School Entry Health Examination Research Articles

Is the Level of Motor Development at School Entry Related to the Use of Municipal Exercise Programs? A Social-Differential Analysis.

Children’s motor development is socially unevenly distributed despite many municipal exercise programs (EXP). It has not been sufficiently investigated whether and how they appeal to children from different social backgrounds. This study investigates the use of municipal EXP in preschool age and the association between participation and motor development considering social circumstances. In school entry health examinations, parents were asked about participating in various EXP (response = 65.5%; n = 6480). Motor development, i.e., body coordination and visual-motor coordination, were assessed by a social pediatric development screening, and social circumstances by migration background (MB) and parental education (PE). Poisson regression estimated adjusted Incidence Rate Ratios (IRR; 95% confidence interval, 95%—CI) for relationships between social circumstances and participation in programs and participation and body coordination/visual-motor coordination. Children with MB (IRR 0.73; 95%—CI 0.71–0.75) and low PE (IRR 0.45; 95%—CI 0.40–0.50) used EXP less often. Children participating less often have a finding in body- (IRR 0.76; 95%-CI 0.63–0.90) and visual-motor coordination (IRR 0.47; 95%—CI 0.35–0.62). Significant effects were found for children with and without MB and higher PE. Municipalities should make EXP more attractive for families with MB and low PE.

Prevalence of dental caries and associated factors among school-aged children in Tripoli, Libya: a cross-sectional study

BackgroundIn many developing countries, the prevalence of dental caries has increased due to lifestyle changes, lack of preventive services, and inadequate access to dental care. In Arab countries, the increased prevalence of caries has correlated with economic growth over the past decades, resulting in greater access to unhealthy foods and higher consumption of sugar, particularly among children. However, few studies have assessed caries prevalence among pediatric populations in Arab countries. The objective of this study was to assess the prevalence of dental caries and factors associated with caries among children in Tripoli, Libya.MethodsThis cross-sectional study included a convenience sample of 1934 children in first grade (age 6–7 years, n = 1000) and seventh grade (age 11–12 years, n = 934). Four health centers in Tripoli were selected for screening based on location and participation in school-entry health examinations. Data were collected through self-administered parent surveys and visual dental screenings by trained examiners from September 24 to October 15, 2019. The survey comprised questions about socioeconomic characteristics and oral health behaviors, including toothbrushing, sugar consumption, and dental care history. During screenings, untreated decay, missing teeth, and filled teeth (DMFT or dmft) were recorded. Prevalence of tooth decay was calculated as the proportion of children with high DMFT/dmft scores. Binary logistic and negative binomial regression analyses (with significance at p ≤ 0.05) were used to assess factors associated with caries.ResultsAmong 1000 first-grade children, 78.0% had decay in their primary teeth, with a mean dmft of 3.7. Among 934 seventh-grade children, 48.2% had caries in their permanent teeth, with a mean DMFT of 1.7. The most significant factors associated with caries prevalence were socioeconomic, such as screening site (first grade, p = 0.02; seventh grade, p < 0.001) and maternal employment (seventh grade, p = 0.02), and behavioral, such as toothbrushing duration (seventh grade, p = 0.01), past dental treatment (both grades, p < 0.001), and past emergency visit (both grades, p < 0.001).ConclusionsCaries prevalence was associated with several behavioral and socioeconomic factors, including screening site, maternal employment, toothbrushing duration, past dental treatment, and past emergency visit. Efforts should be made to address these factors to minimize barriers and improve oral health behavior and care utilization. These findings can be used to evaluate current public health initiatives and inform future planning.

Vaccination rate and adherence of tick-borne encephalitis vaccination in Germany

BackgroundTick-borne encephalitis (TBE) is an arboviral infection of the central nervous system. As there is no causal treatment of TBE, disease prevention by vaccination is especially important. Immunization consists of a three-dose primary vaccination schedule, followed by regular booster doses. In Germany, the Standing Committee on Vaccination (STIKO) at the Robert Koch-Institute recommends TBE vaccination for all those at high risk of contracting TBE. This includes individuals living in, traveling to and/or working in risk areas, and being exposed to ticks. To our knowledge, there are currently no reliable data on TBE vaccination rates in Germany available. MethodsThis retrospective cohort study based on anonymized German health claims data was conducted to determine vaccination rates of TBE primary immunization in 2012 to 2015 by federal state, compliance with the vaccination schedule, and TBE vaccination uptake for the 2011 birth cohort. Vaccination protection rates for each federal state were simulated based on a compartmental model. ResultsVaccination rates of an initiated primary immunization ranged from about 3% in the southern federal states to <1% in the northern federal states. Across all federal states, compliance with the vaccination schedule decreased with each subsequent vaccination. Slightly higher TBE vaccination uptake was determined in the 2011 birth cohort, as compared to the German school entry health examination statistics in 2017. Simulated vaccination protection rates for each federal state ranged from 10% in Hamburg to 51% in Baden-Wuerttemberg. ConclusionsWhile there was an overall low vaccination uptake and a discrepancy between areas of high vs. low TBE risk, this study also indicates a concerning decline in vaccination compliance. Vaccinating physicians should address the importance of adherence upon initiation of TBE vaccination.

