Non-linear longitudinal associations between moderate-to-vigorous physical activity and adiposity across the adiposity distribution during childhood and adolescence: Gateshead Millennium Study.

OBJECTIVE: Insufficient moderate-to-vigorous intensity physical activity (MVPA) is harmful for youth; however, the evidence for differential effects by weight status is limited. The study aimed to examine associations between MVPA and adiposity by weight status across childhood and adolescence. METHODS: Participants were from the Gateshead Millennium Study. Physical activity and body composition measures were taken at age 7 y (n = 502; measures taken between October 2006 and December 2007), 9 y (n = 506; October 2008-September 2009), 12 y (n = 420; October 2011-September 2012), and 15 y (n = 306; September 2014-September 2015). Participants wore an ActiGraph GT1M and epochs were classified as MVPA when accelerometer counts were ≥574 counts/15 s. Weight and height were measured using standardized methods and fat mass using bioelectrical impedance. Associations between MVPA and changes in BMI and FMI were examined by weight status using quantile regression. RESULTS: Higher MVPA was associated with lower FMI for the 25th, 50th, 75th, and 90th percentile and lower BMI at the 50th, 75th, and 90th percentile, independent of accelerometer wear time, sex, and sedentary time. The association between MVPA and change in adiposity was stronger in the higher than lower FMI and BMI percentiles (e.g., 1 h/day more MVPA was associated with a 1.5 kg/m2 and 2.7 kg/m2 lower FMI at the 50th and 90th FMI percentiles, respectively). CONCLUSIONS: The effect of MVPA on adiposity in the higher adiposity percentiles is stronger than reported to date. Given overweight and obese children are the highest risk group for later obesity, targeting MVPA might be a particularly effective obesity prevention strategy.

Timing of the decline in physical activity in childhood and adolescence: Gateshead Millennium Cohort Study.

BACKGROUND AND AIM: There is a widely held and influential view that physical activity begins to decline at adolescence. This study aimed to identify the timing of changes in physical activity during childhood and adolescence. METHODS: Longitudinal cohort study (Gateshead Millennium Study) with 8 years of follow-up, from North-East England. Cohort members comprise a socioeconomically representative sample studied at ages 7, 9, 12 and 15 years; 545 individuals provided physical activity data at two or more time points. Habitual total volume of physical activity and moderate-to-vigorous intensity physical activity (MVPA) were quantified objectively using the Actigraph accelerometer over 5-7 days at the four time points. Linear mixed models identified the timing of changes in physical activity across the 8-year period, and trajectory analysis was used to identify subgroups with distinct patterns of age-related changes. RESULTS: Four trajectories of change in total volume of physical activity were identified representing 100% of all participants: all trajectories declined from age 7 years. There was no evidence that physical activity decline began at adolescence, or that adolescent declines in physical activity were substantially greater than the declines during childhood, or greater in girls than boys. One group (19% of boys) had relatively high MVPA which remained stable between ages 7 and15 years. CONCLUSIONS: Future policy and research efforts to promote physical activity should begin well before adolescence, and should include both boys and girls.

Risk factors for eating disorder symptoms at 12 years of age: A 6-year longitudinal cohort study.

Eating disorders pose risks to health and wellbeing in young adolescents, but prospective studies of risk factors are scarce and this has impeded prevention efforts. This longitudinal study aimed to examine risk factors for eating disorder symptoms in a population-based birth cohort of young adolescents at 12 years. Participants from the Gateshead Millennium Study birth cohort (n = 516; 262 girls and 254 boys) completed self-report questionnaire measures of eating disorder symptoms and putative risk factors at age 7 years, 9 years and 12 years, including dietary restraint, depressive symptoms and body dissatisfaction. Body mass index (BMI) was also measured at each age. Within-time correlates of eating disorder symptoms at 12 years of age were greater body dissatisfaction for both sexes and, for girls only, higher depressive symptoms. For both sexes, higher eating disorder symptoms at 9 years old significantly predicted higher eating disorder symptoms at 12 years old. Dietary restraint at 7 years old predicted boys' eating disorder symptoms at age 12, but not girls'. Factors that did not predict eating disorder symptoms at 12 years of age were BMI (any age), girls' dietary restraint at 7 years and body dissatisfaction at 7 and 9 years of age for both sexes. In this population-based study, different patterns of predictors and correlates of eating disorder symptoms were found for girls and boys. Body dissatisfaction, a purported risk factor for eating disorder symptoms in young adolescents, developed concurrently with eating disorder symptoms rather than preceding them. However, restraint at age 7 and eating disorder symptoms at age 9 years did predict 12-year eating disorder symptoms. Overall, our findings suggest that efforts to prevent disordered eating might beneficially focus on preadolescent populations.

