Development and evaluation study of FLY-Kids: a new lifestyle screening tool for young children

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Abstract

Evaluating, discussing, and advising on young children’s lifestyles may contribute to timely modification of unhealthy behaviour and prevention of adverse health consequences. We aimed to develop and evaluate a new lifestyle screening tool for children aged 1–3 years. The lifestyle screening tool “FLY-Kids” was developed using data from lifestyle behaviour patterns of Dutch toddlers, age-specific lifestyle recommendations, target group analyses, and a Delphi process. Through 10 items, FLY-Kids generates a dashboard with an overview of the child’s lifestyle that can be used as conversation aid. FLY-Kids was completed by parents of children aged 1–3 years attending a regular youth healthcare appointment. Youth healthcare professionals (YHCP) then used the FLY-Kids dashboard to discuss lifestyle with the parents and provided tailored advice. Parents as well as YHCP evaluated the tool after use. Descriptive and correlation statistics were used to determine the usability, feasibility, and preliminary effect of FLY-Kids. Parents ( N = 201) scored an average of 3.2 (out of 9, SD 1.6) unfavourable lifestyle behaviours in their children, while 3.0% complied with all recommendations. Most unfavourable behaviours were reported in unhealthy food intake and electronic screen time behaviour. Parents and YHCP regarded FLY-Kids as usable and feasible. The number of items identified by FLY-Kids as requiring attention was associated with the number of items discussed during the appointment ( r = 0.47, p < 0.001).

Conclusion: FLY-Kids can be used to identify unhealthy lifestyle behaviour in young children and guide the conversation about lifestyle in preventive healthcare settings. End-users rated FLY-Kids as helpful and user-friendly.

What is Known:

• A healthy lifestyle is important for optimal growth, development and overall health of young children (1-3 years) .

• Evaluating, discussing and advising on young children’s lifestyles may contribute to timely modification of unhealthy behaviour and prevention of adverse health consequences .

What is New:

• The new lifestyle screening tool FLY-Kids generates a dashboard with an overview of young children’s lifestyle that can be used as conversation aid between parents and youth healthcare professionals .

• As parents and youth healthcare professionals rated FLY-Kids as helpful and user-friendly, and the number of items identified by FLY-Kids as requiring attention was associated with the number of items discussed during the appointment, FLY-Kids can be considered guiding the lifestyle discussion in preventive healthcare settings .

Supplementary Information

The online version contains supplementary material available at 10.1007/s00431-023-05126-6.

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Most cited references 20

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Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity : Extended international BMI cut-offs

T. J. Cole, T. Lobstein (2012)

The international (International Obesity Task Force; IOTF) body mass index (BMI) cut-offs are widely used to assess the prevalence of child overweight, obesity and thinness. Based on data from six countries fitted by the LMS method, they link BMI values at 18 years (16, 17, 18.5, 25 and 30 kg m(-2)) to child centiles, which are averaged across the countries. Unlike other BMI references, e.g. the World Health Organization (WHO) standard, these cut-offs cannot be expressed as centiles (e.g. 85th). To address this, we averaged the previously unpublished L, M and S curves for the six countries, and used them to derive new cut-offs defined in terms of the centiles at 18 years corresponding to each BMI value. These new cut-offs were compared with the originals, and with the WHO standard and reference, by measuring their prevalence rates based on US and Chinese data. The new cut-offs were virtually identical to the originals, giving prevalence rates differing by < 0.2% on average. The discrepancies were smaller for overweight and obesity than for thinness. The international and WHO prevalences were systematically different before/after age 5. Defining the international cut-offs in terms of the underlying LMS curves has several benefits. New cut-offs are easy to derive (e.g. BMI 35 for morbid obesity), and they can be expressed as BMI centiles (e.g. boys obesity = 98.9th centile), allowing them to be compared with other BMI references. For WHO, median BMI is relatively low in early life and high at older ages, probably due to its method of construction. © 2012 The Authors. Pediatric Obesity © 2012 International Association for the Study of Obesity.

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Predicting adult obesity from childhood obesity: a systematic review and meta-analysis.

M Simmonds, Ryan A. Llewellyn, C G Owen … (2016)

A systematic review and meta-analysis was performed to investigate the ability of simple measures of childhood obesity such as body mass index (BMI) to predict future obesity in adolescence and adulthood. Large cohort studies, which measured obesity both in childhood and in later adolescence or adulthood, using any recognized measure of obesity were sought. Study quality was assessed. Studies were pooled using diagnostic meta-analysis methods. Fifteen prospective cohort studies were included in the meta-analysis. BMI was the only measure of obesity reported in any study, with 200,777 participants followed up. Obese children and adolescents were around five times more likely to be obese in adulthood than those who were not obese. Around 55% of obese children go on to be obese in adolescence, around 80% of obese adolescents will still be obese in adulthood and around 70% will be obese over age 30. Therefore, action to reduce and prevent obesity in these adolescents is needed. However, 70% of obese adults were not obese in childhood or adolescence, so targeting obesity reduction solely at obese or overweight children needs to be considered carefully as this may not substantially reduce the overall burden of adult obesity.

