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Identify and describe diet patterns of children during early childhood using confirmatory factor analysis (CFA). Longitudinal data were drawn from the STRONG Kids 2 program. Mothers were surveyed about their child's diet at 24 (n = 337), 36 (n = 317), and 48 (n = 289) months old. The Block Food Frequency Questionnaire for children aged 2–7 years was used to derive diet patterns; 23 food groups were created for analyses. 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. 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. 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. [ABSTRACT FROM AUTHOR]

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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). 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. 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. 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. [ABSTRACT FROM AUTHOR]

• Earlier enrollment in targeted high-quality ECE programs can multiply the benefits. • Selection factors into ECE for toddlers was different for DLLs and their peers. • Propensity score weights were applied to equate language and age of entry groups. • Toddler entry associated with better English language skills and mixed social-skills. • Language benefits for toddlers persisted one-year later in preschool. Most early care and education (ECE) programs serve 3-5 year olds, but enrolling children at younger ages has the potential to multiply the benefits of ECE enrollment. This study examined characteristics of children and family who enrolled as toddlers (18-35 months; n=450) versus preschoolers (36-48 months; n=2,356), then tested the impact of toddler enrollment in high-quality ECE on fall and spring preschool outcomes for English-only and Spanish dual language learners (DLLs). Groups were balanced using propensity score weights. Toddler enrollment was related differentially to parent education, special needs status, food insecurity, and single-parent household status for DLLs and English-dominant peers. Toddler entry was related to better English language skills (fall E.S.=0.13-0.47; spring E.S.=0.10-0.43) and lower teacher-rated self-control skills (fall E.S.=0.12-0.15; spring E.S.=0.12-0.19) than same language peers. English-only children who entered as toddlers were rated as more independent at preschool entry (E.S.=0.15). Differences were not observed in Spanish-language skills, child-teacher attachment, or behavior problems in preschool. [ABSTRACT FROM AUTHOR]

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. 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. 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%. Parents' lifestyles greatly influenced children's sleep habits in 2020. Pediatricians should actively participate in managing children's sleep problems. [ABSTRACT FROM AUTHOR]

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. 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. 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 (χ2 = 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 (χ2 = 10.57, P =.032). 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. • Measuring and valuing health-related quality of life in children younger than 5 years have gained interest in recent years resulting in the development of a number of new measures including the EuroQoL Toddler and Infant Populations (EQ-TIPS) for children 0 to 36 months. • These results suggest that the Afrikaans version of the EQ-TIPS is a valid measure for toddlers and infants with a health condition in the South African context. • Further research is needed on the EQ-TIPS to establish the acceptability and psychometric properties from a global context and within diverse disease groups. [ABSTRACT FROM AUTHOR]

Understanding parental experiences with managing their toddler's screen use is important to inform the design of interventions addressing early childhood screen use, yet current evidence is limited. To enhance our understanding of the context of toddler screen use, this study characterizes the screen-related discord and dismay parents experience in families with toddlers. In-depth interviews were conducted to explore everyday experiences with screen use among low-income Mexican American caregivers of toddlers (21 mothers, 10 fathers, 1 grandmother). Transcripts were content analyzed to identify prominent themes. Three themes were identified. Experiences of screen-related discord and dismay arose (1) between parent and child, (2) between parents, and (3) surfaced as parental internal dissonance about toddler screen use. Parent-child discord resulted from parental limit setting and child reactions to parental screen use, which often included tantrums. Parent-partner discord included patterns of agreeing to disagree and direct disagreement between partners. Parents also reported their own feelings of ambivalence and dismay as they struggled to reconcile their preferences against their toddler's actual screen use, while living in a screen-saturated world. Findings offer insight into types of screen-related discord and dismay low-income Mexican American parents experience as they attempt to manage their toddler's screen use. Although discord in families is normal, the screen-specific discord reported by participants warrants consideration in efforts promoting healthy screen use in families. Providers can tailor their counseling to consider the range of screen-related discord families of toddlers may experience. • Little is known about screen-related discord in low-income Mexican American families. • Findings offer insight into the types of screen-related discord parents experience. • Parent-child discord stems in part from parental limit setting. • Parent-partner discord reflects disagreement between partners about screen use. • Parents experience feelings of ambivalence and dismay about screen use. [ABSTRACT FROM AUTHOR]

[Display omitted] This publication is the first to report current, global, pediatric oral extemporaneous compounding practices. Complete survey responses were received from 479 participants actively involved in compounding across all the World Health Organization (WHO) regions. The survey addressed oral formulation of extemporaneous liquids, including the use of commercial or in-house vehicles, flavoring excipients, source of formulation recipes, and beyond use dates (BUDs). Over 90% of the survey participants prepared oral liquids. Solid dosage forms, comprising capsules and powder papers (sachets), were also frequently prepared for children, albeit to a lesser extent. The top 20 active pharmaceutical ingredients compounded for children, globally, were: omeprazole, captopril, spironolactone, propranolol, furosemide, phenobarbital, hydrochlorothiazide, ursodeoxycholic acid, sildenafil, melatonin, clonidine, enalapril, dexamethasone, baclofen, caffeine, chloral hydrate, trimethoprim, atenolol, hydrocortisone, carvedilol and prednisolone. Diuretics, drugs for acid-related disorders, and beta-blockers were the top three most frequently compounded classes per the WHO Anatomical Therapeutic Chemical (ATC) classification system. The principal need identified for the practice of extemporaneous compounding for children was the development of an international, open-access formulary that includes validated formulations, as well as updated compounding literature and guidelines. Furthermore, improved access to data from stability studies to allow compounding of formulations with extended BUDs. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the effects of screen time and sleep patterns on the sleep needs of infants and toddlers. A descriptive cross-sectional data were collected from 304 parents of children aged 6 to 36 months old. The screen use of children and parents was assessed with seven questions and A Brief Infant Sleep Questionnaire (BISQ) was used to assess infant sleep. The results of this study indicate that children's adherence to the recommended sleep standards is poor. The most important criteria that caused poor sleeping were the number of awakenings at night, the duration of sleeplessness at night and the minimum total sleep time of <9 h. The most frequently used screen type in all of the age groups and parents was TV, followed by smartphones. As the age of the children increased, the rate of all screen-type use also increased. Factors predicting sleep needs included bedtime, the PED usage of children, parents' watching TV and care of the children by the babysitter. Sleep needs are associated with the sleep patterns and screen usage of the children and parents. Given that screen usage behaviors are tracked from infancy to early childhood, these findings highlight the need for prevention and intervention efforts, as well as for education and policy measures, to limit screen use and exposure from an early age. • Children's adherence to the recommended sleep standards is poor. • The most frequently used screen type in all of the age groups and parents was TV, followed by smartphone. • Sleep needs are predicted by bedtime, child PED usage, parental TV watching, and child care provided by a babysitter. • Parents and other caregivers should be well-versed in the effects of insufficient sleep and too much screen time. [ABSTRACT FROM AUTHOR]

• We sought to understand how infant-toddler teachers' wellbeing related to their teaching. • Teachers reported high levels of adverse childhood experiences (ACEs) and depression. • Individual ACEs and depression were associated with teachers' work-related wellbeing. • Work-related wellbeing was associated with plans to continue teaching in child care centers. • Community ACEs and depression were associated with teachers' support for toddlers' learning. The purpose of this study was to examine the psychological wellbeing of infant-toddler child care teachers in a mid-Atlantic city (n = 160; 69% African American, 98% women) and to explore associations with teaching intentions and quality. Using survey measures and classroom observations, we tested associations between teachers' adverse childhood experiences (ACEs), depressive symptoms, work-related wellbeing (i.e., perceived organizational functioning and workload), intentions to continue teaching, and teaching quality. We found that infant-toddler teachers experienced similar levels of ACEs to Early Childhood Education (ECE) teachers in other studies. However, rates of depressive symptoms were relatively high in this sample (27% scored in the clinical range). Both ACEs and depressive symptoms were associated with teachers' work-related wellbeing. Notably, individual-level ACEs (e.g., household dysfunction and abuse) were associated with depressive symptoms and organizational wellbeing, whereas community ACEs (e.g., neighborhood safety) were not. Organizational wellbeing was significantly and positively associated with the number of years that infant-toddler teachers intended to continue working at their child care centers. Multilevel regression models indicated that community-level ACEs and current depressive symptoms were significantly associated with teachers' engaged support for toddlers' learning. When knowledge of child development was added to the model, depressive symptoms were no longer uniquely associated with engaged support for learning. However, community-level ACEs remained a significant correlate. These findings show that infant and toddler teachers may need more resources to support their psychological wellbeing so that they can support children in the classroom. [ABSTRACT FROM AUTHOR]

