Child BMI Percentile Research Articles

Early exposure to animals and childhood body mass index percentile and percentage fat mass

ABSTRACT Introduction A few studies have identified childhood animal exposure as associated with adiposity, but results are inconsistent and differ in timing. Methods We conducted an observational cohort study of children ages 4–8 in the Environmental Influences on Child Health Outcomes [ECHO] study. The main exposure was having a dog in the home and/or regular contact with farm animals during the first year of life. Outcomes of interest were child BMI percentile (adjusted for gender and age) categorized as normal/underweight (<85th percentile), overweight (85th to <95th), and obese (≥95th), and percent fat mass (continuous). Associations were analyzed using multinomial logistic regression and multivariable linear regression, respectively, with and without multiple imputation. Results First-year animal exposure occurred in 245 of 770 (31.8%) children. Children with early animal exposure had 0.53 (95% CI: 0.28, 0.997) times the odds of being in the obese BMI category compared to those exposed to animals after controlling for covariates: maternal pre-pregnancy BMI, race/ethnicity, reported child activity level, receiving food assistance, age child began daycare (<1 year vs 1+), exclusively breastfed x6 months, and NICU admission (n = 721). Children with early animal exposure had, on average, 1.5% (95% CI: −3.0, −0.1) less fat mass than exposed children after adjustment for maternal BMI, race/ethnicity, activity, food assistance, breastfeeding, and maternal education (n = 548). Multiple imputation did not alter either result. Conclusion These results provide evidence that exposure to dogs or farm animals in the first year of life is associated with lower odds of obesity and lower percent fat mass in childhood.

Examining Associations Between Food Insecurity, Inhibitory Control, and Body Mass Index in Preschoolers.

This study examines relations between food insecurity, inhibitory control, and body mass index (BMI) in early childhood. The sample comes from an evaluation of a state-funded prekindergarten program and includes 126 children (mean age = 4.73 yrs, female = 42%) from families with low incomes. Parents reported on their child's food insecurity. Child inhibitory control was assessed using a performance-based task, and children's height and weight were objectively collected at the same time as the inhibitory control assessment. A regression model was used to test whether inhibitory control moderated the association between food insecurity and BMI. The model included a large battery of covariates and adjusted for clustering at the classroom level. Ad hoc analyses were conducted to examine the robustness of findings to different conceptualizations of food insecurity based on the US Department of Agriculture's categories for severity. A significant interaction revealed that inhibitory control moderated the association between food insecurity and children's BMI percentile. Investigation of the simple slopes suggested that greater food insecurity was related to a higher BMI percentile among children who demonstrated stronger inhibitory control. In addition, results from ad hoc analyses examining categories of food insecurity indicated that experiencing very low food security was also related to a higher BMI among children with average and strong inhibitory control. This study makes a unique contribution to the existing literature by examining relations among food insecurity, inhibitory control, and BMI during a critical period in children's physical and brain development. Findings have implications for public health efforts to address childhood obesity among populations with low incomes.

Association Between State-Based and Trait-Based Responsiveness to Satiety Cues Differs by Child Risk for Overweight/Obesity

ObjectivesThe relationship between parentally reported satiety responsiveness (i.e., trait) and laboratory-assessed satiety responsiveness (i.e., state) in children is not known, making it difficult to interpret and generalize lab-based findings. In addition, while many studies have shown weight-related differences in children’s eating behaviors, less is known about appetitive traits that are present before obesity develops. Therefore, we examined associations between trait- and state-based satiety responsiveness among children with healthy weight who differed by familial risk for obesity. MethodsData from an ongoing longitudinal study were analyzed for 59 healthy-weight, 7–8 year-old children (BMI-for-age% < 85). Familial risk for obesity was determined by parental weight status as low-risk (N = 34, both parents’ BMIs < 25 kg/m2) or high-risk (N = 25, mothers’ BMI ≥ 30 kg/m2; fathers’ BMI ≥ 25 kg/m2). Parents completed the Children’s Eating Behavior Questionnaire to assess satiety responsiveness (SR), a measure of children’s tendency to stop eating once sated (trait). To assess state-based satiety, the Satiety Quotient (SQ) was calculated from an ad-libitum laboratory meal [(Pre-meal hunger – post-meal hunger)/meal intake in grams]. A higher SQ indicates a greater reduction in hunger per gram (i.e., better satiety responsiveness). ResultsOverall, SR and SQ were not correlated (P = 0.57). However, a linear regression controlling for pre-meal hunger and child BMI percentile revealed a risk status-by-SR interaction (β = 0.804, P = 0.04) such that SR was positively associated with SQ in high-risk children (95% CI [0.003, 0.430]), but there was no relationship between SR and SQ in low-risk children (95% CI [–0.203, 0.085]). No differences in SR, SQ, pre-meal hunger, or post-meal hunger were observed between risk groups. ConclusionsParentally reported (trait-based) satiety was positively associated with laboratory-assessed satiety, but only among healthy weight children at high-familial risk for obesity. Parents of children who are at high-risk for developing obesity may be more observant of children’s appetitive traits compared to parents of low-risk children, and this may be helpful in the prevention of obesity. Funding SourcesNIH RO1: DK110060.

