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The most recent data from the Australian Children's Education and Care Quality Authority (ACECQA) present good news; 79% of Australia's Early Childhood Education and Care services are now meeting the National Quality Standard (NQS). Yet one in five services remain below standard. Understanding the context and characteristics of these services, and those of their workforce, and identifying features that distinguish them from services meeting the NQS are the first step in directing quality improvement supports. We compared services rated "Working Towards" with those "Meeting or Exceeding" the standard, through analysis of two discrete datasets: (1) ACECQA snapshots providing service data and (2) The Early Years Workforce Study providing data on educators and educator experience. We identified distinguishing structural characteristics and relational factors within services rated "Working Towards." Based on the findings, strategic directions for bringing the last 21% of services across the line to meet the National Quality Standard are detailed.

The international agenda for quality improvement in early childhood education and care (ECEC) has driven policies targeting workforce professionalisation. Increased training and accountability have been required, but without commensurate renumeration. Attendant staff turnover and educator stress threaten to undermine the achievement of intended policy goals. In a study of the Australian ECEC workforce, we conducted a national survey. We also longitudinally tracked staff turnover in a stratified sample of ECEC centres in remote, regional and urban locations, each with different populations and economic ecosystems. National survey data (N = 916) showed intended exit (22%) was associated with upgrading qualifications and positive motivations at entry to the workforce while intention to stay was associated with having a career role and personal satisfaction. The small variations in wages or work demands in the sector did not moderate these relationships but supportive workplaces increased intention to stay. In tracked centres (N = 98 staff), annual turnover (37%) was explained by personal (e.g., maternity) and workplace factors, both positive (promotion, removing unsuited staff) and negative (dissatisfaction). Highest turnover was in remote locations (47%). We conclude that long term sustainability should attend to appropriate reward of professionalisation. In the short-term supportive workplace culture is critical in retaining and sustaining educators. [This article was co-written with The Early Years Workforce Study team: (Karen Thorpe, Sue Irvine, Paula McDonald), Jennifer Sumsion, Angela Ferguson, Mary Lincoln, Kate Liley, and Pam Spall.]

A growing body of literature highlights the important role of paternal health and socioemotional characteristics in child development, from preconception through adolescence. Much of this research addresses the indirect effects of fathers, for instance, their influence on maternal behaviors during the prenatal period or via the relationship with their partner. However, emerging evidence also recognizes the direct role of paternal health and behavior for child health and adjustment across development. This critical review presents evidence of biological and sociocultural influences of fathers on preconception, prenatal, and postnatal contributions to child development. The National Institutes of Health Environmental influences on Child Health Outcomes (ECHO) program incorporates in its central conceptualization the impact of fathers on family and child outcomes. This critical synthesis of the literature focuses on three specific child outcomes in the ECHO program: health outcomes (e.g., obesity), neurodevelopmental outcomes (e.g., emotional, behavioral, psychopathological development), and positive health. We highlight the unique insights gained from the literature to date and provide next steps for future studies on paternal influences. [ABSTRACT FROM AUTHOR]

Objective: Common obesity‐associated genetic variants at the fat mass and obesity‐associated (FTO) locus have been associated with appetitive behaviors and altered structure and function of frontostriatal brain regions. The authors aimed to investigate the influence of FTO variation on frontostriatal appetite circuits in early life. Methods: Data were drawn from RESONANCE, a longitudinal study of early brain development. Growth trajectories of nucleus accumbens and frontal lobe volumes, as well as total gray matter and white matter volume, by risk allele (AA) carrier status on FTO single‐nucleotide polymorphism rs9939609 were examined in 228 children (102 female, 126 male) using magnetic resonance imaging assessments obtained from infancy through middle childhood. The authors fit functional concurrent regression models with brain volume outcomes over age as functional responses, and FTO genotype, sex, BMI z score, and maternal education were included as predictors. Results: Bootstrap pointwise 95% CI for regression coefficient functions in the functional concurrent regression models showed that the AA group versus the group with no risk allele (TT) had greater nucleus accumbens volume (adjusted for total brain volume) in the interval of 750 to 2250 days (2–6 years). Conclusions: These findings suggest that common genetic risk for obesity is associated with differences in early development of brain reward circuitry and argue for investigating dynamic relationships among genotype, brain, behavior, and weight throughout development. [ABSTRACT FROM AUTHOR]

