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.

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.

Aims and objectives To describe nurses' experiences of a child‐centred family guided intervention of obesity tested within the child health services targeting children identified with overweight and their caregivers. Background Interventions aiming to support families towards a healthier lifestyle can lead to decreased risk of overweight evolving into obesity in a child. At the same time, nurses have found dialogues on weight challenging and may therefore avoid them. Design Qualitative descriptive inductive design following content analysis applying to the COREQ guidelines. Methods Content analysis was used to analyse 13 individual semi‐structured interviews with nurses in the child health service in Sweden after completed training in CCHD, including how to facilitate the dialogue with the use of illustrations. Results The theme Health dialogue about weight is a challenging balancing act facilitated by a supportive intervention emerged through eight subcategories in three main categories. Nurses experienced that CCHD with children identified with overweight and their caregivers provoked an emotional response both for themselves and for the caregivers of the child. The training in child‐centred health dialogues promoted the nurses' work with structure and professionalism, as the nurses carefully took tentative steps to engage the family for a healthy lifestyle. Conclusions Emotional and practical challenges in performing CCHD still remained among nurses after customised training, which might comprise the child's rights to be involved in his or her own care when the child was identified as overweight. However, training for nurses, including lectures and tutorials, was found to increase the quality and professionalism of performing CCHD by providing structure, tools and tutorial support. Relevance to clinical practice Customised training and illustrations can support nurses when performing a structured intervention such as child‐centred health dialogues.

BackgroundThe Child Health Services in Sweden is a well-attended health promoting setting, and thereby has an important role in promoting healthy living habits in families with young children. Due to lack of national recommendations for health dialogues, a Child Centred Health Dialogue (CCHD) model was developed and tested in two Swedish municipalities. The aim of this study was to explore parents’ experiences of health dialogues based on the CCHD model focusing on food and eating habits during the scheduled child health visit at four years of age.MethodsA qualitative design with purposeful sampling was used. Twelve individual interviews with parents were conducted and analysed with qualitative content analysis.ResultsThe analysis resulted in three categories: The health dialogue provides guidance and understanding; Illustrations promote the health dialogue; and Space for children and parents in the health dialogue. In addition, analysis of the latent content resulted in a single theme reflecting the parents’ voice on the importance of having a health dialogue on food and eating habits. The health dialogue, promoted by illustrations, provided guidance and understanding, and gave space for children’s and parents’ involvement.ConclusionsThe results indicate that health dialogues using the CCHD- model create supportive conditions for family members’ active participation in the visits, which may strengthen empowerment and health literacy. The study provides knowledge and guidance for further development, evaluation and implementation of the model.

Childhood obesity is a global health burden that is likely to persist into adulthood and lead to the development of various comorbidities. 1 It tends to have its roots in the preschool years and affects children's immediate health, educational achievements and quality of life. That is why there is an urgent need to prevent obesity and promote healthy lifestyle behaviours at early age. 1 Food intake and physical activity behaviours are seen as modifiable determinants of childhood obesity. Negative indications include a diet low in fruit and vegetable, 2 larger portion sizes than needed, 3 too many sugary drinks, 4 low levels of physical activity and a sedentary lifestyle 5 and a lack of regular and structured family routines. 6 Researchers suggest that the first years of life are a critical time, with regard to developing healthy eating and physical activity, and that parents play a crucial role in that process. 1,7 Reviews have concluded that interventions to prevent obesity in children aged 0-5 years are likely to have optimal effects when

Background Because overweight and obesity are still increasing and prevention of childhood obesity is more likely to be effective when initiated in preschool children, the Child Health Service in the south of Sweden developed a structured child-centred health dialogue model targeting all 4-year-old children and their families. The aim of this study was to describe parents’ recalled experiences of this health dialogue in children with overweight. Methods A qualitative inductive approach with purposeful sampling was used. Thirteen individual interviews with parents (including 11 mothers and 3 fathers) were conducted and analysed with qualitative content analysis. Results The analysis resulted in two categories: ‘A valuable visit with a subtle individual impact’ that described parents’ recalled experiences of the health dialogue and ‘There is a complex interaction between weight and lifestyle’ that reflected the parents’ perceptions of the relationship between their children’s weight and lifestyle. Conclusions Parents recalled the child-centred health dialogue as important and described discussing a healthy lifestyle as one of the obligations of the Child Health Service. Parents wanted confirmation that their family lifestyle was healthy; however, they did not want to discuss the relationship between their family lifestyle and their children’s weight. Parents expressed that when their child followed the child’s growth curve, then this indicated healthy growth. This study supports using the child-centred health dialogue as a model to provide structure for discussing a healthy lifestyle and growth but highlights the difficulties of discussing body mass index and overweight, especially in the presence of children.