title: Television and DVD/video viewing in children younger than 2 years. Audible television and decreased adult words, infant vocalizations, and conversational turns: a population-based study. Utilization of the PICO framework to improve searching PubMed for clinical questions Risk factors for rapid weight gain in preschool children: findings from a UK-wide prospective study Early childhood electronic media use as a predictor of poorer well-being: a prospective cohort study. Young children’s screen activities, sweet drink consumption and anthropometry: results from a prospective European study The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Early life risk factors for obesity in childhood: cohort study Early Television Exposure and Children’s Behavioral and Social Outcomes at Age 30 Months Television Viewing in Infancy and Child Cognition at 3 Years of Age in a US Cohort Weight status and gender-related differences in motor skills and in child care - based physical activity in young children Prospective associations between early childhood television exposure and academic, psychosocial, and physical well-being by middle childhood. The impact of demographic and socio-economic conditions on the prevalence of speech disorders in preschool children in Bitola. Early childhood television viewing and kindergarten entry readiness Television viewing and change in body fat from preschool to early adolescence: The Framingham Children's Study Dietary intakes and physical activity among preschool-aged children living in rural American Indian communities before a family-based healthy lifestyle intervention. Too Much Television? Prospective Associations Between Early Childhood Televiewing and Later Self-reports of Victimization by Sixth Grade Classmates Correlates of body mass index and overweight and obesity of children aged 2 years: findings from the healthy beginnings trial. Television viewing and externalizing problems in preschool children: the Generation R Study. Do working mothers raise couch potato kids? Maternal employment and children's lifestyle behaviours and weight in early childhood. Risk factors for overweight in 2- to 6-year-old children in Beijing, China. GRADE guidelines: 3. Rating the quality of evidence. The prediction of preschool children's weight from family environment factors: gender-linked differences. Children's Television Exposure and Behavioral and Social Outcomes at 5.5 Years: Does Timing of Exposure Matter? Television exposure as a risk factor for aggressive behavior among 3-year-old children. An intervention to preschool children for reducing screen time: a randomized controlled trial.
abstract: OBJECTIVE To determine the television- , DVD- , and video-viewing habits of children younger than 2 years . DESIGN A telephone survey of 1009 parents of children aged 2 to 24 months . SETTING Parents in Minnesota and Washington state were surveyed . PARTICIPANTS A r and om sample of parents of children born in the previous 2 years was drawn from birth certificate records . Households in which English was not spoken were excluded , as were children with major disabilities . MAIN OUTCOME MEASURE The amount of regular television and DVD/video viewing by content , reasons for viewing , and frequency of parent-child coviewing . RESULTS By 3 months of age , about 40 % of children regularly watched  television , DVDs , or videos .  By 24 months , this proportion rose to 90 % . The median age at which regular media exposure was introduced was 9 months . Among those who watched , the average viewing time per day rose from 1 hour per day for children younger than 12 months to more than 1.5 hours per day by 24 months . Parents watched with their children more than half of the time . Parents gave education , entertainment , and babysitting as major reasons for media exposure in their children younger than 2 years . CONCLUSIONS Parents should be urged to make educated choices about their children 's media exposure . Parental hopes for the educational potential of television can be supported by encouraging those parents who are already allowing screen time to watch with their children OBJECTIVE To test the hypothesis that audible television is associated with decreased parent and child interactions .  DESIGN Prospect i ve , population -based observational study . SETTING Community . PARTICIPANTS Three hundred twenty-nine 2- to 48-month-old children . MAIN EXPOSURES Audible television .  Children wore a digital recorder on r and om days for up to 24 months . A software program incorporating automatic speech- identification technology processed the recorded file to analyze the sounds the children were exposed to and the sounds they made . Conditional linear regression was used to determine the association between audible television and the outcomes of interest . OUTCOME MEASURES Adult word counts , child vocalizations , and child conversational turns . RESULTS Each hour of audible television was associated with significant reductions in age-adjusted z scores for child vocalizations ( linear regression coefficient , -0.26 ; 95 % confidence interval [ CI ] , -0.29 to -0.22 ) , vocalization duration ( linear regression coefficient , -0.24 ; 95 % CI , -0.27 to -0.20 ) , and conversational turns ( linear regression coefficient , -0.22 ; 95 % CI , -0.25 to -0.19 ) . There were also significant reductions in adult female ( linear regression coefficient , -636 ; 95 % CI , -812 to -460 ) and adult male ( linear regression coefficient , -134 ; 95 % CI , -263 to -5 ) word count . CONCLUSIONS Audible television is associated with decreased exposure to discernible human adult speech and decreased child vocalizations . These results may explain the association between infant television exposure and delayed language development Background Supporting 21st century health care and the practice of evidence -based medicine ( EBM ) requires ubiquitous access to clinical information and to knowledge-based re sources to answer clinical questions . Many questions go