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By understanding health conditions, impairments, and impact on quality of life for pediatric feeding disorders, assessment and treatment approaches can target multiple levels of health-related domains that improve child health and well-being. The purpose of this study was to characterize medical diagnoses and feeding impairments for children with feeding disorders; examine child quality of life and caregiver impact; and compare quality of life differences between children with feeding disorders and children with other conditions. A cross-sectional study was conducted in the Greater Boston Area, between October 2017 and June 2018. Fifty children with a feeding disorder diagnosis, ages 2-5 years, were enrolled. Demographic and clinical data were abstracted from the electronic health record to characterize medical diagnoses and impairments. Parents completed the Pediatric Quality of Life Generic Core Scales 4.0 (PedsQL) and the Feeding/Swallowing Impact Survey (FS-IS) to understand child quality of life and caregiver impact. We calculated descriptive statistics across the medical diagnosis and impairment groups, and for the surveys. Children presented with heterogeneous medical diagnoses and feeding impairments. We found a mean (SD) total score of 72.82(19.21) on the PedsQL and 2.33(0.89) on the FS-IS demonstrating that children with feeding disorders presented with poor quality of life and their caregivers were negatively impacted by their feeding difficulties. By understanding medical diagnoses, impairments, and quality of life, assessment and treatment methods can be tailored to children's specific needs, as well as address the overall wellbeing of children and their families.

Background Chewing dysfunction can have adverse effects on growth, development and quality of life. There is a lack of evidence-based consensus guidelines for sensorimotor intervention. To address this, we need to understand the current state of the science in clinical sensorimotor interventions for paediatric chewing dysfunction and systematically plan a research agenda and priorities for the field. Aims The purpose of this scoping review was to examine the extent, range and nature of evidence for oral sensorimotor interventions for paediatric chewing dysfunction. Methods & procedures This scoping review entailed five phases that included: identification of the research question; identification of relevant studies; study selection; data charting; and collation, summarization and report of the results. Treatment studies that were peer-reviewed and written in English were included. All studies involved a paediatric population and included an oral sensorimotor and/or chewing intervention. Information regarding study design, population, intervention, comparator, outcome measures and findings were extracted. Main contribution Of the 21 studies included in this scoping review, 53% were specific to children with cerebral palsy. All interventions were multi-component in nature and the treatment studies included a range of study designs, but few were controlled trials with comparators. A wide variety of outcomes measures were used within and across studies to determine treatment effectiveness. Conclusions & implications The findings suggest that in a small number of studies, sensorimotor interventions provide preliminary evidence for effectiveness in specific populations. These and other treatment protocols must be trialled in additional clinical populations and settings to improve the evidence base for sensorimotor treatment of paediatric chewing dysfunction. This review also serves to help prioritize research agendas and further motivates the need for consensus-based clinical guidelines for paediatric chewing treatment. What this paper adds What is already known on the subject Paediatric feeding disorders are highly prevalent and children often have chewing dysfunction that results in significant negative consequences. We lack evidence-based sensorimotor treatment approaches for chewing dysfunction, which directly impacts the care clinicians can provide children. What this study adds to existing knowledge This scoping review is the first step in examining the literature to understand the current state of the science for oral sensorimotor interventions for paediatric chewing dysfunction. Few randomized controlled studies were identified and a majority included children with cerebral palsy. Most of the interventions were multi-component and included a variety of treatment approaches. What are the potential or actual clinical implications of this work? The results of this scoping review can be used as an initial reference for clinicians selecting treatment approaches for chewing dysfunction. It also serves to help prioritize research agendas and further motivates the need for consensus-based clinical guidelines for paediatric chewing treatment.

