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Raynaud’s phenomenon (RP) is a well-known disorder of self-limiting paroxysmal vasospasms occurring in small arteries of the digits, in the order of skin pallor (white), followed by cyanosis (blue), ending with hyperemia (red). These designative triphasic colour changes with exposure to cold, or emotional response is diagnostic in adults. RP is a very rare phenomenon in the young paediatric population as noted by Nigrovic et al with 123 patients

Objective: Autism spectrum disorder (ASD) in very young children with significant cognitive impairment is difficult to diagnose, depriving them of the earliest opportunities for autism-specific intervention. This study delineated specific symptoms in this group, compared to symptoms in children with Global Developmental Delay (GDD) and in ASD with milder developmental delays.Method: Autism Diagnostic Observation Schedule, 2nd Edition, Toddler Module revealed symptoms in three groups of toddlers, with mean ages of 17-20 months: (1) ASD and cognitive/language functioning below the 12-month level (ASD-MA < 12 mos; n = 28), (2) GDD (n = 27), and (3) ASD and cognitive/language functioning at or above the 12-month level (ASD-MA ≥ 12 mos; n = 29). Logistic regression models were fit to control for developmental level. Results: Items in all domains (social interaction, communication, repetitive movements) discriminated ASD-MA < 12 mos from GDD. The two ASD groups, matched for age but differing on developmental level, showed strikingly similar ASD symptomatology. Conclusion: ADOS-2 symptoms differentiated ASD-MA < 12 mos from GDD, after controlling for cognitive impairment. Symptoms in the two ASD groups were minimally related to developmental level. The ADOS-2 Toddler Module successfully captured ASD symptomatology even in children whose developmental level was below the recommended ADOS-2 cutoff of 12 months, which may increase their access to early ASD-specific intervention.

Malnutrition is a health disorder due to a lack or imbalance of nutrients needed for growth, thinking activities and all things related to life. One of the efforts made to help meet the nutritional needs of malnourished children under five is the Recovery Supplementary Feeding (PMT) program. The purpose of this study was to analyze whether the effect of supplementary feeding with local ingredients on changes in body weight of undernourished children under five. The type of research used is pre-experimental research design with one group pre and post-test design. This research was conducted in the working area of the Nanga Public Health Center. The population in this study were all underweight children under five in the working area of the Nanga Health Center as many as 30 people, the sampling technique in this study was total sampling. Data processing is done by editing, coding, entry, tabulating and cleaning. Data analysis in this study was bivariate with Paired Test. The results showed that there was an effect of providing local-based supplementary food to changes in body weight of undernourished children under five as indicated by a p value of 0.000 < 0.05, with a pre-test Mean value (9.744) < Post-test Mean (10.022). and the value of t-count (7.409) > t-table (2005). Based on these results, it can be concluded that the provision of local-based supplementary food is effective in increasing the weight of undernourished children under five.

Anaphylaxis is a systemic allergic reaction that can be caused by food, drugs, insect bites, or unknown triggers in infants and toddlers. Anaphylaxis rates are increasing. Infants and toddlers may have increased exposure to known and unknown allergens, decreased ability to describe their symptoms, and an expanded differential diagnosis for consideration on presentation. The most common symptoms in these age groups are cutaneous and gastrointestinal. Age-specific language may be helpful for caregivers to identify and describe the symptoms of anaphylaxis in infants and toddlers. Long-term management of anaphylaxis includes allergy evaluation to guide avoidance and assess prognosis and education on allergic reaction management; this incorporates the prescription of epinephrine autoinjector and provision of an allergy emergency plan.

Difficulty eating in children cause malnutrition, dehydration, underweight, electrolyte imbalance, impaired cognitive development, anxiety disorders, and in more severe cases can be a life-threatening condition. Tuina massage is a massage technique that can overcome eating difficulties in toddlers. The purpose of this activity is to increase the knowledge and skills of health cadres about nutritional health and Tuina massage. The service was carried out in Pasir Lor village, Karanglewas district, which was attended by 23 cadres. Data collection techniques were carried out using questionnaires about toddler nutrition and observation sheets to assess Tuina's massage skills. The results of the activity showed that the knowledge of cadres before training was mostly in the sufficient category, while the knowledge of cadres after attending the training showed that the level of knowledge of cadres was mostly in the good category. Most of the health cadres have good skills in doing Tuina massage. The training activities were effective and able to increase the knowledge and skills of cadres about toddler nutrition and developmental problems and Tuina massage.

Magnetic resonance imaging (MRI) scoring systems are used in the neonatal period to predict outcome in infants with neonatal encephalopathy. Our aim was to assess the relationship between three MRI scores and neurodevelopmental outcome assessed using Bayley Scales of Infant and Toddler Development, third edition (Bayley-III), at two years in infants with neonatal encephalopathy.Term-born neonates with evidence of perinatal asphyxia born between 2011 and 2015 were retrospectively reviewed. MRI scanning was performed within the first two weeks of life and scored using Barkovich, National Institute of Child Health and Human Development (NICHD) Neonatal Research Network (NRN), and Weeke systems by a single assessor blinded to the infants clinical course. Neurodevelopmental outcome was assessed using composite scores on the Bayley-III at two years. Multiple linear regression analyses were used to assess the association between MRI scores and Bayley-III composite scores, with postmenstrual age at scan and sex included as covariates.Of the 135 recruited infants, 90 infants underwent MRI, and of these, 66 returned for follow-up. MRI abnormalities were detected with the highest frequency using the Weeke score (Barkovich 40%, NICHD NRN 50%, Weeke 77%). The inter-rater agreement was good for the Barkovich score and excellent for NICHD NRN and Weeke scores. There was a significant association between Barkovich, NICHD NRN, and Weeke scores and Bayley-III cognitive and motor scores. Only the Weeke score was associated with Bayley-III language scores.Our findings confirm the predictive value of existing MRI scoring systems for cognitive and motor outcome and suggest that more detailed scoring systems have predictive value for language outcome.