unanswered , however , due to lack of skills in formulating questions , crafting effective search strategies , and accessing data bases to identify best levels of evidence . Methods This r and omized trial was design ed as a pilot study to measure the relevancy of search results using three different interfaces for the PubMed search system . Two of the search interfaces utilized a specific framework called PICO , which was design ed to focus clinical questions and to prompt for publication type or type of question asked . The third interface was the st and ard PubMed interface readily available on the Web . Study subjects were recruited from interns and residents on an inpatient general medicine rotation at an academic medical center in the US . Thirty-one subjects were r and omized to one of the three interfaces , given 3 clinical questions , and asked to search PubMed for a set of relevant articles that would provide an answer for each question . The success of the search results was determined by a precision score , which compared the number of relevant or gold st and ard articles retrieved in a result set to the total number of articles retrieved in that set . Results Participants using the PICO templates ( Protocol A or Protocol B ) had higher precision scores for each question than the participants who used Protocol C , the st and ard PubMed Web interface . ( Question 1 : A = 35 % , B = 28 % , C = 20 % ; Question 2 : A = 5 % , B = 6 % , C = 4 % ; Question 3 : A = 1 % , B = 0 % , C = 0 % ) 95 % confidence intervals were calculated for the precision for each question using a lower boundary of zero . However , the 95 % confidence limits were overlapping , suggesting no statistical difference between the groups . Conclusion Due to the small number of search es for each arm , this pilot study could not demonstrate a statistically significant difference between the search protocol s. However there was a trend towards higher precision that needs to be investigated in a larger study to determine if PICO can improve the relevancy of search results Objective : To examine risk factors for rapid weight gain  between 3 and 5 years of age . Design : Nationally representative prospect i ve cohort study . Participants : A total of 11 653 preschool children participating in the UK Millennium Cohort Study , with anthropometry at 3 and 5 years . Measurements : Weight gain z-scores were calculated from 3 to 5 years . Children in the top quarter of this distribution were classified as gaining weight rapidly . A total of 26 biological and early life , social , psychological , behavioural and environmental risk factors were examined . Results : Among the participants , 13 % of normal weight , 63 % of overweight and 88 % of obese 5-year olds had experienced rapid weight gain since 3 years of age . Six biological and early life factors and two social factors were found to be significantly associated with this growth pattern . In a mutually adjusted model , children were more likely to gain weight rapidly if they had a higher body mass index at age 3 ( adjusted odds ratio : 1.27 , 95 % confidence interval : 1.23–1.32 ) , if they were of Bangladeshi ( adjusted odds ratio : 1.88 , 95 % confidence interval : 1.27–2.79 ) or black ( adjusted odds ratio : 1.47 , 95 % confidence interval : 1.07–2.02 ) ethnicity , if their mother was overweight ( adjusted odds ratio : 1.32 , 95 % confidence interval : 1.15–1.51 ) or had been overweight before pregnancy ( adjusted odds ratio : 1.56 , 95 % confidence interval : 1.36–1.79 ) , if their father was overweight ( adjusted odds ratio : 1.56 , 95 % confidence interval : 1.34–1.81 ) or if their mother smoked during pregnancy ( adjusted odds ratio:1.23 , 95 % confidence interval : 1.09–1.38 ) . Children were also more likely to gain weight rapidly if others smoked in the same room ( adjusted odds ratio : 1.31 , 95 % confidence interval : 1.16–1.49 ) or if they were a lone child in the household ( adjusted odds ratio : 1.14 , 95 % confidence interval : 1.01–1.30 ) . Conclusions : Factors operating during pregnancy and early life increase the risk of rapid weight gain in young children ; thus , signalling the importance of obesity prevention programmes before and during pregnancy and for children at an early age . In particular , these programmes should address parental weight status and smoking habits , both modifiable risk factors IMPORTANCE Identifying associations between preschool-aged children 's electronic media use and their later well-being is essential to supporting positive long-term outcomes . OBJECTIVE To investigate possible dose-response associations of young children 's electronic media use with their later well-being . DESIGN , SETTING , AND PARTICIPANTS The IDEFICS ( Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants ) study is a prospect i ve cohort study with an intervention component . Data were collected at baseline from September 1 , 2007 , through June 30 , 2008 , and at follow-up from September 1 , 2009 , through May 31 , 2010 , in 8 European countries participating in the IDEFICS study . This investigation is based on 3604 children aged 2 to 6 years who participated in the longitudinal component of the IDEFICS study only and not in the intervention .  