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Rates of Blount disease and childhood obesity have increased in parallel, although the co-management of this acquired comorbidity and obesity is not well described. This report shares the course of a toddler with severe obesity who experienced rapid and persistent weight gain without success from nutrition and behavior changes. After repeat subspeciality evaluation, the patient was ultimately diagnosed with signs of early-onset Blount disease, urging the need for adjunct medical therapy. Initiation of topiramate was shown to achieve weight neutrality and improve the patient's body mass index (BMI), appearing to halt the progression of Blount disease and avoiding escalation to surgical treatment. This report suggests topiramate can be an effective and well-tolerated medication in young patients with a pressing need for weight intervention.

الملخص: أهداف البحث: التهاب الجلد الناتج عن الحفاظ هو أحد أكثر الأمراض الجلدية شيوعا لدى الأطفال. الأدوية شائعة الاستخدام للعلاج لها العديد من الآثار الجانبية، مما يفرض الحاجة إلى تقييم استراتيجيات علاجية آمنة. لذلك، فإننا نهدف إلى مقارنة فعالية زيت الأرغان سبينوزا ومرهم الهيدروكورتيزون 1٪ على شفاء التهاب الجلد الحفاظي. طريقة البحث: أجريت دراسة شبه تجريبية في الأردن على أطفال تتراوح أعمارهم بين عامين أو أقل يعانون من التهاب الجلد الحفاظي الخفيف إلى الشديد. في البداية، تم تسجيل 73 مشاركا في مجموعة زيت الأرغان سبينوزا و 74 مشاركا في مجموعة مرهم الهيدروكورتيزون 1 ٪. تم تعيينهم بشكل عشوائي، بعد إجراء القياس الأساسي لالتهاب الجلد الحفاظي. تم قياس الشفاء في الأيام 1و3 و 7 من خلال الزيارات المنزلية، باستخدام مقياس تصنيف مكون من 5 نقاط. تم تحليل البيانات باستخدام نماذج فيشر، مان ويتني يو، ومعادلات التقدير المعممة من خلال برنامج اس بي اس اس الإصدار 25. النتائج: من بين 147 طفلا تم تسجيلهم، أكمل 140 منهم الدراسة. لوحظ انخفاض في درجات التهاب الجلد الحفاظي في كلا المجموعتين. بعد استبعاد العوامل المربكة، كشفت نماذج معادلات التقدير المعممة أن الأطفال الذين استخدموا علاج زيت الأرغان سبينوزا كانوا أقل عرضة بنسبة 25 مرة للإصابة بدرجات التهاب الجلد الحفاظي الحاد وتحسنوا بشكل أسرع من الأطفال الذين استخدموا الهيدروكورتيزون 1٪. كشف الانحدار اللوجستي المتعدد على بيانات خط الأساس أن استخدام كريم الحاجز وتكرار الاستحمام مرة واحدة في الأسبوع كانت تنبؤية بحدوث التهاب الجلد الحفاظي. الاستنتاجات: يعتبر زيت الأرغان سبينوزا أكثر فعالية في علاج التهاب الجلد الحفاظي ويمكن استخدامه كخيار تكميلي. ومع ذلك، ستكون التجارب السريرية الإضافية على عينات أكبر ضرورية لتأكيد النتيجة وإصدار حكم موثوق. Abstract: Objectives: Diaper dermatitis (DD) is one of the most common dermatological disorders in children. Commonly used drugs for treatment have several adverse effects; therefore, assessment of safe therapeutic strategies is necessary. We, therefore, aimed at comparing the efficacy of argan spinosa oil and 1% hydrocortisone ointment on DD healing. Methods: A quasi-experimental study was conducted in Jordan on children 2 years old or younger with mild to severe DD. Initially, 73 participants were enrolled in the argan spinosa oil group, and 74 participants were enrolled in the 1% hydrocortisone ointment group. Participants were assigned to groups randomly after the baseline measurement of DD. Healing was measured on a 5-point scale on days 1, 3, and 7, through home visits. Data were analyzed with Fisher's exact test, the Mann–Whitney U test, and generalized estimating equation (GEE) models in SPSS version 25 software, with a significance level of p