OBJECTIVE Posthemorrhagic hydrocephalus (PHH) is associated with significant morbidity, smaller hippocampal volumes, and impaired neurodevelopment in preterm infants. The timing of temporary CSF (tCSF) diversion has been studied; however, the optimal time for permanent CSF (pCSF) diversion is unknown. The objective of this study was to determine whether cumulative ventricle size or timing of pCSF diversion is associated with neurodevelopmental outcome and hippocampal size in preterm infants with PHH. METHODS Twenty-five very preterm neonates (born at ≤ 32 weeks’ gestational age) with high-grade intraventricular hemorrhage (IVH), subsequent PHH, and pCSF diversion with a ventriculoperitoneal shunt (n = 20) or endoscopic third ventriculostomy (n = 5) were followed until 2 years of age. Infants underwent serial cranial ultrasounds from birth until 1 year after pCSF diversion, brain MRI at term-equivalent age, and assessment based on the Bayley Scales of Infant and Toddler Development, Third Edition, at 2 years of age. Frontooccipital horn ratio (FOHR) measurements were derived from cranial ultrasounds and term-equivalent brain MRI. Hippocampal volumes were segmented and calculated from term-equivalent brain MRI. Cumulative ventricle size until the time of pCSF diversion was estimated using FOHR measurements from each cranial ultrasound performed prior to permanent intervention. RESULTS The average gestational ages at tCSF and pCSF diversion were 28.9 and 39.0 weeks, respectively. An earlier chronological age at the time of pCSF diversion was associated with larger right hippocampal volumes on term-equivalent MRI (Pearson’s r = −0.403, p = 0.046) and improved cognitive (r = −0.554, p = 0.047), motor (r = −0.487, p = 0.048), and language (r = −0.414, p = 0.021) outcomes at 2 years of age. Additionally, a smaller cumulative ventricle size from birth to pCSF diversion was associated with larger right hippocampal volumes (r = −0.483, p = 0.014) and improved cognitive (r = −0.711, p = 0.001), motor (r = −0.675, p = 0.003), and language (r = −0.618, p = 0.011) outcomes. There was no relationship between time to tCSF diversion or cumulative ventricle size prior to tCSF diversion and neurodevelopmental outcome or hippocampal size. Finally, a smaller cumulative ventricular size prior to either tCSF diversion or pCSF diversion was associated with a smaller ventricular size 1 year after pCSF diversion (r = 0.422, p = 0.040, R2 = 0.178 and r = 0.519, p = 0.009, R2 = 0.269, respectively). CONCLUSIONS In infants with PHH, a smaller cumulative ventricular size and shorter time to pCSF diversion were associated with larger right hippocampal volumes, improved neurocognitive outcomes, and reduced long-term ventriculomegaly. Future prospective randomized studies are needed to confirm these findings.

How parents support social learning at the preverbal level for toddlers with autism is rarely reported, limiting the field’s understanding of factors that may influence early development of social competency. As a central challenge in autism that is resistant to intervention, preverbal social initiating is an important indicator of social motivation. This study explored parents’ application of mediated learning principles. Mediated learning theory is based on active engagement in the learning process or “learning to learn” and the Joint Attention Mediated Learning intervention applied the principles to child and parent learning. The investigation explored associations between parents’ application of mediated learning principles with unprompted initiation of joint attention for 119 toddlers with autism. Postintervention videos of unstructured parent–child interaction were used to analyze parents’ application of the principles and child initiation of joint attention. Significant differences were found between intervention and control conditions in parents’ mediation of child learning. In a multiple regression analysis of associations between parents’ application of the principles and toddler initiation of joint attention, parents’ success in applying mediated learning principles predicted toddlers’ initiation of joint attention gains. Considered individually, the strongest predictor of initiation of joint attention was the principle Giving Meaning with the principle Encouraging also showing significance. Lay abstract Little is known about what parents can do to promote initiating joint attention for their toddlers with autism. Initiating joint attention is important because it is an indicator of social motivation and is associated with later communication ability. In this study, parents applied mediated learning principles to help their toddlers engage with them socially. The principles included helping their child focus on social interaction, giving meaning to the social elements of interaction (and de-emphasizing nonsocial elements), and helping their toddlers understand their own social ability by encouraging. At the end of the intervention period, we compared two groups. One group received the Joint Attention Mediated Learning intervention and the other received community-based early intervention services. We found that the Joint Attention Mediated Learning participants applied mediated learning principles more often than the other group. Then, we explored how parents’ application of mediated learning principles related to toddler initiating joint attention and found that parents who were successful in applying the principles had toddlers who were more likely to show initiating joint attention. Our findings indicate that the mediated learning process shows promise as a way to promote early social learning, although other elements of the Joint Attention Mediated Learning intervention, such as actively engaging parents in the learning process, may have also contributed to both child and parent learning.

Early intensive behavioral interventions (EIBI) for children at elevated likelihood for a later diagnosis of autism spectrum disorder (EL-ASD), are often delivered through parent-mediated models. An area of current exploration is whether changes in caregiver behaviors are a mechanism through which to improve and track child behaviors in these interventions. Toddlers and their caregivers participated in an intervention trial (randomized controlled trial) and were randomized to either a parent-mediated intervention (adapted responsive teaching; ART) or a control condition (referral to early intervention and monitoring; REIM). Changes in toddler social communication (SC) behaviors and characteristics of caregiver responsiveness (CR) were quantified over 8 months. Analyses were conducted to assess whether changes in CR mediated the relation between group (ART vs. REIM) and changes in child SC. Results of the current study indicated that caregivers who participated in a parent-mediated intervention improved in three domains of CR (contingent verbal sensitivity, responsivity, affect). CR was also found to be a mechanism through which children's SC skills improved. This work provides evidence that qualities of CR serve as mechanisms through which to improve and monitor child behaviors over the course of EIBIs. These results may lead to novel intervention targets, methods for tracking change, and tailored treatment planning for toddlers with EL-ASD. The data used in this study comes from a clinical trial that was prospectively registered with the Registry of Efficacy and Effectiveness Studies (Registry ID: 316.1v1). LAY SUMMARY: Interventions for toddlers with high likelihood for a later diagnosis of autism often include the caregiver as an active participant in the intervention. In this study, we aimed to understand qualities of caregiver responsiveness (CR) that facilitate improvements in child behaviors during intervention. Results show that increasing verbal CR and affect are ways to improve child social skills over the course of intervention.

Background:Myasthenia gravis is an extremely rare autoimmune disorder affecting the neuromuscular junction. The incidence rate is 0.9-2.0 cases per 1 million children per year.Ocular myasthenia gravispresents as ptosis with extraocular motility restriction and is prone to be misdiagnosed as third nerve palsy and is difficult to diagnose in very young children. Case: A girl aged 2 years 6 months with clinical features with bilateral ptosis and was diagnosed as juvenile ocular myastenia gravis based on history, physical examination and other diagnostic proceduressuch as chest X-raywithin normal limit and no thymoma, the ice test showed positive result, electromyography (EMG) showed decrement response >10%,progstigmin test showed positive result, andserum acetylcholine receptor antibody levels was 0.43 nmol/L (reference range : positive as >0.40 nmol/L). Conclusion:Juvenile ocular myastenia gravis diagnostics can be established using simple examinations such as ice tests,prostigmin test to sophisticated examinations as systemic acetylcholinesterase antibodies. Management begins with a first-line drug, pyridostigmine, that is safe and effective. Disease monitoring and looking for etiology are very important for successful treatment.

Pneumonia toddlers is a contagious disease that are commonly found in West Sumatera Province. The purpose of this study is to determine causes of Pneumoniain Toddlers in the. The type of this study is analytic by using Spear Correlation with a non-reactive approach. The population is all sub-districts in West Sumatra Province; the samples are Pneumonia patient in toddlers in 80 sub-districts of 7 districts / cities. The results of the study shows that there is a correlation between population density (p = 0,000), exclusive breastfeeding (p = 0,000), immunization status (p = 0,000), healthy house (p = 0,000) and nutrition status (p = 0.018) toward Pneumoniain toddler in West Sumatra Province. But, there is no correlation between clean and healthy life behavior toward pneumonia.

