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.

Delivery of Brief Interventions for Heavy Drinking in Primary Care: Outcomes of the ODHIN 5-Country Cluster Randomized Trial.

PURPOSE: We aimed to test whether 3 strategies-training and support, financial reimbursement, and an option to direct screen-positive patients to an Internet-based method of giving brief advice-have a longer-term effect on primary care clinicians' delivery of screening and advice to heavy drinkers operationalized with the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) tool. METHODS: We undertook a cluster randomized factorial trial with a 12-week implementation period in 120 primary health care units throughout Catalonia, England, Netherlands, Poland, and Sweden. Units were randomized to 8 groups: care as usual (control); training and support alone; financial reimbursement alone; electronic brief advice alone; paired combinations of these conditions; and all 3 combined. The primary outcome was the proportion of consulting adult patients (aged 18 years and older) receiving intervention-screening and, if screen-positive, advice-at 9 months. RESULTS: Based on the factorial design, the ratio of the log of the proportion of patients given intervention at the 9-month follow-up was 1.39 (95% CI, 1.03-1.88) in units that received training and support as compared with units that did not. Neither financial reimbursement nor directing screen-positive patients to electronic brief advice led to a higher proportion of patients receiving intervention. CONCLUSIONS: Training and support of primary health care units has a lasting, albeit small, impact on the proportion of adult patients given an alcohol intervention at 9 months.

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.

Tracking of toddler fruit and vegetable preferences to intake and adiposity later in childhood.

This study examined whether toddlers' liking for fruit and vegetables (FV) predicts intake of FV later in childhood, how both relate to childhood adiposity and how these were moderated by factors in infancy. Children in the Gateshead Millennium Study were recruited at birth in 1999-2000. Feeding data collected in the first year were linked to data from a parental questionnaire completed for 456 children at age 2.5 years (30 m) and to anthropometry, skinfolds and bioelectrical impedance and 4-day food diary data collected for 293 of these children at age 7 years. Aged 30 months, 50% of children were reported to like eight different vegetables and three fruits, but at 7 years, children ate a median of only 1.3 (range 0-7) portions of vegetables and 1.0 portion of fruit (0-4). Early appetite, feeding problems and food neophobia showed significant univariate associations with liking for FV aged 30 m, but the number of vegetables toddlers liked was the only independent predictor of vegetable consumption at age 7 years (odds ratio (OR) 1.28 p < 0.001). Liking for fruit aged 30 m also independently predicted fruit intake (OR = 1.31, p = 0.016), but these were also related to deprivation (OR = 2.69, p = 0.001) maternal education (OR = 1.28, p = 0.039) and female gender (OR = 1.8, p = 0.024). Children eating more FV at age 7 years had slightly lower body mass index and skinfolds. An early liking for FV predicted increased later intake, so increasing early exposure to FV could have long term beneficial consequences.

Self-reported quality of life of adolescents with cerebral palsy: a cross-sectional and longitudinal analysis.