Hemophagocytic lymphohistiocytosis (HLH) is a rare, potentially life-threatening clinical syndrome characterized by hyperactivation of inflammatory mediators and harmful end-organ damage. Visceral leishmaniasis (VL)-induced HLH is a rare disease with significant diagnostic and management implications. Herein, we present a case of secondary HLH as a complication of visceral leishmaniasis in a two-year-old toddler. A 2-year-old male toddler was admitted for evaluation of a prolonged 4-week fever. Accompanying the fever, he developed progressive abdominal swelling, intermittent bilateral nasal bleeding, and repeated chest-focus infections of similar duration. The patient was acutely sick, with chronic signs of malnutrition (mid-upper arm circumference of 10.5 cm), fever (39 °C), tachypnea (70 breaths/min), tachycardia (132 beats/min), pallor, and hepatosplenomegaly. Initial investigation revealed leukopenia (2240/μl), anemia (7.3 g/dl), and severe thrombocytopenia (26,000/μl). With consideration of febrile neutropenia, the patient was started on cefepime with further revision to vancomycin and meropenem based on the culture result. After 10 days of persistent fever and poor clinical condition, an immunochromatographic rapid test with the rK39 antigen was conducted, and the patient was found to be positive for Leishmania spp. Intravenous liposomal amphotericin B (AmBisome) was initiated. On the 6th day of treatment, the patient’s clinical and laboratory profiles severely deteriorated, and further laboratory investigation showed elevated triglyceride (524 mg/dl) and ferritin levels (1500 ng/mL). VL-induced secondary HLH was confirmed, and intravenous dexamethasone was initiated. Subsequently, his clinical and laboratory findings significantly improved, and he was discharged with PO dexamethasone. Our case highlights the intricate nature of VL-induced HLH and the need for high index of suspicion and timely management.

Summary: Background: Early childhood is a vital period for development and growth. Promoting beneficial lifestyle behaviours in early childhood can help optimise children's health, development and learning, shape their behaviours in adulthood and offer the best protection against future non-communicable diseases (NCDs). In the Asia–Pacific region, NCDs are significant causes of healthcare burden and mortality. Furthermore, there is also a high prevalence of adverse metabolic risk factors and unhealthy lifestyle behaviours among these children. Method: Representatives from 19 Asia–Pacific nations and/or jurisdictions developed a consensus statement on integrated 24-hour activity guidelines for the early years using the GRADE-ADOLOPMENT framework. Findings: These guidelines apply to all infants, toddlers and pre-schoolers below 5 years of age. The guidelines aim to provide a holistic and practical approach to lifestyle activities by framing physical activity, sedentary behaviour and sleep within a 24-hour period. Dietary patterns were included as they play an integral role in metabolic health and energy balance. Interpretation: Aligned with the World Health Organization's Global Action Plan for the Prevention and Control of NCDs through health promotion interventions in early life, through cultivating healthy lifestyle behaviours in the children's early years, we aim to provide children with the best start in life and reduce the burden of future NCDs in the Asia–Pacific region. Funding: Funded by Integrated platform for research in advancing metabolic health outcomes of women and children