Background: Promising approaches for reduction of childhood obesity include interventions such as Connect for Health, a scalable, primary care-based intervention to improve family-centered outcomes for children ages 2-12 years. Substantial gaps remain in the adoption of proven-effective interventions particularly in settings that care for low-income children. Methods: We used the Consolidated Framework for Implementation Research to examine contextual determinants of implementation of Connect for Health in four organizations that deliver primary care to low-income children in Boston, MA, Denver, CO, and Greenville, SC. The Connect for Health program includes (1) electronic health record (EHR)-based clinical decision support tools to guide clinicians; (2) family educational materials; and (3) text messages for parents to support behavior change. We used the RE-AIM framework to guide our mixed-methods evaluation. Using a quasi-experimental design, we will examine the effectiveness of stakeholder-informed strategies in supporting program adoption and child outcomes. At baseline, we abstracted EHR data from the organizations to describe characteristics of children ages 2-12 years with a BMI ≥ 85th percentile.Results: During the 15-month period prior to implementation, 26,161 children with a BMI ≥ 85th percentile ages 2-12 years were seen for a primary care visit. Across the organizations, 79% of children with a BMI ≥ 85th percentile had public insurance, 49% were Hispanic, and 18% were Black. Approximately 37% of children had a BMI ≥ 95th percentile and 15% had a BMI in the severe obesity category. Childhood obesity ICD-10 diagnostic codes were used more for children with obesity (44%) and severe obesity (60%) than children with overweight (17%); nutrition (7%) and physical activity (6%) counseling codes were seldom used. Referrals for weight management programs were less than 17% and less than 16% for nutrition services. Laboratory evaluations were ordered more often for children with obesity (39%) and severe obesity (64%) than children with overweight (29%)Discussion: A majority of children with overweight and obesity lacked recommended diagnosis codes, referrals, and laboratory evaluations for assessment and management of obesity and related co-morbidities. These findings suggest the need to augment current approaches to increase uptake of proven-effective weight management programs. Trial Registration: Clinicaltrials.gov, NCT04042493, Registered on August 2, 2019; https://clinicaltrials.gov/ct2/show/NCT04042493

BackgroundChildhood obesity is highly prevalent in the US and disproportionately impacts communities of color and low-income populations; these disparities have worsened during the COVID-19 pandemic. Adoption of effective pediatric weight management interventions (PWMIs) that have been evaluated among low-income diverse populations is needed. The Healthy Weight Clinic PWMI, a package co-developed by the American Academy of Pediatrics and Massachusetts General Hospital, helps health centers establish multidisciplinary Healthy Weight Clinics based on previous randomized controlled trials which demonstrated effectiveness. We sought to identify the determinants to successful adoption of this PWMI and understand adaptations needed prior to implementation in new sites. MethodsWe interviewed 20 stakeholders, 10 from two health centers in Mississippi where the Healthy Weight Clinic PWMI will be piloted (pre-implementation sites) and 10 from health centers that have previously implemented it (sites in maintenance stages). Separate interview guides informed by the Consolidated Framework for Implementation Research (CFIR) were developed for the pre-implementation sites and those in maintenance stages, including questions related to adaptations of the PWMI in response to the COVID-19 pandemic. Qualitative data analysis was conducted using directed content analysis based on CFIR constructs. Adaptations in response to the pandemic were categorized using Framework for Reporting Adaptations and Modifications-Expanded (FRAME).ResultsIn pre-implementation sites, an inner setting facilitator mentioned was a positive learning climate. Characteristics of individuals that can facilitate adoption include staff willingness to learn, valuing evidence-based care for childhood obesity, and culturally and weight-sensitive staff. In terms of patient needs and resources (outer setting), social drivers of health are barriers to adoption, but creative solutions were suggested to mitigate these. Other facilitators related to the intervention included its multidisciplinary model and adaptability. Similar themes were elicited from sites in maintenance stages; adaptations brought on by the pandemic, such as telehealth visits and content modification to align with distancing guidelines and the effects of social isolation were also described.ConclusionUnderstanding the determinants to adoption of an evidence-based PWMI informs necessary adaptations and implementation strategies required to facilitate nationwide dissemination of PWMIs, with the goal of reaching the populations most at-risk.

