Building a Foundation for Healthy Active Living CME Modules

​​​​​​​​​​​​​​An exploration ​of the importance of early feeding, relationships, the environment and how primary care providers can help prevent obesity

• Overview and Introduction​

Evaluation: After viewing the module, to receive MOC Part 2 and CME credit you must:

1. Complete the online evaluation.
2. Follow the CME Guidelines listed at the top of this page.

• Breastfeeding
• Bottle Feeding
• Food Introduction
• Healthy Snacks
• Healthy Beverages

​​​​​​​​​​​Evaluation: After viewing all modules, to receive MOC Part 2 and CME credit you must:

1. Complete the online evaluation​​.
2. Follow the CME Guidelines listed at the top of this page.

*The AAP policy statement on breastfeeding has recently been updated to recommend breastfeeding through the first 2 years of life. To read the full updated policy, click here.

• Active Play
• Screen Time
• Sleep
• Adverse Childhood Experiences
• Food Insecurity

​​​​​​​​​​​Evaluation: After viewing all modules, to receive MOC Part 2 and CME credit you must:

1. Complete the ​​​​​o​nline e​valuation​.
2. Follow the CME Guidelines listed at the top of this page.

• Parenting & Feeding Styles
• Hunger & Satiety
• Role Modeling & Routines
• Healthy Family​

​​​​​​​​​​​Evaluation: After viewing all modules, to receive MOC Part 2 and CME credit you must:

1. Complete the ​​​​​online evaluation​​.
2. Follow the CME Guidelines listed at the top of this page.

(Overview) Black RE, Allen LH, Bhutta ZA, et al. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008;371 (9608):243-260

(Overview) Mistry, Kamila B., et al. "A new framework for childhood health promotion: the role of policies and programs in building capacity and foundations of early childhood health."
American Journal of Public Health 102.9 (2012): 1688-1696.

(Overview) Cheung, Patricia C., et al. "Childhood obesity incidence in the United States: a
systematic review." Childhood Obesity 12.1 (2016): 1-11.

(Overview) Ogden, Cynthia L., et al. "Trends in obesity prevalence among children and
adolescents in the United States, 1988-1994 through 2013-2014." Jama 315.21 (2016): 2292-
2299.

(All) Kleinman, Ronald E., and Frank R. Greer. Pediatric nutrition. American Academy of
Pediatrics, 2013.

(All) Unpublished findings: Healthy active living for families project: Parent focus groups.
American Academy of Pediatrics. 2011.

(ALL Nutrition) Caprio, Sonia, et al. "Influence of race, ethnicity, and culture on childhood
obesity: implications for prevention and treatment." Obesity 16.12 (2008): 2566-2577.

(ALL Nutrition) Unpublished findings: Feeding and infant and toddlers study. 2008.

(Breastfeeding/Bottle Feeding) Fox MK, Reidy K, Novak T, Ziegler P. Sources of energy and
nutrients in the diets of infants and toddlers. J Am Diet Assoc. 2006; 106(1 Suppl 1):S28-S42

(Breastfeeding) Schanler, Richard J., Karen G. O'connor, and Ruth A. Lawrence. "Pediatricians'
practices and attitudes regarding breastfeeding promotion." Pediatrics 103.3 (1999): e35-e35.

(Breastfeeding) Grummer-Strawn LM, Shealy KR, Perrine CG, MacGowan C, Grossniklaus DA, Scanlon KS, Murphy PE. Maternity care practices that support breastfeeding: CDC efforts to encourage quality improvement. J Womens Health 2013 Feb;22(2):107–112

(Breastfeeding) Kimbro, RT. On-the-job moms: Work and breastfeeding initiation and duration for a sample of low-income women. Matern Child Health J. 2006;10(1): 19-26

(Breastfeeding) Centers for Disease Control and Prevention. 2016 Breastfeeding Report Card. Available at http://www.cdc.gov/breastfeeding/pdf/2016breastfeedingreportcard.pdf. Accessed August 2016.

