Purpose: Physical activity (PA) participation in early childhood is important to shape healthy movement behaviours across the lifespan; therefore, it is essential that PA is promoted from infancy, and that poor health behaviours (e.g., prolonged sedentary time [ST]) are minimized. This review and meta-analysis examined infants’ and toddlers’ movement behaviours across daytime hours. 

Methods: We searched seven electronic databases for terms relating to infants (<12 months), toddlers (12-35.9 months), PA, ST, and accelerometry. A total of 4,873 articles were examined by two independent reviewers for English-language, peer-reviewed original research, that reported infants’ (counts/min) and/or toddlers’ (min/day) accelerometry-measured PA or ST across daytime hours. Mean PA level (counts/min) for infants was calculated across studies, and ranges were produced. Toddlers’ movement behaviour estimates were aggregated meta-analytically to produce mean daily rates; moderating variables (accelerometer placement, cut-point validity, device type, and epoch length) were explored.

Results: Twenty-four articles from 16 countries (published 2011-2019; n = 3,699 participants) were included in the systematic review. Across 5 studies, infants’ mean PA level was 1,494.4 counts/min (range: 78.2 to 2580.5). Across 20 studies, toddlers’ PA (total, light, moderate-to-vigorous) and ST ranged from 72.9 to 636.5, 48.5 to 582.4, 6.5 to 89.9, and 172.7 to 545.0 min/day, respectively. After accounting for moderating variables, meta-analyses showed toddlers engaged in 246.2 min/day (SE = 28.5; 95% CI: 190.3, 302.0) of total PA, 194.1 min/day (SE = 28.8; 95% CI: 137.7, 250.5) of light PA, 60.2 min/day (SE = 5.9; 95% CI: 48.6, 71.7) of moderate-to-vigorous PA, and 337.0 min/day (SE = 32.7; 95% CI: 273.0, 401.1) of ST.

Conclusions: With limited studies conducted in infants, and lack of cut-points and use of body positioning devices to detect tummy time, PA estimates are inconclusive and lack interpretability. Overall, toddlers reported to exceed the total PA guideline (180 min/day); yet, little of this time is spent at higher intensities. Despite high PA rates, toddlers still engage in substantial ST. Consistency in the application of valid measurement protocols is needed to allow for greater comparability across studies.

Purpose: Provide a description of the nutrition environments, including provider nutrition environment, and foods served and consumed in Family Child Care Homes (FCCH).

Methods: FCCH providers (n=51) within a 60-mile radius of Oklahoma City who care for at least one 2-to-5 year old child and participate in the Child and Adult Care Food Program (CACFP) were invited to participate in a randomized matched-attention controlled trial (Happy Healthy Homes).  FCCH observations were conducted over two, non-consecutive days, averaged for analyses. Nutrition environment was scored using a modified Environment Policy and Assessment Observation (i.e. EPAO) for FCCH. Foods served and child dietary intake for 2-to-5 year old children was observed using the dietary observation in child care (DOCC) protocol. Meal kilocalories and MyPlate serving sizes were determined using Food Processor. Variety was quantified by the total number of exposures to food (fruits, vegetable, high sugar and high fat foods, and whole grains) served and consumed over the two visits. Child and Adults Care Food Program (CACFP) requirement and best practice compliance was determined using a measurement index.

 Results/Findings: Providers were 44.2 ± 14.2 years of age, cared for 9.5 ± 4.2 children, and had 1.4 ± 1.4 additional staff. Total nutrition environment score was 11.7 ± 1.2 (max 19). During lunch, children were served 387.0 ± 137.8 kilocalories, and consumed 269.1 ± 124.8 (daily age-and-activity-based recommendation is 1000-1600 kilocalories). Children were served and consumed less than 1/3 of the MyPlate food group recommendations with the exception of dairy. Children were exposed to an average of 1.7 vegetables, 1.3 fruit, 1.3 high fat foods, 0.5 whole grains, and 0.03 high sugar foods during lunch. Providers met more of the requirements (82% of maximum score) component of CACFP compared to the best practices (51% of maximum points) and food preparation methods (45% of maximum score).