Objective:During the perinatal period, modifiable behaviours contributing to excess weight gain, including sugar-sweetened beverage (SSB) intake, are understudied. We examined the extent to which perinatal SSB intake affects postpartum weight retention (PPWR).Design:We measured SSB intake frequency in the third trimester and 1-month postpartum using the NHANES Dietary Screener Questionnaire. We assessed the association between SSB intake and PPWR (difference between 6-month postpartum and pregravid weight) using multivariable regression adjusted for socio-demographic and anthropometric variables.Setting:Greater Boston area.Participants:Three hundred forty-eight mother–infant pairs in the Rise and SHINE prospective birth cohort.Results:Mean age was 32·7 (sd 5·0) years; the sample was 47 % white, 32 % Hispanic, 14 % Asian and 7 % Black. Women reported mean daily SSB intake frequencies of 0·9 (sd 1·2) and 0·7 (sd 1·0) times/d in the third trimester and 1-month postpartum, respectively. At 6-month postpartum, average weight retention was 3·4 (sd 5·7) kg; 108 (sd 31 %) women had substantial PPWR, defined as a ≥ 5 kg increase between pregravid and 6-month postpartum weight. Each 1-time/d increment in SSB intake frequency during the third trimester (β = 0·46 kg (95 % CI, 0·07, 0·86)) and 1-month postpartum (β = 0·52 kg (95 % CI 0·03, 1·00)) was associated with higher weight retention at 6 months. Increased SSB intake frequency in the third trimester (OR: 1·37; 95 % CI 1·10, 1·75) and 1-month postpartum (OR: 1·17; 95 % CI 0·92, 1·52) resulted in higher odds of substantial PPWR.Conclusions:SSB consumption during the perinatal period is associated with higher weight retention at 6-month postpartum. Avoiding SSB may reduce the risk of excess weight retention.

Background Nearly half of all pregnancies in the United States are reported as unintended and rates are highest among women of low socioeconomic status. The purpose of this study was to examine the associations between unintended pregnancies and maternal mental health and timing of prenatal care among low-income women. Methods In this cross-sectional study, 870 women, whom were participating in the First 1000 Days program in three community health centers in the Boston area, were enrolled at their first prenatal visit from August 2016 – September 2017. We assessed pregnancy intention by self-report using the Pregnancy Risk Assessment Monitoring System. We used self-reported survey information and electronic health record data to assess the following outcomes: current stress, current depression, and timing of initial prenatal visit. We used multivariable logistic regression models to examine associations and adjusted for sociodemographic factors. Results Women were a mean (SD) age of 29.3 (6.1), and 39.2% reported that their pregnancy was unintended. 50.6% of women were Hispanic, 28.4% were White, 10.1% were Black, and 10.9% were other races. 78.9% of women reported an annual household income Conclusions Unintended pregnancies were associated with current stress and depression, and delayed prenatal care in this sample of low-income women suggesting the importance of identifying high-risk women and tailoring interventions to support women’s needs. Trial registration ClinicalTrials.gov (NCT03191591; Retrospectively registered on June 19, 2017).

OBJECTIVE: The purpose of this study was to examine the perspectives of caregivers of children with feeding disorders. We sought to understand their child’s feeding impairment through the lens of caregivers, including the impact impairments had on daily life and social participation, what outcomes matter most to caregivers, contextual determinants that affect achieving desired outcomes, and how treatment approaches can optimally support families. METHODS: We interviewed caregivers of children, ages 2–5 years, who received care at the Center for Feeding and Nutrition at MassGeneral Hospital for Children in Boston, MA. All children had a feeding disorder diagnosis, defined as an impairment in oral intake. We analyzed interview transcripts using principles of immersion-crystallization. RESULTS: We reached thematic saturation after interviewing 30 caregivers (25 female). 66.7% of the children were white, 13.3% Asian, 10.0% Black, and 10.0% were more than one race. 30.0% were Hispanic. We identified the four themes: (1) feeding impairments impact the daily life and social participation of children; (2) improving their child’s health and quality of life is most important to caregivers; (3) child, caregiver, and community factors are facilitators of achieving desired outcomes; whereas time, financial, access, and knowledge factors are barriers; and (4) caregivers prefer treatment approaches that incorporate principles of family-centered care. CONCLUSIONS: Given the daily life and social participation impacts of pediatric feeding disorders, treatment approaches should be family-centered, focus on functional and meaningful outcomes to improve the health and quality of life of children and their families, and address modifiable sociocontextual determinants.

