Encontro com Especialistas - Cuidado Seguro de RN e crianças

Encontro com as Especialistas Roseli Calil, médica neonatologista da Universidade Estadual de Campinas (Unicamp); Eduarda Ribeiro dos Santos, enfermeira e advogada, docente na Faculdade Israelita Albert Einstein; Aline Hennemann, enfermeira especialista na área materno infantil, assessora da CACRIAD/DGCI/SAPS/MS; e Zeni Lamy, médica neonatologista da Universidade Federal do Maranhão (UFMA).

Cuidado e intersetorialidade nos estudos sobre a primeira infância: uma revisão integrativa / Care and intersectorality in early childhood studies: an integrative review

Estudos sobre os primeiros anos de vida, período que vem sendo denominado como primeira infância, são crescentes no Brasil, inclusive produzindo importantes discussões que culminaram na promulgação do Marco Legal para a Primeira Infância, em 2016. Constitucionalmente atribui-se a responsabilidade compartilhada da família, sociedade e o Estado no cuidado das crianças pequenas, no entanto, há uma lacuna de conhecimento sobre ações de cuidado e intersetoriais nessa fase da vida. Este trabalho, a partir de uma revisão integrativa da literatura, busca analisar as concepções abordadas na literatura nacional sobre intersetorialidade e o cuidado na Primeira Infância, a partir do Marco Legal da Primeira Infância. A busca bibliográfica foi realizada entre outubro e dezembro de 2021 e incluiu artigos científicos, documentos, teses e dissertações nacionais, com resumos disponíveis e indexados nas bases Portal BVS, Redalyc, Portal Capes e Scopus. O acervo encontrado foi composto por vinte e cinco (25) publicações lidas integralmente e organizadas em uma matriz de dados. Os dados foram organizados e três categorias analíticas foram discutidas numa síntese interpretativa. Os achados mostram a necessidade de reflexão do cuidado de maneira ampliada, integral e enquanto prática social para enfrentar as práticas hegemônicas, capitalistas, dicotômicas, hierárquicas e que provocam apagamentos no cuidado e inviabilizam práticas intersetoriais. Identificou se que, em prol da garantia e efetivação dos direitos das crianças, se faz necessário a ampliação do entendimento do cuidado, considerando sua polissemia, suas relações éticas e socioculturais a partir do cuidado integral, considerando os sujeitos como ativos nessa relação, produzindo alteridade, emergindo sentidos ausentes e possibilitando a pluralidade das vivências. A intersetorialidade apesar de se apresentar como estratégia fundamental para a garantia de cuidado integral das crianças, especialmente as mais vulneráveis, ainda se mantém ambígua e com poucos resultados enquanto práticas na relação saúde e educação infantil. Mais estudos precisam ser realizados considerando a relevância das ações de saúde e educação para o cuidado, valorizando o presente e favorecendo que de fato se estabeleça um cuidado mais democrático e equitativo em nossa sociedade.

The increasing studies in Brazil about the first years of life, called early childhood, promoted discussions which eventually led to the promulgation of the Early Childhood Legal Framework in 2016. Constitutionally, the responsibility for young children's caring is shared by the family, society and the State, however, a gap in the knowledge of caring and intersectoral actions for this phase of life exist. This article, part of an integrative review, attempts to analyze the concept addressed in the national literature about intersectoral and early childhood care stemming from the Early Childhood Legal Framework. The bibliographic search was carried out between October and December 2021 and included scientific articles, theses and national dissertations with abstracts available and indexed in the BVS, Redalyc, Capes and Scopus portals. The assemblage encountered consisted of 25 articles read in full and organized in a data matrix and three analytical categories were discussed in an interpretative synthesis. The findings reveal the necessity of reflecting about care in a broad, comprehensive manner and as social practice to deal with hegemonic, capitalist, dichotomic, hierarchic actions, provoking shutdowns in care and impeding intersectoral initiatives. For the benefit of warranting and materialization of children's rights, it is required to broaden the understanding of care, pondering its polysemy, its ethical and sociocultural relations arising from full care and making the individuals the protagonists of this relation, creating alterity, emerging previously absent meanings and favoring the plurality of life experiences. The intersectoral aspect, despite appearing as a key strategy to ensure full care to children, particularly the most vulnerable, is still ambiguous with scarce results as practices in the relation between health and childhood education. More studies are necessary considering the relevance of health and education actions for care, valuing the present and favoring the concept of an actual implementation of a more democratic and equalitarian care in our society.

