A Healthy Weight for Toddlers? Two-Year Follow-up of a Randomized Controlled Trial of Group Well-Child Care

Abstract

Rapid weight gain during the first year of life is associated with childhood obesity, adult obesity, and all its concomitant morbidities. 1,2 Over the past 30 years, obesity among children 2 to 5 years old doubled. 3 As pediatric health care providers interact with young families routinely throughout the first few years of life, they may be in an ideal position to influence the rate of weight gain.Innovations in care are needed: although past interventions have demonstrated that intensive anticipatory guidance leads to improved diet and eating habits, 4 within the current system of 12-to 18-minute well-child visits, it is unlikely that pediatric providers can provide this additional support. 5 Group well-child care, one such innovation, the provision of well-child care to 4 to 8 infant/parent dyads, allows providers greater interaction with patients. 6,7 Prior analyses of group well-child care have found that group visits allow increased time for education, modeling behaviors, and parent-to-parent support. [8][9][10][11] In group well-child care, there is an emphasis on maternal/infant relationships and parental selfefficacy, both of which have been associated with less obesity among preschool children, school-age children, and adolescents. 12,13 We, thus, designed a follow-up study of participants in a group well-child randomized controlled trial (RCT) at Yale New Haven Hospital (YNHH) to determine the impact of group well-child care on childhood obesity.This study is a follow-up of our initial RCT, conducted in 2008-2009. For the initial study, inclusion criteria were a mother/infant dyad with the infant in the mother's care, gestation ≥37 weeks and born at YNHH, planning to use the YNHH primary care center (PCC), and with English as the primary language. On consenting to participate in the study, the mother/infant dyad was randomized to receive either group or individual care. In both arms, mother/infant dyads received the initial pediatric assessment at 2 to 4 days of life in a traditional model by a pediatric resident or a nurse practitioner (NP). In the control arm, for the first year of life, dyads received standard individual care provided by pediatric 623230C PJXXX10.

Self-efficacy, infant feeding practices, and infant weight gain: An integrative review

“…The experimental arm received infant well care (over the first year of life) focused on maternal–infant attachment and PSE in a group setting with other mothers and infants. In this sample, no statistically significant differences were observed between groups regarding dietary practices or child weight up to 36 months of age; however, the experimental group had less incidence of ever being overweight (Shah et al, 2016). A limitation of the study was that PSE of the mothers was not measured; therefore, differences between groups could not be examined nor pre-/post-intervention differences.…”

“…Shah and colleagues (2016) conducted an intervention study that examined whether dietary behaviors and/or infant/toddler weight differed in a group of mother–infant dyads who received infant well care in a group setting (experimental) versus an individual setting (control). The experimental arm received infant well care (over the first year of life) focused on maternal–infant attachment and PSE in a group setting with other mothers and infants.…”

“…There is also a lack of intervention studies to examine whether self-efficacy plays a causal role in infant feeding practices. Only one study was identified in which self-efficacy was a focus in the intervention (Shah et al, 2016). Of note, there are two intervention studies reported in the literature (Paul et al, 2014; Wasser et al, 2017) that measure self-efficacy as an outcome following interventions aimed at reducing infants’ risk for obesity, but neither has reported self-efficacy results as of the date of this review.…”

The effectiveness of health professional‐delivered interventions during the first 1000 days to prevent overweight/obesity in children: A systematic review

“…After duplicate removal, and title and abstract screening, 230 references were selected for full‐text review. One hundred and eighty eligible studies were identified, describing 39 trials, comprising 46 interventions . Five trials had more than one eligible intervention arm .…”

Acceptability of Group Visits for Attention-Deficit Hyperactivity Disorder in Pediatric Clinics

“…13 Group visits (also known as shared medical appointment) models for ADHD chronic care management can offer support to families but the acceptability of this model for medical providers and families, is not yet known. 14 While group visit models have been examined for well child visits and other pediatric chronic diseases, such as asthma and diabetes, [15][16][17][18][19][20] they have yet to become part of mainstream practice.…”