The Developmental Psychobiological Model of Experiential Canalization (DPMEC) proposes that conditions of poverty-related adversity influence child self-regulation through parental caregiving, stress hormones, and the child's genetics. However, empirical findings investigating these relationships with prolonged stress hormones are mixed. Further, the relationships among conditions of adversity with prolonged stress hormones have seldom been investigated in toddlers living in poverty. Guided by the DPMEC, we examined the relationships among maternal caregiving, prolonged stress, and self-regulation in toddlers living in poverty in the United States, to include examining whether toddler prolonged stress mediated relations between maternal caregiving and child self-regulation. Participants were mothers and toddlers (20 to 24 months of age) living in poverty, who provided hair samples to measure four months of average cortisol concentration to estimate prolonged stress. We used observational measures to examine maternal caregiving and indirect report to measure children's self-regulation. Findings did not support the role of toddler prolonged stress in mediating the relationship between maternal caregiving and toddler self-regulation. However, multiple linear regression models showed that higher levels of maternal emotionally supportive caregiving significantly predicted better toddler soothability (b = 0.90; p =.03; 95% CI [0.10, 1.69]; partial correlation = 0.26). This study adds partial support for the DPMEC to represent associations between maternal caregiving and toddler self-regulation for mothers and toddlers experiencing poverty. While these data come from an observational study, pediatric nurses may consider assessing maternal supportive caregiving upon reports of poor toddler soothability. • We tested toddlers' stress hormones and self-regulation responses to adversity. • The sample comprised 94 mothers and toddlers living in poverty in the United States. • Toddler stress did not mediate parental caregiving and child self-regulation. • Toddlers had better soothability if mothers were more emotionally supportive. [ABSTRACT FROM AUTHOR]

In young children with early onset ataxia (EOA), quantitative rating of ataxia by the Scale for Assessment and Rating of Ataxia (SARA) is longitudinally influenced by the physiological age effect on motor coordination. To enable longitudinal quantitative interpretation of ataxia by SARA in children with EOA, the EPNS ataxia working group has previously determined SARA-scores in typically developing children (4–16 years of age). In toddlers, this information is still lacking. We therefore aimed to investigate the feasibility and reliability of SARA-scores in typically developing toddlers. In 57 typically developing toddlers (2–4 years), we aimed to determine the: 1. feasibility of SARA-scores, 2. age-related pre-requisites to obtain SARA-scores in toddlers over all domains, 3. SARA-score reliability, 4. mathematical age connection of SARA-scores in toddlers and older children. In typically developing toddlers, the feasibility of SARA is strongly age-dependent (p <.000). After computing compensations for two age-related, unfeasible and therefore un-assessable kinetic subtasks and after allowing the videotaping of non-kinetic SARA sub-task performances at home, the SARA was fully reliably assessable in all (n = 57) toddlers (ICC = 0.732). From two to 16 years of age, SARA-scores were mathematically represented by one continuous, exponentially decreasing trend line approaching the adult-optimum at 16 years of age. In toddlers, SARA-scores are reliably assessable, by using two age-compensations and allowing the videotaping of SARA-performances partly at home. In children with EOA, these data enable longitudinal quantification and interpretation of quantitative ataxia-scores by SARA from 2 years of age throughout childhood. SARA-scores in typically developing toddlers: •Are influenced by age. •Are fully feasible after applying two numerical age-compensations. •Can partly be obtained from home-videos. •Are reliably assessable (substantial ICC). •Reflect an exponentially declining trend-line continuing throughout childhood. [ABSTRACT FROM AUTHOR]

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. [Display omitted] • Complex changes occur to the magnitude of EEG aperiodic exponents in childhood. • Aperiodic exponent topographic maxima shift from back to front from infancy to young adulthood. • More infant and toddler 1/f studies are needed to understand ongoing 1/f trends. [ABSTRACT FROM AUTHOR]

We present a new 18-item parent-report measure of pretense development for 4- to 47-month-olds: the Early Pretending Survey (EPS). Study 1 (N = 231) demonstrated good internal reliability, and a strongly correlated 2-factor structure for 4- to 47-month-olds. Study 2 (N = 587) also showed good internal reliability, and found the two factors loaded onto a latent second-order Pretend Play factor. Study 3 (N = 84) found the EPS correlated with a researcher-led pretense experiment, however it no longer correlated when controlling for age. Additional analyses using subsamples of parents from Studies 2 and 3 showed good inter-observer reliability between parents (N = 29), and good longitudinal stability after 6 months (N = 196). Additional analyses combining Study 1–3 participants (N ≤ 902) found no item functioning differences across demographic variables, including child age, country, and socio-economic factors. Children's EPS scores increased as they aged; girls had higher scores than boys; and children of younger parents had higher scores. Finally, we examined the age patterns of each EPS item, demonstrating when 25 %, 50 %, and 75 % of children were predicted to pass each pretense type. The EPS is useful for researchers to better understand how pretending relates to other areas of development (e.g., cognition, language). The EPS could also help parents, early years educators, and children's media professionals decide which pretense types to use with children of different ages. • We developed the Early Pretending Survey (EPS) for 4–47 months. • The EPS has good internal reliability. • The EPS showed longitudinal stability. • The EPS showed inter-observer agreement. • EPS scores were higher for older children, girls, and children with younger parents. [ABSTRACT FROM AUTHOR]

Background: Parenting interventions during the first years of life on what and/or how to feed infants during complementary feeding can promote healthy eating habits.Objectives: An intervention promoting repeated exposure to a variety of vegetables [repeated vegetable exposure (RVE); what] and an intervention promoting responding sensitively to child signals during mealtime [video-feedback intervention to promote positive parenting-feeding infants (VIPP-FI); how] were compared, separately and combined (COMBI), with an attention control condition (AC). Primary outcomes were vegetable consumption and self-regulation of energy intake; secondary outcomes were child anthropometrics and maternal feeding practices (sensitive feeding, pressure to eat).Methods: Our 4-arm randomized controlled trial included 246 first-time Dutch mothers and their infants. Interventions started when infants were 4-6 mo old and ended at age 16 mo. The present study evaluated effects at 18 (t18) and 24 (t24) mo of age. Vegetable acceptance was assessed using three 24-h dietary recalls, self-regulation of energy intake by an eating-in-the-absence-of-hunger experiment and mother-report, and maternal feeding behavior by observation and mother-report.Results: Linear mixed model and ANOVA analyses revealed no follow-up group differences regarding child vegetable intake or self-regulatory behavior. The proportion of children with overweight was significantly lower in the COMBI group, compared with the VIPP-FI group at t18 (2% compared with 16%), and with the AC group at t24 (7% compared with 20%), although this finding needs to be interpreted cautiously due to the small number of infants with overweight and nonsignificant effects on the continuous BMI z-score measure (P values: 0.29-0.82). Finally, more sensitive feeding behavior and less pressure to eat was found in the VIPP-FI and COMBI groups, compared with the RVE and AC groups, mostly at t18 (significant effect sizes: d = 0.23-0.64).Conclusions: Interventions were not effective in increasing vegetable intake or self-regulation of energy intake. Future research might usefully focus on risk groups such as families who already experience problems around feeding.This trial is registered at clinicaltrials.gov as NCT03348176. [ABSTRACT FROM AUTHOR]