Mastery motivation is a multifaceted, psychological force that stimulates a child to master skills or tasks and is positively associated with language-related competences. Children with developmental delay might have lower levels of motivation, and their parents might face escalated parenting stress as well. The aims of this study were to identify the characteristics of mastery motivation in toddlers with language delay by intergroup and intragroup comparison, and to investigate the associations between specific components of parenting stress and toddler's mastery motivation. Eighty Chinese-speaking Taiwanese toddlers aged 19 to 42 months and their parents (fifty toddlers with language delay and thirty toddlers with typical development) participated in the study. The language delay group was selected based on maternal reports of vocabulary production with the Mandarin-Chinese Communicative Development Inventory and direct assessment with an individualized developmental test or intelligence test. The Revised Dimensions of Mastery Questionnaire (DMQ 18) with Preschool version, and the Parenting Stress Index Short Form were used to measure three domains of child mastery motivation and parents' components of parenting stress, respectively. Toddlers with language delay were rated as having lower gross motor and social mastery motivation than their peers with typical development; however, they showed the strength/weakness intragroup characteristics of higher gross motor motivation and lower social motivation with other children. Parental stress in the language delay group was significantly negatively correlated with mastery motivation, and the component of Parent-Child Dysfunctional Interaction was negatively associated with toddlers' Total Mastery Motivation, social motivation, and two indicators of expressive aspect after controlling for toddlers' age, cognitive ability, and family social-economic status. In conclusion, it is necessary for early interventionists to observe parenting stress and mastery motivation during the process of early intervention.

Emerging evidence suggests that prenatal exposure to ambient SO2 or NO2 induces fetal brain-damage. However, effects of prenatal exposure to SO2 or NO2 on toddler neurodevelopment and the effect-modification by ambient temperature remain unclear. Therefore, a prospective birth-cohort study was conducted from 2010 to 2012 in Shanghai, and 225 mother-child pairs were followed-up from mid-to-late pregnancy until 24–36 months postpartum. During the whole pregnancy, daily SO2/NO2 and temperature levels were obtained for each woman. Gesell-Development-Schedule was used to assess toddler neurodevelopment in the domains of gross-motor, fine-motor, adaptive-behavior, language and social-behavior. Distributed-lag-nonlinear-models simultaneously accounting for exposure-response and lag-response associations were applied to assess the impacts of prenatal SO2/NO2 exposure on neurodevelopment. Each 10-μg/m3 increase in weekly average SO2 concentrations had adverse associations with gross-motor in gestational-weeks 1–6, with adaptive-behavior in weeks 26–30, and with language in weeks 30–36 (developmental-quotient changes: − 1.17% to − 0.12%, P-values

Rates of Blount disease and childhood obesity have increased in parallel, although the co-management of this acquired comorbidity and obesity is not well described. This report shares the course of a toddler with severe obesity who experienced rapid and persistent weight gain without success from nutrition and behavior changes. After repeat subspeciality evaluation, the patient was ultimately diagnosed with signs of early-onset Blount disease, urging the need for adjunct medical therapy. Initiation of topiramate was shown to achieve weight neutrality and improve the patient's body mass index (BMI), appearing to halt the progression of Blount disease and avoiding escalation to surgical treatment. This report suggests topiramate can be an effective and well-tolerated medication in young patients with a pressing need for weight intervention., (© 2024 The Authors.)