(Breastfeeding) Centers for Disease Control and Prevention. "Breastfeeding among US children born 2000–2010, CDC National Immunization Survey." Atlanta: Centers for Disease Control and Prevention (2013).

(Breastfeeding/Bottle Feeding) Wagner, Erin A., et al. "Breastfeeding concerns at 3 and 7 days postpartum and feeding status at 2 months." Pediatrics (2013): peds-2013

(Breastfeeding) Geraghty, Sheela R., Sarah W. Riddle, and Ulfat Shaikh. "The breastfeeding
mother and the pediatrician." Journal of Human Lactation 24.3 (2008): 335-339.

(Bottle feeding) Lakshman, Rajalakshmi, David Ogilvie, and Ken K. Ong. "Mothers’
experiences of bottle-feeding: a systematic review of qualitative and quantitative studies."
Archives of Disease in Childhood 94.8 (2009): 596-601.

(Bottle feeding) Wasser H, Bentley M, Borja J, Goldman BD, et al. Infants perceived as "fussy"
are more likely to receive complementary foods before 4 months. Pediatrics. 2011. doi: 2010-
0166

(Food Introduction) Siega-Riz AM, Deming DM, Reidy KC, et al. Food consumption patterns of infants and toddlers: Where are we now? J Am Diet Assoc supplement. 2011.

(Food Introduction) Rose CM, Savage JS, Birch LL. Patterns of early dietary exposures have
implications for maternal and child weight outcomes. Obesity (Silver Spring) 2016;24:430-438.

(Food introduction) Kumanyika S. Environmental influences on childhood obesity: ethnic and cultural influences in context. Physiol Behav. 2008; 94: 61–70

(Food Introduction) Howard, Anika J., et al. "Toddlers’ food preferences. The impact of novel
food exposure, maternal preferences and food neophobia." Appetite 59.3 (2012): 818-825

(Food Introduction) Fox MK, Condon E, Briefel RR, Reidy KC, Deming DM. Food
consumption patterns of young preschoolers: are they starting off on the right path? J Am Diet Assoc. 2010;110(12 Suppl):S52-S9

(Food Introduction) Birch, Leann L., and Allison E. Doub. "Learning to eat: birth to age 2 y."
The American journal of clinical nutrition 99.3 (2014): 723S-728S.

(Food Introduction) Fox MK, Condon E, Briefel RR, Reidy KC, Deming DM. Food
consumption patterns of young preschoolers: Are they starting off on the right path? J Am Diet Assoc supplement. 2011.

(Food Introduction) Ben-Joseph EP, Dowshen SA, Izenberg P. Do parents understand growth
charts? A national, internet-based survey. Pediatrics. 2009;124(4).

(Food Introduction) Andreyeva, Tatiana, Michael W. Long, and Kelly D. Brownell. "The impact of food prices on consumption: a systematic review of research on the price elasticity of demand for food." American journal of public health 100.2 (2010): 216-222.

(Food Introduction) Huh SY, Rifas-Shiman SL, Taveras EM, Oken E, Gillman MW. Timing of
solid food introduction and risk of obesity in preschool-aged children. Pediatrics. 2011

(Healthy Snacks) Reedy J, Krebs-Smith SM. Dietary sources of energy, solid fats, and added
sugars among children and adolescents in the United States. J Am Diet Assoc. 2010;110(10)

(Healthy Snacking) Piernas C, Popkin BM. Trends in snacking amoung U.S. children. Health Aff (Millwood). 2010;29(3):398-404

(Healthy Snacks) Mascola, Anthony J., Susan W. Bryson, and W. Stewart Agras. "Picky eating
during childhood: A longitudinal study to age 11years." Eating behaviors 11.4 (2010): 253-257

(Healthy Snacking) Fisher, Jennifer Orlet, Barbara J. Rolls, and Leann L. Birch. "Children’s bite
size and intake of an entree are greater with large portions than with age-appropriate or selfselected portions." The American journal of clinical nutrition 77.5 (2003): 1164-1170

(Beverages) Tripathi S, Kiran K, Kamala BK. Relationship between obesity and dental caries in children – a preliminary study. J Int Oral Health. 2010;2(4).

