Infants With Torticollis Who Changed Head Presentation During A Physical Therapy Episode.

PURPOSE: The purpose of this study is to describe infants with congenital muscular torticollis (CMT) who changed head presentation during an episode of physical therapy. METHODS: Data were extracted from electronic medical records between January 2015 and December 2018 to describe infants with CMT who changed presentation. RESULTS: Eighty-nine infants met criteria (predominantly male, non-Hispanic, White, with private insurance). Torticollis symptoms were noticed by 3 months in 90% of infants with a physical therapy examination before 6 months in 100% of infants. Most infants had early mild CMT with abnormal head shape and greater limitation in active cervical range of motion (ROM) than passive cervical ROM. Clinicians frequently recommended weekly physical therapy that included first- choice and supplemental interventions. Episodes of care averaged 7 visits over 64 days with 73% of infants meeting goals. CONCLUSION: Physical therapists should recognize that infants with CMT may change presentation but benefit from physical therapy to resolve symptoms.Digital Abstract available at: http://links.lww.com/PPT/A366.

Exploring Grandparents' Roles in Young Children's Lifestyle Behaviors and the Prevention of Childhood Obesity: An Australian Perspective.

Childhood obesity remains a significant public health issue. Because lifestyle behaviors and weight are established early and track through life stages, prevention strategies must commence in the first years of life. Traditionally, such strategies target parents or formal child care providers. Yet grandparents are increasingly providing care to grandchildren and therefore have an important role in their eating and activity behaviors, which creates a major research gap. This commentary piece, focusing on the Australian context, argues that it is imperative and timely for obesity prevention research to include investigations regarding the role of grandparents in the prevention of obesity-related behaviors in young children.

Practicalities and Research Considerations for Conducting Childhood Obesity Prevention Interventions with Families.

Internationally, childhood obesity is a major public health concern. Given the established difficulties in treating obesity, designing and evaluating effective obesity prevention interventions are research priorities. As parents play a crucial role in establishing positive health behaviours in children, they are a key target for child obesity prevention programs. However, recruiting and engaging parents in such interventions can be a considerable challenge for researchers and practitioners. Members of the 'Parenting, Child Behaviour and Well-being' stream of the Australasian Child and Adolescent Obesity Research Network (ACAORN) have considerable and varied expertise in conducting such interventions and can provide insights into addressing these challenges. This paper aims to highlight considerations regarding the design, implementation, and evaluation of obesity prevention interventions with families and provide practical insights and recommendations for researchers and practitioners conducting family-based research in this area. Case studies of three family-based interventions conducted by ACAORN members are highlighted to provide examples and contextualise the recommendations proposed.

Food neophobia and its association with diet quality and weight in children aged 24 months: a cross sectional study.

BACKGROUND: Food neophobia, the rejection of unknown or novel foods, may result in poor dietary patterns. This study investigates the cross-sectional relationship between neophobia in children aged 24 months and variety of fruit and vegetable consumption, intake of discretionary foods and weight. METHODS: Secondary analysis of data from 330 parents of children enrolled in the NOURISH RCT (control group only) and SAIDI studies was performed using data collected at child age 24 months. Neophobia was measured at 24 months using the Child Food Neophobia Scale (CFNS). The cross-sectional associations between total CFNS score and fruit and vegetable variety, discretionary food intake and BMI (Body Mass Index) Z-score were examined via multiple regression models; adjusting for significant covariates. RESULTS: At 24 months, more neophobic children were found to have lower variety of fruits (ß = -0.16, p = 0.003) and vegetables (ß = -0.29, p < 0.001) but have a greater proportion of daily energy from discretionary foods (ß = 0.11, p = 0.04). There was no significant association between BMI Z-score and CFNS score. CONCLUSIONS: Neophobia is associated with poorer dietary quality. Results highlight the need for interventions to (1) begin early to expose children to a wide variety of nutritious foods before neophobia peaks and (2) enable health professionals to educate parents on strategies to overcome neophobia.

A longitudinal investigation of overweight children's body perception and satisfaction during a weight management program.

BACKGROUND: The Children's Body Image Scale (CBIS) is a measure of body perception and satisfaction. Obesity has a negative impact on children's body satisfaction. This study aimed to (1) determine the construct validity of the CBIS in a purely overweight/obese sample, and (2) explore longitudinal changes in body perception and satisfaction in overweight/obese children participating in a six month weight management program delivered to parents. Data were self-reported by overweight/obese 5 to 9 year old children (n = 127) over a 36 month period. FINDINGS: The CBIS demonstrated good construct validity (Rho: range 0.38 to 0.71, p < 0.05). Accuracy in body size perception did not alter significantly over time (Rho: range 0.45 to 0.59, p < 0.001). No consistent differences in body satisfaction by age or sex were observed. Body satisfaction improved after the six month weight management intervention (mean difference = 0.74, 95% CI 0.15-1.26) which was maintained at 36 month follow up. CONCLUSION: The CBIS is a useful measure to monitor overweight/obese children's body satisfaction. In this cohort, it is suggestive that the child weight management program delivered to parents did not impact negatively on children's body satisfaction.

A parent-led family-focused treatment program for overweight children aged 5 to 9 years: the PEACH RCT.

OBJECTIVE: To evaluate a healthy lifestyle intervention to reduce adiposity in children aged 5 to 9 years and assess whether adding parenting skills training would enhance this effect. PARTICIPANTS AND METHODS: We conducted a single-blinded randomized controlled trial of prepubertal moderately obese (International Obesity Task Force cut points) children, aged 5 to 9 years. The 6-month program targeted parents as the agents of change for implementing family lifestyle changes. Only parents attended group sessions. We measured BMI and waist z scores and parenting constructs at baseline, 6, 12, 18, 24 months. RESULTS: Participants (n = 169; 56% girls) were randomized to a parenting skills plus healthy lifestyle group (n = 85) or a healthy lifestyle-only group (n = 84). At final 24-month assessment 52 and 54 children remained in the parenting skills plus healthy lifestyle and the healthy lifestyle-only groups respectively. There were reductions (P < .001) in BMI z score (0.26 [95% confidence interval: 0.22-0.30]) and waist z score (0.33 [95% confidence interval: 0.26-0.40]). There was a 10% reduction in z scores from baseline to 6 months that was maintained to 24 months with no additional intervention. Overall, there was no significant group effect. A similar pattern of initial improvement followed by stability was observed for parenting outcomes and no group effect. CONCLUSIONS: Using approaches that specifically target parent behavior, relative weight loss of ∼10% is achievable in moderately obese prepubertal children and can be maintained for 2 years from baseline. These results justify an investment in treatment as an effective secondary obesity-prevention strategy.

Randomised controlled trials in overweight children: practicalities and realities.

AIM: To highlight and discuss the practical aspects of conducting high quality, randomised controlled trials (RCTs) with overweight and obese children and their families. CONTENT: Realistic considerations and suggestions for researchers arising from the experiences of three Australian interventions in overweight/obese children are highlighted. The practical implications of key issues arising during this type of RCT include study design, obtaining ethical approval, choice of outcome measures, recruitment, working with families, impact and process evaluation, retention strategies, managing multi-site trials and data management. CONCLUSION: Interventions for overweight children and their families are challenging. Although there were some differences in the design and outcome measures among the three studies, there were many similarities. Multi-site trials, although more expensive than single-site trials, are advantageous in increasing sample size and external validity. Collectively we have developed strategies to address key problems in conducting RCTs, including the common challenges of recruitment, retention and working with families.