Characteristics of tummy time and dose-response relationships with development in infants.

This study aimed to examine change in tummy time patterns and preferences in the first 6 months of life, as well as dose-response relationships between tummy time duration and development at 2, 4, and 6 months. Participants were parents of infants from the Early Movers project in Edmonton, Canada (baseline: n = 411). At 2, 4, and 6 months, infant tummy time duration and preference (i.e., 1 = really likes to 5 = really dislikes) and development (i.e., Ages & Stages Questionnaire (ASQ-3) communication, fine motor, gross motor, problem-solving, personal-social) were measured by a parental questionnaire. In a subsample (n = 127), tummy time patterns (i.e., bout frequency, mean and median bout length) were measured using a 3-day time-use diary. Tummy time bout frequency, bout length, and preference significantly increased over time. Linear dose-response relationships between tummy time duration and development outcomes were observed at 4 (gross motor) and 6 months (all development outcomes). Moreover, at 2 months, 30-44 min/day of tummy time was associated with a higher total development score (vs. < 15 min/day; B = 11.14; 95%CI: 1.60, 20.68). At 6 months, 61-120 min/day (vs. < 30 min/day; B = 27.12; 95%CI: 11.93, 42.32) and > 120 min/day (vs. < 30 min/day; B = 33.80; 95%CI: 18.90, 48.70) of tummy time were associated with higher total development scores. Differences in threshold doses between some developmental outcomes were observed. Conclusion: In the first 6 months of life, increases were observed in tummy time preference as well as tummy time bout frequent and length. This finding may explain why the optimal amount of tummy time needed for more advanced development appeared to increase with age. What is Known: • Tummy time is a type of physical activity in infancy. International and national guidelines recommend at least 30 minutes of tummy time per day for infants who are not yet mobile. What is New: • In the first six months of life, preference for tummy time as well as tummy time bout frequency and length increased. • Tummy time duration had dose-response associations with several development outcomes, and the optimal amount of tummy time needed for more advanced development appeared to increase with age.

Adherence to Canadian 24-Hour Movement Guidelines among infants and associations with development: a longitudinal study.

BACKGROUND: To examine: 1) longitudinal adherence to the Canadian 24-Hour Movement Guidelines in a sample of infants and 2) associations between adherence to the guidelines over time and development. METHODS: Participants were 250 parent-infant dyads from the Early Movers project in Edmonton, Alberta. At 2, 4, and 6 months of age, physical activity, sedentary behaviour, sleep, and development were measured with a parental questionnaire that included items from the Ages & Stages Questionnaire (ASQ-3). Parents also reported the dates six major gross motor milestones were acquired during the first 18 months of life according to World Health Organization criteria. In a sub-sample (n = 93), movement behaviours were also measured with a time-use diary at 2, 4, and 6 months and gross motor development was measured by a physiotherapist using the Alberta Infant Motor Scale (AIMS) at 6 months. Guideline adherence was defined as: 1) ≥ 30 min/day of tummy time, 2) no screen time, some reading time, no restrained bouts > 1 h (time-use diary only), and 3) 14-17 h (2 months) or 12-16 h (4 and 6 months) of sleep per 24-h period. Generalized estimating equations were conducted as well as linear mixed models and linear regression models that adjusted for demographic characteristics. RESULTS: Few infants met the guidelines at all time-points (questionnaire: 2%; time-use diary: 0%). Infants that met a recommendation at 2 months, compared to those that did not, were 1.8-8.2 times more likely to meet that recommendation at subsequent time-points. Meeting more recommendations across time-points, according to both measures, was associated with a higher mean ASQ-3 gross motor score. Each additional time-point of tummy time recommendation adherence (questionnaire-measured) was associated with a 5-11-day earlier acquisition of independent sitting, crawling, and independent standing milestones. In the sub-sample, each additional time-point of guideline adherence was associated with a 16% higher AIMS score at 6 months. CONCLUSIONS: Guideline adherence was low across the first 6 months of infancy. Overall, meeting more recommendations over this period appeared important for gross motor development. Parents and caregivers should be targeted as early as possible with guideline dissemination and activation strategies to promote healthy infant development.

Longitudinal associations between infant movement behaviours and development.