During early childhood the risk of iron deficiency (ID) is high. Serum ferritin serves as a marker of iron status. We explored prevalence of ID and iron deficiency anemia (IDA), and identified determinants of iron status in infants and toddlers. We performed a secondary analysis of the Vitamin D intervention in infants (VIDI) study in Finnish healthy term infants. According to study protocol, at 12- and 24-months of age iron status, growth and dietary intakes were evaluated. ID was defined as serum ferritin <10 μg/L and IDA as serum ferritin <10 μg/L and Hb <112 g/L. For the present study, altogether 766 children provided data (N = 498 infants at 12 months, N = 508 toddlers at 24 months). ID prevalence increased from 14% in infants to 20% in toddlers. IDA prevalence was 3% at both time points. In infants, ID and IDA were more common in boys than in girls (19% vs. 9%, p = 0.001 and 5% vs. 1%, p = 0.039) but no sex-difference in toddlers was observed. Of infants, 30% had daily iron intake below average requirement of 5 mg/day. Higher daily iron intake per body weight (mg/kg) independently associated with higher infant serum ferritin (B (95% CI) 0.30 (0.04, 0.56), p = 0.026). Correlation between iron intake and ferritin was stronger in infants with ID than in infants without ID. Breastfeeding was more common (63% vs. 35%, p < 0.001) among ID infants than in infants without ID. In toddlers, frequent consumption of milk products independently associated with lower ferritin (B (95% CI) −0.03 (−0.05, −0.01), p = 0.001). Consumption of meat and fish associated with better iron status. Serum ferritin at both time points associated with duration of gestation and growth. The association of growth and ferritin was age-dependent in boys, while in girls, faster growth associated consistently with lower ferritin. In Northern European healthy infants and toddlers ID is common. The intake of iron remains below recommendations and food consumption and iron intake associate with iron status. Further studies are warranted to assess significance of ID on child development and clinical health outcomes. The project protocol is registered at ClinicalTrials.gov: NCT01723852. [ABSTRACT FROM AUTHOR]

Background Breastfeeding is associated with a lower risk of subsequent overweight or obesity, but it is uncertain whether this is a causal relation because most studies have not adequately reduced risk of bias due to confounding. Objectives The aim of this review was to examine whether 1) ever compared with never consuming human milk and 2) different durations of human milk consumption among infants fed human milk are related to later risk of overweight or obesity, with emphasis on sibling-pair and intervention studies. Methods The 2020 Dietary Guidelines Advisory Committee, together with the Nutrition Evidence Systematic Review team, conducted a systematic review of articles relevant to healthy full-term infants in countries with a high or very high level of human development. We searched PubMed, Embase, Cochrane, and CINAHL; dual-screened the results using predetermined criteria; extracted data from and assessed the risk of bias for each included study; qualitatively synthesized the evidence; developed conclusion statements; and graded the strength of the evidence. Results The review included 42 articles, including 6 cohorts with sibling-pair analyses and 1 randomized controlled trial of a breastfeeding promotion intervention. Moderate evidence suggested that ever, compared with never, consuming human milk is associated with a lower risk of overweight and obesity at ages 2 y and older, particularly if the duration of human milk consumption is >6 mo. However, residual confounding cannot be ruled out. Evidence was insufficient to determine the relation between the duration of any human milk consumption, among infants fed human milk, and overweight and/or obesity at age 2 y and older. Conclusions Further research, using strong study designs, is needed to disentangle the complex relation between infant feeding practices and the risk of subsequent overweight or obesity, as well as the biological and behavioral mechanisms if the relation is causal. [ABSTRACT FROM AUTHOR]

Background: Developing food-based dietary guidelines (FBDGs) for infants and toddlers is a complex task that few countries have attempted.Objectives: Our objectives are to describe the process of food pattern modeling (FPM) conducted to develop FBDGs for the Dietary Guidelines for Americans, 2020-2025 for infants 6 to <12 mo and toddlers 12 to <24 mo of age, as well as the implications of the results and areas needing further work.Methods: The US 2020 Dietary Guidelines Advisory Committee, with the support of federal staff, conducted FPM analyses using 5 steps: 1) identified energy intake targets; 2) established nutritional goals; 3) identified food groupings and expected amounts, using 3 options for the amount of energy from human milk in each age interval; 4) estimated expected nutrient intakes for each scenario, based on nutrient-dense representative foods; and 5) evaluated expected nutrient intakes against nutritional goals.Results: For human milk-fed infants (and toddlers), example combinations of complementary foods and beverages were developed that come close to meeting almost all nutrient recommendations if iron-fortified infant cereals are included at 6 to <12 mo of age. These combinations would also be suitable for formula-fed infants. For toddlers not fed human milk, 2 patterns were developed: the Healthy US-Style Pattern and the Healthy Vegetarian Pattern (a lacto-ovo vegetarian pattern). Achieving nutrient recommendations left virtually no remaining energy for added sugars.Conclusions: It is challenging to meet all nutrient needs during these age intervals. Added sugars should be avoided for infants and toddlers <2 y of age. Further work is needed to 1) establish a reference human milk composition profile, 2) update and strengthen the DRI values for these age groups, and 3) use optimization modeling, in combination with FPM, to identify combinations of foods that meet all nutritional goals. [ABSTRACT FROM AUTHOR]

Background: It is unknown what the impact of sole hardness is on young children's gait. Yet, this feature is commonly marketed as having differing benefits for young children's walking and development.Research Question: What are the differences in spatiotemporal measures of gait during walking and running in three common types of young children's footwear with a soft sole, compared to a hard sole?Methods: The study used a quasi-experimental design, with the condition order randomised using a Latin square sequence. Forty-seven children were recruited (aged 2-4 years). Participants walked or ran the length of a GAITRite mat in a randomized order in a soft (Shore 48-53) or hard soled (Shore 60-65) sneaker, boot and sandal condition. Linear regression analyses were used to investigate the difference between footwear for the different gait parameters including velocity, cadence, step time, swing percentage, stance percentage, double support time and the toe in/out angle.Results: Children walked with a shorter stride length in the hard-soled sandals compared to the soft- soled sandals (p < 0.05). There were no other differences in spatiotemporal variables in the soft versus hard soled sandals during walking or running (p > 0.05). There were no differences in any spatiotemporal gait variables during walking or running in soft versus hard- soled runners and no differences in walking or running in soft versus hard-soled boots (p > 0.05).Significance: There were few differences in spatiotemporal parameters between soft and hard-soled footwear in both walking and running in three different types of footwear. This may be a positive finding for footwear designers and manufacturers, as a harder sole appeared to have limited impact on spatiotemporal gait parameters. [ABSTRACT FROM AUTHOR]

Background Heavy parasitic loads increase the risk of iron (Fe) deficiency anemia, which remains prevalent globally. Where parasites are common, understanding the influence of parasitic infections on Fe incorporation and erythropoiesis in toddlers is especially important. Objectives The aim of this study was to identify the impacts of malarial and helminth infections on red blood cell (RBC) Fe incorporation and subsequent changes in RBC Fe isotope enrichment for 84 days postdosing in toddlers at high risk for parasitic infections. Methods Fe incorporation was measured in a group of Zanzibari toddlers (n  = 71; 16–25 months) using a stable Fe isotopic method. At study entry, an oral stable Fe isotope was administered. Blood was collected 14 (D14) and 84 (D84) days postdosing for the assessment of Fe status indicators and RBC isotopic enrichment. Blood and stool samples were collected and screened for malaria and helminth parasites. Factors associated with changes in RBC Fe isotope enrichment were identified using regression models. Results Toddlers who had larger weight-for-age z-scores, lower total body Fe, and helminth infections (n  = 26) exhibited higher RBC Fe incorporation. RBC Fe isotope enrichment decreased from D14 to D84 by -2.75 percentage points (P  < 0.0001; n  = 66). Greater loss in RBC Fe isotope enrichment from D14 to D84 was observed in those who received Fe supplementation, those with either helminths or both malarial and helminth infections, and in those with greater RBC Fe incorporation on D14. Conclusions Toddlers who received Fe supplementation exhibited significantly greater losses of RBC Fe isotope enrichment over time. We speculate this greater loss of RBC Fe enrichment is indicative of increased erythropoiesis due to the provision of Fe among anemic or helminth-infected toddlers. [ABSTRACT FROM AUTHOR]

