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BackgroundHospital-based health promotion resources to assist pregnant women in adopting a healthy lifestyle and optimizing gestational weight gain are important, but with limited effects. Increasingly, women are using mobile apps to access health information during the antenatal period. ObjectiveThe aims of the study were to investigate app-usage by Chinese women during pregnancy and to gain a better understanding of their views and attitudes toward apps containing health information. MethodsA mixed methods study design was applied. Study participants were recruited from 2 maternity hospitals in Shanghai, China, between March and July 2018. A self-administered Web-based survey was conducted with 535 pregnant Chinese women on their sources of health information and reasons for using apps during pregnancy. A total of 4 semistructured focus groups were also conducted with the pregnant women (n=28). ResultsThe use of pregnancy-related apps and the internet was common among the respondents. Almost half of the women had used pregnancy-related apps. Specifically, the use of apps for health information declined as pregnancy progressed from 70% (35/50) in the first trimester to 41.3% (143/346) in the third trimester. The main reason for using an app was to monitor fetal development (436/535, 81.5%), followed by learning about nutrition and recording diet in pregnancy (140/535, 26.2%). The women found that the apps were useful and convenient and can support lifestyle modifications during pregnancy. However, some apps also contained misinformation or incorrect information that could cause anxiety as reported by the participants. Many women expressed the need for developing an app containing evidence-based, well-informed, and tailored health information to support them during pregnancy. ConclusionsThe study suggests that apps were widely used by many Chinese women during pregnancy to monitor fetal development, to obtain diet and physical activity information, and to track their body changes. The women highly appreciated the evidence-based information, expert opinions, and tailored advice available on apps. Smartphone apps have the potential to deliver health information for pregnant women.

BackgroundThe prevalence of childhood obesity is increasing in China, and the effect of mobile phone short message service (SMS) interventions to prevent early childhood obesity needs to be evaluated. ObjectiveThe objective of this study was to assess the effect of an SMS intervention on the prevention of obesity in young children. MethodsA quasi-experimental design SMS intervention was carried out in 4 community health centers (CHCs) in Shanghai, China. A total of 2 CHCs were assigned to the intervention group, and 2 CHCs were assigned to the control group. Mothers in the intervention group received weekly SMS messages on breastfeeding and infant feeding from the third trimester to 12 months postpartum. The primary outcomes were children’s body mass index (BMI), BMI z-score, and weight-for-length z-score at 12 and 24 months. Factors associated with higher BMI and weight-for-length z-score at 24 months were also assessed. ResultsA total of 582 expectant mothers were recruited at the beginning of the third gestational trimester. 477 (82.0%) and 467 (80.2%) mothers and their children were followed up to 12 and 24 months postpartum, respectively. There were no significant differences in children’s BMI, BMI z-score, and weight-for-length z-score at 12 and 24 months between the 2 groups. Factors associated with higher BMI, BMI z-score, and weight-for-length z-score at 24 months included higher birth weight, introduction of solid foods before 4 months, and taking a bottle to bed at 12 months. ConclusionsThe SMS intervention did not show a significant effect on children’s BMI, BMI z-score, or weight-for-length z-score at 12 and 24 months. Introduction of solid foods before 4 months and taking a bottle to bed at 12 months were significantly and positively correlated with a higher BMI, BMI z-score, and weight-for-length z-score at 24 months. Further studies with more rigorous design are needed to evaluate the effect of SMS interventions on preventing early childhood obesity.

BackgroundAlthough mobile health (mHealth) has been widely applied in health care services, few studies have reported the detailed process of the development and implementation of text messaging (short message service, SMS) interventions. ObjectiveOur study aims to demonstrate the process and lessons learned from a community-based text messaging (SMS) intervention for improving infant feeding in Shanghai, China. MethodsThe intervention included planning and development, implementation, and process evaluation. A 3-phase process was adopted during planning and development: (1) a formative study with expectant and new mothers to explore the barriers of appropriate infant feeding practices; (2) a baseline questionnaire survey to understand potential intervention approaches; and (3) development of the text message bank. The text messaging intervention was delivered via a computer-based platform. A message bank was established before the start of the intervention containing information on the benefits of breastfeeding, preparing for breastfeeding, early initiation of breastfeeding, timely introduction of complementary foods, and establishing appropriate feeding practices, etc. An expert advisory committee oversaw the content and quality of the message bank. Process evaluation was conducted through field records and qualitative interviews with participating mothers. ResultsWe found that the text messaging intervention was feasible and well received by mothers because of its easy and flexible access. The weekly based message frequency was thought to be appropriate, and the contents were anticipatory and trustworthy. Some mothers had high expectations for timely response to inquiries. Occasionally, the text messages were not delivered due to unstable telecommunication transmission. Mothers suggested that the messages could be more personalized. ConclusionsThis study demonstrates the feasibility and value of text messaging intervention in filling gaps in delivering health care services and promoting healthy infant feeding practices in settings where personal contact is limited.