In electroencephalographic (EEG) data, power-frequency slope exponents (1/f _β ) can provide non-invasive markers of in vivo neural activity excitation-inhibition (E:I) balance. E:I balance may be altered in neurodevelopmental conditions; hence, understanding how 1/f β evolves across infancy/childhood has implications for developing early assessments/interventions. This systematic review (PROSPERO-ID: CRD42023363294) explored the early maturation (0-26 yrs) of resting-state EEG 1/f measures (aperiodic [AE], power law [PLE] and Hurst [HE] exponents), including studies containing ≥1 1/f measures and ≥10 typically developing participants. Five databases (including Embase and Scopus) were searched during March 2023. Forty-two studies were identified (N participants =3478). Risk of bias was assessed using the Quality Assessment with Diverse Studies tool. Narrative synthesis of HE data suggests non-stationary EEG activity occurs throughout development. Age-related trends were complex, with rapid decreases in AEs during infancy and heterogenous changes thereafter. Regionally, AE maxima shifted developmentally, potentially reflecting spatial trends in maturing brain connectivity. This work highlights the importance of further characterising the development of 1/f measures to better understand how E:I balance shapes brain and cognitive development., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To assess how Australian infant and toddler foods compare to a nutrient and promotion profile model (NPPM) developed by the World Health Organization to support the appropriate promotion of commercial food products for children aged 6-36 months., Methods: A cross-sectional audit of infant and toddler foods found at three major Australian supermarkets was conducted in September/October 2022. Using nutrition and promotional data extracted from the packaging, products were classified according to NPPM categories and assessed against relevant compositional, front-of-pack labelling and promotional requirements., Results: Of 330 eligible products identified, just 28% met all NPPM compositional requirements. Toddler foods were less compliant than infant foods overall (18% vs. 31%; p=0.021), and for specific nutrients such as sodium (75% vs. 89%; p=0.003). No products met all NPPM front-of-pack labelling/promotional requirements. Only two-thirds and two-fifths of products were compliant with product name and ingredient list requirements, respectively., Conclusion: Australian infant and toddler foods do not fully comply with the NPPM requirements. While toddler foods performed comparatively worse in terms of their nutritional adequacy, there is considerable scope to improve the nutrient profile of both infant and toddler foods., Implications for Public Health: To better support young children's health and development, the introduction of mandatory nutrition standards for Australian toddler foods, and the improvement of nutrition standards for Australian infant foods, in line with the NPPM, is needed. To be most effective, these should be combined with regulations for the labelling and promotion of these foods in line with the NPPM., Competing Interests: Conflicts of interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this articles., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objective: Identify and describe diet patterns of children during early childhood using confirmatory factor analysis (CFA)., Design: Longitudinal data were drawn from the STRONG Kids 2 program., Participants: Mothers were surveyed about their child's diet at 24 (n = 337), 36 (n = 317), and 48 (n = 289) months old., Variables Measured: The Block Food Frequency Questionnaire for children aged 2-7 years was used to derive diet patterns; 23 food groups were created for analyses., Analysis: Principal component analysis was used to obtain preliminary factor loadings, and loadings were used to form a priori hypotheses for CFA-derived diet patterns. Independent samples t tests were used to compare food groups, nutrient intakes, and child and family characteristics by CFA pattern scores above vs at/below the median., Results: Three diet patterns consistently emerged: (1) processed meats, sweets, and fried foods; (2) vegetables, legumes, and starchy vegetables; and (3) grains, nuts/seeds, and condiments (only 24 and 36 months). Patterns were related to differences in added sugars, dietary fiber and potassium intakes, maternal education, and household income., Conclusions and Implications: Opposing healthful vs Western patterns, extant in child and adult literature, were observed across all ages. The third pattern differed between 24/36 and 48 months, representing a potential shift in food choices or offerings as children age., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Apela (also known as Elabela, Ende, and Toddler) is a small signaling peptide that activates the G-protein-coupled receptor Aplnr to stimulate cell migration during zebrafish gastrulation. Here, using CRISPR/Cas9 to generate a null, reporter-expressing allele, we study the role of Apela in the developing mouse embryo. We found that loss of Apela results in low-penetrance cardiovascular defects that manifest after the onset of circulation. Three-dimensional micro-computed tomography revealed a higher penetrance of vascular remodeling defects, from which some mutants recover, and identified extraembryonic anomalies as the earliest morphological distinction in Apela mutant embryos. Transcriptomics at late gastrulation identified aberrant upregulation of erythroid and myeloid markers in mutant embryos prior to the appearance of physical malformations. Double-mutant analyses showed that loss of Apela signaling impacts early Aplnr-expressing mesodermal populations independently of the alternative ligand Apelin, leading to lethal cardiac defects in some Apela null embryos.