Physical aggression in toddlerhood is empirically linked to anger and often conceptualized as a byproduct of frustration and related negative affect. Further, parenting is the major environmental construct implicated in the development of aggressive behaviors. Given parents' role as "external regulators," parents' responses to their toddlers' negative affect may serve to escalate or de-escalate their toddlers' affective experience, thereby impacting the likelihood of subsequent aggression. In the present study, we examined whether parents' negative affect, harsh, soothing, and distracting responses to their toddlers' negative affect mediated the relation between toddlers' negative affect and their aggressive behavior in brief conflict episodes. During a laboratory visit, a community sample of 69 mother-toddler dyads was observed in a structured interaction task. We found that child negative affect is associated with subsequent aggressive behavior by way of maternal harsh responses to negative affect. Negative emotional expression, soothing, and distraction neither facilitated or hindered children's escalation from negative affect to aggression. Our findings support a dyadic intervention in which patterns of coercive parent-child interactions are targets for prevention and intervention of toddler aggression. • Toddler negative affect was associated with an increased likelihood of subsequent aggressive behaviors, suggesting a developmental "sequence" to aggression. • During brief conflict sequences, maternal harshness significantly mediated the relation between child negative affect and subsequent aggression. • Coercive interactions following expression of negative affect may be a key pathway to aggression. [ABSTRACT FROM AUTHOR]

• Few studies have explored postnatal PAHs influence on children's neurodevelopment. • Urinary OH-PAHs are negatively associated with neurodevelopment of toddlers. • Prenatal exposure to PAHs should be considered for postnatal PAHs influence. • Our findings provide supporting evidence for policymaking of PAHs interventions. To investigate the possible influence of polycyclic aromatic hydrocarbons (PAHs) exposure on neurodevelopment of toddlers at the age of 12 months. Totally 306 subjects were recruited from the Qingdao Birth Cohort established in 2014. PAH-DNA adducts in toddlers' umbilical cord blood samples, hydroxyl-PAH metabolites in their urine samples and the developmental quotients (DQs) were measured. Sex, gestational age, birth weight, and maternal educational background were adjusted to analyze the influence of the PAH exposure on the neurodevelopment of the toddlers using multivariate linear regression model. Pearson correlation test showed that the logarithmic values of hydroxyl-PAH were negatively correlated with the DQs. Multivariate linear regression analysis indicated that logarithmic concentration of 1(9)- hydroxyphenanthrene was still associated with the DQs of the fine motor behaviors with β and 95% confidential interval (CI) of -1.137 (-2.053, -0.222), together with PAH-DNA adducts [β (95% CI): -0.577 (-0.930, -0.225)]. PAH-DNA adducts presented an independently negative influence on the DQs of the gross motor and personal social behaviors with β (95%CI) of -0.470 (-0.814, -0.126) and -0.526 (-0.859, -0.193), respectively. The exposure to PAHs in toddlers at 12 months could influence their neurodevelopment. Additionally, prenatal exposure to PAHs should also be considered. [ABSTRACT FROM AUTHOR]

• Parental book-sharing goals and styles across communities have rarely been studied • Two book-sharing styles were identified: followers and storytellers-followers • Maternal book-sharing goals related to their styles, regardless of their community • Book-sharing styles bore no relation to children's verbal contributions • Findings highlight within- and between-community differences in book-sharing This study examined associations among maternal book-sharing styles and goals for book-sharing activities and children's verbal contributions in three communities. Participants were 106 mother-toddler dyads from New York City (NYC, USA), Münster (Germany), and Chennai (India). Mothers were videotaped sharing a book with their two-year-olds and interviewed about their book-sharing goals. Cluster analyses identified two book-sharing styles: 53% adopted a follower style (focused on maintaining the flow of the conversation, while requesting and providing some information), and 47% of mothers adopted a storyteller-follower style (focused on providing information about the text and maintaining the flow of the conversation). NYC mothers were more likely to adopt a follower style compared to Münster and Chennai mothers. While NYC mothers embraced the goal of enjoyment and bonding more, Chennai mothers embraced the goal of learning from books more, and Münster mothers embraced the goal of soothing the child more. Maternal book-sharing styles and goals were associated. Embracing the goal of enjoyment and bonding was related to adopting a follower style, above community and demographic variables. Maternal book-sharing styles were not related to children's verbal contributions. Findings highlight variation within and across communities in how mothers approach booksharing with their toddlers. [ABSTRACT FROM AUTHOR]

Background: Clinicians and footwear manufacturers often advise young children to wear soft-soled footwear when they are first learning to walk. There is limited evidence as to why this advice is given, and if soft-soled shoes are as close to barefoot as thought.Research Question: What are the differences in spatiotemporal measures of gait during walking and running in three common types of children's footwear with a soft-soled compared to barefoot in young children?Methods: The study used a quasi-experimental design, with the condition order randomised using a Latin square sequence. Forty-seven children were recruited (2 - 4 years). Participants walked or ran the length of a GAITrite mat in a randomized order for barefoot and soft-soled sneaker, boot and sandal conditions. Linear regression analyses were used to investigate the main effect of each soft-soled footwear compared to bare feet in the different gait parameters.Results: For walking and running trials, cadence decreased whereas step time and stride length increased in all footwear types compared to the barefoot condition. While wearing sneakers and sandals increased the stance percentage for walking and running trials, compared to barefoot, this difference was only apparent during the running trial for the boots. Likewise, although double support time increased for both the boots and sneakers in walking and running, compared to barefoot, this difference was only observed in the sandals during walking.Significance: This research found that various types of soft-soled footwear impacted gait compared to the barefoot condition, with some differences seen between walking and running trials. These findings challenge the assumption that soft-soled footwear facilitate a similar gait to barefoot walking and running, although the clinical significance of these differences is unknown. [ABSTRACT FROM AUTHOR]

Background: There is extensive lack of awareness of maternal mental health and its impact on child development in low- and middle-income countries (LAMICs). The aim of this systematic review was to analyze evidence for various maternal perinatal mental health disorders and their association with different domains of infant and toddler neurodevelopment during the first two postnatal years in LAMICs.Methods: A comprehensive literature search was conducted within six databases from Jan 1990-April 2019. All included studies were narratively synthesized.Results: Twenty-four studies, nine cross sectional and 15 longitudinal cohort studies, were included. Three studies were conducted in low-income, 11 in lower-middle-income and ten in upper-middle-income countries. The majority of studies assessed maternal mental health postnatally and 14 of these 22 studies found a significant association with infant and toddler neurodevelopment. Five of the ten studies reporting on exposure to prenatal mental health found a significant association. The most common maternal mental health disorder studied was depression, while the main neurodevelopmental outcomes assessed were motor, cognitive and language development.Limitations: Meta-analysis could not be conducted due to the variability in the reported maternal mental health disorders and the different times of assessment of exposures and outcomes.Conclusions: Maternal perinatal mental health disorders and their association with different domains of neurodevelopment in LAMICs is still inconclusive due to a limited number of papers. Mother-infant dyads in LAMICs are exposed to multiple and cumulative risk factors and causal pathways between maternal mental health and infant neurodevelopment are still poorly understood. [ABSTRACT FROM AUTHOR]

