Table 4_Carer perspectives on overweight, obesity and dental caries in early childhood: findings from a systematic qualitative review.docx

IntroductionFormula and bottle feeding behaviours can increase obesity and tooth decay (early childhood caries, ECC) in early childhood, through non-responsive feeding and prolonged exposure to sugar. Parents’ beliefs can be barriers to behaviour change for obesity and ECC prevention. Understanding these beliefs towards children's teeth and weight can address parents’ priorities and develop prevention messages. This qualitative systematic review (PROSPERO registration #CRD42022348783) aimed to identify parent or carer perspectives on obesity and ECC in children aged ≤6 years.
MethodsDatabase searching of CINAHL, Medline and EMBASE, with hand searching, was undertaken. Included papers were qualitative research publications, focused on parent or carer beliefs and attitudes towards overweight, obesity or ECC in infants and children. Inductive thematic analysis was undertaken to generate themes, with a strengths-based approach focused on parents’ lived experience. Quality appraisal was undertaken with the CASP Qualitative Checklist. Descriptive characteristics of the study and participants, and qualitative findings, were extracted qualitatively in NVivo.
Results7,365 references were identified from database and hand searching, with 98 references included for analysis. Three research themes were generated: (1) parenting to support child wellness, including healthy teeth and weight; (2) parents’ response to unwellness, including identifying symptoms, causes and protective factors for unhealthy weight and teeth; (3) information and resources needed to support healthy weight and teeth. There was high or potential risk of bias in qualitative methodology when studies did not address researcher-participant relationships or rigorous data analysis processes.
DiscussionFindings highlight the need for strength-based messages for children's teeth and weight, increased understanding of formula and bottle feeding as obesity and ECC risk factors, and holistic approaches to care by dental and primary care professionals.
Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD42022348783, PROSPERO CRD42022348783.

引言：配方奶与奶瓶喂养行为可通过非应答式喂养以及长期糖分暴露，增加幼儿罹患肥胖与早期儿童龋病（early childhood caries, ECC）的风险。家长的认知观念可成为肥胖及ECC预防行为改变的阻碍因素。明晰家长对儿童牙齿与体重的相关认知，能够明确家长的优先诉求并助力制定针对性预防宣教内容。本项定性系统综述（PROSPERO注册编号：CRD42022348783）旨在梳理家长及照护者对6岁及以下儿童肥胖与ECC的认知视角。
研究方法：本研究通过检索CINAHL、Medline、EMBASE数据库，并辅以人工检索完成文献筛选。纳入文献为聚焦婴幼儿及儿童超重、肥胖或ECC相关的家长/照护者认知与态度的定性研究成果。本研究采用归纳式主题分析法生成研究主题，并以优势为本的视角聚焦家长的亲身经历。采用批判性评价技能项目（CASP）定性研究检查表开展质量评价。研究与受试者的描述性特征，以及定性研究结果，均通过NVivo软件完成质性提取。
研究结果：通过数据库与人工检索共识别出7365篇参考文献，最终纳入98篇用于分析。本研究共生成3类核心主题：（1）助力儿童健康成长的养育行为，涵盖健康牙齿与体重的养护；（2）家长对儿童健康异常的应对行为，包括识别异常体重与牙齿健康问题的症状、诱因及保护因素；（3）支持维持健康体重与牙齿健康所需的信息及资源。若研究未关注研究者与受试者的互动关系或未采用严谨的数据分析流程，则其定性研究方法存在较高或潜在的偏倚风险。
讨论：本研究结果凸显了三方面的需求：一是针对儿童牙齿与体重健康制定优势导向的宣教内容；二是加深对配方奶与奶瓶喂养作为肥胖及ECC危险因素的认知；三是推动牙科与基层医疗专业人员采用整体化照护方案。
系统综述注册信息：https://www.crd.york.ac.uk/PROSPERO/view/CRD42022348783，PROSPERO注册编号：CRD42022348783。