Preventing obesity in infants and toddlers in child care

描述(申请人提供)：预防儿童肥胖的需要延伸到我们最小的孩子。在生命的最初几年，肥胖和体重过度增加与儿童时期的高血压、反复喘息、较高的住院率和其他不利的身体和心理社会健康状况独立相关。因此，需要有效的方法来预防儿童早期肥胖。由于近三分之二的六岁以下美国儿童经常在户外接受照顾，有组织的儿童护理是预防肥胖的重要环境。然而，很少有干预措施将重点放在儿童保育上，更少的干预措施针对的是托儿所中的幼儿。这项拟议的研究是一项新的干预措施，既针对儿童护理中心、家庭的环境，也针对儿童与其护理提供者之间发生的互动。这项研究的主要目的是评估为期六个月的干预措施在改善儿童保育中心的营养和身体活动环境方面的效果，这些托儿中心为从出生到两岁的种族和民族多样化的儿童和家庭提供服务。这项研究将是一项随机对照试验，有640名儿童在北卡罗来纳州的80个托儿中心接受治疗。重点将放在中心政策、提供者和父母的做法，以及影响饮食摄入和体力活动的儿童家庭环境上。干预措施将包括四个相辅相成和相辅相成的部分：(1)中心自我评估；(2)由保健专业人员为提供者和家长提供有针对性的技术援助和指导；(3)对儿童保育提供者的培训；以及(4)家长外联和支持。随机分配到对照组的中心将在干预结束时获得干预材料和简短的技术援助。这项研究的结果包括儿童饮食摄入量、体力活动和两种肥胖症测量方法：身长体重和皮肤褶皱厚度。托儿中心和儿童的家庭环境也将被测量，以评估他们对健康行为的支持程度。这项研究的结果将提供有关儿童保育中心和家庭内的营养和体力活动政策和做法的新信息。研究结果还将为改善儿童保育系统和帮助预防幼儿肥胖的政策努力提供参考。

DESCRIPTION (provided by applicant): The need to prevent childhood obesity extends down to our youngest children. Obesity and excessive weight gain in the first few years of life are independently associated with higher blood pressure, recurrent wheezing, higher hospital admission rates, and other adverse physical and psychosocial health conditions in childhood. Thus, effective approaches to prevent obesity in early childhood are needed. Because nearly two-thirds of U.S. children under six years of age are routinely cared for outside of the home, organized child care is an important setting for obesity prevention. Few interventions, however, have focused on child care, and even fewer have targeted very young children in care. The proposed study is a novel intervention targeting both the environment of the child care center, the family home, and the interactions that take place between children and their care providers. The primary aim of this study is to evaluate the efficacy of a six-month-long intervention in improving the nutrition and physical activity environments of child care centers serving racially and ethnically diverse children from birth to two years of age and the family home. The study will be a randomized controlled trial with 640 children attending 80 child care centers in North Carolina. The focus will be on center policies, provider and parent practices, and children's home environments that influence dietary intake and physical activity. The intervention will include four complementary and mutually reinforcing components: (1) center self-assessment; (2) targeted technical assistance and guidance by a health professional for providers and parents; (3) training for child care providers; and (4) parent outreach and support. Centers randomized to the control arm will receive intervention materials and abbreviated technical assistance at the end of the intervention. Outcomes for this study include child dietary intake, physical activity, and two adiposity measures: weight-for-length and skin fold thicknesses. Child care centers and children's home environments will also be measured to evaluate how well they support healthy behaviors. Results of this study will provide new information on nutrition and physical activity policies and practices within child care centers and the family home. Findings will also inform policy efforts to improve the child care system and help prevent obesity in very young children.