Background: The World Health Organization (WHO) recommend tummy time for infants due to the benefits of improved motor development and reduced likelihood of plagiocephaly. Due to the poor uptake of these recommendations, a comprehensive analysis regarding additional benefits and/or the association of tummy time with other health outcomes is required. Further understanding the effects of tummy time on infant health and development may assist to improve compliance with the WHO tummy time recommendations of 30-minutes per day.

Objective: To review existing evidence regarding the association of tummy time with a broad and specific range of infant health outcomes.

Methods: Electronic databases were searched between June 2018 and April 2019. Peer-reviewed, English language articles were included if they investigated a population of healthy infants (birth to 12 months), used an observational or experimental study design containing an objective or subjective measure of tummy time which examined the association with a health outcome (adiposity, motor development, psychosocial health, cognitive development, fitness, cardiometabolic health or risks/harms). Two reviewers independently extracted data and assessed their quality.

Results: Sixteen articles representing 4237 participants from 8 countries were included. Tummy time was positively associated with gross motor and total development, reduction in BMI-z, prevention of brachycephaly and the ability to move while prone, supine, crawling and rolling. An indeterminate association was found for social and cognitive domains, plagiocephaly, walking, standing and sitting. No association was found for fine motor development and communication. Most studies were observational in design and lack the robustness of a randomized controlled trial. High selection and performance bias were also present. This review also highlighted that further work is required regarding the objective measurement of tummy time rather than relying on parent-proxy questionnaires.

Conclusions: These findings guide the prioritization of interventions aimed to assist infants meet the global and national physical activity guidelines. Results from this review can be used to educate parents, educators and clinicians about the additional benefits of tummy time.

Purpose: Quality of early childhood education and care (ECEC) is important for children’s outcomes. To date, quality has largely been measured in the cognitive and socio-emotional domains of child development. The Movement Environment Rating Scale (MOVERS) was recently developed to assess quality in the physical domain. The aim of this study was to determine validity and reliability of MOVERS.

Methods: Data were collected from 13 ECEC setting. Quality was assessed in the 3-5-year-old room using MOVERS, the Sustained Shared Thinking and Emotional Well-being (SSTEW) scale and the Environment Policy Assessment and Observation (EPAO). Children’s gross motor skills were assessed using the Test of Gross Motor Development 2nd edition (TGMD-2). Children’s fine motor skills were assessed using the Ages & Stages Questionnaire 3rd edition (ASQ-3). MOVERS test-retest reliability was calculated using ICCs, percentage agreement and weighted Kappa. Internal consistency was examined using Cronbach’s alpha. To examine concurrent validity between MOVERS, SSTEW and EPAO, correlation coefficients were calculated. Multi-level regression analyses were conducted to examine the criterion validity related to child outcomes associations (TGMD-2, ASQ-3) with MOVERS.

Results: Test-retest reliability revealed excellent reliability of MOVERS (ICC=0.959; p<0.0001; Weighted Kappa 0.904; p<0.0001; percentage agreement: 69% - 100%). Cronbach’s alpha analyses indicated excellent internal consistency of the scale (a=0.90 first observations, a=0.89 second observations). There were a large number of statistically significant correlations between the MOVERS and the SSTEW (Spearman’s rho 0.57 – 0.87, p < 0.05). Generalized linear mixed models showed a strong relationship between Item 4 of MOVERS (Body movement to support fine motor skills) and ASQ-3. However, the relationship between Item 3 (Gross motor skills) of the MOVERS and TGMD-2 was not statistically significant.

Conclusion: This is the first study to report on the validity and reliability of the MOVERS scale. Despite the small sample size, the results revealed excellent test-retest reliability and excellent internal consistency of the MOVERS scale. Finding relevant tests to evaluate concurrent validity of the MOVERS was challenging due to MOVERS innovative focus on assessing both structural and process quality rather than just process quality.

Purpose:

Preschool children spend a significant amount of their time in the childcare centre environment, however studies of the childcare physical environmental influences on preschool children’s physical activity behaviours are sparse and limited by the lack of use of device measured physical activity and objectively measured physical environment data. The use of device measured physical activity and spatial data can provide objective information on how spaces are used and the types of physical activity preschool children do in the child care outdoor environment. This study aims to investigate where preschool children are most and least active in the childcare outdoor environments using device measured physical activity and objectively measured physical environment data.

