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.
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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.
Neighbourhood ethnic diversity buffers school readiness impact in ESL children.Can J Public Health. 2010 Nov-Dec;101 Suppl 3:S13-8. Can J Public Health. 2010. PMID: 21416798 English, French.
Examining the social determinants of children's developmental health: protocol for building a pan-Canadian population-based monitoring system for early childhood development.BMJ Open. 2016 Apr 29;6(4):e012020. doi: 10.1136/bmjopen-2016-012020. BMJ Open. 2016. PMID: 27130168 Free PMC article.
School Readiness.Pediatrics. 2019 Aug;144(2):e20191766. doi: 10.1542/peds.2019-1766. Epub 2019 Jul 22. Pediatrics. 2019. PMID: 31331984 Review.
School readiness.Pediatrics. 2008 Apr;121(4):e1008-15. doi: 10.1542/peds.2008-0079. Pediatrics. 2008. PMID: 18381499 Review.
Influence of Surgical Procedures and General Anesthesia on Child Development Before Primary School Entry Among Matched Sibling Pairs.JAMA Pediatr. 2019 Jan 1;173(1):29-36. doi: 10.1001/jamapediatrics.2018.3662. JAMA Pediatr. 2019. PMID: 30398535 Free PMC article. Clinical Trial.
- Brown RS, Parekh G. The intersection of disability, achievement, and equity: a system review of special education in the TDSB. Toronto, Ontario, Canada: Toronto District School Board, 2013.
- Constante K. Strong roots, bright futures: the promise of education and early human development. An interview with Fraser mustard. Ontario Ministry of Education 2010;111:1–8.
- Janus M, Offord DR. Development and psychometric properties of the early development instrument (EDI): a measure of children's school readiness. Can J Behav Sci 2007;39:1–22. 10.1037/cjbs2007001 - DOI
- Janus M, Gaskin A. School readiness. Encyclopedia of quality of life research. New York: Springer, 2014.