Dealing with imperfect randomization: Inference for the highscope perry preschool program.

This paper considers the problem of making inferences about the effects of a program on multiple outcomes when the assignment of treatment status is imperfectly randomized. By imperfect randomization we mean that treatment status is reassigned after an initial randomization on the basis of characteristics that may be observed or unobserved by the analyst. We develop a partial identification approach to this problem that makes use of information limiting the extent to which randomization is imperfect to show that it is still possible to make nontrivial inferences about the effects of the program in such settings. We consider a family of null hypotheses in which each null hypothesis specifies that the program has no effect on one of several outcomes of interest. Under weak assumptions, we construct a procedure for testing this family of null hypotheses in a way that controls the familywise error rate - the probability of even one false rejection - in finite samples. We develop our methodology in the context of a reanalysis of the HighScope Perry Preschool program. We find statistically significant effects of the program on a number of different outcomes of interest, including outcomes related to criminal activity for males and females, even after accounting for the imperfectness of the randomization and the multiplicity of null hypotheses.

Field-based physical fitness assessment in preschool children in China.

BACKGROUND: Physical fitness in the preschool years is considered a marker of current and future health. Therefore, understanding physical fitness levels of preschool children is necessary. Furthermore, the use of field-based methods to measure physical fitness is essential for assessing children in authentic venues such as schools. Hence, the main purpose of this study was to describe the physical fitness of Chinese preschool children across field-based methods considering a statement of confidence intervals for reference in physical fitness in each age and genders. METHODS: A total of 619 children (296 boys and 323 girls) aged 3-6 years old from China participated in the present study. Physical fitness was measured using the Chinese National Physical Fitness Measurement (CNPFM-Pre) battery, which included the tennis ball throw (upper-limb muscular strength), standing long jump (lower-limb muscular strength), shuttle run test (speed-agility), double-leg timed hop (coordination), sit-and-reach (flexibility), and balance beam test (dynamic balance). RESULTS: The results revealed significant differences in gender for standing long jump (SLJ; η2 = 0.012, p = 0.007), tennis ball throw (TT; η2 = 0.081, p < 0.001), sit-and-reach (SR; η2 = 0.114, p < 0.001), and one-legged stance test (OST; η2 = 0.037, p < 0.001). Age had positive effects on all physical fitness performance tests, as the shuttle run test (η2 = 0.672, p < 0.001), SLJ (η2 = 0.513, p < 0.001), TT (η2 = 0.394, p < 0.001), double-legged timed hop test (DTH; η2 = 0.445, p < 0.001), SR (η2 = 0.069, p < 0.001), balance beam test (BBT; η2 = 0.367, p < 0.001), and OST (η2 = 0.336, p < 0.001). Older preschool children performed better than their younger counterparts in all the tests. No significant interactions between age groups and gender were found. CONCLUSIONS: This study provided age- and gender-specific physical fitness performance data in Chinese preschool children. Gender differences in physical fitness tests performance already exists at the preschool age. All physical fitness component results increased with age in this cohort. These findings can help healthcare, physical education, and pediatric professionals understand the physical fitness development of preschool children at different ages and help design sports tasks for preschool boys and girls.

Outdoor playing during preschool was associated with a reduced risk of school-age obesity in Japan.

AIM: This study investigated the association between outdoor play habits during preschool and school-age obesity. METHODS: We conducted a longitudinal cohort study of all children born in Japan during 2 weeks in January and July 2001. We defined outdoor play habits at age 2.5 years (third survey) as exposure, while parent-reported height and weight at age 7 years (seventh survey) were defined as overweight and obesity status using the WHO reference. Logistic regression models were used to estimate odds ratios (ORs) for associations between preschool outdoor play habits and school-age obesity, adjusting for parental and child factors. RESULTS: Of 53 575 children born, 42 812 had data on outdoor play habits at age 2.5 years, with 91% (38 970) having such habits. At age 7 years, 31 743/42 812 (74%) children had height and weight data, with 3249/31 743 (10%) classified as overweight or obesity (BMI SD score ≥1.0). Outdoor play habits were negatively associated with obesity (adjusted OR 0.85, 95% confidence interval (CI): 0.74-0.97). CONCLUSION: Outdoor play habits in early preschool years are associated with a reduced risk of school-age obesity. Parents and caregivers may consider encouraging their children to outdoor play habits at an early age to help prevent obesity later in life.

Validation of the French version of the preschool form of the social responsiveness scale-second edition (SRS-2-P).

