{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T03:27:47Z","timestamp":1792466867502,"version":"4.5.0"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T00:00:00Z","timestamp":1689033600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Despite high rates of obesity and weight-related conditions observed in children with Down syndrome, little is known about how to prevent these conditions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>The purpose of this study was to identify parent-perceived facilitators and barriers to health for toddlers (12\u201336 months old) with Down syndrome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>We conducted in-depth, semi-structured interviews with the mothers of 25 toddlers with Down syndrome. All interviews were conducted using Zoom Video Technology, audio recorded and transcribed before being coded in NVivo software using a structured protocol. Thematic analysis was used to identify themes in perceived facilitators and barriers to health at the level of the child, family, and community. Data were triangulated using reflective journaling, video review of child meals, and member-checking techniques.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified unique themes for facilitators (on the move and sound sleep) and barriers (co-occurring conditions and eating behaviors) at the level of the child. At the level of the family and community, overarching themes that were viewed as either a facilitator or barrier, depending on the context, were identified (role models matter, time is critical, the importance of place, and social support).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>These themes can help clinicians and researchers tailor their health promotion interventions to meet the unique needs of children with Down syndrome by using strength-based approaches and providing families with the tools to overcome barriers.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2023.1155850","type":"journal-article","created":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T04:43:17Z","timestamp":1689050597000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["Parental perception of facilitators and barriers to health among young children with down syndrome: a qualitative study"],"prefix":"10.3389","volume":"11","author":[{"given":"Angela R.","family":"Caldwell","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yeook","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nada","family":"Alshahwan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kishore","family":"Vellody","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roxanna M.","family":"Bendixen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kayley","family":"Renz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiffany","family":"Duong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Dodd","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Terhorst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aviva","family":"Must","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,7,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1016\/j.ridd.2016.06.018","article-title":"Overweight and obesity in children and adolescents with down syndrome-prevalence, determinants, consequences, and interventions: a literature review","volume":"57","author":"Bertapelli","year":"2016","journal-title":"Res Dev Disabil"},{"key":"B2","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1016\/j.jpeds.2016.02.046","article-title":"Retrospective study of obesity in children with down syndrome","volume":"173","author":"Basil","year":"2016","journal-title":"J Pediatr"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1087","DOI":"10.1038\/ejcn.2013.137","article-title":"Resting energy expenditure and adiposity accretion among children with down syndrome: a 3-year prospective study","volume":"67","author":"Hill","year":"2013","journal-title":"Eur J Clin Nutr"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1685","DOI":"10.1016\/j.ridd.2011.02.023","article-title":"Fat and lean masses in youths with down syndrome: gender differences","volume":"32","author":"Gonz\u00e1lez-Ag\u00fcero","year":"2011","journal-title":"Res Dev Disabil"},{"key":"B5","doi-asserted-by":"publisher","first-page":"601","DOI":"10.2147\/tcrm.s10235","article-title":"Reduced exercise capacity in persons with down syndrome: cause, effect, and management","volume":"6","author":"Mendonca","year":"2010","journal-title":"Ther Clin Risk Manag"},{"key":"B6","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1016\/j.jpeds.2017.05.077","article-title":"Nonalcoholic