Maternal Depressive Symptoms and Their Association with Breastfeeding and Child Weight Outcomes.

Children of mothers with depressive symptoms are at a higher risk for psychosocial, behavioral, and developmental problems. However, the effects of maternal depression on children’s physical growth are not well understood. To address the gaps in the literature, this study examined the association between maternal depressive symptoms, breastfeeding behaviors, and child weight outcomes. Data from 204 mother–child dyads who participated in the STRONG Kids 1 Study were used. Mothers and children were assessed twice when the children were 3 and 4 years old. Height and weight measurements of children and mothers were collected by trained researchers during both assessments. Multiple linear regression and analysis of covariance tests were used to examine the associations between maternal depressive symptoms, breastfeeding, and age and sex-adjusted child body mass index percentile. Recurrent maternal depressive symptoms when the child was 3 and 4 years old were not associated with child body mass index percentiles (BMI-P) at age 4. Mothers who breastfed for at least 6 months had significantly lower depressive symptoms when their children were 3 years of age, but the differences did not persist at age 4. In this community sample, maternal depressive symptoms were not associated with child BMI-P, regardless of breastfeeding duration.

Maternal self-efficacy is associated with mother-child feeding practices in middle childhood

ObjectiveMaternal self-efficacy (MSE) is a well-established correlate of health outcomes in young children, though little is known about this association in older children. The purpose of this cross-sectional study was to examine how MSE relates to mother-child feeding practices in middle childhood. MethodsA total of 306 children ages 8–12 (Mean age = 9.72, SD = 0.91, 52.9% female) and their mothers participated in this study. Mothers completed the New General Self-Efficacy Scale and the Child Feeding Questionnaire. A series of hierarchical regression models were used to examine how MSE related to maternal food restriction, maternal pressure to eat, and maternal food monitoring. ResultsAfter accounting for maternal Body Mass Index (BMI), education, and age, and child Body Mass Index Percentile (BMI%ile) and age within the first step of each regression model, MSE emerged as a significant predictor for maternal restriction of foods (p = .024) and maternal food monitoring (p = .048). MSE was not significantly related to maternal pressure to eat. ConclusionsThis study is the first to establish that higher MSE is significantly related to healthier mother-child feeding practices in middle childhood, providing preliminary justification for enhancing MSE within comprehensive family interventions to support child weight-related health.

Effects of Coparenting Quality, Stress, and Sleep Parenting on Sleep and Obesity Among Latinx Children: A Path Analysis.

We sought to examine the associations among parent-level constructs, sleep-related parenting practices, and child sleep in Latinx families. A quantitative study was conducted with 101 Latinx parents of children aged 2-5 years. Key variables that were examined included parental stress, coparenting quality, bedtime routine consistency, parent-child sleep interactions, and child's sleep duration. Path analysis results indicated that (1) parent stress had a direct effect on child sleep duration (p =.005) and was mediated by parent-child sleep interactions (p =.021); (2) coparenting quality had a direct effect on child sleep duration (p =.001) and was mediated by bedtime routine consistency (p =.010); and (3) bedtime routine consistency had an indirect effect on child body mass index percentile and was mediated by sleep duration (p =.049). Coparenting quality and parental stress may be important constructs to consider when designing interventions to improve Latinx child sleep duration.

Development of Brief Child Nutrition and Physical Activity Screening Questions for Electronic Health Record Use.