BACKGROUND: Few studies have examined the associations of pediatric weight management interventions (PWMIs) with reduction in parental stress. We sought to examine the extent to which a PWMI reduces parental stress and whether changes in parental healthful feeding practices and support for physical activity are associated with reduction in parental stress. METHODS: We analyzed data from the Clinic and Community Approaches to Healthy Weight randomized controlled trial (RCT). Parental stress change over 12 months was analyzed using a multivariate mixed linear model. We then examined associations of changes in healthful feeding practices and support for physical activity over 12 months with changes in stress using a multivariate linear model. RESULTS: In multivariate-adjusted models, participation in a PWMI was associated with decrease in parental stress at 12 months, with a mean difference (MD) of −0.24 U [95% confidence interval (CI): −0.45, −0.04]. Increases in scores for exercising regularly [MD = −0.27 (95% CI: −0.52, −0.03)] and keeping healthy food at home [MD = −0.38 (95% CI: −0.66, −0.10)] were associated with decrease in stress. CONCLUSIONS: Participation in a PWMI was associated with decrease in parental stress. Encouraging parents of children with overweight and obesity to keep healthy food in the house and exercise regularly may represent important strategies to improve parental stress. PWMI effectiveness studies should consider parental stress as an outcome while addressing social determinants of health that may influence parental stress. Clinical Trial Registration Number: NCT03012126.

Atypical eating habits are more common in children with autism spectrum disorders (ASD) than typically developing (TD) peers. Feeding problems may lead to the double burden of specific nutrient deficiencies and excessive weight gain, with a consequent increase in obesity prevalence. The dietary intake of Italian preschoolers with ASD compared to their TD peers and the impact of their dietary choices on their weight status and relationship to food selectivity (FS) were investigated. Dietary patterns and their associations with body mass index (BMI) were evaluated in 65 children with ASD and 82 peers with TD aged 1.3–6.4 years. Eating habits were assessed with a modified version of a parent-rated semi-quantitative Food Frequency Questionnaire. Moreover, the prevalence of FS and possible links with dietary patterns and BMI were investigated in the ASD group. Children with ASD consumed significantly higher amounts of simple sugars, processed and ultra-processed carbohydrates, both low- and high-fat animal proteins, and lower amounts of vegetables and fruits compared to peers with TD. The obesity rate was 1.5% in children with TD and more than fourfold (6.2%) in children with ASD, although the difference between groups was not statistically significant. FS was significantly more frequent in children with ASD than in peers with TD. Children with ASD and FS showed significantly lower annual intakes of vegetable proteins and fiber (considered essential nutrients for a healthy diet) than children with ASD without FS. Our results showed that children with ASD showed different dietary habits than those with TD, with the higher consumption of energy-dense foods and lower amounts of food-sourced fibers, which could place them at increased risk to develop overweight, obesity, and micronutrient deficiencies later in life.

Background: Despite evidence that offering multidisciplinary treatment for children with obesity is effective, access to evidence-based pediatric weight management interventions (PWMIs) is limited. The Healthy Weight Clinic PWMI is a multidisciplinary approach in primary care that improves BMI among children with a BMI ≥ 85th percentile. Objective: To describe the method by which we will evaluate the adoption, acceptability, and feasibility of integrating and implementing a multidisciplinary Healthy Weight Clinic (HWC) into primary care. Design/Methods: We used the Consolidated Framework for Implementation Research (CFIR) domains and constructs to inform our implementation strategies. We will use a Type III hybrid effectiveness-implementation design to test our implementation strategies and improvement in BMI. Sources of data collection will include qualitative interviews with patient caregivers, HWC staff and surveys with HWC staff, patient caregivers, and electronic health record data. Our outcomes are guided by the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. Results: We identified all five CFIR domains as integral for successful implementation. Some strategies to address barriers within these domains include online self-paced training modules for the HWC staff, a virtual learning collaborative, and engagement of site leadership. Outcomes will be measured at the patient and pilot site levels, and they will include patients reached, patient health outcomes such as BMI and quality of life, level of adoption, acceptability, feasibility, and sustainability of the PWMI. Conclusion: Our use of implementation science frameworks in the planning of Healthy Weight Clinic PWMI could create a sustainable and effective program for dissemination.

Purpose: To compare two different tasks and kinematic measures in terms of their ability to detect Amyotrophic lateral sclerosis (ALS) and differences in ALS severity in order to establish potential candidate markers of bulbar decline.Method: We tracked jaw kinematics during speech and chewing to determine which is more affected by bulbar motor deterioration, based on measures of maximum speed and articulatory working space. Data were collected from 31 individuals diagnosed with ALS and 17 neurologically intact controls.Result: (1) Both sentence and chewing tasks were effective in distinguishing between the groups of individuals with ALS and controls, (2) jaw maximum speed for both chewing and speech was a more sensitive marker for bulbar dysfunction than articulatory working space, (3) the sentence task distinguished between ALS subgroups stratified by severity and (4) distinct jaw kinematic differences existed between chewing and sentence tasks. More specifically, movement speed for speech decreased with severity while movement speed for chewing increased with disease severity.Conclusion: The findings from the current investigation suggest that measures of jaw movement speed during chewing and sentence tasks are affected by bulbar deterioration, and jaw speed during a sentence task may serve as a candidate marker of bulbar disease onset and severity.