BACKGROUND: Children with cerebral palsy who can self-report have similar quality of life (QoL) to their able-bodied peers. Is this similarity also found in adolescence? We examined how self-reported QoL of adolescents with cerebral palsy varies with impairment and compares with the general population, and how factors in childhood predict adolescent QoL. METHODS: We report QoL outcomes in a longitudinal follow-up and cross-sectional analysis of individuals included in the SPARCLE1 (childhood) and SPARCLE2 (adolescent) studies. In 2004 (SPARCLE1), a cohort of 818 children aged 8-12 years were randomly selected from population-based cerebral palsy registers in nine European regions. We gathered data from 500 participants about QoL with KIDSCREEN (ten domains); frequency of pain; child psychological problems (Strengths and Difficulties Questionnaire); and parenting stress (Parenting Stress Index). At follow-up in 2009 (SPARCLE2), 355 (71%) adolescents aged 13-17 years remained in the study and self-reported QoL (longitudinal sample). 76 additional adolescents self-reported QoL in 2009, providing data for 431 adolescents in the cross-sectional sample. Researchers gathered data at home visits. We compared QoL against matched controls in the general population. We used multivariable regression to relate QoL of adolescents with cerebral palsy to impairments (cross-sectional analysis) and to childhood QoL, pain, psychological problems, and parenting stress (longitudinal analysis). FINDINGS: Severity of impairment was significantly associated (p<0·01) with reduced adolescent QoL on only three domains (Moods and emotions, Autonomy, and Social support and peers); average differences in QoL between the least and most able groups were generally less than 0·5 SD. Adolescents with cerebral palsy had significantly lower QoL than did those in the general population in only one domain (Social support and peers; mean difference -2·7 [0·25 SD], 95% CI -4·3 to -1·4). Pain in childhood or adolescence was strongly associated with low adolescent QoL on eight domains. Childhood QoL was a consistent predictor of adolescent QoL. Child psychological problems and parenting stress in childhood or their worsening between childhood and adolescence predicted only small reductions in adolescent QoL. INTERPRETATION: Individual and societal attitudes should be affected by the similarity of the QoL of adolescents with and without cerebral palsy. Adolescents with cerebral palsy need particular help to maintain and develop peer relationships. Interventions in childhood to alleviate psychological difficulties, parenting stress, and especially pain, are justified for their intrinsic value and for their longer term effect on adolescent QoL. FUNDING: SPARCLE1 was funded by the European Union Research Framework 5 Program (grant number QLG5-CT-2002-00636), the German Ministry of Health GRR-58640-2/14, and the German Foundation for the Disabled Child. SPARCLE2 was funded by: Wellcome Trust WT086315 A1A (UK and Ireland); Medical Faculty of the University of Lübeck E40-2009 and E26-2010 (Germany); CNSA, INSERM, MiRe-DREES, and IRESP (France); Ludvig and Sara Elsass Foundation, The Spastics Society and Vanforefonden (Denmark); Cooperativa Sociale "Gli Anni in Tasca" and Fondazione Carivit, Viterbo (Italy); Göteborg University-Riksforbundet for Rorelsehindrade Barn och Ungdomar and the Folke Bernadotte Foundation (Sweden).

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.

Prevalence of alcohol related attendance at an inner city emergency department and its impact: a dual prospective and retrospective cohort study.

BACKGROUND: Alcohol related hospital attendances are a potentially avoidable burden on emergency departments (EDs). Understanding the number and type of patients attending EDs with alcohol intoxication is important in estimating the workload and cost implications. We used best practice from previous studies to establish the prevalence of adult alcohol related ED attendances and estimate the costs of clinical management and subsequent health service use. METHODS: The setting was a large inner city ED in northeast England, UK. Data were collected via (i) retrospective review of hospital records for all ED attendances for four pre-specified weeks in 2010/2011 to identify alcohol related cases along with 12 months of follow-up of the care episode and (ii) prospective 24/7 assessment via breath alcohol concentration testing of patients presenting to the ED in the corresponding weeks in 2012/2013. RESULTS: The prevalence rates of alcohol related attendances were 12% and 15% for the retrospective and prospective cohorts, respectively. Prospectively, the rates ranged widely from 4% to 60% across week days, rising to over 70% at weekends. Younger males attending in the early morning hours at weekends made up the largest proportion of alcohol related attendances. The mean cost per attendance was £249 (SD £1064); the mean total cost for those admitted was £851 (SD £2549). The most common reasons for attending were trauma related injuries followed by psychiatric problems. CONCLUSIONS: Alcohol related attendances are a major and avoidable burden on emergency care. However, targeted interventions at weekends and early morning hours could capture the majority of cases and help prevent future re-attendance.

Professional's Attitudes Do Not Influence Screening and Brief Interventions Rates for Hazardous and Harmful Drinkers: Results from ODHIN Study.

AIMS: To determine the relation between existing levels of alcohol screening and brief intervention rates in five European jurisdictions and role security and therapeutic commitment by the participating primary healthcare professionals. METHODS: Health care professionals consisting of, 409 GPs, 282 nurses and 55 other staff including psychologists, social workers and nurse aids from 120 primary health care centres participated in a cross-sectional 4-week survey. The participants registered all screening and brief intervention activities as part of their normal routine. The participants also completed the Shortened Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ), which measure role security and therapeutic commitment. RESULTS: The only significant but small relationship was found between role security and screening rate in a multilevel logistic regression analysis adjusted for occupation of the provider, number of eligible patients and the random effects of jurisdictions and primary health care units (PHCU). No significant relationship was found between role security and brief intervention rate nor between therapeutic commitment and screening rate/brief intervention rate. The proportion of patients screened varied across jurisdictions between 2 and 10%. CONCLUSION: The findings show that the studied factors (role security and therapeutic commitment) are not of great importance for alcohol screening and BI rates. Given the fact that screening and brief intervention implementation rate has not changed much in the last decade in spite of increased policy emphasis, training initiatives and more research being published, this raises a question about what else is needed to enhance implementation.

