Greater Frontoparietal Connectivity During Task Engagement Among Toddlers With Parent-Reported Inattention.

Attention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with lifelong impairments. ADHD-related behaviors have been observed as early as toddlerhood for children who later develop ADHD. Children with ADHD have disrupted connectivity in neural circuitry involved in executive control of attention, including the prefrontal cortex (PFC) and dorsal attention network (DAN). It is not known if these alterations in connectivity can be identified before the onset of ADHD. Children (N = 51) 1.5-3 years old were assessed using functional near-infrared spectroscopy while engaging with a book. The relation between mother-reported ADHD-related behaviors and neural connectivity, computed using robust innovation-based correlation, was examined. Task engagement was high across the sample and unrelated to ADHD-related behaviors. Observed attention was associated with greater connectivity between the right lateral PFC and the right temporal parietal junction (TPJ). Children with greater ADHD-related behaviors had greater frontoparietal connectivity, particularly between the PFC bilaterally and the right TPJ. Toddlers at risk for developing ADHD may require increased frontoparietal connectivity to sustain attention. Future work is needed to examine early interventions that enhance developing attention and their effect on neural connectivity between the PFC and attention networks.

Relationship Between Neurodevelopmental Areas and Difficulties in Emotional-Behavioural Variables in Children With Typical Development Under 2 Years of Age: Sex Differences.

The aim of this study was to examine the relationship between neurodevelopmental areas and possible difficulties in emotional-behavioural variables, and to determine if sex moderated this relationship. A community sample of 231 boys and girls with typical development and with a mean age of 19.84 months was evaluated, using the Bayley-III and CBCL 1.5-5 scales. The main results confirmed: (1) better linguistic abilities in girls in both language areas (receptive communication and expressive communication), finding more evidence according to the Bayesian analysis in expressive communication; (2) in the emotional-behavioural area girls had higher scores in withdrawal; (3) significant negative correlations of low magnitude were found between the Bayley and CBCL scales, particularly in the areas of language and cognitive and internalising and externalising problems; (4) children with low cognitive abilities and those with poor receptive communication showed more inter and externalising difficulties; (5) no significant predictive value or moderating effect of sex was found, (6) the number of participants who simultaneously manifested significant deficits in both domains (neurodevelopmental and emotional-behavioural) was very reduced. Future research should corroborate these results and the characteristics of the relationship found at these early ages. Detecting the population at risk in the first two years of life would enable the implementation of interventions aimed at improving neurodevelopmental deficits and emotional-behavioural problems. Thus, identification of deficits in one domain should lead to evaluation of the other.

Validation of Serbian version of the LittlEARS® Early Speech Production Questionnaire for the assessment of early language development in typically developing children.

OBJECTIVE: The LittlEARS® Early Speech Production Questionnaire (LEESPQ) was developed to provide professionals with valuable information about children's earliest language development and has been successfully validated in several languages. This study aimed to validate the Serbian version of the LEESPQ in typically developing children and compare the results with validation studies in other languages. METHODS: The English version of the LEESPQ was back-translated into Serbian. Parents completed the questionnaire in paper or electronic form either during the visit to the paediatric clinic or through personal contact. A total of 206 completed questionnaires were collected. Standardized expected values were calculated using a second-order polynomial model for children up to 18 months of age to create a norm curve for the Serbian language. The results were then used to determine confidence intervals, with the lower limit being the critical limit for typical speech-language development. Finally, the results were compared with German and Canadian English developmental norms. RESULTS: The Serbian LEESPQ version showed high homogeneity (r = .622) and internal consistency (α = .882), indicating that it almost exclusively measures speech production ability. No significant difference in total score was found between male and female infants (U = 4429.500, p = .090), so it can be considered a gender-independent questionnaire. The results of the comparison between Serbian and German (U = 645.500, p = .673) and Serbian and English norm curves (U = 652.000, p = .725) show that the LEESPQ can be applied to different population groups, regardless of linguistic, cultural or sociological differences. CONCLUSION: The LEESPQ is a valid, age-dependent and gender-independent questionnaire suitable for assessing early speech development in children aged from birth to 18 months.

The Effects of a Relationship-Focused Professional Development Intervention on Infant and Toddler Teachers' Mindfulness-Based Strategies for Coping.

