Natalie A. Williams

Normal Sleep in Children and Adolescents

This article reviews the normal development of sleep in infants, children, and adolescents, with specific focus on both the subjective and objective aspects of sleep. Notably, sleep duration decreases substantially from infancy through adolescence with increased consolidation of sleep to the nighttime period only. Sleep architecture exhibits developmental changes with decreases in slow-wave sleep and increases in stage 2 sleep from childhood through adolescence. Although the development of sleep is a dramatic and relatively rapid process during the first decades of life, changes in sleep continue across the life span.

Risk factors for poor attendance in a family-based pediatric obesity intervention program for young children.

Objective: This study examined the role of demographic characteristics, psychological factors, and family functioning on attendance in a randomized controlled trial of a family-based pediatric obesity program. Method: Participants included 155 children between the ages of 4 and 7 years (M age = 5.77, 57.4% female, 73.6% black, M body mass index = 25.5) and their primary caregivers who were randomized to the treatment group. Three groups of participants were created based on their patterns of attendance during the program: (1) noncompleters, (2) partial completers, and (3) completers. Results: Results indicated no differences among the attendance groups in child gender, child body mass index, or child psychological functioning. Significant group differences were found with respect to race/ethnicity, parent marital status, and family income, such that noncompleters were more likely to be racial/ethnic minorities, to living in single parent households, and to have lower incomes than partial completers and completers. After controlling for the effects of these sociodemographic risk factors, noncompleters, and partial completers reported more family dysfunction characterized by high levels of disengagement than completers. Conclusion: Adapting existing weight management programs to include a focus on family engagement in the early stages of treatment may help to improve participation in family-based obesity interventions targeting high risk, socioeconomically disadvantaged youth.

External Validity Reporting in Behavioral Treatment of Childhood Obesity

CONTEXT To aid translation of childhood obesity interventions evidence into practice, research studies must report results in a way that better supports pragmatic decision making. The current review evaluated the extent to which information on key external validity dimensions, participants, settings, interventions, outcomes, and maintenance of effects, was included in research studies on behavioral treatments for childhood obesity. EVIDENCE ACQUISITION Peer-reviewed studies of behavioral childhood obesity treatments published between 1980 and 2008 were identified from (1) electronic searches of social science and medical databases; (2) research reviews of childhood obesity interventions; and (3) reference lists cited in these reviews. Included studies reported on a controlled obesity intervention trial, targeted overweight or obese children aged 2-18 years, included a primary or secondary anthropometric outcome, and targeted change in dietary intake or physical activity behaviors. EVIDENCE SYNTHESIS 1071 publications were identified and 77 met selection criteria. Studies were coded on established review criteria for external validity elements. All studies lacked full reporting of generalizability elements. Across criteria, the average reporting was 23.9% (range=0%-100%). Infrequently reported were setting-level selection criteria and representativeness, characteristics regarding intervention staff, implementation of the intervention content, costs, and program sustainability. CONCLUSIONS Enhanced reporting of relevant and pragmatic information in behavioral investigations of childhood obesity interventions is needed to improve the ability to evaluate the applicability of results to practice implementation. Such evidence would improve translation of research to practice, provide additional explanation for variability in intervention outcomes, and provide insights into successful adaptations of interventions to local conditions.

Optimism and Pessimism in Children with Cancer and Healthy Children: Confirmatory Factor Analysis of the Youth Life Orientation Test and Relations with Health-Related Quality of Life

OBJECTIVE To test the measurement equivalence of the Youth Life Orientation Test (YLOT) in children with cancer (N = 199) and healthy controls (N = 108), and to examine optimism and pessimism as predictors of childrens health-related quality of life (HRQL). METHODS Confirmatory factor analysis (CFA) was conducted to establish the two factor structure of the YLOT and to test for metric invariance. RESULTS A two-factor structure for the YLOT was confirmed and found to be stable across our study groups. There were no differences in mean levels of optimism and pessimism between cancer patients and controls after controlling for race/ethnicity. Higher optimism was associated with lower self-reports of pain and better emotional/behavioral functioning, whereas pessimism was related to poorer mental health and general behavior, and greater impact on the family. CONCLUSIONS Optimism and pessimism appear to be differentially related to certain aspects of childrens HRQL, and should be investigated separately in relation to these outcomes.

Relation of Caregiver Alcohol Use to Unintentional Childhood Injury

OBJECTIVE The present study used a case-crossover design to investigate the association of caregiver alcohol consumption and supervision to childrens injury occurrence and severity. METHOD A community sample of 170 mothers of toddlers was interviewed biweekly about their childrens daily injuries for a period of 6 months. RESULTS Proximal caregiver-reported alcohol use predicted higher likelihood of injury occurrence and higher injury severity, whereas caregiver-reported supervision predicted lower likelihood of injury occurrence and lower injury severity. CONCLUSION Even at low levels, proximal caregiver alcohol use may contribute to higher risk for childhood injuries and more severe injuries. The combined effect of supervision and drinking on injury likelihood warrants further exploration.

