Poor sleep is increasingly common in children and associated with poor health outcomes, including childhood obesity; suggesting the importance of caregivers establishing healthy sleep hygiene routines early in life. However, sleep and eating behavior likely interact and influence each other to impact health outcomes, with increasing evidence linking sleep duration and dietary quality. Since less is known about these associations in infancy and early childhood, we aimed to evaluate the cross-sectional association between food parenting behaviors and sleep in children 0-26months. We evaluated parent responses (n=10523) to the Early Healthy Lifestyles (EHL) questionnaire completed during Geisinger pediatric care between 2016-2020. Data were categorized by child age in months (mo.): <6 (n=3385), 6-11 (n=2241), 12-17 (n=2278), and 18+ (n=2619). Within each age group, chi-square tests were used to compare food parenting EHL responses (e.g., breastmilk use, consuming higher sugar or higher fat foods, using food to soothe, and pressure to finish bottles/snacks/meals) to sleep parenting behaviors (e.g., bedtime after 8pm [“late bedtime”]; frequent night wakening [2+ times]; and feeding child when wakes at night [“night feeding”]. Significant associations with P-values <0.05 are reported.

On average, 63% of parents indicated, ‘yes’ to late bedtime after 8pm; 32% indicated their child wakes frequently at night; and 43% indicated feeding their child when they wake at night. At all time points, the use of breastmilk and parent use of food to soothe displayed associations with frequent night wakening and night feeding. Parental pressure to finish foods was associated with frequent night wakening only in <6mo and 18+mo. Lastly, high consumption of sugary foods (except <6mo) and pressure to finish foods (except 6-11mo) was associated with late bedtime.

These results reveal a consistent association between feeding and sleep measures across a population of children aged 0-26months. Notably, the use of breastmilk and using food to soothe were two items consistently associated with sleep measures across all ages.  Recent studies suggest eating behaviors may mediate sleep-obesity associations that develop in late-childhood, and as such, the EHL tool may be a useful screener for tailored anticipatory guidance to improve sleep in infancy and childhood.

Purpose: Children from low-income households experience increased food insecurity during summer months when school-based nutrition assistance programs are not readily available. This systematic review aimed to a) characterize current community-based child summer nutrition assistance programs and b) examine their effects on children’s nutrition-related outcomes, including food insecurity, diet quality, body mass index (BMI) and percent body fat (BF), to guide program improvements to maximize desired effects on children’s summer nutrition-related outcomes.

Methods: CINAHL, ERIC, Ovid Medline and Scopus databases were searched using terms, including “summer,” “out of school,” “food,” “nutrition,” “meal,” “lunch” or “insecurity,” and 659 English manuscripts published since 2000 were identified. Three independent reviewers assessed abstracts and full-texts and 14 manuscripts met the following eligibility criteria: studies evaluated effects of a summer program with a nutrition assistance component on children’s nutrition-related outcomes. 

Results/findings: Among the 14 studies, 57% to 79% focused on 6- to 12-year-old children, and 86% reported children were from low-income households. The 14 studies were classified into the following intervention types: food, physical activity and behavioral education (43%), food only (29%), food and physical activity (21%), or a monthly payment ($60/child) for food purchases (7%). Regardless of intervention type, most studies reported on diet quality (n=7 of 14). BMI or BF were only assessed by programs with physical activity (n=7 of 9). Only three studies assessed food insecurity. Of the studies that assessed these outcomes, 70% reported an improvement in diet quality, and 100% and 29% reported a reduction in food insecurity and BMI, respectively. However, these outcome measures varied in type and only three studies employed a randomized controlled trial design, the gold standard in the field.

Conclusion: Child summer nutrition assistance programs offer a variety of services, including meals, physical activities and nutrition education. Our review findings are promising and suggest programs may improve children’s diet quality and reduce food insecurity among 6- to 12-year-old children from low-income households. However, their effect on reducing BMI/BF was minimal. Further studies with more rigorous design are needed to confirm the findings and evaluate if multi-component programs are critical to improve children’s summer nutritional-related outcomes.

