Associations between pain, health, and lifestyle factors in 10-year-old boys and girls from a Swedish birth cohort.

BACKGROUND: Pain is common in children and its associations with various biopsychosocial factors is complex. Comprehensive pain assessments could contribute to a better understanding of pediatric pain, but these assessments are scarce in literature. The aim of this study was to examine differences in pain prevalence and pain patterns in 10-year-old boys and girls from a Swedish birth cohort and to study associations between pain, health-related quality of life and various lifestyle factors stratified by sex. METHODS: 866 children (426 boys and 440 girls) and their parents from the "Halland Health and Growth Study" participated in this cross-sectional study. Children were categorized into two pain groups, "infrequent pain" (never-monthly pain) or "frequent pain" (weekly-almost daily pain), based on a pain mannequin. Univariate logistic regression analyses, stratified by sex, were performed to study associations between frequent pain and children's self-reports of disease and disability and health-related quality of life (Kidscreen-27, five domains), and parents' reports of their child's sleep (quality and duration), physical activity time, sedentary time, and participation in organized physical activities. RESULTS: The prevalence of frequent pain was 36.5% with no difference between boys and girls (p = 0.442). Boys with a longstanding disease or disability had higher odds of being in the frequent pain group (OR 2.167, 95% CI 1.168-4.020). Higher scores on health-related quality of life in all five domains for girls, and in two domains for boys, was associated with lower odds of being categorized into the frequent pain group. Frequent pain was associated with poor sleep quality (boys OR 2.533, 95% CI 1.243-5.162; girls OR 2.803, 95% CI 1.276-6.158) and more sedentary time (boys weekends OR 1.131, 95% CI 1.022-1.253; girls weekdays OR 1.137, 95% CI 1.032-1.253), but not with physical activity. CONCLUSIONS: The high prevalence of frequent pain needs to be acknowledged and treated by school health-care services and the healthcare sector in order to prevent pain from influencing health and lifestyle factors negatively in children.

Infants were introduced to complementary feeding earlier in 2018 compared with 2003.

AIM: Until 2001, the Swedish advice was to postpone the introduction of eggs, fish and peanuts until the age of 1 year. One reason was to reduce the risk of food allergy. The earlier introduction of complementary feeding is now advised. Our aim was to study adherence to current recommendations and whether the time of introduction changed between 2003 and 2018. METHODS: Data were obtained from two prospective, longitudinal, population-based cohort studies of children born in 2003 (n = 4987) and in 2018 (n = 3936). Parents answered comparable questionnaires when the children were 6 and 12 months old. RESULTS: At 6 months, in the 2018 cohort, eggs were introduced to 67.2% of the infants, fish to 78.9%, gluten to 89.1%, cow's milk to 76.6% and peanuts to 46.2%. In adjusted Cox regression analyses, introduction of complementary feeding with gluten, fish and eggs was made significantly earlier in the 2018 cohort compared with the 2003 cohort, adjusted for heredity, own allergic disease and parental educational level (p < 0.01). CONCLUSION: Complementary feeding with eggs, fish and gluten was introduced earlier in infants born in 2018 compared with 2003, possibly reducing the risk of developing allergic disease. Current recommendations from child welfare centres are being followed.

Early rapid weight gain, parental body mass index and the association with an increased waist-to-height ratio at 5 years of age.

