Hispanic Toddlers Research Articles

Measuring Dietary Quality Among Toddlers in the Feeding Infants and Toddlers Study, 2016, Using the New Healthy Eating Index-Toddlers-2020

BackgroundChild diet can influence risk for obesity and other related noncommunicable diseases. Few studies have used the Healthy Eating Index (HEI)-Toddlers-2020 to assess diet quality among toddlers (children aged 12 to 23.9 months). ObjectiveThe aim of this study was to examine diet quality among toddlers participating in the Feeding Infants and Toddlers Study, 2016, and determine differences by sociodemographic characteristics. Caregiver perception of how their toddler’s diet aligns with HEI-Toddlers-2020 diet quality scores was also assessed. DesignThis cross-sectional study used 24-hour dietary records collected in 2016. Participants and settingData were collected on toddlers ages 12 to 23.9 months (N = 1133) participating in the Feeding Infants and Toddlers Study, 2016. Main outcome measuresDiet quality was assessed using the HEI-Toddlers-2020. Statistical analyses performedThe population ratio method was used for all analyses using weighted data to estimate HEI-Toddlers-2020 scores overall and within subgroups. To determine significant differences of the HEI-Toddlers-2020 score between subgroups, pairwise t tests were used. Statistical significance at P < .05 was used as a cutoff for all 2-sided P values. ResultsAverage HEI-Toddlers-2020 score among toddlers ages 12 to 23.9 months participating in the Feeding Infants and Toddlers Study, 2016, was 71.2 out of a possible 100. Total scores (mean, standard error) varied by race and ethnicity with Hispanic toddlers having higher scores compared with non-Hispanic White toddlers (76.4 ± 2.5 vs 69.0 ± 1.2; P = .03) and by federal poverty level with those >200% of the poverty level having higher scores compared with those <100% of the poverty level (74.7 ± 1.5 vs 67.0 ± 2.6; P = .01). ConclusionsOpportunities for improvement in dietary intake were identified using the new HEI-Toddlers-2020 to assess diet quality among children ages 12 to 23.9 months. Scores were indicative of toddlers consuming excess added sugars and lower-than-recommended amounts of seafood and plant proteins, greens and beans, whole grains, and vegetables. Interventions to improve diet quality in toddlers may benefit from focusing on foods children should eat more of along with foods to consume in moderation.

“Struggle at night – He doesn’t let me sleep sometimes”: a qualitative analysis of sleeping habits and routines of Hispanic toddlers at risk for obesity

BackgroundHispanic children face disproportionately higher risks for early life obesity and resultant comorbidities such as Type 2 diabetes and fatty liver disease. Sleep habits are modifiable behaviors that impact early childhood obesity; Hispanic infants have been shown to have less nighttime sleep compared to their white counterparts. Pediatricians often coach families on parents’ nighttime responsive feeding and longer child sleep duration as protective factors against early life obesity, but must understand the family context and potential barriers. This study aimed to discover the sleeping habits and routines of Hispanic toddlers at risk for obesity through the perspective of their mothers.MethodsThis qualitative study used a phenomenological approach. 14 Hispanic mothers were recruited from a Federally Qualified Health Center in Central Texas for qualitative interviews regarding their experience raising a small child. Children aged 6 to 18 months with child weight-for-length ratio ≥ 85% for age were approached for study involvement and consented during well child visits. Interviews occurred over several months during 2018–2019; NVivo software was used for analysis of qualitative themes. Two reviewers coded and used constant comparative methods to identify common themes.ResultsMothers diverged from AAP recommended guidelines for infant and toddler feeding and sleep habits. Mothers shared their intentions and the real-life barriers to implementing recommended habits. Mothers discussed wanting to have their child sleep in a separate bed or room but not having the resources (i.e., financial, space) to do so. Additionally, mothers discussed knowing not to feed to soothe at night but couldn’t bring themselves to let their child cry if they knew feeding would soothe them. Co-sleeping, feeding to sleep, middle of the night feeding, and lack of structured sleep habits were common interview themes and potentially modifiable factors.ConclusionsPediatricians need to be sensitive to culture and the real-world needs of families to determine if best practices are “practical.” Themes from these parent interviews can inform tailored interventions for children at high risk of obesity. Interventions should promote responsive nighttime feeding and structured sleep, working with individual family logistics, to coach families towards optimal healthy environments and healthy child weight.