Purpose: Children’s (5-12 years) engagement in movement behavior (sedentary, physical activity, and sleep) is related to obesity risk and may vary seasonally. Past systematic reviews of these variations were conducted nearly a decade ago neglected to examine seasonal changes in children’s sleep behaviors, and failed to account for the presence or absence of the school day during measurement periods. The purpose of this systematic review and meta-analysis is to summarize current literature on the seasonal variation in movement behaviors in children.

Methods: This review was guided and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analyses checklist. PubMed, PsycInfo, Web of Science and Embase were searched for relevant studies. To be included studies had to (1) measure children and (2) include outcomes related to sedentary behaviors physical activity, and/or sleep during at least two meteorological seasons.

Results/findings: A total 18,542 articles were identified, 8,567 articles were screened after removing duplicates, and 300 full-text studies were reviewed. Movement behaviors were extracted from 47 studies (n=27,093 participants). Most studies were conducted in Europe (k=23) and North America (k=18). Most studies measured physical activity or sedentary behaviors only (k=40) while 5 studies measured sleep only, and 2 studies measured sleep and physical activity or sedentary behaviors. The most measured season was spring (k=40) 20 studies measured 2 seasons only, 14 studies measured 3 seasons, and 13 studies measured all 4 seasons. Children were consistently the most active and least sedentary during spring when compared to fall, winter, or summer.  Findings for sleep were mixed between seasons. Compared to other seasons a pattern emerged where sedentary behaviors were higher and physical activity was lower during the months of summer, but only when school was not in session.

Conclusions: Children’s movement behaviors fluctuate seasonally and thus, interventions need to be designed to target behaviors during the times when children’s behaviors are the least healthy, specifically during the summer (when children are not in school) and winter. A paucity of sleep studies stops the current literature from disentangling seasonal variation in sleep from variation due to changing exposure to structured days.

Purpose: The structured days hypothesis posits that ‘structured days’ (i.e., days with pre-planned, segmented, and adult-supervised compulsory environments) protect children (6-11 years) from engagement in obesogenic behaviors (i.e., physical activity, diet, screen time, and/or sleep). Adolescence (12-19 years) is a critical time for the development of obesogenic behaviors as it is a period of developmental milestones and increased autonomy. Thus, structured days may be especially important for adolescents’ health behaviors. Therefore, the objective of this systematic review and meta-analysis is to examine adolescents’ obesogenic behaviors on relatively more and less structured days.

Methods: This systematic review and meta-analysis was registered prospectively in PROSPERO (registration number: CRD42020169008) and was guided and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analyses checklist. Embase, PubMed, Web of Science, and PsychINfo were systematically searched for cross-sectional, longitudinal, and intervention (i.e., baseline data only) studies that included one or more obesogenic behavior – on more structured days versus less structured days (i.e., weekday versus weekend or school year versus summer/holiday) in adolescents (12-19 years).

Results/findings: Titles and abstracts (k=42,878) were screened with 2,767 full-text articles retrieved. After review of full-text articles, 296 studies were identified (sleep k=147, physical activity k=88, screen time k=81, diet k=8). Most studies were conducted in North America, Europe & Central Asia, or East Asia & the Pacific, used self-report measures, and compared school weekdays to weekend days. Meta analyses indicated that adolescents’ physical activity was lower (standardized mean difference [SMD]=-0.25 [95%CI −0.48, −0.03]) and screen time was higher (SMD=-0.48 [95%CI −0.66, −0.29]) on less structured days (e.g., weekend days). Differences did not reach statistical significance for sleep (SMD=-0.23 [95%CI −0.48, 0.02]) and diet (SMD=-0.13 [95%CI −0.77, 0.51]), however sleep timing (SMD=-1.05 [95%CI −1.31, -0.79]) and diet quantity (SMD=-0.29 [95%CI −0.35, -0.23]) were less healthy on less structured days.

Conclusions: Findings aligned with the SDH and indicate that adolescents’ obesogenic behaviors are less healthy on less structured days. Interventions to prevent and treat obesity in adolescents may be more successful if they are designed to target times that are less structured.