Dietary intake can affect the physical, cognitive, and socioemotional development of young children. Few studies have explored the relationships between dietary intake and the cognitive and socioemotional dimensions of school readiness. This study aimed to investigate the longitudinal associations between children's dietary intake in early childhood, and cognitive and socioemotional school readiness indicators at age 4-5 years using data from the Longitudinal Study of Australian Children. A total of 4,253 children were included in the analysis. Multiple linear regression models were built to investigate whether dietary intake (measured by questionnaire at parent interview) at age 2-3 years predicted school readiness indicators of socioemotional and behavioral functioning (measured by parent-reported Strengths and Difficulties Questionnaire [SDQ total score and pro-social scale]), verbal (assessed by Peabody Picture Vocabulary Test--Third Edition [PPVT-III]) and nonverbal (assessed by "Who Am I" test [WAI] cognitive skills) at age 4-5 years. Furthermore, using cross-sectional data at age 4-5 years, four multiple linear regression models were built to investigate if dietary intake was correlated with the aforementioned school readiness indicators. All models were adjusted for potential confounders. It was found that every one-point increase in child dietary intake score at age 2-3 years led to a decrease in SDQ total score by 0.19 (95% confidence interval [CI] = [0.10, 0.28], and an increase in SDQ pro-social scale, WAI score and PPVT score by 0.07 (95% CI = [0.03, 0.10]), 0.27 (95% CI = [0.13, 0.41]), and 0.20 (95% CI = [0.09, 0.30]), respectively, at age 4-5 years. Children's dietary intake was also a correlate of their school readiness at age 4-5 years. These results add to the limited evidence base suggesting that children's early dietary intake may play an important role in later socioemotional and behavioral development, and the development of cognitive skills, which are critical school readiness indicators.

Issue Addressed: Patients with low English proficiency (LEP) often require interpreter services in health care, however, their usage remains low. This study aimed to explore the barriers to accessing interpreter services and suggests ways services can be improved in hospitals. Methods: We conducted focus groups with clinicians and a retrospective audit of patient records. The clinicians were recruited from the inpatient wards and Emergency Department in a Sydney hospital, August 2022. The focus group discussion explored clinicians' experiences using an interpreter, and ways to improve access to the service. It was recorded, transcribed and coded thematically using Braun and Clarke's (2006) 6‐step framework. The patient record data were linked with the interpreter service booking data to determine whether patients flagged as requiring an interpreter on admission were provided with the service. Results: Two focus groups were conducted with clinicians (N = 9 in total). Long wait times for telephone interpreters, an inflexible booking system, and low availability of in‐person interpreters were identified as the barriers. The COVID‐19 pandemic also impacted in‐person service provision. Conclusion: Some systemic barriers including an inflexible booking process and long wait times for immediate interpreter services were identified. The low use of interpreter services is attributed to the difficulties accessing the service and poor documentation in patient records. So What?: Greater availability of in‐person interpreter services, an upgraded booking system, and effective implementation the NSW Health Standard Procedures for Working with Health Care Interpreters will address some of these barriers. [ABSTRACT FROM AUTHOR]