In October 2017, substantial changes were made to improve the nutritional quality of meals served in the Child and Adult Care Food Program (CACFP). This study describes the experience of child care providers and sponsors during the first year of implementation. A 1-time survey was administered to CACFP sponsors in Delaware 1 year after implementation of the changes. Data analysis included frequencies and chi-square tests of independence. Among respondents (n = 137), 21% faced moderate or significant challenges. Food cost (53.1%) and communicating with parents about changes (44.6%) were the most common challenges faced. The majority reported that parents supported the changes and that children and teachers generally ate the new food. A minority of providers in Delaware faced significant challenges, suggesting that broad changes to CACFP may be feasibly implemented across settings. Training focused on food cost and parent communication may be warranted. [ABSTRACT FROM AUTHOR]

Objectives: ActiGraph accelerometer cut-points are commonly used to classify sedentary behaviour (SB) in young children. However, they vary from 5counts/5s to 301counts/15s, resulting in different estimates and inconsistent findings. The aim was to examine the concurrent validity of ActiGraph GT3X+cut-points against the activPAL for measuring SB in 2-3-year-olds during free-living conditions.Design: Observational validation-study.Methods: Sixty children were fitted with the activPAL and ActiGraph simultaneously for at least 2h. Nine ActiGraph cut-points ranging from 60 to 1488 counts per minute were used to derive SB. Bland & Altman plots and equivalent tests were performed to assess agreement between methods.Results: Estimates of SB according to the different ActiGraph cut-points were not within the activPAL ±10% equivalent interval (-4.05; 4.05%). The ActiGraph cut-points that showed the lower bias were 48counts/15s (equivalence lower limit: p= 0.597; equivalence upper limit: p<0.001; bias: -4.46%; limits of agreement [LoA]: -21.07 to 30.00%) and 5counts/5s (equivalence lower limit: p<0.001; equivalence upper limit: p= 0.737; bias: -5.11%; LoA: 30.43 to 20.20%). For the 25counts/15s, 37counts/15s and 48counts/15s ActiGraph cut-points, the upper limits were within the equivalent interval (p<0.001) but not the lower limits (p>0.05). When using the 5counts/5s and 181counts/15s ActiGraph cut-points, lower limits were within the equivalent interval (p<0.001) but not the upper limits (p>0.05). Confidence intervals of the remaining ActiGraph cut-points lie outside the equivalent interval.Conclusions: Although none of the ActiGraph cut-points provided estimates of SB that were equivalent to activPAL; estimates from 48counts/15s and 5counts/5s displayed the smallest mean bias (˜5%). [ABSTRACT FROM AUTHOR]

• Safe, effective and more affordable pneumococcal conjugate vaccines (PCV) are needed. • This new PCV targets serotypes most likely to cause disease in low- and middle-income countries. • The vaccine was safe and immunogenic in adults, toddlers and infants in this phase 1/2 trial. • The data support progression to a phase 3 licensure trial of the new PCV. A more affordable pneumococcal conjugate vaccine (PCV) that provides comparable protection to current PCVs is needed to ensure sustainable access in resource-limited settings. Serum Institute of India Pvt. Ltd.'s PCV candidate (SIIPL-PCV) has the potential to meet this need as manufacturing efficiency has been optimized and the vaccine targets the most prevalent disease-causing serotypes in Africa and Asia. We report SIIPL-PCV's safety, tolerability, and immunogenicity in adults, toddlers, and infants in The Gambia. This phase 1/2, randomized, double-blind trial sequentially enrolled 34 PCV-naive adults (18–40 years old), 112 PCV (Prevenar 13® [PCV13])-primed toddlers (12–15 months old), and 200 PCV-naive infants (6–8 weeks old), who were randomized (1:1) to receive SIIPL-PCV or a licensed comparator vaccine. Infants received three-doses of SIIPL-PCV or PCV13 at 6, 10, and 14 weeks of age co-administered with routine Expanded Program on Immunization (EPI) vaccines. Reactogenicity was solicited through seven-days post-vaccination; unsolicited adverse events (AEs) were assessed throughout the study. The safety and immunogenicity of a matching booster at 10–14 months of age were evaluated in a subset of 96 infants. Immune responses were evaluated post-primary and pre- and post-booster vaccinations. Reactogenicity was primarily mild-to-moderate in severity. In infants, the most common solicited reactions were injection-site tenderness and fever, with no meaningful treatment-group differences. There were no serious or severe vaccine-related AEs and no meaningful trends in SAEs, vaccine-related AEs, or overall AEs. Infant post-primary seroresponse rates (IgG level ≥ 0.35 µg/mL) were ≥89% for all serotypes except 6A (79%) in the SIIPL-PCV group. IgG GMCs were >1 µg/mL for all serotypes in both SIIPL-PCV and PCV13 groups. Post-booster GMCs were comparable between groups. SIIPL-PCV was well-tolerated, had an acceptable safety profile, and was immunogenic for all vaccine serotypes. Results support the evaluation of SIIPL-PCV in a phase 3 non-inferiority trial. Clinicaltrials.gov: NCT02308540. [ABSTRACT FROM AUTHOR]

• Toddlers at-risk for language delays showed gains in gesture use after a month-long intervention. • Targeting gestures could increase rates of communication, building additional word-learning opportunities. • Future research should examine if these strategies can be embedded by caregivers. This study uses a single-case, multiple probe design to investigate the effects of a naturalistic intervention on deictic gesture use in toddlers who are from low-SES backgrounds. The month-long study included strategies drawn from the literature on early communication interventions to increase the rate of child gesture use in toddlers at-risk for later delays. These strategies include frequent modeling of deictic gestures (points, shows, reaches, and gives), creating opportunities for the child to gesture by using environmental arrangements, choices, and wait time, and by responding and expanding each gesture. All three child participants made gains in their rates of deictic gestures after the onset of intervention with no overlap between the intervention and baseline conditions. Children also made gains to gesture + vocalization combinations and gesture + word combinations in this short-term intervention. This study offers preliminary evidence that prelinguistic interventions for children at-risk can be used to increase rates of communication in toddlers in poverty. [ABSTRACT FROM AUTHOR]

Background: Dietary DHA intake among US toddlers is low. Healthy physical growth is an important objective for the clinical care of children born preterm.Objectives: The aim of the trial was to examine the effects of supplementing toddlers born preterm with DHA and arachidonic acid (AA) for 180 d on growth and adiposity.Methods: Omega Tots, a randomized placebo-controlled trial, was conducted between April 2012 and March 2017. Children born at <35 wk gestation who were 10-16 mo in corrected age were assigned to receive daily oral supplements of DHA and AA (200 mg each, "DHA + AA") or corn oil (placebo) for 180 d. Prespecified secondary outcomes included weight, length, head circumference, mid-upper arm circumference, triceps and subscapular skinfolds, BMI, and their respective z scores, and body fat percentage, which were measured at baseline and trial completion. Mixed-effects regression was used to compare the change in outcomes between the DHA + AA and placebo groups, controlling for baseline values.Results: Among 377 children included in the analysis (median corrected age = 15.7 mo, 48.3% female), 348 (92.3%) had growth or adiposity data at baseline and trial end. No statistically significant differences between the DHA + AA and placebo groups in growth or adiposity outcomes were observed. For instance, the change in weight-for-age z scores was 0.1 for the DHA + AA group and 0.0 for the placebo group (effect size = 0.01, P = 0.99). However, post-hoc subgroup analyses revealed a statistically significant interaction between treatment group and sex, suggesting somewhat slower linear growth for females assigned to the DHA + AA group compared with the placebo group.Conclusions: Among toddlers born preterm, daily supplementation with DHA + AA for 180 d resulted in no short-term differences in growth or adiposity compared with placebo. If DHA supplementation is implemented after the first year of life, it can be expected to have no effect on short-term growth or adiposity. This trial is registered with clinicaltrials.gov as NCT02199808. [ABSTRACT FROM AUTHOR]