Significant reduction of ketoacidosis at diabetes onset in children and adolescents with type 1 diabetes-The Stuttgart Diabetes Awareness Campaign, Germany.

To prevent the potentially life-threatening complication, diabetic ketoacidosis (DKA) at type 1 diabetes onset in children and adolescents, awareness campaigns can lead to a significant reduction of DKA. As in Germany, the incidence of DKA at diabetes onset had remained at a constant rate over the last 15 years and increasing numbers of very young children present with higher risk for DKA we decided to set up the Stuttgart Ketoacidosis Awareness Campaign. Over 3 years (2015-2017) the campaign was conducted using information flyers and posters illustrating the typical symptoms of diabetes at school entry health examinations at the Public Health Department, in day-care facilities, in all pediatric practices and by regular public activities. The period between 2011 and 2013 was selected as a reference period. Approximately 17 000 children, median age 4.5 years, and their families were informed about the campaign during the preschool health examination. A total of 118 children and adolescents were treated with newly diagnosed type 1 diabetes compared with 127 during the reference period. During the campaign the incidence of DKA decreased significantly from 28% to 16%. Awareness campaigns like the Stuttgart Ketoacidosis Awareness Campaign about the typical clinical symptoms of type 1 diabetes can significantly reduce the risk for DKA at diabetes onset. Important factors for the success of our campaign were the close cooperation between the children's hospital and the public health department, the targeted approach of families, teachers, and pediatricians and the duration of the campaign over 3 years.

The School Entry Health Examination: A Critical View of History and Status Quo.

At the end of the 19th century, the school entrance medical examination of all school beginners was established in Germany. The focus was on exclusion of infectious diseases and illnesses that could make school attendance more difficult or worsen during the school visit. In the middle of the 20th century the concept of "school maturity" came to the foreground. Different "school maturity concepts" were applied but abandoned because they could not withstand an evaluation. Meanwhile, the concept of "school maturity" has been replaced by the concept of "school ability". The question no longer arises as to whether or not a child can be taught at school, but rather the assistance and support with which this can be achieved. Today, the school entrance medical check-up in nearly all the federal states includes, in addition to a medical history, an assessment of the precautionary and vaccination status, a visual and hearing test as well as assessment of the development of the child and his/her individual support requirements, especially in the field of cognition and language. In almost all German federal states, the school entrance examinations use up considerable resources of the pediatric and adolescent services in the public health departments. In the paper presented, this is critically discussed, and a discourse is suggested as to whether these resources could be used more effectively in terms of child health considering changed social conditions, such as the mandatory health checks in childhood in many federal states, the increase of immigrants from other countries, in particular asylum seekers, or the "Inclusion", i. e. with closure of special-needs schools and the associated challenges in the regular schools.

Gestational diabetes predicts the risk of childhood overweight and abdominal circumference independent of maternal obesity

Gestational diabetes mellitus is believed to be a risk factor for childhood overweight/obesity. We aimed to assess whether this association is either a reflection or independent of confounding by maternal BMI. Data from 7355 mother-child dyads of the German Perinatal Prevention of Obesity cohort with full anthropometric information on mothers and children, gestational diabetes and confounding factors were obtained at school entry health examination. We calculated crude and adjusted logistic regression models for the association of gestational diabetes and childhood overweight/obesity and abdominal adiposity defined by age- and sex-specific percentiles for BMI and waist circumference. Among all children (mean age 5.8 years), 8.1% were overweight, 2.6% were obese and 15.5% had abdominal adiposity. The prevalence of overweight (obesity) was 21% (8.2%) in children of mothers with gestational diabetes and 10.4% (2.4%) in children of healthy mothers. Analyses with adjustment for maternal BMI and other potential confounders yielded an odds ratio of 1.81 (95% CI 1.23-2.65) and 2.80 (95% CI 1.58-4.99) for the impact of gestational diabetes on childhood overweight and obesity, respectively. Similar results were obtained for the risk of childhood abdominal adiposity (odds ratio 1.64, 95% CI 1.16-2.33) by maternal gestational diabetes. The postulated increased risk of overweight and abdominal adiposity in offspring of mothers with gestational diabetes cannot be explained by maternal BMI alone and may be stronger for childhood obesity than for overweight.