Purpose: There is limited data on the lifestyle behaviours of school-aged children in Singapore. To bridge this gap, we evaluated adherence to 24-hour movement guidelines and the correlates of this among children from a Singapore mother-offspring cohort.

Methods: My E-Diary for Activities and Lifestyle (MEDAL) is a validated, web-based lifestyle diary. Children aged 10 years in the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study self-reported their daily activities on MEDAL over two weekdays and two weekend days. Median (interquartile range) daily moderate-to-vigorous physical activity (MVPA), screen-viewing and sleep duration were calculated. Adherence to the Canadian/Australian 24-hour movement guidelines was defined as: ≥60min MVPA/day, ≤2h screen-viewing/day, and 9–11h sleep/night. Socio-demographic variables were examined for potential associations with guideline adherence using multivariable logistic regression.

Results/findings: Of 600 children, 369 children (61.5%) recorded at least two valid weekdays and one valid weekend day on MEDAL. The children engaged in 40.7 (16.4–81.8) minutes of MVPA, 3.8 (1.9–6.0) hours of screen-viewing and 10.0 (8.9–11.9) hours of night-time sleep per day. Only 36.3%, 27.4% and 36.0% met MVPA, screen-viewing and sleep guidelines respectively; 5.1% met all three guidelines; and 32.8% did not meet any guideline. Children of Chinese ethnicity were less likely to meet the MVPA guideline, while children of Malay ethnicity and whose mothers were of low (primary/secondary) educational level were less likely to meet the screen-viewing guideline. Children of mothers with post-secondary education and from low household income were less likely to meet the sleep guideline. Girls were more likely to exceed recommended sleep duration. Children who did not meet the screen viewing guideline were less likely to meet the MVPA guideline and were more likely to exceed the recommended sleep duration.

Conclusions: Most children did not meet the 24-hour movement guidelines, putting them at risk of poor outcomes. Our findings suggest that some groups are less likely to meet the guidelines, warranting targeted interventions. Future interventions that promote adequate screen-viewing may also benefit MVPA and vice versa, however additional strategies may be required to promote adequate sleep among children of this age.

Purpose: Research suggests that a positive feedback loop exists, in which youth with greater levels of physical activity, develop better motor competence, leading to further increases in PA engagement. However, very little evidence has been provided on the reallocation of time between physical activity and other activity behaviours, and the effect on motor competence. The study aimed to examine the cross-sectional associations between 24-hour activity compositions and motor competence in children and adolescents, while stratifying by sex and school type, and investigate the predicted differences in motor competence when time was reallocated between activity behaviours.

Methods: Data were collected from 359 participants (aged 11.5±1.4 years; 49.3% boys; 96.9% White British).  Seven-day 24-hour activity behaviours (sleep, sedentary time, light physical activity (LPA), moderate-to-vigorous physical activity (MVPA)) were assessed using wrist-worn accelerometers. Motor competence outcomes were obtained using the Dragon Challenge (process, product, time, and overall scores). Linear mixed models examined associations between activity behaviour compositions and motor competence outcomes for all participants and stratified by school type (primary or secondary) and sex. Post-hoc analyses modelled the influence of reallocating fixed durations of time between activity behaviours on outcomes.

Results: In all participants, relative to other activity behaviours, MVPA had the strongest associations with motor competence outcomes and time reallocations to MVPA from any of the other three behaviours was associated with higher overall, process, and time scores (Effect Size (ES) ranged from 0.05–0.07 (5min) and 0.19–0.27 (20min)). The stratified models displayed that MVPA had the strongest associations with outcomes in both sexes, irrespective of school type. The largest positive and negative predicted differences occurred when MVPA replaced LPA or sleep (ES ranged from 0.04–0.10 (5min) and 0.14–0.39 (20min)), and when LPA or sleep replaced MVPA (ES ranged from -0.03–-0.11 (5min) and -0.13–-0.54 (20min)), respectively.

Conclusions: Relative to other activity behaviours, MVPA appears to have the greatest influence overall on motor competence outcomes. Reallocating time from LPA or sleep to MVPA reflected the largest positive predicted changes in motor competence outcomes. Therefore, our findings reinforce the key role of MVPA for children’s and adolescents’ motor competence.