OBJECTIVES: To evaluate the psychometric properties of the French form of the preschool social responsiveness scale-2 (SRS-2-P-Fr). PARTICIPANTS: A sample of French children aged 2 to 4 years comprising a group of 93 children with autism spectrum disorder (ASD) and a community control group of 201 children. MATERIALS AND METHODS: Study of internal consistency using Cronbach's α coefficient, convergent validity using correlations with the ADI-R and ADOS-2, and diagnostic accuracy using the receiver operating characteristic curve to determine the best threshold scores useful for screening ASD in preschool children. RESULTS: Good internal consistency (0.78 to 0.98) according to Cronbach's alpha coefficients for the total score and the sub-scores of the SRS-2-P scale. The study of convergent validity showed strong correlations with the total score of the ADOS-2 Toddlers and the communication and reciprocal social interaction sub-scores of the ADI-R. Diagnostic accuracy indicated that the best cut-off score for detecting ASDs was 56 (area under the curve=0.97, sensitivity 0.925, specificity 0.98). CONCLUSION: The SRS-2-P-Fr is a valid instrument for the early detection of ASD in preschool children in France and can facilitate diagnosis.

Finger use mirroring young children's ways of experiencing numbers.

Children who encounter questions about quantities or numbers are observed to use their fingers in different ways to aid their problem solving. This study aimed to contribute to the area of finger counting research with an inquiry of what children's finger use tells us about their knowledge of numbers. A basic argument is that it is not sufficient to observe the actual use of fingers; there is a need for interpretations of what the finger use means to the children, taking the children's perspective as the outset. This was done by analyzing 4- and 5-year-olds' finger use through the lens of phenomenography and variation theory of learning to describe the qualitatively different ways in which children use fingers as an expression of their ways of experiencing the meanings of numbers. Five categories of finger use that show a variety in the meanings the fingers represent emerged: Fingers represent individual items, quantities, countables, number relations, and number structure. The results show that children's finger use may give access to their ways of understanding numbers; some ways of using fingers indicate expressions of more or less advanced meanings of numbers. A conclusion from the results is that to develop number knowledge and skills, children are aided by learning to see and use their fingers as representing composed units. Some children need the structural support of fingers to solve number problems, and fingers should be used to explore number structures rather than used as countables.

The near and far transfer effects of computerized working memory training in typically developing preschool children: Evidence from event-related potentials.

Working memory (WM) refers to the ability to actively maintain and process information needed to complete complex tasks such as comprehension, learning, and reasoning. Recent studies have examined the efficacy of computerized working memory training (WMT) in improving cognitive functions in general and WM in particular, with mixed results. Thus, to what extent can WMT produce near and far transfer effects to cognitive function is currently unclear. This study investigated the transfer effects of a computerized WMT for preschool children and also examined the possible neural correlates using the event-related potential (ERP) technique. A total of 50 Chinese preschoolers (64.44 ± 7.76 months old; 24 girls) received 4-week training during school hours. Compared with those in the active control group, children in the training group showed better gains in behavioral performance in the WM task and significantly more changes in ERP markers of the WM and inhibitory control tasks (near transfer effect). However, no evidence was found for transfer to fluid intelligence (far transfer effect). These findings suggest that WMT is capable of enhancing cognitive functioning in preschool children, and as such this work has important implications for educational practice and it may help to design and refine cognitive interventions for typically developing children and those with WM problems or other cognitive deficits (e.g., children with attention-deficit/hyperactivity disorder).

Effectiveness of glass-ionomer sealant versus fluoride varnish application to prevent occlusal caries among preschool children over 18-24 months - A randomised controlled trial.

OBJECTIVES: To compare the clinical efficacies of 5 % sodium fluoride varnish (NaFV) and glass-ionomer sealant (GIS) in preventing occlusal caries in primary second molars (PSMs). MATERIALS AND METHODS: A total of 736 children were recruited from 18 kindergartens and randomised into either Group 1- receiving NaFV quarterly, or Group 2 - single placement of GIS at baseline. Interventions were performed on 1431 and 1264 PSMs in Group 1 and Group 2, respectively. The primary outcome was the development of ICDAS≥4 dentine caries at the occlusal surfaces of PSMs. RESULTS: A total of 736 children (383 in Group 1; 353 in Group 2) received the intervention. After 18-24 months, 479 children with 1764 PSMs were reviewed. Despite a low GIS retention rate of 2.4 % by 18-24 months, only 17.1 % of PSM in the GIS group developed caries into dentine. No significant difference was identified when compared to the proportion of PSMs with caries into dentine in the NaFV group (17.0 %). Regression analysis with GEE revealed that only baseline dft score and plaque level had a significant influence on development of ICDAS≥4 dentine caries in PSMs. CONCLUSIONS: Quarterly-applied NaFV and a single placement of medium viscosity GIS have similar clinical efficacies in preventing occlusal caries among preschool children. CLINICAL SIGNIFICANCE: There is no significant difference between quarterly-applied NaFV and GIS in preventing occlusal caries at PSMs. Dental clinicians can choose to use either of these preventive methods after considering their own and parents' preferences, children's cooperation and other practical factors.