Added Sugars Intake among US Infants and Toddlers

BackgroundLimited information is available on added sugars consumption in US infants and toddlers. ObjectivesTo present national estimates of added sugars intake among US infants and toddlers by sociodemographic characteristics, to identify top sources of added sugars, and to examine trends in added sugars intake. DesignCross-sectional analysis of 1 day of 24-hour dietary recall data. Participants/settingA nationally representative sample of US infants aged 0 to 11 months and toddlers aged 12 to 23 months (n=1,211) during the period from 2011 through 2016 from the National Health and Nutrition Examination Survey. Trends were assessed from 2005-2006 through 2015-2016 (n=2,795). Main outcome measuresAmong infants and toddlers, the proportion consuming any added sugars, the average amount of added sugars consumed, percent of total energy from added sugars, and top sources of added sugars intake. Statistical analysisPaired t tests were used to compare differences by age, sex, race/Hispanic origin, family income level, and head of household education level. Trends were tested using orthogonal polynomials. Significance was set at P<0.05. ResultsDuring 2011 to 2016, 84.4% of infants and toddlers consumed added sugars on a given day. A greater proportion of toddlers (98.3%) consumed added sugars than infants (60.6%). The mean amount of added sugars toddlers consumed was also more compared with infants (5.8 vs 0.9 tsp). Non-Hispanic black toddlers (8.2 tsp) consumed more added sugars than non-Hispanic Asian (3.7 tsp), non-Hispanic white (5.3 tsp), and Hispanic (5.9 tsp) toddlers. A similar pattern was observed for percent energy from added sugars. For infants, top sources of added sugars were yogurt, baby food snacks/sweets, and sweet bakery products; top sources among toddlers were fruit drinks, sugars/sweets, and sweet bakery products. The mean amount of added sugars decreased from 2005-2006 through 2015-2016 for both age groups; however, percent energy from added sugars only decreased among infants. ConclusionAdded sugars intake was observed among infants/toddlers and varied by age and race and Hispanic origin. Added sugars intake, as a percent of energy, decreased only among infants from 2005 to 2016.

Sleep Duration, Sedentary Behaviors, and Physical Activity across Weight Status in Hispanic Toddlers' Participants of the WIC Program.

To describe physical activity, sedentary behaviors and sleep duration in toddlers' participants of the WIC program in Puerto Rico and assess its association with excessive weight. This was a cross-sectional analysis of data gathered in the follow-up visit (12 months later) of a longitudinal study among toddlers 12-36 months old participants of the WIC program. In this follow-up visit, a Sleep, Sedentary Behaviors and Physical Activity Questionnaire was included. From the 213 eligible participants for the follow-up visit, 76 completed the follow-up visit. Most were girls (52.6%), with median age 21 months and most were categorized as healthy weight (76.3%). In general, toddlers spent a total median of 142 min/d in sedentary behaviors, 300 min/d in physical activities and 690 min/d sleeping. There was a higher duration of physical activities among overweight/obese compared to healthy weights (p<0.05) but similar duration of sedentary behaviors and sleep by weight status (p>0.05). There was a greater proportion of overweight/obese toddlers meeting the screen time recommendation (88.9%) compared to healthy weight toddlers (62.1%; p<0.05). Also, there was a significant positive age-adjusted correlation between time spent in unstructured physical activity (R=0.23, p<0.05) with weight-for-length z-score. Infant weight status was not significantly correlated to parent's perception or knowledge of physical activity or sleep in toddlers (p>0.05). Most toddlers studied met the recommendations for duration of sleep, sedentary behaviors, and physical activity. Overweight/obese toddlers engage in more physical activities than those with a healthy weight status. These findings could be due to educational interventions by the WIC program to promote physical activities, as these toddlers are active WIC participants.