BACKGROUND: This study aimed to address methodological limitations of the evidence that informed national and international movement behaviour guidelines for the early years. Specifically, the primary objective was to examine the longitudinal associations of infant physical activity (i.e., tummy time) and sedentary behaviour (i.e., back time, screen time, reading time, restrained time) with gross motor development. Secondary and tertiary objectives were to examine longitudinal associations of: (1) infant physical activity and sedentary behaviour with communication, fine motor, personal-social, and problem solving development, and (2) sleep time with primary and secondary outcomes. METHODS: Participants were 411 parents and their infants from the Early Movers project in Edmonton, Canada. Physical activity, sedentary behaviour, and sleep were measured with a parental questionnaire and the Ages & Stages Questionnaire (ASQ-3) developmental screening tool was administered at 2, 4, and 6 months. Parents reported the dates six major gross motor milestones (i.e., independent sitting, crawling, assisted standing, assisted walking, independent standing, independent walking) were acquired in the first 18 months of life according to World Health Organization criteria. In a subsample (n = 125), gross motor development was assessed using the Alberta Infant Motor Scale (AIMS) at 6 months. RESULTS: Higher tummy time across time points was significantly associated with higher ASQ-3 gross motor and personal-social development scores over time, higher total AIMS scores at 6 months, and earlier acquisition of all gross motor milestones. Higher reading time across time points was significantly associated with higher ASQ-3 fine motor, gross motor, personal-social, and total development scores over time. In contrast, higher back time across time points was significantly associated with lower total AIMS scores at 6 months and the later acquisition of assisted standing, assisted walking, and independent walking. Similarly, higher restrained time across time points was significantly associated with a later acquisition of supported walking. CONCLUSIONS: Tummy time was consistently longitudinally associated with more advanced gross motor development and reading with more advanced total development. Whereas, some detrimental associations were observed for back and restrained time. Findings support the promotion of tummy time and certain sedentary behaviours (i.e., reading) in young infants to enhance overall development.

Exploring a parent-focused physical literacy intervention for early childhood: a pragmatic controlled trial of the PLAYshop.

BACKGROUND: Parents play a key role in young children's physical activity and physical literacy development. Little research has explored parent-focused interventions to improve young children's physical literacy. We examined if a theory-based, feasible physical literacy training workshop (PLAYshop) for parents could improve their physical literacy knowledge and confidence and improve parenting practices related to facilitating the physical literacy development of their preschool-aged child (3-5 years). The secondary objective was to explore implementation facilitators and barriers. METHODS: We conducted a pragmatic controlled trial in two Canadian cities (Edmonton and Victoria) from November 2019 - March 2020. A total of 143/151 parents were eligible and assigned to intervention (n = 71) or control group (n = 72). The PLAYshop included: (i) a 75-min in-person workshop with interactive activities and physical literacy educational messages, (ii) educational materials, (iii) an equipment pack, and (iv) two post-workshop booster emails. Surveys measured parents' knowledge and confidence at baseline and follow-up. Application of PLAYshop concepts and implementation facilitators and barriers were explored with interviews of parents and workshop leaders. Repeated measures ANOVAs and thematic analyses were completed. RESULTS: Parents' knowledge and confidence improved significantly over time; intervention group changes were significantly greater than control group changes (p < 0.001; ɳ2 = .32). Parents applied PLAYshop concepts at-home, including child-led play, making activities fun, and promoting child manipulative and locomotor skills. Time was a key parental implementation barrier. Program implementation issues varied by context (location and participants). CONCLUSIONS: PLAYshop participation changed parents' physical literacy knowledge and confidence and physical literacy enhancing play with their children. Implementation feasibility was high. The findings from this real-world trial highlight an efficacious and scalable intervention that warrants further testing. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04394312 . Registered 19/05/2020.

The impact of new government childcare accreditation standards on children's in-care physical activity and sedentary time.

