BACKGROUND AND OBJECTIVES: Children born preterm experience socioemotional difficulties, including increased risk of autism spectrum disorder (ASD). In this secondary analysis, we tested the effect of combined docosahexaenoic acid (DHA) and arachidonic acid (AA) supplementation during toddlerhood on caregiver-reported socioemotional outcomes of children born preterm. We hypothesized that children randomly assigned to DHA 1 AA would display better socioemotional outcomes compared with those randomly assigned to a placebo. METHODS: Omega Tots was a single-site randomized, fully masked, parallel-group, placebocontrolled trial. Children (N = 377) were 10 to 16 months at enrollment, born at ,35 weeks' gestation, and assigned to 180 days of daily 200-mg DHA 1 200-mg AA supplementation or a placebo (400 mg corn oil). Caregivers completed the Brief Infant-Toddler Social and Emotional Assessment and the Pervasive Developmental Disorders Screening Test-II, Stage 2 at the end of the trial. Liner mixed models and log-binomial regression compared socioemotional outcomes between the DHA 1 AA and placebo groups.RESULTS: Outcome data were available for 83% of children (n treatment = 161; n placebo = 153). Differences between DHA 1 AA and placebo groups on Brief Infant-Toddler Social and Emotional Assessment scores were of small magnitude (Cohen's d # 0.15) and not statistically significant. Children randomly assigned to DHA 1 AA had a decreased risk of scoring at-risk for ASD on the Pervasive Developmental Disorders Screening Test-II, Stage 2 (21% vs 32%; risk ratio = 0.66 [95% confidence interval: 0.45 to 0.97]; risk difference = 20.11 [95% confidence interval: 20.21 to 20.01]) compared with children randomly assigned to a placebo. CONCLUSIONS:No evidence of benefit of DHA 1 AA supplementation on caregiver-reported outcomes of broad socioemotional development was observed. Supplementation resulted in decreased risk of clinical concern for ASD. Further exploration in larger samples of preterm children and continued follow-up of children who received DHA 1 AA supplementation as they approach school age is warranted.WHAT'S KNOWN ON THIS SUBJECT: Preterm children are at increased risk for socioemotional difficulties, including autism spectrum disorder (ASD). Docosahexaenoic acid (DHA) supplementation may reduce ASD behaviors, but effects on socioemotional development more broadly are less clear.WHAT THIS STUDY ADDS: Differences between the DHA 1 arachidonic acid and placebo groups on socioemotional development were not statistically significant, and effects were small. Children randomly assigned to DHA 1 arachidonic acid had a decreased risk of clinical concern for ASD compared with children randomly assigned to a placebo.

PurposeObesity prevention is increasingly focused on early childhood, but toddlers have not been well-studied, and children born preterm are frequently excluded. The Play & Grow Cohort was established to investigate child growth in relation to parent-child interactions in mealtime and non-mealtime settings.ParticipantsBetween December 2017 and May 2019, 300 toddlers and primary caregivers were recruited from records of a large paediatric care provider in Columbus, Ohio, USA. This report describes recruitment of the cohort and outlines the data collection protocols for two toddler and two preschool-age visits. The first study visit coincided with enrolment and occurred when children (57% boys) were a mean (SD) calendar age of 18.2 (0.7) months.Findings to dateChildren in the cohort are diverse relative to gestational age at birth (16%, 28–31 completed weeks’ gestation; 21%, 32–36 weeks’ gestation; 63%, ≥37 weeks’ gestation) and race/ethnicity (8%, Hispanic; 35%, non-Hispanic black; 46%, non-Hispanic white). Caregivers enrolled in the cohort are primarily the child’s biological mother (93%) and are diverse in age (range 18–54 years), education (23%, high school or less; 20% graduate degree) and annual household income (27%, <US$20 000 24%, ≥US$90 000). Parent-child interactions were video-recorded during play in the laboratory at 18 months (n=299) and during play, reading and mealtime in the home (n=284) at 24 months. The preschool phase of the study was impacted by COVID-19. Parent-child interactions were video-recorded during play and mealtime at home at 36 months (n=141) and during a standardised buffet meal in the laboratory at 42 months (n=50). Caregivers unable to participate in face-to-face visits due to COVID-19 completed questionnaires.Future plansAssessment during middle childhood is being planned. Future visits will include anthropometric measurements and parent-child interactions at mealtime. School-based outcomes are additionally being considered.