Teaching is a demanding profession with teachers of very young children reporting high rates of stress and exhaustion. We tested the effects of a relationship-focused professional development intervention designed to enhance teachers' use of mindfulness-based strategies to support coping on trajectories of teachers' stress, exhaustion (emotional, physical, and mental), and coping. Infant and toddler teachers (N = 81) from Early Head Start (EHS) or EHS childcare partnerships (CCP) were randomized to the intervention or usual care control condition. Using ecological momentary assessment, teachers completed twice-weekly reports of stress, exhaustion, coping, and coping strategy effectiveness via smartphones for 40 weeks. Multilevel linear regression modeling, accounting for within-person repeated measures, showed no intervention effects on stress and exhaustion trajectories. Teachers in the intervention reported increased use of mindfulness-based strategies for coping over time as compared to the control group, although frequency of use peaked and then declined. While perceptions of stress and exhaustion did not change, teachers' increased use of mindfulness-based strategies suggests improvements in how teachers managed stress and exhaustion; however, the decline in use of coping suggests the need for ongoing support within the workplace.

The measurement of young children's nocturnal sleep health and the development of the Perception of Infant and Toddler Sleep Scale (PoITSS) in Aotearoa New Zealand whanau (families).

OBJECTIVES: To modify an existing questionnaire Brief Infant Sleep Questionnaire - Revised (BISQ-R) to ensure that it is suitable to measure nocturnal sleep health in a diverse sample of young children from Aotearoa New Zealand whanau (families), and to develop a "Perception of Infant and Toddler Sleep Scale" (PoITSS) to use as a primary outcome measurement in an upcoming trial. METHODS: Items from the BISQ-R were adapted for use among ethnically diverse whanau, and tested online with caregivers of 0-2 year old children. A PoITSS score was generated by scaling the responses from three of the questionnaire items to create a value between 0 (very poor) and 10 (very good). Caregivers provided qualitative feedback about the ease of interpreting and answering questionnaire items. RESULTS: Caregivers of 957 children (35% Maori, 12% Pacific) completed the questionnaire. Few differences in children's nocturnal sleep were observed by demographic characteristics. The mean PoITSS score was 6.9 (SD 2.3) and was slightly higher among Maori children (mean difference 0.4, 95% CI 0.1, 0.7). Test-retest indicated good reliability (ICC=0.81). While the majority (86%) of caregivers did not find it difficult to answer any of the items which formed the PoITSS, qualitative feedback indicated that simple modifications to some items would help ensure that they would be well understood by most caregivers. CONCLUSIONS: Items from the BISQ-R were successfully adapted, and the PoITSS scale was shown to be appropriate, for use in ethnically diverse Aotearoa New Zealand whanau with young children.

Sensory processing in typically developing toddlers with and without sleep problems.

This study investigates the sensory processing of typically developing toddlers with and without sleep problems. The research group consisted of typically developing toddlers with sleep problems (n = 110, mean age=18.35 ± 3.4 months), while the control group included typically developing toddlers without sleep problems (n = 110, mean age=18.67 ± 3.5 months) and their mothers. Toddlers were assigned to the research and control groups based on their sleep problems, as determined by the Brief Infant Sleep Questionnaire. The sensory processing of the toddlers was evaluated using the Infant/Toddler Sensory Profile 2. Sensory patterns and sensory processing sub-parameters of the research and control groups were compared. The sensory processing of the research group showed atypical behavioral responses in low registration (low awareness or indifferent attitude to sensory stimuli), sensory sensitivity (distracted or irritable attitude, intensely stimulated by sensory stimuli), and sensory avoiding (intentional avoidance of sensory stimuli or attitudes that produce out-of-norm responses) patterns compared to the control group (p < 0.05). Behavioral responses were similar in the sensory seeking (disturbing or dangerous attitude to the environment in search of sensory stimuli) pattern (p > 0.309). Statistically significant differences were observed in all sub-parameters of sensory processing compared to the control group. Our findings indicate that toddlers with sleep problems are at risk for sensory processing issues. Toddlers with sleep problems exhibit atypical sensory responses related to sensory sensitivity, low registration, and sensory avoiding. It should be considered that toddlers with sleep problems may show sensitivity to different sensory stimuli, avoidance or may not be able to recognize sensory stimuli. These findings suggest that the inclusion of sensory profile assessments in interdisciplinary care for toddlers with sleep problems may contribute to parent-infant well-being.