fatty liver disease in Italian children with down syndrome: prevalence and correlation with obesity-related features","volume":"189","author":"Valentini","year":"2017","journal-title":"J Pediatr"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e1382","DOI":"10.1542\/peds.2011-1262","article-title":"Lipid profiles of children with down syndrome compared with their siblings","volume":"129","author":"Adelekan","year":"2012","journal-title":"Pediatrics"},{"key":"B8","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1007\/s13679-014-0098-7","article-title":"Obesity prevention for children with developmental disabilities","volume":"3","author":"Must","year":"2014","journal-title":"Curr Obes Rep"},{"key":"B9","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1080\/08990220.2017.1415880","article-title":"Pedometer-determined physical activity levels of healthy children and children with down\u2019s syndrome","volume":"34","author":"Alhusaini","year":"2017","journal-title":"Somatosens Mot Res"},{"key":"B10","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1097\/PEP.0000000000000556","article-title":"Physical activity levels of children with down syndrome","volume":"31","author":"Fox","year":"2019","journal-title":"Pediatr Phys Ther"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/1028415X.2022.2161139","article-title":"Imbalanced dietary patterns, anthropometric, and body composition profiles amongst adults with down syndrome","author":"Herrera-Quintana","year":"2022","journal-title":"Nutr Neurosci"},{"key":"B12","doi-asserted-by":"publisher","first-page":"36","DOI":"10.3390\/children10010036","article-title":"Nutrition as prevention of diet-related diseases-a cross-sectional study among children and young adults with down syndrome","volume":"10","author":"Bia\u0142ek-Dratwa","year":"2022","journal-title":"Children (Basel)"},{"key":"B13","doi-asserted-by":"publisher","first-page":"943516","DOI":"10.3389\/fpsyg.2022.943516","article-title":"Sleep and behavioral problems in preschool-age children with down syndrome","volume":"13","author":"Fuc\u00e0","year":"2022","journal-title":"Front Psychol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1016\/j.sleep.2020.12.022","article-title":"Sleep problems in Australian children with down syndrome: the need for greater awareness","volume":"78","author":"Chawla","year":"2021","journal-title":"Sleep Med"},{"key":"B15","doi-asserted-by":"publisher","first-page":"424","DOI":"10.1590\/0004-282X-ANP-2021-0242","article-title":"Sleep disorders in down syndrome: a systematic review","volume":"80","author":"Santos","year":"2022","journal-title":"Arq Neuropsiquiatr"},{"key":"B16","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1016\/S2352-4642(19)30400-6","article-title":"Nutritional challenges in children and adolescents with down syndrome","volume":"4","author":"Nordstr\u00f8m","year":"2020","journal-title":"Lancet Child Adolesc Health"},{"key":"B17","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1016\/j.eatbeh.2010.05.006","article-title":"Picky eating during childhood: a longitudinal study to age 11 years","volume":"11","author":"Mascola","year":"2010","journal-title":"Eat Behav"},{"key":"B18","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1007\/s11121-014-0505-z","article-title":"Preventing weight gain and obesity: indirect effects of the family check-up in early childhood","volume":"16","author":"Smith","year":"2015","journal-title":"Prev Sci"},{"key":"B19","doi-asserted-by":"publisher","first-page":"2333794X19835640","DOI":"10.1177\/2333794X19835640","article-title":"Trends in obesity and overweight in Oregon children with down syndrome","volume":"6","author":"Pierce","year":"2019","journal-title":"Glob Pediatr Health"},{"key":"B20","doi-asserted-by":"publisher","first-page":"56","DOI":"10.3945\/an.111.001347","article-title":"Institute of medicine (IOM) early childhood obesity prevention policies. Washington, DC: the national academies press; 2011","volume":"3","author":"McGuire","year":"2012","journal-title":"Adv Nutr"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1072","DOI":"10.1001\/jamapediatrics.2013.2356","article-title":"Healthy habits, happy homes: randomized trial to improve household routines for obesity prevention among preschool-aged children: randomized trial to improve household routines for obesity prevention among preschool-aged children","volume":"167","author":"Haines","year":"2013","journal-title":"JAMA Pediatr"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1902","DOI":"10.1016\/j.jada.2008.08.017","article-title":"Providing