Kognitive, sprachliche, motorische und sozial-emotionale Defizite bei verhaltensauffälligen Schulanfängern

Studies show that ADHD, conduct disorders, and anxiety disorders are clinical disorders mostly diagnosed in schoolstarters. The preschool medical examination in Bremen was therefore extended by behavioral screenings. Based on their screening results from the SEU (health examination for school entry) 2011 in Bremen, 67 preschoolers were tested for behavioral disorders. Subsequently, children with behavioral or emotional symptoms (N = 56) were compared to symptomfree controls (N = 52) for their cognitive, motoric, linguistic, and social-emotional development. Psychosocial health was obtained through external assessment by the parents and kindergarten teachers. Results of the WPPSI-III, M-ABC-2, and ET 6-6 were included in the analysis. 32 children met the criteria for behavioral disorders. Children with behavioral or emotional symptoms showed significant lower scores on tests measuring cognitive, motoric, linguistic and emotional development compared to controls. Results suggest that there is necessity to screen all preschoolers for behavioral disorders before entering school. Because children with clinical or subclinical behavioral disorders showed major developmental deficits compared to children without behavioral symptoms, it is essential to conduct a multiple assessment on children with suspected behavioral disorders to ensure early developmental support and adequate interventional programs.

Hearing impairments among Saudi preschool children

BackgroundHearing loss among school-entrant children in the developing world has been widely reported as a significant health problem. Failure to detect hearing loss, either congenital or acquired, in children may result in lifelong deficits in speech and language acquisition. The aims of this study were: (1) to estimate the prevalence of hearing loss and (2) to identify its different types. MethodsThis is a cross-sectional study that included all children (n=2574) aged 4–8 years who attended the obligatory health examination for kindergarten (=370) and primary school (n=2204) entry at the school health center of King Abdulaziz Medical City, Riyadh, Saudi Arabia, from March 2009 to December 2010. Pure-tone air conduction audiometry was conducted for each child in a sound-treated room followed by a diagnostic test. Tympanometry was performed as a complement to the overall objectives of a hearing screening program. ResultsA total of 45 children were diagnosed with hearing impairment (84.4% conductive and 15.6% sensori-neural), with an overall prevalence of 1.75% (95% C.I.: 1.25, 2.25). The majority of cases were females (71.1%), of school age (80.0%), with conductive deafness (84.4%). More than one-half of cases had bilateral deafness (55.6%) of mild degree (57.8%). As for conductive deafness, otitis media with effusion ranked first as a cause of deafness (34.9%), followed by wax and chronic otitis media (23.3% each), while traumatic perforated drum came last (2.3%). Sensorineural deafness constituted 16.2% of all cases. ConclusionConductive hearing loss is the primary type of hearing loss among children and is easy to correct. The urgent development of audiological services in other school health centers in the country, particularly those with good referral systems to Ministry of Health hospitals, is needed. Evidence-based guidelines to identify, monitor, and manage otitis media with effusion (OME) in children in the primary healthcare setting and a strategy to prevent hearing loss are recommended.

Family history and parental recognition of overweight in Croatian children

The aim of this study was to evaluate the perception of parents on the weight status of their offspring, particularly in relation to a family history of obesity and obesity-related illnesses. A cross-sectional study of 1,068 child-parent dyads sampled at school entry health examination was conducted (median age of the child 6.75 years, range 5.7-8.3 years, 50.3 % males). The parental perception of the weight status of their child was compared to the body mass index (BMI, kilogram per square meter), calculated from measured weight and height. Weight status (underweight, normal, overweight, and obese) was defined using the United States Centers for Disease Control and Prevention BMI for age reference charts. Backward multiple linear regression analysis was used to determine possible predictors of parental misclassification of overweight/obese children. Among this cohort of children, 12 % were overweight, 10.2 % obese, and 8.1 % were underweight. Only 24.8 % of obese children and 2.2 % of overweight children were considered "overweight" by their parents. A positive family history was not significantly associated with parental recognition of overweight. Parental misperception of overweight/obese children as being normal was related to the child BMI z-score (odds ratio (OR) 0.036; 0.012-0.111) and diabetes in family history (OR 3.187; 1.207-8.413). The majority of parents did not perceive their overweight/obese children as overweight. As having an obese family member or one who has suffered from an obesity-related illness does not increase the parental ability to recognize overweight in their children, strategies to increase public awareness about the importance of one's family medical history are needed.