Can't play, won't play: longitudinal changes in perceived barriers to participation in sports clubs across the child-adolescent transition.

BACKGROUND: Participation in sports is associated with numerous physical and psychosocial health benefits, however, participation declines with age, and knowledge of perceived barriers to participation in children is lacking. This longitudinal study of children and adolescents aimed to use the ecological model of physical activity to assess changes in barriers to participation in sports clubs to identify age-specific and weight-specific targets for intervention. METHODS: Longitudinal study-Perceived barriers to sports participation were collected from a birth cohort, the Gateshead Millennium Study (n>500) at ages 9 and 12 years. The open-ended question 'Do you find it hard to take part in sports clubs for any reason?' was completed with free text and analysed using content analysis, and the social-ecological model of physical activity. RESULTS: Barriers from across the social-ecological model were reported. Barriers at 9 years were predominantly of a physical environmental nature, and required high parental involvement (for transport, money, permission), or were associated with a lack of suitable clubs. At 12 years, perceived barriers were predominantly classed as intrapersonal ('they're boring') or social environmental ('my friends don't go'). Perceived barriers were not associated with weight status. CONCLUSIONS: Perceived barriers to sports participation change rapidly in childhood and adolescence. Future interventions aiming to increase sports participation in children and adolescents should target specific age groups, should consider the rapid changes which occur in adolescence, and aim to address prominent barriers from across the socioecological model. Perceived barriers may be unrelated to current weight status, allowing for more inclusive solutions.

Development of sedentary behavior across childhood and adolescence: longitudinal analysis of the Gateshead Millennium Study.

BACKGROUND: In many parts of the world policy and research interventions to modify sedentary behavior of children and adolescents are now being developed. However, the evidence to inform these interventions (e.g. how sedentary behavior changes across childhood and adolescence) is limited. This study aimed to assess longitudinal changes in sedentary behavior, and examine the degree of tracking of sedentary behavior from age 7y to 15y. METHODS: Participants were part of the Gateshead Millennium Study cohort. Measures were made at age 7y (n = 507), 9y (n = 510), 12y (n = 425) and 15y (n = 310). Participants were asked to wear an ActiGraph GT1M and accelerometer epochs were defined as sedentary when recorded counts were ≤25 counts/15 s. Differences in sedentary time and sedentary fragmentation were examined using the Friedman test. Tracking was examined using Spearman's correlation coefficients and trajectories over time were assessed using multilevel linear spline modelling. RESULTS: Median daily sedentary time increased from 51.3% of waking hours at 7y to 74.2% at 15y. Sedentary fragmentation decreased from 7y to 15y. The median number of breaks/hour decreased from 8.6 to 4.1 breaks/hour and the median bout duration at 50% of the cumulative sedentary time increased from 2.4 min to 6.4 min from 7y to 15y. Tracking of sedentary time and sedentary fragmentation was moderate from 7y to 15y however, the rate of change differed with the steepest increases/decreases seen between 9y and 12y. CONCLUSION: In this study, sedentary time was high and increased to almost 75% of waking hours at 15y. Sedentary behavior became substantially less fragmented as children grew older. The largest changes in sedentary time and sedentary fragmentation occurred between 9y to 12y, a period which spans the transition to secondary school. These results can be used to inform future interventions aiming to change sedentary behavior.