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.

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.

Association between participation in life situations of children with cerebral palsy and their physical, social, and attitudinal environment: a cross-sectional multicenter European study.

OBJECTIVE: To evaluate how participation of children with cerebral palsy (CP) varied with their environment. DESIGN: Home visits to children. Administration of Assessment of Life Habits and European Child Environment Questionnaires. Structural equation modeling of putative associations between specific domains of participation and environment, while allowing for severity of child's impairments and pain. SETTING: European regions with population-based registries of children with CP. PARTICIPANTS: Children (n=1174) aged 8 to 12 years were randomly selected from 8 population-based registries of children with CP in 6 European countries. Of these, 743 (63%) agreed to participate; 1 further region recruited 75 children from multiple sources. Thus, there were 818 children in the study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Participation in life situations. RESULTS: For the hypothesized associations, the models confirmed that higher participation was associated with better availability of environmental items. Higher participation in daily activities-mealtimes, health hygiene, personal care, and home life-was significantly associated with a better physical environment at home (P<.01). Mobility was associated with transport and physical environment in the community. Participation in social roles (responsibilities, relationships, recreation) was associated with attitudes of classmates and social support at home. School participation was associated with attitudes of teachers and therapists. Environment explained between 14% and 52% of the variation in participation. CONCLUSIONS: The findings confirmed the social model of disability. The physical, social, and attitudinal environment of disabled children influences their participation in everyday activities and social roles.

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.

Correlates of objectively measured physical activity and sedentary behaviour in English children.

BACKGROUND: Evidence on the correlates of objectively measured physical activity and sedentary behaviour in childhood is limited. This study aimed to identify correlates of physical activity and sedentary behaviour among 7-year-old children in England. METHODS: Physical activity was measured using Actigraph accelerometry in 480 participants as part of the Gateshead Millennium Study during 2006-07. Twenty-two potential correlates across five domains (demographic and biological; psychological, cognitive and emotional; behavioural; social and cultural; physical environmental) were tested for associations with total volume of habitual physical activity, moderate-vigorous intensity physical activity (MVPA) and sedentary behaviour. Multiple linear regression analysis was used. RESULTS: Seven correlates, including four that are potentially modifiable, were significantly associated with total physical activity, MVPA and sedentary behaviour in final models: gender, child weight status, maternal age, child interest in active play, active commuting to school, parenting practice and season. Four of these variables were significantly associated with all three constructs in final models. The final models explained 18, 18 and 24% of variance in total volume of physical activity, MVPA and sedentary behaviour, respectively. CONCLUSION: A number of potentially modifiable factors are associated with increased physical activity and/or reduced sedentary behaviour in English children. These could be valuable targets of future interventions.

Mother-child feeding interactions in children with and without weight faltering; nested case control study.

AIMS: To explore whether the Mellow Parenting assessment system can detect any difference in parent-child meal time interaction between children with weight faltering (failure to thrive) and normally growing children. SUBJECTS AND METHODS: Thirty mother-infant dyads with weight faltering and 29 healthy controls nested within the Gateshead Millennium prospective cohort study were assessed at mean age 15.6 months (range 13-20). Video-tapes of two standardized meals per child by a researcher blind to infant health status were analysed using a simplified version of the Mellow Parenting Coding System (MPCS), an all events measure of maternal-child interactivity. These were linked to questionnaire data on eating behaviour and growth held on the children. RESULTS: The MPCS had good inter-rater reliability (0.82) and coherent inter-relationships between coding domains. During case meals there were significantly fewer positive interactions overall: cases median 81.5 (IQR 4-496); controls 169.5 (40-372) and within all the commonly observed domains (Anticipation (p=0.013), autonomy (p=0.003), responsiveness (p=0.005) and cooperation (p=0.016)). There were only low levels of distress and control or negative behaviours and no significant differences were found in these between the groups. The case infants had significantly lower reported appetite by the age of 4 months and higher reported avoidance of feeding at the age of 8 months than controls. CONCLUSIONS: Mothers of weight faltering infants generally showed fewer interactions with their infants at mealtimes. It is not clear whether this is causal or simply a maternal adaptive response to their child's eating behaviour.