[Cross-Sectional Study of Nutritional Service Capacity for Infants and Toddlers in Urban and Rural Medical Facilities in Sichuan Province]. / å››å·çœåŸŽä¹¡åŒ»ç–—æœºæž„å©´å¹¼å„¿è¥å »æœåŠ¡èƒ½åŠ›çŽ°å†µç ”ç©¶.

Objective: To investigate and analyze the current status and challenges of infant and toddler nutritional services in urban and rural medical facilities in Sichuan Province. Methods: In 2022, a questionnaire survey was conducted to collect data on infant and toddler nutritional services, including feeding guidance, physical growth assessment, and micronutrient deficiency screening, as well as information on personnel and tools in medical facilities throughout Sichuan Province. The provision of nutritional services was analyzed and the urban-rural disparities were assessed. Results: A total of 2206 medical facilities (29.1% from urban areas and 70.9% from rural areas) were investigated. Only 35.8% of medical facilities provided all three types of nutritional services. Specifically, the overall service provision rates were high for feeding guidance (94.6%) and physical growth assessment (85.0%), but lower for micronutrient deficiency screening (37.4%). Rural facilities exhibited significantly lower rates than their urban counterparts for both physical growth assessment and micronutrient deficiency screening (P<0.05). The provision rates of feeding guidance ranged from 70.6% to 93.2%, with responsive feeding guidance being the least implemented (70.6%), particularly in rural areas compared to urban areas (P<0.05). Rates for physical growth assessment and micronutrient deficiency screening ranged from 75.3% to 81.8% and 23.6% to 30.8%, respectively, both showing lower rates in rural settings compared to urban ones (P<0.05). Nutrition service providers were predominantly nurses (52.3%) and clinical practitioners (43.4%). The availability of dietary assessment tools ranged from 7.7% to 15.9%, significantly lower in rural areas compared to urban areas (P<0.001), while physical measurement tools were widely available at rates of 94.6% to 98.5%. Conclusion: At present, the infant and toddler nutritional service provisions of medical facilities in Sichuan Province are incomplete, particularly so in the implementation of feeding guidance, physical growth assessment, and micronutrient deficiency screening. There is a notable shortage of personnel and necessary tools, with rural areas facing more significant challenges. Enhancing the overall capacity of infant and toddler nutritional services in Sichuan Province is essential, with specific attention needed for rural healthcare settings.

Commercially-produced infant and toddler foods-How healthy are they? An evaluation of products sold in Australian supermarkets.

In response to the need for better guidance and regulation for commercially produced infant and toddler foods and beverages, the WHO Regional Office for Europe published a Nutrient and Promotion Profile Model (hereafter NPPM) in 2022. This study assessed the nutritional and promotional profile of infant and toddler foods (for ages 6-36 months) sold in Australian supermarkets in 2022 using the NPPM. The main types of claims used for product promotion were also examined and results were presented by category and by packaging type. Nutrient and claims data were extracted for commercially produced infant and toddler products from The George Institute's FoodSwitch database. Products were classified according to NPPM food categories and assessed against relevant nutritional and promotional requirements. Of the 309 products examined, 78% failed to meet the nutritional requirements of the NPPM, and 0% met the promotional requirements. Every product had at least one claim on-pack that was prohibited under the NPPM, with some products displaying up to 21 different claims on-pack. Pouches had the highest number of prohibited claims of all packaging types. Findings highlight that urgent work is needed to improve the nutritional quality of commercially produced infant and toddler foods in Australia. The high use of prohibited claims also suggests the need to regulate the type and number of claims that can be made on-pack, as parents and carers could easily be misled by the deceptive labelling that is currently allowed to be displayed.

An Evaluation of the Nutritional and Promotional Profile of Commercial Foods for Infants and Toddlers in the United States.

