Appetite to Play Intervention for Active Child Development

Overseen By Patti-Jean Naylor, PhD

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: University of British Columbia

Disqualifiers: Outside Metro Vancouver, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

52 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

The trial tests a new support program called "Appetite to Play," designed to help childcare providers in British Columbia implement best practices for active play. The goal is to determine if this program can improve children's physical activity, reduce sedentary behavior, and enhance motor skills. The trial includes two groups: one receiving the full support program and another on a waitlist to receive it later. Childcare centers in Metro Vancouver caring for children aged 2½ to 6 years are eligible to participate. This study could influence future policies on active play in childcare settings. As an unphased trial, it offers a unique opportunity to contribute to research that may enhance children's health and development in these environments.

Will I have to stop taking my current medications?

The trial information does not specify whether participants need to stop taking their current medications.

What prior data suggests that this intervention is safe for childcare providers and children?

Research shows that the Appetite to Play program is well-received and effective in various locations. Studies indicate it reaches a wide audience, with nearly 26,000 website visits and 195 workshops conducted. These results suggest the program is safe, as no problems have been reported. The program aids childcare providers in promoting active play, which is generally safe and beneficial for children. Overall, evidence suggests this program is safe for use, particularly since it involves only educational resources and support, not medical treatments. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Appetite to Play intervention because it goes beyond typical resources by actively building the capacity of childcare providers to promote active play. Unlike standard materials that are passively accessed, this intervention includes engaging e-learning modules and ongoing support through regular emails. This approach is designed to empower providers with practical, actionable strategies to enhance active play, potentially leading to more effective outcomes in child development.

What evidence suggests that the Appetite to Play intervention is effective for improving active play in childcare centers?

Research has shown that the Appetite to Play program can significantly enhance the promotion of active play in childcare settings. In this trial, the experimental group will receive the Appetite to Play + intervention, which includes e-learning modules and support emails to assist childcare providers in implementing best practices for active play. Previous studies have found that the program reaches many people, with numerous visits to the website and workshop attendance, indicating successful engagement with childcare providers. The program aims to help childcare providers adopt best practices for active play, which can improve children's physical activity and motor skills. Evidence from these studies highlights its success in enhancing physical activity and nutrition policies. Overall, Appetite to Play appears promising in fostering environments that support active child development. ^{1 5 6 7 8}

Who Is on the Research Team?

Louise C Masse, PhD

Principal Investigator

University of British Columbia

Are You a Good Fit for This Trial?

This trial is for full-time childcare providers and managers in Metro Vancouver who work with children aged 2 1/2 to 5 years. Childcare centers must have at least 10 kids, operate over four hours daily, and volunteer for the study. Children involved must attend these centers and be within the specified age range.

Inclusion Criteria

You need childcare for more than 4 hours a day.

Your child must go to a specific childcare that has agreed to take part in the study.

The child must be between 30 and 60 months old.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

The experimental group receives the Appetite to Play + intervention, which includes 3 e-learning online modules and weekly to bi-weekly email support.

3 months

Online modules and email support

Waitlist Control

The standard of care waitlist control group will receive the intervention at 3-months post-randomization.

3 months

Follow-up

Participants are monitored for changes in physical activity behavior, characteristics of childcare settings, and characteristics of providers.

6 months

What Are the Treatments Tested in This Trial?

Interventions

• Appetite to Play

Trial Overview The 'A Good Start Matters' intervention aims to enhance Active Play practices in childcare facilities by providing implementation support strategies. The effectiveness will be evaluated based on changes in Active Play practices and improvements in child-level outcomes like physical activity, sedentary behavior, and motor skills.

How Is the Trial Designed?

Group I: Standard of care waitlist control Experimental Treatment 1 Intervention

The standard of care waitlist control group will receive the intervention at 3-months post-randomization. The standard of care group has access to the Appetite to Play materials which are available to everyone. The site includes resources that childcare providers can use.

Group II: Intervention group Experimental Treatment 1 Intervention

The experimental group will receive the Appetite to Play + intervention which is a capacity-building intervention that support childcare providers in implementing the best practices for active play. It includes a 3 e-learning online modules and then the are supported with weekly . bi-weekly emails.

Appetite to Play is already approved in Canada for the following indications:

Approved in Canada as Appetite to Play for:

• Promoting physical activity and healthy eating habits in childcare settings

Who Is Running the Clinical Trial?

