A child placed in day care is no more likely to gain too much weight than a child who stays home with a parent, a new study indicates.
More sophisticated approaches
Earlier research had suggested there may be an increased risk of obesity for children in day care.
But a new analysis reveals that the potential association between excess weight and non-parental child care faded away after researchers took into account other factors that also influence childhood obesity.
"When we implemented these more sophisticated analytical approaches, we found that association really went away," said study author Dr Inyang Isong, an instructor at Harvard Medical School and a paediatrician with Boston Children's Hospital.
"We cannot say that sending a child to day care makes your child overweight," Isong continued. "We just don't have enough evidence to say that."
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Three out of five children in the United States are in some kind of regular child care, the study authors said in background notes.
"Given that 60 percent of children are in some kind of day care arrangement, these results should be good news for many, many parents," said Dr Michael Grosso, medical director of paediatrics at Northwell Health's Huntington Hospital in Huntington, New York.
A number of factors
Paediatricians and parents have had longstanding concerns that child care might increase a child's risk of gaining weight, said Dr Allison Driansky, an attending paediatrician at Cohen Children's Medical Centre in New Hyde Park, New York.
Most states do not have strict regulations regarding diet and exercise provided at day care, Isong and Driansky said.
"The concern was anytime you take control out of a parent's hands about what a child is eating or what a child is doing during a day, that could lead to obesity," Driansky said. "Not every parent is lucky enough to have a top-of-the-line day care. I think there was some concern that the day care wouldn't cooperate with what a parent wants for their child."
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The new analysis included data from about 10,700 US children from diverse social, economic and ethnic backgrounds.
In the study, Isong and her colleagues assessed the potential influence on weight gain from a number of factors in children's lives. These included a child's gender and race, the age and weight of the mother, the family's financial and social status, the number of parents in the home, and the quality of the neighbourhood in which the family lived.
"We tried to control for a vast array of factors that could influence decisions to place children in child care," Isong said. "When we controlled for all those factors, the association went away."
However, Isong added that this study "is not in any way full proof". Such proof would involve a clinical trial in which children would be randomly assigned to either child care or home care.
The findings were published online in the journal Paediatrics.
"This study did a really beautiful job attempting to understand this very complicated problem," Driansky said. "I'm not sure [the study authors] completely put it to rest, but I think they certainly helped alleviate this worry and highlighted future areas of research for this question."
Regardless, parents still should make sure that their day care is providing nutritious food and encouraging physical activity, Grosso said.
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"Undoubtedly, individual child care settings will produce different outcomes," Grosso said. "Children encouraged to spend active time outdoors will do better than those stuck to a screen. Those who are offered calorie-dense foods as entertainment will be at risk, while those receiving healthful portions of whole grains, fruits and vegetables will do better."
Driansky offered some tips for parents worried about their kids' weight:
- Encourage activity and outdoor play, and get them involved in sports.
- Provide at least five servings of fruits or vegetables a day.
- Limit sugary beverages, including fruit juice.
- Limit TV time, including no TV before the age of 2 and no more than an hour a day after that.
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