Many toddlers are still malnourished. Poor parenting style causes the growth and development of toddlers which is also not good. Poor nutritional status of children under five, lack of or obesity is associated with poor parenting. The purpose of this study was to identify the relationship between maternal parenting and the nutritional status of children under five in Tarung Village, Waikabubak City, West Sumba Regency. The research design used cross sectional. The population is mothers who have 34 children under five with a sample of 31 people taken by Simple Random Sampling Technique. The research instrument uses the Google Form application and KMS Book. The results of the study prove that almost half of mothers have poor parenting and most toddlers have poor nutritional status. The results of the statistical test obtained pvalue = (0.047) < (0.05) so that it was concluded that there was a relationship between maternal parenting and the nutritional status of children under five in Tarung Village, Waikabubak City, West Sumba Regency. For further researchers, it is recommended to consider the determinant factors of nutritional status that have not been studied.

The coronavirus disease 2019 (COVID-19) in children has been shown to have lower morbidity and mortality in children as compared with adults. The neurological complications related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are increasingly reported in children, yet the cerebrovascular complications are rare. We report a case of a toddler who presented with right-sided hemiparesis and motor aphasia, with an antecedent history suggestive of COVID-19 infection. The child tested negative on the nasopharyngeal swab for real-time reverse transcription-polymerase chain reaction (RT-PCR), but the serology for anti-SARS-CoV-2 IgG assay was positive. The neuroimaging showed an acute infarct in the left middle cerebral artery territory. A detailed evaluation for causes of childhood stroke was unrevealing, except for the presence of severe iron deficiency anemia (IDA). The child was diagnosed as acute ischemic stroke (AIS) most probably secondary to mild COVID-19 infection. The objective of this case report is to explain the possibility of AIS after a mild COVID-19 infection, complicated by the underlying severe IDA. Therefore, an association between COVID-19 and stroke in children needs to be emphasized and RT-PCR for SARS-CoV-2 as well as serological assay must be included in the workup of stroke in the young.

Despite findings demonstrating the importance of parental present-centered awareness, factors undermining mindful parenting have received less attention. Increasingly, evidence points to parental psychopathology as a salient risk factor for parenting difficulties. Thus, the goal of the present study was to investigate specific dimensions of parental trauma-related distress and general negative affectivity during pregnancy as predictors of mindful parenting during toddler age. Parental psychopathology, parent–infant bonding, and mindful parenting were assessed in a sample of heterosexual couples (N = 159) across four waves of data collection spanning pregnancy to child age two. Data were analyzed using path analysis within a dyadic framework. Results demonstrated the unique impact of maternal trauma-related distress during pregnancy (e.g., intrusions and avoidance) on facets of mindful parenting more than two years later. Further, among both mothers and fathers, general negative affectivity common across internalizing disorders undermined mindful parenting through impaired parent–infant bonding. Findings highlight the need for early intervention efforts that incorporate mindfulness strategies to reduce subthreshold symptoms of prenatal psychopathology, promote healthy bonding, and improve parental awareness and self-regulation, thereby enhancing the overall parent–child relationship.

Foreign body (FBA) in the airway is a common cause of sudden onset of respiratory distress in children. Prompt recognition and early intervention is required to minimize the potentially serious and sometimes fatal consequences.

Background: Nutritional parenting is part of the parenting style which includes household practices which are realized by the availability of food as well as health care and other sources for the child's survival, growth and development. One of the causes of malnutrition is the pattern of mother's care for toddlers, especially in terms of family nutritional intake, from food preparation, selection of food ingredients, to food menus. The purpose of this study was to obtain in-depth information about how nutrition parenting for malnourished toddlers in the working area of Sungai Parit Public Health Center, Indragiri Hulu Regency. Method: This is a qualitative analytic study with a phenomenal design. The data were collected by conducting in-depth interviews, observation and document review. The number of informants in this study amounted to 13 people, divided into 4 main informants (main caregiver / mother), and 9 supporting informants (4 families, 4 people in charge of the nutrition program, 1 cadre). Result: The mothers' lack of knowledge about nutritional care, the practice of giving complementary breastfeeding and dietary arrangements for children is still low, the implementation of health services utilization and poor sanitation implementation is still not good. Conclusion : The implementation of nutrition parenting in the ditch river community health center is not good, this is due to the low knowledge of mothers about nutrition parenting, the low level of exclusive breastfeeding for toddlers, the inaccurate practice of giving complementary breastfeeding to children, less varied dietary arrangements, application of utilization of health services that are not yet good and the implementation of environmental sanitation is still poor.

AIM: To assess the causal effect of being born extremely preterm (EP

BACKGROUND: Universal provision of iron supplements (drops or syrup) or multiple micronutrient powders to young children in low-to-middle-income countries where anemia is prevalent is recommended by the World Health Organization and widely implemented. The functional benefits and safety of these interventions are unclear. METHODS: We conducted a three-group, double-blind, double-dummy, individually randomized, placebo-controlled trial to assess the immediate and medium-term benefits and risks of 3 months of daily supplementation with iron syrup or iron-containing multiple micronutrient powders, as compared with placebo, in 8-month-old children in rural Bangladesh. The primary outcome was cognitive development, as assessed by the cognitive composite score on the Bayley Scales of Infant and Toddler Development, third edition, immediately after completion of the assigned 3-month regimen; scores range from 55 to 145, with higher scores indicating better cognitive performance. Secondary outcomes included the cognitive composite score at 9 months after completion of the assigned regimen; behavioral, language, and motor development, as well as growth and hematologic markers, immediately after completion and at 9 months after completion; and safety. RESULTS: We randomly assigned 3300 infants to receive iron syrup (1101 infants), multiple micronutrient powders (1099), or placebo (1100) daily. After completion of the assigned 3-month regimen, no apparent effect on the cognitive composite score was observed with iron syrup as compared with placebo (mean between-group difference in change in score from baseline, -0.30 points; 95% confidence interval [CI], -1.08 to 0.48) or with multiple micronutrient powders as compared with placebo (mean between-group difference in change in score from baseline, 0.23 points; 95% CI, -0.55 to 1.00). No apparent effect on any other developmental or growth outcome was observed immediately after completion of the assigned regimen or at 9 months after completion. At 9 months after completion of the assigned regimen, the prevalences of anemia, iron deficiency, and iron deficiency anemia increased in all three trial groups but remained lower among the children who received iron syrup or multiple micronutrient powders than among those who received placebo. The risk of serious adverse events and incidence of symptoms of infection were similar in the three trial groups. CONCLUSIONS: In this trial involving infants in Bangladesh, 3 months of daily supplementation with iron syrup or multiple micronutrient powders did not appear to have an effect on child development or other functional outcomes as compared with placebo. (Funded by the National Health and Medical Research Council of Australia; BRISC Australian New Zealand Clinical Trials Registry number, ACTRN12617000660381.).