University of British Columbia

Lead Sponsor

Trials

1,506

Recruited

2,528,000+

Canadian Institutes of Health Research (CIHR)

Collaborator

Trials

1,417

Recruited

26,550,000+

Published Research Related to This Trial

The FUNPALs Playgroup, a 10-week program for parents and toddlers, showed significant improvements in toddler diet, with a large effect size, indicating it effectively enhanced healthy eating behaviors among participants.

While the program was well-received and had high retention rates (78%), it did not show a statistically significant improvement in physical activity levels for toddlers, suggesting that while dietary changes were successful, more focus may be needed on increasing physical activity.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feasibility and Efficacy of the "FUNPALs Playgroup" Intervention to Improve Toddler Dietary and Activity Behaviors: A Pilot Randomized Controlled Trial. Cepni, AB., Taylor, A., Crumbley, C., et al.[2021]

The Mealtime PREP intervention, which encourages exploration and play during meals, showed moderate effectiveness in increasing children's acceptance of targeted foods, as measured by the number of bites taken.

This pilot study involved 20 parents and children aged 1-5 years with sensory food aversions, suggesting that Mealtime PREP could be a promising approach to improve dietary variety, but further research with larger and more diverse groups is needed.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Promoting Routines of Exploration and Play during Mealtime: Estimated Effects and Identified Barriers. Caldwell, AR., Skidmore, ER., Terhorst, L., et al.[2023]

Children who are tube-fed in their early years may struggle with developing normal oral-motor skills, which are crucial for effective feeding.

To help these children transition to oral feeding, it is important to implement a consistent program of oral stimulation and training, which can support the development of necessary skills for biting, chewing, sucking, and swallowing.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impaired development of oral-motor functions required for normal oral feeding as a consequence of tube feeding during infancy. Kamen, RS.[2004]

A brief 2-hour parenting discussion group, called Hassle Free Mealtimes Triple P, significantly improved mealtime behaviors in children and parenting practices, with large effect sizes reported by 86 parents of 2- to 5-year-olds with mealtime difficulties.

The positive effects of the intervention were maintained at a 6-month follow-up, indicating that this low-intensity program could effectively address common mealtime challenges in young children and is a feasible option for parents seeking help.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Hassle Free Mealtimes Triple P: a randomised controlled trial of a brief parenting group for childhood mealtime difficulties. Morawska, A., Adamson, M., Hinchliffe, K., et al.[2015]

Infants with nonorganic failure to thrive (NOFTT) displayed more challenging behaviors during play, such as negative emotions, reduced vocalization, and increased gaze aversion, compared to healthy infants.

Mothers of infants with NOFTT were less engaged during play, and the play environments were more chaotic, suggesting that improving mother-infant interactions could be beneficial for these infants.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Behavioral characteristics of infants with nonorganic failure to thrive during a play interaction. Steward, DK.[2019]

A new behavior checklist was successfully developed to measure changes in family eating habits, physical activity, and parenting practices after an intervention aimed at low-income parents of children aged 3 to 11, demonstrating good reliability (r = 0.83).

The checklist was found to be feasible for use in community nutrition programs and showed significant correlations with established measures of dietary habits and physical activity, indicating its effectiveness in evaluating educational interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Developing a measure of behavior change in a program to help low-income parents prevent unhealthful weight gain in children. Dickin, KL., Lent, M., Lu, AH., et al.[2022]

The Play & Grow Cohort study includes 300 diverse toddlers and their caregivers, focusing on parent-child interactions during mealtime and play to understand obesity prevention, particularly in children born preterm.

Data collection involved video recordings of interactions at various ages, with plans for future assessments during middle childhood to include more detailed measurements and school-based outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Play & Grow: prospective observational cohort of toddlers to inform obesity prevention, Columbus, Ohio, USA. Parrott, A., Zvara, BJ., Keim, SA., et al.[2022]

Severe acute malnutrition (SAM) not only raises the risk of death but also hampers children's motor, cognitive, and psychosocial development, affecting 43% of children under five globally.

Integrating early childhood development (ECD) interventions, such as sensory stimulation and structured play therapy, into the management of SAM is crucial for improving outcomes, yet these components are often underemphasized in current nutritional rehabilitation programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Strengthening Psychosocial Stimulation in the Management of Children With Severe Acute Malnutrition: Experience From a Nutrition Rehabilitation Center. Kumar, P., Rohatgi, S., Singh, P., et al.[2021]

A study involving three children aged 1 to 4 years with feeding disorders found that a finger prompt procedure effectively increased food acceptance and reduced inappropriate mealtime behaviors.