EXPOSURE Early childhood electronic media use . MAIN OUTCOMES AND MEASURES The following 6 indicators of well-being from 2 vali date d instruments were used as outcomes at follow-up : Peer problems and Emotional problems subscales from the Strengths and Difficulties Question naire and Emotional well-being , Self-esteem , Family functioning , and Social networks subscales from the KINDLR ( Question naire for Measuring Health-Related Quality of Life in Children and Adolescents-Revised Version ) . Each scale was dichotomized to identify those children at risk for poorer outcomes . Indicators of electronic media use ( weekday and weekend television and electronic game [e-game]/computer use ) from baseline were used as predictors . RESULTS Associations varied between boys and girls ; however , associations suggested that increased levels of electronic media use predicted poorer well-being outcomes . Television viewing on weekdays or weekends was more consistently associated with poorer outcomes than e-game/computer use . Across associations , the likelihood of adverse outcomes in children ranged from a 1.2- to 2.0-fold increase for emotional problems and poorer family functioning for each additional hour of television viewing or e-game/computer use depending on the outcome examined . CONCLUSIONS AND RELEVANCE Higher levels of early childhood electronic media use are associated with children being at risk for poorer outcomes with some indicators of well-being . Further research is required to identify potential mechanisms Background / Objectives : This longitudinal study describes the relationship between young children ’s screen time , dietary habits  and anthropometric measures . The hypothesis was that television viewing and other screen activities at baseline result in increased consumption of sugar-sweetened beverages ( SSB ) and increased BMI , BMI z-score and waist to height ratio ( WHtR ) two years later . A second hypothesis was that SSB consumption mediates the association between the screen activities and changes in the anthropometric measures .Subjects/ Methods : The study is a part of the prospect i ve cohort study IDEFICS ( “ Identification and prevention of dietary and lifestyle-induced health effects in children and infants ” ) , investigating diet , lifestyle and social determinants of obesity in 2 to 9-year-olds in eight European countries ( baseline n=16 225 , two-year follow-up ; n=11 038 ) .  Anthropometry was objective ly measured , and behaviours were parent-reported . Results : The main hypothesis was supported , but the second hypothesis was not confirmed . The odds ratio of being in the highest quintile of % change in WHtR was 1.26 ( 95 % CI : 1.17–1.36 ) and in BMI 1.22 ( 95 % CI : 1.13–1.31 ) , for each hour per day watching television . The odds ratio of having  increased SSB consumption was 1.19 ( 95 % CI : 1.09–1.29 ) for each hour per day watching TV . The associations for total screen time were slightly weaker . Conclusions : The results indicate substantial effects of TV viewing and other screen activities for young children , both on their consumption of sugary drinks and on an increase in BMI and central obesity . Our findings suggest that television viewing seems to have a stronger effect on food habits and anthropometry than other screen activities in this age group Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Abstract Objective To identify risk factors in early life ( up to 3 years of age ) for obesity in children in the United Kingdom . Design Prospect i ve cohort study . Setting Avon longitudinal study of parents and children , United Kingdom . Participants 8234 children in cohort aged 7 years and a sub sample of 909 children ( children in focus ) with data on additional early growth related risk factors for obesity . Main outcome measures Obesity at age 7 years , defined as a body mass index 3 95th centile relative to reference data for the UK population in 1990 . Results Eight of 25 putative risk factors were associated with a risk of obesity in the final models : parental obesity ( both parents : adjusted odds ratio , 10.44 , 95 % confidence interval 5.11 to 21.32 ) , very early ( by 43 months ) body mass index or adiposity rebound ( 15.00 , 5.32 to 42.30 ) , more than eight hours spent watching television per week at age 3 years ( 1.55 , 1.13 to 2.12 ) , catch-up growth ( 2.60 , 1.09 to 6.16 ) , st and ard deviation score for weight at age 8 months ( 3.13 , 1.43 to 6.85 ) and 18 months ( 2.65 , 1.25 to 5.59 ) ; weight gain in first year ( 1.06 , 1.02 to 1.10 per 100 g increase ) ; birth weight , per 100 g ( 1.05 , 1.03 to 1.07 ) ; and short ( < 10.5 hours ) sleep duration at age 3 years ( 1.45 , 1.10 to 1.89 ) . Conclusion Eight factors in early life are associated with an increased risk of obesity in childhood Background Previous research has suggested that television ( TV ) viewing may be associated with increased behavioral and emotional problems in children . However , there are few prospect i ve studies targeted for its association with outcomes of children under 3 years old . The purpose of this study was to exam the association between children ’s early TV exposure at ages 18 and 30 months and the behavioral and  emotional outcomes at age 30 months . Methods We analyzed data collected prospect ively in the Japan Children ’s Study .  TV exposure was assessed by mothers ’ report at infant ages of 18 and 30 months . The outcomes were assessed using the Strengths and Difficulties Question naire ( SDQ ) . Analysis of Covariance was used to estimate the effect of TV exposure on behavioral and emotional outcomes . Results The percentage of children who watched TV 4 hours or more per day was 29.4 % at age 18 months , 24.5 % at age 30 months , and 21 % at both ages . Hyperactivity – inattention at age 30 months was positively associated with TV exposure at age 18 months , whereas prosocial behavior was negatively associated with hours of exposure even after adjustment . However , there were no significant differences in SDQ subscales according to daily hours of TV viewing at age 30 months . Conclusions Daily TV exposure at age 18 months was associated with hyperactivity – inattention and prosocial behavior at age 30 months . However , the directly casual relation was not proved in the present study . Additional research considering the TV program content and exposure timing are needed to investigate the causal relation between TV viewing and behavioral outcome OBJECTIVE . To examine the extent to which  infant television viewing  is associated with language and visual motor skills at 3 years of age . MEASURES . We studied 872 children who were participants in Project Viva , a prospect i ve cohort . The design used was a longitudinal survey , and the setting was a