Health+promotion

PTRS 832 wiki assignment
toc During class on June 18, we will discuss 4 "hot topics" in pediatric health and wellness: "Back to Sleep" and tummy time, childhood immunizations, childhood obesity (nutrition and fitness), and competitive sports and training in children. In preparation for this discussion, each of you has been assigned one of the topics, and are responsible for finding one peer-reviewed journal article and one web-based resource (website, blog post, article, etc) related to your topic.

I have created a heading on this wiki page for each of the four topics. Under the appropriate heading, please post or embed a link to the web-based resource you found and add details about your journal article to the evidence summary table (to see a sample evidence summary table, please scroll to the bottom of this page http://ptrs8332011.wikispaces.com/Cerebral+Palsy to view an evidence summary table created by students in PTRS 833 last fall).

This must be completed before class on June 18. Please be ready to discuss these topics and share your findings with your classmates in class.

Evidence Summary Table
months to 17 years. || The purpose of this study was to describe the physiologic changes and to evaluate the safety of placing pediatric patients with ALI/ARDS prone for 20 hours/day during the acute phase of their illness. || This study found that early repeated prone positioning as a therapeutic intervention can improve systemic oxygenation in patients with ALI/ARDS. Benefits include improved arterial oxygenation and the use of less toxic levels of inspired oxygen and airway pressures. This also helps to reduce the total length that patients with ALI have to stay on mechanical ventilation. || These factors were not related : sleep position (prone was 51% of cases and supine was 49% of cases), death at night or vs day. -Note: of those factors, only smoking was significantly correlated with brainstem alterations including hypoplasia of the arcuate nucleus (as we remember is an important cardiorespiratory center in the medulla). The authors believe that the environmental smoke may influence the arousal mechanism, a key feature in the apnea theory for SIDS. || From the provider interviews, barriers to education on tummy time were identified. These included time constraints, other priorities, uncertainty, and confusion. The internet search showed a wide variety of information on infant positioning. Based on these findings, it is clear that there is a need for more consistent parental education regarding infant positioning during both sleep and awake times. || L. Baur J. Simpson C. Rissel V. Flood || Archives of Pediatric Adolescent Medicine || Aug. 2011 || Effectiveness of an Early Intervention on Infant Feeding Practices and "Tummy Time" || 667 First time mothers and their infants delivered between 24 and 36 weeks of pregnancy. Randomly allocated between control group and intervention group. Intervention group had a nurse visit at 30-36 weeks gestation and followed by 5 more visits at 1,3,5,9, and 12 months after birth. 4 topics addressed: Infant feeding, nutrition and active play, family physical activity and nutrition, social support || The purpose of this study was to assess the effectiveness of early interventions on early-life risk factors for obesity in children with "tummy time" being one of the outcome measures being assessed due to its importance in the strengthening of the child's neck and back which are crucial for more complicated movements such as sitting, rolling over, crawling, and pulling bodies to a standing position as well as enhanced motor development. || //Despite the benefits of tummy time, it was found that approximately a quarter of mothers in the study didn't practice tummy time daily with their child.// The intervention decreased the age at which infants started tummy time (P=.03) and modestly increased daily practice of tummy time by 7% from 76% to 83% (P=.05). || Thompson, JM Mitchell, EA || Journal of Pediatrics || Oct 2003 || Determinants of Nonsynostotic Plagiocephaly: a case control study. || One hundred infants who had been given a diagnosis of nonsynostotic plagiocephaly and 94 control subjects selected from a citywide database of infants; all between the ages of 2 and 12 months. || The aim of this study was to determine and quantify the causes of nonsynostotic plagiocephaly in infants. || This study found that in the first six weeks a child was more likely to develop this if they were sleeping in the supine position, not to have had varied head position while sleeping, and have had less than five minutes of tummy time a day. This study supported the early identificiation of a preferred head orientation that may help to prevent the development of nonsynostotic plagiocephly in infants. Infants who prefer one side may develop neck muscle dysfunction. This can be prevented by giving the infant different head positions when putting them down to sleep and also by giving supervised tummy time while the infant is awake. ||
 * **Author** || **Source** || **Date** || **Title** || **Sample** || **Methodology/Main Idea** || **Results** ||
 * Russel, D., et al. || South African Journal of Occupational Therapy || May 2009 || Prone Positioning and motor development in the first 6 weeks of life || 120 Black, healthy 6-week old infants; 59 males and 61 female; 2 groups: group 1 that spends > 30 minutes awake in prone position and group 2 spends <30 minutes || This study aimed to collect data on the length of time that 6-week-old babies spend in the prone position and determine the association between prone positioning when awake and motor development. || There was a significant differencebetween the two groups in their gross motor development. Group 1 were more advanced in activities, such as head control, turning of the head, weight displacement towards the thorax, active movements of arms, and position of LE. ||
