Purpose:

To explore summertime changes in children’s health and wellbeing using a holistic lens. This is the first interdisciplinary review that synthesized educational, health, behavioural and psychological research to examine summertime changes in academic, health, and wellbeing outcomes and the role of disadvantage. The research questions were:

1.     What are the geographical and historical trends in the literature?

2.     How do children’s academic, health and wellbeing outcomes change over the summer holidays?

3.     Do these changes differ for disadvantaged children?

Methods:

A scoping review was conducted: six electronic databases were searched for peer-reviewed studies. To be eligible, studies were required to specifically track changes over summer. Data extraction used a standardized template. The PICO elements were:

Population: school aged children and adolescents (five to 18 years old)

Concept: health (health, behaviour, wellbeing) or academic outcomes

Context: specific to the summer holiday period.

Results:

76 studies were included, involving 14,231,111 children. Outcomes were categorized based on summertime change (significant or suggestive decline/increase, or mixed/neutral). Outcomes were also compared against the school term and assessed for disparities related to socioeconomic status or race/ethnicity. Some distinct patterns emerged: academic outcomes, particularly in numeracy, declined over summer with only disadvantaged children showing decline in literacy. Physical health declined over summer, with increases in adiposity and decreases in cardiovascular fitness. Data on muscular fitness, sleep, diet, and mental wellbeing were sparse. For health behaviours, sedentary and screen time increased with mixed patterns in physical activity and a lack of data regarding sleep and diet.

Health behaviours were worse for disadvantaged children and there were sharper declines in academic outcomes. Disadvantaged children seem to be impacted to a greater extent by the change in routine and environment over summer which influences their behaviours.

Summer provides an opportunity to intervene in complex problems like childhood obesity and the inequity in health and achievement outcomes experienced by disadvantaged children. Targeted interventions during summer could mitigate overall declines and address inequity while future research could investigate mental, social and emotional wellbeing.

Background: Children with autism spectrum disorder (ASD) can have strong preferences for processed, energy-dense foods with low nutritional value that can contribute toward obesity. Previous research has reported poorer dietary patterns during summer versus school months in neurotypical children may be a result of reduced access to structured settings where the food and beverages served are restricted. Despite the increased risk of obesity in children with ASD, little is known about dietary patterns during summer versus school months in this population.

Methods: A within-subjects observational study compared dietary patterns during a school month versus a summer month in children with ASD. Dietary patterns over a 14-day period were captured via the Beverage and Snack Questionnaire (BSQ) completed by a caregiver and child at school and summer timepoints. T-tests explored within-subject differences in dietary patterns during school versus summer, and by age and weight-status (between-subjects). Outcomes were expressed as percent of days (%days) for each BSQ item.

Results: Thirteen child/caregiver dyads provided 332 completed daily BSQs (174 summer, 158 school). There were no observed differences in dietary patterns of children with ASD (range 4-to-9 years old, 9 males, 6 race/ethnicity minority, 5 overweight/obese) during school versus summer. Younger children (4-to-5-year-olds) reported consumption of potato chips on 69%days (summer) versus 42%days (school) (p<0.05). Older children (7-to-9-year-olds) reported a higher %days consuming vegetables and orange juice during both summer and school timepoints compared to younger children (p<0.05). Children with ASD and with overweight/obesity consumed salty snacks on +18%days more during summer versus school (p<0.05). During the school months, children with ASD and with overweight/obesity reported higher %days consuming potato chips, salty snacks, and cookies compared to their counterparts (p<0.05). During the summer month, children with ASD with OWOB had higher %days consuming salty snacks and fast food versus their counterparts (p<0.05).

Discussion: Preliminary evidence suggests different dietary patterns among children with ASD during school versus summer months by age and weight status subgroups. Larger studies in diverse samples that incorporate additional measures of diet are needed to further explore dietary patterns of children with ASD.

Background: In the US, children gain 2-3 times more weight during their 3-month summer vacation compared to the entire 9-month school year. Children from low-income households and historically marginalized populations are most susceptible. According to the Structured Days Hypothesis, accelerated BMI gain during the summer may be due to the removal of health-promoting structure, specifically school. During summer, a common form of health-promoting structure are summer day camps (SDC). Summer day camps are predominately fee-for-service, which creates a financial barrier for children from low-income households. One solution to address accelerated BMI gain is providing free access to existing summer programming.

Methods: In summers 2021-2023, we randomized 422 children (8.2±1.5yrs, 48% female, 51% Black, 69% at or below 200% Federal Poverty Level, 30% food insecure) from 7 elementary schools to one of two conditions: summer as usual (control, n=199) or free SDC for 8-10wks (intervention, n=223). The SDC was operated by a local parks and recreation commission and offered every weekday 8AM-5PM (except holidays), provided breakfast, lunch, and snacks, and opportunities for physical activity. Children’s height/weight were measured before school ended (May) and upon return from summer (late August). Intent-to-treat analysis examined changes in BMI z-scores (zBMI) from beginning to end of summer. Dose-response models examined differences in changes in zBMI over the summer as a function of attending any summer program in both invention and control children.

Results: Intent-to-treat analysis indicated children in the control group exhibited increases in zBMI during the summer (+0.04) while children in the intervention group reduced zBMI (-0.05) (group-x-time difference -0.09,
-0.17 to -0.01). Dose response indicated for every one day/week increase in attending SDC resulted in a -0.03 zBMI reduction, for a difference in zBMI between children not attending summer programing vs. children attending summer programming every weekday of -0.17 (-0.27 to -0.7).

Discussion: Policies targeting upstream structural factors, such as universal access to existing community programming, could lead to reductions in accelerated summer BMI gain among children from low-income households. Because these programs can be cost-prohibitive, providing access to SDC could fill an important gap in obesity prevention efforts outside the school year.