Objective: The aim was to examine the relationship between caregiver's mental health (parental psychological distress, and parenting stress), dysfunctional parenting (lax or overreactive parenting), and the screen media use in understanding attention‐deficit/hyperactivity disorder (ADHD) symptoms of children within an integrated model framework. Background: Familial factors and screen use have shown to be significantly related to ADHD in children. However, theoretical models of the role of family environment, screen use, and ADHD have rarely been tested jointly, and little is known about these associations in southeastern European middle‐income countries (MICs). Method: Data from 835 primary caregivers (92% biological mother, 4% biological father, 3% grandmother or grandfather, 1% other) of children (2 to 9 years) from three MICs were analyzed using path analyses, and models were tested for generalizability across education levels and marital status using multigroup analyses. ADHD‐related symptoms were assessed with a structured clinical interview (Mini International Neuropsychiatric Interview for Children and Adolescents–Parent Version [MINI‐KID‐P]) and the Child Behavioral Checklist (CBCL). Results: Whereas screen use was directly associated with ADHD symptoms across measures, a significant indirect effect of lax parenting on attentional problems via screen use was found only for the CBCL parent report. The final models were tested using multigroup analyses across education levels and marital status with no significant differences. Conclusion: Investments in resource and capacity building for children's primary caregivers that target lax parenting and limiting of screen use may impact children's attentional problems across educational levels and married and nonmarried caregivers. [ABSTRACT FROM AUTHOR]

Appetitive traits are associated with body weight. Increased understanding of how appetitive traits evolve from early life could advance research on obesity risk and inform intervention development. We report on tracking and age-related differences in appetitive traits in childhood within the RESONANCE cohort. Parents of RESONANCE children aged 6.02 ± 2.99 years completed the Child Eating Behavior Questionnaire (CEBQ). Pearson correlations of appetitive traits and age were tested for all participants contributing at least one observation, using each participant's first observation (N = 335). Children's first and second observations of the CEBQ (n = 127) were used to test tracking (paired correlations) and age-related differences (paired t-tests) within individuals. CEBQ correlations with age suggested that satiety responsiveness, slowness in eating, emotional undereating, and desire to drink decreased with age (r = −0.111 to r = −0.269, all p < 0.05), while emotional overeating increased with age (r = 0.207, p < 0.001). Food fussiness demonstrated a quadratic relationship with age. Paired t-tests further supported an increase in emotional overeating with age (M: 1.55 vs. 1.69, p = 0.005). All CEBQ subscales demonstrated moderate to high tracking (r = 0.533 to r = 0.760, p < 0.001). Our initial findings within the RESONANCE cohort suggest that food avoidant traits are negatively related with age, while emotional overeating increases with age, and that appetitive traits track through childhood. [ABSTRACT FROM AUTHOR]

There is increasing evidence that parenting and feeding interact to influence children's eating behaviour and weight status. Interpretation of existing research is complicated by the lack of consensus in the conceptualisation and measurement of both "parenting" and "feeding", particularly the distinction between "styles", "dimensions" and "practices". In addition, the lack of validated tools to concurrently assess feeding practices in infancy limits the capacity to examine the relationships between parenting and feeding in infancy and their short- and long-term influence on weight status. In this paper, we provide an overview of the constructs examined in this emerging area of research, highlight the conceptual, definitional and measurement challenges and propose a unifying model to aid design and the interpretation of intervention studies. Progress on these methodological issues will contribute to the robust evidence required to justify investment in interventions that focus on parenting and feeding in the context of child obesity prevention. (Contains 1 table and 2 figures.)