Despite growing concerns over the increasing popularity and health impact of commercial foods for infants and toddlers, no nutrition or promotional guidelines currently exist for the United States. In 2022, the WHO Regional Office for Europe published a nutrient and promotion profile model (NPPM) to provide guidance and regulation for commercially produced infant and toddler foods. This study assessed the nutritional and promotional profile of infant and toddler foods (6-36 months of age) collected from the top 10 grocery chains in 2023. Products were assessed against the WHO NPPM nutritional and promotional requirements. The type and number of claims across packaging type were also assessed. Of the 651 products examined, 60% failed to meet the nutritional requirements of the NPPM, and 0% met the promotional requirements. Almost 100% of products had at least 1 claim on-pack that was prohibited under the NPPM, with some products displaying up to 11 prohibited claims. Snack-size packages had the lowest compliance with nutrient requirements. These findings highlight that urgent work is needed to improve the nutritional quality of commercially produced infant and toddler foods in the United States. The high use of prohibited claims also suggests the need to regulate the type and number of claims allowed on-pack.

Measuring Dietary Quality Among Toddlers in the Feeding Infants and Toddlers Study, 2016 Using the New Healthy Eating Index-Toddlers-2020.

BACKGROUND: Child diet can impact risk for obesity and other related noncommunicable diseases. Few studies have used the Healthy Eating Index (HEI)-Toddlers-2020 to assess diet quality among toddlers (children aged 12-23.9 months). OBJECTIVE: The aim of this study was to examine diet quality among toddlers participating in the Feeding Infants and Toddlers Study (FITS), 2016 and determine differences by sociodemographic characteristics. Caregiver perception of how their toddler's diet aligns with HEI-Toddlers-2020 diet quality scores was also assessed. DESIGN: This cross-sectional study used 24-hour dietary records collected in 2016. PARTICIPANTS/SETTING: Data were collected on 12- to 23.9-month-old toddlers (n = 1,133) participating in the FITS 2016. MAIN OUTCOME MEASURE: Diet quality was assessed using the HEI-Toddlers-2020. STATISTICAL ANALYSES PERFORMED: The population ratio method was used for all analyses using weighted data to estimate HEI-Toddlers-2020 scores overall and within subgroups. To determine significant differences of the HEI-Toddlers-2020 score between subgroups, pairwise t-tests were used. Statistical significance at p<.05 was used as a cutoff for all two sided p-values. RESULTS: Average HEI-Toddlers-2020 score among 12-23.9-month-olds participating in FITS 2016 was 71.2 out of a possible 100. Total scores varied by race and ethnicity with Hispanic toddlers having higher scores compared to non-Hispanic White toddlers (76.4 (2.5) vs. 69.0 (1.2), p=.03) and by federal poverty level with those >200% of the poverty level having higher scores compared to those <100% of the poverty level (74.7 (1.5) vs. 67.0 (2.6), p=.01). CONCLUSIONS: Opportunities for improvement in dietary intake were identified using the new HEI-Toddlers-2020 to assess diet quality among 12-23.9-month-olds. Scores were indicative of toddlers consuming excess added sugars and lower than recommended amounts of seafood and plant proteins, greens and beans, whole grains, and vegetables. Interventions to improve diet quality in toddlers may benefit from focusing on foods children should eat more of along with foods to consume in moderation.

The Effect of Screen Habits and Alternative Activities on Tactile Exploration Skills in 6- to 36-Month-Old Toddlers.

BACKGROUND/OBJECTIVES: With the rising ubiquity of digital media and screens in everyday life, toddlers are increasingly exposed to different screens from an early age (i.e., television, computer, tablet, phone). However, few studies have examined the effect of these screens on toddlers' perceptual development. Since tactile exploration skills are necessary for environmental discovery and overall development, the current research investigates the links between screen-use habits and the tactile exploration skills (with visual control) of 6- to 36-month-old toddlers. METHODS: The study involved observing the interactions of 135 toddlers with various objects and assessing the complexity of their visuo-tactile exploration strategies through two original experimental tasks. Data concerning screen habits and other relevant factors, such as socio-economic level, were collected using a parental questionnaire. RESULTS: Toddlers with greater screen exposure time demonstrated weaker tactile exploration skills and employed less age-appropriate exploration strategies. Socio-economic factors and parental engagement in alternative activities significantly influenced these developmental outcomes. CONCLUSIONS: These findings emphasize the importance of reducing screen time and promoting interactive co-viewing and alternative activities to mitigate the negative effects of screen exposure. Further longitudinal research is needed to determine the long-term impacts of early screen exposure on tactile exploration and overall psychological development.

Improving Parental Health Literacy in Primary Caregivers of 0- to 3-Year-Old Children Through a WeChat Official Account: Cluster Randomized Controlled Trial.