To develop and validate a new questionnaire assessing feeding styles in toddlers, the Toddler Feeding Style Questionnaire (TFSQ). An instrumental design was used in this study. A convenience sample of 546 Spanish mothers of a toddler (12–24 months-old) completed the TFSQ and a web-based survey to obtain data on feeding styles, sociodemographic and anthropometric characteristics, weaning and attachment style. Items were developed and classified into two content domains: responsiveness and demandingness. For the construct validity analysis, the sample was randomly divided into two halves used to the exploratory and confirmatory factor analysis, respectively. Validation hypotheses about the differences in the TFSQ scores were suggested. The factorial analysis revealed a responsiveness scale and a demandingness scale. The McDonald's Omega and Cronbach's alpha values coincided in both scales, being 0.84 and 0.75, respectively. A high responsiveness and demandingness feeding styles degree of agreement showed a statistically significant association with the correspondent scale (p <.01). The 33.3% of children who are overweight or obese have mothers who classify themselves as neglectful. Both scales were related to the mothers' attachment styles, toddler's age and the time of weaning at 6 and 12 months. The TFSQ provides a valid and reliable Responsiveness and Demandingness scale to evaluate feeding styles in toddlers. Parental feeding styles influence future eating behavior and children's weight. There is a lack of validated instruments used to evaluate feeding styles in toddlerhood based on the two theoretical dimensions of responsiveness and demandingness. • The TFSQ is based on the theoretical dimensions of feeding styles. • The TFSQ measures the dimensions of demandingness and responsiveness. • Mothers' feeding styles influence the toddlers' weight-for-length z-scores. • Both dimensions are related to the toddler's age and the time of weaning. • Feeding styles dimensions are associated with the mother's attachment style. [ABSTRACT FROM AUTHOR]

The present study explored the perspectives of mothers from three communities regarding their role in play activities with their toddlers. The mothers of two-year-old children from Muenster, Germany (n = 34), Chennai, India (n = 36), and New York City, USA (n = 36), participated in the study. Qualitative content analysis was utilized to analyze the mothers' responses to semi-structured interview questions. Four roles were identified as characterizing the mothers' narratives, namely mothers as facilitators, teachers, play partners, or observers. The goal of facilitator was to support children's autonomy; teachers often described educational learning goals; and play partners and observers highlighted the play itself. In the data, two-thirds of the mothers from New York City were identified as facilitators, while half of the Chennai sample were identified as teachers. The Muenster sample recorded the largest variation with regard to the four roles. The findings suggest variations in how the mothers in our samples viewed their role in play situations, both within and across communities. • Mothers of toddlers from three communities were examined. • The mothers described their role and goals in play activities with their children. • Four mother roles were found: facilitator, teacher, play partner, and observer. • Variability in mothers' roles was found both within and across the communities. [ABSTRACT FROM AUTHOR]

• Prenatal levels of OH-PCBs correlated with neurodevelopment in Dutch toddlers. • Four OH-PCBs and ∑ 6 OH-PCBs correlated positively with MDI at 30 months. • Higher prenatal levels of PCB-153 correlated with delayed MDI at 18 months. • One PBDE correlated negatively with MDI (P <.10) and two positively with PDI (1 trend). • Prenatal p,p'-DDE, PCP, and HBCDD were not associated with MDI or PDI at 18 months. Organohalogen compounds (OHCs), i.e. polychlorinated biphenyls (PCBs, are wide-spread environmental pollutants known to be neurotoxic for the developing brain. The hydroxylated metabolites of PCBs, OH-PCBs, might be even more toxic due to their structure and interference with thyroid hormone metabolism. We found that prenatal exposure to OH-PCBs was associated with thyroid hormone metabolism at toddler age. Little, however, is known about the neurotoxicity of OH-PCBs in humans. To determine whether prenatal background exposure to OHCs has an effect on mental and motor development in children at the age of 18 and 30 months. One hundred and eighty-one healthy mother-infant pairs were included in this observational study performed in the Netherlands. We measured maternal pregnancy levels of PCB-153 and three OH-PCBs. In one part of the cohort we measured another nine PCBs and three OH-PCBs and in the other part we measured five brominated diphenyl ethers (BDEs), dichloro-diphenyldichloroethylene (p,p'-DDE), pentachlorophenol (PCP), and hexabromocyclododecane (HBCDD). We used the mental development index (MDI) and the motor development index (PDI) of the Bayley Scales of Infant Development II (BSID-II) to assess children's mental and motor development (mean = 100; delayed score <85). Higher prenatal PCB-153 levels were associated with a delayed MDI score at 18 months. None of the other compounds were associated with a delayed score, but several associations were found between OHC levels and BSID-II scores. The sum of all six OH-PCBs and three individual OH-PCBs, 4-OH-PCB-107, 3-OH-PCB-153, and 4′−OH-PCB-172, correlated positively with MDI at 30 months. The compound 3′−OH-PCB-138 showed a similar trend. A higher 4-OH-PCB-187 was associated with a lower MDI at 18 months. We found a similar trend for higher BDE-99. Higher BDE levels were associated with higher PDI at 18 months. The levels of p,p'-DDE-, PCP, and HBCDD were not associated with BSID-II scores at 18 months. Higher prenatal levels of PCB-153 were associated with a delayed MDI score at 18 months. None of the other compounds were associated with a delayed score, but several associations were found between OHC levels and BSID-II scores. Prenatal OH-PCBs were positively associated with mental development at 30 months, whereas one OH-PCB was negatively associated at 18 months. BDE levels were positively associated with psychomotor development. Prenatal p,p'-DDE, PCP, and HBCDD levels were not associated with neurodevelopment at 18 months. [ABSTRACT FROM AUTHOR]

Background: Parental risk factors can have a significant detrimental impact on child development, yet most parenting interventions do not address parental mental health. There is also a dearth of evidence regarding parenting interventions for families with children under two years old. Mellow Parenting (MP) is a suite of parenting interventions targeting at-risk families with complex needs, including those with very young children. Preliminary studies suggest that MP can improve both parent and child outcomes, but no evaluation has been conducted in routine practice.Methods: Using a real-world design we analysed routine data from a UK cohort of n = 183 mother-child dyads, collected over a 21-month period. Data were gathered immediately pre- and post-intervention. Outcomes included maternal mental health, parenting confidence, daily parenting stress, and child behaviour. Intention-to-treat and 'completer' analyses were performed. Associations between attendance, participant demographics, and pre-post change in outcomes were modelled.Results: MP participation was associated with improvements in maternal mental health (d = 0.36), parenting confidence (d = 0.42), and a component of child psychosocial behaviour (conduct problems; d = 0.36), but not overall child difficulties, or daily parenting stress. Mothers with a partner experienced larger benefits in mental health and parenting confidence compared to single mothers. Younger mothers, and those with a history of mental health problems, attended more intervention sessions.Limitations: The study used real-world data and was thus uncontrolled, limiting causal interpretations.Conclusions: This is the first study to explore MP participation on a multi-site national level and suggests that group-based parenting interventions may be effective for at-risk families. These results should be expanded upon via controlled studies that incorporate follow-up data. [ABSTRACT FROM AUTHOR]