The prevalence of child emotional and behavioral problems is an international problem but is higher in low‐ and middle‐income countries (LMIC) where there are often less mental health supports for families. Parenting programs can be an effective means of prevention, but must be low‐cost, scalable, and suitable for the local context. The RISE project aims to systematically adapt, implement, and evaluate a low‐cost parenting program for preventing/reducing child mental health problems in three middle‐income countries in Southeastern Europe. This small pre–post pilot study is informed by the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE‐AIM) framework and tested the feasibility of the intervention, the implementation, and evaluation procedures: Phase 1 of the three‐phase Multiphase Optimization Strategy (MOST) for program adaptation. Local facilitators delivered the Parenting for Lifelong Health (PLH) for Young Children program to parents of children aged 2–9 in North Macedonia, the Republic of Moldova and Romania in 2018. Parents completed assessments pre‐ and post‐program. Results demonstrated positive pre–post change for participating families (N = 140) on various outcomes including child externalizing and internalizing symptoms and parenting behavior, in all three countries, all in the expected direction. Program participation was associated with positive outcomes in participating families. Based on the experiences of this pilot study, we outline the practical implications for the successful implementation of parenting programs in the three countries that will inform our next study phases, factorial experiment, and RCT. [ABSTRACT FROM AUTHOR]

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Objective: Obesity risk transmits from parents to children. Underlying neural mechanisms were investigated in this study by evaluating influences of familial obesity risk defined by maternal obesity and influences of current overweight on three indices of brain structure in adolescents.Methods: In total, 22 lean adolescents with lean mothers (lean low-risk), 25 lean adolescents with mothers with obesity/overweight (lean high-risk), and 36 adolescents with obesity/overweight underwent structural MRI scans for estimation of regional gray and white matter volume and cortical thickness.Results: The lean high-risk compared with the lean low-risk group demonstrated lower gray and white matter volume and cortical thickness in the postcentral gyrus (somatosensory cortex), lower gray and white matter volume in the opercular cortex (taste cortex), lower gray matter volume and cortical thickness in the anterior cingulate cortex, and lower cortical thickness in the precuneus. Comparisons of the lean and obesity/overweight groups revealed further structural alterations in the postcentral gyrus, posterior cingulate gyrus, and middle temporal gyrus.Conclusions: Familial obesity risk and current obesity/overweight were associated with overlapping and distinct patterns of brain structure alterations. Longitudinal studies are warranted to investigate whether structural changes associated with familial obesity risk predict future weight trajectories. [ABSTRACT FROM AUTHOR]

The international agenda for quality improvement in early childhood education and care (ECEC) has driven policies targeting workforce professionalisation. Increased training and accountability have been required, but without commensurate renumeration. Attendant staff turnover and educator stress threaten to undermine the achievement of intended policy goals. In a study of the Australian ECEC workforce, we conducted a national survey. We also longitudinally tracked staff turnover in a stratified sample of ECEC centres in remote, regional and urban locations, each with different populations and economic ecosystems. National survey data (N = 916) showed intended exit (22%) was associated with upgrading qualifications and positive motivations at entry to the workforce while intention to stay was associated with having a career role and personal satisfaction. The small variations in wages or work demands in the sector did not moderate these relationships but supportive workplaces increased intention to stay. In tracked centres (N = 98 staff), annual turnover (37%) was explained by personal (e.g., maternity) and workplace factors, both positive (promotion, removing unsuited staff) and negative (dissatisfaction). Highest turnover was in remote locations (47%). We conclude that long term sustainability should attend to appropriate reward of professionalisation. In the short-term supportive workplace culture is critical in retaining and sustaining educators. [ABSTRACT FROM AUTHOR]

