Published online July 27, 2009
PEDIATRICS Vol. 124 No. 2 August 2009, pp. 555-562 (doi:10.1542/peds.2008-2857)
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ARTICLE

Early Child Care and Adiposity at Ages 1 and 3 Years

Sara E. Benjamin, PhD, MPH, RDa, Sheryl L. Rifas-Shiman, MPHa, Elsie M. Taveras, MD, MPHa,b, Jess Haines, PhD, MHSc, RDa, Jonathan Finkelstein, MD, MPHa,b, Ken Kleinman, ScD, MSa and Matthew W. Gillman, MD, SMa,c

a Obesity Prevention Program, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts
b Division of Pediatrics, Children's Hospital Boston, Boston, Massachusetts
c Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts

BACKGROUND: The majority of infants in the United States are in nonparental child care, yet little is known about the effect of child care on development of obesity.

OBJECTIVE: To examine the relationship between child care attendance from birth to 6 months and adiposity at 1 and 3 years of age.

METHODS: We studied 1138 children from a prospective cohort of pregnant women and their offspring. The main exposure was time in child care from birth to 6 months of age, overall and by type of care: (1) child care center; (2) someone else's home; and (3) child's own home by nonparent. The main outcomes were weight-for-length (WFL) z score at 1 year and BMI z score at 3 years of age.

RESULTS: A total of 649 (57%) infants attended child care; 17% were cared for in a center, 27% in someone else's home, and 21% in their own home by a nonparent. After adjustment for confounders, overall time in child care was associated with an increased WFL z score at 1 year and BMI z score at 3 years of age but not skinfold thicknesses. Center and own home care were not associated with the outcomes, but care in someone else's home was associated with an increase in both the 1- and 3-year outcomes.

CONCLUSION: Child care in the first 6 months of life, especially in someone else's home, was associated with an increased WFL z score at 1 year and BMI z score at 3 years of age.

Key Words: child care • childhood obesity • nutrition • physical activity • infancy

Abbreviations: WFL—weight for length • SS+TR—sum of subscapular and triceps skinfold thickness • SS/TR—ratio of subscapular to triceps skinfold thickness • CI—confidence interval

Accepted Dec 3, 2008.


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