Methods:

Participants included 403 preschool children aged 2-5 years from 31 childcare centres taking part in the part in the Play Spaces & Environments for Children's Physical Activity (PLAYCE) Study in Perth, Western Australia. Participant wore an accelerometer (Actigraph GT3X) and a Global Positioning System (GPS) device (Qstarz Q-1000XT) on for7 days. Optimized hot-spot analysis was performed using ArcGISpro to identify the statistically significant spatial clusters of GPS points with high or low physical activity levels in every childcare centre.

Results:

Clusters of hotspots were found to be gathered in childcare open areas (20 out of 30 childcare centres) and around sand boxes next to an open space or large play equipment. Dramatic play areas were associated with a mix of hotspot and coldspot. Gardens were associated with coldspots for activity. Preliminary finding shows that childcare outdoor areas are used differently by boys and girls.

Conclusions: 

children attending childcare centres were most active in open areas and around sandboxes that were next to an open area or large play equipment. Only light intensity physical activity behaviours were seen around gardens. Both vigorous and light intensity physical activity behaviours were seen in dramatic play areas in childcare centres. These finding provide preliminary evidence to help identify where preschool children are physically active or inactive in the childcare environment, and will help to inform the planning, design, building of childcare centres that are sensitive to children’s needs.

Purpose: Physical activity is integral to children’s health and wellbeing. Many children attend Early Childhood Education and Care (ECEC), and these environments afford the contexts to support children to be physically active, however, children are not meeting the recommended guidelines for PA while in ECEC. Children’s physical activity and sedentary behaviour in ECEC settings is influenced by a number of factors. The purpose of this study was to examine three less-studied environmental factors on children’s physical activity and sedentary behaviour in ECEC– routine, size of the outdoor environment and time spent in the outdoor environment.

Method: A cross-sectional study (n=490, aged 2-5y, 11 ECECs) was completed. ECEC routine, size of the outdoor environment and time spent in the outdoor environment were calculated for each centre. Children’s physical activity and sedentary behaviour was measured using accelerometers. A multivariate linear regression analysis examined associations of the attributes of ECEC centres (routine, time outdoors, and size of outdoor environment) with the outcome variables, adjusting for the effects of centre clustering and gender.

Results: Children in centres that offered free routines spent significantly less time in sedentary behaviour (SB) (28.27mins/hr vs 33.15mins/hr; p=0.001) and more time in total physical activity (TPA) (7.99mins/hr vs 6.57mins/hr; p=0.008) and moderate- to vigorous- activity (MVPA) (9.49mins/hr vs 7.31 mins/hr; p=0.008) than centres with structured routines. Children in centres with an outdoor environment greater than 400m² spent significantly less time in sedentary behaviour (28.94 min/hr vs 32.42 mins/hr; p=0.012). Although not significant, children in centres that offered >4h outdoor time spent less time in SB (29.12mins/hr vs 32.65mins/hr) and more time in TPA (16.79mins/hr vs 14.39mins/hr) than those that offered less outdoor time.

Conclusion: Modifiable practices such as offering a free routine, increasing the time spent in outdoor environments and managing the available space effectively could potentially offer an easy and sustainable way for ECEC to promote physical activity and reduce sedentary behaviour.

Purpose: The first five years of life are characterized by significant brain development that is critical for cognitive development. Sedentary behaviour and physical activity are important considerations for optimal cognitive development. Few studies have examined whether patterns of these behaviours (i.e., sedentary and physical activity bouts, and sedentary breaks) change across early childhood and none have examined whether these are longitudinally associated with cognitive outcomes. The current study examined: 1) changes in total duration and patterns of sedentary time and physical activity across three time-points, and 2) longitudinal associations of sedentary time and physical activity durations and patterns with cognitive development.

Methods: This longitudinal study included 100 participants aged 2-5 years from Edmonton, Canada, at baseline (2015-16). Participants wore ActiGraph accelerometers at baseline and 6- and 12-month follow-ups. Sedentary time, light- (LPA), and moderate-to-vigorous-intensity physical activity (MVPA) duration and patterns (time spent in a range of bouts [1-3 to ≥10 min] and sedentary breaks) were calculated. Participants also completed response inhibition (Fish-Shark Go/No-Go), working memory (Nebraska Barnyard) and global cognitive ability (Woodcock-Johnson III) measures at 2 or 3 time-points. Multilevel growth modelling was used to examine sedentary and physical activity changes and their longitudinal associations with cognitive outcomes.