multisite group practice in Massachusetts . At 6 months , 1 year , and 2 years , mothers reported the number of hours their children watched television in a 24-hour period , from which we derived a weighted average of daily television viewing . We used multivariable regression analyses to predict the independent associations of television viewing between birth and 2 years with Peabody Picture Vocabulary Test III and Wide-Range Assessment of Visual Motor Abilities scores at 3 years of age . RESULTS . Mean daily television viewing in infancy ( birth to 2 years ) was 1.2 ( SD : 0.9 ) hours , less than has been found in other studies of this age group . Mean Peabody Picture Vocabulary Test III score at age 3 was 104.8 ( SD : 14.2 ) ; mean st and ardized total Wide-Range Assessment of Visual Motor Abilities score at age 3 was 102.6 ( SD : 11.2 ) . After adjusting for maternal age , income , education , Peabody Picture Vocabulary Test III score , marital status , and parity , and child 's age , gender , birth weight for gestational age , breastfeeding duration , race/ethnicity , primary language , and average daily sleep duration , we found that each additional hour of television viewing in infancy was not associated with Peabody Picture Vocabulary Test III or total st and ardized Wide-Range Assessment of Visual Motor Abilities scores at age 3 . CONCLUSION . Television viewing in infancy does not seem to be associated with language or visual motor skills at 3 years of age Background Over the last decades , a decline in motor skills and in physical activity and an increase in obesity has been observed in children . However , there is a lack of data in young children . We tested if differences in  motor skills and in physical activity  according to weight or gender were already present in 2- to 4-year-old children . Methods Fifty-eight child care centers in the French part of Switzerl and were r and omly selected for the Youp'là bouge study .  Motor skills were assessed by an obstacle course including 5 motor skills , derived from the Zurich Neuromotor Assessment test . Physical activity was measured with accelerometers ( GT1 M , Actigraph , Florida , USA ) using age-adapted cut-offs .  Weight status was assessed using the International Obesity Task Force criteria ( healthy weight vs overweight ) for body mass index ( BMI ) . Results Of the 529 children ( 49 % girls , 3.4 ± 0.6 years , BMI 16.2 ± 1.2 kg/m2 ) , 13 % were overweight . There were no significant weight status-related differences in the single skills of the obstacle course , but there was a trend ( p = 0.059 ) for a lower performance of overweight children in the overall motor skills score . No significant weight status-related  differences in child care-based physical activity  were observed . No gender-related differences were found in the overall motor skills score , but boys performed better than girls in 2 of the 5 motor skills ( p ≤ 0.04 ) . Total physical activity as well as time spent in moderate-vigorous and in vigorous activity during child care were 12 - 25 % higher and sedentary activity 5 % lower in boys compared to girls ( all p < 0.01 ) . Conclusions At this early age , there were no significant weight status- or gender-related differences in global motor skills . However , in accordance to data in older children , child care-based physical activity  was higher in boys compared to girls . These results are important to consider when establishing physical activity recommendations or targeting health promotion interventions in young children OBJECTIVE To estimate the influence of  early childhood television exposure  on fourth- grade academic , psychosocial , and lifestyle characteristics . DESIGN Prospect i ve longitudinal study . SETTING Institut de la Statistique du Québec , Québec , Canada . PARTICIPANTS A total of 1314 ( of 2120 ) children . Main Exposure Parent-reported data on weekly hours of television exposure  at 29 and 53 months of age . We conducted a series of ordinary least-squares regressions in which children 's academic , psychosocial , and lifestyle characteristics are linearly regressed on early and preschool television exposure . OUTCOME MEASURES Parent and teacher reports of academic , psychosocial , and health behaviors and body mass index measurements ( calculated as weight in kilograms divided by height in meters squared ) at 10 years of age . RESULTS Adjusting for preexisting individual and family factors , every additional hour of television exposure at 29 months corresponded to 7 % and 6 % unit decreases in classroom engagement ( 95 % confidence interval [ CI ] , -0.02 to -0.004 ) and math achievement ( 95 % CI , -0.03 to 0.01 ) , respectively ; 10 % unit increases in victimization by classmates ( 95 % CI , 0.01 to 0.05 ) ; 13 % unit decreases in time spent doing weekend physical activity ( 95 % CI , 0.81 to 2.25 ) ; 9 % unit decreases in activities involving physical effort ( 95 % CI , -0.04 to 0.00 ) ; higher consumption scores for soft drinks and snacks by 9 % and 10 % ( 95 % CI , 0.00 to 0.04 and 95 % CI , 0.00 to 0.02 ) , respectively ; and 5 % unit increases in body mass index ( 95 % CI , 0.01 to 0.05 ) . Preschool increments in exposure also made a unique contribution to developmental risk . CONCLUSIONS The long-term risks associated with higher levels of early exposure may chart developmental pathways toward unhealthy dispositions in adolescence . A population -level underst and ing of such risks remains essential for promoting child development INTRODUCTION Speech development in preschool children should be consistent with a child 's overall development . However , disorders of speech in childhood are not uncommon . OBJECTIVE The purpose of the study was to determine the impact of demographic and socio-economic conditions on the prevalence of speech disorders in preschool children in Bitola . METHODS The study is observational and prospect i ve with two years duration . During the period from May 2009 to June 2011 , 1607 children aged 3 and 5 years , who came for regular examinations , were observed . The following research methods were applied : pediatric examination , psychological testing ( Test of Chuturik ) , interviews with parents and a question naire for behavior of children ( Child Behavior Checklist - CBCL ) . RESULTS 1,607 children were analyzed , 772 aged three years , 835 aged five years , 51.65 % male and 49.35 % female . The prevalence of speech disorders was 37.65 % . Statistical analysis showed that these disorders were more frequent in three years old children , males living in rural areas and in larger families . They did not have their own rooms at home , they were using mobile phones and were spending many hours per day watching television , ( p<0.01 ) . Also , children whose parents had lower levels of education and were engaged in agriculture , often had significant speech disorders , ( p<0.01 ) . CONCLUSION Speech disorders in preschool children in Bitola have a high prevalence . Because of their influence on later cognitive development of children , the process requires cooperation among parents , children , speech and the audiologist with the significant role in prevention , early detection and treatment Background : Using a large population -based sample , this study aims to verify whether televiewing at 29 mo , a common early childhood pastime , is prospect ively associated with school readiness at 65 mo . Methods : Participants are a prospect i ve longitudinal cohort of 991 girls and 1,006 boys from the Quebec Longitudinal Study of Child Development with parent-reported data on weekly hours of televiewing at 29 mo of age . We conducted a series of ordinary least-squares regressions in which children ’s scores on direct child assessment s of vocabulary , mathematical knowledge , and motor skills , as well as kindergarten teacher reports of socioemotional functioning , were linearly regressed on early televiewing . Results : Every SD increase ( 1.2 h ) in daily televiewing at 29 mo predicted decreases in receptive vocabulary , number knowledge scores , classroom engagement , and gross motor locomotion scores , as well as increases in the frequency of victimization by classmates . Conclusion : Increases in total time watching television at 29 mo were associated with subsequent decreases in vocabulary and math skills , classroom engagement ( which is largely determined by attention skills ) , victimization by classmates , and physical prowess at kindergarten . These prospect i ve associations , independent of key potential confounders , suggest the need for better parental awareness and compliance with existing viewing recommendations put forth by the American Academy of Pediatrics ( AAP ) OBJECTIVE : To prospect ively examine the relation between television watching and body fat change in children from preschool to early adolescence . METHODS : In a longitudinal study , 106 children were enrolled during preschool years ( mean age 4.0 y ) and followed into early adolescence ( mean age 11.1 y ) . Parents completed an annual question naire on the child 's television and video habits .  Body mass index ( BMI ) , triceps skinfolds , and sum of five skinfolds were recorded yearly at annual clinic visits . Longitudinal statistical analyses were carried out using mixed modeling procedures to control for potential confounding by a number of factors . RESULTS : Television watching was an independent predictor of the change in the child 's BMI , triceps , and sum of five skinfolds throughout childhood . Its effect was only slightly attenuated by controlling for the baseline body fat , level of physical activity ( as measured repeatedly by Caltrac accelerometer ) , percent of calories from fat , total calorie intake , or the parents ' BMI or education . By age 11 , children who watched 3.0 h or more of television per day had a mean sum of skinfolds of 106.2 mm , compared with a mean sum of skinfolds of 76.5 mm for those who watched less than 1.75 h per day ( P=0.007 ) . Furthermore , the adverse effect of television viewing was worse for those children who were also sedentary or had a higher-fat diet . CONCLUSIONS : Children who watched the most television during childhood had the greatest increase in body fat over time . Healthy lifestyle education design ed to prevent obesity and its consequences should target television-watching habits of children OBJECTIVE To report dietary intake and physical activity among preschool-aged children living in rural American Indian communities before participation in a family-based healthy lifestyle intervention  and to compare data to current age-specific recommendations . SUBJECTS/ DESIGN One hundred thirty-five preschool-aged children , living in rural American Indian communities , provided diet and physical activity data before participating in a 2-year r and omized healthy lifestyle intervention .  Three 24-hour dietary recalls assessed nutrient and food and added sugar intake , which were compared to the National Academy of Science 's Dietary Reference Intakes , the US Department of Agriculture 's MyPyramid , and American Heart Association recommendations . Time watching television and moderate plus vigorous activity was compared to MyPyramid and American Academy of Pediatrics recommendations . STATISTICAL ANALYSIS Nutrient , food group , added sugar intake , and time watching television and in moderate or vigorous activity  were compared to recommendations by computing the percent of recommendations met . Nonparametric tests identified differences in diet and physical activity among age groups and normal and overweight children ( body mass index < 85th and > or = 85th percentile ) . RESULTS Average nutrient intakes met recommendations whereas food group intakes did not . Mean fruit and vegetable intakes for 2- to 3-year-olds were 0.36 c/day fruit and 0.45 c/day vegetables and , for 4- to 5-year-olds , 0.33 c/day fruit and 0.48 c/day vegetables . Both age groups reported consuming more than 50 g added sugar , exceeding the recommendation of 