Reducing obesity in early childhood : results from romp & chomp, an Australian community-wide intervention program

Background: There is growing evidence that community-based interventions can reduce childhood obesity in older children.
Objective: We aimed to determine the effectiveness of the Romp & Chomp intervention in reducing obesity and promoting healthy eating and active play in children aged 0–5 y.
Design: Romp & Chomp was a community-wide, multisetting, multistrategy intervention conducted in Australia from 2004 to 2008. The intervention occurred in a large regional city (Geelong) with a target group of 12,000 children and focused on community capacity building and environmental (political, sociocultural, and physical) changes to increase healthy eating and active play in early-childhood care and educational settings. The evaluation was repeat cross-sectional with a quasiexperimental design and comparison sample. Main outcome measures were body mass index (BMI), standardized BMI (zBMI; according to the Centers for Disease Control and Prevention 2000 reference charts), and prevalence of overweight/obesity and obesity-related behaviors in children aged 2 and 3.5 y.
Results: After the intervention there was a significantly lower mean weight, BMI, and zBMI in the 3.5-y-old subsample and a significantly lower prevalence of overweight/obesity in both the 2- and 3.5-y-old subsamples (by 2.5 and 3.4 percentage points, respectively) than in the comparison sample (a difference of 0.7 percentage points; P < 0.05) compared with baseline values. Intervention child-behavioral data showed a significantly lower intake of packaged snacks (by 0.23 serving), fruit juice (0.52 serving), and cordial (0.43 serving) than that in the comparison sample (all P < 0.05).
Conclusion: A community-wide multisetting, multistrategy intervention in early-childhood settings can reduce childhood obesity and improve young children's diets. This trial was registered with the Australian Clinical Trials Registry at anzctr.org.au as ACTRN12607000374460.

Mixed-age grouping in early childhood – creating the outdoor learning environment

Children attending centre-based early childhood care and education programmesacross Australia are most likely to be grouped according to age anddevelopment. While multi- or mixed-age grouping has been seen to havepositive benefits on young children’s learning and pro-social behaviours, thisapproach is not usually adopted in the organisation of children’s grouping inmost long day care settings across the county. This paper reports on a case studywhich explored one urban children’s setting where the outdoor learning spacehas been specifically designed to enable a mixed-age approach for children. Thefindings suggest that while the educators see many benefits across the age groupsin engaging in this approach, there is still a preference to segregate the veryyoung children arising from concerns for their safety. The study also found thatplanning for learning especially in regards pro-social learning with the olderchildren has been problematic

Family-centred practice : empowerment, self-efficacy, and challenges for practitioners in early childhood education and care

Family-centred practice has been included in the Victoria, Australia Early Years Learning and Development Framework as a key practice principle for professionals working across all early years programs in that state. While this model of partnership for engaging and collaborating with families has long been used in the early intervention sector, the efficacy of adopting this model more widely across the wider early childhood education and care sector has not been explored. This article presents a discussion on family-centred practice as a model for engaging with families in the care and education of their children. Through an analysis of the underlying philosophy and an examination of the core principles and characteristics, the article explores family-centred practice as it sits within a broader theory of partnership. This analysis identifies that while there are essential principles and characteristics that position the model within a partnership framework, it is the notion of empowerment, an underpinning philosophy guiding the model, that adds another dimension to the way practitioners in early childhood education and care settings collaborate with families. In examining the broader early childhood context, the capacity of many early childhood practitioners to effectively implement empowering behaviours is challenged.

Partnerships in early childhood education and care : empowering parents or empowering practitioners

Research acknowledges that outcomes for young children are enhanced when effective partnerships are developed between educators and families. The Australian Early Years Learning Framework provides direction for the professional practice of early childhood educators by acknowledging the importance of educators working in partnership with families. In the Victorian state-based early years framework, family-centred practice has been included as the practice model. Family-centred practice has as its core a philosophy of professionals supporting the empowerment of parents as active decision makers for their child. The early childhood education and care sector in Australia, however, is made up of a workforce which is largely perceived as being undervalued as a profession. This raises questions as to the capacity of these educators to support the empowerment of parents when they themselves are coming from a position of disempowerment due to their professional status. This article reports on findings from a small-scale study of childhood educators working in a long day-care setting which aimed to identify perceptions of the partnerships that exist between themselves and parents. In the course of the investigation, it became evident that some of educators felt disempowered in the relationships that exist with some families.