Influence of temperament on children's cooperation during dental treatment.

Background: The etiologies of childhood dental fear/dental behavior management problems have been extensively studied, especially the role of children's temperaments. This study aimed to evaluate the effect of temperament and its associated variables on the anxiety and cooperation level of preschool children in a dental clinic. Materials and Methods: This cross-sectional study involved 103, 4-6-year-old patients (39 boys and 64 girls). The children's parents or guardians completed the Child Fear Survey Schedule (CFSS) Dental Subscale and the Malhotra temperament questionnaire before the treatment. Patients' anxiety and cooperation levels were then assessed through three distinct treatment stages of fluoride therapy, injection of local anesthesia, and drilling, by applying the Venham anxiety and clinical cooperation scales. The data were analyzed using analysis of variance, Mann-Whitney, Kruskal-Wallis, and Chi-square tests. The significance level of 0.05 was deemed relevant in the analysis. Results: A significant correlation was established between the mean of CFSS and the variety of temperament (P = 0.001). Anxiety and uncooperative behavior during injection and drilling were strongly related to lower sociability scores. Furthermore, higher anxiety during the drilling stage was related to higher impulsivity scores. Conclusion: The evaluation of children's anxiety and cooperation in dental clinics heavily relies on temperament and certain related factors, such as sociability. These variables serve as crucial benchmarks in understanding and assessing the psychological state of children during dental procedures.

Impaired head circumference growth and behavioural problems in childhood: Longitudinal findings from the MINA-Brazil birth cohort.

BACKGROUND: Previous evidence on the relation between early head circumference (HC) growth and behavioural outcomes in preschoolers has been inconsistent. OBJECTIVE: We aimed to investigate whether HC growth from birth to 5 years of age was related to internalising or externalising behavioural problems at 5 years of age in a sex-specific manner. METHODS: Among 303 girls and 318 boys from the MINA-Brazil birth cohort, we examined the associations between changes in HC from birth to 5 years of age and internalising and externalising behaviour problem scores at 5 years according to the Strengths and Difficulties Questionnaire for parents. HC values were transformed into sex- and age-specific z-scores (HCZ) using World Health Organisation standards, and the differences between values at 5 years of age and birth were classified into quintiles. We estimated adjusted mean differences with 95% confidence intervals in behavioural problem scores between HCZ change quintiles using multivariable linear regression by sex. To examine nonlinear associations, we included cubic spline terms. RESULTS: Head circumference growth from birth to 5 years of age was inversely and nonlinearly associated with internalising problems in girls. Compared with girls at the lowest quintile of HC growth, those above had an adjusted 1.27 (95% confidence interval 0.28, 2.27) points lower mean internalising problems score. This association was mostly driven by HC growth during the first 2 years. We found no association between HC growth and externalising behaviour in either sex. CONCLUSIONS: Impaired HC growth was related to higher mean internalising problem scores at 5 years of age in girls but not in boys. HC growth was not associated with externalising problems.

Risk of Severe Early Childhood Caries over Time in Low-Income Preschoolers.

INTRODUCTION: Early childhood caries (ECC), and the progression to severe ECC (S-ECC), is a serious oral health issue, leading to acute pain, sepsis, tooth loss, and compromised quality of life. Although the association between sociodemographic factors and ECC has been widely discussed, it remains unclear whether the same association exists between inequality and S-ECC. OBJECTIVES: To investigate the impact of low income on the oral health of preschool children and explore any additional risk factors for developing ECC and S-ECC during follow-up. METHODS: The study used Taipei Child Development Screening Program data from 2014 to 2019. It included children aged 3 to 5 y who had more than 2 oral exams and completed baseline oral health questionnaires. Low-income children were matched 1:4 with controls by age and gender. Evaluation of ECC and S-ECC used the dmft index during follow-up exams. Generalized estimating equations (GEEs) assessed the impact of household income on ECC and S-ECC risk over time. RESULTS: Of the 895 participants, 179 were from low-income households. We revealed a significantly higher risk of developing S-ECC (adjusted odds ratio [aOR] 1.99; 95% confidence interval [CI] 1.25-3.17) in children from low-income households, with no significantly increased of risk of developing ECC. Children who consumed sugary beverages >4 times per week showed elevated risks of developing both ECC (aOR 1.77; 95% CI 1.07-2.94) and S-ECC (aOR 1.89; 95% CI 1.13-3.17). Protective factors included children with mothers with a college education (S-ECC: aOR 0.50; 95% CI 0.32-0.79). CONCLUSION: Children from low-income households have a significant risk of developing S-ECC compared with children from non-low-income households during follow-up. Factors contributing to this risk include lower maternal education, poor maternal oral health, and increased consumption of sugar-sweetened beverages. Policymakers should develop health measures to reduce the prevalence of ECC and S-ECC in children from low-income households whose mothers have lower educational levels and poor oral health. KNOWLEDGE TRANSFER STATEMENT: The results of this study highlight the significant S-ECC risk among preschool children from low-income households in Taipei, with other risk factors including higher consumption of sugar-sweetened beverages, lower maternal education, and poor maternal oral health. Policymakers can use our findings to develop targeted policy and behavioral interventions to reduce S-ECC in vulnerable populations.