Parental Perception of Weight Status: Influence on Children's Diet in the Gateshead Millennium Study.

OBJECTIVE: Recognising overweight and obesity is critical to prompting action, and consequently preventing and treating obesity. The present study examined the association between parental perceptions of child weight status and child's diet. METHODS: Participants were members of the Gateshead Millennium Study. Parental perception of their child's weight status was assessed using a questionnaire and compared against International Obesity Task Force cut-offs for childhood overweight and obesity when the children were aged 6-8 years old. Diet was assessed at age 6-8years old using the FAST (Food Assessment in Schools Tool) food diary method. The association between parental perception and dietary patterns as defined by Principal Components Analysis, was assessed using multivariate regression after adjustment for child's gender, child's weight status, maternal body mass index (BMI), maternal education and deprivation status. RESULTS: Of the 361 parents who provided complete data on confounders and on their perception of their child's weight status, 63 (17%) parents perceived their child as being of 'normal' weight or 'overweight' when they were actually 'overweight' or 'obese', respectively. After adjustment for confounders, parents who misperceived their child's weight had children with a lower 'healthy' dietary pattern score compared to children whose parents correctly perceived their weight (ß = -0.88; 95% CI: -1.7, -0.1; P-value = 0.028). This association was found despite higher consumption of reduced sugar carbonated drinks amongst children whose parents incorrectly perceived their weight status compared to children whose parents perceived their weight correctly (52.4% vs. 33.6%; P-value = 0.005). CONCLUSIONS: In conclusion, children whose parents did not correctly perceive their weight status scored lower on the 'healthy' dietary pattern. Further research is required to define parents' diets based on their perception status and to examine if a child's or parent's diet mediates the association between parental perception and child weight.

Influence of adiposity on health-related quality of life in the Gateshead Millennium Study cohort: longitudinal study at 12 years.

OBJECTIVE: To examine whether adiposity is associated with an impaired quality of life (an individual's perception of their life) in general population samples in early adolescence. DESIGN AND METHODS: Relationships between a direct measure of adiposity (fat mass index from bioimpedance) and a proxy measure (waist circumference), and a generic (KIDSCREEN-27) and a weight-specific measure of health-related quality of life (HRQoL, Impact of Weight on Quality of Life-Kids (IWQOL-Kids)) were examined in a longitudinal population-based cohort of young adolescents aged 12 years (n=519). The effects of change in adiposity over time (from 7 years and 9 years) were also examined (n=331-445 in longitudinal analyses). RESULTS: Impairment in HRQoL was associated with current adiposity but it was not predicted by earlier adiposity. At 12 years, higher adiposity was associated with lower Physical Well-Being on KIDSCREEN-27, and with lower Total Scores on the weight-specific IWQOL-Kids instrument, the latter particularly in girls. CONCLUSIONS: Health and education professionals need to be aware in their clinical practice that higher adiposity impairs HRQoL in general populations of young adolescents. Further research would be useful to determine whether or not children of primary school age self-reporting lower HRQoL are more likely to develop higher adiposity later in adolescence or early adulthood.

A cluster randomised trial testing an intervention to improve parents' recognition of their child's weight status: study protocol.

BACKGROUND: Parents typically do not recognise their child's weight status accurately according to clinical criteria, and thus may not take appropriate action if their child is overweight. We developed a novel visual intervention designed to improve parental perceptions of child weight status according to clinical criteria for children aged 4-5 and 10-11 years. The Map Me intervention comprises age- and sex-specific body image scales of known body mass index and supporting information about the health risks of childhood overweight. DESIGN: This cluster randomised trial will test the effectiveness of the Map Me intervention. Primary schools will be randomised to: paper-based Map Me; web-based Map Me; no information (control). Parents of reception (4-5 years) and year 6 (10-11 years) children attending the schools will be recruited. The study will work with the National Child Measurement Programme which measures the height and weight of these year groups and provides feedback to parents about their child's weight status. Before receiving the feedback, parents will complete a questionnaire which includes assessment of their perception of their child's weight status and knowledge of the health consequences of childhood overweight. The control group will provide pre-intervention data with assessment soon after recruitment; the intervention groups will provide post-intervention data after access to Map Me for one month. The study will subsequently obtain the child height and weight measurements from the National Child Measurement Programme. Families will be followed-up by the study team at 12 months. The primary outcome is any difference in accuracy in parental perception of child weight status between pre-intervention and post-intervention at one month. The secondary outcomes include differences in parent knowledge, intention to change lifestyle behaviours and/or seek advice or support, perceived control, action planning, coping planning, and child weight status at 12 month follow-up. DISCUSSION: The Map Me tool has potential to make a positive impact on children's health at a population level by introducing it into current intervention programmes to improve accuracy of parental perception of child's weight status. This trial will inform the action of researchers, educators, health professionals and policy makers. TRIAL REGISTRATION: Current Controlled Trials ISRCTN91136472. Registered 3 May 2013.