Purpose: To report the clinical and genetic findings of a male toddler who presented bilateral bullous retinoschisis with a novel RS1 mutation. Observations: This is an observational case report of a patient referred to our hospital with esotropia. A comprehensive ophthalmic examination was performed with the boy (age, 1 year 4 months) under general anesthesia that included fundus examinations, fluorescein angiography (FA), swept-source optical coherence tomography (SS-OCT), and full-field electroretinography (FF-ERG). Genetic analysis of the coding region in the RS1 gene was performed by Sanger sequencing for the patient and mother. There was a family history of X-linked retinoschisis (XLRS). Fundus examinations and FA showed bullous retinoschisis bilaterally in the inferior retina. The SS-OCT images showed two kinds of schisis in the inner nuclear layer (INL) and more proximally. In general, the inner plexiform layer, ganglion cell layer, and retinal nerve fiber layer are in the proximal INL; however, in this case there was hyperreflective tissue with a rough surface instead of normal retinal layers. In addition, in the schisis cavity between the hyperreflective tissue and separated retina, a number of hyperreflective fiber-like strands arose from the hyperreflective tissue and extended to the schisis cavity. During the follow-up period, the bullous retinoschisis collapsed spontaneously in the right eye. FF-ERG showed a reduced b-wave and relatively preserved a-wave in all components. Genetic analysis showed a novel RS1 mutation (c.185_186insT, p.E62DfsX24 in exon 4) in the patient and mother. Conclusions and importance: We report the detailed retinal structure in a genetically identified case of bullous retinoschisis. The notable finding was that the cavity of bullous retinoschisis contained a number of fiber-like strands as observed in the cavity of typical retinoschisis.

Background: Our aim was to describe the exposure of French children aged 12-36 months to screens (time, content, age of first exposure) and to analyze different moderating factors: sociodemographic data, parents' screen time, and other factors (childcare arrangements, language spoken at home, book reading)., Population and Methods: We conducted an observational, cross-sectional, descriptive and analytical study based on 171 questionnaires from parents of children aged 12-36 months who consulted different hospitals in the Paris region during the summer of 2020., Results: The median screen time was 1 h per day and was essentially television time. The median age of first exposure for children was 12 months. Among the most-watched sites, YouTube was in first place. One third of the children chose the content they watched alone, and the majority did so without any parental guidance (66%). Children watched a screen during mealtime every day in 25% of cases, before bedtime in 12.3% of cases, and 8.8% had a screen in their bedroom. More than one third of families left the television on in the background most of the time. In the multivariate analysis, a high level of screen time was notably linked to the child's age, the parents' screen time, and background television. However, the parental reason for exposure "to calm the child" was the most strongly correlated factor with significant child screen time. Reading books appeared to be a determining factor for less screen exposure., Conclusion: These results emphasize the importance of raising parents' awareness about the potential negative effects of screen exposure (particularly on children's cognitive and emotional development) as early as possible during the maternity period. Implementing this prevention in the maternity wards could be an effective way of informing and educating parents about the potential negative effects of screen time on their child's development., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.)

