Prevent/Weight Gain/Infancy/Healthy Eating/Sleeping

这项研究将测试两种干预措施的效果，旨在促进生命最初两年的健康饮食和睡眠行为。访问护士将在家庭环境中对父母进行两个程序的培训。这些程序旨在防止婴儿期睡眠时间短和体重增加加速，这是儿童和成年期肥胖的两个新风险因素。目前，2至5岁的儿童中有20-25%已经超重或有超重的风险，因此需要采取干预措施，重点关注至关重要的婴儿。由于幼儿超重的患病率持续上升，因此需要一级预防干预措施：1）在肥胖开始之前中断肥胖的自然史，2）易于重现，3）可以应用于导致肥胖的许多行为起源的家庭环境。有证据表明，长时间的母乳喂养和长时间的睡眠是儿童肥胖的保护因素。此外，研究表明，婴儿对新食物的恐惧反应可以减少，接受新食物，并有机会反复尝试新食物。父母如何处理新恐惧症是决定孩子是否会学会接受一系列健康食物的关键，特别是低能量密度和高营养的食物，如水果和蔬菜。这些食物的充足摄入量与幼儿体重增加缓慢和体重状况较低有关。参与者将被随机分配接受两种、一种或两种可能的干预措施，由地区家庭健康机构的访问护士在家庭环境中提供。首先，将使用简单的父母培训程序，教导婴儿在8周龄时整夜睡眠，包括睡前“集中喂养”，将喂养替代品作为婴儿醒来和痛苦的第一选择，并构建家庭环境以强调日/夜差异。第二个干预措施，将教父母如何帮助婴儿学会接受新的，健康的食物，使用重复的接触。为了衡量这些干预措施的影响，将评估出生至2年之间的年龄别体重z评分、夜间觉醒和饮食摄入的变化，并在2年时确定BMI。将进行生物电阻抗分析和肥胖相关生物标志物的实验室评价。在研究期结束时还将进行一项夜间多导睡眠图研究，以评估该队列的睡眠特征。

This research will test the effects of two interventions designed to promote healthy eating and sleeping behaviors in the first two years of life. Parents will be trained in two procedures in the home environment by visiting nurses. The procedures are designed to prevent short sleep duration and accelerated weight gain during infancy, two emerging risk factors for obesity in childhood and adulthood. Currently, between 20-25% of children aged 2 to 5 years are already overweight or at-risk for overweight making interventions that focus on infants of critical importance. Because the prevalence of overweight in young children continues to rise, primary preventive interventions are needed that 1) interrupt the natural history of obesity before it starts, 2) are easily reproducible, and 3) can be applied in the home environment where many of the behaviors that lead to obesity originate. There is evidence that prolonged breastfeeding and long sleep duration are protective factors for childhood obesity. Additionally, research has shown that the infant's neophobic response to new foods can be reduced, and new foods accepted, with repeated opportunities to try new foods. How parents deal with neophobia is crucial in determining whether the child will learn to accept a range of healthy foods, particularly foods low in energy density and high in nutrients, such as fruits and vegetables. Adequate intakes of these foods are associated with slower weight gain and lower weight status among toddlers. Participants will be randomized to receive both, one, or none of two possible interventions, delivered in the home setting by visiting nurses from a regional home health agency. First, infants will be taught to sleep through the night by 8 weeks of age using simple training procedures for parents, involving "focal feedings" before bedtime, alternatives to feeding as the first alternative to infant waking and distress, and structuring the home environment to emphasize day/night differences. The second intervention, will teach parents how to help infants learn to accept new, healthy foods, using repeated exposure. To measure the impact of these interventions, change in weight-for-age z scores, night waking, and dietary intake will be assessed between birth and 2 y, and BMI will be determined at 2 y. Bioelectric impedance analysis and a laboratory evaluation for biomarkers related to obesity will be performed. An overnight polysomnographic study will also be performed at the end of the study period to assess sleep characteristics in this cohort.