Stability of biological father presence as a proxy for family stability: cross-racial associations with the longitudinal development of emotion regulation in toddlerhood.

The current study, utilizing data from the National Early Head Start Research and Evaluation Project (Love etal., 2005) explored the relationship between biological father presence and emotion regulation over toddlerhood among children from low-income families. Conceptualizing biological father presence as a proxy for family role development, results are interpreted from a role development theoretical perspective. The latent growth curve model was compared based on child ethnoracial status (African American, Caucasian, Hispanic) and child gender. Consistent biological father presence was associated with toddlers' regulatory development across toddlerhood, and this relationship was most robust among Caucasian toddlers as compared to African American toddlers. Findings for Hispanic toddlers were not significantly different from those of Caucasian or African American families. Results bolster the literature on father presence and child outcomes. Analyses address consistency in father presence as a proxy for coherent role development and define a link between consistent father presence and children's regulatory development, demonstrating ethnoracial differences which are likely attributed to the social construction of family roles.

Association of infant feeding and dietary intake on obesity prevalence in low‐income toddlers

This cross-sectional study assesses the independent and combined effects of breastfeeding (BF) and dietary intake, specifically sugar-sweetened beverages (SSB), on obesity prevalence in low-income, primarily Hispanic toddlers. The following data were collected in 2011 via phone surveys with caregivers of 2295 low-income children (2-4 years) from Los Angeles County Women, Infants, and Children (WIC) programs: infant feeding, dietary intake, gestational diabetes status, birth weight, gestational age, and mother's BMI. WIC staff measured children's height and weight. Chi-square tests and binary logistic regressions assessed the independent and combined effects of BF and dietary intake on obesity prevalence. Compared to no BF, BF ≥ 12 mos was associated with a 47% reduction in obesity prevalence (AOR = 0.53, 95% CI 0.4-0.8, P = 0.004). Compared to 2 + SSB/d, no SSB/d intake was associated with a 28% reduction in obesity prevalence (AOR = 0.72, 95% CI 0.5-1.0, P = 0.03). High intake of soda, diet soda, and fruit drinks were linked to increases in obesity prevalence. There was no effect of 100% juice, milk (plain or flavored) fruit, vegetable, fast food, or sweetened grain intake on obesity prevalence. These findings support encouragement of BF ≥ 12 mos and no SSB intake to prevent obesity in low-income, primarily Hispanic, toddlers.

Association of Screen Time Use and Language Development in Hispanic Toddlers

This study examined the association between screen media use, media content, and language development among 119 Hispanic infants and toddlers. Children and their caregivers were recruited through an urban, Early Head Start program. Duration and content of screen media exposure was measured through a 24-hour recall questionnaire, and language development was measured at baseline and at 1-year follow up. Children in the sample spent an average of 3.29 hours engaged with screen media (median 2.5 hours per day). In both cross-sectional and longitudinal analyses, children who watched over 2 hours of television per day had increased odds of low communication scores. Whereas child-directed media was associated with low language scores, adult-directed media was not. Our findings support the mounting literature on the deleterious impacts of screen media in toddler's language development. Guidance and alternatives to screen media use should be available to families in pediatric practices and early childhood centers.

Qualitative Assessment of Teachers’ Opinion on the Early Childhood Nutrition Education

Theory, Prior Research, Rationale: Recent research suggests that breastfeeding could protect against obesity. The age-appropriate body weight increase was consistently reported among breast-fed infants, but fewer studies were conducted in later childhood and with mixed results. Data from WIC toddlers from different ethnic groups would help close the knowledge gap. Study Design, Setting, Participants, and Intervention: The data are drawn from the Nashville Children EatingWell (CHEW) for Health Nutrition Survey. Participants were 150WIC families with children aged 2 to 4 years who are African American, Hispanic orWhite in the Nashville metropolitan area. Outcome, Measures and Analysis: Breastfeeding variables, anthropometric measures of children and mothers, and mothers’ other demographic variables were included in the analyses. Chi-square tests and ANOVA were applied for group comparisons. Results: Nearly half (47%) of the children were exclusively bottle-fed. The most common reason for bottle-feeding was mothers’ perceived difficulties (28%). Among breast-fed children, 63% were also fed formula at the same time (mixed-feeding). Mixed feeding was more prevalent among Hispanic toddlers (52.5%)(P<0.0001), and resulted in more obese toddlers (22.4%) than breast-feeding only and bottle-feeding only (P<0.05).However, breastfeeding for# 3 months did not differ from exclusively bottle-feeding in children’s adiposity. Conclusions and Implications: Mixed-feeding and bottle-feeding were related to a higher risk of obesity whereas short term breast-feeding may not protect ageappropriate weight gain among toddlers. Results from the current study suggest that breastfeeding promotion is important among WIC participants, in particular for the Hispanic population. Funding: NIFA.