Different age-specific incidence and remission rates in pre-school and primary school suggest need for targeted obesity prevention in childhood

School entry marks a tremendous change in the children's life style, which might well be relevant for the emergence of overweight. Previous studies suggested a dramatic increase in the prevalence of overweight during this age. To compare the age-specific balance between the incidence and remission of overweight between pre-school and primary school age children. We combined the data of three studies that had been conducted within the setting of the compulsory school entry health examination in different parts of Germany: one covering retrospective cohort data from age 2 to school entry (n=5045), one prospective data from school entry to fourth grade (n=1235) and one comprising both (n=1194). We assessed the rates of incidence and remission of overweight and obesity from age 2 to school entry and from school entry to fourth grade. In pre-school age, the pooled incidence for overweight was 8.2% (95% confidence interval: 7.5, 8.9) compared with a remission rate of 62.6% (58.4, 66.7), yielding a prevalence at school entry of 10.7% (9.9, 11.5). In primary school age, the pooled incidence for overweight increased to 14.6% (13.1, 16.1), whereas the remission rate was reduced to 17.7% (13.8, 22.3), yielding a prevalence of 23.7% (22.0, 25.4) in fourth grade. A similar pattern was observed for obesity. While high remission rates balance incident overweight in pre-school years, the dramatic increase in the prevalence of overweight and obesity in primary school years reflects a higher incidence and even more a lower remission rate. Obesity prevention programs in primary school age are mandatory and need to address primary and secondary prevention elements.

Der Einfluss von Vorläuferfähigkeiten auf die Rechtschreib-, Lese- und Rechenleistung in der Grundschule

The aim of this study was to determine the role of precursors in the prediction of school achievement. 372 children were followed from health examination for school entry to the second grade. Preschool skills assessed by a screening of developmental stage (SOPESS) were related to second-grade reading (ELFE 1-6), spelling (DERET 1-2+), and arithmetic (DEMAT 1+) by correlation and regression analyses. Correlations between numeracy and math abilities (r=0,340) met with our expectations as also did those between verbal abilities and spelling (r=0,276). The subtests of attention and counting (SOPESS) contribute significantly to an explanation of the variance in school achievement. Numeracy predicts math achievement, and verbal memory contributes to school achievement in math and spelling. Our findings support the contribution of visual selective attention, phonological memory, and verbal abilities to the development of reading, spelling, and math at primary school.

Prevalence of refractive errors among pre-school children at King Abdulaziz Medical City, Riyadh, Saudi Arabia

Background Vision disorders are the fourth most common disability of children and the leading cause of handicapping conditions in childhood. The present study was undertaken to identify the prevalence and pattern of refractive errors among the school-entrant children at King Abdul Aziz Medical City (KAMC), Riyadh city – Kingdom of Saudi Arabia. Methods The study population consisted of all the school-entrants ( n = 1319), who attended the obligatory health examination for kindergarten and primary school entry during the period from March 2008 until October 2008. Every child was subjected to a 10 min – visual acuity test (VAT) and autorefractive test applied by qualified optometrist. Children with a visual acuity of 20/28 or worse in one or both eyes, or with eye disorder (strabismus, nystagmus, ptosis and others) or abnormal ocular movement, were referred for a 45 min complete ophthalmic examination, which consists of: (1) Distance visual acuity (V/A), (2) cover – uncover test, and (3) non-cycloplpegic retinoscopy. Refractive error cut-off point was defined according to their spherical equivalent refractive error (SERE). Results Out of the 1319 children, 60 children were diagnosed as having one or more refractive error, with an over-all prevalence of 4.5% (4.2% in boys and 4.9% in girls) with no sex difference. Prevalence of different refractive errors were as follows; Myopia (2.5%, 95%CI1.7:3.3%), hyperopia (2.1%, 95%CI 1.3:2.9%), astigmatism (2.5%, 95%CI 1.7:3.3%), amblyopia (0.5%, 95%CI 0.1:0.9%) and strabismus (0.5%, 95% CI 0.1:0.9%). Conclusion Our results raise the need for school-based program that provides prescription glasses when needed to students at no cost, through government and non-governmental collaborative fund. However, there is a need for further studies to evaluate the cultural beliefs towards the use of spectacles in Saudi communities.