Objective measurement of sedentary behavior: impact of non-wear time rules on changes in sedentary time.

BACKGROUND: Accelerometry non-wear time rules might affect sedentary time, and the associations with health outcomes such as adiposity. However, the exact effect of different non-wear time rules on sedentary time and reported changes in sedentary time is unknown. This study evaluated the effect of different accelerometry non-wear time rules on sedentary time and changes in sedentary time from age 9-12 years. METHODS: Accelerometry data were collected as part of the Gateshead Millennium Birth Cohort study. Participants were 9.3 (± 0.4) years at baseline (n = 17) and 12.5 (± 0.3) years at follow-up (n = 440). Sedentary time was defined using an accelerometry cut-point of 25 counts per 15 s. Non-wear time was defined using manual data reduction (the reference method) and 10 min, 20 min and 60 min consecutive zeros. Differences between methods were analyzed using repeated measures ANOVA with Bonferroni post-hoc analyses. RESULTS: Mean daily sedentary time at age 9 ranged from 364 min per day to 426 min using the 10 min and 60 min rule, respectively (p < 0.05). At 12 years, mean daily sedentary times ranged from 424 min to 518 min (p < 0.05). Mean changes in daily sedentary time over the three years ranged from 60 min to 93 min using the 10 min and 60 min rule, respectively (p < 0.05). When adjusting for wear time, differences in average sedentary time between methods decreased from 62 min to 27 min (age 9), 95 min to 32 min (age 12) and 33 min to 10 min (changes between 9 to 12 years). CONCLUSIONS: Using different non-wear time rules results in significant differences in daily sedentary time and changes in sedentary time. Correcting for wear time appears to be a reasonable approach to limiting these differences and may improve comparability between future studies. Using the 20 min rule, while correcting for wear time, provided the most accurate estimates of sedentary time and changes in sedentary time, compared to the manual reference in 9-12 year-olds.

Longitudinal associations between sports participation, body composition and physical activity from childhood to adolescence.

OBJECTIVES: Several important research questions have been addressed: (1) What are the cross-sectional associations between sports club participation, objectively measured physical activity, and adiposity? (2) Do measures of physical activity and adiposity predict subsequent sports club participation? (3) Does sports club participation predict subsequent measures of physical activity and adiposity? and (4) Do changes in sports club participation predict changes in objective measures of physical activity and adiposity? DESIGN: Longitudinal and cross-sectional. METHODS: Data from the Gateshead Millennium Study birth cohort (n=609 at age 7 years) were analysed for associations between adiposity, sports club participation and accelerometer-measured physical activity from ages 7y to 9y to 12y. RESULTS: Seventy-two per cent of 9 year olds and 63% of 12 year olds took part in a sports club. Sports club participation was significantly associated with overall accelerometer-measured physical activity at 12y (coefficient=0.0.09; 95% CI: 0.01-0.16) but not 9y. An inverse relationship between fat mass (estimated from bioelectric impedance) and sport club participation, and between fat mass and accelerometer-measured physical activity was observed at 12y, but not 9y. Sports club participation at 9y was highly predictive of participation at 12y. Sports club participation was significantly associated with socioeconomic status; fewer children from poorer areas took part. CONCLUSIONS: Sports club participation in adolescence may be associated with decreased levels of adiposity. Furthermore, the potential benefits of sports club participation for adiposity are likely generated from continuous participation in sports, rather than any long-term protective effects.