Background Chaos has implications for child health that may extend to childhood obesity. Yet, results from studies describing associations between chaos and childhood obesity are mixed. New approaches to studying the environments of young children may help to clarify chaos-obesity relationships. Methods We conducted a concurrent mixed methods analysis of quantitative and qualitative data describing home and neighborhood chaos among a diverse cohort of 283 caregiver-toddlers dyads from Ohio. We examined the underlying structure of environmental and household chaos using exploratory factor analysis then sought to validate the structure using qualitative field notes. We generated total scores for factors of chaos and described their distributions overall and according to cohort characteristics. Additionally, we conducted a thematic content analysis of brief ethnographies to provide preliminary construct validity for our indicators of chaos. Results Dyads varied according to household composition, income, education, and race/ethnicity. We found evidence for a multi-factor structure for chaos, which included disorganization and neighborhood noise. Household disorganization scores ranged from 0 to 7.3 and were on average 2.1 (SD = 1.8). Neighborhood noise scores ranged from 0 to 4 and were on average 1.1 (SD = 1.1). Both disorganization and neighborhood noise were associated with indicators of socioeconomic disadvantage, such as lower educational attainment and household income. Qualitative data from households with high and low scores on the two identified factors were aligned in ways that were supportive of construct validity and further contextualized the social and material environments in which chaos occurred. Conclusions Chaos represents a complex construct with implications spanning various disciplines, including childhood obesity research. Previous studies suggest challenges associated with measuring chaos may limit the conclusions that can be drawn about which aspect of chaos (if any) matter most of early childhood weight development. We advance the literature by demonstrating chaos may be comprised of conceptually distinct subdomains. Future childhood obesity prevention research may benefit from more contemporary measure of chaos, such as those relying on direct observations that account for a multifaceted underlying structure.

Background: Chaos has implications for child health that may extend to childhood obesity. Yet, results from studies describing associations between chaos and childhood obesity are mixed. Challenges to studying chaos-obesity relationships may include inconsistencies in how chaos is operationalized and reliance on caregiver perceptions. Furthermore, multiple pathways may link chaos to obesity, though few have been empirically examined.Methods: We conducted a concurrent mixed methods analysis of quantitative and qualitative data describing home and neighborhood chaos among a diverse cohort of 283 caregiver-toddlers dyads from Ohio. We examined the underlying structure of environmental and household chaos using exploratory factor analysis then sought to validate the structure using qualitative field notes. We generated total scores for factors of chaos and described their distributions overall and according to cohort characteristics. Additionally, we conducted a thematic content analysis of brief ethnographies to identify potential pathways linking chaos to childhood obesity with the intention to direct future research efforts.Results: Dyads varied according to household composition, income, education, and race/ethnicity. We found evidence for a multi-factor structure for chaos, which included disorganization and neighborhood noise. Household disorganization scores ranged from 8-18 and were on average 11.37 (SD = 2.58). Neighborhood noise scores ranged from 4-12 and were on average 6.93 (SD = 1.89). Both disorganization and neighborhood noise were associated with indicators of socioeconomic disadvantage, such as food insecurity and lower income-to-poverty ratio, though only disorganization was associated with additional social factors within homes, such as caregiver mental health and overall health. Finally, we identified unique themes from brief ethnographies which future contextualize the social and material environments in which chaos was observed, including child behavior and caregiver-child interactions.Conclusions: Chaos is a complex construct composed of multiple factors and the mechanisms linking chaos to childhood obesity may be equally complex. Future studies of chaos-obesity relationships may require greater specificity when operationalizing chaos and empirical study of pathways, like child behavior and caregiver-child interactions, may inform future obesity prevention strategies.

Early childhood is a critical period of life when nutritional choice and mealtime routines develop and obesogenic tendencies may be established. There is a need for greater understanding of toddlers and how parent-child interactions over time and across contexts relate to development of obesity. The purpose of this protocol paper is to describe the recruitment strategy, protocol, and characteristics of participants in the Play and Grow cohort. Between December 2017 and May 2019, three-hundred caregivers and their 16- to 19-month-old toddler (57 percent male) were recruited from records of the major pediatric provider in Central Ohio and enrolled in an ongoing 2-year prospective study. The cohort is diverse in race and ethnicity, parent education and age, household income, and family composition. Thirty-seven percent of children were born preterm (less than 37 weeks gestation). The first visit, completed by 299 families at mean (SD)18.2 (0.7) months child calendar age, included video-recorded parent-child interaction during play, anthropometric measurements, and caregiver questionnaire. Six months later, a home visit completed by 284 families included observation and video-recording of parent-child interaction in mealtime and non-mealtime contexts. This diverse cohort is being followed prospectively through ongoing home and laboratory visits at child ages 36 and 42 months. Growth trajectories of children will be analyzed in relation to self-regulation and quality of parent-child interaction.