Process and impact evaluation of the romp & chomp obesity prevention intervention in early childhood settings : lessons learned from implementation in preschools and long day care settings

Background: The Romp & Chomp controlled trial, which aimed to prevent obesity in preschool Australian children, was recently found to reduce the prevalence of childhood overweight and obesity and improve children’s dietary patterns. The intervention focused on capacity building and policy implementation within various early childhood settings. This paper reports on the process and impact evaluation of this trial and the lessons learned from this complex community intervention.
Methods: Process data was collected throughout and audits capturing nutrition and physical activity-related environments and practices were completed postintervention by directors of Long Day Care (LDC) centers (n = 10) and preschools (n = 41) in intervention and comparison (n = 161 LDC and n = 347 preschool) groups.
Results: The environmental audits demonstrated positive impacts in both settings on policy, nutrition, physical activity opportunities, and staff capacity and practices, although results varied across settings and were more substantial in the preschool settings. Important lessons were learned in relation to implementation of such community-based interventions, including the significant barriers to implementing health-promotion interventions in early childhood settings, lack of engagement of for-profit LDC centers in the evaluation, and an inability to attribute direct intervention impacts when the intervention components were delivered as part of a health-promotion package integrated with other programs.
Conclusions: These results provide confidence that obesity prevention interventions in children’s settings can be effective; however, significant efforts must be directed toward developing context-specific strategies that invest in policies, capacity building, staff support, and parent engagement. Recognition by funders and reviewers of the difficulties involved in implementing and evaluating such complex interventions is also critical to strengthening the evidence base on the effectiveness of such public health approaches to obesity prevention.

Preventing maternal and early childhood obesity: the fetal flaw in Australian perinatal care

Almost half of Australian women of child-bearing age are overweight or obese, with a rate of 30–50% reported in early pregnancy. Maternal adiposity is a costly challenge for Australian obstetric care, with associated serious maternal and neonatal complications. Excess gestational weight gain is an important predictor of offspring adiposity into adulthood and higher maternal weight later in life. Current public health and perinatal care approaches in Australia do not adequately address excess perinatal maternal weight or gestational weight gain. This paper argues that the failure of primary health-care providers to offer systematic advice and support regarding women’s weight and related lifestyle behaviours in child-bearing years is an outstanding ‘missed opportunity’ for prevention of inter-generational overweight and obesity. Barriers to action could be addressed through greater attention to: clinical guidelines for maternal weight management for the perinatal period, training and support of maternal health-care providers to develop skills and confidence in raising weight issues with women, a variety of weight management programs provided by state maternal health services, and clear referral pathways to them. Attention is also required to service systems that clearly define roles in maternal weight management and ensure consistency and continuity of support across the perinatal period.

Obesity prevention interventions in early childhood education and care settings with parental involvement: a systematic review

Partnering early childhood education and care (ECEC) and the home together may be more effective in combating obesogenic risk factors in preschool children. Thus, an evaluation of ECEC obesity prevention interventions with a parental component was conducted, exploring parental engagement and its effect on obesity and healthy lifestyle outcomes. A search revealed 15 peer-reviewed papers. Some studies demonstrated positive weight changes, and secondary outcomes of changes in physical activity and healthy eating were reported in most studies; study quality ranged from fair to good. Four findings were linked to weight changes: (1) when educational material is consistent across settings; (2) capacity building of parents; (3) parents encouraging their children to drink water and (4) parental satisfaction and participation. A partnership between parents and ECEC may be a powerful force in the prevention of paediatric obesity. A better understanding of collaborative parental engagement is needed.

Effective family partnerships in early childhood education and care: An investigation of the nature of interactions between educators and parents

This Doctoral dissertation presents findings of a research study exploring the nature of the interactions between early childhood educators and parents as they reflect a framework of partnership centred on mutuality, trust, reciprocity and shared decision making. Examining the nature of the relationships. In examining the interactions , the study found that while mutuality, trust and reciprocity were evident in the interactions between the parents and the educators, shared decision making, where parents were mutual partners in the decision making around their child, was not evident.