Association between peer relationship problems and childhood overweight/obesity

To assess the association between peer relationship problems and childhood overweight and obesity. Data on 4718 preschool children were obtained at the obligatory school entry health examination in Bavaria. Parentally reported peer relationship problems ('normal', 'borderline' or 'abnormal') were assessed from the Strengths and Difficulties Questionnaire. Overweight and obesity were defined according to age- and gender-specific BMI cut-off points. Multivariate logistic regression analysis was performed to control potential confounders. The prevalence of overweight and obesity was higher among children with 'borderline' or 'abnormal' peer relationship problems compared to 'normal' children. The association of 'abnormal' peer relationship problems was still significant in the final logistic regression model for girls [odds ratio (OR) for overweight 2.0; 95% confidence interval (CI): 1.4-3.0; OR for obesity 2.6; 95% CI: 1.3-5.0]. Among boys the adjusted odds ratio were lower and no longer significant. The significantly increased prevalence of overweight and obesity among preschool children with peer relationship problems could not be explained by confounding. It seems evident that there is a relevant co-morbidity of peer relationship problems and obesity in pre-school children pointing to the need of interventions focusing on both physical as well as psychosocial health.

Erhebung des Entwicklungsstandes im Rahmen der ärztlichen Schuleingangsuntersuchung

Society and education policy have led to significant changes for school starters. This not only concerns the lowering of school entry age but also the focus of health examinations for school entry on promotion-oriented diagnostics. This examination aims to evaluate the child's school readiness to ensure that from a (work-) medical point of view, the child will be able to meet the expected requirements at his/her future work place, namely, school. The present article demonstrates the consequences of the current requirements by discussing the example of the health examination for school entry in North Rhine-Westphalia. By focusing specifically on the assessment of the child's developmental status as one component of the health examinations for school entry, the effects of the changing conditions become visible. Aspects of health policy are shown considering "the new morbidity" and early preventive medical check-ups. Using the example of the assessment of developmental status the effects of the current requirements and the consequent need for a new concept of this particular component of the health examination for school entry are described.

Erhebung der sozial-emotionalen Kompetenz im Rahmen der ärztlichen Schuleingangsuntersuchung

In recent years, social-emotional competence of preschool children has come to the fore. In spite of this, social-emotional skills have been largely neglected in health examination for school entry in comparison with cognitive skills. After a description of the concepts "emotional competence" and "social competence" the importance of social-emotional skills for school readiness and academic achievement is shown. Then we describe how these skills can be assessed in health examinations for school entry. One can differentiate between behavioural observation, interview, and questionnaires. Advantages and disadvantages of these methods are demonstrated and suitable diagnostic instruments are mentioned.

Entwicklung und Normierung des Einschulungsscreenings SOPESS

This paper offers insight into the development and the standardisation of the social-pediatric screening, SOPESS. The screening was developed for assessing children's developmental stages in the context of the health examination for school entry in North Rhine Westphalia. As the cutoff date regarding age, time of school entry has been rendered flexible, health examinations are due up to six months earlier than before. The screening's theoretical basis is described, its development and standardisation are presented, and its psychometric properties reported.

Meal frequency, breakfast consumption and childhood obesity

In a recent study meal frequency was inversely related to childhood obesity. To assess an inverse association between meal frequency and childhood obesity with particular focus on breakfast consumption. Anthropometric data on 4,642 children aged 5 to 6 years were obtained in 5 Bavarian public health offices (Germany) during the obligatory school entry health examination in 2004/2005. An extensive questionnaire on risk factors for childhood obesity was answered by their parents. Obesity was defined according to sex- and age-specific body mass index (BMI) cut-off points, recommended by the International Obesity Task Force. Main exposures were meal frequency and breakfast consumption. The prevalence of obesity decreased by number of daily meals: 3 or less, 5% (95%CI 4 to 6%), 4 meals, 3% (95%CI 2 to 4%) and 5 or more meals 2% (95%CI 2 to 4%) (trend test p < 0.05). After adjustment for sociodemographic and constitutional factors odds ratios (OR) for obesity were 0.71 (95%CI, 0.50 to 1.01) for 4 meals and 0.57 (95%CI 0.37 to 0.88) for 5 or more meals, compared with 3 or less daily meals. The OR was 0.72 (95%CI 0.58 to 0.90) per additional meal. Additional adjustment for regular breakfast only marginally changed the OR of meal frequency on obesity to 0.75 (95%CI 0.60 to 0.95) per additional meal. High meal frequency was inversely associated with childhood obesity. This association was not explained by potential confounders or regular breakfast consumption. These findings support the hypothesis of an independent protective impact of frequent daily meals other than breakfast on childhood obesity.

