för typ 2 diabetes. Om föräldrarna, framförallt pappan, läst på högskola eller universitet var barnen mindre ofta överviktiga/feta. Andra faktorer som föräldrarnas ålder, om barnet hade några syskon och om barnet levde med en ensamstående förälder visade sig inte ha betydelse för utvecklingen av övervikt och fetma hos barnen. Tidig uppfödning har också studerats. Vi fann ingen korrelation mellan kort amning, dvs. mindre än 4 månader, och utvecklingen av övervikt/ fetma hos 5 år gamla barn. Föräldrarna har också fått svara på hur frekvent barnet åt olika livsmedel vid 2.5 år och vid 5 år. Saft var det enda livsmedel som enskilt hade ett samband med utveckling av övervikt och fetma vid 5 år. Gröt föreföll ha en skyddande effekt. I en delstudie har fysisk aktivitet mätts med stegräknare. Ju färre steg ett barn tog, desto större risk förelåg för övervikt och fetma. Låg fysisk aktivitet var också associerad till ett högre C-peptidvärde och minskad insulinkänslighet. Barn som tittar mycket på TV/video hade ett högre fasteblodsocker. Konklusion: Av betydelse för utveckling av övervikt och fetma hos barn är barnets eget BMI i tidig ålder och dess hereditet för övervikt och fetma samt hereditet för typ 2 diabetes. Tidig nutrition verkar inte ha några uppenbara samband med övervikt och fetma hos 5 år gamla barn. Låg fysisk aktivitet var associerad till högt faste C-peptid och ökad insulinresistens, vilket skulle kunna stressa β-cellerna och därmed, i enlighet med β- cell stress hypotesen, kunna bidra till en ökad förekomst av typ 1 diabetes hos barn