Background: To develop and test brief nutrition and physical activity screening questions for children ages 2-11 years that could be used as a pragmatic screening tool to tailor counseling, track behavior change, and improve population health. Methods: A literature review identified existing validated questions for nutrition and physical activity behaviors in children ages 2-11 years. Response variation and concurrent validity was then assessed using a mechanical Turk (MTurk) crowdsourcing survey employed in 2018. Additionally, cognitive interviews were conducted with both providers and parents of 2- to 11-year-old children to assess screening question priorities and perceived added value. Results: The literature review identified 260 questions, and 20 items were selected with expert guidance based on prespecified criteria (simplicity and potential utility for both clinical interactions during a well-child exam and population health). MTurk surveys yielded 1147 records that met eligibility criteria and revealed 6 items that had adequate response variation and were significantly correlated with parent-reported child BMI or BMI percentile, exhibiting concurrent validity. Cognitive interviews with 10 providers and 20 parents uncovered themes regarding suggestions and usability of the questions, eliminating 3 items due to parent and provider concerns. Combining quantitative and qualitative results, 3 nutrition and physical activity screening items remained for inclusion into the electronic health record (EHR). Conclusions: The three-pronged validation methodology produced a brief, 3-item child nutrition and physical activity screener to incorporate in the EHR, where it can inform tailored counseling for well-child care and be used to test associations with population health outcomes.

The Maternal Factor: Associations Between Maternal Health Characteristics And Child And Family Health Habits.

Childhood physical activity (PA) is important for adequate growth and development. Child PA is influenced by family health habits, such as encouragement and active involvement. Mothers are of central importance within the family unit, as their personal and supportive behaviors can alter the health-promoting home environment. To better understand the dynamics of family health behavior, maternal characteristics associated with child and family PA must be explored. PURPOSE: Determine associations between maternal health characteristics (anthropometrics and PA) with child and family health habits. METHODS: Mother-child dyads (children aged 5.0-7.9 years) were recruited. Mother and child height and weight were measured objectively and body mass index (BMI) was calculated (age- and sex-specific percentiles for children). Mothers completed the International Physical Activity Questionnaire - Short Form to evaluate maternal PA; MET hours PA/week were calculated. Child PA was measured using accelerometry-determined counts per minute. Mothers completed the Family Nutrition and Physical Activity Questionnaire to evaluate family PA participation score, which was the sum of two survey items; higher scores indicate higher frequency of PA practices including family encouragement and involvement. The association between maternal PA and BMI with child PA and family PA participation was assessed using linear regression, and adjusted for maternal age, child hours away from home, household income, and child BMI percentile. RESULTS: Fifty-two mother-child dyads participated. On average, mothers were 82.7% Caucasian, 67.3% employed full-time, 46.2% normal weight, and obtained 44.8±48.4 MET hours PA/week. Children averaged 1159.8±262.8 CPM and mothers reported average family PA participation score of 6.2±7.4 (max. score 8). Maternal BMI was not related to child or family outcomes (p>0.05). Maternal PA was associated with more frequent family PA participation score (p=0.028). CONCLUSIONS: In this sample, maternal characteristics were related to beneficial family health habits, rather than individual child PA. Mothers may influence the collective behavior more so than individual behavior. Future research should seek to study the mechanisms driving association between maternal and family PA.

Data driven decision making to characterize clinical personas of parents of children with cystic fibrosis: a mixed methods study

BackgroundBeginning at a young age, children with cystic fibrosis (CF) embark on demanding care regimens that pose challenges to parents. We examined the extent to which clinical, demographic and psychosocial features inform patterns of adherence to pulmonary therapies and how these patterns can be used to develop clinical personas, defined as aspects of adherence barriers that are presented by parents and/or perceived by clinicians, in order to enhance personalized CF care delivery.MethodsWe undertook an explanatory sequential mixed-methods study consisting of i) multivariate clustering to create clusters corresponding to parental adherence patterns (quantitative phase); ii) parental participant interviews to create clinical personas interpreted from clustering (qualitative phase). Clinical, demographic and psychosocial features were used in supervised clustering against clinical endpoints, which included adherence to airway clearance and aerosolized medications and self-efficacy score, which was used as a feature for modeling adherence. Clinical implications were developed for each persona by combing quantitative and qualitative data (integration phase).ResultsThe quantitative phase showed that the 87 parent participants were segmented into three distinct patterns of adherence based on use of aerosolized medication and practice of airway clearance. Patterns were primarily influenced by self-efficacy, distance to CF care center and child BMI percentile. The two key patterns that emerged for the self-efficacy model were most heavily influenced by distance to CF care center and child BMI percentile. Eight clinical personas were developed in the qualitative phase from parent and clinician participant feedback of latent components from these models. Findings from the integration phase include recommendations to overcome specific challenges with maintaining treatment regimens and increasing support from social networks.ConclusionsAdherence patterns from multivariate models and resulting parent personas with their corresponding clinical implications have utility as clinical decision support tools and capabilities for tailoring intervention study designs that promote adherence.