 * Curley, M., et al. || Chest: The Official Journal of the American College of Chest Physicians || July 2000 || The Effects of Early and Repeated Prone Positioning in Pediatric Patients With Acute Lung Injury || 25 pediatric patients who had Acute Lung Injury or Acute Respiratory Distress Syndrome (ALI/ARDS), ranging in age from 2
 * Chizawsky, L.L. & Scott-Findlay, S. || Association of Women’s Health, Obstetric and Neonatal Nurses || October 2005 || Tummy time! Preventing unwanted effects of the “Back to Sleep” campaign || Infants within the first year of life due to the widespread shift in infant sleeping position to prevent sudden infant death syndrome (SIDS) || Parents should try to place babies on their tummies two to three times a day for short periods and increase this time gradually. The key points for parents to remember are that tummy time should only happen when baby is awake and supervised. || Placing baby prone on her or his parents’ chest allows for tummy time while still providing baby with a sense of warmth, comfort and security. Parents should try to place babies on their tummies two to three times a day for short periods and increase this time gradually. ||
 * Majnemer,A. & Barr, R. || Developmental Medicine and Child Neurology || July 2005 || Influence of Supine Sleep Positioning on Early Motor Milestone Acquisition || 2 sample of infants born at term, all consistently placed in supine sleep position : 71 4-month old infants and 50 6-month old infants || This was a cross-sectional observational study that used a combination of questionnaires, a behavioral diary and a motor examination to determine whether supine sleep-positioned infants have delayed motor skills at 4 and 6 months of age. || 4-month old infants were less likely to achieve skills that involved antigravity extension of the neck and trunk compared to the normative sample. 6-month olds were less likely to sit unsupported compared to normative data. Diaries showed that both groups were limited to prone position exposure. A higher age of parents and higher level of education were correlated with lower motor scores, possibly due to knowledge of "dangers" of prone positioning. ||
 * Goetter M., and Stepans M. || The Journal of Perinatal Education: Advancing Normal Birth || Fall 2005 || First-Time Mothers' Selection of Infant Supine Sleeping Position || 61 new mothers total, 29 in control and 32 in experimental group between the ages of 18 and 39 || The study was a longitudinal, quanitative experimental design that used a convenience sample. The experimental group of mothers were educated about SIDS and the nurse demonstrated optimal sleeping position for the infant at night (supine) and (prone) while supervised. The control group was not specifically educated about SIDS and received no demonstration. 7 weeks later phone calls were made to determine if the mothers followed the instructions for supine infant sleeping. || Mothers in the experimental group chose to place the infant in supine more often than the control group for the first week. However, this result did not carry over to the 7 week mark and no difference was seen between groups at that time. This suggests that additinal education cobined with demonstration resulted in greater compliance by the mothers, but the affect was not lasting. ||
 * Trachtenberg, F. L., et al. || Journal of the American Academy of Pediatrics || 2012 || Risk Factor Changes for Sudden Infant Syndrome After Initiation of Back to Sleep Campaign || 568 SIDS deaths in infants <1 year old || Causes if deaths in 568 infants between 1991 and 2008 were looked at the and the risk factors for the deaths were determined and divded into intrinsic and extrinsic factors (such as sleep position). The risk factors were compared from before the Back to Sleep campaign era and after the initiation. || Nintey-nine percent of infants who died of SIDS had at least one risk factor. Only 5% of SIDS deaths happened in infants with no extrinsic risk. The back to sleep campaign did not have an effect on the average number of risk factors in those infants who died from SIDS. ||
 * Matturri, L., Ottaviani, G., Lavezzi, A || Virchows Archive - The European Journal of Pathology || Dec 2006 || Maternal smoking and sudden infant death syndrome: epidemiological study related to pathogoy || Autopsies of 128 sudden infnat death victims (age<1 yr), 64 males and 38 females, all caucasian || The purpose of this study was to correlate the different risk factors w/the autopsy results and thus to determine if one or more variables is really specfic for SIDS (looking particularly at maternal smoking). The risk factors included "non-preventable" factors that included sex, age, and time of death and "preventable" factors that included parental cigarette smoking, prone position in the crib, and formula feeding. || These factors have high prevalence for SIDS: mothers smoking during and after pregnancy (79%), using formula feeding (64%), age <6 months particularly b/t 2 and 4 months (45% of cases), males more than females (63% mal cases), and have higher incidence in the winter season compared to other seasons (44%).
 * Koren, A., et al. || Journal of Pediatric Health Care || July 2010 || Parental Information and Behaviors and Provider Practices Related to Tummy Time and Back to Sleep || 119 mothers and their newborns; 9 healthcare providers; popular parenting websites || The purpose of this exploratory study was to determine understanding and behaviors among parents related to positioning of their infants. This was done through surveys. Healthcare providers were interviewed for a single 45-minute period to ascertain their practices regarding infant positioning education. Lastly, researchers performed two internet searches to determine what information was available online to parents. || From the parent surveys, it was found that placing an infant in a supine position when awake was the most common practice. This was most often due to frustrated and/or unhappy infants, time constraints, and uncertainty.
 * L. Wen
 * Hutchison, BL