Caregivers reported high acceptability of the finger prompt intervention, suggesting it is a feasible adjunct treatment for food refusal in young children.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of a finger prompt variation in the treatment of pediatric feeding disorders. Rubio, EK., Volkert, VM., Farling, H., et al.[2021]

The Functional Evaluation of Eating Difficulties Scale (FEEDS) effectively predicts long-term feeding outcomes in infants with neurodevelopmental disorders, based on a study of 144 infants aged 0 to 12 months.

Lower FEEDS scores are associated with a higher likelihood of achieving autonomous oral feeding by 24 months, indicating that the FEEDS can help identify infants at risk for eating difficulties early in their development.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Functional Evaluation of Eating Difficulties Scale to predict oral motor skills in infants with neurodevelopmental disorders: a longitudinal study. Cavallini, A., Provenzi, L., Scotto Di Minico, G., et al.[2019]

Children with failure-to-thrive showed significantly less positive affect and more negative affect during feeding compared to normally growing children, indicating emotional challenges related to their condition.

The study found that both acute and chronic malnutrition in failure-to-thrive children was linked to increased negative emotions during feeding, suggesting that addressing nutritional needs may improve emotional responses in these situations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Disturbances of affect expression in failure-to-thrive. Polan, HJ., Leon, A., Kaplan, MD., et al.[2015]

In a pilot study involving five mother-child pairs, the Nursing Child Assessment Teaching Scale (NCATS) indicated that two dyads had low levels of mutually adaptive interactions, suggesting potential areas for improvement in parenting practices.

The 24-hour Sleep Activity Record (SAR) highlighted irregular sleep and feeding patterns in four out of five children, indicating that these factors should be considered in occupational therapy assessments for young children with failure to thrive.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Parent-child interactions and everyday routines in young children with failure to thrive. Stewart, KB., Meyer, L.[2019]

A study involving 32 toddlers with food refusal showed that a sensory-based feeding intervention significantly improved mealtime behavior compared to a control group that only received nutrition education.

The intervention consisted of 1 hour sessions, 5 days a week for 4 weeks, followed by weekly sessions for 8 weeks, demonstrating that this approach can effectively address feeding disorders in young children.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Sensory Based Feeding Intervention for Toddlers With Food Refusal: A Randomized Controlled Trial. Kim, AR., Kwon, JY., Yi, SH., et al.[2021]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11505106/

Scaling up healthy eating in early childhood education and care Results indicated that Appetite to Play had high reach (25 867 individual website visits, 195 workshops delivered), effectiveness (significant increases in ...

2. cambridge.org cambridge.org/core/journals/public-health-nutrition/article/scaling-up-healthy-eating-in-early-childhood-education-and-care-evaluation-of-the-appetite-to-play-capacitybuilding-intervention/45948ECF53066754B730A27D2D616D88

Scaling up healthy eating in early childhood education and ... Results indicated that Appetite to Play had high reach (25 867 individual website visits, 195 workshops delivered), effectiveness (significant ...

3. liebertpub.com liebertpub.com/doi/10.1089/chi.2024.0365

Tracking Physical Activity and Nutrition Policies ... Appetite to Play is a bundle of evidence-informed implementation strategies designed to support adoption and implementation of the provincial-level Active Play ...

4. researchgate.net researchgate.net/publication/339188150_Implementing_Appetite_to_Play_at_scale_in_British_Columbia_Evaluation_of_a_Capacity-Building_Intervention_to_Promote_Physical_Activity_in_the_Early_Years

Implementing Appetite to Play at scale in British Columbia This paper describes implementation at scale of Appetite to Play (ATP), a capacity-building intervention for childcare providers.

5. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0195666324004847

Effects of a shared activities parenting intervention on ... This pilot randomized controlled trial evaluated impacts of a novel shared activities intervention designed to promote positive parent-child interactions.

6. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0195666320316822

INSIGHT responsive parenting intervention effects on child ... The INSIGHT RP intervention demonstrated sustained effects on maternal feeding practices through age 3 years, with some intervention effects showing moderation ...

7. onlinelibrary.wiley.com onlinelibrary.wiley.com/doi/10.1111/hsc.14106

Nurturing children's development through healthy eating ... Rigorous evidence shows clear links between adequate nutrition and physical activity (provided in the context of responsive emotionally ...

8. cdc.gov cdc.gov/pcd/issues/2023/22_0325.htm

Effect of Applying Best Practices for Physical Activity and ... We found that children engaged in more physical activity in homes where caregivers met best practices related to physical activity and screen time.