Determinants of accurate visual perception of child anthropometric phenotype among ethnically diverse preschool parents in the United States.

The literature reports that regardless of the high obesity prevalence estimates in young children, parents often do not accurately perceive their child's weight status. The purpose of this analysis was to examine the association between parent/child demographic characteristics including ethnicity, country of birth and years living in the United States and the perception of child's anthropometric phenotype status based on a visual silhouette instrument. Caregiver (n=456) and child sociodemographic, perception of child anthropometric phenotype status and height/weight measurements were collected in 2015, from 24 childcare centres in Miami, Florida, among children ages 2-to-5years old. Chi-square analysis determined parent perception accuracy by actual child healthy (<body mass index [BMI] 85th percentile) or unhealthy (≥ BMI 85th percentile) status. Multivariable linear regression modelled phenotype trends by caregiver perception. Twenty-eight per cent of the sample was of unhealthy weight. Overall, 74.6% of caregivers did not accurately identify their child's BMI phenotype category versus 25% who did (p<.001); 8% of Hispanic and 13% of non-Hispanic parents of a child with an unhealthy BMI correctly identified their child's anthropometric phenotype. A higher proportion of Cuban (22%) caregivers of a child with an unhealthy BMI percentile versus Mexican caregivers (13.9%) visually identified their child as healthy weight. Child BMI percentile was significantly associated with parent perception of child healthy phenotype (OR: 1.05, 95% CI 1.04, 1.06). Findings here add evidence to the existing body of literature that emphasise parent perception of child weight status as a critical lynchpin in the childhood obesity epidemic. Intervention efforts must continue to educate parents on healthy weight development strategies.

Differences in Frequency of Visits to Pediatric Primary Care Practices and Emergency Departments by Body Mass Index.

To examine differences in utilization across health care settings among children by body mass index (BMI) categories to help identify opportunities for interventions. A retrospective study was conducted using 1 year of electronic health records following an index primary care visit for children 3 to 17 years old in 2016. Index visits occurred at >40 pediatric practices affiliated with a Northeastern health system. Using normal BMI as a reference group, we examined the extent to which children's BMI percentile categories were associated with primary care visits, emergency department (ED) visits, hospitalizations, and ED visit acuity. Age, sex, race/ethnicity, and insurance status were used as covariates. Of those with biologically plausible values for height and weight (n=30,352), the prevalences of overweight, obesity, and severe obesity were 16.3%, 12.4%, and 5.7%, respectively. Children outside of the normal BMI range made more primary care visits; however, relative patterns of ED utilization were not consistent. Children with obesity versus normal BMI were less likely to have ED visits of high acuity. Risk of hospitalization was higher among children with overweight or severe obesity. Children's BMI categories were associated with health care utilization, specifically primary care visits, ED visits, and hospitalizations. Further investigation is needed to explore the drivers of these differences in utilization, such as the impact of stigma and perceived weight bias on care-seeking patterns, and to examine the role of settings outside of primary care in pediatric weight management.

Pediatric-Adapted Liking Survey (PALS): A Diet and Activity Screener in Pediatric Care.

Clinical settings need rapid yet useful methods to screen for diet and activity behaviors for brief interventions and to guide obesity prevention efforts. In an urban pediatric emergency department, these behaviors were screened in children and parents with the 33-item Pediatric-Adapted Liking Survey (PALS) to assess the reliability and validity of a Healthy Behavior Index (HBI) generated from the PALS responses. The PALS was completed by 925 children (average age = 11 ± 4 years, 55% publicly insured, 37% overweight/obese by Body Mass Index Percentile, BMI-P) and 925 parents. Child–parent dyads differed most in liking of vegetables, sweets, sweet drinks, and screen time. Across the sample, child and parent HBIs were variable, normally distributed with adequate internal reliability and construct validity, revealing two dimensions (less healthy—sweet drinks, sweets, sedentary behaviors; healthy—vegetables, fruits, proteins). The HBI showed criterion validity, detecting healthier indexes in parents vs. children, females vs. males, privately- vs. publicly-health insured, and residence in higher- vs. lower-income communities. Parent’s HBI explained some variability in child BMI percentile. Greater liking of sweets/carbohydrates partially mediated the association between low family income and higher BMI percentile. These findings support the utility of PALS as a dietary behavior and activity screener for children and their parents in a clinical setting.