Effects of breastfeeding and low sugar-sweetened beverage intake on obesity prevalence in Hispanic toddlers

Few studies have examined the independent and additive effects of breastfeeding (BF) and sugar-sweetened beverage (SSB) intake in early life on overweight and obesity prevalence. The objective was to assess the effects of BF and SSB intake on the prevalence of overweight and obesity in Hispanic toddlers. Nutrition data were collected via phone surveys with caregivers of 1483 Hispanic children (2-4 y of age) from the Los Angeles County Women, Infants, and Children (WIC) program. BF history at 2-4 y of age was categorized as follows: no BF, >1 wk to <6 mo BF, 6 to <12 mo BF, and ≥12 mo BF. SSB intake at 2-4 y of age was categorized as follows: high SSB (≥2 SSBs/d), mid SSB (1 SSB/d), and no SSB. The height and weight of the children were measured by WIC staff and stored in the Integrated Statewide Information System. Binary logistic regressions assessed the effects of BF and SSB categories on overweight and obesity prevalence. In comparison with the no-BF participants, the odds of obesity were lower in the ≥12-mo-BF participants (OR: 0.55; 95% CI: 0.37, 0.83; P = 0.004). In comparison with high-SSB participants, the odds of obesity were lower in the no-SSB participants (OR: 0.69; 95% CI: 0.47, 1.00; P = 0.047). In comparison with the combined no-BF/high-SSB participants, the odds of obesity were lower in the ≥12-mo BF/no-SSB participants (OR: 0.39; 95% CI: 0.19, 0.80; P = 0.01). The results suggest that BF for ≥1 y and low SSB intake during the toddler years can have profound effects on reducing the prevalence of obesity in Hispanic toddlers.

Iron Deficiency in Early Childhood in the United States: Risk Factors and Racial/Ethnic Disparities

Iron deficiency affects 2.4 million US children, and childhood iron-deficiency anemia is associated with behavioral and cognitive delays. Given the detrimental long-term effects and high prevalence of iron deficiency, its prevention in early childhood is an important public health issue. The study objectives were to (1) identify risk factors for iron deficiency in US children 1 to 3 years old, using data from the most recent waves of the National Health and Nutrition Examination Survey IV (1999-2002) and (2) examine risk factors for iron deficiency among Hispanic toddlers, the largest minority group of US children. Analyses of the National Health and Nutrition Examination Survey IV were performed for a nationally representative sample of US children 1 to 3 years old. Iron-status measures were transferrin saturation, free erythrocyte protoporphyrin, and serum ferritin. Bivariate and multivariable analyses were performed to identify factors associated with iron deficiency. Among 1641 toddlers, 42% were Hispanic, 28% were white, and 25% were black. The iron deficiency prevalence was 12% among Hispanics versus 6% in whites and 6% in blacks. Iron deficiency prevalence was 20% among those with overweight, 8% for those at risk for overweight, and 7% for normal-weight toddlers. Fourteen percent of toddlers with parents interviewed in a non-English language had iron deficiency versus 7% of toddlers with parents interviewed in English. Five percent of toddlers in day care and 10% of the toddlers not in day care had iron deficiency. Hispanic toddlers were significantly more likely than white and black toddlers to be overweight (16% vs 5% vs 4%) and not in day care (70% vs 50% vs 43%). In multivariable analyses, overweight toddlers and those not in day care had higher odds of iron deficiency. Toddlers who are overweight and not in day care are at high risk for iron deficiency. Hispanic toddlers are more likely than white and black toddlers to be overweight and not in day care. The higher prevalence of these risk factors among Hispanic toddlers may account for their increased prevalence of iron deficiency.