Conclusion: While CACFP compliance was high, service of volumes sufficient to meet MyPlate recommendations was low for all food groups, except dairy. Compliance with CACFP best practices was low. Continued efforts are needed to understand the ECE nutrition environment and enhance nutritional quality of foods provided to children.

Purpose: Many preschoolers spend a significant amount of time in child care, an environment that is influential in the early development of sedentary and physical activity behaviours that track across the lifespan. In response to the COVID pandemic, early childhood education and care (ECEC) programs follow government-mandated guidelines to prevent virus transmission. These guidelines include restrictions on access to shared spaces and physical distancing recommendations. The purpose of this study was to explore the impact of COVID guidelines in the ECEC setting on sedentary behaviour, physical activity time, and step count among preschoolers in child care.

Methods: This time-series cross-sectional study compared 238 preschoolers (3-5 years) from licensed child care programs in Alberta, Canada. Data collection occurred pre-COVID in Fall 2019 (N=143, 51.0% female, 4.3 ± 0.7 years) and during COVID in Fall 2020 (N=95, 53.7% female, 4.2 ± 0.7 years). Participants wore ActiGraph GT3X+ accelerometers around the waist for seven ECEC days. A minimum of 250 minutes of wear time per day for a minimum of four days was required for inclusion in the analyses. Sedentary behaviour and total physical activity were identified using Pate cutpoints and independent samples t-tests were conducted to compare pre-COVID and COVID cohorts. 

Results: Children in a child care setting spent significantly more time in sedentary behaviour pre-COVID (322.1 ± 47.2 min per day) than during COVID (290.7 ± 59.2 min per day; p<.001). Step count was also greater during COVID (5506.8 ± 1747.6 steps per day) compared to preschoolers step count pre-COVID (4847.6 ± 1771.8 steps per day; p=.005). Time spent in physical activity pre-COVID (119.3 ± 45.9 min per day) was not statistically different from preschoolers during COVID (120.2 ± 34.4 min per day; p=.868).

Conclusions: During the implementation of COVID guidelines, preschoolers engage in less sedentary behaviour and take more steps compared to pre-COVID levels. These changes may be connected to outdoor activities implemented by ECEC programs in an effort to follow physical distancing recommendations. 

Purpose: Studying physical activity (PA) via accelerometers among toddlers is challenging due to non-compliance with wear time (WT) instructions and parental non-compliance with completing activity logs (ALs). Processing software categorizes low activity counts as “sedentary.” Parent-completed ALs can help correctly categorize low activity counts for sleep and non-WT. The aims of this study are to ascertain 1) patterns of accelerometer and log compliance among participants, 2) whether compliance varies by parent qualities, and 3) whether sedentary time differs by compliance.

Methods: Baseline accelerometer and demographic data from a pilot RCT of a community wellness program for parents with toddlers (12-35 months) was used for a secondary analysis. Parents were instructed to have toddlers wear an Actigraph wGT3x accelerometer (Pensacola, FL) on the hip for 8 consecutive days and to complete ALs. A valid day included >600 minutes WT. The ActiLife6 program parsed raw activity counts into daily activity levels per standard protocol (Butte et al., 2014). Log accuracy scores were based on congruence between ALs and accelerometer counts. Non-parametric analyses examined relationships between variables.

Results: The sample (n=50) comprised toddlers (Mage = 27 months, 58% male) and parents (Mage = 31.7 years, 84% female), who were racially/ethnically diverse. Valid accelerometer data accompanied by ALs was provided by 28 families, whereas 8 returned only valid accelerometer data, 4 returned only ALs, and 10 provided neither. The mean for valid days was 5.02 (SD=3.78). The mean log accuracy score was 2.11 (SD=1.68) out of 4 possible points. On the ALs, 31 parents reported bedtimes, 23 reported naps, and 30 explained other non-WT. Parents with a spouse/partner were more likely to complete ALs (p<.05). Toddler sedentary time did not differ between those with ALs (356 min., SD=60.2) and those without ALs (341 min., SD=89.7).