Background: First 1,000 Days is a systems-oriented program starting in early pregnancy lasting through the first 24 months of infancy focused on preventing obesity and related risk factors among low income, mother-infant pairs. The program was developed in partnership with stakeholders to create an infrastructure for system-wide change. It includes screening for adverse health behaviors and socio-contextual factors, patient navigation and educational materials to support behavior change and social needs, and individualized health coaching for women at highest risk of obesity and has been shown to reduce excess gestational weight gain for women who were overweight at the start of their pregnancy. Methods: We collected information through self-administered questionnaires during the first and third trimester of gestation and from electronic health records relating to obesity risk factors. Measures collected included behavior (i.e., diet, physical activity and screen time) and psychosocial outcomes, as well as enrollment in Women, Infant, and Children (WIC) program. We examined the extent to which participation in the program was associated with changes in behaviors and psychosocial outcomes among women during pregnancy.Results: Women completed surveys at their initial and third trimester prenatal visits (n=264). Mean age (SD) was 30.2 (5.51) years and 75% had an annual household income of 2 and 64% started pregnancy with a BMI ≥ 25 kg/m2. In multivariable adjusted models, we observed decreases in intake of sugary-drinks (-0.96 servings/day; 95% CI: -1.86, -0.06) and in screen time (-0.21 hours/day; 95% CI: -0.40, -0.02), and an increase in physical activity (0.87 days/week; 95% CI: 0.56, 1.17) from the first to third trimester. We also observed a decrease in pregnancy-related anxiety score (-1.06 units; 95% CI: -1.32, -0.79) and higher odds of enrollment in Women, Infant, and Children (WIC) program (OR: 2.58; 95% CI: 1.96, 3.41). Conclusions: Our findings suggest that a systems-oriented prenatal intervention is associated with improvements in behaviors and psychosocial outcomes during pregnancy among low-income mothers.Trial registration: ClinicalTrials.gov (NCT03191591; Retrospectively registered on June 19, 2017)

Background First 1000 Days is a systems-oriented program starting in early pregnancy lasting through the first 24 months of infancy focused on preventing obesity and related risk factors among low income, mother-infant pairs. The program was developed in partnership with stakeholders to create an infrastructure for system-wide change. It includes screening for adverse health behaviors and socio-contextual factors, patient navigation and educational materials to support behavior change and social needs, and individualized health coaching for women at highest risk of obesity and has been shown to reduce excess gestational weight gain for women who were overweight at the start of their pregnancy. The purpose of this study was to examine changes from the first to third trimester for women participating in the First 1000 Days Program. Methods We collected information through self-administered questionnaires during the first and third trimester of gestation and from electronic health records relating to obesity risk factors. Measures collected included behavior (i.e., diet, physical activity and screen time) and psychosocial (i.e., anxiety) outcomes, as well as enrollment in Women, Infant, and Children (WIC) program. We examined the extent to which participation in the program was associated with changes in behaviors and psychosocial outcomes among women during pregnancy. Results Women completed surveys at their initial and third trimester prenatal visits (n = 264). Mean age (SD) was 30.2 (5.51) years and 75% had an annual household income of 2 and 64% started pregnancy with a BMI ≥ 25 kg/m2. In multivariable adjusted models, we observed decreases in intake of sugary-drinks (− 0.95 servings/day; 95% CI: − 1.86, − 0.03) and in screen time (− 0.21 h/day; 95% CI: − 0.40, − 0.01), and an increase in physical activity (0.88 days/week; 95% CI: 0.52, 1.23) from the first to third trimester. We also observed a decrease in pregnancy-related anxiety score (− 1.06 units; 95% CI: − 1.32, − 0.79) and higher odds of enrollment in Women, Infant, and Children (WIC) program (OR: 2.58; 95% CI: 1.96, 3.41). Conclusions Our findings suggest that a systems-oriented prenatal intervention may be associated with improvements in behaviors and psychosocial outcomes during pregnancy among low-income mothers. Trial registration ClinicalTrials.gov (NCT03191591; Retrospectively registered on June 19, 2017).

