Background Prevention of child obesity is an international public health priority and believed to be effective when started in early childhood. Caregivers often ask for an early and structured response from health professionals when their child is identified with overweight, yet cost‐effective interventions for children aged 2–6 years and their caregivers in Child Health Services are lacking. Objectives To evaluate the effects and cost‐effectiveness of a child‐centered health dialogue in the Child Health Services in Sweden on 4‐year‐old children with normal weight and overweight. Methods Thirty‐seven Child Health Centers were randomly assigned to deliver intervention or usual care. The primary outcome was zBMI‐change. Results A total of 4598 children with normal weight (zBMI: 0.1 [SD = 0.6] and 490 children with overweight (zBMI: 1.6 [SD = 0.3]) (mean age: 4.1 years [SD = 0.1]; 49% females) were included. At follow‐up, at a mean age of 5.1 years [SD = 0.1], there was no intervention effect on zBMI‐change for children with normal weight. Children with overweight in the control group increased zBMI by 0.01 ± 0.50, while children in the intervention group decreased zBMI by 0.08 ± 0.52. The intervention effect on zBMI‐change for children with overweight was –0.11, with a 95% confidence interval of –0.24 to 0.01 (p = 0.07). The estimated additional costs of the Child‐Centered Health Dialogue for children with overweight were 167 euros per child with overweight and the incremental cost‐effectiveness ratio was 183 euros per 0.1 zBMI unit prevented. Conclusions This low‐intensive multicomponent child‐centered intervention for the primary prevention of child obesity did not show statistical significant effects on zBMI, but is suggested to be cost‐effective with the potential to be implemented universally in the Child Health Services. Future studies should investigate the impact of socio‐economic factors in universally implemented obesity prevention programs.

Summary Promoting young children’s health through health promotion activities is an investment for the future. In the Child Health Services in the south of Sweden a structured Child-Centred Health Dialogue (CCHD) directed to all 4-year-old children was developed using illustrations based on the most important health messages associated with the promotion of healthy lifestyle in preschool children. The aim of this study was to explore the experiences of children participating in CCHD using 21 non-participant observations during their 4-year health visit and additionally 16 individual interviews 0–7 days after their visit, conducted in the child’s home in the presence of a caregiver. Children participated as social actors when guided to express their views based upon their own understanding was the overall main category generated from the qualitative content analysis. The children showed that they liked to participate actively but could influence their choice to participate. They expressed their views based on their daily life and wanted to understand the meaning of the information with which they interacted. The study revealed that 4-year-old children given the opportunity to speak for themselves—elucidating the child’s perspective—interpreted the health messages in a different way than the intended meaning of the illustrations developed by adults. These findings are important for the improvement of CCHD and underline the utmost importance of including children in research on health promotion. This study supports the view that 4-year-old children can take an active role in their health and are capable of making health information meaningful.

HBHC was found to be an equally safe and effective way of providing care as hospital-based care at the onset of type 1 diabetes for children who are medically stable.

Aims: The aim of this study was to test a Child-Centred Health Dialogue model for primary prevention of obesity for 4-year-old children in Child Health Services, for its feasibility and the responsiveness of its outcomes. Methods: A feasibility study was set up with a non-randomised quasi-experimental cluster design comparing usual care with a structured multicomponent Child-Centred Health Dialogue consisting of two parts: (1) a universal part directed to all children and (2) a targeted part for families where the child is identified with overweight. Results: In total, 203 children participated in Child-Centred Health Dialogue while 582 children received usual care. Nurses trained in the model were able to execute both the universal health dialogue and the targeted part of the intervention. Tutorship enabled the nurses to reflect on and discuss their experiences, which strengthened their confidence and security. One year after the intervention fewer normal-weight 4-year-olds in the intervention group had developed overweight at the age of five compared with the control group, and none had developed obesity. The difference in overweight prevalence at follow-up did not reach statistical significance. Conclusions: This study demonstrates that a child-centred, multicomponent, interactive intervention for the promotion of healthy lifestyles and primary prevention of obesity for all 4-year-old children participating in Child Health Services is feasible on a small scale. As almost all caregivers make use of Child Health Services in Sweden, the findings should be confirmed in a randomised controlled trial before the intervention can be implemented on a larger scale.