Physical activity, diet and BMI in children aged 6-8 years: a cross-sectional analysis.

OBJECTIVE: To assess relationships between current physical activity (PA), dietary intake and body mass index (BMI) in English children. DESIGN AND SETTING: Longitudinal birth cohort study in northeast England, cross-sectional analysis. PARTICIPANTS: 425 children (41% of the original cohort) aged 6-8 years (49% boys). MAIN OUTCOME MEASURES: PA over 7 days was measured objectively by an accelerometer; three categories of PA were created: 'active' ≥60 min/day moderate-to-vigorous-intensity PA (MVPA); 'moderately active' 30-59 min/day MVPA; 'inactive' <30 min/day MVPA. Dietary intake over 4 days was measured using a prospective dietary assessment tool which incorporated elements of the food diary and food frequency methods. Three diet categories were created: 'healthy', 'unhealthy' and 'mixed', according to the number of portions of different foods consumed. Adherence to the '5-a-day' recommendations for portions of fruit and vegetables was also assessed. Children were classified as 'healthy weight' or 'overweight or obese' (OW/OB) according to International Obesity Taskforce cutpoints for BMI. Associations between weight status and PA/diet categories were analysed using logistic regression. RESULTS: Few children met the UK-recommended guidelines for either MVPA or fruit and vegetable intake, with just 7% meeting the recommended amount of MVPA of 60 min/day, and 3% meeting the 5-a-day fruit and vegetable recommendation. Higher PA was associated with a lower OR for OW/OB in boys only (0.20, 95% CI 0.04 to 0.88). There was no association detected between dietary intake and OW/OB in either sex. CONCLUSIONS: Increasing MVPA may help to reduce OW/OB in boys; however, more research is required to examine this relationship in girls. Children are not meeting the UK guidelines for diet and PA, and more needs to be done to improve this situation.

Creation of an adiposity index for children aged 6-8 years: the Gateshead Millennium Study.

OBJECTIVE: A number of measures of childhood adiposity are in use, but all are relatively imprecise and prone to bias. We constructed an adiposity index (AI) using a number of different measures. METHODS: Detailed body composition data on 460 of the Gateshead Millennium Study cohort at the age of 6-8 years were analysed. The AI was calculated using factor analysis on age plus thirteen measures of adiposity and/or size. Correlations between these variables, the AI, and more traditional measures of adiposity in children were investigated. RESULTS: Based on the factor loading sizes, the first component, taken to be the AI, consisted mainly of measures of fat-mass (the skinfold measurements, fat mass score, and waist circumference). The second comprised variables measuring frame size, while the third consisted mainly of age. The AI had a high correlation with body mass index (BMI) (rho = 0.81). CONCLUSIONS: While BMI is practical for assessing adiposity in children, the AI combines a wider range of data related to adiposity than BMI alone and appears both valid and valuable as a research tool for studies of childhood adiposity. Further research is necessary to investigate the utility of AI for research in other samples of children and also in adults.

Pain in young people aged 13 to 17 years with cerebral palsy: cross-sectional, multicentre European study.