BACKGROUND/OBJECTIVES: Obesity-related adverse health consequences are closely associated with abdominal obesity. Risk factors for overweight and obesity have been studied but there is a lack of information regarding risk factors for abdominal obesity, especially in the preschool population. The aim of the present study was to examine early life risk factors for an increased waist-to-height ratio (WHtR) in children at five years of age and, in addition, to investigate if these risk factors also were associated with overweight or obesity. SUBJECTS/METHODS: The study population comprised 1,540 children from a population-based longitudinal birth cohort study that included 2,666 Swedish children. The children were included if they had complete growth data for the analyses used in this study. Children were classified as having WHtR standard deviation scores (SDS) ≥ 1 or < 1 at five years of age, according to Swedish reference values, and as having body mass index standard deviation scores (BMISDS) for overweight/obesity, or normal weight/underweight according to the International Obesity Task Force criteria. Associations between child-related, socioeconomic status-related, parental health-related and nutrition- and feeding practice-related factors during the first two years and a WHtRSDS ≥ 1 or a BMISDS for overweight/obesity at five years were investigated with logistic regression analyses. RESULTS: At five years of age, 15% of the children had WHtRSDS ≥ 1 and 11% had overweight or obesity. In multivariable analyses, rapid weight gain (RWG) during 0-6 months (OR: 1.90, 95% CI: 1.23-2.95, p = 0.004), maternal pre-pregnancy BMI (1.06, 1.01-1.11, p = 0.019) and paternal BMI (1.11, 1.01-1.21, p = 0.028) were associated with WHtRSDS ≥ 1. RWG during 0-6 months (2.53, 1.53-4.20, p<0.001), 6-12 months (2.82, 1.37-5.79, p = 0.005), and maternal pre-pregnancy BMI (1.11, 1.06-1.17, p<0.001) were associated with overweight or obesity. CONCLUSIONS: Early risk factors, including rapid weight gain, are associated with increased WHtRSDS and overweight or obesity at 5 years of age. Preventive interventions should target early RWG and parental overweight and obesity.

Swedish survey of infant sleep practices showed increased bed-sharing and positive associations with breastfeeding.

AIM: Many countries lack monitoring of infant sleep practices, despite associations with sudden infant death. We studied sleep positions, bed-sharing and breastfeeding in a new birth cohort. METHODS: Data were obtained from a prospective, population-based cohort study of children born in western Sweden in 2018. The parents of 9,465 six-month-old infants, via postal questionnaires, were asked about their infants' sleeping positions at three and six months, including where they slept and any bed-sharing arrangements. The data were compared with our earlier 2003-2004 birth cohort. RESULTS: Questionnaires were completed by the parents of 3,590 (38%) infants. At three months, 54% of the infants slept in a separate cot in their parents' room. A further 43% slept in their parents' bed: 42% in baby nests and 42% in close contact with their parents. At six months, 33% bed-shared, compared with 20% in 2003-2004 (p < 0.001). Bed-sharing was positively associated with breastfeeding (odds ratio at three months: 1.5-2.8, 95% confidence interval: 1.1-4.5). CONCLUSION: Most infants slept in separate cots during the first three months. However, bed-sharing showed an increasing trend and baby nests were popular. Bed-sharing was positively associated with breastfeeding, but the association may not be causal.

Nutrition- and feeding practice-related risk factors for rapid weight gain during the first year of life: a population-based birth cohort study.

BACKGROUND: Rapid weight gain (RWG) during infancy increases the risk of excess weight later in life. Nutrition- and feeding practices associated with RWG need to be further examined. The present study aimed to examine nutrition- and feeding practice-related risk factors for RWG during the first year of life. METHODS: A population-based longitudinal birth cohort study of 1780 infants, classified as having RWG or non-RWG during 0-3-4, 0-6 and 6-12 months. RWG was defined as a change > 0.67 in weight standard deviation scores. Associations between nutrition- and feeding practice-related factors and RWG were examined with logistic regression models. RESULTS: Of the participating infants, 47% had RWG during 0-3-4 months, 46% during 0-6 months and 8% during 6-12 months. In the fully adjusted models, bottle-feeding at birth and at 3-4 months and nighttime meals containing formula milk were positively associated with RWG during 0-3-4 months (p < 0.05 for all). Breastfeeding at 3-4 months and nighttime meals containing breast milk were negatively associated with RWG during this period (p < 0.001). Bottle-feeding at birth, 3-4 and 6 months and nighttime meals containing formula milk at 3-4 months were positively associated with RWG during 0-6 months (p < 0.01 for all). Breastfeeding at 3-4 and 6 months was negatively associated with RWG (p < 0.01). During 6-12 months, only bottle-feeding at 3-4 months was positively associated with RWG (p < 0.05). CONCLUSIONS: RWG was more common during the first 6 months of life and bottle-feeding and formula milk given at night were risk factors for RWG during this period.