Conclusions: Toddler and parent compliance with WT instructions and AL completion varied. Returned AL quality was poor with many missing key information to correctly characterize low activity counts. Sedentary time did not differ between toddlers with or without ALs. Research is needed to identify strategies to improve compliance and data quality in studies of early childhood PA.

 

Purpose: A new physical activity and sedentary behaviour accreditation standard for childcare settings was introduced by a provincial government in 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 implementing the new accreditation standard and non-accredited control centres in and around Ottawa, Ontario. Secondary objectives were to examine whether age group (toddler, preschooler) or the childcare environment moderated any group differences in change of the primary outcomes and if changes in children’s body mass index (BMI) Z-scores or cognitive development differed between accreditation and control groups.

Methods: Participants were 252 toddlers (19–35 months) and preschoolers (36–60 months) in Alberta (n=11) and Ontario (n=8) childcare centres from the supporting Healthy physical AcTive Childcare setting (HATCH) study. In-care ST (≤25 counts/15-seconds), light-intensity physical activity (LPA; 26-419 counts/15-seconds), and moderate- to vigorous-intensity physical activity (MVPA; ≥420 counts/15-seconds) were accelerometer–derived before and 6 months after the implementation of the new standard. 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 objectively assessed using the Environment and Policy Assessment and Observation (EPAO) and Movement Environment Rating Scale (MOVERS) tools. Demographic characteristics were measured with the HATCH parent questionnaire 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 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 only observed in the accreditation group and significant increases in expressive vocabulary (B=3.18, 95%CI: 0.05,6.30) were only observed in the control group.

Conclusions: This new accreditation standard did not significantly increase physical activity or decrease ST in childcare settings and therefore may not explain findings for BMI Z-scores and cognitive development. Additional training and resources may be needed.

Purpose. In 2016-17, the provincial government of British Columbia (BC) scaled up a capacity building initiative for early years providers (Appetite to Play (ATP)). The goal of ATP was to enhance the capacity of early years providers to implement policies and practices that supported both physical activity and healthy eating (HE). The purpose of this study was to determine whether the childcare environment changed with regards to HE policies and practices.

Methods. Surveys were conducted prior to (2015-16) and following the delivery of ATP (2018-19). Participants included managers and staff of licensed childcare centers serving children 3–5 years of age across BC. Hierarchical mixed effects models were used to examine change over time in 11 HE policies and 1 HE practice. Models controlled for childcare size and area-level population size, education and income.

Findings. A total of 1,479 respondents from 829 centers were included. Compared to 2015-16, childcare centers in 2018-19 had higher odds of having a written HE policies related to: providing HE education (OR: 2.6, 95% CI: 1.7,4.1), HE training for staff (OR: 1.9, 95% CI: 1.1,3.1), encouraging children to try new foods (OR: 1.8, 95% CI: 1.2,2.8), serving family-style meals (OR: 2.3, 95% CI: 1.3, 4.0), offering water or milk (OR: 2.2, 95% CI: 1.4, 3.5), types of milk served (OR: 2.0, 95% CI: 1.2, 3.5), amount of fruit juice offered (OR: 2.6, 95% CI: 1.6, 4.4), staff role modeling of HE (OR: 3.1, 95% CI: 1.7, 5.9), including fruit and/or vegetables during meals and snacks (OR: 2.6, 95% CI: 1.6, 4.4), types of foods at parties (OR: 2.0, 95% CI: 1.3, 3.0) and types of foods brought from home (OR: 4.5, 95% CI: 2.9, 5.9). There was no change in staff behaviours related to checking the healthiness of foods packed in lunch boxes.   

Conclusions. Substantial changes were observed over a 2-year period across all HE policies during the period of implementation support with ATP. The extent to which implementation of the ATP intervention led to improvements in dietary practices needs further exploration.