Background Small-quantity lipid-based nutrient supplements (SQ-LNS) are designed to address undernutrition during the complementary feeding period. SQ-LNS contains added sugars, but limited research has assessed whether infants' acceptance varies between versions with and without sugars. Objectives Our objective was to examine the effects of repeated exposure on children's acceptance of sweetened and unsweetened SQ-LNS. We aimed to understand caregivers' perceptions of children's liking of the 2 SQ-LNS versions and their influences on infant acceptance of SQ-LNS. Methods Caregivers (86% non-Hispanic White) and children (7-24 mo), participated in a randomized, 2-week home-exposure study and baseline and post-home exposure assessments. Children were randomized to receive sweetened or unsweetened SQ-LNS versions, mixed with infant oatmeal. At in-person visits, caregivers fed both SQ-LNS versions to children and rated their child's liking for each. Caregivers fed the SQ-LNS version to which their child was randomized until the child refused to eat more. Acceptance was measured as total grams consumed. Mixed-effects linear models tested the change in SQ-LNS consumed between baseline and postexposure by the SQ-LNS version and number of home exposures. Covariates included the amount of SQ-LNS consumed at baseline, child BMI z-score, child age, and breastfeeding experience. Results Children's acceptance of both SQ-LNS versions increased from baseline to postexposure (β, 0.71 g; 95% CI: 0.54-0.89 g; P = 0.04), regardless of SQ-LNS version (P = 0.88) or number of home exposures (P = 0.55). Caregivers rated children's liking of unsweetened SQ-LNS higher at baseline (P = 0.02). Children with lower liking ratings at baseline showed the greatest increases in acceptance between baseline and postexposure (P = 0.01). Conclusions Children's acceptance of SQ-LNS increased with repeated exposure, whether offered the sweetened or unsweetened version, providing preliminary support that adding sugar to SQ-LNS may not improve acceptance in young children. Children who initially like the supplement less may need repeated experience to learn to accept SQ-LNS. This trial was registered at clinicaltrials.gov as NCT04544332.

Background Angelman syndrome (AS) is a rare neurodevelopmental disorder caused by the absence of functional UBE3A in neurons. Excess low-frequency oscillations as measured with electroencephalography (EEG) have been identified as a characteristic finding, but the relationship of this EEG finding to the symptomatology of AS and its significance in the pathophysiology of AS remain unknown. Methods We used correlations and machine learning to investigate the cross-sectional and longitudinal relationship between EEG spectral power and motor, cognitive, and language skills (Bayley Scales of Infant and Toddler Development, Third Edition); adaptive behavior (Vineland Adaptive Behavior Scales, Second Edition); AS-specific symptoms (AS Clinical Severity Scale); and the age of epilepsy onset in a large sample of children (age: 1–18 years) with AS due to a chromosomal deletion of 15q11-q13 (45 individuals with 72 visits). Results We found that after accounting for age differences, participants with stronger EEG delta-band abnormality had earlier onset of epilepsy and lower performance scores across symptom domains including cognitive, motor, and communication. Combing spatial and spectral information beyond the delta frequency band increased the cross-sectional association with clinical severity on average by approximately 45%. Furthermore, we found evidence for longitudinal correlations of EEG delta-band power within several performance domains, including the mean across Bayley Scales of Infant and Toddler Development, Third Edition, scores. Conclusions Our results show an association between EEG abnormalities and symptom severity in AS, underlining the significance of the former in the pathophysiology of AS. Furthermore, our work strengthens the rationale for using EEG as a biomarker in the development of treatments for AS, a concept that may apply more generally to neurodevelopmental disorders.

We describe a female toddler with rectal bleeding from extensive colonic polyposis, and diagnosed with familial adenomatous polyposis. She has epilepsy from infancy attributed to focal cortical dysplasia. Hepatoblastoma was diagnosed at 13 months of age. Germline testing detected a pathogenic APC (adenomatous polyposis coli gene) variant. We discuss the anecdotal management of this case, including the clinical utility of genetic confirmation. We review the genotype-phenotype correlation of the APC mutational spectrum, and the existing evidence supporting the hypothesis that cortical dysplasia is part of the APC-related spectrum.

Anaemia is a condition in which there is a decrease in red blood cells or haemoglobin levels in red blood cells caused by several factors such as chronic diseases, iron and folic acid deficiency, or chronic bleeding. Anaemia is one of the world’s nutritional problems, especially in developing countries, including Indonesia. According to RISKESDAS 2013, the number of stunting children in Indonesia had reached 37% (estimated 9 million toddlers) One of the factors that can cause stunting is anaemia during pregnancy. This research aims to determine whether there is a correlation between anaemia-related knowledge of mothers who have children aged 2-5 years old with the incidence of stunting. The research used in the study used analytical research with a cross-sectional method. The data was collected using questionnaires distributed to mothers who have children at the age of 2-5 years in Mekarbakti Village, Sumedang District, West Java. The study results showed that the incidence of stunting is higher in the group of respondents who have better knowledge of anaemia. The conclusion is that there is no correlation between the level of anaemia- related knowledge of mothers who have children aged 2-5 years with the incidence of stunting in Mekarbakti Village (P Value> 0.05). Keywords: Anemia, Stunting, Toddler

Campak merupakan penyebab penyakit eksantema dengan karekteristik demam, batuk, pilek, konjungtivitis, ruam konfluens makulopapula eritematosa,dan enantema yang patognomonik dan campak menjadi salah satu penyebab utama kematian pada anak tahun 2007-2015. Tujuan penelitian ini untuk Hubungan tingkat pengetahuan dan sikap ibu terhadap status imunisasi pada balita pasien campak di Rumah Sakit Bakti Timah Pangkalpinang.Metode penelitian deskripsi korelasi. Populasi penelitian ini Ibu/ Orang Tua yang memiliki balita umur 1-4 tahun dan terkena penyakit campak di Rumah Sakit Bakti Timah Pangkalpinang. Sampel penelitian ini sebanyak 42 responden berdasarkan data pasien balita yang terkena penyakit campak di Rumah Sakit Bakti Timah Pangkalpinang. Sampel kontrol diambil Sampling Non Probabilitas. Data dianalisis dengan analisis univariat dan bivariat menggunakan uji statistik Chi-square dengan tingkat kemaknaan 0,05.Hasil penelitian variabel dengan status imunisasi pada balita pasien campak ditemukan adanya hubungan. Hasil penelitian menunjukkan bahwa variabel pengetahuan (POR = 7,741), Sikap Ibu (POR = 6600). Disarankan bagi Rumah Sakit dapat memberikan konseling edukasi kepada orang tua balita bahwa pentingya imunisasi campak dan bahaya penyakit campak serta memberikan peran serta petugas kesehatan dirumah sakit untuk komunikasi yang baik pada pasien dan keluarga pasien penderita campak.

We report a case of an epiretinal membrane (ERM) in a 3-year-old girl, which was accidently discovered after a strabismus surgery. The ERM occurred twice in 2 years and spontaneously released within 3 months, which has not been previously reported.