BACKGROUND: A new physical activity and sedentary behaviour accreditation standard criterion for childcare settings was introduced by the provincial government in Alberta, Canada. The primary objective of this study was to examine if changes for in-care physical activity and sedentary time (ST) differed between centres in and around Edmonton, Alberta after implementing the new accreditation standards and non-accredited control centres in and around Ottawa, Ontario. Secondary objectives were to examine whether baseline age group (toddler, preschooler) or the childcare environment moderated any group differences in change of the primary outcomes. Furthermore, accreditation and control group differences in change of children's body mass index (BMI) Z-scores or cognitive development as well as educators' perceptions of the primary outcomes were explored. METHODS: Participants were 252 toddlers (19-35 months) and preschoolers (36-60 months) in childcare centres from Alberta (n = 11) and Ontario (n = 8) in the supporting Healthy physical AcTive CHildcare setting (HATCH) study. In-care ST, light-intensity physical activity (LPA), and moderate- to vigorous-intensity physical activity (MVPA) were accelerometer-derived before and 6 months after the implementation of the new standards. At both time points, cognitive development (working memory, expressive vocabulary), heights, and weights were measured, and BMI Z-scores were calculated. Additionally, the childcare environment was observed using the Environment and Policy Assessment and Observation (EPAO) and Movement Environment Rating Scale (MOVERS) tools. Demographic characteristics were parent-reported and weather variables were derived from Environment Canada data. Mixed models were conducted. RESULTS: In adjusted models (n = 241), change in children's in-care ST (B = -0.07, 95%CI: - 1.43,1.29), LPA (B = 0.08, 95%CI: - 0.89,1.05), and log-transformed MVPA (B = 0.01, 95%CI: - 0.09,0.11) were not significantly different between accreditation and control groups. Age group and the childcare environment were not moderators. Significant increases in BMI Z-score (B = 0.19, 95%CI: 0.03,0.35) and high working memory (OR = 3.24, 95%CI: 1.32,7.97) were observed in the accreditation group and significant increases in expressive vocabulary (B = 3.18, 95%CI: 0.05,6.30) were observed in the control group. CONCLUSIONS: The new accreditation criterion may not significantly change physical activity or ST in childcare settings and therefore may not explain findings for BMI Z-scores and cognitive development. Additional training and resources may be needed.

Associations between screen time and cognitive development in preschoolers.

Objectives: To examine the cross-sectional associations between screen time and cognitive development in preschoolers. Methods: Participants were 97 preschoolers (36 to 60 months) in Alberta and Ontario, Canada in the supporting Healthy physical AcTive Childcare setting (HATCH) study. The time that children spent watching television, videos or DVDs (television time) or playing video or computer games (video game time) on a television, computer, or portable device was assessed using a parental questionnaire. Television time and video game time were summed to calculate total screen time. Adherence to the screen time recommendation (≤1 hour/day) of the Canadian 24-Hour Movement Guidelines was calculated. Expressive vocabulary and working memory were assessed using the Early Years Toolbox. Due to the distribution of working memory, it was categorized as a binary variable based on the median score. The associations between screen time and cognitive development were examined using mixed models (expressive vocabulary) or generalized mixed models (working memory). Results: Screen time was not associated with expressive vocabulary. Preschoolers who had higher total screen time were less likely to have better working memory (OR=0.52; 95%CI:0.31, 0.88), despite the null associations for television time (P=0.155) and video game time (P=0.079). Preschoolers who met the screen time recommendation were more likely to have higher working memory capacity (OR=3.48; 95%CI:1.06, 11.47), compared to those who did not meet the recommendation. Conclusion: Limiting total screen time to no more than one hour per day may facilitate working memory development in preschoolers. Screen time may be unrelated to expressive language development in this age group.

An Environmental Scan of Existing Canadian Childcare Resources Targeting Improvements in Health Behaviours.

The objective was to conduct an environmental scan of existing Canadian childcare resources targeting nutrition, physical activity, sedentary behaviour, and/or sleep. A comprehensive search plan was conducted that involved four search strategies: (1) grey literature databases, (2) customized Google search engines, (3) targeted websites, and (4) consultation with content experts. A resource (i.e., information, materials) must have been created by government or an organization/agency within Canada, available in English, intended for childcare educators or directors working with children ≤ 5 years of age, and focused on targeting improvements in nutrition, physical activity, sedentary behaviour, and/or sleep. The quality of each included resource was assessed using a modified version of the Authority, Accuracy, Coverage, Objectivity, Date, Significance checklist. A total of 192 eligible resources were included. Most resources targeted only nutrition (n = 101) or physical activity (n = 60), and few resources targeted only sedentary behaviour (n = 2) or sleep (n = 1). The remaining 28 resources targeted more than one health behaviour. The 4 most common topics of resources were menu/meal planning (n = 55), healthy nutrition practices/environment (n = 37), physical activities/games (n = 33), and nutrition/food literacy (n = 20). Only 52 included resources cited evidence. One-third of the included resources (n = 64) were rated as high quality, including 55 that received a point for the significance criterion. Therefore, numerous high quality Canadian childcare resources exist for nutrition and physical activity. Future resource development is needed for sedentary behaviour and sleep. Findings can assist future intervention work and the database of resources can be utilized by relevant stakeholders to support other childcare initiatives. Supplementary Information: The online version contains supplementary material available at 10.1007/s10643-021-01266-2.