Web-based resources
A Guide to Your Baby's Sleep and Napping from WebMD: []

"Healthy Children" []

"Baby Zone" []

"Parents: Healthy Kids Happy Families" []

Back to Sleep and Tummy to Play []

"Tummy Time for Infants" - is a brief 2 page flyer that explains why tummy time is important, how to make it interesting, and tips on how to get your infant to have more tummy time during their time awake: []

[|March of Dimes Baby Care 101--Tummy Time]

"Tummy Time Tools" []

Evidence Summary Table
Policy statement from the American Academy of Pediatrics. A review of the literature shows that many goals set forth by Healthy People 2010 have been met in terms of immunization coverage for childrew, including over 90% coverage of IPV, MMR, VZB, HBV, and Hib, though the goal of 80% coverage of adolescents has not been met. Challenges to increased coverage include patient cost, physician reimbursement, manufacturing and delivery problems, and the influx of new vaccines. Physicians should continue to advocate for immunization. Harrison et. al || Official Journal Of The American Academy Of Pediatrics || November 2011 || Childhood Immunizations: When Physicians and Parents Disagree || Discussion on what doctors should do in event of a parent refusing vaccinations for their child --- 24 month old boy whose mother is refusing vaccinations || Discussion on how physicians should deal with this issue. A breakdown of ethics, law, communication, parental decision making, clinical response, and recommendations are given to help doctors and parents through a difficult conversation and decision. || No direct results just a thought provoking article that lays out all of the factors that play into a parent and doctor conversation about immunizations || et al. || British Journal of General Practice http://www.ncbi.nlm.nih.gov/pubmed/11761204 || Nov 2001 || Parents' perspectives on the MMR immunisation: a focus group study. || Qualitative study using focus group discussions - forty eight parents coming from different socioeconomic backgrounds whose youngest child was between 14 months and 3 years attended discussion groups. || Three groups accepted MMR vaccine and three groups who refused it. Data analysis used modified grounded theory technique. The aim of the study was to investigate what influences parents to either accept or refuse the vaccination and the impact of the recent controversy of its safety. || Four key factors influenced the parents' decisions: 1: beliefs about the risks and benefits of the vaccine compared to the disease itself 2: informations from the media about its safety 3:health care professionals advice and attitudes 4:view on the importance of individual choice on immunizations 1.Complete and age-appropriate vaccination were significantly reduced among children who belonged to a minority group, had multiple siblings and had parents who perceived the long distance to the place of immunization as a major barrier. 2. The study found that most participants had beliefs favoring immunizations but this did not match up to current immunization status due to socioeconomic factors 3.Paternal education was inversely associated with delayed immunization || [|http://www.sciencedirect.com.proxy.kumc.edu]: || July 2011 || Evaluation of an algorithm for patient-specific childhood immunization clinical decision support system || Study subjects were age 6-years or younger in 2008 and had visited the pediatric clinic on the campus of Wishard Memorial Hospital. Immunization records were retrieved from the RMRS for 135 randomly selected pediatric patients. || The study compared vaccine recommendations from the CDSS for both eligible and recommended timelines, based on the child's date of birth and vaccine history, to recommendations from registered nurses who routinely selected vaccines for administration in a busy inner city hospital, using the same date of birth and vaccine history. The reasons for disagreement between suggestions from the CDSS and nurses were also identified. || For the 135 children, a total of 1215 vaccination suggestions were generated by nurses and were compared to the recommendations of the CDSS. The overall agreement rates were 81.3% and 90.6% for the eligible and recommended timelines, respectively. Common reasons for disagreement between the CDSS and nurses were: (1) missed vaccination opportunities by nurses, (2) nurses sometimes suggested a vaccination before the minimal age and minimal waiting interval, (3) nurses usually did not validate patient immunization history, and (4) nurses sometimes gave an extra vaccine dose. || Speculation that thimerosal containing vaccines also caused autism was also discussed. || Initial concerns about vaccines for MMR and Thimerosal-containing vaccines causing the onset of autism started in 1998.Lack of association was found in studies conducted in California and the United Kingdom. Both studies compared temporal trends in MMR coverage with trends in autism prevalence. Neither study found a positive correlation between this data. A study conducted in Japan found that even though MMR vaccines had been discontinued in 1993, an increase in autism prevalence among cohorts was found. Controlled epidemiologic studies have not found an association between MMR vaccinations and autism. Thimerasol containig vaccines were also cited to not link to autism. Many vaccines that used to contain this preservative have since removed this ingredient due to speculation. ||
 * **Author** || **Source** || **Date** || **Title** || **Sample** || **Methodology/Main Idea** || **Results** ||
 * Gilmour and
 * Thorpe, et al. || Vaccine || Dec 2011 || Homeschooling parents' practices and beliefs about childhood immunizations || Electronic survey of 124 parents representing 396 home school children between the ages of 0-18 years || Since vaccines are required to attend public school this survey was geared to find out how many home school children have vaccines and the parents' beliefs about vaccines. || 38% of families had children with complete vaccines, 56% had partial vaccines, and 6% had not received any vaccines. 64% felt that vaccines were good at preventing disease. Only 33% thought it was a good idea to follow the American Academy of Pediatrics recommendations on vaccines. 39% had safety concerns about vaccines and 48% thought vaccines have dangerous side effects. ||
