Pediatric obstructive sleep apnea (OSA) has become widely recognized only in the last few decades as a likely cause of significant morbidity among children. Many of the clinical characteristics of pediatric OSA, and the determinants of its epidemiology, differ from those of adult OSA. We systematically reviewed studies on the epidemiology of conditions considered part of a pediatric sleep-disordered breathing (SDB) continuum, ranging from primary snoring to OSA. We highlight a number of methodologic challenges, including widely variable methodologies for collection of questionnaire data about symptomatology, definitions of habitual snoring, criteria for advancing to further diagnostic testing, and objective diagnostic criteria for SDB or OSA. In the face of these limitations, estimated population prevalences are as follows: parent-reported "always" snoring, 1.5 to 6%; parent-reported apneic events during sleep, 0.2 to 4%; SDB by varying constellations of parent-reported symptoms on questionnaire, 4 to 11%; OSA diagnosed by varying criteria on diagnostic studies, 1 to 4%. Overall prevalence of parent-reported snoring by any definition in meta-analysis was 7.45% (95% confidence interval, 5.75-9.61). A reasonable preponderance of evidence now suggests that SDB is more common among boys than girls, and among children who are heavier than others, with emerging data to suggest a higher prevalence among African Americans. Less convincing data exist to prove differences in prevalence based on age. We conclude by outlining specific future research needs in the epidemiology of pediatric SDB.

Among the 4 parenting styles, authoritarian parenting was associated with the highest risk of overweight among young children. Understanding the mechanisms through which parenting styles are associated with overweight risk may lead to the development of more-comprehensive and better-targeted interventions.

A mosaic of cross-phylum chemical interactions occurs between all metazoans and their microbiomes. A number of molecular families known to be produced by the microbiome have a profound impact on the balance between health and disease 1-9. Considering the diversity of the human microbiome, numbering over 40,000 operational taxonomic units 10 , the impact of the microbiome on the chemistry of an entire animal remains underexplored. In this study, mass spectrometry informatics and data visualization approaches 11-13 were used to provide an assessment of the impacts of the microbiome on the chemistry of an entire mammal by comparing metabolomics data from germ-free (GF) and specific pathogen Reprints and/or permissions can be provided by R. Quinn or P.C. Dorrestein.

Higher BMI z score in girls as young as 36 months of age and higher rate of change of BMI between 36 months old and grade 1, a period well before the onset of puberty, are associated with earlier puberty, which suggests that increasing rates of obesity in the United States may result in an earlier average age of onset of puberty for US girls.

Objective Examine associations of maternal mobile device use with the frequency of mother-child interactions during a structured laboratory task. Methods Participants included 225 low-income mother-child pairs. When children were ~6 years old, dyads were videotaped during a standardized protocol in order to characterize how mothers and children interacted when asked to try familiar and unfamiliar foods. From videotapes, we dichotomized mothers based on whether or not they spontaneously used a mobile device, and counted maternal verbal and nonverbal prompts toward the child. We used multivariate Poisson regression to study associations of device use with eating prompt frequency for different foods. Results Mothers were an average of 31.3 (SD 7.1) years old and 28.0% were of Hispanic/non-white race/ethnicity. During the protocol, 23.1% of mothers spontaneously used a mobile device. Device use was not associated with any maternal characteristics, including age, race/ethnicity, education, depressive symptoms, or parenting style. Mothers with device use initiated fewer verbal (RR 0.80 [95% CI: 0.63, 1.03]) and nonverbal (0.61 [0.39, 0.96]) interactions with their children than mothers who did not use a device, when averaged across all foods. This association was strongest during introduction of halva, the most unfamiliar food (0.67 [0.48, 0.93] for verbal and 0.42 [0.20, 0.89] for nonverbal interactions). Conclusions Mobile device use was common and associated with fewer interactions with children during a structured interaction task, particularly nonverbal interactions and during introduction of an unfamiliar food. More research is needed to understand how device use affects parent-child engagement in naturalistic contexts.

To determine if limited ability to delay gratification (ATDG) at age 4 years is independently associated with an increased risk of being overweight at age 11 years and to assess confounding or moderation by child body mass index z score at 4 years, self-reported maternal expectation of child ATDG for food, and maternal weight status.

Purpose of review To highlight the recent findings on sleep–obesity associations in children. We focus on sleep duration, sleep timing and chronotype, and describe the potential mechanisms underlying sleep–obesity associations. Recent findings Poor sleep is increasingly common in children and associations between short sleep duration in early childhood and obesity are consistently found. Less is known about the infancy period, and the findings in adolescents are inconsistent. Sleep timing patterns may also contribute to obesity risk. Variable and shifted sleep schedules and evening chronotypes have recently been linked to adiposity in adults; less is known about children. Further, there is little understanding regarding the mechanisms of association. The timing of eating, dietary intake, obesogenic eating behaviors, and changes in appetite-regulating hormones have been identified as possible mechanisms for sleep–obesity associations and may be promising avenues for future research. Longitudinal and experimental work with children is needed to determine the nature of associations. Summary Beyond sleep duration, sleep timing patterns may contribute to obesity risk. Biological and behavioral processes have been proposed as mechanisms that may explain the association. Understanding the pathways through which poor sleep patterns could increase obesity risk in children may provide novel avenues for intervention.

OBJECTIVES Childhood obesity and bullying both are pervasive public health problems. The objective of this study was to determine the relationship between childhood obesity and being bullied in third, fifth, and sixth grades while testing for potential confounding and moderation. METHODS A total of 821 children who were participating in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (50% male, 81% white, 17% obese, 15% overweight in third grade) were studied. Generalized estimating equations were used to evaluate the relationship between child weight status and the odds of being bullied as reported by child, mother, and teacher, accounting for repeated measures and adjusting for grade level in school, child gender, child race, family income-to-needs ratio, school racial and socioeconomic composition, and mother- and teacher-reported child social skills and child academic achievement. RESULTS In sixth grade, 33.9%, 44.5%, and 24.9% of the children were reported to be bullied per teacher-, mother-, and self-report, respectively. There was a significant independent association between being obese and being bullied (odds ratio: 1.63 [95% confidence interval: 1.18–2.25]). The relationship between being obese and being bullied was attenuated but not eliminated by all covariates except gender. The relationship was not moderated by any of the covariates. CONCLUSIONS Children who are obese are more likely to be bullied, regardless of a number of potential sociodemographic, social, and academic confounders. No protective factors were identified. Effective interventions to reduce bullying of obese children need to be identified.