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Systematic review of the relationships between physical activity and health indicators in the early years (0-4 years)

Valerie Carson, Eun-Young Lee, Lyndel Hewitt … (2017)

Background Given the rapid development during the early years (0-4 years), an understanding of the health implications of physical activity is needed. The purpose of this systematic review was to examine the relationships between objectively and subjectively measured physical activity and health indicators in the early years. Methods Electronic databases were originally searched in April, 2016. Included studies needed to be peer-reviewed, written in English or French, and meet a priori study criteria. The population was apparently healthy children aged 1 month to 59.99 months/4.99 years. The intervention/exposure was objectively and subjectively measured physical activity. The comparator was various volumes, durations, frequencies, patterns, types, and intensities of physical activity. The outcomes were health indicators ranked as critical (adiposity, motor development, psychosocial health, cognitive development, fitness) and important (bone and skeletal health, cardiometabolic health, and risks/harm). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was used to assess the quality of evidence for each health indicator by each study design. Results Ninety-six studies representing 71,291 unique participants from 36 countries were included. Physical activity interventions were consistently (>60% of studies) associated with improved motor and cognitive development, and psychosocial and cardiometabolic health. Across observational studies, physical activity was consistently associated with favourable motor development, fitness, and bone and skeletal health. For intensity, light- and moderate-intensity physical activity were not consistently associated with any health indicators, whereas moderate- to vigorous-intensity, vigorous-intensity, and total physical activity were consistently favourably associated with multiple health indicators. Across study designs, consistent favourable associations with health indicators were observed for a variety of types of physical activity, including active play, aerobic, dance, prone position (infants; ≤1 year), and structured/organized. Apart from ≥30 min/day of the prone position for infants, the most favourable frequency and duration of physical activity was unclear. However, more physical activity appeared better for health. Evidence ranged from “very low” to “high” quality. Conclusions Specific types of physical activity, total physical activity, and physical activity of at least moderate- to vigorous-intensity were consistently favourably associated with multiple health indicators. The majority of evidence was in preschool-aged children (3-4 years). Findings will inform evidence-based guidelines. Electronic supplementary material The online version of this article (10.1186/s12889-017-4860-0) contains supplementary material, which is available to authorized users.

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Author and article information

Contributors

Koen Joosten: k.joosten@erasmusmc.nl

Journal

Journal ID (nlm-ta): Eur J Pediatr

Journal ID (iso-abbrev): Eur J Pediatr

Title: European Journal of Pediatrics

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0340-6199

ISSN (Electronic): 1432-1076

Publication date (Electronic): 15 August 2023

Publication date PMC-release: 15 August 2023

Publication date (Print): 2023

Volume: 182

Issue: 10

Pages: 4749-4757

Affiliations

[1 ]GRID grid.416135.4, ISNI 0000 0004 0649 0805, Department of Pediatrics and Pediatric Surgery, , Erasmus MC-Sophia Children’s Hospital, University Medical Center Rotterdam, ; PO Box 2060, 3000 CB Rotterdam, The Netherlands

[2 ]Department of Public Health, Erasmus MC, University Medical Center Rotterdam, ( https://ror.org/018906e22) Rotterdam, The Netherlands

[3 ]GRID grid.5645.2, ISNI 000000040459992X, Department of Medical Informatics, , University Medical Center Rotterdam, ; Rotterdam, The Netherlands

[4 ]Reinier Academy, Reinier de Graaf Hospital, ( https://ror.org/00wkhef66) Delft, The Netherlands

[5 ]National Institute for Public Health and the Environment, ( https://ror.org/01cesdt21) Bilthoven, the Netherlands

[6 ]Netherlands Organisation for Applied Scientific Research TNO, Unit Healthy Living, ( https://ror.org/01bnjb948) Child Health Expertise Group, Leiden, The Netherlands

[7 ]The Netherlands Nutrition Centre, ( https://ror.org/04zmc7w78) The Hague, The Netherlands

[8 ]Dutch Knowledge Centre for Youth Health, Utrecht, The Netherlands

[9 ]GRID grid.7177.6, ISNI 0000000084992262, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Amsterdam UMC, , University of Amsterdam, Emma Children’s Hospital, ; Amsterdam, The Netherlands

[10 ]Association of Dutch Infant and Dietetic Foods Industries, The Hague, The Netherlands

Author notes

Communicated by Gregorio Milani

Article

Publisher ID: 5126

DOI: 10.1007/s00431-023-05126-6

PMC ID: 10587277

PubMed ID: 37580556

SO-VID: 44947b96-bf96-4d36-bd24-2471e4f945b1

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 28 April 2023

Date revision received : 9 July 2023

Date accepted : 18 July 2023

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100002999, Ministerie van Volksgezondheid, Welzijn en Sport;

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ScienceOpen disciplines: Pediatrics

Keywords: lifestyle,toddlers,screening,conversation aid

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ScienceOpen disciplines: Pediatrics

Keywords: lifestyle, toddlers, screening, conversation aid

Development and evaluation study of FLY-Kids: a new lifestyle screening tool for young children

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Abstract

Supplementary Information

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Pediatric Pulse: Advancing Neonatal and Child Health

Most cited references 20

Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity : Extended international BMI cut-offs

Predicting adult obesity from childhood obesity: a systematic review and meta-analysis.

Systematic review of the relationships between physical activity and health indicators in the early years (0-4 years)

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Author notes

Article

History

Funding

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