Factors Related to Overweight and Risk for Overweight Status Among Low-Income Hispanic Children

The purpose of this research was to investigate the agent, host, and environmental factors that are related to overweight status in a sample of low-income Hispanic toddlers who were enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children in a large southwestern city in the United States. Among children at risk for overweight status, the mothers' body mass index (BMI) and the number of servings of fat in the children's daily diet were positively associated with their weight/height percentiles whereas servings of protein in the daily diet and the children's reporting of hunger were negatively associated with their weight/height percentiles. Among overweight children, age was positively associated with their weight/height percentiles. No other variable in the ecological model was associated with normal weight or overweight children and their weight/height percentiles. Different approaches to dietary counseling and health promotion may be indicated based on a child's weight/height percentile or BMI.

Feeding Infants and Toddlers Study: Meal and Snack Intakes of Hispanic and Non-Hispanic Infants and Toddlers

Objective To describe meal and snack patterns of Hispanic and non-Hispanic infants and toddlers. Design A cross-sectional telephone survey in which mothers or other primary caregivers reported their infants’ and toddlers’ food and beverage intake for a 24-hour period. Subjects/setting Subjects were a subset of the national random sample of children aged 4-24 months who participated in the 2002 Feeding Infants and Toddlers Study. The Feeding Infants and Toddlers Study includes a stratified random sample of 3,022 infants and toddlers aged 4-24 months. Three hundred seventy-one Hispanic and 2,637 non-Hispanic children who had 24-hour dietary recalls are included in the subset. Analyses Means±standard errors of daily intakes of energy, nutrients, and nutrient densities were calculated, as were percentages of children consuming foods at each eating occasion. Results Hispanic and non-Hispanic infants and toddlers, on average, were fed seven times per day. Overall, the percentages of children who ate snacks increased with age, and more than 80% of toddlers aged 12-24 months consumed afternoon snacks, with more than 90% of Hispanic children consuming an afternoon snack. In each age group, there were significant differences between ethnic groups in nutrient intakes by eating occasion. No significant difference was seen for energy across all meal occasions. At age 6-11 months, Hispanic children had a significantly lower intake of carbohydrate at dinner and lower intake of saturated fat at afternoon snacks compared with non-Hispanic children ( P<.05). The main difference between Hispanic children’s and non-Hispanic children’s intakes by eating occasion is at age 12-24 months. Hispanics aged 12-24 months had significantly ( P<.05) lower percentages of energy from fat and saturated fat and a significantly ( P<.05) higher percentage of carbohydrate at lunch compared with non-Hispanic children. For dinner, Hispanic toddlers had significantly ( P<.05) lower intakes of total fat and saturated fat compared with non-Hispanic toddlers at age 12-24 months. Overall fiber intake contributed 2 g/meal for both ethnic groups. Snacks contributed, on average, less than 1 g fiber, except Hispanic toddlers had significantly higher fiber intake at afternoon snacks (1.5 g) than non-Hispanic toddlers. Foods frequently consumed at meals and snacks were lacking in whole grains, vegetables, and fruits. Most nutrients were not significantly different between Hispanics and non-Hispanics for meals and snacks. Conclusions Considering the sizeable contribution that snacks make toward overall energy, parents and caregivers should plan toddlers’ snacks to complement meals by including additional fruits, vegetables, and whole grains that are culturally appropriate rather than fruit drinks, cookies, and crackers. This will increase fiber intake and limit fat and sugar intakes. To develop healthful eating patterns, introduce toddlers to foods eight to 10 times to increase food acceptance and the likelihood of establishing healthful eating patterns. Dietetics professionals need to consider cultural differences when developing meal and snack patterns for Hispanic and non-Hispanic infants and toddlers.