 * Evans,
 * many of the parents felt pushed by healthcare professionals to get the vaccine
 * all of the parents felt that it was a difficult decision ||
 * Danis et al || Vaccine || Feb 2010 || Socioeconomic factors play a more important role in childhood vaccination coverage than parental perceptions: a cross-sectional study in Greece || The study used school registry to gain basic demographic characteristics of the children, child vaccination booklet to gain vaccination status and self-administered questionnaire to parents/guardians about beliefs, attitudes and barriers to immunizations. A sample size 3434 participants || The purpose of the study was to identify age-appropriate vaccination status among 6-year-old children as related to parental beliefs and attitudes, socioeconomic status and perceived barriers. The results from the questionnaire were compared to the vaccination records and well as the socioeconomic status of the family. || Main Findings:
 * Zhu et al || Atificial Intelligence in Medicine
 * Min-Woong Sohn, PhD et al || Pediatrics: Official Journal Of the American Academy of Pediatrics. || November 2011 || Welfare, Maternal Work, and On-Time Childhood Vaccination Rates || The cohort consisted of a stratified random sample of 1899 families that were receiving welfare in Illinois between September and November 1998 The child sample consisted "target" children who were younger than 3 years at the time of the first survey. || Retrospective study to examine how the work requirements for mothers receiving welfare may affect timely vaccination rates for children. || The study found that "welfare receipt was associated with higher on-time vaccination rates but maternal work was not, independent of each other." However, when the two variables were combined, they found that maternal work was associated with lower on-time vaccination rates. These findings suggest that work requirements for mothers of families who are receiving welfare may ultimately have a negative effect on whether children will get their vaccinations on time. The authors suggested that these findings help identify an at risk population of children for not having the correct vaccination schedule and that these findings direct further legislation when defining ||
 * Smith, Philip J., et al. || Archives of Pediatrics and Adolescents || May 2009 || Progress in Timely Vaccination Coverage Among Children Living in Low-Income Households || Retrospective study that evaluated progress in timely vaccination coverage in children ages 19-35 months who are associated with low-income households || Discussed the barriers associated with timely vaccination in children ages 19-35 months who are associated with low-income households. Compared low-income children vs. high-income children on timeliness of vaccinations. Evaluated the following vaccinations: 4 doses of DTaP-DTP, 3 doses of polio, 1 dose of MMR, 3 doses of hepatitis, 3 doses of Hib, and 1 dose of varicella vaccine by the age of 19 months. || Timely vaccination coverage increased significantly from 1994 to 2004 for the DTaP-DTP, polio, MMR, hepatitis B, and varicella vaccines. However, timely vaccination rates were significantly lower among low-income children vs. high-income children. Smith et al. encourage the following to improve timely vaccination rates: increasing awareness of the VFC program (covers vaccination for low-income children), educational interventions to address health concerns and barriers to vaccination coverage, reminder/recall system, and improved reimbursement for Medicaid and VFC children. ||
 * DeStefano || Clinical Pharmacology & Therapeutics || 2007 || Vaccines and Autism: Evidence Does Not Support Causal Association || Discussion of evidence/research against the link of MMR vaccine and Autism prevalence. || This article discusses multiple studies on the prevalence of autism and the MMR vaccination. Several studies were incorporated within this article. None of the studies listed provided significant correlations or provided support for the relationship between MMR vaccination and increase autism prevalence.
 * DeStefano || Clinical Pharmacology & Therapeutics || 2007 || Vaccines and Autism: Evidence Does Not Support Causal Association || Discussion of evidence/research against the link of MMR vaccine and Autism prevalence. || This article discusses multiple studies on the prevalence of autism and the MMR vaccination. Several studies were incorporated within this article. None of the studies listed provided significant correlations or provided support for the relationship between MMR vaccination and increase autism prevalence.
 * DeStefano || Clinical Pharmacology & Therapeutics || 2007 || Vaccines and Autism: Evidence Does Not Support Causal Association || Discussion of evidence/research against the link of MMR vaccine and Autism prevalence. || This article discusses multiple studies on the prevalence of autism and the MMR vaccination. Several studies were incorporated within this article. None of the studies listed provided significant correlations or provided support for the relationship between MMR vaccination and increase autism prevalence.
 * Hammer L.D, et al. || Pediatrics || June 2010 || Increasing Immunization Coverage || Policy statement from the American Academy of Pediatrics. || Incorporates data from annual National Immunization Surveys and qualitative analysis of the challenges in increasing vaccination coverage. || A review of the literature shows that many goals set forth by Healthy People 2010 have been met in terms of immunization coverage for childrew, including over 90% coverage of IPV, MMR, VZB, HBV, and Hib, though the goal of 80% coverage of adolescents has not been met. Challenges to increased coverage include patient cost, physician reimbursement, manufacturing and delivery problems, and the influx of new vaccines. Physicians should continue to advocate for immunization. ||