Establishing healthy feeding habits during infancy is crucial for optimal growth. However, certain parental feeding and cultural practices might hinder the development of children's healthy eating behaviours. This research explored responsive feeding practices among migrant mothers in Australia. Semi‐structured telephone interviews were conducted in their native language with 20 Arabic and 20 Mongolian‐speaking migrant mothers with children under 2 years old or currently pregnant. Thematic analysis was conducted using the framework method. Both cultural groups followed a variety of feeding practices, including on demand responsive feeding or structured schedules. Arabic‐speaking mothers tended to demonstrate responsive feeding practices more frequently than Mongolian‐speaking mothers, except for those using formula feeding, who consistently followed a fixed feeding routine. When introducing solid foods, mothers from both groups often overlooked their babies' hunger and satiety cues, frequently pressuring their children to finish their entire plate. One cited reason for this was the challenge parents faced in identifying such cues. Arabic‐speaking mothers often supplemented with formula top‐ups after introducing solid foods, due to the belief that breast milk or solid foods alone might not sufficiently nourish their infants. Additionally, some Arabic‐speaking mothers used food‐based rewards to encourage eating. Mongolian mothers expressed a cultural preference for chubby babies, a potential reason why they may have been inclined to pressure‐feed their children. Moreover, both groups reported using digital devices to distract their children during meals. This study highlights the necessity of tailoring future resources and services related to responsive feeding practices to accommodate diverse literacy levels and cultural backgrounds. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Maxillary canines are often impacted, which can result in tooth disorders and adversely affect occlusal and facial development. The case report describes complete bilateral impaction of maxillary canines and significant root resorption of a central incisor. The multidisciplinary approach is the optimal strategy for addressing impacted maxillary canines. [ABSTRACT FROM AUTHOR]

Background: Exclusive breastfeeding for the first 6 months followed by ongoing breastfeeding to 12 months and beyond is associated with multiple benefits for both mother and child. Maternal smoking is associated with a reduction in breastfeeding. Little is known about the effect of partner smoking on breastfeeding. Aims: This study explores the smoking behaviour of mothers and their partners in the first two years of a child's life and its associations with breastfeeding practice. Materials and Methods: We performed a secondary data analysis using survey data on 1155 mothers from their third trimester of pregnancy and at six, 12 and 24 months after delivery. Survey questions included smoking status of both mother and partner and breastfeeding intention and practice. Logistic regression models were conducted at each time point. Findings: Where the mother or both parents smoke, babies were less likely to be breastfed at six months of age (adjusted odds ratio (aOR) 0.29, 95% CI: 0.13–0.66) compared with families where neither parent smoked. Non‐smoking mothers with smoking partners were less likely to intend to breastfeed (aOR 0.29, 95% CI: 0.11–0.82) and their babies were less likely to be breastfed at six and 12 months of age (aOR 0.64, 95% CI: 0.42–0.98 and 0.64, 95% CI: 0.43–0.95 respectively). There was no difference in breastfeeding behaviour between smoking and non‐smoking parents at 24 months. Conclusion: Smoking parents are less likely to breastfeed their babies at ages six and 12 months. Breastfeeding promotion should target both smoking mothers and smoking partners. [ABSTRACT FROM AUTHOR]

Background: Evidence links tummy time (ie, the time spent in awake prone positioning that is encouraged and supervised by an adult) to infants' health outcomes such as gross motor and total development. However, the associations between tummy time and other movement and sleep behaviors as the child develops remain unknown. The aim of this study was to examine whether early introduction and practice of tummy time within the first 6 months of age were associated with active and outdoor playtime, screen time, and nocturnal sleep time of children when they were 12 and 24 months old. Methods: A longitudinal analysis was conducted using data extracted from an Australian trial. Using telephone surveys with mothers, demographic data were collected from third trimester of pregnancy and tummy time data were collected at 6 months of age. Data on playtime, screen time, and nocturnal sleep duration as dependent variables were collected at 12 and 24 months of age. Multiple logistic regression models were built to investigate the associations. Results: Children who started tummy time within 4 weeks of age were more likely to have >10 hours sleep at night at 12 months (adjusted odds ratio 1.54, 95% confidence interval, 1.08–2.19). They were more likely to have >3 hours per day of outdoor play and have <1 hour per day of screen time at 24 months. Children who practiced tummy time every day were more likely to have >2 hours per day of active play at 12 months and have <1 hour per day of screen time at 24 months. Conclusions: Starting tummy time earlier and frequently was associated with more favorable movement and sleep of young children at 12 and 24 months of age. [ABSTRACT FROM AUTHOR]