Levels and correlates of physical activity and screen time among early years children (2-5 years): Cross-cultural comparisons between Canadian and South Korean data.

BACKGROUND: Cross-cultural research can provide insight into whether levels and correlates of movement behaviours among early years children vary across different cultural contexts. This study (1) compared children's physical activity (PA) and screen time (ST) and parental and environmental correlates of PA and ST between samples of Canadian and South Korean (Korean thereafter) early years children (2-5 years) and (2) investigated parental and environmental correlates of PA and ST and whether country moderates the relationships. METHODS: Cross-sectional data from 121 Canadian children (3.4 years; 49.6% girls) and 101 Korean children (3.4 years; 54.9% girls) who participated in the Parents' Role in Establishing healthy Physical activity and Sedentary behaviour habits (PREPS) study were used. Demographic information, children's PA, ST, PA- or ST-specific parental cognitions and behaviours, and home and neighbourhood environments were measured using a proxy-reported questionnaire. Two-tailed independent samples T test or Mann Whitney U test, chi-square tests, linear regression and moderation analyses were performed. RESULTS: Canadian children spent more time in non-organized PA compared to Korean children (111 vs. 63 min/day), whereas time spent in organized PA was higher in Korean children than Canadian children (25 vs. 9 min/day). Canadian children had more ST than Korean children (159 vs. 110 min/day). Similarly, Canadian parents reported higher screen (142 vs. 116 min/day) and sitting time (317 vs. 286 min/day) than Korean parents. Though children's behaviours, as well as parental cognitions and behaviours, varied between the two samples, similar correlates of children's PA and ST were observed. The relationship between presence of electronics in children's bedrooms and children's ST was moderated by country, with Canadian children showing a stronger relationship than Korean children. CONCLUSIONS: Supporting parents to adopt cognitions and behaviours that are conducive to healthy PA and ST patterns of their own and their early years children may be important for both Canada and Korea.

Physical activity and sedentary behavior across three time-points and associations with social skills in early childhood.

BACKGROUND: The growth and development that occurs in early childhood has long-term implications, therefore understanding the relevant determinants is needed to inform early prevention and intervention. The objectives of the study were to examine: 1) the longitudinal associations of physical activity and sedentary behavior with social skills and 2) how physical activity and sedentary behavior track over three time-points. METHODS: Participants were from the Parents' Role in Establishing healthy Physical activity and Sedentary behavior habits (PREPS) project. A total of 251 eligible toddlers and their parents participated at baseline in 2014/15 (time 1; 1.6 ± 0.2 years) and a sub-sample participated at 1-year (time 2; n = 79; 2.7 ± 0.3 years) and 2-year (time 3; n = 77; 3.7 ± 0.4 years) follow-ups. Sedentary time (≤25 counts/15 s), light-intensity physical activity (LPA; 26-419 counts/15 s), and moderate- to vigorous-intensity physical activity (MVPA; ≥420/15 s) were objectively measured with wGT3X-BT ActiGraph accelerometers, and standardized for wear time. Parents reported their children's screen time (television/video, video/computer games) at all three time-points. Parents also reported on children's social skills using the Adaptive Social Behavior Inventory (ASBI) at time-points 2 and 3, and comply (e.g., cooperates; 10 items), express (e.g., joins play; 13 items), and disrupt (e.g., teases; 7 items) subscales were created by summing items. Generalized estimating equations (GEE) were conducted to address objective one. Tracking coefficients (low: ß1 < 0.30; moderate: ß1 = 0.30-0.59; moderate-high: ß1 = 0.60-0.90; high: ß1 > 0.9) were conducted using GEE to address objective two. RESULTS: Across the study, screen time was negatively associated with express (b = - 0.068, 95%CI: -0.114, - 0.023) and comply (b = - 0.056; 95%CI: -0.094, - 0.018) scores and positively associated with disrupt scores (b = 0.004; 95% CI: 0.001, 0.006). Findings were similar for television/videos but less consistent for video/computer games. No associations were observed for physical activity. Screen time significantly tracked at moderate-high levels (ß1 = 0.63; 95% CI: 0.45, 0.81), while all other behaviors tracked at moderate levels (ß1 = 0.35-0.49; p < 0.01) over the three time-points. CONCLUSIONS: Screen time was unfavorably associated with social skills across early childhood. Furthermore, all behaviors tracked at moderate to moderate-high levels from toddler to preschool ages. Therefore, promoting healthy physical activity and sedentary behavior patterns early in life, especially for screen time, may be important.