Individual Differences in Infants' Joint Attention Behaviors With Mother and a New Social Partner.

Relations between infant-mother attachment security at 15 months and infants' (N = 206) joint attention behaviors (a) with an experimenter at 8 and 15 months, and (b) with their mothers at 15 months were investigated. No concurrent or longitudinal relations were observed between attachment security and infants' tendency to respond to an experimenter's bids for joint attention. Higher levels of initiating joint attention with an experimenter at 15 months were associated with insecure-avoidant attachment. Insecure-avoidant attachment was also associated with lower scores for initiating high-level joint attention behaviors (pointing, showing, and giving) with the mother at age 15 months. The fact that security-related differences in initiating joint attention with an experimenter were observed only once the attachment relationship was consolidated suggests that (a) attachment security may influence infants' active engagement with new social partners, and (b) insecure-avoidant infants may compensate for reduced social contact with the caregiver by initiating more interaction with other social partners.

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.

Do maternal ratings of appetite in infants predict later Child Eating Behaviour Questionnaire scores and body mass index?

In a longitudinal birth cohort maternal ratings of children's appetite made at 6 weeks, 12 months and 5-6 years were correlated with one another and with subscales from the Child Eating Behaviour Questionnaire (CEBQ) at 5-6 years, and body mass index (BMI) at 6-8 years. Statistically significant correlations were found between the children's appetite ratings. Appetite ratings in infancy were also correlated with the CEBQ subscale scores at 5-6 years to a limited extent, but not with the BMI at 6-8 years. The appetite rating at 5-6 years and three of the CEBQ subscales were independently associated with BMI. Children with higher levels of Emotional Over-Eating and Desire to Drink had higher BMIs, and children with higher levels of Satiety Responsiveness had lower BMIs. These results provide further evidence that there are concurrent associations between appetite ratings in childhood and BMI but suggest that appetite ratings in infancy are related only weakly to later appetite measures and do not predict later BMI.

Self-reported quality of life of 8-12-year-old children with cerebral palsy: a cross-sectional European study.

BACKGROUND: Little is known about the quality of life (QoL) of disabled children. We describe self-reported QoL of children with cerebral palsy, factors that influence it, and how it compares with QoL of the general population. METHODS: 1174 children aged 8-12 years were randomly selected from eight population-based registers of children with cerebral palsy in six European countries and 743 (63%) agreed to participate; one further region recruited 75 children from multiple sources. Researchers visited these 818 children. 318 (39%) with severe intellectual impairment could not self-report; 500 (61%) reported their QoL using KIDSCREEN, an instrument with scores in ten domains, each with SD=10. Multivariable regression was used to relate QoL to impairments, pain, and sociodemographic characteristics. Comparisons were made with QoL data from the general population. FINDINGS: Impairments were not significantly associated with six KIDSCREEN domains. Comparison of least and most able groups showed that severely limited self-mobility was significantly associated with reduced mean score for physical wellbeing (7.6, 95% CI 2.7-12.4); intellectual impairment with reduced mean for moods and emotions (3.7, 1.5-5.9) and autonomy (3.3, 0.9-5.7); and speech difficulties with reduced mean for relationships with parents (4.5, 1.9-7.1). Pain was common and associated with lower QoL on all domains. Impairments and pain explained up to 3% and 7%, respectively, of variation in QoL. Children with cerebral palsy had similar QoL to children in the general population in all domains except schooling, in which evidence was equivocal, and physical wellbeing, in which comparison was not possible. INTERPRETATION: Parents can be reassured that most children aged 8-12 years with cerebral palsy will have similar QoL to other children. This finding should guide social and educational policy to ensure that disabled children participate fully in society. Because of its association with QoL, children's pain should be carefully assessed.