Background: Parental health literacy is important to children's health and development, especially in the first 3 years. However, few studies have explored effective intervention strategies to improve parental literacy. Objective: This study aimed to determine the effects of a WeChat official account (WOA)-based intervention on parental health literacy of primary caregivers of children aged 0-3 years. Methods: This cluster randomized controlled trial enrolled 1332 caregiver-child dyads from all 13 community health centers (CHCs) in Minhang District, Shanghai, China, between April 2020 and April 2021. Participants in intervention CHCs received purposefully designed videos via a WOA, which automatically recorded the times of watching for each participant, supplemented with reading materials from other trusted web-based sources. The contents of the videos were constructed in accordance with the comprehensive parental health literacy model of WHO (World Health Organization)/Europe (WHO/Europe). Participants in control CHCs received printed materials similar to the intervention group. All the participants were followed up for 9 months. Both groups could access routine child health services as usual during follow-up. The primary outcome was parental health literacy measured by a validated instrument, the Chinese Parental Health Literacy Questionnaire (CPHLQ) of children aged 0-3 years. Secondary outcomes included parenting behaviors and children's health outcomes. We used the generalized linear mixed model (GLMM) for data analyses and performed different subgroup analyses. The ß coefficient, risk ratio (RR), and their 95% CI were used to assess the intervention's effect. Results: After the 9-month intervention, 69.4% (518/746) of caregivers had watched at least 1 video. Participants in the intervention group had higher CPHLQ total scores (ß=2.51, 95% CI 0.12-4.91) and higher psychological scores (ß=1.63, 95% CI 0.16-3.10) than those in the control group. The intervention group also reported a higher rate of exclusive breastfeeding (EBF) at 6 months (38.9% vs 23.44%; RR 1.90, 95% CI 1.07-3.38) and a higher awareness rate of vitamin D supplementation for infants younger than 6 months (76.7% vs 70.5%; RR 1.39, 95% CI 1.06-1.82). No significant effects were detected for the physical score on the CPHLQ, breastfeeding rate, routine checkup rate, and children's health outcomes. Furthermore, despite slight subgroup differences in the intervention's effects on the total CPHLQ score and EBF rate, no interaction effect was observed between these subgroup factors and intervention factors. Conclusions: Using a WHO literacy model-based health intervention through a WOA has the potential of improving parental health literacy and EBF rates at 6 months. However, innovative strategies and evidence-based content are required to engage more participants and achieve better intervention outcomes.

RSV Prevention Within Reach for Older Infants and Toddlers: The Role of Active Immunization.

This review article will summarize the vaccines and monoclonal antibodies currently under evaluation for the prevention of RSV disease in older infants, toddlers and young children. We will review the rationale for passive protection during the first months of life, and the role of active immunization afterwards, either with live attenuated, protein-based or mRNA vaccines.

Association between neural prosody discrimination and language abilities in toddlers: a functional near-infrared spectroscopy study.

BACKGROUND: Language delay affects near- and long-term social communication and learning in toddlers, and, an increasing number of experts pay attention to it. The development of prosody discrimination is one of the earliest stages of language development in which key skills for later stages are mastered. Therefore, analyzing the relationship between brain discrimination of speech prosody and language abilities may provide an objective basis for the diagnosis and intervention of language delay. METHODS: In this study, all cases(n = 241) were enrolled from a tertiary women's hospital, from 2021 to 2022. We used functional near-infrared spectroscopy (fNIRS) to assess children's neural prosody discrimination abilities, and a Chinese communicative development inventory (CCDI) were used to evaluate their language abilities. RESULTS: Ninety-eight full-term and 108 preterm toddlers were included in the final analysis in phase I and II studies, respectively. The total CCDI screening abnormality rate was 9.2% for full-term and 34.3% for preterm toddlers. Full-term toddlers showed prosody discrimination ability in all channels except channel 5, while preterm toddlers showed prosody discrimination ability in channel 6 only. Multifactorial logistic regression analyses showed that prosody discrimination of the right angular gyrus (channel 3) had a statistically significant effect on language delay (odd ratio = 0.301, P < 0.05) in full-term toddlers. Random forest (RF) regression model presented that prosody discrimination reflected by channels and brain regions based on fNIRS data was an important parameter for predicting language delay in preterm toddlers, among which the prosody discrimination reflected by the right angular gyrus (channel 4) was the most important parameter. The area under the model Receiver operating characteristic (ROC) curve was 0.687. CONCLUSIONS: Neural prosody discrimination ability is positively associated with language development, assessment of brain prosody discrimination abilities through fNIRS could be used as an objective indicator for early identification of children with language delay in the future clinical application.