[Current Situation and Influencing Factors of Kindergarten Teachers' Participation in Training for Preschool Sex Education].

Objective To understand the current situation and influencing factors of kindergarten teachers' participation in training for preschool sex education in Luzhou city,and provide a basis for improving the sex education literacy of kindergarten teachers in the future. Methods A multi-stage stratified cluster sampling method was adopted,and a questionnaire survey was conducted from December 2021 to January 2022 on the knowledge,attitude,and practice of preschool sex education among all the teachers in 24 kindergartens in Luzhou city. Results Among the 461 teachers,43.0% had participated in lectures/courses/training activities related to preschool sex education;99.1% hoped to participate in lectures/courses/training activities related to preschool sex education;82.6% learned about child sexual knowledge through school education;75.5% expressed the hope to learn about child sexual knowledge through expert training.The results of multivariate Logistic regression showed that except private kindergartens as an inhibiting factor (OR=0.57,95%CI=0.37-0.87,P=0.008),high monthly income (OR=3.52,95%CI=1.13-9.30,P=0.011),more ways to know about sex education knowledge (OR=2.87,95%CI=1.76-4.70,P<0.001),and social support (OR=1.58,95%CI=1.04-2.38, P=0.030) were promoting factors for teachers to participate in the training for preschool sex education. Conclusion The kindergarten teachers presented a participation rate but a high demand for the training for preschool sex education.They mainly obtain the sex education knowledge from school education.The nature of kindergarten,monthly income of teachers,social support situation,and ways of understanding sex education knowledge are the key factors influencing the teachers' participation in the training for preschool sex education.

Executive function as a mechanism for the emergence and expression of moral knowledge.

We outline two accounts by which executive function (EF) supports children's moral reasoning: an emergence and an expression account. The emergence account postulates that EF supports the development of moral concepts because it relates to how children navigate their early social environments and how well they can internalize moral messages. The expression account postulates that EF supports children's in-the-moment moral reasoning for complex moral situations. We present data from two studies with preschool children to assess each account. In support of the emergence account, EF longitudinally and positively predicted moral reasoning, but only for children who have experienced moderate forms of peer conflict. In support of the expression account, EF was only correlated with judgments that required the coordination of multiple pieces of information (i.e., retaliation and criterion judgments). We conclude that EF is an important cognitive mechanism of moral development and discuss various implications of these findings for both moral development and EF theory.

A Qualitative Study of Naturally Living Parents and Child Oral Health: Omissions and Commissions.

BACKGROUND: Oral health continues to be one of the most common and costly diseases in early childhood, and there is a need for further, innovative research. PURPOSE: We explored the ways naturally living parents (those who embody the "natural" within their parenting ideology and behavior) navigated and perceived their children's oral health. METHODS: Twelve participants who identified as being "naturally living parents" participated in semistructured interviews. Data were thematically analyzed, and findings were aligned to an omissions and commissions framework to exhibit the complexity of parent decision-making. RESULTS: Parents performed distinct omissions, including omitting fluoride, sugar, and "toxins" to maintain their children's oral health. Parents talked about having a commitment to knowledge building to protect their children's oral health (e.g., ingredient label reading and increasing knowledge of "safe" ingredients). Findings also provide insight into how parents consider and trust health information and health care providers and ways they gather information relating to oral health. CONCLUSIONS: Analysis indicated that although parents navigated both omissions and commissions, omissions were more overtly present. Compared to previous health research using this framework, omissions and commissions were not as clearly demarcated in relation to oral health. The results show that oral health is a complex interplay of omissions and commissions, and parents must navigate not only discrete elements that affect the oral health of their children but also how these are influenced by considerations including social well-being. KNOWLEDGE TRANSFER STATEMENT: The study highlights the need for dentists and early childhood health professionals to consider the complex way some parents perceive, inform, and rationalize decisions regarding their children's oral health. There is a need for nuance when considering children's oral health and naturally living parenting, especially in relation to effectively communicating health information that fosters trust and is considerate of broader lifestyle and health factors.