obesity prevention counseling to children during a primary care clinic visit: results from a pilot study","volume":"108","author":"Kubik","year":"2008","journal-title":"J Am Diet Assoc"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s40608-018-0188-2","article-title":"Community-based childhood obesity prevention intervention for parents improves health behaviors and food parenting practices among hispanic, low-income parents","volume":"5","author":"Otterbach","year":"2018","journal-title":"BMC Obes"},{"key":"B24","doi-asserted-by":"publisher","first-page":"674","DOI":"10.1089\/chi.2015.0009","article-title":"Pediatric primary care\u2013based obesity prevention for parents of preschool children: a pilot study","volume":"11","author":"Sherwood","year":"2015","journal-title":"Child Obes"},{"key":"B25","doi-asserted-by":"publisher","first-page":"992","DOI":"10.1111\/jir.12617","article-title":"Feeding and swallowing difficulties in children with down syndrome","volume":"63","author":"Anil","year":"2019","journal-title":"J Intellect Disabil Res"},{"key":"B26","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/j.appet.2018.03.018","article-title":"Measuring feeding difficulties in toddlers with down syndrome","volume":"126","author":"van Dijk","year":"2018","journal-title":"Appetite"},{"key":"B27","volume-title":"The state of food security and nutrition in the world 2020 the state of food security and nutrition in the world 2020: Transforming food systems for affordable healthy diets","year":"2020"},{"key":"B28","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/j.ijporl.2015.12.014","article-title":"Sleep problems and obstructive sleep apnea in children with down syndrome, an overwiew","volume":"82","author":"Maris","year":"2016","journal-title":"Int J Pediatr Otorhinolaryngol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1904","DOI":"10.12659\/MSM.893377","article-title":"Delays in motor development in children with down syndrome","volume":"21","author":"Malak","year":"2015","journal-title":"Med Sci Monit"},{"key":"B30","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1111\/jir.12580","article-title":"A schedule of gross motor development for children with down syndrome","volume":"63","author":"Winders","year":"2019","journal-title":"J Intellect Disabil Res"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1391","DOI":"10.1007\/s11135-021-01182-y","article-title":"A worked example of braun and clarke\u2019s approach to reflexive thematic analysis","volume":"56","author":"Byrne","year":"2022","journal-title":"Qual Quant"},{"key":"B32","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual Res Psychol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"846","DOI":"10.1080\/0142159X.2020.1755030","article-title":"Thematic analysis of qualitative data: aMEE guide No. 131","volume":"42","author":"Kiger","year":"2020","journal-title":"Med Teach"},{"key":"B34","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1007\/978-981-10-5251-4_7","article-title":"Mind maps in qualitative research","volume-title":"Handbook of research methods in health social sciences","author":"Wheeldon","year":"2019"},{"key":"B35","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1111\/j.1365-2788.2010.01308.x","article-title":"Identifying facilitators and barriers to physical activity for adults with down syndrome: facilitators and barriers to activity","volume":"54","author":"Mahy","year":"2010","journal-title":"J Intellect Disabil Res"},{"key":"B36","doi-asserted-by":"publisher","first-page":"1020","DOI":"10.1111\/j.1365-2788.2011.01425.x","article-title":"Identifying the barriers and facilitators to participation in physical activity for children with down syndrome: physical activity in down syndrome","volume":"55","author":"Barr","year":"2011","journal-title":"J Intellect Disabil Res"},{"key":"B37","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1111\/jar.12220","article-title":"Physical activity engagement in young people with down syndrome: investigating parental beliefs","volume":"30","author":"Alesi","year":"2017","journal-title":"J Appl Res Intellect Disabil"},{"key":"B38","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1080\/14330237.2018.1455308","article-title":"Parents of children with down syndrome: do resilience and social support matter to their experience of carer stress?","volume":"28","author":"Onyedibe","year":"2018","journal-title":"J Psychol Afr"},{"key":"B39","doi-asserted-by":"publisher","first-page":"488","DOI":"10.1177\/1367493517727131","article-title":"Parenting