Opportunities to Promote Healthy Weight Through Child Care Licensing Regulations: Trends in the United States, 2016-2020.

BACKGROUND: Policies that support healthy nutrition and physical activity environments in early care and education (ECE) settings can help promote healthy weight in children. State child care licensing regulations are a critical mechanism for setting such policies. OBJECTIVES: To develop a research instrument to evaluate the promotion of healthy child weight in state child care licensing regulations and assess the strength of the regulations over time. DESIGN: For measure development, systematic reviews of evidence on the impact of healthy weight strategies relevant to the ECE environment were combined with expert stakeholder input to identify 15 healthy weight promotion policy standards and a coding tool to measure the strength and comprehensiveness of regulatory language matching these standards. For assessing the strength of regulations, the coding tool was applied to child care regulations nationwide in 2016 and again in 2020. SUBJECTS/SETTING: Child care licensing regulations in 2016 and 2020 for all 50 US states plus Washington DC. OUTCOME MEASURES: Strength and comprehensiveness scores for state licensing regulations. STATISTICAL ANALYSES: Intraclass correlation coefficients were calculated to estimate interrater reliability of the coding tool. Paired t tests were used to compare scores within states from 2016 to 2020. RESULTS: Interrater reliability for the coding tool had intraclass correlation coefficients of 0.81 for strength and 0.87 for comprehensiveness scores. Strength and comprehensiveness of states' healthy weight promotion policies increased significantly over time (P < .001). However, most states still lack important healthy weight policies in their licensing regulations, such as prohibiting serving sugary drinks. CONCLUSIONS: This study presents a reliable research instrument for measuring the strength and comprehensiveness of healthy weight promotion standards in child care licensing regulations. States have increased their incorporation of strategies for healthy weight into state policy.

What predicts legislative success of early care and education policies?: Applications of machine learning and Natural Language Processing in a cross-state early childhood policy analysis.

Following the pioneering efforts of a federal Head Start program, U.S. state policymakers have rapidly expanded access to Early Care and Education (ECE) programs with strong bipartisan support. Within the past decade the enrollment of 4 year-olds has roughly doubled in state-funded preschool. Despite these public investments, the content and priorities of early childhood legislation-enacted and failed-have rarely been examined. This study integrates perspectives from public policy, political science, developmental science, and machine learning in examining state ECE bills in identifying key factors associated with legislative success. Drawing from the Early Care and Education Bill Tracking Database, we employed Latent Dirichlet Allocation (LDA), a statistical topic identification model, to examine 2,396 ECE bills across the 50 U.S. states during the 2015-2018. First, a six-topic solution demonstrated the strongest fit theoretically and empirically suggesting two meta policy priorities: 'ECE finance' and 'ECE services'. 'ECE finance' comprised three dimensions: (1) Revenues, (2) Expenditures, and (3) Fiscal Governance. 'ECE services' also included three dimensions: (1) PreK, (2) Child Care, and (3) Health and Human Services (HHS). Further, we found that bills covering a higher proportion of HHS, Fiscal Governance, or Expenditures were more likely to pass into law relative to bills focusing largely on PreK, Child Care, and Revenues. Additionally, legislative effectiveness of the bill's primary sponsor was a strong predictor of legislative success, and further moderated the relation between bill content and passage. Highly effective legislators who had previously passed five or more bills had an extremely high probability of introducing a legislation that successfully passed regardless of topic. Legislation with expenditures as policy priorities benefitted the most from having an effective legislator. We conclude with a discussion of the empirical findings within the broader context of early childhood policy literature and suggest implications for future research and policy.

Alignment of State Regulations With Breastfeeding and Beverage Best Practices for Childcare Centers and Family Childcare Homes, United States.