16 g. Overweight vs normal weight children reported significantly more sweetened beverage intake ( 8.0+/-0.10 vs 5.28+/-0.08 oz/day , P<0.01 ) . On average , all children reported watching television 2.0 hours/day and significant differences were observed for total television viewing and nonviewing time between overweight and normal weight children ( 8.52+/-0.6 vs 6.54+/-0.6 hours/day , P<0.01 ) . All children engaged in < 20 minutes/day of moderate or vigorous activity . CONCLUSIONS Overall , children in this sample did not meet MyPyramid recommendations for fruits or vegetables and exceed added sugar intake recommendations . Television viewing time and time when the television was on in the home was highly prevalent along with low levels of moderate or vigorous activity . The Healthy Children Strong Families intervention we studied has potential for improving nutrition and physical activity among preschool-aged children living in rural American Indian communities Background : Using a birth cohort , this study aim ed to verify whether televiewing at 29 months , a common early childhood pastime , is prospect ively associated with self-reported victimization at age 12 . Methods : Participants are 991 girls and 1006 boys from the Quebec Longitudinal Study of Child Development . The main predictor comprised parent-reported daily televiewing by their children at 29 months . In the sixth grade , children reported how often they experienced victimization by classmates in the past year . The authors conducted multivariate linear regression , in which child self-reports of victimization were linearly regressed on early televiewing and potential confounders . Results : Every SD unit increase ( 0.88 hours ) in daily televiewing at 29 months predicted an 11 % SD unit increase in self-reported peer victimization by sixth grade classmates ( unst and ardized B = .031 , p < .001 , 95 % confidence interval = 0.014–0.042 ) . This relationship was adjusted for child characteristics ( gender , preexisting externalizing behaviors , baseline cognitive abilities , and televiewing at age 12 ) and family characteristics ( family configuration , income , and functioning , and maternal education ) . Conclusions : Daily televiewing time at 29 months was associated with a subsequent increased risk of victimization by classmates at the end of sixth grade , a period which represents a critical developmental transition to middle school . Youth who experience peer victimization are at an increased risk of long-term mental health issues , such as depression , underachievement , and low self-esteem . This prospect i ve association , across a 10-year period , suggests the need for better parental awareness , acknowledgement , and compliance with existing recommendations put forth by the American Academy of Pediatrics OBJECTIVE We sought to determine early life factors that predict body mass index ( BMI ) and overweight/obesity  of children aged 2 years . METHODS A longitudinal and prospect i ve analysis was conducted with 330 first-time mothers and their newborns . Children 's weight and length were measured at 2 years . Main factors of interest included reported infant feeding practice s , children 's fruit/vegetable consumption , and television ( TV ) time . Maternal demographic data , weight and height , and smoking status were collected by face-to-face interview at baseline . Multiple linear and logistic regression models were run to determine factors that predicted BMI or overweight/obesity of children aged 2 years , respectively . RESULTS At age 2 years , 242 remained in the study ( retention rate 73 % ) . Mean ( SD ) BMI of children was 16.87 kg/m(2 ) ( 1.62 ) , with 14 % classified as overweight/obese . Factors predicting lower child BMI were longer breastfeeding duration , less TV viewing time , and lower child 's birth weight as well as maternal healthy prepregnancy weight status . Factors predicting children 's overweight/obesity status were shorter breastfeeding duration , earlier introduction of solid food , and maternal overweight or obesity . CONCLUSIONS At 2 years of age , longer breastfeeding duration was associated with lower BMI , while greater TV viewing time was associated with higher BMI , after adjusting for other factors . Early introduction of solids and maternal overweight or obesity were independently associated with overweight or obesity OBJECTIVE To determine whether the amount , type , and patterns of television viewing predict the onset or the persistence of  externalizing problems in preschool children . DESIGN Longitudinal study of a prospect i ve population -based cohort in the Netherl and s. SETTING Parents reported time of television exposure and type of programs watched by children . Externalizing problems were assessed using the Child Behavior Checklist at 18 and 36 months . PARTICIPANTS A population -based sample of 3913 children . MAIN EXPOSURE Television viewing time , content , and patterns of exposure  ( at 24 and 36 months ) in children with and without preexisting problems to assess the incidence and persistence of externalizing problems . MAIN OUTCOME MEASURES Externalizing problems at 36 months . RESULTS Program content and time of television exposure assessed at 24 months did not predict the incidence of externalizing problems at 36 months ( odds ratio , 2.24 ; 95 % CI , 0.97 - 5.18 ) . However , the patterns of exposure over time reflecting high levels of television viewing were associated with the incidence of externalizing problems ( odds ratio , 2.00 ; 95 % CI , 1.07 - 3.75 ) and the persistence of the preexisting externalizing problems ( 2.59 ; 1.03 - 6.55 ) . CONCLUSIONS Our study showed that high television exposure increases the risk of the incidence and the persistence of externalizing problems in preschool children Alarm about the increasing prevalence of childhood obesity has focussed attention on individual lifestyle behaviours that may contribute to unhealthy weight . More distal predictors such as maternal employment may