Early childhood education and care educators supporting parent-child relationships: a systematic literature review

Building strong relationships between children and parents is vital for children’s social and emotional development. A majority of children attend early childhood education and care (ECEC) settings where they experience a range of relationships (educator–child, educator– parent, parent–child). Educators build relationships with children and parents, yet their influence on parent–child relationships is not well understood. Therefore, an evaluation of interventions/programs designed to promote parent–child relationships in ECEC settings (long day care, occasional care and preschool) and a range of settings (play groups, community groups and health centers) was conducted. The search revealed 21 peer-reviewed studies and seven interventions: two conducted in ECEC settings and five in a range of parent–child support settings. All studies reported intervention efficacy, yet none examined educators’ influence on parent–child relationships. Investigation into current educator practices is recommended to ensure educators are supported to promote and nurture parent– child relationships, consequently strengthening children’s social and emotional development.

Building capacity: strategic professional development for early childhood practitioners

An innovative framework for early childhood students and professionals using an interactive program titled SAM: A Self-Assessment Manual.

This provides a strategic and guided approach to enable practitioners to respond critically to activities and questions such as: 'Where have I come from?', 'Where am I now?' and 'Where do I want to go next?' The book and an accompanying CD-ROM allow readers to practically apply the framework to everyday practice, individually or as part of a group.

Addresses an identified need within the early childhood profession for targeted career development and professional support.

Comments from those who have used the program include: 'After reflection and discussion SAM has allowed me to set myself new goals for my future career, both in the workplace now and further down the track' and 'SAM has me thinking about current practice, how this relates to different theories and where my philosophy fits in'.

Early childhood caries: current evidence for aetiology and prevention

Background: Despite the fact that it is largely preventable, dental caries (decay) remains one of the most common chronic diseases of early childhood. Dental decay in young children frequently leads to pain and infection necessitating hospitalization for dental extractions under general anaesthesia. Dental problems in early childhood have been shown to be predictive of not only future dental problems but also on growth and cognitive development by interfering with comfort nutrition, concentration and school participation. Objective: To review the current evidence base in relation to the aetiology and prevention of dental caries in preschool-aged children. Methods: A search of MEDLINE, CINALH and Cochrane electronic databases was conducted using a search strategy which restricted the search to randomized controlled trials, meta-analyses, clinical trials, systematic reviews and other quasi-experimental designs. The retrieved studies were then limited to articles including children aged 5 years and under and published in English. The evidence of effectiveness was then summarized by the authors. Conclusions: The review highlighted the complex aetiology of early childhood caries (ECC). Contemporary evidence suggests that potentially effective interventions should occur in the first 2 years of a child's life. Dental attendance before the age of 2 years is uncommon; however, contact with other health professionals is high. Primary care providers who have contact with children well before the age of the first dental visit may be well placed to offer anticipatory advice to reduce the incidence of ECC.

Should early childhood be a priority period for obesity prevention?

This thesis explored a range of issues relating to overweight and obesity in children aged 0 to 5 years in Victoria, Australia. Key findings included relatively low prevalence and decreasing trends of overweight and obesity, and strong existing support for health behaviours in kindergartens and child care services.

Promoting Fundamental movement skill development and physical activity in early childhood settings : a cluster randomized controlled trial

The aim of this study was to assess the feasibility, acceptability and potential efficacy of a physical activity program for preschool children. A 20-week, 2-arm parallel cluster randomized controlled pilot trial was conducted. The intervention comprised structured activities for children and professional development for staff. The control group participated in usual care activities, which included designated inside and outside playtime. Primary outcomes were movement skill development and objectively measured physical activity. At follow-up, compared with children in the control group, children in the intervention group showed greater improvements in movement skill proficiency, with this improvement statically significant for overall movement skill development (adjust diff. = 2.08, 95% CI 0.76, 3.40; Cohen’s d = 0.47) and significantly greater increases in objectively measured physical activity (counts per minute) during the preschool day (adjust diff. = 110.5, 95% CI 33.6, 187.3; Cohen’s d = 0.46). This study demonstrates that a physical activity program implemented by staff within a preschool setting is feasible, acceptable and potentially efficacious.

Where to from here? Career choices of pre-service teachers undertaking a dual early childhood / primary qualification

Recent Australian government initiatives in the early childhood education and care sector are placing demands for an increase in the number of degree qualified early childhood teachers. Many universities are now offering courses with dual qualifications as a way to provide alternate career opportunities for pre-service teachers; however it cannot be assumed that an equal number of graduates will filter into both primary school and early childhood education jobs. This paper presents a study which examined the expected career choices of pre-service teachers from two Victorian universities who were undertaking a dual early childhood / primary qualification. The findings of the study have implications for teacher education curriculum design in relation to the practical components of courses. The authors therefore argue that more attention needs to be focused on the practical components of teacher training courses considering issues of quality and timing.