OBJECTIVES: Childcare is an important setting for nutrition; nearly half of young children in the United States participate in licensed childcare, where they consume up to two-thirds of their daily dietary intake. We compared state regulations for childcare with best practices to support breastfeeding and healthy beverage provision. METHODS: We reviewed regulations for childcare centers (centers) and family childcare homes (homes) in effect May-July 2016 and rated all 50 states for inclusion (1 = not included, 2 = partially included, 3 = fully included) of 12 breastfeeding and beverage best practices. We calculated average ratings for 6 practices specific to infants aged 0-11 months, 6 practices specific to children aged 1-6 years, and all 12 practices, by state and across all states. We assessed significant differences between centers and homes for each best practice by using McNemar-Bowker tests for symmetry, and we assessed differences across states by using paired student t tests. RESULTS: States included best practices in regulations for centers more often than for homes. Average ratings (standard deviations) in regulations across all states were significantly higher in centers than in homes for infant best practices (2.1 [0.5] vs 1.8 [0.5], P < .001), child best practices (2.1 [0.6] vs 1.8 [0.6], P = .002), and all 12 best practices combined (2.1 [0.5] vs 1.8 [0.6], P < .001). CONCLUSIONS: Although best practices were more consistently included in regulations for centers than for homes, many state childcare regulations did not include best practices to support breastfeeding and the provision of healthy beverages. Findings can be used to inform efforts to improve regulations and to reduce differences between centers and homes.

Prevalence and Relationships among Physical Activity Policy, Environment, and Practices in Licensed Childcare Centers from a Manager and Staff Perspective.

Physical activity (PA) is critical to early childhood health and development, and childcare is a key setting for establishing physically active play. In British Columbia (BC), a provincial standard for active play in childcare was enacted, identified here as the Active Play (AP) standard. Pragmatic constraints limit real-world data collection for evaluating policy impact. We explored whether information about policies, practices, and the environment varied when it was collected from managers or staff. Surveys were distributed to BC childcare centers before AP standard enactment to ascertain current PA and fundamental movement skill policies and practices. The full sample (n = 1037 from 625 facilities) and a subsample of paired managers and staff (n = 261 centers) were used to explore agreement across managers and staff in reported prevalence and relationships among indicators. The policy prevalence and relationships for active play and outdoor play variables were relatively similar for manager and staff data, although the matched data had modest agreement and less than optimal intraclass correlations. The prevalence of manager-reported PA policies ranged from 47% for screen-time limits to 77% for fundamental movement skill activities. The manager and staff data highlighted indoor and outdoor space as a primary factor in AP standard adherence. With reliance on sampling staff unfeasible, it appears that the manager data may adequately describe the policies and practices of childcare providers with some notable issues.

Observed compliance with safe sleeping guidelines in licensed childcare services.

OBJECTIVE: To independently assess compliance with safe sleeping guidelines for infants <12 months in licensed childcare services. DESIGN: Full-day, in-situ observations of childcare practices (including sleep and non-sleep periods) conducted in 2016-2017. SETTING: Australian home-based and centre-based licensed childcare services. All subject to national regulation and legislation to comply with safe sleeping guidelines. PARTICIPANTS: The sample was 18 licensed childcare settings (15 centre-based, 3 home-based) that had infants <12 months (n=49) attending at the time of observation. 31 educators completed self-report surveys. MAIN OUTCOMES AND MEASURES: Standard observations of childcare practices, including a 20-item infant Safe Sleeping Guideline checklist. Educator characteristics, including each individual's knowledge, beliefs and attitudes regarding safe sleeping practices. RESULTS: 83% of childcare services were observed to be non-compliant on at least 1 of 20 target guidelines (median 2.5, max=7); 44% were observed placing infants prone/side and 67% used loose bedding, quilts, doonas/duvets, pillows, sheepskins or soft toys in cots. 71% of the childcare settings had a copy of current safe sleeping guidelines displayed either in or at entry to the infant sleep room. CONCLUSION: Despite 25 years of public health messaging, non-compliance with safe sleeping guidelines was observed to be high in childcare services. Understanding of the reasons underlying non-compliance, particularly in contexts were legislative mandate and access to information regarding safe sleeping is high, is critical to informing ongoing public health messaging and should be the focus of future studies. TRIAL REGISTRATION NUMBER: ANZCTR 12618001056280-pre-results.