Snake bite is an often-neglected,1 life-threatening emergency prevalent in rural areas of tropical countries such as Indonesia.2 The WHO reported a worldwide incidence of 5 million snake bites per year, with 100,000–200,000 deaths.3 The incidence rate and likelihood of subsequent complications are higher in children than adults.4 According to the WHO, 35% of child deaths related to poisonous animal bites are attributable to snake bites and occur more frequently in boys than girls.5 In Indonesia, no national epidemiological data on snake bites in children is available, but the WHO estimated that 5–8 snake bite cases occur weekly in Lombok, West Nusa Tenggara.6 Lower limbs are the most common site for bites (72%), while facial bites are quite rare (10%).7 Bites involving children and/or the face are considered as severe envenomation and usually require antivenom at an appropriate dose and timing to be effective.8 Therefore, it is important that hospitals are equipped with life-saving intervention measures to optimize care and improve the chances of survival.9 Nevertheless, in developing countries, the use of antivenom is limited by the absence of standardized guidelines, scarcity/unavailability, and high cost.9 In Indonesia, the only antivenom, serum antibisa ular (SABU), is costly and difficult to obtain due to limited quantities, especially in rural areas. Furthermore, SABU is a polyvalent antivenom with low coverage, as it is only indicated for Naja sputatrix, Bungarus fasciatus, and Agkistrodon rhodostoma, despite the numerous other snake species endemic to Indonesia.2

Objectives Exposure to gestational diabetes mellitus (GDM) in utero may impact nutritional intake and lifestyle habits in early childhood. However, it is unclear whether nutritional status predicts greater risk for metabolic disturbances, such as insulin resistance (IR). The primary objectives were: 1) to determine parent-reported nutritional risk scores in 2-year-old children born to women with and without GDM and 2) to assess whether these scores predict IR in 5-year-old children. Methods Children exposed (n=34) and unexposed (n=46) to GDM were screened at 2 years of age using the Toddler version of the Nutrition Screening Tool for Every Preschooler (NutriSTEP). At a 5-year follow up, IR was assessed using the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Results Total NutriSTEP scores ranged from 6 to 33, with higher scores indicating greater risk. After controlling for infant birthweight, sex of the child, child ethnicity, maternal age at time of pregnancy, breastfeeding status and maternal prepregnancy body mass index, average NutriSTEP scores were higher in children exposed to GDM compared with those unexposed (13.8±1.1 vs 11.2±1.1, p=0.03). NutriSTEP scores at 2 years emerged as a positive independent predictor of HOMA-IR at 5 years. For each unit increase in NutriSTEP score, suggesting greater nutritional risk, we saw a 0.48 (95% confidence interval, 0.17 to 0.80; p=0.003) increase in score on the HOMA-IR. Conclusions Parent-reported nutritional risk is greater in GDM-exposed children, and these nutritional behaviours developed during the first years of life may predispose to metabolic disturbance in early childhood.

Background Type of infant feeding has been linked to later nutritional outcomes, including dietary diversity and obesity in childhood. Little is known about how introduction to complementary feeding and diet quality in early childhood vary by infant feeding type and sex. Objective Our objective was to investigate whether early childhood dietary patterns vary by infant feeding type and sex. Methods Data from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Infants and Toddler Feeding Practices Study 2 (ITFPS-2) was used, including children with complete information on the WIC infant food package received at ages 1, 7, and 11 mo (N = 2839). Based on this information, children were grouped as fully breastfed, mostly breastfed, mostly formula fed, and fully formula fed. Outcomes include introduction of complementary foods; caloric intake aged between 1 and 36 mo; and Healthy Eating Index (HEI)-2015 between 13 and 36 mo. Mixed models were used adjusting for child's, mother's, and family's sociodemographic characteristics. Results Across all infant feeding groups, the mean age of introduction to any solids was before the age of 6 mo; fully breastfed children were introduced to complementary foods closer to the recommended age (mean 5.1-5.2 mo) compared with other feeding groups (mean 4.6-4.8 mo). Fully formula fed infants consumed significantly more energy than fully breastfed infants at ages 1 mo (boys = 55 kcal/d, girls = 47 kcal/d), 12 mo (boys = 68 kcal/d, girls = 59 kcal/d), 24 mo (boys = 81 kcal/d, girls = 71 kcal/d), and 36 mo (boys = 95 kcal/d, girls = 83 kcal/d). No meaningful differences were observed for HEI-2015 between infant feeding groups or child sex, with average scores of HEI-2015 for all children being 61-63 out of 100. Conclusion Early childhood dietary patterns were slightly better among children who were fully breastfed as infants, compared with children in other infant feeding groups. The diets of all WIC-participating children could be improved.

Background: East Java is one of the regions in Indonesia that has received more attention regarding stunting because the incidence has around 36%. Stunting is a phenomenon of malnutrition that occurs in children where there are growing problems related to the length or height of the child. The history of choric energy deficiency in the mother during pregnancy, birth weight, and birth length is closely related to the incidence of stunting. The incidence of stunting at the Puskesmas Tambak Wedi Surabaya in 2018 was 18.9%. This data has increased from 2017 to 2.7%. Therefore, this study aims to determine the relationship between birth weight and birth length with the incidence of stunting under five at Puskesmas Tambak Wedi Surabaya. Methods: This study used observational analytic with a cross-sectional approach. The sample used was 30 toddlers with a simple random sampling technique. Stunting in toddlers is included in the dependent variable, while birth weight and birth length are included in the independent variables. Spearman's test was used to analyze the data in this study. Results: This study shows that there is a relationship between birth weight and the incidence of stunting in children under five who obtained a correlation coefficient value of 0.450 with a p-value of 0.012 with sufficient strength and there was a relationship between birth length and the incidence of stunting under-five children who obtained a correlation coefficient value of 0.463 with a p-value of 0.010 with sufficient relationship strength. Conclusion: Birth weight and birth length are associated with the incidence of stunting under five. Mothers need to follow the advice of health workers in maintaining nutrition during preconception, antenatal, natal, and post-natal periods with the help of the husband and family.

Background:High blood pressure is a risk factor for cardiovascular disease and neurological disease among children and adults. The American Heart Association recommended blood pressure evaluation among children aged more than 3 years for early detection of complications. Nutritional status was considered to have association with elevated blood pressure in children. Objective:To assess the association between nutritional status and the blood pressure of preschool children in Denpasar, Bali. Methods:This was a descriptive analytic cross-sectional study. Four hundred and fifty-six children aged 3-6 years who attended Kindergarten 2019 in Denpasar were enrolled by the cluster random sampling design. Results:From 456 samples obtained ratio between boys and girls was 1,1: 1. Median age of the sample was 5 years (3-5 years old). The majority of nutritional status was well nourished (52.2%) and obesity was found 11.8%. majority children had normotension (64%), and followed by pre-hypertension (25.4%), hypertension stage 1 (8.6%) and hypertension stage 2 (2%). Bivariate analysis showed that obesity and sex were risk factor for toddler having higher level of blood pressure with. Multivariate analysis showed children with obesity and boys are 2.8- and 1.8-times more likely to have hypertension (CI 95% 1.72-4.81; CI 95% 1.24-2.76, respectively). Low birth weight and prematurity were not found to be significantly related to level of blood pressure. Conclusion:Children with obesity were found to be significantly related to elevated blood pressure (hypertension).

Toxicity related to acetaminophen is most encountered with the acute ingestion of large doses. However, toxicity may also result from chronic ingestion, even when recommended doses are administered over a prolonged period of time. We present the case of a 20-month-old female toddler who received therapeutic recommended doses of acetaminophen (oral or intravenous) following multiple surgical interventions for treatment of a tracheo-esophageal fistula following ingestion of a button battery. The potential role of chronic acetaminophen administration in the etiology of hepatoxicity is discussed and prevention strategies are presented.