Patterns of preschool children's screen time, parent-child interactions, and cognitive development in early childhood: a pilot study.

BACKGROUND: The primary objective of this study was to explore the feasibility of a virtual study protocol for a future longitudinal study, including recruitment, study measures, and procedures. The secondary objective was to examine preliminary hypotheses of associations, including 1) the correlations between total duration and patterns of screen time and cognitive development, and 2) the differences in quality of parent-child interactions for two screen-based tasks and a storybook reading task. METHODS: Participants included 44 children aged 3 years and their parents from Edmonton, Alberta and surrounding areas. Children's screen time patterns (i.e., type, device, content, context) were parental-reported using a 2-week online daily diary design. Children's cognitive development (i.e., working memory, inhibitory control, self-control, and language) was measured virtually through a recorded Zoom session. Parent-child interactions during three separate tasks (i.e., video, electronic game, and storybook reading) were also measured virtually through a separate recorded Zoom session (n = 42). The quality of the interactions was determined by the Parent-Child Interaction System (PARCHISY). Descriptive statistics, Intra-class correlations (ICC), Spearman's Rho correlations, and a one-way repeated measures ANOVA with a post-hoc Bonferroni test were conducted. RESULTS: All virtual protocol procedures ran smoothly. Most (70%) participants were recruited from four 1-week directly targeted Facebook ads. High completion rates and high inter-rater reliability in a random sample (Diary: 95% for 13/14 days; Cognitive development: 98% 3/4 tests, ICC > 0.93; Parent-child interactions: 100% for 3 tasks, Weighted Kappa ≥ 0.84) were observed for measures. Across cognitive development outcomes, medium effect sizes were observed for five correlations, with positive correlations observed with certain content (i.e., educational screen time) and negative associations observed for total screen time and certain types (show/movie/video viewing) and contexts (i.e., co-use). Medium and large effect sizes were observed for the differences in parent-child interaction quality between the three tasks. CONCLUSIONS: The virtual study protocol appeared feasible. Preliminary findings suggest it may be important to go beyond total duration and consider type, content, and context when examining the association between screen time and cognitive development. A future longitudinal study using this virtual protocol will be conducted with a larger and more generalizable sample.

Demographic Correlates of Movement Behaviors in Infants: A Longitudinal Study.

BACKGROUND: Demographic correlates of movement behaviors in infants are unclear. This study examined the longitudinal associations between demographic correlates and movement behaviors in infants. METHODS: Participants were 411 parents of infants from the Early Movers project in Edmonton, Canada. Movement behaviors, infant and parental age, and nonparental care time were assessed using a parental questionnaire at 2, 4, and 6 months of age. Other infant and parental demographic variables were assessed at 2 months of age. Linear and generalized linear mixed models were conducted. RESULTS: Infant age was associated with all movement behaviors except for restrained time. White infants and those with older parents had less tummy time but increased odds of having reading time. Infants of the most educated parents also had lower tummy time. Higher parental education and more siblings were associated with no screen time and longer infant sleep time. Infants with immigrant parent(s) were less likely to have reading time. No associations were found for infant sex, time spent in nonparental care, and parental marital status. CONCLUSION: Since no single demographic group demonstrated healthy patterns for all movement behaviors, promotion of a healthy balance of movement behaviors may be needed universally for all infants.

Examining correlates of outdoor play in childcare centres.