This cross-sectional, descriptive study examined unmet social and economic needs and health information requests of low-income, expecting fathers who participated in the First 1000 Days program. The First 1000 Days is a systems-level intervention aiming to prevent obesity among low-income mothers and infants across 3 community health centers in Greater Boston, MA, USA. Fathers who attended their partner’s first prenatal care visit were invited to complete a program survey during early pregnancy. Among 131 fathers surveyed, 45% were white, 21% were Hispanic/Latino, 55% were foreign-born, and 69% reported an annual income under $50 000. Fathers reported elevated levels of food insecurity (18%) and 33% were unaware of someone that could provide a $50 loan; however, over 85% of fathers knew someone that could provide non-financial social support. Fathers requested information about pregnancy, birth preparation, and fatherhood. Findings support addressing fathers’ unmet needs during pregnancy and providing father-specific perinatal information.

Introduction Jaw movement during chewing and speech is facilitated by neural activation patterns for opening and closing movements of the mandible. This study investigated anatomic- and task-dependent differences in intermuscular coherence (IMC) and their association with the parameters of jaw muscle activity using surface electromyography (sEMG). Methods We recorded sEMG activation from bilateral and ipsilateral jaw-closing muscle pairs during non-nutritive and nutritive chewing, and during a syllable repetition task. IMC and cross-correlational analyses between bilateral and ipsilateral muscle pairs were performed. Results Intermuscular coherence in the beta band was statistically significant between agonist jaw-closing muscle pairs, with beta IMC weaker for rapid syllable repetition compared to chewing tasks. Cross-correlational analysis of muscle co-activation, as well as sEMG burst amplitude, was positively associated with beta IMC strength. Discussion Beta IMC was influenced heavily by task-dependent behavioral goals and physiologic demands, which was interpreted as evidence of shared neural drive among jaw-closing muscles.

Background Connect for Health is an evidence-based weight management program with clinical- and family-facing components for delivery in pediatric primary care for families of children ages 2 to 12 years. We used the Consolidated Framework for Implementation Research (CFIR) to guide formative work prior to national implementation. The purpose of this study was to describe the process and results of stakeholder engagement and program adaptation. Methods We used mixed qualitative and quantitative methods to iteratively adapt and optimize the program by assessing needs and perspectives of clinicians and parents, as well as contextual barriers, facilitators, and organizational readiness for the uptake of the proposed program tools and implementation strategies. We conducted interviews with primary care clinicians from four health care organizations in Boston, MA; Denver, CO; and Greenville, SC, and used principles of immersion-crystallization for qualitative analyses. We also conducted surveys of parents of children with a body mass index ≥ 85th percentile. Results We reached thematic saturation after 52 clinician interviews. Emergent themes representing the CFIR domains of intervention characteristics, outer and inner setting, and process included (1) importance of evidence-based clinical decision support tools that integrate into the workflow and do not extend visit time, (2) developing resources that respond to family’s needs, (3) using multimodal delivery options for family resources, (4) addressing childhood obesity while balancing competing demands, (5) emphasizing patient care rather than documentation and establishing sustainability plans, and (6) offering multiple training methods that incorporate performance feedback. Of the parents surveyed (n = 400), approximately 50% were Spanish-speaking and over 75% reported an annual income < $50,000. Parents affirmed the importance of addressing weight management during well-child visits, being provided with referrals and resources, and offering multiple methods for resource delivery. Decisions about program modifications were made at the program and healthcare-system level and based on stakeholder engagement findings. Modifications included cultural, geographic, and target audience adaptations, as well as varied resource delivery options. Conclusions To ensure the fit between the Connect for Health program and national implementation settings, adaptations were systematically made through engagement of clinician and parent stakeholders to support adoption, sustainability, and health outcomes. Trial registration NCT04042493

The perturbing effects of vibration applied to head and body structures are known to destabilize motor control and elicit corrective responses. Although such vibration response testing may be informative for identifying sensorimotor deficits, the effect of whole-head vibration has not been tested on oromotor control. The purpose of this study was to determine how jaw movements respond to the perturbing effects of whole-head vibration during jaw motor tasks. Ten healthy adults completed speech, chewing, and two syllable repetition tasks with and without whole-head vibration. Jaw movements were recorded using 3D optical motion capture. The results showed that the direction and magnitude of the response were dependent on the task. The two syllable repetition tasks responded to vibration, although the direction of the effect differed for the two tasks. Specifically, during vibration, jaw movements became slower and smaller during the syllable repetition task that imposed speed and spatial precision demands; whereas jaw movements became faster and larger during the syllable repetition task that only imposed speed demands. In contrast, jaw movements were unaffected by the vibration during speech and chewing. These findings suggest that the response to vibration may be dependent on spatiotemporal demands, the availability of residual afferent information, and robust feedforward models.