Assessment of Water Intake among Chinese Toddlers: The Report of a Survey.

Toddlerhood (aged 13~36 months) is a period of dietary transition, with water intake being significantly influenced by parental feeding patterns, cultural traditions, and the availability of beverages and food. Nevertheless, given the lack of applicable data, it is challenging to guide and evaluate the water intake of toddlers in China. In this study, our objectives were to assess the daily total water intake (TWI), evaluate the consumption patterns of various beverages and food sources contributing to the TWI, determine the conformity of participants to the adequate intake (AI) recommendation of water released by the Chinese Nutrition Society, and analyze the various contributors to the daily total energy intake (TEI). The data for the assessment of water and dietary intake were obtained from the cross-sectional dietary intake survey of infants and young children (DSIYC, 2018-2019). A total of 1360 eligible toddlers were recruited in the analysis. The differences in related variables between two age groups were compared by Mann-Whitney U test and Chi-Square test. The potential correlation between water and energy intake was examined utilizing age-adjusted partial correlation. Toddlers consumed a median daily TWI of 1079 mL, with 670 mL (62.3%, r = 0.752) derived from beverages and 393 mL (37.7%, r = 0.716) from foods. Plain water was the primary beverage source, contributing 300 mL (52.2%, r = 0.823), followed by milk and milk derivatives (MMDs) at 291 mL (45.6%, r = 0.595). Notably, only 28.4% of toddlers managed to reach the recommended AI value. Among these, toddlers obtain more water from beverages than from foods. The median daily TEI of toddlers was 762 kcal, including 272 kcal from beverages (36.4%, r = 0.534) and 492 kcal from foods (63.6%, r = 0.894). Among these, the median daily energy intake from MMDs was 260 kcal, making up 94.6% of the energy intake from beverages (r = 0.959). As the pioneer survey on TWI of toddlers in China based on nationally representative data, attention to the quality and quantity of water intake and actions to better guide parents by both individuals and authorities are eagerly anticipated. Additionally, the revision of the reference value of TWI for Chinese toddlers is urgently required.

Unfavorable food consumption in children up to school entry age: results from the nationwide German KiESEL study.

Introduction: Evidence points toward the early life being crucial for preventing nutrition-related diseases. As promotion of healthier food preferences in toddlerhood and preschool age might still modulate the trajectories of disease risk, understanding diet in these age groups is necessary. The objective was to analyze food consumption and diet quality of 1-5-year-old children living in Germany in relation to age and sex. Methods: Data from 890 children, a subsample of the representative, cross-sectional Children's Nutrition Survey to Record Food Consumption (KiESEL) conducted by the German Federal Institute for Risk Assessment in 2014-2017, were analyzed. Dietary data were collected using food records (3 consecutive plus 1 independent day). Diet quality was evaluated against the German food-based dietary guidelines (FBDG). Results: Consumption of unfavorable foods (e.g., sweets, soft drinks) exceeded the recommended maximum of 10% of energy intake (E%) by a multiple in all age and sex groups (medians: 24.8-35.8 E%). Preschoolers consumed more unfavorable foods than toddlers and boys more than girls. More than half of the children exceeded the recommendation for meat intake (medians: 2.3-3.2% of the total food consumption (%TFC) vs. 2 %TFC), especially preschoolers. In nearly all children, vegetable consumption was too low (medians: 4.2-4.5 %TFC vs. 12 %TFC). Also, milk/milk product consumption was below recommendations, more so in preschoolers (median: 12.0 %TFC ♂, 11.9 %TFC ♀ vs. 18 %TFC) than in toddlers (median: 16.1 %TFC ♂, 19.6 %TFC ♀). In toddlers and preschoolers with overweight or obesity, adherence to dietary recommendations of these food groups was largely similar to that of the total sample. Overall, 5-year-olds showed an unhealthier dietary pattern than 1-year-olds, which already emerged at age 2 years and became more evident at age 3 years. Discussion: An adverse dietary pattern arises and even deteriorates at a very young age, showing sex-specific aspects. High attention from public health and research needs to be given to toddlerhood and even earlier life phases, e.g., to develop more age-specific FBDGs, aiming at reducing unhealthy food consumption.