Compliance with the New 2017 Child and Adult Care Food Program Standards for Infants and Children before Implementation.

BACKGROUND: Nationally, child care providers serve nutritious food to over 4.5 million children each day as part of the federal Child and Adult Care Food Program (CACFP). As implementation of the first major revisions to the CACFP standards occurs in 2017, understanding how to support compliance is critical. METHODS: In 2016, surveys were sent to a randomly selected sample of 2400 licensed California child care centers and homes. Compliance with the new CACFP standards and best practices for infants under 1 year and children 1-5 years of age was assessed. Also, compliance was compared by CACFP participation, and between centers and homes. Interviews were conducted with 16 CACFP stakeholders to further understand barriers to and facilitators of compliance. RESULTS: Analysis of 680 survey responses revealed that compliance with most individual CACFP standards and best practices examined was high (>60% of sites). However, compliance with all new standards was low (<23% of sites). Compliance was lowest for timing of introduction of solids to infants, not serving sweet grains, serving yogurt low in sugar, and serving appropriate milk types to children. When different, compliance was higher for sites participating in CACFP versus nonparticipants, and for centers versus homes. Although providers indicated few barriers, stakeholders identified the need for incremental and easily accessible trainings that provide practical tips on implementation. CONCLUSION: Training on a number of topics is needed to achieve full implementation of the new CACFP standards to ensure that young children in child care have access to healthier meals and snacks.

Implementation Strategies Used by States to Support Physical Activity Licensing Standards for Toddlers in Early Care and Education Settings: An Exploratory Qualitative Study.

BACKGROUND: Child care settings have been a target for childhood obesity prevention efforts; changing licensing standards to require physical activity (PA)-related best practices is one strategy being used by states. The mechanisms used to support implementation by providers remain understudied, despite the potential for these efforts to significantly impact child-level outcomes. This qualitative study explored the mechanisms used and any outstanding challenges to implementation experienced by US states with one specific best practice PA licensing standard for toddlers (60-90 min of PA/day). METHODS: All states with the selected PA licensing standard were invited to participate (N = 9). Interviews were conducted with the licensing administrator and others in the state involved with implementation and referred by the Administrator (e.g., Licensing Inspectors). A total of 20 individuals from seven states were interviewed. All interviews were recorded, professionally transcribed, and analyzed to identify themes. RESULTS: A range of strategies was reported, however the majority of interviewees reported that providers experienced few challenges with implementation. Steps taken during the rulemaking process and technical assistance provided by licensing staff, government and nonprofit partners were frequently mentioned as contributing to implementation success. Challenges faced by licensing staff included lack of resources and a need for specific, age-appropriate PA-promoting activities that providers could easily implement. CONCLUSIONS: Based on the experience of participating states, other jurisdictions may want to explore adding PA-related requirements to their licensing standards. The lessons learned from these seven states may be helpful during the rulemaking and implementation processes.

Physical activity and sedentary behavior legislation in Canadian childcare facilities: an update.

BACKGROUND: Within the childcare sector, physical activity and sedentary behaviors are not legislated at a national level in Canada. Efforts have been undertaken to identify factors within childcare facilities which support and deter physical activity and sedentary behaviors. The purpose of this paper was to provide an amended review of the legislative landscape, at the provincial and territorial level, regarding physical activity and sedentary behaviors (via screen-viewing) in Canadian childcare centers. METHODS: Individual childcare acts and regulations for each province and territory were collected; documents were reviewed with a focus on sections devoted to child health, physical activity, screen time, play, and outdoor time. An extraction table was used to facilitate systematic data retrieval and comparisons across provinces and territories. RESULTS: Of the 13 provinces and territories, 8 (62%) have updated their childcare regulations in the past 5 years. All provinces provide general recommendations to afford gross motor movement; but the majority give no specific requirements for how much or at what intensity. Only 3 provinces (Northwest Territories, Nunavut, and Nova Scotia) explicitly mentioned daily physical activity while all provinces' and territories' required daily outdoor play. Only 1 province (New Brunswick) made mention of screen-viewing. CONCLUSIONS: The variability in childcare regulations results in different physical activity requirements across the country. By providing high-level targets for physical activity recommendations, by way of provincial/territorial legislation, staff would have a baseline from which to begin supporting more active behaviors among the children in their care. Future research is needed to support translating physical activity policies into improved activity levels among young children in childcare and the role of screen-viewing in these venues.