BackgroundStudies on the transmission of suicide risk have focused on parental history of suicide attempts (SAs), overlooking when the attempt happened. This study examined how the offspring's risk of attempting or dying by suicide varied by the timing of a first parental SA and the sex of the parent who attempted suicide.MethodsParticipants were 59 469 members of the 1987 Finnish Birth Cohort. The Finnish Hospital Discharge and Cause of Death Registers were the sources for parental and offspring SAs and offspring suicide. Timing of parental SA was coded as before (pre-pregnancy and pregnancy) and after the child's birth [infant/toddler years (0–2 years), childhood (3–11 years), adolescence (12–17 years), and young adulthood (18–26 years)].ResultsIn the multivariate models, having a parent who attempted suicide increased the offspring's risk of attempting suicide (odds ratio (OR) = 1.77, 95% confidence interval (CI) 1.39–2.25), but not of dying by suicide. Compared to unexposed offspring, those exposed after child's birth were at higher risk of attempting suicide (OR = 1.90, 95% CI 1.46–2.47), specifically when the parent attempted during offspring's childhood, adolescence, and young adulthood. A first maternal SA increased offspring's risk of attempting suicide regardless of the timing.ConclusionsThe impact of a parental SA on offspring's risk of attempting suicide differed depending on the timing and sex of the parent who attempted suicide, suggesting that the transmission of suicide risk may occur through genetic as well as environmental factors. Our findings call for an intergenerational approach in suicide risk assessment.

Although symptoms of autism are present early in life and early diagnosis can lead to better outcomes, there is a dearth of validated caregiver-report interviews designed for children under the age of 3 years. We developed the Toddler Autism Symptom Inventory, a semi-structured interview designed to assess the presence and absence of skills and symptoms in children aged 12–36 months. Reliability and validity of items and a cutoff score for likelihood of autism spectrum disorder were established. Specificity and sensitivity of this cutoff were confirmed with a cross-validation sample. The Toddler Autism Symptom Inventory effectively identified most children with autism without excessive false positives. The Toddler Autism Symptom Inventory is a developmentally appropriate caregiver interview for use in diagnostic evaluations of children under age 3 years that offers clearly operationalized diagnostic criteria and a cutoff for autism likelihood for very young children. Lay abstract Determining whether a young child has an autism spectrum disorder requires direct observation of the child and caregiver report of the child’s everyday behaviors. There are few interviews for parents that are specifically designed for children under 3 years of age. The Toddler Autism Symptom Inventory is a new interview that asks caregivers of children age 12–36 months about symptoms of possible autism spectrum disorder. The Toddler Autism Symptom Inventory uses a cutoff score to indicate likelihood for autism spectrum disorder; this cutoff score appears to accurately identify most children who are diagnosed with autism spectrum disorder without identifying too many who do not have autism spectrum disorder. The Toddler Autism Symptom Inventory interview can help clinicians to determine whether a young child shows symptoms suggestive of an autism spectrum disorder.

AIM: The research objectives were to determine the specific and sensitive intervention model in stunting prevention efforts in the coronavirus disease 2019 (COVID-19) pandemic and also to determine the relationship between specific and sensitive interventions on children’s nutritional status under five in the COVID-19 pandemic in stunting locus village. METHODS: This type of research was an observational study with a cross-sectional approach. The population size is 35 families of short children under five and the sample size is 35 people with the sampling technique is total sampling. This study used the Chi-square test with a significance level of p < 0.05 with SPSS computer software. RESULTS: Nutritional status based on the body weight/age index, 63% was very underweight and underweight. Based on body height/age, 28.6% was stunted. Based on body weight/body height, 17.1% was severe malnutrition and 40.0 % was malnutrition. The results of the bivariate analysis for specific nutrition interventions with body weight/ age showed p = 0.98, body weight/age had p = 0.668, and body height/age had p = 0.968, which indicated no significant relationship. CONCLUSIONS: Sensitive nutrition intervention showed no relationship between sensitive intervention and children’s nutritional status under five.

Introduction Though itchy ears cause significant discomfort, patients generally do not consult a doctor till it becomes chronic. Moreover, itching as a symptom hardly receives any attention in non-dermatological clinics and is generally not considered as a condition worth evaluating. Thus, this study was performed to examine the predisposing factors of itchy ears and the outcomes of corresponding treatment. Materials and Methods This was a prospective observational study carried out over a period of 12 months (July 2019 to June 2020). The study included 200 patients belonging to the age group ranging from toddler to elderly (≤70 years) and presenting at the ENT OPD of a Tertiary Care Teaching Institute with the complaints of itching in one or both the ears. Following the diagnosis, appropriate treatment was started. The patients were then followed-up after 10 days, to note if symptom of itchiness in the ear(s) had relieved. Results Out of 200 patients, 89 presented with itchy ears due to various etiology, of which most common were otomycosis (N=30), allergic rhinitis (N=15), and keratosis obturans (N=10). However, majority of the patients (N=111) had impacted wax as the predisposing factor (trauma (N=27), abnormal anatomy (N=65), or hereditary (N=19)), resulting in itchy ears. On the 10th day, complaint of itchy ears was relieved in majority of the patients. However, amongst 30 patients, 3 patients with fungal infection of the external auditory canal still complained of itchy ears and thus, were referred to dermatologist. Conclusion Impacted wax was the most frequently observed predisposing factor and was commonly observed across all the age groups. Majority of the patients responded well to the treatment and were relieved of itchy ears.

Osteogenesis imperfecta (OI) is characterized by fractures and progressive bone deformities. Fracture rates peak during the toddler and adolescent years and decline during adulthood but do not stop entirely. We describe a kindred, the affected members of which were the mother and two sons, who presented with an apparently unique phenotype of OI. Our patients demonstrated a pattern of prenatal bone deformities followed by multiple, nontraumatic long bone fractures within the first two years of life and then an absence of nontraumatic fractures thereafter. No extra-skeletal manifestations have been noted to date. The mother did not receive bisphosphonate therapy but had no nontraumatic fractures after the age of five months. Intravenous bisphosphonate therapy was started for both sons within two months of birth, with the most recent infusions at age 18 months and 28 months in Patients 2 and 3, respectively. Two patients harbored a variant of uncertain significance in the COL1A1 gene. This heterozygous variant, c.3548C>T; p.(Pro1183Leu), is listed in the OI Variant Database as affecting only one other individual with osteopenia. We describe three family members with a unique presenting phenotype of OI, characterized by cessation of nontraumatic fractures after the first two years of life.