Background: Although proven effective interventions for childhood obesity exist, there remains a substantial gap in the adoption of recommended practices by clinicians. Objective: The aims are to: (1) package implementation and training supports to facilitate the adoption of the evidence-based Healthy Weight Clinic Pediatric Weight Management Intervention (PWMI) (based on three previous effectiveness trials); (2) pilot and evaluate the packaged Healthy Weight Clinic PWMI; and (3) develop a sustainability and dissemination plan. Design/Methods: We used the Consolidated Framework of Implementation Research constructs to create an Implementation Research Logic Model that defined the facilitators and barriers of the Healthy Weight Clinic PWMI. We linked these constructs to implementation strategies and mechanisms. Packaging and design will be informed by the core essential components and functions of the PWMI along with stakeholder engagement. Once the package is complete, we will pilot the PWMI by using a Type III effectiveness-implementation hybrid design. Implementation outcomes will be evaluated by using the RE-AIM framework. Results: We will create an integrated, multisystems level package for national dissemination. The package will include training and a suite of resources for primary care physicians and healthy weight clinic staff, including: patient and caregiver facing videos, patient and caregiver handouts, group curriculum guide, online provider trainings, and access to a virtual learning collaborative. Conclusion: The results will highlight the extent to which the package of the Healthy Weight Clinic PWMI facilitates the adoption of effective strategies for treating childhood obesity. Lessons learned will inform modifications to the Healthy Weight Clinic PWMI and strategies for future scaling.

National guidelines suggest that pregnant women consume 2–3 servings of fish weekly and often focus exclusively on limiting mercury exposure. We examined if meeting this recommendation in the third trimester of pregnancy was associated with differences in infant fecal microbiota composition and diversity. We used multinomial regression to analyze data from 114 infant–mother dyads. Applying 16S rRNA gene sequencing, we identified 3 infant fecal microbiota profiles: Bifidobacterium dominant, Enterobacter dominant, and Escherichia dominant. We found that 20% of mothers met the recommended fish consumption, and those infants whose mothers met the recommendation were more likely to have a Bifidobacterium-dominant profile than an Escherichia-dominant profile (RR ratio: 4.61; 95% CI: 1.40, 15.15; P = 0.01). In multivariable models, the significant association persisted (P

Background: Multi-sector stakeholder engagement is essential in understanding what is needed for the implementation, dissemination and sustainability of pediatric weight management interventions (PWMI).Methods: We sought to examine the perspectives of stakeholders during the pre-implementation period of a two-arm, PWMI randomized controlled trial (RCT) in federally qualified health centers and YMCAs. We conducted the interviews prior to the implementation of the RCT and reached thematic saturation. Interviews were transcribed and coded using the Consolidated Framework for Implementation Research (CFIR) approach as the intent of the trial was to observe implementation and efficacy outcomes. Our aims were (1) to understand the core components needed for a successful PWMI and (2) to identify determinants and barriers to implementation and future wide-scale dissemination. We conducted the interviews prior to the implementation of the RCT and reached thematic saturation after interviewing 26 stakeholders representing 13 groups. Interviews were transcribed and coded using the framework analysis approach.Results and discussion: We identified themes that stakeholders perceived as core components of a PWMI: a formal curriculum with illustrative examples for patients (i.e. demonstrating how much sugar is in sugary beverages), a patient and family centered program, group visits, and inclusion of high-quality core personnel such as a community health worker, a physician, a behavior health clinician and a dietitian. Determinants of successful implementation and dissemination included partnerships among community and clinical organizations, sustained funding, supportive policies such as insurance reimbursement for community health workers and dietitians, and identifying and addressing needs of dissemination sites, and identifying and addressing patient barriers. These findings helped to identify the core components required for PWMIs and how best to address key determinants affecting implementation and dissemination. Trial registration: ClinicalTrials.gov: NCT03012126; registration date: 12 December 2016, https://clinicaltrials.gov/ct2/show/NCT03012126