Graphical abstract Highlights • Apelin and Elabela constitute a spatiotemporal double ligand system to control APJ signaling. • Both of APJ ligands are non-redundantly required for heart development and physiology. • There is a crosstalk of Apelin-APJ system and renin-angiontensin system in heart pathology. • Further mechanistic insights into the Apelin, Elabela and APJ system are necessary. Abstract Apelin is an endogenous peptide ligand for the G protein-coupled receptor APJ/AGTRL1/APLNR and is widely expressed throughout human body. In adult hearts Apelin-APJ/Apelin receptor axis is potently inotropic, vasodilatory, and pro-angiogenic and thereby contributes to maintaining homeostasis in normal and pathological hearts. Apelin-APJ/Apelin receptor is also involved in heart development including endoderm differentiation, heart morphogenesis, and coronary vascular formation. APJ/Apelin receptor had been originally identified as an orphan receptor for its sequence similarity to Angiotensin II type 1 receptor, and it was later deorphanized by identification of Apelin in 1998. Both Apelin and Angiotensin II are substrates for Angiotensin converting enzyme 2 (ACE2), which degrades the peptides and thus negatively regulates their agonistic activities. Elabela/Toddler, which shares little sequence homology with Apelin, has been recently identified as a second endogenous APJ ligand. Elabela plays crucial roles in heart development and disease conditions presumably at time points or at areas of the heart different from Apelin. Apelin and Elabela seem to constitute a spatiotemporal double ligand system to control APJ/Apelin receptor signaling in the heart. These expanding knowledges of Apelin systems would further encourage therapeutic applications of Apelin, Elabela, or their synthetic derivatives for cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Abstract Background An 18-month-old female toddler presented with severe vulvar ulcers and pancytopenia with investigations revealing Pseudomonas aeruginosa bacteremia. Case A previously healthy 18-month-old female toddler presented with 6 days of fevers, vulvar rash, and ulcers. Vulvar cultures showed Staphylococcus aureus and P aeruginosa. Bloodwork showed pancytopenia and P aeruginosa bacteremia. She started receiving broad-spectrum antibiotics. Bone marrow aspirate revealed a hypocellular marrow with erythroid dysplasia. Vulvar ulcers progressed rapidly, therefore magnetic resonance imaging was performed to rule out necrotizing fasciitis. She was diagnosed with ecthyma gangrenosum (EG). Three months after initial presentation, she was diagnosed with precursor B-cell acute lymphoblastic leukemia. Summary and Conclusion This case highlights that health care providers should suspect EG when severe vulvar ulcers are present with P aeruginosa infection and neutropenia. Because EG poses significant morbidity and mortality, its presence should prompt aggressive antimicrobial therapy and mobilization of a multidisciplinary team to initiate workup for an underlying immunodeficiency syndrome or malignancy. This case also illustrates that surgical debridement might be avoided in certain patients with EG as long as meticulous wound care and close monitoring with a multidisciplinary team are in place. [ABSTRACT FROM AUTHOR]

Résumé La première consultation au cabinet dentaire reste fréquemment associée à une urgence. Pourtant, la carie précoce du jeune enfant est une réalité clinique à laquelle le chirurgien-dentiste est trop souvent confronté. Il apparaît primordial de travailler main dans la main avec les professionnels de santé qui côtoient les familles. Le pharmacien peut transmettre au plus tôt des conseils d'hygiène bucco-dentaire et alimentaire adaptés. Il est également souvent le premier interlocuteur en cas de traumatisme ou douleurs dentaires. Summary The first dental visit is frequently associated with an emergency. However, early caries in young children is a clinical reality dentists see all too frequently. It is essential to work hand in hand with health professionals who deal with families. The pharmacist can provide advice on adapted oral and food hygiene. He is also often the first contact for dental trauma or pain. [ABSTRACT FROM AUTHOR]

The article offers information on The Feeding Infants and Toddlers Study (FITS) 2016. Topics discussed include breastfeeding, breast milk substitutes, and introduction of complementary foods in infants; transition of toddlers and young children to family diets; and better data on nutrient requirements of infants.

Abstract Purpose The aims of this study were as follows: To determine the national incidence of facial fractures among infants, toddlers, and children; to evaluate the types of facial fractures; and to analyze common products/activities associated with the fractures. Materials and methods A retrospective review was conducted to explore patterns of facial fractures among infants (<1 year), toddlers (1–3 years), and children (3–5 years), using the National Electronic Injury Surveillance System (NEISS) from the Consumer Product Safety Commission (CPSC). The database was searched for emergency department (ED) visits involving facial fractures sustained by children 1 month through 5 years of age from 2004 through 2016 and analyzed for patient demographics, primary diagnosis and associated products/activities. Subset analyses were performed between age groups to determine the relationship between causes of injury and age using extrapolated national incidences. Results A total of 1507 ED visits for facial fractures among infants, toddlers, and children were obtained and extrapolated to an estimated total of 39,388 ED visits, averaging 3030 annually. The majority of these ED visits were for facial fractures that occurred at home. Most facial fractures sustained at the age period of 1 month–5 years old were nasal fractures. Facial fractures in infants were caused most commonly by floors or flooring materials, likely due to falls, while household items/furniture-related injuries were the most common cause of facial fractures in both toddlers and children. Facial fractures from playground equipment and riding toys were more common in children than in the other age groups. Conclusion The reported trends in the incidence by age group and types of fracture can assist physicians by serving as supplement for clinical history and examination when encountering this challenging patient population. Our findings highlight preventative opportunities, particularly in baby care items and beds for reducing facial fractures in infants. Similarly, preventative opportunities are highlighted in household items and furniture for lowering the incidence of facial fractures in toddlers and children. Our study also suggests ensuring safe handling of playground equipment and riding toys for the prevention of facial fractures in children. [ABSTRACT FROM AUTHOR]

This paper presents a conceptual model and reviews the empirical evidence to support a nightly bedtime routine as a key factor in the promotion of not only healthy sleep, but also of broad development and wellbeing in early childhood. A bedtime routine embodies the characteristics of nurturing care and early child stimulation, which are deemed to be essential for positive outcomes, especially for at-risk children. Furthermore, common, adaptive components of a bedtime routine can contribute to an array of positive developmental outcomes beyond improved sleep, inclusive of language development, literacy, child emotional and behavioral regulation, parent-child attachment, and family functioning, among other outcomes. These bedtime routine components include activities in the broad domains of nutrition (e.g., feeding, healthy snack), hygiene (e.g., bathing, oral care), communication (e.g., reading, singing/lullabies) and physical contact (e.g., massage, cuddling/rocking). A bedtime routine can provide multiple benefits to child and family functioning at a time of day that many parents are present with their children. Although additional research on hypothesized routine-related child outcomes and mechanisms of action are needed, promoting a bedtime routine may be a feasible and cost-effective method to promote positive early childhood development worldwide, particularly for socioeconomically disadvantaged and other at-risk young children. [ABSTRACT FROM AUTHOR]

Temporal-spatial reach parameters are revealing of upper-limb function in children with motor impairments, but have not been quantified in a toddler population. This work quantitatively characterizes temporal-spatial reach in typically-developing (TD) and very-low-birth-weight (VLBW) preterm toddlers, who are at increased risk of motor impairment. 47 children born VLBW (<1500 g birth-weight; ≤32 weeks gestation) and 22 TD children completed a reaching assessment at 18–22 months of age, adjusted for prematurity. Inertial sensors containing accelerometers, gyroscopes and magnetometers were fixed to toddlers’ wrists while they reached for a cube. Reach time, path length, velocity at contact, peak velocity magnitude and timing, acceleration at contact, and peak acceleration were derived from inertial-sensor and high-speed video data. Preterm children also received the Bayley Scales of Infant Development—3rd Edition (BSID-III). Compared to TD toddlers, preterm toddlers had significantly different reach path length, velocity at contact, peak velocity magnitude and timing, acceleration at contact, and peak acceleration. Among preterm toddlers, decreased reach time (rho = −.346, p = .018), decreased time to peak velocity (r = −.390, p = .007), and increased peak acceleration (r = .298, p = .044) correlated to higher BSID-III fine motor scores. Toddlers with below-average fine motor scores had significantly higher peak and contact velocity. Preterm toddlers demonstrated substantial differences in temporal-spatial reach parameters compared to TD toddlers, and evidence indicated several reach parameters were revealing of function and may be useful as a clinical assessment. [ABSTRACT FROM AUTHOR]