also be implicated since working mothers have less time to supervise children 's daily activities . The research reported here used two waves of data from the Longitudinal Study of Australian Children to investigate whether  mothers ' hours in paid work  shape young children 's  television viewing , snacking and physical activity , and through those lifestyle behaviours , children 's weight at ages 4 - 5 years and 6 - 7 years . At both ages , children 's lifestyle behaviours were interrelated and associated with weight status . Cross-sectional analysis confirmed small , direct associations between longer hours of maternal employment and child weight at age 4 - 5 years , but not with child 's weight measured two years later . In both the cross-sectional and prospect i ve analyses , the children of mothers who worked part-time  watched less television and were less likely to be overweight than children of mothers who were not employed or who worked full-time . While associations were small , they remained significant after adjustment for maternal weight , household income and other factors . The combination of direct and indirect relationships between mothers ' work hours and the weight status of their young children provides additional support to calls for family-friendly work policies as an important means for promoting healthy family lifestyles and early childhood wellbeing OBJECTIVE To assess the prevalence of overweight among Chinese preschool children and to explore risk factors of childhood obesity focusing on parental characteristics , feeding practice and lifestyle . METHODS Data on 930 families with 2- to 6-year-old children in five kindergartens were obtained in a cross sectional study . Families were r and omly selected from two of all six urban districts in Beijing , China . Information on parental characteristics , dietary habits , lifestyle habits , and feeding practice was collected by parental self-report question naires . The children 's stature and weight were measured in light clothing and without shoes . Overweight and obesity were defined according to international cut-off values , as proposed by the International Obesity Task Force . Multivariate regression analysis was used to explore risk factors of child overweight . RESULTS The overall prevalence of overweight and obesity was 10.7 % and 4.2 % , respectively , and increased with age . The prevalence of child overweight was 14.1 % and 7.5 % in obese and non-obese families , respectively . Significant associations were observed between child and parent characteristics for overweight , frequency of eating in restaurant , television hours , and hours of physical activity . Child overweight was associated with parental overweight ( Odds Ratio [ OR ] 2.43 , 95 % CI 0.78 , 6.59 ) , low maternal education level ( OR 2.22 , 95 % CI 1.39 , 3.55 ) , food restriction ( OR 2.68 , 95 % CI 1.64 , 4.29 ) , and television watching > 2h/d ( OR 1.56 , 95 % CI 1.17 , 2.09 ) , after adjusting for sex , age , family income and kindergarten ( for cluster study design ) . CONCLUSIONS Overweight prevalence among Chinese preschool children in Beijing is comparable to some European countries . Prevention strategies should include identified lifestyle risk factors This article introduces the approach of GRADE to rating  quality of evidence .  GRADE specifies four categories-high , moderate , low , and very low-that are applied to a body of evidence , not to individual studies . In the context of a systematic review , quality reflects our confidence that the estimates of the effect are correct . In the context of recommendations , quality reflects our confidence that the effect estimates are adequate to support a particular recommendation . R and omized trials begin as high- quality evidence , observational studies as low quality . " Quality " as used in GRADE means more than risk of bias and so may also be compromised by imprecision , inconsistency , indirectness of study results , and publication bias . In addition , several factors can increase our confidence in an estimate of effect . GRADE provides a systematic approach for considering and reporting each of these factors . GRADE separates the process of assessing quality of evidence from the process of making recommendations . Judgments about the strength of a recommendation depend on more than just the quality of evidence The main objective of this study was to test an explanatory model predicting preschool girls ' and boys ' body weight from certain child variables ( food intake , sedentary behaviors , and eating habits ) , as well as family variables ( interaction during mealtime and level of family financial re sources allocated to meeting children 's eating needs ) . A r and omized stratified sub sample of parents was selected from a larger study ( Quebec Longitudinal Study of Child Development , QLSCD-1998 - 2002 ) , with a breakdown of 581 girls and 611 boys of 4 years of age . Children 's skin fold ratio , weight , height , and Body Mass Index ( BMI ) were recorded . Question naires were administered to parents ( usually the mother ) . Using structural equation modeling ( SEM ) separately for girls and boys , the family environment model of healthy weight development was tested . Results yielded a good fit of the model for both genders . For boys , significant predictors of body weight in the model were family food insecurity and conflicts during mealtime . Healthy eating was predicted by food insecurity , mealtime conflicts , and sedentary behaviors . Mealtime conflicts predicted sedentary behaviors . For girls , none of the variables predicted body weight , however food insecurity predicted less healthy eating . These results outline the importance of prevention and intervention within families with young children BACKGROUND . The American Academy of Pediatrics recommends children ≥2 years of age limit daily media exposure to ≤1 to 2 hours and not have a television set in children 's bedrooms . However , there are limited prospect i ve studies