children with down syndrome: societal influences","volume":"21","author":"Huiracocha","year":"2017","journal-title":"J Child Health Care"},{"key":"B40","doi-asserted-by":"publisher","first-page":"4239","DOI":"10.1016\/j.ridd.2013.09.011","article-title":"Health related quality of life in parents of six to eight year old children with down syndrome","volume":"34","author":"Marchal","year":"2013","journal-title":"Res Dev Disabil"},{"key":"B41","doi-asserted-by":"publisher","first-page":"831","DOI":"10.1515\/jpem-2016-0422","article-title":"Concentrations of leptin, adiponectin and other metabolic parameters in non-obese children with down syndrome","volume":"30","author":"Tenneti","year":"2017","journal-title":"J Pediatr Endocrinol Metab"},{"key":"B42","doi-asserted-by":"publisher","first-page":"1344","DOI":"10.1093\/ajcn\/nqy357","article-title":"Caloric compensation in infants: developmental changes around the age of 1 year and associations with anthropometric measurements up to 2 years","volume":"109","author":"Brugaill\u00e8res","year":"2019","journal-title":"Am J Clin Nutr"},{"key":"B43","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1016\/j.appet.2017.04.018","article-title":"Caloric compensation in preschool children: relationships with body mass and differences by food category","volume":"116","author":"Carnell","year":"2017","journal-title":"Appetite"},{"key":"B44","doi-asserted-by":"publisher","first-page":"925","DOI":"10.1038\/ijo.2015.30","article-title":"Impact of adiposity, age, sex and maternal feeding practices on eating in the absence of hunger and caloric compensation in preschool children","volume":"39","author":"Remy","year":"2015","journal-title":"Int J Obes (Lond)"},{"key":"B45","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1352\/1934-9556-50.2.109","article-title":"Physical activity patterns of youth with down syndrome","volume":"50","author":"Esposito","year":"2012","journal-title":"Int Dev Disabil"},{"key":"B46","doi-asserted-by":"publisher","first-page":"60","DOI":"10.3104\/reports.1996","article-title":"Parents\u2019 perceptions of health and physical activity needs of children with down syndrome","volume":"12","author":"Menear","year":"2007","journal-title":"Downs Syndr Res Pract"},{"key":"B47","doi-asserted-by":"publisher","first-page":"1932701","DOI":"10.1080\/17482631.2021.1932701","article-title":"Physical activity among children with down syndrome: maternal perception","volume":"16","author":"Alghamdi","year":"2021","journal-title":"Int J Qual Stud Health Well-Being"},{"key":"B48","doi-asserted-by":"publisher","first-page":"867","DOI":"10.5664\/jcsm.7126","article-title":"Prevalence of obstructive sleep apnea in children with down syndrome: a meta-analysis","volume":"14","author":"Lee","year":"2018","journal-title":"J Clin Sleep Med"},{"key":"B49","doi-asserted-by":"publisher","first-page":"1984","DOI":"10.1111\/cdev.12443","article-title":"Sleep disturbance and expressive language development in preschool-age children with down syndrome","volume":"86","author":"Edgin","year":"2015","journal-title":"Child Dev"},{"key":"B50","doi-asserted-by":"publisher","first-page":"1572","DOI":"10.1016\/j.ridd.2013.01.031","article-title":"Cross syndrome comparison of sleep problems in children with down syndrome and williams syndrome","volume":"34","author":"Ashworth","year":"2013","journal-title":"Res Dev Disabil"},{"key":"B51","doi-asserted-by":"publisher","first-page":"194599817726286","DOI":"10.1177\/0194599817726286","article-title":"Accuracy of parental perception of nighttime breathing in children with down syndrome","volume":"158","author":"Friedman","year":"2017","journal-title":"Otolaryngol Head Neck Surg"},{"key":"B52","doi-asserted-by":"publisher","first-page":"432","DOI":"10.1001\/archotol.132.4.432","article-title":"Obstructive sleep apnea: should all children with down syndrome be tested?: should all children with down syndrome be tested?","volume":"132","author":"Shott","year":"2006","journal-title":"Arch Otolaryngol Head Neck Surg"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2023.1155850\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T04:43:20Z","timestamp":1689050600000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2023.1155850\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,11]]},"references-count":52,"alternative-id":["10.3389\/fped.2023.1155850"],"URL":"https:\/\/doi.org\/10.3389\/fped.2023.1155850","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,11]]},"article-number":"1155850"}}