The OWL Screening Tool-A Protocol for Holistic Pediatric Lifestyle Assessment

Background/Objectives: The identification of health risk factors in children should rely not only on body mass index but also on modifiable lifestyle behaviors. Early screening for physical inactivity, poor nutrition, inadequate sleep, and chronic stress is crucial for effective preventive healthcare. The aim of this project was to develop the OWL screening tool, a protocol for the holistic assessment of key lifestyle risk factors in children aged 6-12. Methods/Rationale: The OWL tool was developed by integrating evidence-based recommendations from major health societies (WHO, EFSA, the National Sleep Foundation, and the Pediatric Endocrine Society), incorporating psychological principles, and adapting validated components from existing pediatric screening instruments. Its design prioritizes flexibility for use across various age groups and settings. The development process resulted in the 20-item OWL questionnaire, structured into four lifestyle domains: nutrition, physical activity, sleep, and stress management. Each item is a closed-ended question requiring a dichotomous (yes/no) response. One point is awarded for each health-promoting behavior endorsed, yielding a total possible score of 20. The tool is suitable for self-report by older children, parent-report for younger children, or clinician-administered review. Conclusions: By integrating sleep and stress management with traditional lifestyle factors, the OWL screening tool offers a highly relevant approach to pediatric preventive care. The findings presented here should be interpreted as a proof-of-concept, and the tool is not yet ready for clinical implementation without further rigorous evaluation.