Preschoolers BMI: Associations with Patterns of Caregivers\u27 Feeding Practices Using Structural Equation Models

Childhood obesity is a major health concern. Caregivers\u27 feeding practices are modifiable targets of obesity prevention. The study tested two hypotheses: (1) autonomy-promoting feeding practices are associated with lower BMI; and (2) diet mediates the association. We also explored examined whether feeding practices and BMI z-score (BMIz) associations are moderated by child sex, caregiver race, education, family poverty level, and food insecurity. Cross-sectional study of 437 preschoolers (44.4% girls, 38.2% Black/Other, mean age 48.1 months) and caregivers (90.2% female) from 50 child care centers. Feeding Practices were measured by Comprehensive Feeding Practices Questionnaire, child-size perception by preschooler silhouettes, temperament by the Behavior Rating Inventory of Executive Function, child diet by Young Children Food and Drink Questionnaire, and BMIz by measured weight and height. Latent profile analysis delineated feeding practice patterns. Structure equation modeling assessed the patterns in relationship to BMIz. Mediation and multiple-group analyses were used to assess mechanisms of feeding practice patterns and BMIz association. From the three feeding practice patterns, Controlling, Balancing, and Regulating, Regulating was associated with lower child BMIz ( = -0.09) compared to Controlling. Higher difficult temperament ( = 0.09), higher caregiver BMIz ( = 0.26), and caregiver desire for thinner ( = 0.23) were associated with BMIz ( \u3c 0.05). Evaluations of moderators and mediators were not significant. Comprehensive feeding practices support family factors related to child BMIz. Longitudinal research is needed to examine temporal associations between feeding practices and BMIz, with attention to autonomy-supporting practices, promotion of young children\u27s self-regulation, and caregivers\u27 perceptions of child temperament and size. Trial Registration: NCT03111264

Post Intensive Care Syndrome in Pediatrics – enhancing understanding through a novel Bioecological Theory of Human Development lens

Background: The Post Intensive Care Syndrome in pediatrics (PICS-p) framework offers a new understanding of the long-term impact of critical illness on child’s and family’s health. However, a comprehensive theoretical guide to investigate potential factors influencing these outcomes and recoveries is needed. Objective: The aim of the study is to conceptualize post-intensive care outcomes in children and their families after PICU discharge in the context of the child’s surrounding environment and systems.Method: We used theory Adaptation, a shift in the use and perspective of the Bioecological Theory of Human Development (BTHD); and Theory Synthesis, the integration of BTHD and the PICS-p, to provide a novel PICSS-PF perspective for understanding PICS-p within the broader context of the child and family. This integration helps to see higher order perspectives to link post-PICU outcomes and child development within the context of child’s surroundings.Results: While PICS-p is a model for understanding and studying post-PICU outcomes and recovery in four domains of physical, cognitive, emotional and social health, the BTHD offers a new lens for a holistic view of the contextual systems and factors affecting the outcomes and recovery. The BTHD contextual systems include intrapersonal (demographics, clinical), interpersonal (adjacent people’s characteristics and interactions), institutional (family situations, PICU environment), community, social resources, and networks. Conclusions: Knowing the complex nature of post-PICU outcomes in children and their families, the PICSS-PF helps in better understanding of the complex interplay of factors that contribute to PICS in children and their families, leading to the development of more effective interventions to address this condition

Patterns of caregivers\u27 feeding practices and associated characteristics among preschool-age children in the United States

During early childhood, caregiver feeding practices (FP) influence children\u27s diet and eating habits. Inconsistent methods of operationalizing FP have resulted in limited evidence regarding simultaneous FP patterns. This study examined the heterogeneity in FP among caregivers of preschoolers, along with the child, caregiver, and family characteristics associated with FP patterns. Caregivers of preschoolers (n = 437, 90% women) enrolled in 50 childcare centers across Maryland completed the Comprehensive Feeding Practices Questionnaire (CFPQ) and provided demographic information and perceptions of their child\u27s size and temperament. Exploratory Factor Analysis of CFPQ identified 13 factors, and latent profile analysis (LPA) empirically identified three FP classes. Using multinomial structural equation models, we regressed FP classes on child sex, race, age, poverty level, food insecurity education, caregiver perception of child size and temperament. The most common FP pattern (69%) reflected high coercive and control with low autonomy and structural practices (Controlling Class). A second pattern (16%) had high coercive control with moderate structural and autonomy practices (Regulating Class). The third pattern (15%) reflected moderate levels of all practices (Balancing Class). Caregivers who desired their child to be heavier (aOR = 0.40, 95% CI = 0.22–0.72), were more financially secure (aOR = 0.80, 95%CI = 0.65–0.98), and were single (aOR = 0.38, 95% CI = 0.18–0.80) were less likely to be in the Balancing versus Controlling class. For each unit increase in child temperament t-score [higher = difficult], caregivers were more likely to be in the Balancing (aOR = 1.04, 95% CI = 1.01–1.07) or Regulating class (aOR = 1.04, 95% CI = 1.01–1.08) compared to the Controlling class. In this statewide sample, many caregivers endorsed controlling behaviors without endorsing empowering behaviors to help children become healthy eaters. Future studies should examine how caregiver feeding practices evolve and relate to children\u27s eating habits, growth, and development over time

On the move or barely moving? Age-related changes in physical activity, sedentary, and sleep behaviors by weekday/weekend following pandemic control policies

This study examined pre-pandemic (2017-early March 2020) to early-pandemic (Spring 2020) changes in moderate-to-vigorous PA (MVPA), light PA (LPA), and sedentary behavior/sleep (SS), by weekday/weekend, and age (preschool, elementary, middle school). We re-enrolled children from two pre-pandemic obesity prevention trials and examined differences in accelerometer-measured PA from pre-pandemic to early-pandemic across age groups using linear mixed models. Children (n = 75) were 51% multiple race/ethnicities, 29% preschool, 28% elementary, 43% middle school, 65% suburban, 21% rural, and 13% urban. Pre-pandemic to early-pandemic changes in weekday MVPA (p = 0.006), LPA (p = 0.018), and SS (p = 0.003) differed by age. On weekdays, middle schoolers’ MVPA decreased 15.36 min/day (p = 0.002) and SS increased 94.36 min/day (p \u3c 0.001) with non-significant changes among preschoolers and elementary schoolers. Compared to elementary schoolers, middle schoolers’ changes in weekday MVPA (b = −16.34, p = 0.036) and SS (b = 63.28, p = 0.039) significantly differed. Declines in weekday MVPA and increases in SS among middle schoolers suggest that, compared with younger children, middle schoolers are dependent on school and recreational facilities for PA, and in their absence engage in more sedentary activities and sleep