Longitudinal birth cohort study found that a significant proportion of children had abnormal metabolic profiles and insulin resistance at 6 years of age.

AIM: Metabolic syndrome represents a cluster of risk factors for cardiovascular disease, and we investigated whether otherwise healthy 6-year-olds showed metabolic alterations. METHODS: This study followed up a representative Swedish population-based cohort of full-term infants recruited on the maternity ward at Hallands Hospital Halmstad, Sweden, from 2008 to 2011. They were examined at a mean of 6.6 years of age (range 6.5-6.9) using various measures for signs of metabolic syndrome. RESULTS: One key measure showed that 55 (26%) of the 212 children had one or more risk factors for metabolic syndrome requiring action. The 37 who were obese (3%) or overweight (14%) were significantly more likely to be insulin resistant than the normal weight group (28% versus 5%, p < 0.001) and have high triglycerides (8% versus 0%, p < 0.001). Children with high waist circumferences had higher systolic (p = 0.01) and diastolic (p = 0.02) blood pressure than those with normal waist circumferences. Waist circumference identified children at high risk of metabolic syndrome better than body mass index. CONCLUSION: A significant percentage of 6-year-old children showed abnormal metabolic profiles, including insulin resistance, which increased their risk of cardiovascular disease. Waist circumference was a stronger marker for metabolic alterations than body mass index.

Consuming milk cereal drinks at one year of age was associated with a twofold risk of being overweight at the age of five.

AIM: We previously reported that consuming milk cereal drinks at six months of age was associated with a high body mass index (BMI) at 12 and 18 months. This study examined the association between daily consumption at 12 months of age and BMI at the age of five. METHODS: We followed up 1870/2666 (70%) children recruited at birth in 2007-2008 for the Swedish longitudinal population-based Halland Health and Growth Study a mean of 5.09 ± 0.28 years. Feeding practices were obtained from parental questionnaires, and anthropometric data were collected by child health nurses. RESULTS: At five years, 11.6% were overweight and 2.3% were obese. Milk cereal drinks were consumed by about 85% and 10% at one and five years of age, respectively. Consumption at 12 months was associated with almost double the risk of being overweight at five years of age (adjusted odds ratio 1.94, 95% confidence interval 1.08-3.50). Other risk factors were a family history of obesity, low paternal educational level and paternal smoking. CONCLUSION: Consuming milk cereal drinks daily at 12 months was associated with a twofold risk of being overweight at five years. These findings may affect the counselling guidelines used at child healthcare centres.

Higher parental education was associated with better asthma control.

AIM: Inhaled corticosteroids have resulted in the improved control of asthma and a reduced need for hospitalisation. This study aimed to examine the prevalence of uncontrolled asthma and factors that affect asthma control. METHODS: The data came from a longitudinal cohort study of children. The parents answered questionnaires from age 6 months to 12 years. The response rate at age 12 years was 76% (3637/4777) and doctor-diagnosed asthma was reported in 6.4% (n = 233). Asthma control was examined with the Asthma Control Test (ACT), where scores below 20 denote uncontrolled asthma. RESULTS: Of the children with asthma at age 12 years, 15% had an ACT value below 20, that is uncontrolled asthma. Independent risk factors for uncontrolled asthma were wheeze triggered by exercise (adjusted OR, aOR 5.6; 1.9-16.6), cat at home (aOR 3.5; 1.2-10.0) and current doctor-diagnosed rhinitis (aOR 2.8; 95% CI 1.1-7.0). A higher education in the parents reduced the risk of uncontrolled asthma (aOR 0.3; 95% CI 0.1-0.8). Only six children (i.e. 2.6%) reported hospitalisation due to asthma during the last year. CONCLUSION: Of the children with asthma, 15% had uncontrolled asthma. Higher education in the parents was associated with better asthma control in the children.

Infant body mass index growth patterns predicted overweight at five years, waist-to-height ratio did not add to this predictivity.