Background: With the addition of new guidance for children from birth to 24 months in the Dietary Guidelines for Americans, 2020-2025 (DGA), a Healthy Eating Index (HEI) was developed for toddlers., Objective: To evaluate the psychometric properties of the HEI-Toddlers-2020, 5 analyses relevant to construct and concurrent validity and 2 related to reliability were examined., Design: Twenty-four-hour diet recall data from the cross-sectional National Health and Nutrition Examination Survey (2011-2018) were used. In addition, exemplary menus were analyzed., Participants/setting: The main analytic sample included toddlers aged 12 through 23 months (n = 838), with additional analyses of toddlers aged 12 through 35 months (n = 1,717) from the United States. Included participants had valid diet recalls and available weight-for-age data., Main Outcome Measures: Outcomes measures included HEI-Toddlers-2020 total and component scores on menus, population distributions, and correlations., Statistical Analyses: HEI total and component scores were calculated using menus from the American Academy of Pediatrics and Healthy Eating Research. Score means and distributions were estimated using a Markov Chain Monte Carlo approach with National Health and Nutrition Examination Survey data (2011-2018). Principal component analysis explored dimensions and Pearson correlations examined components, energy, and Cronbach α. In addition, HEI-Toddlers-2020 and HEI-2020 scores were compared for identical intakes at age 24 months., Results: For validity, exemplary menus received high scores with the HEI-Toddlers-2020. The mean ± SE total HEI-Toddlers-2020 score for toddlers aged 12 through 23 months was 62.9 ± 0.78 and ranged from 40.1 to 84.4 (1 st to 99 th percentile). Correlation between diet quality and diet quantity was low (-0.15); the scree plot revealed multiple factors. In addition, total scores for identical intakes were approximately 1.5 points higher for HEI-Toddlers-2020 compared with HEI-2020 (difference range for component scores, -4.97 to 4.89). For reliability, most of the intercorrelations among components were low to moderate (0 to 0.49), with a few exceptions among related components. Cronbach α was .48. These results indicate that the index is multidimensional, with no single component driving the total score, and no unnecessary components that are highly correlated with another component., Conclusions: The results demonstrated evidence supportive of validity and reliability. The HEI-Toddlers-2020 can be used to assess alignment with the DGA for toddlers., (Copyright © 2023 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

The objective of this study is to explore the prevalence of and factors associated with depressive symptoms in mothers with young children. Methods: This is a cross-sectional face-to-face study performed between January 1, 2010 and June 30, 2011. Mothers of premature infants with a gestational age of less than 37 weeks were recruited. Premature infants with any congenital anomaly or severe congenital heart disease were excluded. Controls were mothers of full-term infants with birth weight over 2500 g and without admission to a neonatal intensive care unit. Outcome measures included the Center for Epidemiologic Studies Depression Scale for maternal depressive symptoms, the Family Apgar Index for family support, and the Chinese Maudsley Personality Inventory for personality traits. Results: A total of 102 mothers of preterm infants and 111 mothers of full-term infants were recruited. The prevalence of depressive symptoms was 27.7% (59/213) in all mothers of this study, 29.4% (30/102) in mothers of preterm infants, and 26.1% (29/111) in mothers of full-term infants. Predictors of maternal depressive symptoms included the following: extended family structure, lack of postpartum confinement, low family support, and a personality characterized by neuroticism. Conclusion: Depressive symptoms were common among mothers of young children. Family function and neurotic personality were highly correlated with depressive symptoms in mothers caring for young children. Pediatric health care providers are suggested to screen for maternal depressive symptoms and provide family-oriented support in Taiwan.

Blunt cardiac rupture is typically a fatal injury with overall mortality exceeding 90%. Most of the patients never reach the hospital alive. In pediatric patients, only 0.03% of cases following blunt trauma admissions have a cardiac injury. This report presents a rare survivor of 16-months old toddler injured in a domestic accident suffering a right atrial rupture repaired through a median sternotomy. To the best of our knowledge this is the youngest case reported in the literature.

Abstract Objective: To describe the quantity and diversity of food and beverage intake in Australian children aged 12–16 months and to determine if the amount and type of milk intake is associated with dietary diversity. Methods: Mothers participating in the NOURISH and South Australian Infant Dietary Intake (SAIDI) studies completed a single 24‐hour recall of their child's food intake, when children (n=551) were aged 12–16 months. The relationship between dietary diversity and intake of cow's milk, formula or breastmilk was examined using one‐way ANOVA. Results: Dairy and cereal were the most commonly consumed food groups and the greatest contributors to daily energy intake. Most children ate fruit (87%) and vegetables (77%) on the day of the 24‐hour recall while 91% ate discretionary items. Half the sample ate less than 30 g of meat/alternatives. A quarter of the children were breastfeeding while formula was consumed by 32% of the sample, providing 29% of daily energy intake. Lower dietary diversity was associated with increased formula intake. Conclusions: The quality of dietary intake in this group of young children is highly variable. Most toddlers were consuming a diverse diet, though almost all ate discretionary items. The amount and type of meat/alternatives consumed was poor. Implications: Health professionals should advise parents to offer iron‐rich foods, while limiting discretionary choices and use of formula at an age critical in the development of long‐term food preferences.