OBJECTIVES: Childcare centres are an important setting for young children to engage in outdoor play. The objectives for this study were to (1) determine the average outdoor play duration and frequency for toddlers (19-35 months) and preschoolers (36-60 months) in childcare centres, (2) determine if duration and frequency differed across winter (December-March) and non-winter (April-November) months, and (3) determine correlates of outdoor play duration and frequency. METHODS: Childcare centre directors (n = 240) in Alberta, Canada, completed a questionnaire adapted from the Nutrition and Physical Activity Self-Assessment for Child Care (GO NAP SACC) Outdoor Play Tool that measured outdoor play separately for toddlers/preschoolers and winter/non-winter months. Consistent with the tool, centres were categorized as meeting or not meeting best practices for outdoor play duration and frequency. The questionnaire also measured demographic, socio-cultural, environmental, and policy correlates. Chi-squared tests and multiple logistic regression models were conducted. RESULTS: More centres met the outdoor play duration and frequency best practices in non-winter than in winter months for toddlers (duration: 79.2% vs 24.9%; frequency: 11.4% vs 1.4%) and preschoolers (duration: 55.7% vs 14.6%; frequency: 20.2% vs 3.4%). Correlates of outdoor play duration and frequency varied across age groups and seasons. However, educator certification, educator professional development, and play areas were most consistent across final models. CONCLUSIONS: Findings from this study suggest correlates of outdoor play may differ across age groups and seasons. Interventions aimed at increasing outdoor play in childcare centres appear warranted, especially in winter months for northern locations.

RéSUMé: OBJECTIFS: Il est important que les enfants en garderie aillent jouer dehors. L'étude avait les objectifs suivants : 1) déterminer pendant combien de temps et à quelle fréquence les tout-petits (19 à 35 mois) et les enfants d'âge préscolaire (36 à 60 mois) en garderie jouaient dehors; 2) déterminer si la durée et la fréquence diffèrent en hiver (décembre à mars) par rapport aux autres saisons (avril à novembre); et 3) déterminer les corrélations entre le temps passé dehors et la fréquence à laquelle les enfants jouent dehors. MéTHODES: Des personnes (n = 240) à la tête de garderies de l'Alberta, au Canada, ont rempli un questionnaire adapté du Nutrition and Physical Activity Self-Assessment for Child Care (GO NAP SACC) Outdoor Play Tool qui mesurait séparément les données pour les tout-petits et les enfants d'âge préscolaire et les mois d'hiver et autres mois. Conformément à l'outil, les garderies ont été classées selon qu'elles respectent ou non les meilleures pratiques en matière de temps passé dehors pour les enfants et de fréquence à laquelle ils jouent dehors. Le questionnaire a également permis de mesurer les corrélats démographiques, socioculturels, environnementaux et politiques. Des tests du khi carré et des modèles de régression logistique multiple ont été réalisés. RéSULTATS: Le nombre de garderies qui ont respecté les meilleures pratiques pour ce qui est du temps passé dehors pour les enfants et de la fréquence à laquelle ces derniers jouent dehors est plus élevé dans les mois non hivernaux que dans les mois hivernaux, à la fois chez les tout-petits (79,2 % contre 24,9 % pour la durée, 11,4 % contre 1,4 % pour la fréquence) et chez les enfants d'âge préscolaire (55,7 % contre 14,6 % pour la durée, 20,2 % contre 3,4 % pour la fréquence). Les corrélats de la durée et de la fréquence variaient selon les groupes d'âge et les saisons. Cependant, la formation des éducateurs, le perfectionnement professionnel des éducateurs et les aires de jeux étaient les données les plus stables parmi les modèles finaux. CONCLUSIONS: Les résultats de cette étude suggèrent que les corrélats du temps passé à jouer dehors peuvent différer selon les groupes d'âge et les saisons. Les interventions visant à faire en sorte que les enfants jouent plus souvent dehors en garderie semblent justifiées, en particulier pendant les mois d'hiver pour les régions nordiques.

A real-world feasibility study of the PLAYshop: a brief intervention to facilitate parent engagement in developing their child's physical literacy.