to address how timing of media exposure influences  children 's health . OBJECTIVE . Our goal was to examine relations among children 's early , concurrent , and sustained  television exposure  and behavioral and social skills outcomes at 5.5 years . METHODS . We analyzed data collected prospect ively from the Healthy Steps for Young Children national evaluation . Television exposure was defined as > 2 hours of daily use ( at 30–33 months and 5.5 years ) and television in child 's bedroom ( at 5.5 years ) . At 5.5 years , outcomes were assessed by using the Child Behavior Checklist and social skills using the Social Skills Rating System . Linear regression was used to estimate the effect of television exposure on behavioral and social skills outcomes . RESULTS . Sixteen percent of parents reported that their child watched > 2 hours of television daily at 30 to 33 months only , 15 % reported > 2 hours of television daily at 5.5 years only , and 20 % reported > 2 hours of television daily at both times . Forty-one percent of the children had televisions in their bedrooms at 5.5 years . In adjusted analyses , sustained television viewing was associated with behavioral outcomes . Concurrent television exposure was associated with fewer social skills . For children with heavy television viewing only in early childhood , there was no consistent relation with behavioral or social skills outcomes . Having a television in the bedroom was associated with sleep problems and less emotional reactivity at 5.5 years but was not associated with social skills . CONCLUSIONS . Sustained exposure is a risk factor for behavioral problems , whereas early exposure that is subsequently reduced presents no additional risk . For social skills , concurrent exposure was more important than sustained or early exposure . Considering the timing of media exposure is vital for underst and ing the consequences of early experiences and informing prevention strategies OBJECTIVE To examine associations of  child television ( TV ) exposure and household TV use with  aggressive behavior among 3-year-old children while controlling for demographic characteristics and risk and protective factors for aggression . DESIGN The Fragile Families and Child Wellbeing Study , a prospect i ve cohort study . SETTING Data collected at home and by telephone from parents of children born from 1998 to 2000 from 20 cities . PARTICIPANTS Mothers who completed a 36-month in-home survey and met inclusion criteria ( n = 3128 ) . MAIN EXPOSURE Direct child TV exposure and household TV use were the primary explanatory variables . Additional risk factors included neighborhood disorder and maternal factors like depression . OUTCOME MEASURES Childhood aggression was assessed with the Child Behavior Checklist/2 - 3 . Multivariate linear regression models were used to examine associations between TV measures , additional risk factors , and childhood aggression . RESULTS Children who were spanked in the past month ( beta = 1.24 , P < .001 ) , lived in a disorderly neighborhood ( beta = 2.07 , P < .001 ) , and had a mother reporting depression ( beta = 0.92 , P < .001 ) and parenting stress ( beta = 0.16 , P < .001 ) were significantly more likely to exhibit aggressive behavior .  Direct child TV exposure  ( beta = 0.16 , P < .001 ) and household TV use ( beta = 0.09 , P < .001 ) were also significantly associated with childhood aggression , even when controlling for other factors . CONCLUSIONS Three-year-old children exposed to more TV , both directly and indirectly , are at increased risk for exhibiting aggressive behavior . Further research is essential to determine whether pediatric recommendations concerning TV and children should include limits for general household TV use BACKGROUND Screen time , defined as time spent watching television , DVDs , or videos or playing computer or video games , has been related to serious health consequences in children , such as impaired language acquisition , violent behaviour , tobacco smoking and obesity . Our aim was to determine if a simple intervention aim ed at preschool-aged children , applied at the health maintenance visits , in the primary care setting , would be effective in reducing screen time . METHODS We used a two group r and omized controlled trial design . Two- to 6-year-old children and their parents were r and omly assigned to receive an intervention to reduce their screen time , BMI and parental report of aggressive behaviour . At the end of the intervention we made home visits at 2 , 6 and 9 months and the parents completed question naire . RESULTS Parents in the intervention group reported less screen time and less aggressive behaviour than those in the control group but there were no differences in BMI z scores . CONCLUSIONS This study shows that a preschool-based intervention can lead to reductions in young children 's television/video viewing
target: Associations between objective ly measured total sedentary time and indicators of adiposity and motor development were predominantly null .
  Associations between screen time and indicators of adiposity , motor or cognitive development , and psychosocial health were primarily unfavourable or null .
  Associations between time spent seated ( e.g. , in car seats or strollers ) or in the supine position , and indicators of adiposity and motor development , were primarily unfavourable or null .
  Conclusions These findings continue to support the importance of minimizing screen time for disease prevention and health promotion in the early years , but also highlight the potential cognitive benefits of interactive non-screen-based sedentary behaviours such as reading and storytelling .
background: Background The purpose of this systematic review was to examine the relationships between  sedentary behaviour ( SB ) and health indicators in children aged 0 to 4 years , and to determine what doses of SB ( i.e. , duration , patterns [ frequency , interruptions ] , and type ) were associated with health indicators .