Web-based resources
CDC website: Childhood Immunizations http://www.cdc.gov/vaccines/ Mayo Clinic-- Childhood vaccines: Tough questions, straight answers. []

Medline Plus: http://www.nlm.nih.gov/medlineplus/childhoodimmunization.html

HealthyChildren.Org

[]

American Council on Science and Health []

Kids Health: http://kidshealth.org/parent/general/body/vaccine.html

I post this with my tongue firmly in my cheek, but nonetheless, this stands as a powerful illustration of the danger of misinformation: []

Immunize.org []

Pro's and Con's of vaccinations []

Concerns About Autism- CDC & Prevention []

Evidence Summary Table
Heart Journal || May 2012 || Understanding childhood obesity in America: Linkages between household income, community resources, and children's behaviors || 109, 634 in grades 1, 4, 7, and 9 in Massachusetts,and 999 6th graders in 4 regions of Michigan || The researchers sought to discover if a relationship existed between childhood obesity and socioeconomic status, and how household incomes affect children's physical activity level by comparing results from school records for BMI and census on income levels. || The study revealed that in Massachusetts, as income level dropped, levels of childhood obesity rose significantly, differing by up to 33.2%. Results also showed that, for 6th graders in Michigan, as income levels dropped, percentage of fried food eaten per day doubled and time in front of the television tripled. Similarly, vegetable intake and physical activity levels decreased significantly in lower income households. || C. and Layte, R. || Social Science and Medicine || April 2012 || Breastfeeding and risk of overweight and obesity at nine-years of age || 7,798 nine year olds in Ireland || A retrospective multivariable analysis to discover if breastfeeding affects a child's weight at nine years old. || Breastfeeding significantly lowered at child's risk for being obese at nine years old when controlling socio- demographic factors, the child's own lifestyle behaviors, and parental BMI. A 38% risk reduction of obesity was associated with 13-25 weeks of being breasfed and being breastfed for 26 weeks or longer resulted in a 51% risk reduction of obesity. ||
 * **Author** || **Source** || **Date** || **Title** || **Sample** || **Methodology/Main Idea** || **Results** ||
 * Ludwig, D., et al. || The Lancet || February 2001 || Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis || 548 ethnically diverse schoolchildren average age 11.7 years; enrolled in public schools near the Boston, MA area. || A prospective study done over 19 months looking at self reported data of sugar-sweetened drink consumption and examiner measured BMI. || From baseline to followup 57% of the children in this study showed an increase in intake of sugar-sweetened drinks. Researchers found that the odds ratio of becoming obese increased 1.6 times for each additional can or glass of sugar-sweetened drink they consumed each day. The children also reported roughly 1-2 hours of moderate to vigorous activity per day. Also change in diet soda intake was negatively associated with obesity incidence. ||
 * Piernas, C. and Popkin, B. || PubMed || June 2011 || Food Portion Patterns and Trends among U.S. Children and Total Eating Occasion Size, 1977-2006 || 31,337 American children between ages 2-18 || 4 nationally representative surveys of food intake between 1977-78 and 2003-06 were given to the sample of kids to assess portion sizes of select "unhealthy" foods as well as the energy derived from these foods, and locations these foods were purchased in and their portion sizes. || Results showed a significant increase in daily caloric intake between the mentioned 30 years, portion sizes increased significantly both in calories and g/ mL/ oz except for desserts, energy derived from said foods accounted for more of total energy however intake occasions decreased. THere were also increases in energy density of said foods except for hot dogs and sodas,and portion sizes by selling source also showed mostly increases. ||
 * Eagle, TF., et al. || The American
 * McCrory,