Summary: Background: Child food intake and appetitive behaviors show an inconsistent pattern of associations with parental feeding practices. Relationships likely vary depending on parent feeding style, and on the method by which child eating behaviors are measured. Objectives: We tested relationships of controlling and less controlling forms of parental promotion and limitation of eating with food intake and appetitive behaviors assessed in preschoolers' normal school environments. Methods: As part of a 5‐day protocol, preschoolers consumed standardized lunches, and caloric compensation, eating rate and eating in the absence of hunger were assessed. Feeding practices were measured using the Child Feeding Questionnaire (CFQ) and Parent Feeding Styles Questionnaire (PFSQ). CFQ‐Pressure to eat and CFQ‐Restriction were controlling forms of promotion/limitation of child intake, and CFQ‐Monitoring and PFSQ‐Prompting to eat were less controlling forms. Results: Children (3–5y, n = 70) of parents with higher CFQ‐Pressure to eat scores showed lower total intake, consuming significantly fewer calories from bread, snacks and fruits and vegetables. Higher PFSQ‐Prompting to eat was associated with lower fruit and vegetable intake only. CFQ‐Restriction and CFQ‐Monitoring scores were unassociated with food intake. Higher CFQ‐Pressure to eat was associated with slower eating rate, while higher CFQ‐Monitoring was associated with lower intake in absence of hunger. Conclusions: Parental promotion and limitation of intake were associated with preschoolers' eating behaviors assessed in an ecologically valid setting, without parents present. Controlling and less controlling forms showed differential patterns of associations. Results were consistent with child‐to‐parent and parent‐to‐child effects, but research using longitudinal designs is needed to test bidirectional relationships. [ABSTRACT FROM AUTHOR]

Objective: To examine longitudinal patterns of child introduction to foods and drinks targeted for restriction by parents and associations between child intake frequency, mother's own liking, child early exposure and child liking for restricted foods and drinks at 5 years old.Design: The study involved secondary analyses of longitudinal data from mothers and children participating in the NOURISH randomised controlled trial. Patterns of descriptive data were examined, and a binary logistic regression model tested for prediction of child liking of a selection of restricted foods and drinks.Setting: Brisbane and Adelaide, Australia.Participants: Two hundred and eleven mothers and their first born 5-year-old children.Results: The proportion of children who had tried the selected restricted foods and drinks progressively increased from 14 months to 5 years old. Mothers' own high liking for both sweet and savoury restricted foods and drinks predicted child high liking for the same items at 5 years old. Child high intake frequency at 5 years old also predicted child high liking for sweet foods and drinks, but child early exposure did not predict child liking for the restricted items examined.Conclusions: These results challenge the belief that limiting children's intake of foods high in sugar, fat and/or salt will increase their liking for them. Findings instead suggest that restricting children's access to such foods may be beneficial. While further research is required, mothers should be made aware that their own food preferences may inadvertently influence their child's liking for the very foods they are trying to restrict. [ABSTRACT FROM AUTHOR]

Introduction Families in low-income and middle-income countries (LMICs) face multiple challenges (eg, poverty and adverse childhood experiences) that increase the risk for child mental health problems, while the context may provide them with few resources. Existing preventionoriented parenting programmes have been shown to be effective in reducing child behaviour problems and associated risk factors. This project has the overall goal of adapting, implementing and testing a parenting intervention in three Southeastern European LMIC and uses the Multiphase Optimisation Strategy and dimensions of the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. It is implemented over three phases: (1) preparation, (2) optimisation and (3) evaluation. The preparation phase, the subject of this paper, involves the adaptation and feasibility piloting of the parenting programme. Methods and analysis This protocol describes the assessment of an evidence-informed indicated prevention programme for families with children aged 2-9 years (Parenting for Lifelong Health for Young Children) for implementation in FYR of Macedonia, Republic of Moldova and Romania. In this phase, officials, experts, parents and practitioners are interviewed to explore their views of suitability and needs for further adaptation. In addition, a small pre-post pilot study will test the feasibility of the programme and its implementation as well as the evaluation measures in the three countries with 40 families per country site (n=120). Quantitative data analysis will comprise a psychometric analysis of measures, testing pre-post differences using ANCOVA, χ² tests and regression analysis. For qualitative data analysis, a thematic approach within an experiential framework will be applied. [ABSTRACT FROM AUTHOR]