Methods and baseline characteristics of a randomized trial treating early childhood obesity: The Positive Lifestyles for Active Youngsters (Team PLAY) trial

There are few effective obesity interventions directed towards younger children, particularly young minority children. This paper describes the design, intervention, recruitment methods, and baseline data of the ongoing Positive Lifestyles for Active Youngsters (Team PLAY) study. This randomized controlled trial is designed to test the efficacy of a 6-month, moderately intense, primary care feasible, family-based behavioral intervention, targeting both young children and their parent, in promoting healthy weight change. Participants are 270 overweight and obese children (ages 4 to 7 years) and their parents, who were recruited from a primarily African American urban population. Parents and children were instructed in proven cognitive behavioral techniques (e.g. goal setting, self-talk, stimulus control and reinforcement) designed to encourage healthier food choices (more whole grains, fruits and vegetables, and less concentrated fats and sugar), reduce portion sizes, decrease sweetened beverages and increase moderate to vigorous physical activity engagement. The main outcome of this study is change in BMI at two year post enrollment. Recruitment using reactive methods (mailings, TV ads, pamphlets) was found to be more successful than using only a proactive approach (referral through physicians). At baseline, most children were very obese with an average BMI z-score of 2.6. Reported intake of fruits and vegetables and minutes of moderate to vigorous physical activity engagement did not meet national recommendations. If efficacious, Team PLAY would offer a model for obesity treatment directed at families with young children that could be tested and translated to both community and primary care settings.

Subjective Distress and Emotional Resources in Parents of Children With Food Allergy

This study evaluated emotional functioning in parents of children with food allergy and examined child factors as correlates of caregiver adjustment. Questionnaire data regarding parent subjective distress and emotional resources, allergy characteristics, and child behaviors were gathered from 282 caregivers of food-allergic children. Parents reported experiencing mild-to-moderate distress related to guilt and worry, unresolved anger and sorrow, and long-term uncertainty. Greater distress was associated with caring for a younger child and having a child with emotional or behavioral problems. Parents who perceived having more emotional resources endorsed less distress and had children with fewer emotional or behavioral problems.

Body esteem, peer difficulties and perceptions of physical health in overweight and obese urban children aged 5 to 7 years.

OBJECTIVE To determine whether there is an association between body mass index (BMI) and body esteem in young overweight and obese urban children, and to test peer relationship difficulties and perceived physical health as mediators of this relationship. METHODS Child self-reported body esteem, and parent-reported child peer relationship difficulties (being bullied by peers and peer rejection) and physical health perceptions were obtained from 218 overweight and obese children aged 5-7 years (81% racial/ethnic minority, M BMI = 25.3) and their primary caregivers. RESULTS Higher BMI was associated with lower body esteem for both girls and boys. This relation was mediated by poor physical health for boys but not for girls. Peer relationship difficulties did not mediate the observed association between BMI and body esteem in either group; however, girls with higher BMI experienced more bullying and being bullied by peers was associated with lower body esteem in girls. CONCLUSIONS Intervening with perceptions of physical health may buffer overweight and obese boys from developing low body esteem in early childhood.

Parenting children with food allergy: preliminary development of a measure assessing child-rearing behaviors in the context of pediatric food allergy.

BACKGROUND Food allergy affects up to 8% of children and is increasingly common. Although adult caregivers initially assume the primary role in childrens daily allergy management activities, as children approach school age they assume greater responsibility for the prevention of allergic exposures. The ways that parents prepare children for this transition are likely to influence childrens subsequent risk for allergic exposures, yet few studies have examined parent behaviors in the context of pediatric food allergy. OBJECTIVE To develop a brief measure to evaluate specific parenting practices related to caring for a child with food allergy. METHODS A total of 292 primary caregivers of food-allergic children completed an Internet-based survey that included the Parenting Children with Food Allergy (PCFA) questionnaire. RESULTS Factor analysis of the PCFA items suggested 3 factors that accounted for 98% of the variance: autonomy support, protection/monitoring, and emergency education. Internal consistencies for the 3 scales were acceptable (alpha = .79, .73, and .82, respectively). Child age and medical variables (history of emergency epinephrine use, perceived severity of worst allergic reaction, and number of different food allergies) were associated with parenting practices. CONCLUSION Although additional psychometric data for the PCFA are needed, preliminary findings suggest that this measure may be useful in evaluating parenting within the context of pediatric food allergy.

Social Contexts of Infant Feeding and Infant Feeding Decisions

Background: Infant feeding takes place within a network of social relationships. However, the social context in which infant feeding advice is received remains underresearched. Objective: The objective of this study was to evaluate the social contexts of infant feeding by examining individual and relationship characteristics of mothers and network members associated with advice to exclusively breastfeed, exclusively formula feed, or use a combination of breast milk and formula. Methods: Information about 287 network members was reported by 80 low-income mothers during a one-time survey. Characteristics of relationships associated with mothers receiving advice (exclusively breastfeed/formula feed, combination feed) from each network member were identified using 2-level logistic regression analyses. Results: Mothers had greater odds of receiving advice to exclusively breastfeed from network members who help make feeding decisions (odds ratio [OR], 2.44; 95% confidence interval [CI], 1.35-4.42), exclusively breastfed their own child or children (OR, 6.99; 95% CI, 2.96-16.51), and were health care providers (OR, 4.82; 95% CI, 1.70-13.67). Mothers had greater odds of receiving advice to breastfeed in combination with formula from network members who provided emotional support (OR, 2.45; 95% CI, 1.31-4.55), combination fed their own child or children (OR, 4.85; 95% CI, 1.80-13.05), and had an opinion that was important to the mother (OR, 2.67; 95% CI, 1.13-6.33). Mothers had greater odds of receiving advice to exclusively formula feed from network members who exclusively formula fed their own child or children (OR, 2.23; 95% CI, 1.07-4.66) than those who did not. Conclusion: Social relationship characteristics and network members’ infant feeding experiences may have implications for the advice new mothers receive. Future research should investigate social contexts of infant feeding longitudinally to inform interventions.