Development of a culturally enhanced caregiver-facilitated language nutrition intervention "+Language is Medicine" to address developmental delay in Diné (Navajo) toddlers.

Introduction: Developmental Delay (DD) is highly common in American Indian and Alaska Native (AI/AN; Indigenous) toddlers and leads to high numbers of AI/AN children who eventually need special education services. AI/AN children are 2.89 times more likely to receive special education compared to other children in the U.S., yet developmental disorders are more frequently under diagnosed and untreated in AI/AN infants and toddlers. DD, which can be identified as early as toddlerhood, can lead to negative impacts on developmental trajectories, school readiness, and long-term health. Signs of DD can be identified early with proper developmental screening and remediated with high quality early intervention that includes effective parent training. There are many evidence-based language facilitation interventions often used in Early Intervention programs. However, in communities in rural parts of the Navajo Nation where there are limited services and resources, infants and toddlers with early signs of DD are often missed and do not get the culturally responsive support and evidence-based intervention they deserve. Methods: The community-based +Language is Medicine (+LiM) study team partnered with tribal home visitors, community members, and a Diné linguist/elder using a collaborative virtual workgroup approach in 2021 and 2022 to present the +LiM pilot study aims and to discuss strategies for enhancing a language intervention for toddlers experiencing DD in their tribal community. This paper will detail the stages of community engagement, intervention enhancement and preparation for field testing of the +LiM intervention to address elevated rates of DD in toddlers in the Northern Agency of the Navajo Nation. Results: Two major outcomes from this collaborative workgroup included: (1) a team-initiated redefining of language nutrition to align with Indigenous values that center cultural connectedness and native language use and (2) a five-lesson caregiver-facilitated curriculum titled +Language is Medicine which includes caregiver lessons on language nutrition, language facilitation, shared book reading, pretend play, and incorporation of native language into home routines. These two workgroup outcomes were leveraged to develop a pilot pre-/post-intervention study to test the effectiveness of the +LiM intervention with caregiver-toddler dyads living on the Navajo Nation. Discussion: Delivering tailored child interventions through tribal home visiting are cost-effective and innovative methods for reaching reservation-based families who benefit from culturally responsive parent coaching and instruction. The +LiM team has applied a precision tribal home visiting approach to enhance methods of early intervention for children with DD. Our enhancement process was grounded in Indigenous community-based participatory research that centered culture and language.

Evaluation of the Centers for Disease Control and Prevention's Essentials for Parenting Toddlers and Preschoolers on parent behavioral outcomes.

BACKGROUND: The Centers for Disease Control and Prevention's web-based behavioral parent training (BPT) program, Essentials for Parenting Toddlers and Preschoolers (EfP), uses a psychoeducational approach to promote positive parenting and address common parenting challenges. The purpose of this study was to assess the effects of EfP on parenting behavior and whether implementation format impacted behavioral outcomes. METHODS: A sample of 200 parents of 2- to 4-year-old children were recruited via Internet advertising. Using a repeated single subject, multiple baseline design, parents were randomly assigned to guided navigation (GN; n = 100) or unguided navigation (UN; n = 100) study conditions. Parents were provided secure access to the EfP website and completed 18 weekly surveys. Latent growth curve modeling was used to determine intervention effectiveness on behavioral outcomes. RESULTS: Latent growth curve modeling indicated both GN and UN study conditions significantly increased use of praise (ß = 0.19, p = 0.038) and commands and consequences (ß = 0.17, p < 0.001), and decreased corporal punishment use (ß = -0.01, p = 0.017) and attitudes promoting corporal punishment (ß = -0.01, p < 0.001) over the study period. The UN condition exhibited a significant initial decrease in time-out use that increased over time to match the GN condition. CONCLUSIONS: This study provides evidence for the effectiveness of EfP in promoting non-violent parenting behavior and increasing positive parenting techniques. The format of EfP implementation made no difference in parenting behaviors over time. Digital BPT programs like EfP provide access to evidence-informed parenting resources and can enhance positive parenting.