Background Telephone helplines providing 24-h specialist-nurse contact present a source of immediate support for women encountering challenges with breastfeeding and may serve to prolong breastfeeding duration by building self-efficacy. To date there is little evidence on interaction effectiveness and still less on the relative effectiveness for women from different socio-economic backgrounds. Research Aim To establish the effect on maternal breastfeeding self-efficacy of calls made to a nurse-led parenting helpline. Methods From a corpus of calls made to the Australian Child Health Line (N = 723), those made by women presenting a breastfeeding concern as a prime issue (n = 60) were scored for breastfeeding self-efficacy at commencement and completion of recorded interactions. Analyses examined the significance and direction of change from beginning to end of calls and compared difference in change across calls originating from high and low social advantage locations. Results A significant increase in self-efficacy was found, but with low effect size. There was considerable variation among calls; 53% showed improvement, 25% showed no change and 22% showed reduction in breastfeeding self-efficacy. While most calls were made by women from socially advantaged locations, change was more positive for the small number of callers from disadvantaged locations. Conclusion The potential of nurse-led reactive telephone support is evident, but dependent on qualities of the interaction. For women living in disadvantaged locations telephone support may be of particular significance given the greater social barriers to breastfeeding they are likely to encounter. [ABSTRACT FROM AUTHOR]

Objective: Child fussy eating has been associated with a range of maternal feeding practices; however, whether effects are parent-driven, child-driven, or bidirectional (i.e., both) remains unclear. This study tested for bidirectional relationships between nonresponsive and structure-related maternal feeding practices and child fussy eating at age 2, 3.7, and 5 years using a cross-lagged model approach.Methods: First-time Australian mothers (N = 207) reported four nonresponsive and four structure-related feeding practices and child food fussiness (FF) using validated questionnaires at child age 2, 3.7, and 5 years. Bivariate cross-lagged analyses were conducted for each of the eight feeding practices separately.Results: Both child- and parent-driven associations were observed. Higher FF at 3.7 years predicted higher nonresponsive feeding practices and less structure-related practices at 5 years. Higher structure-related practices at 2 and 3.7 years predicted lower FF at 3.7 and 5 years, respectively. Use of food as a reward for behavior at 3.7 years predicted higher FF at 5 years.Conclusions: Both parent- and child-driven associations explain the relationship between fussy eating and feeding practices. Given that early fussy eating is associated with more nonresponsive feeding, providing parents with anticipatory guidance to manage fussy eating behavior in infants and toddlers may help to avoid the use of these practices. Furthermore, the use of structure-related feeding practices and avoiding the use of food rewards may help to prevent the development of fussy eating. [ABSTRACT FROM AUTHOR]

Objective: To characterise parent presentations of fussy eating and mealtime interactions at a point of crisis, through analyses of real-time recordings of calls to a parenting helpline.Design: Qualitative analysis included an inductive thematic approach to examine clinical parent presentations of fussy eating and derive underlying themes relating to mealtime interactions.Setting: Calls made to the Child Health Line regarding feeding concerns were recorded and transcribed verbatim.Subjects: From a corpus of 723 calls made during a 4-week period in 2009, twelve were from parents of children aged 6-48 months.Results: Parents of infants (≤12 months, n 6) presented feeding concerns as learning challenges in the process of transitioning from a milk-based to a solid-based diet, while parents of toddlers (13-48 months, n 6) presented emotional accounts of feeding as an intractable problem. Parents presented their child's eating behaviour as a battle (conflict), in which their children's agency over limited intake and variety of foods (child control) was constructed as 'bad' or 'wrong'. Escalating parent anxiety (parent concern) had evoked parent non-responsive feeding practices or provision of foods the child preferred.Conclusions: Real-time descriptions of young children's fussy eating at a time of crisis that initiated parents' call for help have captured the highly charged emotional underpinnings of mealtime interactions associated with fussy eating. Importantly, they show the child's emerging assertion of food autonomy can escalate parents' emotional distress that, in the short term, initiates non-responsive feeding practices. The current study identifies the importance of educational and emotional support for parents across the period of introducing solids. [ABSTRACT FROM AUTHOR]