The role of weight stigma in parental weight talk.

Many parents engage in "weight talk" with their child, such as encouraging their child to lose weight or making comments about their own weight or others' weight. What parents say to their children about weight can affect children's well-being, yet little is known about parental characteristics that may be at play regarding this common practice. This study examined the role of weight stigma in parental weight talk, and whether internalized weight bias mediates the relationship between parents' experiences of weight stigma and weight-based conversations and comments. A sample of 453 parents (Mage =35.07) with children 2 to 17years old (Mage =8.76) completed surveys measuring parental experiences with weight stigma, weight bias internalization, and frequency of different types of parental weight talk. Mediations were tested via the PROCESS macro. Independent of controls (parent BMI, child BMI percentile, parent and child sex, parent and child age, race, income, and education), experienced weight stigma was indirectly associated with greater frequency of weight-based conversations (β=.08) and comments about oneself (β=.08) and others (β=.04) via parents' internalized weight bias. These findings offer novel insights for understanding parental weight talk and can inform pediatric providers working with families on weight-related issues.

The Healthy Homes/Healthy Kids 5-10 Obesity Prevention Trial: 12 and 24-month outcomes.

Pediatric primary care is an important setting for addressing obesity prevention. The Healthy Homes/Healthy Kids 5-10 randomized controlled trial evaluated the efficacy of an obesity prevention intervention integrating pediatric primary care provider counseling and parent-targeted phone coaching. Children aged 5 to 10years with a BMI between the 70th and 95th percentile and their parents were recruited from pediatric primary care clinics. Participants received well-child visit provider counseling about obesity and safety/injury prevention and were then randomized to a 14-session phone-based obesity prevention (OP; n=212) or safety and injury prevention contact control (CC; n=209) intervention. The primary outcome was 12 and 24-month child BMI percentile. There was no overall significant treatment effect on child BMI percentile. Caloric intake was significantly lower among OP compared with CC participants at 12months (P<.005). In planned subgroup analyses, OP condition girls had significantly lower BMI percentile (P<.05) and BMI z-score (P<.02) at 12 and 24months relative to CC girls and were less likely to be overweight (38.0% vs 53.0%, P<.01) or (obese 3.4% vs 8.8%, P<.10) at follow-up. An obesity prevention intervention integrating brief provider counseling and parent-targeted phone counseling did not impact 12 and 24-month BMI status overall but did have a significant impact on BMI in girls.

Parental influences on screen time and weight status among preschool children from Brazil: a cross-sectional study

BackgroundLittle is known about the influence of parental attributes and parental screen time behaviours on pre-schooler’s screen time and weight status in low-to-middle income countries. The purpose of this study was to examine the relationships between parental screen time, parental self-efficacy to limit screen time, child screen time and child BMI in preschool-aged children in Brazil.MethodsThree hundred eighteen parent-child dyads from Caruaru, Brazil completed a survey measuring sociodemographic data, weekday and weekend screen time, and parental self-efficacy for limiting screen time. Height and weight were measured and used to derive BMI and BMI percentile. Observed variable path analysis was used to evaluate the relationships between the parental and child variables.ResultsAnalyses were conducted for screen time on weekdays and weekend days. Parental screen time was positively associated with child screen time, either directly (weekdays = β = 0.27, p < 0.001, weekends = β = 0.24, p < 0.001) or indirectly through reduced self-efficacy to limit child screen time (weekdays = β = − 0.15, p = 0.004, weekends = β = − 0.16, p = 0.004). After controlling for household income, parental occupation, and parental BMI, greater child screen time on weekends, not weekdays, was associated with higher child BMI percentile (β = 0.15, p = 0.006).ConclusionsParental screen time and self-efficacy to limit screen time are important influences on child screen time and weight status in pre-schoolers from Brazil. Reducing parental screen time and increasing parental confidence to limit screen time may be effective strategy to prevent overweight in Brazilian pre-schoolers.