 * Collins, CE & Okely, AD || Pediatrics || April 2011 || Parent diet modification, child activity, or both in obese children: an RCT || 165 overweight children as defined by the International Obesity Task-force cut points || 3 intervention arms: Diet arm, Activity arm, and a Diet + activity arm each 6 months in duration. || All groups demonstrated clinically important reduction in BMI. The parent centered diet education group was most effective but not significantly different from the diet and activity group. The activity only program demonstrated a lower reduction of BMI. ||
 * D'Hondt, E., et al. || International Journal of Obesity || April 2012 || A longitudinal analysis of gross motor coordination in overweight and obese children versus normal-weight peers || 50 overweight children, combined with 8 obese children (aged 6-10) and 50 normal weight age and gender matched peers || Anthropometric measurements and level of gross motor coordination assessed in 2007 and again in 2009 among the 2 groups. Children were also given questionnaires at baseline testing. || The study concluded that there is an increasingly widening gap between the gross motor abilities of normal weight children to their overweight/obese peers. It was concluded that participation in sports is a huge contribution to gross motor skills in this age group, and interventions targeting the obese children should be done due to the lack of participation of this population in organized sports. ||
 * Seo, DC & Lee, CG || Journal of School Health || June 2012 || Association of school nutrition policy and parental control with childhood overweight || 246 child-parent pairs from 10 randomly selected public secondary schools in Indiana || Previously validated measures were used to obtain the children's obese status, which included: individual school nutrition policies, parental control over children's intake and physical activity, and frequency of family mealtimes. || Children who attended schools where soda pop and non-low-fat salty snacks could be purchased were more likely to be obese than those at schools where such items were not sold. Children whose parents rarely or never ensured that their child was avoiding eating too many sweets, avoiding spending too much time watching TV, or engaging in physical activity were more likely to be obese than children whose parents did so always or most of the time. ||
 * Sigmund, E., Sigmundova,D., ElAnsari,W. || Child: care, health and development || May 2009 || Changes in physical activity in pre-schoolers and first-grade children: longitudinal study in the Czech Republic || 176 kindergarden children (84 female, 94 male) || With use of an accelerometer for calculating energy expenditure and a pedometer for calculating number of steps, physical activity was measured for a 7-day period in both kindergarden and first grade. The study was longitudinal in nature as the same group of children was monitored over one year. || Results included decreased intensity of activity along with decreased volume of activity in first grade children. Physical activity levels decreased significantly on both weekdays and weekends, with declines occurring while the children were at school, at after school nursery programs and over weekends. The authors suggest that physical activity intervention be promoted during after-school programs and during weekends in school-aged children. ||
 * Sanchez-Vaznaugh, Sanchez BN, Rosas LG, Baek J, Egerter S. || American Journal of Preventative Medicine || May 2012 || Physical Education Policy and Children's Physical Fitness || 91,236 fifth graders (51% male, 49% female) || To assess if these CA fifth graders were being compliant with physical education requirements over the span of 4 years (2006-2010). Grades 1-6 require a minimum of 200 minutes every 10 days. || Results showed that out of the 55 public school districts only 50% (about 28 districts) were compliant with physical education requirements. Physical fitness was also assessed using the 1 mile run or walk test. The cut off for meeting the "standard" was 12 min and 30 sec for the girls and 11 min and 30 sec for the boys in that age group. Policies may improve children's fitness levels, however their success may be linked to compliance. ||