Background: This study examined bidirectional relationships between maternal feeding practices and child food responsiveness and satiety responsiveness from 2 to 5 years. Methods: Mothers (N = 207) reported their own feeding practices and child eating behaviours using validated questionnaires at child ages 2, 3.7, and 5 years. Cross-lagged analyses were conducted to test for bidirectional effects, adjusting for child BMI z-score (based on measured weight and height) at 14 months. Results: Eating behaviours and feeding practices showed strong continuity across the three time points. Maternal feeding practices (higher reward for behaviour [β =0.12, p = 0.025] and lower covert restriction [β = -0.14, p =0.008]) were prospectively associated with higher food responsiveness. Conversely, increased child satiety responsiveness was primarily prospectively associated with mothers' feeding practices (increased structured meal timing [β =0.11, p = 0.038], overt [β =0.14, p = 0.010] and covert restriction [β =0.11, p = 0.022]). The only exception was family meal setting, which was prospectively negatively associated with satiety responsiveness (β = -0.11, p =0.035). Conclusion: While maternal feeding practices and child satiety and food responsiveness show strong continuity between child age 2 and 5 years, maternal feeding practices appear to be associated with child food responsiveness over time. Conversely, child satiety responsiveness, but not food responsiveness, may also be associated with maternal feeding practices over time. These results are consistent with interventions that provide feeding advice to parents on how to respond appropriately to individual child eating behaviour phenotype. Trial registration: ACTRN12608000056392. Registered 29 January 2008. [ABSTRACT FROM AUTHOR]

Background: Concerns about fussy eating are common amongst parents of young children. However, studies of the long-term impact of fussy eating show mixed results with regard to adequacy of dietary intake and child growth. This may be in part because there is no accepted definition of fussy eating and studies measure the construct in different ways, commonly relying on parent perception. This longitudinal analysis explores maternal and child characteristics associated with maternal perception of her toddler as a fussy eater in early toddlerhood and subsequent use of feeding practices at 2 years. Methods: Mothers completed a self-administered questionnaire at child age 14 months, describing perception of their child as fussy/not fussy and child behaviour. Intake was assessed using a single 24-h recall and weight was measured by research staff. At child age 2 years mothers completed the validated 28-item Feeding Practices and Structure Questionnaire (FPSQ-28). Weight-for-age z-score (WAZ) was derived from WHO standards. Gram daily intake of fruit, vegetables and meat/ alternative and a dietary diversity score were determined. Maternal/child characteristics independently associated (p ≤ 0.05) with perception of child as a fussy eater were determined using logistic regression. Variables were combined in a structural equation model assessing the longitudinal relationship between child/maternal characteristics, perception of child as a fussy eater and eight FPSQ factors. Results: Mothers' (n = 330) perception of her child as a fussy eater at age 14 months, was associated with higher frequency of food refusal and lower WAZ (R² = 0.41) but not dietary intake. Maternal perception as fussy (age 14 months) was associated with four FPSQ factors at 2 years (n = 279) - Reward for Eating, Reward for Behaviour, Persuasive Feeding and Overt Restriction, χ²/df = 1.42, TLI = 0.95, CFI = 0.95, RMSEA = 0.04(0.03--0.05), PCLOSE = 0.99. Conclusions: Lower relative child weight and food refusal prompted mothers to perceive their child as fussy. These behaviours in healthy weight children most likely reflect self-regulation of energy intake and neophobia. This perception was prospectively associated with use of non-responsive feeding practices, which may increase obesity risk. Future interventions could directly address perceptions of growth and fussiness, supporting parents to understand food refusal as developmentally appropriate behaviour in healthy young children. Trial registration: ACTRN12608000056392. Registered 29 January 2008. [ABSTRACT FROM AUTHOR]