The Job Content, Context, and Requirements of Regulated Home-Based Childcare Workers.

Contrary to a large and growing literature on center-based childcare workers, we know little about the work and health experiences of those providing childcare services in their homes. This study examines the job content, context, and requirements of regulated Home-Based Childcare workers in Canada. It is based on the qualitative analysis of eleven individual semistructured interviews. These workers perform business administration tasks and more housekeeping and domestic work than those in the center-based childcare, which affect their health and well-being. In addition, they reported factors related to the context and the content of their job such as the high physical and mental efforts, the absence of contact with other adults during working hours, the lack of external help, the exposure to noise and bad odors, the interference of work with personal and family life, the precarious remuneration, and the lack of benefits as potential factors that may affect their health.

State Variations in Infant Feeding Regulations for Child Care.

OBJECTIVES: Early care and education (ECE) settings have become primary targets for policy change in recent years. In our 2008 study, we assessed state and regional variation in infant feeding regulations for ECE and compared them to national standards. We conducted the same regulatory review to assess change over time. Because all but 2 states have updated their regulations, we hypothesized that states would have made substantial improvements in the number of regulations supporting infant feeding in ECE. METHODS: For this cross-sectional study, we reviewed infant feeding regulations for all US states for child care centers (centers) and family child care homes (homes). We compared regulations with 10 national standards and assessed the number of new regulations consistent with these standards since our previous review. RESULTS: Comparing results from 2008 and 2016, we observed significant improvements in 7 of the 10 standards for centers and 4 of the 10 standards for homes. Delaware was the only state with regulations meeting 9 of the 10 standards for centers in 2008. In 2016, Delaware and Michigan had regulations meeting 8 of the 10 standards. Previously, Arkansas, the District of Columbia, Minnesota, Mississippi, Ohio, and South Carolina had regulations consistent with 4 of the 10 standards for homes. In 2016, Delaware, Mississippi, and Vermont had regulations meeting 7 of the 10 standards. CONCLUSIONS: Evidence suggests that enacting new regulations may improve child health outcomes. Given that many states recently enacted regulations governing infant feeding, our findings point to the growing interest in this area.

Evaluation of a Physical Activity Regulation for Child Care in Massachusetts.

OBJECTIVES: A number of states have enacted regulations to increase physical activity in children attending child care, but most were not evaluated. In 2010, Massachusetts (MA) enacted a new regulation requiring 60 minutes of light, moderate, and vigorous physical activity (LMVPA) for children in child care; we conducted a prospective evaluation. We hypothesized that MA centers would comply with the regulation at follow-up, resulting in increases in children's LMVPA. METHODS: We evaluated compliance with the regulation in MA using Rhode Island (RI) as the comparison. We measured physical activity in a longitudinal sample of 20 centers and cross-sectional samples of 180 children per state three times before and three times after the regulation took effect. We assessed physical activity using the Observation System for Recording Activity in Preschoolers. We conducted difference-in-differences tests to evaluate changes in LMVPA in MA compared with RI from baseline to follow-up. RESULTS: Children were active for at least 60 minutes of LMVPA in over 80% of centers at baseline and follow-up in MA and RI. Nevertheless, LMVPA increased in both states. In multivariable adjusted regressions, LMVPA increased from baseline to follow-up [MA estimate 38.1 minutes; confidence interval (CI): 28.6, 47.5; p ≤ 0.0001; and RI estimate 42.7 minutes; CI: 35.2, 50.1; p ≤ 0.0001]. The average difference-in-differences estimate indicated no difference in MA compared with RI (estimate -4.6 minutes; CI: -16.6, 7.5; p = 0.46) since LMVPA increased comparably in both states. CONCLUSIONS: Although LMVPA increased in MA, we observed similar changes in RI. Thus, other factors could have influenced children's physical activity.