Overweight and Obesity in Children Starting School in Augsburg – Prevalence and Influencing Factors

A comprehensive approach to the prevention of overweight and obesity requires identifying the socioeconomic and cultural factors involved. This study set out to determine the prevalence of overweight and obesity among children starting school in Augsburg, Germany. Another aim was to examine influencing factors and any associations between the findings and the children's first language. In the context of the school entry health examination for the 2006/2007 school year, the parents of 2306 children were surveyed by means of an anonymous questionnaire. The investigators documented each child's sex, age, body weight, height, and first language, as well as the preschool attended. The data were evaluated descriptively using SPSS 14.0. Overall, 13.1% (n = 302) of the children were overweight, including 4.9% (n = 113) who were obese. The prevalence of overweight and obesity was nearly twice as high among children whose first language was not German. Half of all children did not attend a sports or dance group. More than half of the overweight children watched television for one to three hours each day. The prevalence of overweight and obesity differs depending on ethnic origin. Children from immigrant families are a high-risk group. Targeted prevention strategies are necessary for children of elementary school age. Our data may serve as the basis for developing neighborhood or district-wide interventions.

Synchronisierung von Schuleingangsuntersuchungen in Niedersachsen

In the German federal state of Lower-Saxony the districts are responsible for conducting school entry health examinations. There exist two different standard protocols for diagnosis and documentation, denoted as Weser-Ems (WE) and SOPHIA. In order to analyse and improve the comparability between these two protocols, a working group was established in 2006. One of the objectives was to adjust the protocols in such a way that in the future the collected data will allow for joint health reporting. Each variable was discussed individually by the working group, and if diagnosis or documentation differed between the two protocols, specific modifications were proposed. For certain variables external expert opinions were obtained. For those variables that had to be revised quite generally, specific sub-working groups were established. As prerequisite for implementation, the recommendations of the working group had to be accepted by the user groups through majority votes. Of 88 (WE) or, respectively, 66 (SOPHIA) variables, 39 (WE) or, respectively, 34 variables initially fulfilled the requirements for a joint analysis. As a result of the working group, for more than 20 other variables the requirements for a joint analysis could be achieved. As soon as the sub-working groups have completed their work, also the issues of physical coordination, cognitive abilities and psychological health will be available for joint analysis. The synchronisation of school entry health examinations in Lower-Saxony is an example of how different protocols of diagnosis and documentation can be adapted to each other to enable joint data analysis without loosing their individual characteristics.

Alternative regression models to assess increase in childhood BMI

BackgroundBody mass index (BMI) data usually have skewed distributions, for which common statistical modeling approaches such as simple linear or logistic regression have limitations.MethodsDifferent regression approaches to predict childhood BMI by goodness-of-fit measures and means of interpretation were compared including generalized linear models (GLMs), quantile regression and Generalized Additive Models for Location, Scale and Shape (GAMLSS). We analyzed data of 4967 children participating in the school entry health examination in Bavaria, Germany, from 2001 to 2002. TV watching, meal frequency, breastfeeding, smoking in pregnancy, maternal obesity, parental social class and weight gain in the first 2 years of life were considered as risk factors for obesity.ResultsGAMLSS showed a much better fit regarding the estimation of risk factors effects on transformed and untransformed BMI data than common GLMs with respect to the generalized Akaike information criterion. In comparison with GAMLSS, quantile regression allowed for additional interpretation of prespecified distribution quantiles, such as quantiles referring to overweight or obesity. The variables TV watching, maternal BMI and weight gain in the first 2 years were directly, and meal frequency was inversely significantly associated with body composition in any model type examined. In contrast, smoking in pregnancy was not directly, and breastfeeding and parental social class were not inversely significantly associated with body composition in GLM models, but in GAMLSS and partly in quantile regression models. Risk factor specific BMI percentile curves could be estimated from GAMLSS and quantile regression models.ConclusionGAMLSS and quantile regression seem to be more appropriate than common GLMs for risk factor modeling of BMI data.