Purpose To evaluate neurodevelopmental outcomes after intravitreal bevacizumab (IVB) therapy in retinopathy of prematurity (ROP) infants compared with those not exposed to IVB. Clinical Relevance The primary concern regarding IVB treatment of ROP is the potential systemic side effects, especially the risk of causing severe neurodevelopmental impairment (sNDI). Results regarding neurodevelopmental outcomes after IVB therapy are conflicting. Methods We conducted a meta-analysis and searched PubMed, Embase, and Web of Science for related publications from inception through March 12, 2020. The eligibility criteria were as follows: comparative studies of ROP patients that (1) included IVB as a treatment arm, (2) included a control group without bevacizumab treatment, and (3) reported on at least 1 neurodevelopmental outcome, such as sNDI, Bayley Scales of Infant and Toddler Development, Third Edition (Bayley III), composition scores, or cerebral palsy (CP). The primary outcome was sNDI, with the odds ratio (OR) calculated. Secondary outcomes were mean differences (MDs) for cognitive, language, and motor scores (Bayley III) and OR for CP. The quality of evidence was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation approach. Results Eight studies, 6 including laser-controlled ROP infants and 2 including ROP infants not requiring treatment, were included. The weighted OR for sNDI in the IVB group was 1.39 (95% confidence interval [CI], 0.98–1.97). The weighted MDs were –1.92 (95% CI, –4.73 to 0.88), –1.32 (95% CI, –4.65 to 1.99), and –3.66 (95% CI, –6.79 to –0.54) for cognitive, language, and motor scores in Bayley III, respectively. The OR for CP was 1.20 (95% CI, 0.56–2.55). No differences were observed between the preset subgroups comprising laser-controlled ROP infants and ROP infants not requiring treatment. The current quality of evidence was rated as low (sNDI and all Bayley III scores) to very low (CP). Conclusions Risk of sNDI was not increased in ROP patients after IVB treatment. Bayley III scores were similar in the IVB and control groups, except for a minor difference in motor performance. These findings suggest that the risk of additional sNDI after IVB treatment is low. Randomized trials are warranted to provide a higher quality of evidence.

This article describes a rare case of lactation ketoacidosis in a patient who started a ketogenic diet while nursing an infant and toddler. The patient presented to the ED with a history of nausea, vomiting, and postural dizziness, and was found to have a significant metabolic acidosis and elevated lipase level. The metabolic changes induced in this patient could occur in anyone with high metabolic demands who also is on a strict ketogenic diet. The case highlights the importance of a dietary history in patients with unexplained metabolic derangements.

Febrile convulsion often found in children 3-5 years old. This problem is a seizure that occurs when the body temperature rises and is caused by the extracranium process. This research was to decide the relationship between mother’s knowledge and management of febrile convulsion in children 1-5 years old in the Tengah village of Pancur Batu district 2020. This research is a cross-sectional study. We used to simple random sampling technique with 30 respondents. We used a questionnaire for the instrument. The final results showed that the majority of mother's knowledge regarding the management of febrile seizures was in the good category (86.7%) and the majority of febrile seizure management was in the category (90.0%). The results of chi-square statistical test show there is a relationship between knowledge of the mother with the handling of febrile seizures in children in the Tengah village of Pancur Batu District in 2020 (p value = 0,039). This study is expected to be an alternative for health workers to increase the promotion and prevention of problems related to the first treatment of febrile seizures. A person's knowledge is a factor that can influence a mother to take action, the better the mother's knowledge of diseases or health problems, the better the handling and vice versa, if the mother's knowledge is less, the handling of health problems will be better. Health education to the community will be a means to increase knowledge about handling health problems in the community.

The incidence of stunting is one of the sustainable development goals target. To achieve it, an intervention that is right and significant and in accordance with the priority of stunting risk factors. The priority of risk factors is influenced by many things in different places. Thus, this research is the key as a strategy in identifying priority factors as a prevention strategy against stunting toddlers in Palembang. This research is an analytical observational research with case control approach. The samples were collected using purposive sampling techniques and 170 research subjects were obtained. The data was collected from Health Centre of Palembang City by measuring the height according to the age of the toddlers and carried out interviews with the toddler’s mother. There results were analysed using Chi-square statistical tests. The analysis results obtained which had a meaningful relation with stunting incidence are maternal age, maternal work, maternal body height, maternal body weight, history of anemia during pregnancy, number of birth, pregnancy gap factor, history of iron or folate supplement consumption history, number of ANC visits, history of infectious diseases during pregnancy, and exclusive breastfeeding. The most dominant risk factors in sequence the chances of stunting children are the number of children more than one by 12 times, anemia during pregnancy by 9 times, mothers who have a high risk age has 7 times, the mother's height is not ideal by 6 times, the distance of pregnancy is equal to or less than 24 months by 4 times, an ANC visit is less than 4 times the chance of 4 times , do not give exclusive breast milk by 4 times, mothers who work outside the house by 3 times, do not consume iron or folate supplements by 3 times.

Objective To assess the feasibility and safety of one dose of Darbepoetin alpha (Darbe) administered to neonates ≥34 weeks with mild neonatal encephalopathy (NE). Methods Randomized, masked, placebo-controlled study including neonates ≥34 weeks gestation with mild NE. Neonates were randomized to receive one dose of Darbe (10 μg/kg IV) or placebo. Clinical and laboratory maternal and newborn data were collected. The Bayley Scales of Infant and Toddler Development, third edition (Bayley-III) and a standardized neurological examination at 8-12 months of corrected age were assessed. Results There were no differences in baseline characteristics of the 21 infants randomized (9 Darbe, 12 placebo). Adverse events were not reported at any time. Bayley-III scores were average in both Darbe and placebo groups. Conclusion This study demonstrates that a randomized, masked, placebo-controlled trial is safe and feasible. A large, randomized trial is warranted to assess the effect of Darbe in this population.

Very little is known about the 30% of children with Autism Spectrum Disorder (ASD) who remain minimally verbal when they enter school. Restricted and repetitive behaviors (RRBs) are well-characterized in younger, preschool, and toddler samples. However, the prevalence and impact of RRBs has not been characterized in older, minimally verbal children. The goal of this study was to characterize this core diagnostic feature in minimally verbal children with ASD ages 5-8 years over a 9-month period to better understand how these behaviors manifest in this crucially understudied population. RRBs were coded from caregiver-child interactions (CCX) at four timepoints. Upon entry into the study, children demonstrated an average of 17 RRBs during a 10-min CCX. The most common category was Verbal. RRBs remained constant over 6 months; however, a slight reduction was observed at the final timepoint. Compared to prior literature on younger samples, minimally verbal children with ASD demonstrated higher rates of RRBs and higher rates of verbal RRBs. Further work is required to understand the function and impact of RRBs in minimally verbal children. LAY ABSTRACT: Approximately one-third of children with autism spectrum disorder (ASD) remain minimally verbal at the time of school entry. In this study, we sought to characterize the presence of restricted and repetitive behaviors (RRBs) in school-aged children (5-8) who were minimally verbal. Compared to prior studies, minimally verbal children with ASD had higher frequencies of RRBs and demonstrated a different profile of behaviors, including more verbal RRBs.

Although coronavirus disease 2019 (COVID-19) is mild in nearly all children, a small proportion of pediatric patients develop severe or critical illness. Guidance is therefore needed regarding use of agents with potential activity against severe acute respiratory syndrome coronavirus 2 in pediatrics.A panel of pediatric infectious diseases physicians and pharmacists from 18 geographically diverse North American institutions was convened. Through a series of teleconferences and web-based surveys, a set of guidance statements was developed and refined based on review of best available evidence and expert opinion.Given the typically mild course of pediatric COVID-19, supportive care alone is suggested for the overwhelming majority of cases. The panel suggests a decision-making framework for antiviral therapy that weighs risks and benefits based on disease severity as indicated by respiratory support needs, with consideration on a case-by-case basis of potential pediatric risk factors for disease progression. If an antiviral is used, the panel suggests remdesivir as the preferred agent. Hydroxychloroquine could be considered for patients who are not candidates for remdesivir or when remdesivir is not available. Antivirals should preferably be used as part of a clinical trial if available.Antiviral therapy for COVID-19 is not necessary for the great majority of pediatric patients. For those rare cases of severe or critical disease, this guidance offers an approach for decision-making regarding antivirals, informed by available data. As evidence continues to evolve rapidly, the need for updates to the guidance is anticipated.