(Beverages) Heyman, Melvin B., and Steven A. Abrams. "Fruit Juice in Infants, Children, and
Adolescents: Current Recommendations." Pediatrics (2017): e20170967.

(Beverages) Skinner JD, Ziegler P, Ponza M, Jada. Transitions in infants’ and toddlers’ beverage patterns. 2004.

(All Environment) Taveras, Elsie M., et al. "Racial/ethnic differences in early-life risk factors for childhood obesity." Pediatrics 125.4 (2010): 686-695.

(Physical Actvitiy) Sheikh J, Kaplan MS. Association of being overweight with greater asthma
symptoms in inner-city black and Hispanic children. Pediatrics. 1999;104:376. Also, Gennuso J, Epstein LH, Paluch RA, Cerny F. The relationship between asthma and obesity in urban minority children and adolescents. Arch Pediatr Adolesc Med. 1998;152(12):1197-1200

(Physical Activity) Brown WH, Pfeiffer KA, McIver KL, Dowda M, Addy CL, Pate RR. Social
and environmental factors associated with preschoolers’ nonsedentary physical activity. Child Dev. 2009;80(1):45-58.

(Physical Activity) National Association for Sport and Physical Education. Active Start: A
Statement of Physical Activity Guidelines for Children Birth to Five. Reston, VA: NASPE
Publications: 2009.

(Physical Acitivity) Garrett M, McElroy A, Staines A. Locomotor milestones and babywalkers:
Cross sectional study. BMJ. 2002;324:1494.

(Physical Activity) Booth, J.N., Leary, S.D., Joinson, C., Ness, A.R., Tomporowski, P.D., Boyle,
J.M., and Reilly, J.J. Associations between objectively measured physical activity and academic attainment in adolescents from a UK cohort. Br. J. SportsMed. 2014;48 (3): 265–270

(Physical Activity) Pfeiffer, K. A., M. Dowda, K. L. McIver, and R. R. Pate. 2009. Factors
related to objectively measured physical activity in preschool children. Pediatric Exercise
Science 21(2):196-208.

(Physical Activity) Alhassan, S., J. R. Sirard, and T. N. Robinson. 2007. The effects of
increasing outdoor play time on physical activity in Latino preschool children. International
Journal of Pediatric Obesity 2(3):153-158.

(Screen time) Rideout VJ, Hamel E. The Media Family: Electronic Media in the Lives of
Infants, Toddlers, Preschoolers, and Their Parents. Menlo Park, CA: Kaiser Family Foundation; 2006.

(Screen time) Vandewater EA, Park SE, Huang X, Wartella EA. No: You can’t watch that –
parental rules and young children’s media use. Am Behav Sci. 2005;48(5):608–623.

(Screen time) Zero to eight: Children’s media use in America. A Common Sense Media
Research Study. 2013.

(Screen time) Vandewater EA, Bickham DS, Lee JH, Cummings HM, Wartella EA, Rideout VJ.
When the television is always on: Heavy television exposure and young children’s development. Am Behav Sci. 2005;48(5):562–577.

(Sleep) Taveras, Elsie M., et al. "Short sleep duration in infancy and risk of childhood
overweight." Archives of pediatrics & adolescent medicine 162.4 (2008): 305-311.

(Sleep) Dollman J, Ridley K, Olds T, Lowe E. Trends in the duration of school-day sleep among 10- to 15-year-old south Australians between 1985 and 2004. Acta Paediatr. 2007; 96(7):1011- 1014. Also, Iglowstein I, Jenni OG, Molinari L, Largo RH. Sleep duration from infancy to adolescence: Reference values and generational trends. Pediatrics. 2003;111(2):302-307.

(Sleep) National Sleep Foundation. Sleep in America. 2008. Available at
http://www.sleepfoundation.org/sites/default/files/2008%20POLL%20SOF.PDF.
National Sleep Foundation. Children and sleep. 2011. Available at
http://www.sleepfoundation.org/article/sleep-topics/children-and-sleep..