This article describes the changes in normal sleep regulation, structure, and organization and sleep-related changes in respiration from infancy to adolescence. The first 2 years of age are striking, with more time asleep than awake. With development, the electroencephalogram architecture has a marked reduction in rapid eye movement sleep and the acquisition of K-complexes, sleep spindles, and slow-wave sleep. During adolescence there is a reduction in slow-wave sleep and a delay in the circadian phase. Infants have a more collapsible upper airway and lower lung volumes than older children, which predisposes them to obstructive sleep apnea and sleep-related hypoxemia., Competing Interests: Conflicts of Interest No conflicts of interests with any of the authors., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Good sleep is essential for children's healthy growth. In 2005, we conducted a questionnaire survey on children's sleep habits and their background, targeting parents who attended health checkups for their 3-year-old children in Asahikawa City, Hokkaido. In 2020, we performed a secondary survey, including additional questions regarding media usage. We analyzed changes in children's sleep environment by comparing the results of both surveys., Methods: Children from 500 families (n = 420; 219 males, 201 females; mean age, 3.6 years) who underwent 3.5-year-old health checkups (per the changed schedule in 2015) in Asahikawa City from July 2020 to November 2020 and their parents who had completely answered the questionnaire were included., Results: The proportion of children who used childcare support system such as nursery schools or kindergarten increased from 30% in the previous survey to 95% in the present survey. The mean nocturnal sleep duration of children was 9.33 h in the present survey, 0.77 h shorter than that in the previous survey; similar to the previous survey results, it was significantly short (8.71 h) in children who went to bed after 10 PM. Moreover, it was significantly short in children who watched television for more than two hours or used media within two hours before going to bed or if parents used smartphones or watched motion pictures for >30 min/day. The rate of consulting pediatricians regarding sleep problems decreased from 3% to 2.4%., Conclusion: Parents' lifestyles greatly influenced children's sleep habits in 2020. Pediatricians should actively participate in managing children's sleep problems., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.)

This chapter reviews the Peds B-SATED model of pediatric sleep health and common pediatric sleep problems. Aspects of pediatric sleep health and sleep problems are considered across development, from infants through adolescents. Finally, information about clinical screening in both primary and specialty care is discussed, and subjective sleep questionnaires are reviewed., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objectives: The EuroQol Group is exploring the development of a health-related quality of life measure for toddlers and infant populations (EuroQoL Toddler and Infant Populations [EQ-TIPS]) aged 0 to 36 months. This study aimed to report on the cross-cultural adaptation and validity of the South African Afrikaans EQ-TIPS., Methods: The development of the Afrikaans EQ-TIPS followed the EuroQol guidelines including forward-backward translation and cognitive interviews with 10 caregivers of children aged 0 to 36 months. Thereafter, 162 caregivers of children 0 to 36 months of age were recruited from a pediatric hospital inpatient and outpatient facility. The EQ-TIPS; Ages and Stages Questionnaire; face, legs, activity, cry, and consolability; and dietary information were completed by all caregivers. The distribution of dimension scores, Spearman's correlation, analysis of variance, and regression analysis were used to explore the validity of the EQ-TIPS., Results: The descriptive system of the EQ-TIPS was generally well understood and accepted by caregivers. The correlation coefficients for concurrent validity were significant and moderate for pain and weak and significant for the other dimensions hypothesized to correlate. Known groups were compared and inpatients had a significantly higher report of pain (χ 2  = 7.47, P = .024) and more problems reported across all EQ-TIPS dimensions (recorded on the level sum score) (Kruskal Wallis H = 3.809, P = .05) and reported significantly worse health on the visual analog scale (Kruskal Wallis H = 15.387, P < .001). There were no age-related differences except for a lower report of problems with movement in the 0- to 12-month group (χ 2  = 10.57, P = .032)., Conclusion: The Afrikaans version of the EQ-TIPS is well understood and accepted by caregivers and valid for use with children aged 0 to 36 months in South Africa., (Copyright © 2023 International Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.)