Feeding Infants and Toddlers Study: Characteristics and Usual Nutrient Intake of Hispanic and Non-Hispanic Infants and Toddlers

Objective To compare demographic and maternal characteristics and usual nutrient intakes of Hispanic and non-Hispanic infants and toddlers 4 to 24 months of age in the United States. Design We conducted three interviews by telephone to collect information on sociodemographic and maternal characteristics, feeding practices, and dietary intake in the 2002 Feeding Infants and Toddlers Study. We collected 24-hour dietary recalls, including a second day’s intake on a subsample, using the Nutrition Data System for Research. We used the Personal Computer version of the Software for Intake Distribution Estimation to estimate usual nutrient intake and nutrient adequacy and excess for three age subgroups—infants 4-5 months, infants 6-11 months, and toddlers 12-24 months—and Hispanic or non-Hispanic ethnicity. Subjects A national sample of 3,022 infants and toddlers age 4-24 months, including 371 Hispanic and 2,637 non-Hispanic subjects. Statistical analysis We compared means, percentile distributions, and percentages by age/Hispanic ethnicity subgroup, and applied the Dietary Reference Intakes to assess nutrient intakes. Results Mothers of Hispanic infants and toddlers were younger, less likely to be married, and had lower education levels than mothers of non-Hispanic infants and toddlers ( P<.01). Hispanic infants and toddlers had significantly higher rates of participation in the Special Supplemental Nutrition Program for Women, Infants, and Children than non-Hispanic infants and toddlers (42% to 23%) and were more likely to reside in urban areas and have lower annual household income levels ( P<.01). There were no significant differences in usual energy intake between Hispanic and non-Hispanic infants and toddlers, and mean usual energy intake exceeded the mean estimated energy requirement for all age/ethnicity subgroups. Hispanic toddlers consumed a significantly higher proportion of energy from carbohydrate (56% to 53%, P<.01) and a significantly lower percentage of energy from fat (31% to 33%, P<.01) than non-Hispanics. Comparing usual mean intakes, Hispanic infants age 6 to 11 months had a significantly lower intake of calcium than non-Hispanics (means of 574 mg and 626 mg per day, respectively, P<.05) and a significantly higher intake of sodium compared with non-Hispanics of the same age (means of 647 mg to 476 mg per day, P<.01). For infants, mean usual intakes were adequate for all nutrients. For toddlers, the prevalence of nutrient inadequacy was low (<1%) with the exception of vitamin E, which was inadequate for 39% of Hispanic toddlers and 50% of non-Hispanic toddlers. For nutrients with defined Tolerable Upper Intake Levels, more than one third to almost half of toddlers exceeded the Tolerable Upper Intake Levels for vitamin A and zinc, and more than half (53% and 58% for Hispanics and non-Hispanic toddlers, respectively) exceeded the Tolerable Upper Intake Level for sodium. Usual mean intakes of vitamins A, C, and E and folate, potassium, and fiber were significantly higher among Hispanic toddlers compared with non-Hispanic toddlers. Conclusions The Feeding Infants and Toddlers Study data provide information that is useful to practitioners, Special Supplemental Nutrition Program for Women, Infants, and Children program staff, and parents for delivering nutrition education messages that are consistent with dietary guidance for infants and toddlers as well as compatible with cultural preferences.

Perceptions of Health Status and Play Activities in Parents of Overweight Hispanic Toddlers and Preschoolers

Childhood overweight among lower socioeconomic, Hispanic children has increased. Interviews regarding health status and play patterns were conducted with 76 predominantly Hispanic mothers of overweight toddlers and preschoolers served by Women, Infants, and Children (WIC). Most participants believed their child was healthy and half were unconcerned about their child's weight. Most parents reported having a safe place to play and access to a playground, although gender differences were found. Access to an outside play area was related to amount of active play activities. Children watched an average of 1.7 hours per day of television. Health professionals must partner with parents to address childhood obesity.

The Promotion of Social Interaction, Self-Determination, and Language in Hispanic and Migrant Infants and Toddlers in an Early Head Start Program

The Promotion of Social Interaction, Self-Determination, and Language in Hispanic and Migrant Infants and Toddlers in an Early Head Start Program