Background: Children born preterm are at increased risk of autism spectrum disorder (ASD). n-3 (ω-3) Combined with n-6 (ω-6) fatty acids including γ-linolenic acid (GLA) may benefit children born preterm showing early signs of ASD. Previous trials have reported that docosahexaenoic acid (DHA) promotes cognitive development in preterm neonates and n-3 fatty acids combined with GLA improve attention-deficit-hyperactivity disorder.Objectives: The objectives of the pilot Preemie Tots Trial were 1) to confirm the feasibility of a full-scale trial in toddlers born very preterm and exhibiting ASD symptoms and 2) to explore the effects of supplementation on parent-reported ASD symptoms and related behaviors.Methods: This was a 90-d randomized, fully blinded, placebo-controlled trial in 31 children 18-38 mo of age who were born at ≤29 wk of gestation. One group was assigned to daily Omega-3-6-9 Junior (Nordic Naturals, Inc.) treatment (including 338 mg eicosapentaenoic acid, 225 mg DHA, and 83 mg GLA), and the other group received canola oil (124 mg palmitic acid, 39 mg stearic acid, 513 mg linoleic acid, 225 mg α-linolenic acid, and 1346 mg oleic acid). Mixed-effects regression analyses followed intent-to-treat analysis and explored effects on parent-reported ASD symptoms and related behaviors.Results: Of 31 children randomly assigned, 28 had complete outcome data. After accounting for baseline scores, those assigned to treatment exhibited a greater reduction in ASD symptoms per the Brief Infant Toddler Social Emotional Assessment ASD scale than did those assigned to placebo (difference in change = - 2.1 points; 95% CI: - 4.1, - 0.2 points; standardized effect size = - 0.71). No other outcome measure reflected a similar magnitude or a significant effect.Conclusions: This pilot trial confirmed adequate numbers of children enrolled and participated fully in the trial. No safety concerns were noted. It also found clinically-significant improvements in ASD symptoms for children randomly assigned to receive Omega-3-6-9 Junior, but effects were confined to one subscale. A future full-scale trial is warranted given the lack of effective treatments for this population. This trial was registered at www.clinicaltrials.gov as NCT01683565. [ABSTRACT FROM AUTHOR]

Introduction Complementary feeding plays a crucial role in the development of infants and toddlers and studies suggest benefits specific to the introduction of food textures. Objectives Evaluate the recommendations given to parents, their practices, and their attitudes towards the introduction of food textures during complementary feeding in France. Methods This was a cross-sectional pilot study conducted in 2013. One hundred and eighty-one parents with at least one child aged 6–36 months living in France completed an ad hoc questionnaire. Results Eighty-eight percent of the parents surveyed received oral information on complementary feeding, but only 46% received such information on the introduction of food textures. Pediatricians were the most frequently listed source of oral information on complementary feeding. More than half the parents also looked for additional information in books and on the internet. While oral recommendations matched parents’ practices, they seemed to occur at a later age compared to infants’ physiological ability to handle new textures. The quality of information on food texture advice available in paper and electronic formats evaluated using a 4-point scale was found to be limited. Introducing new food texture was spontaneously reported as the most common difficulty in complementary feeding (16%). Fear of choking when first introducing food pieces was reported by 54% of the parents. Conclusions The parents’ lack of information on the introduction of food textures, as well as their fear that their child may choke, should encourage providing new recommendations in France. [ABSTRACT FROM AUTHOR]

Establishment of a consistent bedtime routine is often recommended to families with young children with sleep difficulties. However, there are limited studies assessing specific bedtime routines in the treatment of infant and toddler sleep disturbances. Thus, the purpose of this study was to examine the impact of a massage-based bedtime routine on infant sleep, maternal sleep, and maternal mood. A total of 123 mothers and their 3- to 18-month-old infant were randomly assigned to a routine (one-week baseline of usual bedtime routine, two-weeks intervention) or control group (three-weeks of their usual bedtime routine). All mothers completed the Brief Infant Sleep Questionnaire (BISQ) on a weekly basis and measures of maternal sleep and mood (eg, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Edinburgh Postnatal Depression Scale). This bedtime routine resulted in improvements in child and mother night wakings, maternal perceptions of child sleep and mood (ie, sleep problem, bedtime ease, and morning mood), and improvements in maternal sleep quality. No comparative changes were seen in the control group. Notably, other than number of night wakings for both the child and the mother, there were no changes in other sleep patterns including sleep onset latency, duration of night wakings, longest stretch of sleep, or sleep duration. This study supports recommending a massage-based routine in those families, with the codicil that improvements in maternal perceptions and maternal sleep will be noted, with few improvements in sleep itself other than night wakings. [ABSTRACT FROM AUTHOR]

Background: Institution of a consistent bedtime routine has been demonstrated to improve sleep in young children within two weeks. However, no studies have investigated the rate of this change and when most change occurs. The purpose of this study was to examine the nightly change in infant sleep and maternal perceptions after implementing a bedtime routine.Methods: Mothers (n=134) and their infant (8-18 months) were randomly assigned to implementation of a bedtime routine intervention for a two-week period.Results: Two-level piecewise linear growth models showed that the intervention resulted in the most rapid change in the first three nights of the intervention across sleep outcomes, including sleep onset latency, the frequency and duration of nighttime awakenings, sleep consolidation, and maternal perceptions of bedtime ease, sleep quality, and infant mood. No significant additional improvement in sleep onset latency emerged after these first three nights, whereas small additional improvements occurred for all other outcomes throughout the remainder of the intervention period.Conclusions: These results indicate that sleep disturbances in infants and toddlers can be quickly ameliorated within just a few nights after implementation of a consistent bedtime routine, including a bath, massage, and quiet activities. Future research should consider the potential mechanisms behind these relatively fast improvements in sleep, such as reduced household chaos or physiological changes (e.g. core body temperature, cortisol). [ABSTRACT FROM AUTHOR]

Endocrine disrupting flame retardant (FR) chemicals form a human health concern, that is investigated mostly from the perspective of adult- and early life exposure. No overview of studies on toddler exposure and health effects exist. However, toddlerhood is a critical developmental period and toddlers are at increased risk for exposure because of their age-specific behavior. This systematic review encompasses toddler FR exposure studies in three countries, associated health effects and potential environmental, demographic, or behavioral risk- or protective factors for toddler exposure. A systematic literature search in four databases (PubMed, Embase.com, The Cochrane Library (via Wiley) and Web of Science Core collection) resulted in the identification of ten publications representing seven unique studies that measured brominated and/or phosphorylated FRs in toddlers' (8–24 month-old) serum, urine, hand wipes and feces. This review showed that toddlers are exposed to a range of FRs, that thyroid hormone disruption is associated with FR exposure and that factors in the indoor environment, including products such as plastic toys, might increase FR exposure. Considering the limited amount of studies, and the variety of biological matrices, FRs, and risk- and protective factors, this review did not reveal a uniform pattern of toddler exposure across the different cohorts studied. More evidence is necessary and considering the feasibility of invasive sampling in young children, we suggest to emphasize research on non-invasive matrices. [ABSTRACT FROM AUTHOR]

Introduction Gestational phthalate exposures have been adversely associated with attention, externalizing, and internalizing behaviors in childhood. Early childhood temperament may be a marker of later behavioral patterns. We therefore sought to determine whether gestational phthalate exposures were associated with infant and toddler temperament. Methods The Mount Sinai Children’s Environmental Health Study is a prospective cohort study of children born between May 1998 and July 2001 in New York City (N = 404). Phthalate metabolites were measured in spot urine samples collected from pregnant women in their third trimester. Child temperament was assessed by parental report at 12-months using the Infant Behavior Questionnaire (IBQ) (N = 204) and at 24-months using the Toddler Behavior Assessment Questionnaire (TBAQ) (N = 279). We used multiple linear regression to evaluate associations between urinary phthalate metabolites and eleven temperament domains. Results Phthalate biomarker concentrations were weakly associated with lower gross motor activity levels as well as higher duration of orienting at the 12-month assessment. Mono(3-carboxypropyl) phthalate (MCPP), monobenzyl phthalate (MBzP) and the sum of metabolites of di(2-ethylhexyl) phthalate (∑DEHP) were associated with lower levels of smiling and laughing at 12 months. At 24-months, social fear and lower pleasure was linked to higher concentrations of MCPP and MBzP, and higher ∑DEHP was weakly associated with increased anger levels at 24-months. Conclusions Though we observed some weak associations between biomarkers of prenatal exposure to phthalates and temperament at 12- and 24-months, overall phthalates biomarkers were not strongly associated with alterations in temperament. [ABSTRACT FROM AUTHOR]