Background: Breastfeeding has numerous effects on maternal and child health. The effect of breastfeeding on infant sleep remains inconclusive., Objectives: We aimed to examine whether full breastfeeding (FBF) during the first 3 mo is associated with longitudinal infant sleep trajectories in their first 2 y of life., Methods: The study was embedded in the Tongji Maternal and Child Health Cohort study. Information on infant feeding practices was collected at 3 mo of age, and maternal/child pairs were assigned to the FBF or the non-FBF group (including partially breastfeeding and exclusive formula feeding) on the basis of feeding practices during the first 3 mo of life. Sleep data of infants were obtained at 3, 6, 12, and 24 mo. Total, night, and day sleep trajectories across 3 to 24 mo were estimated with group-based models. Each sleep trajectory was differentiated on the basis of sleep duration at 3 mo (long/moderate/short) and the interval from 6 to 24 mo (moderate/short). Multinomial logistic regression was used to investigate the association of breastfeeding practices with infant sleep trajectories., Results: Among the 4056 infants studied, 2558 (63.1%) received FBF for 3 mo. When compared with FBF infants, non-FBF infants had shorter sleep duration at 3, 6, and 12 mo (P < 0.01). Non-FBF infants were more likely to experience Moderate-Short (OR: 1.31; 95% CI: 1.06, 1.61) and Short-Short (OR: 1.56; 95% CI: 1.12, 2.16) total sleep trajectories and more likely to experience Moderate-Short (OR: 1.84; 95% CI: 1.22, 2.77), and Short-Moderate (OR: 1.40; 95% CI: 1.06, 1.85) night sleep trajectories than FBF infants., Conclusions: Full breastfeeding for ≥3 mo were positively associated with longer infant sleep duration. Infants fully breastfed were more likely to experience better sleep trajectories characterized by longer duration in their first 2 y of life. Full breastfeeding may benefit infants through healthy sleep., (Copyright © 2022 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)

Background: Accurate assessment of toddler diet quality is essential for understanding current intakes and evaluating the effect of interventions and programs to promote healthy eating and prevent chronic disease., Objectives: The goal of this article was to assess the diet quality among toddlers using two different indices appropriate for 24-mo-old toddlers and compare differences in scoring between the measures by race and Hispanic origin., Methods: We used cross-sectional data from 24-mo-old toddlers participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Infant and Toddler Feeding Practices Study-2 (ITFPS-2), a national study that includes 24-hour dietary recall information from children enrolled in WIC at birth. The main outcome measure was diet quality using both the toddler diet quality index (TDQI) and the healthy eating index (HEI)-2015. We derived mean scores for overall diet quality and for each component. We examined associations between the distribution of diet quality scores across terciles and by race and Hispanic origin using Rao-Scott chi-square tests of association., Results: Nearly half of the mothers and caregivers self-identified as Hispanic (49%). Diet quality scores were higher when using the HEI-2015 compared with the TDQI (56.4 vs. 49.9, respectively). The difference in component scores was largest for refined grains, followed by sodium, added sugars, and dairy. Toddlers from Hispanic mothers and caregivers had significantly higher component scores for greens and beans and dairy but had lower scores for whole grains (P < 0.05) than those for the other racial and ethnic subgroups assessed., Conclusions: We found noteworthy differences in toddler diet quality depending on whether the HEI-2015 or TDQI is used, and children of different racial and ethnic subgroups may be differentially classified as having high or low diet quality depending on which index is used. This may have important implications for understanding which populations are at risk of future diet-related diseases., (Copyright © 2022 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)