Posicionamiento de la Asociación Española de Pediatría de Atención Primaria (AEPap) sobre el modelo de asistencia infantil / Stance of the Spanish Association of Primary Care Pediatrics (AEPap) on child care model

La Asociación Española de Pediatría de Atención Primaria (AEPap) hace una reflexión sobre el modelo de asistencia infantil español, sus problemas y los antecedentes de algunos países de nuestro entorno. Así mismo, y frente a los que cuestionan el modelo español, hace una serie de propuestas para avanzar en la efectividad y sostenibilidad del modelo español (AU)

The Spanish Association of Primary Care Pediatrics (AEPap) has reflected on the model of Spanish child care, its problems and the background of some countries around us. Also, and in front of those who question the Spanish model, makes a series of proposals to advance the effectiveness and sustainability of the Spanish model (AU)

Child Care and Development Fund (CCDF) Program. Final rule.

This final rule makes regulatory changes to the Child Care and Development Fund (CCDF) based on the Child Care and Development Block Grant Act of 2014. These changes strengthen requirements to protect the health and safety of children in child care; help parents make informed consumer choices and access information to support child development; provide equal access to stable, high-quality child care for low-income children; and enhance the quality of child care and the early childhood workforce.

Active Early: one-year policy intervention to increase physical activity among early care and education programs in Wisconsin.

BACKGROUND: Early childcare and education (ECE) is a prime setting for obesity prevention and the establishment of healthy behaviors. The objective of this quasi-experimental study was to examine the efficacy of the Active Early guide, which includes evidenced-based approaches, provider resources, and training, to improve physical activity opportunities through structured (i.e. teacher-led) activity and environmental changes thereby increasing physical activity among children, ages 2-5 years, in the ECE setting. METHODS: Twenty ECE programs in Wisconsin, 7 family and 13 group, were included. An 80-page guide, Active Early, was developed by experts and statewide partners in the fields of ECE, public health, and physical activity and was revised by ECE providers prior to implementation. Over 12 months, ECE programs received on-site training and technical assistance to implement the strategies and resources provided in the Active Early guide. Main outcome measures included observed minutes of teacher-led physical activity, physical activity environment measured by the Environment and Policy Assessment and Observation (EPAO) instrument, and child physical activity levels via accelerometry. All measures were collected at baseline, 6 months, and 12 months and were analyzed for changes over time. RESULTS: Observed teacher-led physical activity significantly increased from 30.9 ± 22.7 min at baseline to 82.3 ± 41.3 min at 12 months. The change in percent time children spent in sedentary activity decreased significantly after 12 months (-4.4 ± 14.2 % time, -29.2 ± 2.6 min, p < 0.02). Additionally, as teacher led-activity increased, percent time children were sedentary decreased (r = -0.37, p < 0.05) and percent time spent in light physical activity increased (r = 0.35, p < 0.05). Among all ECE programs, the physical activity environment improved significantly as indicated by multiple sub-scales of the EPAO; scores showing the greatest increases were the Training and Education (14.5 ± 6.5 at 12-months vs. 2.4 ± 3.8 at baseline, p < 0.01) and Physical Activity Policy (18.6 ± 4.6 at 12-months vs. 2.0 ± 4.1 at baseline, p < 0.01). CONCLUSIONS: Active Early promoted improvements in providing structured (i.e. teacher-led) physical activity beyond the recommended 60 daily minutes using low- to no-cost strategies along with training and environmental changes. Furthermore, it was observed that Active Early positively impacted child physical activity levels by the end of the intervention. However, resources, training, and technical assistance may be necessary for ECE programs to be successful beyond the use of the Active Early guide. Implementing local-level physical activity policies combined with support from local and statewide partners has the potential to influence higher standards for regulated ECE programs.