AIM: The aim of the present study was to examine body mass index (BMI) and waist-to-height ratio (WHtR) growth patterns from birth until five years regarding their ability to predict overweight or obesity in children at five years of age. METHODS: Population-based longitudinal birth cohort study of 1540 children from the south-west region of Sweden, recruited at the first visit to the child health care centres in 2007-2008. The children were followed for five years and classified into two weight groups according to the 2012 International Obesity Task Force criteria. BMI and WHtR standard deviation scores (SDS) were analysed with Student's t-tests and multiple logistic regression models. RESULTS: BMI-SDS and WHtR-SDS growth patterns were from an early age different in children with overweight or obesity, compared to in children with normal weight or underweight. Overweight or obesity was significantly predicted by BMI-SDS at 0-1 month (p < 0.001), ΔBMI-SDS between 0-1 and 12 months (p < 0.001) and between 18 and 48 months (p < 0.001), but not by WHtR-SDS, except for a negative association between 18 and 48 months in the boys (p = 0.040). CONCLUSION: Overweight or obesity at five years could be predicted by early BMI-SDS growth patterns, and WHtR-SDS did not add to the predictivity with regard to BMI-SDS.

Body mass index classification misses to identify children with an elevated waist-to-height ratio at 5 years of age.

BACKGROUND: Abdominal adiposity is an important risk factor in the metabolic syndrome. Since BMI does not reveal fat distribution, waist-to-height ratio (WHtR) has been suggested as a better measure of abdominal adiposity in children, but only a few studies cover the preschool population. The aim of the present study was to examine BMI and WHtR growth patterns and their association regarding their ability to identify children with an elevated WHtR at 5 years of age. METHODS: A population-based longitudinal birth cohort study of 1540 children, followed from 0 to 5 years with nine measurement points. The children were classified as having WHtR standard deviation scores (WHtRSDS) <1 or ≥1 at 5 years. Student's t-tests and Chi-squared tests were used in the analyses. RESULTS: Association between BMISDS and WHtRSDS at 5 years showed that 55% of children with WHtRSDS ≥1 at 5 years had normal BMISDS (p < 0.001). Children with WHtRSDS ≥1 at 5 years had from an early age significantly higher mean BMISDS and WHtRSDS than children with values <1. CONCLUSIONS: BMI classification misses every second child with WHtRSDS ≥1 at 5 years, suggesting that WHtR adds value in identifying children with abdominal adiposity who may need further investigation regarding cardiometabolic risk factors.

Antibiotics in the first week of life were associated with atopic asthma at 12 years of age.

AIM: This study explored the prevalence of atopic and nonatopic asthma in 12-year-old children and whether they were associated with different risk factors. In particular, we wanted to analyse whether receiving antibiotics during the first week of life was associated with asthma at that age. METHODS: Data were obtained from a longitudinal cohort study of 5654 Swedish children born in 2003. The parents answered questionnaires from the age of six months until 12 years. The response rate at 12 years was 3637/4777 (76%). RESULTS: At 12 years, 6.4% reported current doctor-diagnosed asthma. Treatment with antibiotics during the first week of life was associated with an increased risk of atopic asthma, with an adjusted odds ratio of 2.2 and 95% confidence interval of 1.2-4.2. Being born small for gestational age was associated with an increased risk of nonatopic asthma, with an adjusted odds ratio of 3.8 and 95% confidence interval of 1.1-13.7. Asthma that only occurred with colds was reported by 28%. CONCLUSION: Antibiotic treatment during the first week of life was associated with an increased risk of atopic asthma at 12 years, suggesting an immune-mediated effect. Being born small for gestational age increased the risk of nonatopic asthma.

Eating fish and farm life reduce allergic rhinitis at the age of twelve.