The Impact of a Healthy Weight Intervention Embedded in a Home-Visiting Program on Children's Weight and Mothers’ Feeding Practices

ObjectiveTo examine whether a healthy weight intervention embedded in the Parents as Teachers (PAT) home visiting program, which was previously found to improve mothers’ body mass index (BMI) and obesity-related behaviors, changed the BMI of preschool children or maternal feeding practices. MethodsThis stratified randomized trial included preschool-aged children at risk for overweight whose mothers were overweight or had obesity (n = 179). The Healthy Eating and Active Living Taught at Home (HEALTH) intervention was based on the Diabetes Prevention Program. Differences were examined using repeated-measures mixed-ANOVA models. ResultsCompared with PAT usual care, the HEALTH intervention had no effect on children's BMI or maternal feeding practices. However, combined analyses showed that children's BMI percentile decreased (P = .007), BMI z-scores were maintained (P = .19), and 3 of 8 feeding practices improved over time (P < .05). Conclusions and ImplicationsAdditional research is needed to assess the effectiveness of PAT to prevent preschool-age obesity using rigorous designs (eg, group-randomized trials) and to identify its active components. HEALTH is ready to be scaled up to prevent maternal weight gain through embedding within the national PAT program.

Early Exposure to Cumulative Social Risk and Trajectories of Body Mass Index in Childhood.

Childhood social risk has been associated with increased risk of childhood obesity. However, little is known about early exposure of cumulative social risk on BMI percentile (BMIp) trajectories in early childhood. Public data from the Fragile Families and Child Wellbeing Study were analyzed (N = 3809). Maternal reports of experiences of multiple social risk factors were obtained at age 1 and 3 assessments of children. Two cumulative social risk scores were calculated by summing social factors assessed at age 1 and at age 3. Child BMIp was assessed at ages 3, 5, and 9. Linear mixed models were used to examine the effect of cumulative social risk on sex-specific BMIp trajectories. Compared with girls experiencing low social risk at either age 1 or 3, girls experiencing high social risk (≥ 2 factors) at age 1 or 3 only had higher initial BMIp at age 3 [β0 = 5.70 (95% confidence interval, CI: 0.15-1.26) and 1.37 (95% CI: -2.25 to 4.99), respectively] and had nonsignificantly greater BMIp growth rate [β1 = 0.39 (95% CI: -0.86 to 1.63) and 0.32 (95% CI: -0.86 to 1.63)]. Girls experiencing high social risk at both ages had nonsignificantly but consistently lower BMIp [β1 = -1.24 (95% CI: -2.93 to 0.46)]. In addition, girls experiencing a sum of ≥4 risk factors at both ages had lower BMIp growth rate [β1 = -1.77 (95% CI: -3.39 to -0.15)] compared to girls experiencing no risk factor. No associations were observed among boys. Early exposure to cumulative social risk may have long-term impact on BMIp trajectories among girls, depending on timing of exposure. Understanding the effect of cumulative social risk in different contexts, including sex, chronicity, and timing of exposure, may have practical implications for informing effective intervention to combat childhood obesity.

Preventing Childhood Obesity Through a Mindfulness-Based Parent Stress Intervention: A Randomized Pilot Study

To assess the feasibility of engaging stressed, low-income parents with obesity in a novel mindfulness-based parent stress intervention aimed at decreasing the risk of early childhood obesity. An 8-week mindfulness-based parent stress group intervention (parenting mindfully for health) plus nutrition and physical activity counseling (PMH+N) was developed for parents with obesity aimed at preventing obesity in their at-risk 2- to 5-year-old children. PMH+N was compared with a control group intervention (C+N), and improvement in parenting was assessed before and after the intervention using the laboratory-based toy wait task (TWT). In addition, nutrition, physical activity, and stress were assessed using a multimethod approach. After establishing feasibility in 20 parent-child dyads (phase 1), 42 dyads were randomized to PMH+N vs C+N (phase 2). Compared with the C+N group, the PMH+N group demonstrated significantly better group attendance (P < .015), greater improvement in parental involvement (P < .05), and decreased parental emotional eating rating (P < .011). Furthermore, C+N, but not PMH+N, was associated with significant increases in child body mass index percentile during treatment (P < .03) when accounting for the TWT before and after changes in parenting scores. These findings suggest that a mindfulness-based parent stress intervention to decrease childhood obesity risk is feasible, requires further testing of therapeutic mechanisms in larger samples, and may be a potential way to attenuate the risk of childhood obesity. ClinicalTrials.govNCT01974102.