BACKGROUND: Development of physical literacy, defined as "the motivation, confidence, physical competence, knowledge and understanding to value and take responsibility for engagement in physical activities for life," can support children's physically active behaviors and consequent health benefits. Little research has explored interventions to improve children's physical literacy, although substantive evidence shows parents play a key role in children's physically active behaviors and development of fundamental movement skills. The purpose of this study was to explore the feasibility of a novel, physical literacy program (the PLAYshop) designed to build parents' self-efficacy to support their child's physical literacy. METHODS: A non-randomized, one-arm concurrent nested design was used. Thirty-five parents of young children (3-8 years of age) attended a 75-min workshop inclusive of interactive activities, educational messages, and the provision of resources focused on core physical literacy concepts. Pre- and post-workshop surveys used quantitative measures to assess parents' satisfaction, knowledge, confidence, and intention to adopt practices. Follow-up interviews qualitatively explored the implementation experiences of both parents and facilitators. Paired t tests and thematic analysis were undertaken. RESULTS: Of the 33 eligible parents, 23 completed both pre- and post-workshop surveys. Follow-up interviews were completed with 11 parents and four workshop facilitators. Parents' self-reported knowledge and confidence to support their child's physical literacy development significantly increased after PLAYshop participation. The majority of parents were satisfied with the workshop and motivated to apply learnings at home with their child. Workshop facilitators identified seven workshop strengths (e.g., workshop champions and skilled facilitators) and four challenges (e.g., recruitment and unfavorable spaces). Limitations include the lack of control group and recruitment challenges. CONCLUSIONS: The PLAYshop was perceived positively by parents and facilitators and appeared to improve parent self-efficacy and intention to promote physical literacy with their child. Recruitment and attendance were key implementation challenges. The findings from this real-world study support the preliminary feasibility of the PLAYshop intervention and highlight areas to improve the intervention and recruitment prior to efficacy testing in a more rigorous trial format.

Longitudinal correlates of sleep duration in young children.

OBJECTIVE: The primary aim of this study was to longitudinally examine potential demographic and screen time correlates of nap duration, nighttime sleep duration, and total sleep duration in young children over two time points. METHODS: Data from the supporting Healthy physical AcTive Childcare setting (HATCH) study were analyzed. Participants were 206 toddlers (19-35 months) and preschoolers (36-60 months) in Alberta and Ontario, Canada. Child age, screen time (television, video games), and sleep duration (nap, nighttime) were measured at baseline and six-month follow-up, while other demographic variables were assessed at baseline only using the HATCH parental questionnaire. Mixed models were performed to examine the associations between potential correlates and sleep duration over time. RESULTS: In the multiple regression models, significant correlates of total sleep duration (min/d) were child age (months; B = -3.03; 95%CI:-3.88,-2.19) and parental education (bachelor's degree vs. below bachelor level; B = 29.74, 95%CI:7.43,52.06). Significant correlates of nighttime sleep duration (min/d) included child age (B = -0.81; 95CI%:-1.53,-0.10), child race/ethnicity (Caucasian vs. non-Caucasian; B = 15.31; 95%CI:0.38,30.25), household income (>$150,000 vs. <$50,000; B = 32.93, 95%CI:9.80,56.06), television time (B = -0.19, 95%CI:-0.32,-0.05), video games time (B = -0.19, 95%CI: -0.38, -0.01) and total screen time (B = -0.19; 95%CI:-0.29,-0.08). Significant correlates of nap duration (min/d) were child age (B = -2.10; 95%CI:-2.68,-1.51) and race/ethnicity (Caucasian vs. non-Caucasian; B = -13.73; 95%CI:-25.78,-1.68). CONCLUSION: Young children who were non-Caucasian, from lower income families, who had less-educated parents, or who had more screen time tended to have shorter sleep duration. Targeting these demographic groups and screen time appears important for promoting adequate sleep duration in early childhood.

Associations between sleep duration, adiposity indicators, and cognitive development in young children.

OBJECTIVE: This study aimed to examine the associations between sleep duration, adiposity indicators, and cognitive development in young children. METHODS: Participants were 217 children aged 19-60 months in Canada in the supporting Healthy physical AcTive Childcare setting (HATCH) study. Nap duration and nighttime sleep duration were assessed using a parent questionnaire and were summed up as total sleep duration. Body mass index (BMI) z-scores and weight status were determined using the World Health Organization growth standards. Expressive vocabulary and working memory were assessed using the Early Years Toolbox in preschoolers only (36-60 months; n = 101). Mixed models (BMI z-score, expressive vocabulary) and generalized mixed models (weight status, working memory) were conducted. RESULTS: A linear association between total sleep duration and BMI z-score (B = -0.12; 95% CI: -0.23, -0.01) were observed. Compared to children having nighttime sleep within ±1SD (9.13-11.13 h/d) of the mean, those having shorter nighttime sleep had higher BMI z-scores (B = 0.39; 95% CI: 0.06, 0.73) and an increased risk of being overweight (OR = 4.54; 95% CI: 1.39, 14.81). Nap duration was not associated with adiposity indicators. In preschoolers, sleep duration was not associated with expressive vocabulary. Total sleep duration and nap duration were not associated with working memory. However, non-nappers were more likely to have greater working memory (OR = 4.04; 95% CI: 1.09, 14.92) compared to those having nap duration within ±1SD (0.46-2.18 h/d) of the mean. CONCLUSION: Promoting longer total sleep, including more than nine hours of nighttime sleep, appears important for maintaining healthy adiposity levels in young children. Cessation of napping may be associated with better working memory in preschoolers.