OBJECTIVE: To determine the prevalence and associations of self- and parent-reported pain in young people with cerebral palsy (CP). DESIGN AND SETTING: Cross-sectional questionnaire survey conducted at home visits in nine regions in seven European countries. Participants were 13 to 17-year-olds (n=667) drawn from population CP registers in eight regions and from multiple sources in one region. 429 could self-report; parent-reports were obtained for 657. Data were collected on: severity, frequency, site and circumstances of pain in previous week; severity of pain associated with therapy in previous year. RESULTS: The estimated population prevalence of any pain in previous week was 74% (95% CI 69% to 79%) for self-reported pain and 77% (95% CI 73% to 81%) for parent-reported pain. 40% experienced leg pains, 34% reported headaches and 45% of those who received physiotherapy experienced pain during therapy. Girls reported more pain than boys (OR=2.1, 95% CI 1.5 to 3.0) and young people reported more pain if they had emotional difficulties (comparing highest and lowest quartiles: OR=3.1, 95% CI 1.7 to 5.6). Parents reported more pain in children with emotional difficulties (OR=4.2, 95% CI 2.7 to 6.6), or with more impaired walking ability. CONCLUSIONS: Pain in young people with CP is highly prevalent. Because pain causes immediate distress and is associated with lower subjective well-being and reduced participation, clinicians should routinely assess pain. Clinical interventions to reduce pain should be implemented and evaluated. The efficacy of medical and therapeutic interventions causing pain should be re-examined to establish if their benefit justifies the pain and fear of pain that accompany them.

Effect of choice of outcome measure on studies of the etiology of obesity in children.

PURPOSE: Epidemiologic studies of the etiology of childhood obesity often use proxies for adiposity as outcomes. This study aimed to compare the ability of a range of proxy measures to detect associations with sedentary behavior. METHODS: Longitudinal study of children in the Gateshead Millennium Study who were 7 years at baseline and 9 years at follow-up. Associations between 2-year changes in objectively measured sedentary behavior and changes in proxies for adiposity (waist circumference, waist Z score, body mass index, body mass index Z score) and measurement of body composition (fat mass index from bioelectric impedance) were examined. Associations were tested with linear regression. RESULTS: Associations between 2-year increases in sedentary behavior and increases in adiposity were detectable by using the fat mass index as the outcome, but not the simple proxy measures of adiposity, as outcomes. CONCLUSIONS: Proxy measures are inferior to measures of body composition as outcomes in epidemiologic studies.

Early predictors of objectively measured physical activity and sedentary behaviour in 8-10 year old children: the Gateshead Millennium Study.

BACKGROUND: With a number of studies suggesting associations between early life influences and later chronic disease risk, it is suggested that associations between early growth and later physical activity (PA) may be a mediator. However, conflicting evidence exists for association between birth weight and childhood PA. In addition, it is important to know what other, potentially modifiable, factors may influence PA in children given its' association with childhood and later adiposity. We used the Gateshead Millennium Study (GMS) to identify predictors of childhood PA levels. METHODS: The GMS is a cohort of 1029 infants born in 1999-2000 in Gateshead in northern England. Throughout infancy and early childhood, detailed information was collected. Assessments at age 9 years included body composition, objective measures of habitual PA and a range of lifestyle factors. Mean total volumes of PA (accelerometer count per minute, cpm) and moderate-vigorous intensity PA (MVPA), and the percentage of time spent in sedentary behaviour (%SB) were quantified and related to potential predictors using linear regression and path analysis. RESULTS: Children aged 8-10 years were included. Significant differences were seen in all three outcome variables between sexes and season of measurement (p<0.001). Restricting children's access to television was associated with decreased MVPA. Increased paternal age was associated with significant increases in %SB (p = 0.02), but not MVPA or total PA. Increased time spent in out of school sports clubs was significantly associated with decreased %SB (p = 0.02). No significant associations were seen with birth weight. CONCLUSION: A range of factors, directly or indirectly, influenced PA and sedentary behaviour. However, associations differed between the different constructs of PA and %SB. Exploring further the sex differences in PA would appear to be useful, as would encouraging children to join out of school sports clubs.

Physical activity, sedentary behavior, and adiposity in English children.

BACKGROUND: The importance of variation in total volume of physical activity or moderate- to vigorous-intensity physical activity (MVPA) to development of body fatness in childhood is unclear, and it is unclear if physical activity has a greater influence on adiposity in boys than girls. PURPOSE: To assess relationships between 2-year changes in objectively measured physical activity, sedentary behavior, and adiposity in English children. METHODS: Prospective cohort study, set in Northeast England, of a socioeconomically representative sample of 403 children. Measures were change in accelerometer-determined physical activity and sedentary behavior from age 7 to 9 years (data collected 2006/2007 and 2008/2009; analyzed in 2010) and concurrent change in adiposity (fat mass index derived from bioelectric impedance) and change in BMI Z-score. RESULTS: Decline in MVPA was associated with a greater increase in fat mass index in boys but not girls. Declining MVPA was associated with increased BMI Z-score in boys but not girls. Increased sedentary behavior was not associated with increased BMI Z-score in either gender. CONCLUSIONS: Avoiding mid-late childhood reductions in MVPA may reduce excessive fat gain, although such strategies may have greater impact on boys than girls.