Hábitos de vida y estilos de cuidado de los progenitores relacionados con la obesidad infantil. Comparación de una población española con poblaciones de países del norte de Europa: Energy-Project / Lifestyles and styles of parental care related to childhood obesity. Compare Spain with Northern European Countries: Energy-project

Fundamentos: La prevalencia de obesidad infantil es más alta en España que en los países del norte de Europa por razones que todavía se desconocen. El objetivo fue comprobar si variables referentes a hábitos de vida y a estilos de cuidado de los progenitores relacionados con la obesidad infantil difieren entre los países del Norte de Europa y España. Métodos: Los datos fueron obtenidos del proyecto internacional ENERG. Se analizaron los de España, Países Bajos, Bélgica y Noruega, incluyendo a 1.937 niños y 2.061 niñas de 10 a 12 años de edad. Se estudiaron los comportamientos de los padres referidos a variables dietéticas, variables relacionadas con la actividad física y los estilos de cuidado. Se calcularon las medias y las proporciones de todas las variables y a continuación se calculó la asociación de las diferentes variables con el país de origen utilizando el coeficiente beta y la Odds Ratio (OR) como medidas de asociación. Resultados: En comparación con los progenitores del Norte de Europa, los progenitores españoles consumen bebidas azucaradas menos días por semana (Media: 1,37 vs 2,16) pero consumen más zumos de frutas (Media: 2,61 vs 2,35). Los progenitores españoles son más activos yendo a su trabajo, son menos sedentarios pero realizan actividad física en su tiempo libre menos días por semana (Media de días por semana que realizan actividad física en su tiempo libre: 1,88 vs 2,21). Además, son menos negociadores con sus hijos (Media (0-4): 1,26 vs 1,68) y evitan menos los modelos negativos de conducta (Media (0-4): 0,90 vs 1,29). Sin embargo, prestan más atención (Media (0-4): 3,42 vs 3,04) y estimulan más los hábitos saludables (Media (0-4): 2,38 vs 2,06). Conclusiones: Las variables referentes a hábitos de vida y a estilos de cuidado relacionados con la obesidad infantil difieren entre los progenitores españoles y los de los países del Norte de Europa aunque estas diferencias no son estadísticamente significativas. Por lo tanto, las diferencias en los estilos de vida y estilos de cuidado de los progenitores probablemente no expliquen las diferencias en la obesidad infantil entre los países del Norte y España (AU)

Background: The prevalence of childhood obesity is higher in Spain than in Northern European countries for reasons that are still unknown. The objective was to determine whether variables related to lifestyle habits and styles of parental care related to obesity in children differ between the countries of Northern Europe and Spain. Methods: Data were obtained from the ENERGY international project using questionnaires. We analyzed data from Spain, the Netherlands, Belgium and Norway including 1937 boys and 2061 girls aged 10-12 years old. We have studied the behavior of parents related to dietary variables, variables related to physical activity and ways of care. We calculated the mean and the proportions of all the variables and then calculated the association between different variables with the country of origin using the beta coefficient and the odds ratio (OR) as a measure of association. Results: Compared with parents in Northern Europe, Spanish parents consume significantly less days a week sugary drinks (Mean: 1.37 vs 2.16) but they consume more fruit juices (Mean: 2,61 vs 2,35). Spanish parents are more active going to their work, they are less sedentary but perform physical activity in their leisure time fewer days per week (Mean days per week they do physical activity in their leisure time: 1.88 vs 2.21). In addition, they are less negotiators with their children (Mean (0-4): 1.26 vs 1.68) and prevent less negative role models (Mean (0-4): 0.90 vs 1.29). However, they pay more attention (Mean (0-4): 3.42 vs 3.04) and encourage more healthy habits (Mean (0-4): 2.38 vs 2.06). Conclusions: The variables related to lifestyle habits and styles of care related to childhood obesity differ between Spanish parents and those of the countries of Northern Europe but these differences are not statistically significant. Therefore, differences in lifestyles and parenting practices might not explain the significant differences in childhood obesity between the Northern countries and Spain (AU)