BACKGROUND: The prevalence of allergic rhinitis has increased, but the cause of this rise is partly unknown. Our aim was to analyse the prevalence, risk factors, and protective factors for allergic rhinitis in 12-year-old Swedish children. METHODS: Data were collected from a prospective, longitudinal cohort study of children born in western Sweden in 2003. The parents answered questionnaires when the children were 6 months to 12 years. The response rate at 12 years was 76% (3637/4777) of the questionnaires distributed. RESULTS: At the age of 12, 22% of children had allergic rhinitis and 57% were boys. Mean age at onset was 7.8 years, and 55% reported their first symptoms after 8 years. The most common trigger factors were pollen (85%), furry animals (34%), and house dust mites (17%). A multivariate analysis showed that the adjusted odds ratios and 95% confidence intervals for the independent risk factors for allergic rhinitis at 12 were as follows: parental allergic rhinitis (2.32, 1.94-2.77), doctor-diagnosed food allergy in the first year (1.75, 1.21-2.52), eczema in the first year (1.61, 1.31-1.97), and male gender (1.25, 1.06-1.47). Eating fish once a month or more at age of 12 months reduced the risk of allergic rhinitis at 12 years of age (0.70, 0.50-0.98) as did living on a farm with farm animals at 4 years (0.51, 0.32-0.84). Continuous farm living from age 4 to 12 seemed to drive the association. CONCLUSIONS: Allergic rhinitis affected > 20% of 12-year-olds, but was lower in children who ate fish at 12 months or grew up on a farm with farm animals.

Parents with overweight children two and five years of age did not perceive them as weighing too much.

AIM: This study examined whether the parents of children who were overweight at two and five years of age perceived their children as being too heavy and related the findings to sociodemographic factors. METHODS: The data collection included parental questionnaires and anthropometric data from a longitudinal birth cohort of 2666 children born in the south-west region of Sweden in 2007-2008. RESULTS: We found that 14.9 and 11.8% of the children were considered overweight or obese at the age of two and five, but 96.4 and 87.1% of their parents perceived their weight to be just about right at these ages. The difference was statistically significant (p < 0.001). Parents who were overweight themselves and had a low educational level were associated with a higher probability of misperception: at two years of age, the odds ratio was 2.75 (95% confidence interval 1.80-4.21), and at the age of five, it was 1.92 (1.24-2.97). CONCLUSION: Most parents did not perceive that their overweight children weighed too much, but their judgement improved as the child got older. Parents who were overweight or had a low educational level were more likely to misperceive their child's weight. Health Care professionals need to be aware of this gap in perception.

What makes parents act and react? Parental views and considerations relating to 'child health' during infancy.

Lifestyle factors and behaviours are adopted very early in life and tend to persist throughout life. Considering that the parents are the primary gatekeepers for their child's health, there is a need to gain more knowledge and deeper understanding about what causes parents to act and react in order for early preventive efforts to have any effect. The aim was to explore the parental views and considerations concerning 'child health' among parents with infants 8-10 months old. The sample was strategic and 16 parents (aged 23-41) were recruited from three child health centres in Sweden. Open-ended interviews were conducted and a qualitative, manifest content analysis approach was utilized. The parents described the subject 'child health' as a large, multifaceted concept. Three categories emerged during data analysis: developing a sixth sense, being affected by perceptions and believing health and ill health as a continuum. The parents perceived food and feeding issues as one of the most worrying aspects and a significant indicator of 'child health'. In order to meet the parents on their turf, the 'healthy health message' conveyed needs to take the parental perspective into consideration rather than attempting to educate the parents from predetermined assumption, belief and values.

Area-based study shows most parents follow advice to reduce risk of sudden infant death syndrome.

AIM: Guidance on reducing the risk of sudden infant death syndrome (SIDS) was successfully introduced to a number of countries in the early 1990s. The most important recommendations were supine sleeping for infants and non-smoking for mothers. This 2012-2014 study examined adherence to the national Swedish SIDS advice. METHODS: We asked 1000 parents with infants registered at child healthcare centres in western Sweden to complete a questionnaire on infant care from birth to 12 months of age. RESULTS: We analysed 710 responses and found that, in the first three months, 1.3% of the infants were placed in the prone sleeping position and 14.3% were placed on their side. By three to five months, this had risen to 5.6% and 23.6%. In the first three months, 83.1% were breastfed, 84.1% used a pacifier and 44.2% shared their parents' bed, while 5.8% slept in another room. Bed sharing was more likely if infants were breastfed and less likely if they used pacifiers. During pregnancy, 2.8% of the mothers smoked and the mothers who had smoked during pregnancy were less likely to bed share. CONCLUSION: Overall adherence to the SIDS advice was good, but both prone and side sleeping practices should be targeted.

