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BMJ Open. 2019 Nov 19;9(11):e030709. doi: 10.1136/bmjopen-2019-030709.

Fit for School Study protocol: early child growth, health behaviours, nutrition, cardiometabolic risk and developmental determinants of a child's school readiness, a prospective cohort.

Author information

1
Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada.
2
Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.
3
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
4
Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
5
Department of Nutritional Sciences, Faculty of Medicine, Universtiy of Toronto, Toronto, Ontario, Canada.
6
Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada jessica.omand@sickkids.ca.
7
The HUB Health Research Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
8
Department of Paediatrics, St. Michael's Hospital, Toronto, Ontario, Canada.
9
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
10
Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada.
11
Healthy Active Living and Obesity Research, Children's Hospital of Eastern Ontario Research Institute, Healthy Active Living and Obesity Research, Ottawa, Ontario, Canada.
12
Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
13
The Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.

Abstract

INTRODUCTION:

School readiness is a multidimensional construct that includes cognitive, behavioural and emotional aspects of a child's development. School readiness is strongly associated with a child's future school success and well-being. The Early Development Instrument (EDI) is a reliable and valid teacher-completed tool for assessing school readiness in children at kindergarten age. A substantial knowledge gap exists in understanding how early child growth, health behaviours, nutrition, cardiometabolic risk and development impact school readiness. The primary objective was to determine if growth patterns, measured by body mass index trajectories in healthy children aged 0-5 years, are associated with school readiness at ages 4-6 years (kindergarten age). Secondary objectives were to determine if other health trajectories, including health behaviours, nutrition, cardiometabolic risk and development, are associated with school readiness at ages 4-6 years. This paper presents the Fit for School Study protocol.

METHODS AND ANALYSIS:

This is an ongoing prospective cohort study. Parents of children enrolled in the The Applied Health Research Group for Kids (TARGet Kids!) practice-based research network are invited to participate in the Fit for School Study. Child growth, health behaviours, nutrition, cardiometabolic risk and development data are collected annually at health supervision visits and linked to EDI data collected by schools. The primary and secondary analyses will use a two-stage process: (1) latent class growth models will be used to first determine trajectory groups, and (2) generalised linear mixed models will be used to examine the relationship between exposures and EDI results.

ETHICS AND DISSEMINATION:

The research ethics boards at The Hospital for Sick Children, Unity Health Toronto and McMaster University approved this study, and research ethics approval was obtained from each school board with a student participating in the study. The findings will be presented locally, nationally and internationally and will be published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER:

NCT01869530.

KEYWORDS:

EDI; body mass index; brain development; early development instrument; kindergarten; school readiness

Conflict of interest statement

Competing interests: JLM received an unrestricted research grant for a completed investigator-initiated study from the Dairy Farmers of Canada (2011–2012) and Ddrops provided non-financial support (vitamin D supplements) for an investigator-initiated study on vitamin D and respiratory tract infections (2011–2015). PP received unrestricted research grants for completed investigator-initiated studies from Danone Institute of Canada (2002–2004 and 2006–2009), Dairy Farmers of Ontario (2008–2010) and Mead Johnson Nutrition provided non-financial support (Fer-In-Sol liquid iron supplement) (2011–2017) for an ongoing investigator-initiated trial of iron deficiency in young children that was funded by Canadian Institutes of Health Research (FRN # 115059). CBi received a research grant from the Centre for Addiction and Mental Health Foundation (CAMH 2017-2020). CBo reports previously receiving a grant for a completed investigator-initiated study from the SickKids Centre for Health Active Kids (CHAK) (2015–2016) involving the development and validation of a risk stratification tool to identify young asymptomatic children at risk of iron deficiency. These agencies had no role in the design, collection, analyses or interpretation of the results of this study or in the preparation, review or approval of the manuscript. All other authors declare no conflicts of interest.

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