Results: Sedentary time decreased (β [95% CI]=-9.24 [-15.76, -2.72]; intercept=75.72 min), whereas MVPA duration increased (5.65 [1.89, 9.41]; 362.14) with age. There was also a significant decrease in time spent in ≥10-min sedentary bouts (-9.76 [-13.56, -5.96]; 71.56) and significant increases in sedentary breaks (13.41 [7.18, 19.63]; 251.34), and time spent in 1-3-min (2.56 [0.96, 4.15]; 16.82) and 3-5-min (0.86 [0.33, 1.38]; 3.57) MVPA bouts. There was minimal evidence of longitudinal associations with cognitive outcomes.

Conclusions: The observed changes in sedentary time and MVPA are promising for child health. Nevertheless, these were unrelated to cognitive outcomes. Future studies with larger sample sizes should investigate whether specific types of activities are associated with cognitive development over time and establish whether or not these can be changed through interventions.

Purpose: Young children are recommended to spend more time outdoors for health benefits, particularly in developed countries. However, increasing levels of climate change induced air pollution and safety concerns may influence children's outdoor time. The objectives of this study were to examine 1) longitudinal associations between air pollution, neighbourhood/traffic safety, and outdoor time and 2) how outdoor time tracks over 4 years during early childhood.

Methods: A birth cohort that participated in the Panel Study of Korean Children (PSKC) (N=2,150) in Years 2010-2014 (ages 2-6 years) were included. Trained staff visited each participating household and the PSKC questionnaire was completed by the primary caregiver each year. in addition to outdoor time and neighbourhood and traffic safety variables, five air pollutants (Particulate Matter [PM] 10, Ozone (O3), Carbon monoxide [CO], Nitrogen Dioxide [NO2], and Sulfur dioxide [SO2]) from the Air Korea were used. Child's age and gender, household income, and parental education were included as covariates. Generalized linear mixed models were conducted with gamma distribution because outdoor time was skewed positively. Tracking coefficients for outdoor time across three time points were also calculated.

Results: Of 1,802 children who participated in the PSKC at age 2 (retention rate: 84%), 1,451 children who had complete data on key variables in all three time points were included in the analysis. On average, children spent 34, 55, and 49 min/day outdoors at age 2, 4, and 6, respectively (no significant gender differences observed). Over time, Low CO (b = 0.119, p < 0.001) and O3 (b = 0.066, p = 0.017) levels and safe neighbourhood (b = 0.081, p = 0.026) predicted higher outdoor time. Outdoor time at age 2 significantly tracked at low levels at age 4 (b = 0.09; p = 0.001) but not at age 6 (b = 0.05; p = 0.101).­­­­­

Conclusions: This study identified air quality and neighbourhood safety as potential key correlates of time spent outdoors across early childhood. Strategies to promote outdoor time among young children could consider climate change-related air pollution levels and neighbourhood safety in South Korea.

Purpose: The early childhood education and care (ECEC) environment has a significant role to play in the promotion of physical activity and reduction of sedentary behaviour in young children. Educators’ physical activity and sedentary behaviours maybe an important social factor influencing children’s physical activity and sedentary behaviour, however limited evidence exists on this relationship. The primary aim was to examine the relationships between educators’ physical activity and sedentary behaviours and children’s physical activity and sedentary behaviour within ECEC settings.

Methods: A cross sectional study, involving 11 ECEC centres from NSW, Australia. Data for each centre were collected over five consecutive days. Objectively measured physical activity and sedentary behaviour were collected from children using Actigraph accelerometers. Data were analysed using STATA 13c. Linear regression was used to examine relationships between children and educators, adjusted for centre clustering.

Results: Data were collected from 110 educators and 490 children. A significant association was reported between educators’ sedentary behaviour and children’s sedentary behaviour (p=0.047). Educators spent 61% of their work day in sedentary behaviour sedentary behaviour and 4% in moderate- to vigorous-intensity physical activity. Children spent 48% of their day in sedentary behaviour and 16% in moderate- to vigorous-intensity physical activity.

Conclusions: The relationship between educators’ physical activity and children’s physical activity has received limited attention in previous studies. Furthermore, no studies have investigated the relationship between educators’ sedentary behaviour and children’s sedentary behaviour. The positive relationship identified between educators’ sedentary behaviours and children’s sedentary behaviour in this study highlights a novel area to target in future interventions. Improving physical activity and sedentary behaviours of educators will likely improve children physical activity levels and reduce time spent being sedentary and thus health and wellbeing outcomes.