The allergic march comprises the coexistence of related patterns of allergic disease not just the progressive development of one disease.

AIM: This study explored the development and comorbidity of allergic diseases by analysing the relationship between allergic manifestations in infancy and at the age of 8. METHODS: We included 5654 children born in Sweden in 2003 in a longitudinal study. Parents answered postal questionnaires when the children were six months and one, four-and-a-half and eight years of age. RESULTS: The response rate at eight years was 4051 (71.6%), and we analysed 3382 children with complete data. The number of manifestations in infancy increased the risk of allergic disease at eight years of age: 72% of children with one early manifestation were symptom free at 8, compared to 45% with two or more manifestations. Similar manifestations occurred in infancy and at the age of 8, for example recurrent wheeze increased the risk of doctor-diagnosed asthma by an adjusted odds ratio of 6.5. Eczema and food allergy independently increased the risk of all four allergic manifestations at eight years. CONCLUSION: Allergic disease at the age of 8 was related to the number of allergic manifestations in infancy. Manifestations were similar at both ages, suggesting an allergic march with the coexistence of disease patterns rather than the progressive development of one disease.

Overweight at four years of age in a Swedish birth cohort: influence of neighbourhood-level purchasing power.

BACKGROUND: A number of child/parental factors have been shown to be significant predictors of childhood overweight, although a better understanding of possible contextual influences of neighbourhood-level characteristics might provide new insights leading to tailored, targeted interventions. The aim of this study was to explore the impact of neighbourhood purchasing power and its relationship with other known risk factors related to childhood overweight in a prospective birth cohort. METHODS: A prospective, population-based, birth-cohort study was conducted in south-western Sweden, comprising 2,666 infants born in 2007-2008. Childhood overweight was assessed by body mass index (BMI) data from follow-up examinations at four years of age (n = 2,026) and overweight defined according to the International Obesity Task Force. Using logistic regression analysis, the influential child/parental predictors were identified from the candidate predictors, viz. child's gender, as well as birth weight adjusted for gestational age and parental factors at recruitment, including maternal smoking status, maternal BMI (before pregnancy), paternal BMI and parental educational level. The children's residential parishes at follow-up were stratified by parish-level household purchasing power (<10 %, 10-19.9 %, 20-29.9 % and ≥30 % of all resident families with low purchasing power) and the "contextual" influence was analysed. In each such neighbourhood stratum, the adjusted overweight ratio (AOR), i.e. the ratio between the observed number of overweight children and the expected number, taking account of the influential child/parental predictors, was estimated. RESULTS: The prevalence of overweight at four years of age was 11.9 %. In the economically strongest neighbourhoods (i.e. <10 % of resident families with low purchasing power), the AOR was 0.60 (95 % confidence interval (CI): 0.34-0.98). The corresponding empirically Bayes-adjusted AOR was 0.73 (95 % CI: 0.46-1.02; 97 % posterior probability of AOR <1). In the other neighbourhood strata, the statistical evidence of a deviant AOR was weaker. CONCLUSION: The economically strongest neighbourhoods had a lower prevalence than expected of overweight at four years of age. This finding should prompt studies to acquire more knowledge of potentially modifiable factors that differ between neighbourhoods and are related to childhood overweight, providing a basis for tailored, targeted interventions.

Breastfeeding and dummy use have a protective effect on sudden infant death syndrome.

UNLABELLED: We conducted a literature review on the effect of breastfeeding and dummy (pacifier) use on sudden infant death syndrome (SIDS). From 4343 abstracts, we identified 35 relevant studies on breastfeeding and SIDS, 27 on dummy use and SIDS and 59 on dummy use versus breastfeeding. CONCLUSION: We found ample evidence that both breastfeeding and dummy use reduce the risk of SIDS. There has been a general reluctance to endorse dummy use in case it has a detrimental effect of breastfeeding. However, recent evidence suggests that dummy use might not be as harmful to breastfeeding as previously believed.