(ACEs) Beck AF, Klein MD. Moving from social risk assessment and identification to
intervention and treatment. Acad Pediatr. 2016;16(2):97–8.

(ACES) Felitti, Vincent J., et al. "Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE)
Study." American journal of preventive medicine 14.4 (1998): 245-258.

(ACEs) Academy of Pediatrics. Early childhood adversity, toxic stress, and the role of the
pediatrician: Translating developmental science into lifelong health. Pediatrics, 2012; 129, 224–231.

(Food Insecurity) Freeman, Andrea. "First Food Justice: Racial Disparities in Infant Feeding as
Food Oppression." Fordham L. Rev. 83 (2014): 3053.

(Food Insecurity) Jyoti, Diana F., Edward A. Frongillo, and Sonya J. Jones. "Food insecurity
affects school children’s academic performance, weight gain, and social skills." The Journal of nutrition 135.12 (2005): 2831-2839.

(Responsive feeding) Black MM, Aboud FE. Responsive feeding is embedded in a theoretical
framework of responsive parenting. J Nutr. 2011;141:490-494.

(Responsive Feeding) Pérez-Escamilla R, Segura-Pérez S, Lott M, on behalf of the RWJF HER
Expert Panel on Best Practices for Promoting Healthy Nutrition, Feeding Patterns, and Weight Status for Infants and Toddlers from Birth to 24 Months. Feeding Guidelines for Infants and Young Toddlers: A Responsive Parenting Approach. Durham, NC: Healthy Eating Research, 2017.

(Responsive Feeding) Perrin, Eliana M., et al. "Use of a pediatrician toolkit to address parental perception of children's weight status, nutrition, and activity behaviors." Academic pediatrics 10.4 (2010): 274-281.

(Responsive feeding) Aboud, Frances E., Sohana Shafique, and Sadika Akhter. "A responsive
feeding intervention increases children's self-feeding and maternal responsiveness but not weight gain." The Journal of nutrition 139.9 (2009): 1738-1743.

(Responsive Feeding/Hunger and Satiety) Daniels, L. A., et al. "Evaluation of an intervention to promote protective infant feeding practices to prevent childhood obesity: outcomes of the NOURISH RCT at 14 months of age and 6 months post the first of two intervention modules." International journal of obesity 36.10 (2012): 1292-1298.

(Responsive Feeding/Hunger and Satiety) DiSantis, K. I., et al. "The role of responsive feeding
in overweight during infancy and toddlerhood: a systematic review." International Journal of
Obesity 35.4 (2011): 480-492.

(Hunger and Satiety) Gross, Rachel S., et al. "Maternal perceptions of infant hunger, satiety, and pressuring feeding styles in an urban Latina WIC population." Academic pediatrics 10.1 (2010): 29-35.

(Hunger and Satiety) Birch, Leann L., and Jennifer O. Fisher. "Development of eating behaviors among children and adolescents." Pediatrics 101.Supplement 2 (1998): 539-549.

(Role Modeling and Routines) Spagnola, Mary, and Barbara H. Fiese. "Family routines and
rituals: A context for development in the lives of young children." Infants & young children 20.4 (2007): 284-299.

(Role Modeling and Routines) Scaglioni, Silvia, Michela Salvioni, and Cinzia Galimberti.
"Influence of parental attitudes in the development of children eating behaviour." British Journal of Nutrition 99.S1 (2008): S22-S25.

(Healthy Family) Patrick, Heather, and Theresa A. Nicklas. "A review of family and social
determinants of children’s eating patterns and diet quality." Journal of the American College of Nutrition 24.2 (2005): 83-92.

(Healthy Family) Strauss, Richard S., and Judith Knight. "Influence of the home environment on the development of obesity in children." Pediatrics 103.6 (1999): e85-e85.

(Healthy Families) Earls MF, Committee on Psychosocial Aspects of Child and Family Health;
American Academy of Pediatric.. Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. Pediatrics. 2010;126(5):1032–1039