Web-based resources
> > > >
 * Disney Bans Junk Food Commercials on their Network
 * []
 * [|Childhood Obesity Affects Math Performance-ABC News]
 * [|American Heart Association Childhood Obestiy Resources]
 * []
 * [|Packard Pediatric Weight Control Program]
 * []
 * [|CDC Obesity Facts Adolescent & School Health]
 * http://www.activeacademics.org/
 * http://www.kcet.org/socal/departures/landofsunshine/green-justice/there-is-nearly-unanimous-agreement.html
 * Look up PE requirements by state: http://www.aahperd.org/naspe/standards/stateStandards/

Evidence Summary Table

 * **Author** || **Source** || **Date** || **Title** || **Sample** || **Methodology/Main Idea** || **Results** ||
 * Fleisig, G., et al. || The American Journal of Sports Medicine || November 2010 || Risk of serious injury for young baseball pitchers: a 10-year prospective study || 481 youth pitchers from ages 9-14 || The purpose was to measure the cumulative incidence of throwing injuries in youth pitchers over a 10 year period || Those who pitched more than 100 innings in a year were 3.5 times more likely to be injured. Playing catcher also appears to increase a pitchers risk of injury ||
 * Caine,D., et al. || Clinical Journal of Sport Medicine || October 2001 || Does Gymnastics Training Inhibit Growth of Females? || Young female gymnasts-literature review || The authors reviewed literature of several historic and longitudinal studies to determine if gymnastics training inhibits growth of females. They mention that public concerns have been raised over the increasing dominance of smaller-statured female gymnasts. || Elite level female gymnasts experience attenuated growth during periods of heavy training, and some "catch-up" growth during periods of rest. Some studies showed conflicting evidence that this could be due to insufficient diet and nutrient intake during periods of heavy training. ||
 * Sperlich, B., C. Zinner, et al. || European Journal of Applied Physiology || August 2010 || High-intensity interval training improves VO(2peak), maximal lactate accumulation, time trial and competition performance in 9-11-year-old swimmers. || N = 26 (13 male/13 female) competitiveswimmers ages 9-11 || Previous studies have shown that traditional high training volumes have no advantage over hihg-intensity training at a lower volume in both post-pubescent and collegiate athletes. The purpose of this study was to see if these effects held true for pre-pubescent (ages 9-11) competitive swimmers. The study compared performance times for both 100m and 2,000m events when athletes trained for 5 weeks of high intensity interval training and then 5 weeks of high volume training. || When participants were trained using high intensity interval training they saw significant improvements in 2,000m time, competition performance, and VO2max. They also saw increases in maximum rate of lactate accumulation with high intensity training. These results were achieved with less training time and volume as compared to high volume training. ||
 * Brenner, Joel S. and the Council on Sports Medicine and Fitness || Pediatrics, Official Journal of the American Academy of Pediatrics || June 2007 || Overuse Injuries and Overtraining, and Burnout in Child and Adolescent Athletes || 6 to 18 year old athletes-clinical report || Overuse injuries, overtraining, and burnout are growing problems in child athletes in the United States. Children are more at risk for overuse/repetitive injuries because their growing bones cannot handle the repetitive stress like mature adult bones. Adolescents are at risk for overtraining because they are participating in more than one sport per year and are not allowing themselves a break from athletics to allow their injuries to heal and focus on strength. When child athletes focus on one sport they are at risk for burnout which will decrease athletic performance. || The American Academy of Pediatrics Council on Sports Medicine and Fitness recommends limiting 1 sporting activity no more than 5 days/week with at least 1 day of complete rest. Child athletes should have at least 2 to 3 months off per year from their sport to allow injuries to heal, refresh the mind, and work on strength conditioning, and proprioception. If the mind and body is not given sufficient time to rest, the adolescent is at risk for burnout. ||