Background The addition of budesonide to surfactant in very-low-birth-weight infants with less severe RDS decreased bronchopulmonary dysplasia (BPD) severity. Long-term neurodevelopmental follow-up was needed to monitor for systemic effects of budesonide. Methods Infants ≤1250 g who received intratracheal budesonide (0.25 mg/kg) with surfactant (n = 173) were compared to a historical cohort who received surfactant alone (n = 294). Peabody Developmental Motor Scales II at 4-6 months corrected age and Bayley Scales of Infant & Toddler Development III at 18-22 months corrected age were compared. Results There were no differences in muscle tone or motor skills by Peabody exam. There were no differences in the cognitive, language, or motor domains between cohorts on Bayley III. Conclusions In a cohort of infants treated with budesonide mixed with surfactant, there were no differences in developmental outcomes at 4-6 months or 18-22 months corrected age.

Communication is a core challenge for individuals on the autism spectrum, and many autistic individuals experience challenges with language. Prospective studies of younger siblings of children with autism show that siblings not only have an increased likelihood of developing autism themselves, but that even siblings without an autism spectrum diagnosis are more likely to have a language delay as toddlers than their peers without familial history of autism (Marrus et al., 2018). While there is substantial variability in the communicative abilities of siblings of children with autism in toddlerhood, it is not clear how these differences translate beyond the first 3 years of life. The present study used meta-analysis to evaluate a wide range of literature and determine whether siblings of children with autism (Sibs-A) over 48 months of age differ from comparison groups in their language and communication abilities. A total of 26 studies describing 22 cohorts were included. Over 2,000 Sibs-A were compared with neurotypical individuals without familial history of autism or siblings of individuals with another neurodevelopmental disability. Meta-analysis revealed a small but significant effect such that Sibs-A performed lower than comparison peers in overall language and communication. Effects were strongest for expressive language and linguistic processing speed, and there were substantially larger differences for experimenter-administered measures than for parent-report, though findings must be considered in the context of other study characteristics. Suggestions based on this meta-analytic review are provided to guide future research in understanding individual differences in the communicative development and outcomes of Sibs-A. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

This article describes the development of a method to evaluate the acceptance of different snack food textures by children with food texture sensitivities, including children with and without Down syndrome (DS). An in-home use test (HUT) was developed to reflect recent taste study and allow greater recruitment. In this study, parents with children (ages 11-60 months) with DS (CWDS) and without (typically developing, CTD) were recruited and based on responses to several questions, children were categorized as food texture sensitive (TS) or nontexture sensitive (NTS). In total, 111 CWDS (49 TS and 62 NTS) and 107 CTD (42 TS and 65 NTS) participated. To select the food products for assessment, a trained panel profiled commercially available infant and toddler solid snack foods (n = 41), from which 16 products were selected and sorted into four flavor groupings. For the HUT, participating children evaluated each food product once per day for 6 days. Parents recorded their children's reactions to each food product; a panel of trained coders coded each video for verbal and nonverbal behaviors using a novel coding scheme. Parent prompts were also coded. Several challenges were experienced during this study, including poor-quality videos, and standardization of the home environment during the feeding sessions. However, the high degree of successful completion of the HUT (96%) was attributed to the high motivation of the parents involved, as well as the close interaction between the experimenters and the participants on an individual family level.

BACKGROUND The objective of this study was to determine sex-specific differences in inflammatory cytokine responses to red blood cell (RBC) transfusion in preterm infants in the neonatal period and their relationship to later neurocognitive status. METHODS Infants with a birth weight

Nutritional problems are a complex problem not only due to powerlessness or economic inadequacy, but also regarding knowledge, attitudes and behavior. The practice of giving food to infants and children, especially at the age of 0–23 months, must be carried out correctly and appropriately. Feeding errors in this period can lead to malnutrition and stunting. The purpose of this study was to determine the knowledge of mothers about nutrition with feeding behavior in toddlers. Method :The research method used was an analytic survey with a cross sectional approach. Conducted at Botania puskesmas, the study was conducted for 6 months, the population in this study were toddlers' mothers who came to the Botania puskesmas. The sample in this study was 40 people. The sampling technique was carried out by accidental sampling technique with research instruments using a questionnaire. Data analysis using Chi square. Result : The results of the research on maternal knowledge about good toddler nutrition were equal to the frequency of maternal knowledge about adequate nutrition, namely (20) respondents (50%), the majority of toddlers' feeding behavior was good (22) toddlers (55%). Chi-square statistical test obtained p-value = 0.00

The growth and development of toddlers is influenced by hereditary and environmental factors. Genetic factors, biologically have strong influences on toddlers’ growth in their early years of life. While psychologically, a good interpersonal relation of pregnant women with their families will make them more ready to undergo the pregnancy and childbirth. On the other hand, socially, the level of parental education might affect the nutrition intake and parenting patterns. For the economic factor, the level of family income and their ability to provide sufficient nutrition input might affect the nutritional status during gestation. The nutrition input during pregnancy highly contributes to the fetus growth and development. A poor nutrition input during gestation might cause an Intrauterine Growth Retardation (IUGR) and growth and development disorder. This study aimed to analyze the bio-psychosocial and economic factors of gestation period on toddler growth and development. This is a correlational analytic study with 80 mothers and toddlers as the sample. The data was analysed using univariat, bivariate with Chi square and multivariate with logistic regression. The results show that the statistically significant independent variables which influence the growth and development of toddlers are the mother height (p = 0.001), LILA (p = 0.008), family income (p = 0.007), infant birth weight (p = 0.009) and family support (p = 0.013). While the statistically insignificant independent variable is the mother level of education (p = 0.086).

Stunting is a chronic nutritional problem that arises as a result of prolonged malnutrition. The incidence of stunting arises as a result of long-standing conditions such as poverty, improper parenting behavior, and frequent illnesses due to poor hygiene and sanitation. According to WHO, the prevalence of stunting in Indonesia is around 8.9 million, in Riau Islands as many as 262 cases, in Batam City as many as 154 cases. The purpose of this study was to determine the relationship between economic status and the incidence of stunting. Method : The research method used was an analytic survey with a cross sectional approach. Conducted at Posyandu in the working area of Puskesmas Sambau, Batam City, the study was conducted for 6 months, the population in this study were all mothers who had toddlers aged 24-59 months, with a sample of 58 respondents, using purposive sampling technique. Data collection using a questionnaire. Data presented in tabular and textual form, data analysis using Chi-square. Result : The results obtained were low economic status (55.6%), and the incidence of stunting (39.7%). The results of the statistical test of economic status obtained a p-value of 0.004, so Ho is rejected. Conclusion :. There is a relationship between Parents' Knowledge of Toddler Nutrition and Family Economic Status with the Incidence of Stunting in Toddlers at the Posyandu in the working area of Puskesmas Sambau, Batam City. It is hoped that parents will pay more attention to the nutrition of children under five so that the incidence of stunting can be reduced.