Amyotrophic lateral sclerosis (ALS) is a progressive neurological disease that can result in difficulties with mastication leading to malnutrition, choking or aspiration, and reduced quality of life. When evaluating mastication, clinicians primarily observe spatial and temporal aspects of jaw motion. The reliability and validity of clinical observations for detecting jaw movement abnormalities is unknown. The purpose of this study is to determine the reliability and validity of clinician-based ratings of chewing performance in neuro-typical controls and persons with varying degrees of chewing impairments due to ALS. Adults chewed a solid food consistency while full-face video were recorded along with jaw kinematic data using a 3D optical motion capture system. Five experienced speech-language pathologists watched the videos and rated the spatial and temporal aspects of chewing performance. The jaw kinematic data served as the gold-standard for validating the clinicians’ ratings. Results showed that the clinician-based rating of temporal aspects of chewing performance had strong inter-rater reliability and correlated well with comparable kinematic measures. In contrast, the reliability of rating the spatial and spatiotemporal aspects of chewing (i.e., range of motion of the jaw, consistency of the chewing pattern) was mixed. Specifically, ratings of range of motion were at best only moderately reliable. Ratings of chewing movement consistency were reliable but only weakly correlated with comparable measures of jaw kinematics. These findings suggest that clinician ratings of temporal aspects of chewing are appropriate for clinical use, whereas ratings of the spatial and spatiotemporal aspects of chewing may not be reliable or valid.

The development of chewing is an essential motor skill that is continually refined throughout early childhood. From a motor control perspective, the advancement of textures is dependent upon the fit between a child’s oral anatomic and motor system and food properties. The purpose of this exploratory study is to identify age-related changes in chewing motor coordination and control and to determine if these changes are associated with the differing structural properties of solid foods, as well as to explore the role of explanatory variables such as the emergence of teeth and bite force. The masticatory muscle coordination (i.e., coupling of synergistic and antagonistic muscle pairs) and control (i.e., speed, displacement, chewing rate, duration, and number of chews) of fifty children were assessed cross-sectionally at five ages: 9-, 12-, 18-, 24-, and 36- months using electromyography (EMG) and 3D optical motion capture while children ate three foods that had differing structural properties. The results of this study found that children made gains in their chewing motor control (decreased duration of chewing sequences and lateral jaw displacement) and coordination (improved jaw muscle coupling) throughout this period. The structural differences in foods also affected chewing performance at all ages. These preliminary findings suggest that some solid textures are better adapted for immature mandibular control than others and that the development of chewing is a protracted process that may be impacted by the emergence of teeth and changes to bite force.

A child's transition to independent eating is a protracted process that progresses over the course of many years. Although major health agencies, such as the World Health Organization, now offer clear guidance when to begin introducing solids, advice about how to safely transition to progressively challenging foods is varied and comes from a staggering number of sources. The resulting conflicting views have promoted parental confusion and anxiety about what foods are appropriate and when to advance to new textures. Efforts to develop science-based recommendations for complementary feeding include research on the development of chewing motor skills. Chewing development is an essential aspect of feeding readiness that is often overlooked by agencies developing recommendations for complementary feeding, and little is known about the development of chewing motor skills and how children learn to accommodate foods with varying textures. Such information is essential for designing developmentally appropriate foods, minimizing food aversions, providing caregivers science-based guidance regarding the safety and appropriateness of new foods, and identifying children at risk for choking or feeding impairments.

A child's transition to independent eating is a protracted process that progresses over the course of many years. Although major health agencies, such as the World Health Organization, now offer clear guidance when to begin introducing solids, advice about how to safely transition to progressively challenging foods is varied and comes from a staggering number of sources. The resulting conflicting views have promoted parental confusion and anxiety about what foods are appropriate and when to advance to new textures. Efforts to develop science-based recommendations for complementary feeding include research on the development of chewing motor skills. Chewing development is an essential aspect of feeding readiness that is often overlooked by agencies developing recommendations for complementary feeding, and little is known about the development of chewing motor skills and how children learn to accommodate foods with varying textures. Such information is essential for designing developmentally appropriate foods, minimizing food aversions, providing caregivers science-based guidance regarding the safety and appropriateness of new foods, and identifying children at risk for choking or feeding impairments.