Earlier predictors of eating disorder symptoms in 9-year-old children. A longitudinal study.

The aim of the study was to examine predictors of eating disorder symptoms in a population based sample at the earliest age at which they can be measured using the Children's Eating Attitudes Test. Data were collected from the longitudinal Gateshead Millennium Study cohort; 609 children participated in the 7 year data sweep (and their mothers and teachers), and 589 children participated in the 9 year data sweep. Eating disorder symptoms at 9 years were higher in boys, and in children from more deprived families. Higher eating disorder symptoms were associated with more body dissatisfaction at 9 years. Higher symptoms were predicted by higher levels of dietary restraint and of emotional symptoms, but not greater body dissatisfaction, 2 years earlier. The study showed that some correlates of high eating disorder symptoms found in adolescents and adults are also found in children, before the rise in diagnosable eating disorders over the pubertal period.

Incorporating children's and their parents' perspectives into condition-specific quality-of-life instruments for children with cerebral palsy: a qualitative study.

OBJECTIVES: This study investigated the extent of agreement between children with cerebral palsy (CP) and their parents concerning their views on what contributed to the children's quality of life. It also investigated how well an Australian condition-specific health-related quality of life self-report measure for children with CP, the Cerebral Palsy Quality of Life Questionnaire for Children (CP QOL-Child), mapped to the views of UK children and parents. METHODS: UK children with CP aged 8 to 13 years and their parents participated in qualitative interviews about their perspectives on the child's quality of life. RESULTS: The interviews with 28 children and 35 parents showed considerable overlap but also some divergence. For example, both parties considered social relationships to be important, but children described how they enjoyed being on their own at times whereas parents tended not to value time spent alone for children. The CP QOL-Child covered most themes considered to be important to the children's quality of life. Omissions included relationships with extended family members, restful recreational activities and associated possessions, relaxing, tiredness, negative emotions, and safety. CONCLUSIONS: Both children's and parents' views are required for the development of child health-related quality of life instruments. The CP QOL-Child has good coverage of many aspects discussed in the interviews. Cultural differences may account for its omission of some topics considered important by UK children and parents. Rewording of many of the CP QOL-Child's items and further work on item content would optimize its suitability for UK children and possibly for children elsewhere.

Is baby-led weaning feasible? When do babies first reach out for and eat finger foods?

The baby-led weaning philosophy proposes that when solids are introduced, infants should be encouraged to self-feed with solid food, as opposed to spoon-feeding purees. We used data from the Gateshead Millennium Study (GMS) to define the range of ages at which infants reach out for and eat finger foods and related this to developmental status. GMS recruited infants shortly after birth and followed them prospectively using postal questionnaires. Of the 923 eligible children, 602 had data on when they first reached out for food, and 340 (56%) had done so before age 6 months, but 36 (6%) were still not reaching for food at age 8 months. Infants who had not reached out for food by 6 months were less likely to be walking unaided at age 1 year (85 out of 224, 38%) compared with those who did (155 out of 286, 54%; P < 0.001). For the 447 parents who completed a diary of the first five occasions when their child ate finger foods, the first finger food eaten was before age 6 months for 170 (40%) and before age 8 months for 383 (90%); foods offered were mainly bread, rusks or biscuits. Of the 604 with information at age 8 months about current intake, all but 58 (9.6%) were having some finger foods at least daily, but only 309 (51%) were having them more than once per day. Baby-led weaning is probably feasible for a majority of infants, but could lead to nutritional problems for infants who are relatively developmentally delayed.