 * Benjamin, Holly M.D., Glow, Kimberly M.D. PhD. || The Physician and Sportsmedicine || September 2003 || Strength Training for Children and Adolescents: What Can Physicians Recommend? || Children and adolescents- Literature Review || These authors reviewed multiple studies in a literature review to determine the effects of strength and weight training in children and adolescents. They looked at research articles throughout the years to indicate how study findings have changed and what the accepted beliefs are now. || There is a stigma associated with competitive sports and strength training for children and adolescents. Past studies have linked this type of training to stunted growth due to growth plate fractures, muscle strains/sprains, low back injuries, and adverse psychological affects. Despite both positive and negative statistical data from the previous research, the overall conclusion at present is that with appropriate supervision of an organized strength training program (focusing more on technique and less on the amount being lifted), children and adolescents can see strength gains and improved joint flexibility with little to no injury or detriment to their growth cycle or their psychosocial status. Also, an appropriate, supervised strength training program may help decrease sport-related injury by enhancing motor performance. Lastly, it is important not to forget the general health improvement and potential disease prevention that is associated with this type of program. ||
 * Malina, Robert M || Current Sports Medicine Reports || November 2010 || Early Sport Specialization: roots, effectiveness, risks || Children and adolescents-Literature Review || The author did a literature review looking at different aspects of early specialization in youth sports. He looked at the reasons why this has become so prevalent, if this specialization actually works and the risks associated with participation. || The study found that one of the main reasons for children participating in early specialization are parents. There is a great allure of having their child get an edge or an upper hand in competition. In addition, the pursuit of scholarships and a child being labeled early on as "gifted" play major roles in this increased desire to be apart of this early specialization. A previous study stated that 10 years of experience along with over 10,000 hours of deliberate practice are necessary in order to have international success in several disciplines. Parents feel that they must get there child as much of a jump start on this as possible. In reality, a very small amount of athletes develop elite status despite having this early start. Most tend to hear the success stories of people such as Tiger Woods, but these are few far and in between. Many of these children participating are at increased risk for social isolation, burn out, overdependence, manipulation, increased injury, and compromised growth and maturation. ||
 * Britton, JW || Wisconsin Medical Journal || Jan 2005 || Kids Can't Fly:Preventing Falls in Childres || Children and adolscents-Literature Review || This author wanted to find out strategies to prevent fall injuries in children. || Falling is the leading cause of injury for children of all ages. If health care providers educate parents and family members about the risk of injury when falling then injury can be prevented when applied to competitive sports. ||

Web-based resources
The Pros and Cons of Competitive Sports on Youth: [] [] [] [] [|http://articles.cnn.com/2006-07-03/us/rise.kids.sports_1_youth-sports-tennis-lessons-kids?_s=PM:] http://www.worldclasscoaching.com/blog/?p=1726