Associations Between the Child Care Environment and Children's In-Care Physical Activity and Sedentary Time.

BACKGROUND: Child care centers are important for children's behaviors. AIMS: To examine the cross-sectional associations between child care environmental characteristics and physical activity and sedentary time in children. METHODS: Participants were 124 toddlers and 118 preschoolers from 19 centers in Alberta and Ontario, Canada, in the supporting Healthy physical AcTive CHildcare setting (HATCH) study. In-care physical activity and sedentary time were assessed using Actigraph accelerometers. Child care environments, including structure (e.g., resources) and process (e.g., activities) quality, were measured using three instruments: (1) the Environment and Policy Assessment and Observation and (2) the Children's Physical Environments Rating Scale, and (iii) the Movement Environment Rating Scale. Mixed models were performed to examine the associations between environmental characteristics and children's sedentary time, light physical activity, and moderate-to-vigorous physical activity. RESULTS: A few structure quality characteristics related to child care policy and indoor environment were associated with higher physical activity and lower sedentary time in toddlers. The overall structure quality (B = 0.04; 95% CI [0.003, 0.08]) and process quality (B = 0.08; 95% CI [0.02, 0.15]) of the child care environment were associated with log moderate-to-vigorous physical activity in preschoolers. Specifically, structure quality characteristics of the outdoor environment and physical activity time, and process quality characteristics relevant to curriculum and pedagogy, were associated with higher physical activity and lower sedentary time in preschoolers. DISCUSSION AND CONCLUSION: The child care structure quality characteristics that are important for children' physical activity and sedentary behavior may vary by age group. Improving the overall process quality, in particular curriculum and pedagogy, of the child care environment, may promote more physical activity in preschoolers.

Sedentary Time and Physical Activity Associations Between Child Care Educators and Children.

INTRODUCTION: This study examines the associations between objectively measured sedentary time and physical activity among child care educators and children in their direct care and aims to determine if the associations differed between toddlers (aged 19-35 months) and preschoolers (aged 36-60 months). METHODS: The participants were educators and children from 19 child care centers in Edmonton and Ottawa, Canada, as part of the Supporting Healthy Active Child Care Settings study. Sedentary time, light-intensity physical activity, and moderate to vigorous-intensity physical activity during child care were measured with accelerometers in 2017-2018. Nap time data were removed for children and educators based on room schedules. Children were matched with the main educator in their room that had the highest total physical activity, resulting in 187 children and 38 educators. Multilevel linear regression models with interaction terms were conducted in 2019. RESULTS: Children engaged in 30.0, 23.1, and 6.9 minutes per hour of sedentary time, light-intensity physical activity, and moderate to vigorous-intensity physical activity, respectively. Educators engaged in 33.5, 23.6, and 2.9 minutes per hour of sedentary time, light-intensity physical activity, and moderate to vigorous-intensity physical activity, respectively. No significant interactions were observed, so age-stratified analyses were not conducted. Each additional 5 minutes per hour of educator sedentary time was significantly associated with 0.5 minutes per hour lower child moderate to vigorous-intensity physical activity. Each additional 5 minutes per hour of educator moderate to vigorous-intensity physical activity was significantly associated with 1.3 minutes per hour higher child moderate to vigorous-intensity physical activity. No other significant observations were observed. CONCLUSIONS: The educators' sedentary time and moderate to vigorous-intensity physical activity may have a small but potentially meaningful influence on children's moderate to vigorous-intensity physical activity because educators directly care for multiple children. Targeting these educator behaviors may be one strategy to increase children's moderate to vigorous-intensity physical activity during child care.