Understanding Outcomes in Behavior Change Interventions to Prevent Pediatric Obesity: The Role of Dose and Behavior Change Techniques.

Behavioral interventions to prevent pediatric obesity have shown inconsistent results across the field. Studying what happens within the "black box" of these interventions and how differences in implementation lead to different outcomes will help researchers develop more effective interventions. To compare the implementation of three features of a phone-based intervention for parents (time spent discussing weight-related behaviors, behavior change techniques used in sessions, and intervention activities implemented by parents between sessions) with study outcomes. A random selection of 100 parent-child dyads in the intervention arm of a phone-based obesity prevention trial was included in this analysis. Sessions were coded for overall session length, length of time spent discussing specific weight-related behaviors, number of behavior change techniques used during the sessions, and number of intervention-recommended activities implemented by the parents between sessions (e.g., parent-reported implementation of behavioral practice/rehearsal between sessions). The primary study outcome, prevention of unhealthy increase in child body mass index (BMI) percentile, was measured at baseline and 12 months. Overall session length was associated with decreases in child BMI percentile ( b = -0.02, p = .01). There was no association between the number of behavior change techniques used in the sessions and decreases in child BMI percentile ( b = -0.29, p = .27). The number of activities the parents reported implementing between sessions was associated with decreases in child BMI percentile ( b = -1.25, p = .02). To improve future interventions, greater attention should be paid to the intended and delivered session length, and efforts should be made to facilitate parents' implementation of intervention-recommended activities between sessions (ClinicalTrials.gov, No. NCT01084590).

Impact of continuous low-dose antibiotic prophylaxis on growth in children with vesicoureteral reflux

Continuous antibiotic prophylaxis (CAP) is a mainstay of treatment for children with vesicoureteral reflux (VUR). There has been an increasing focus on the effect of antibiotics on gut microbiota and subsequent repercussions on growth. Continuous antibiotic prophylaxis is generally considered safe; however, its impact on growth in children with VUR remains unknown. This objective of this study was to determine whether CAP altered height, weight, or body mass index (BMI) in children with VUR. Children diagnosed with primary VUR were identified. Demographics including weight and height percentiles, BMI and BMI percentiles, age, gender, antibiotic class, prior antibiotic use, urinary tract infectionhistory, and breakthrough infections were tested in univariate and multivariate analyses. Primary outcome was change in BMIas well as weight, height, and BMI percentiles. One hundred eighty patients (146 girls, 34 boys) were prescribed CAP at mean age of 29.2±26.2 months. Mean follow-up on CAP was 4.1±3.3 years, with median follow-up of 3.08 years. Mean increase in weight percentile was 1.49 (2.02 males, 1.37 females; P=0.46). Mean decrease in height percentile was -4.44 (-2.18 males, -4.95 females; P=0.51). Age at diagnosis (P=0.004) and history of prior treatment courses of antibiotics (P=0.007) were associated with a significant BMI increase (Fig.1). Body mass index percentile increased from 58.4 to 66.5; however, this increase was only significant in children aged above 1 year(P<0.0001). Of note, children above 1 year of age were significantly more likely to have a history of prior treatment courses of antibiotics (58% vs32%; P<0.0001), and when controlling for prior antibiotic use, the increase in BMI percentile in those over 1 year of age did not reach significance. The use of antibiotics has been associated with alterations in pediatric growth parameters in both animal models and clinical studies. However, little information exists on the impact of prophylactic-dosed antibiotics on growth. While this study is limited by the retrospective analysis and small sample size, it was found that the use of CAP did impact growth parameters, with a stronger effect seen in children who had received prior treatment courses of antibiotics before the infection leading to the initiation of CAP. Continuous antibiotic prophylaxis was correlated with significant increase in BMI in children with prior antibiotic usage and a significant increase in BMI percentile in children aged above 1 year. Continuous antibiotic prophylaxis was also associated with decreased height percentiles, particularly in patients aged less than 1 year, though it did not reach statistical significance. Further analysis is needed to investigate whether these effects on weight, height, and BMI are persistent and clinically significant.