Dyadic examination of parents' general psychological distress and coparenting in families with young children: The mediating role of couple satisfaction.

The current research explored the dyadic relationships between general psychological distress (GPD) and coparenting dimensions (cooperation, conflict, triangulation) through the mediation of couple satisfaction among parents with young children. The sample comprised 184 heterosexual couples (184 mothers, 184 fathers, age range from 25 to 57 years) married for 10 years on average. The actor-partner interdependence model (APIM) and APIM Mediation Model analyses demonstrated significant relationships between mothers' and fathers' GPD and all three of their own coparenting dimensions (direct actor effects), also through their own couple satisfaction (indirect actor-actor effects). Additionally, mothers' GPD had direct effects on fathers' coparenting cooperation (partner effect). Fathers' GPD had significant indirect effects on all dimensions of mothers' coparenting through mothers' couple satisfaction (partner-actor effects), plus on mothers' coparenting triangulation through fathers' couple satisfaction (actor-partner effect). Findings were in line with Family System Theory and consistent with prior research. Clinical implications were discussed.

The neuropsychology of early childhood and infancy.

OBJECTIVES: Piaget's theory emphasizes the biological structures children utilize to make sense of their environment and based on those experiences become able to adapt. Many factors can intervene in the gradual and complex process of development, causing an array of issues both acute and chronic. METHOD: Several studies have found that disability in the early months is a strong predictor of cognitive impairment in preschool. The presence of early functional anomalies may represent developmental delay and/or neurodevelopmental disorders. RESULTS: Understanding the risk factors and detecting such signs early on is important to prevent or minimize later cognitive, behavioral, and psychosocial problems. The study aims to emphasize how critical the early years are to a child's future cognitive, physical, emotional, and social development as well as their overall well-being. DISCUSSION: In addition, the fact that crucial developmental stages can be hampered or obstructed by a variety of factors is highlighted.

Fundamental movement skills proficiency in preschool-aged boys and girls: Family matters.

To investigate the associations of fundamental movement skill (FMS) proficiency with family factors, including socioeconomic status (SES) and caregiver characteristics, by sex in young children in China. Participants included 1,207 Chinese children aged 3-6 years in this cross-sectional study. Children's FMS, consisting of locomotor skills and object control (OC) skills, were assessed. Information on family SES and caregiver characteristics was reported by the parents. Sex differences in outcomes and the associations of FMS with family factors by sex were examined using SPSS 26.0. Boys scored significantly higher than girls in terms of overall FMS and OC skills (both p < 0.01). There were significant and negative associations between children's FMS and parental education level and parental body mass index (BMI), which varied by sex. Boys who were regularly cared for by parents had higher FMS and OC skill scores than did those who were primarily looked after by grandparents (both p < 0.01). This complex interplay between sex and family factors (i.e. parental education level, parental BMI, and the identity of primary caregiver) on FMS proficiency in young children underscores the urgent need for developing sex-tailored, family-involved, and socio-culturally adapted interventions to enhance FMS proficiency at the preschool stage.

Intergenerational continuation of parent-child separation and 1-year telomere length attrition among mother-offspring dyads in rural China: The moderating effects of resilience.

BACKGROUND: Although stressor exposure early in life was known risk factor for telomere length (TL) attrition, limited literature explored it across generations. Furthermore, the effects of resilience have rarely been examined. Here, we examined whether the effects of intergenerational parent-child separation on offspring 1-year TL attrition vary by the levels of resilience. METHOD: In a sample of 342 mother-child dyads living in rural China, the intergenerational continuation of parent-child separation was defined as the two generations both experiencing parent-child separation from both parents for >6 months a year early in life assessed by the parent-reported questionnaire, whereas intergenerational discontinuity refers to parent-child separation exposed in one generation only. TL was measured at baseline (from June to November 2021) and 1-year later with children's buccal mucosa swabs, with resilience polygenic risk scores (PRS) evaluated based on 4 single-nucleotide variations in 4 resilience-related genes (OXTR, FKBP5, NPY, and TNF-α). RESULTS: Among 342 mother-offspring dyads, 35 (10.2 %) experienced intergenerational continuation of parent-child separation, and 139 (40.6 %) were identified as discontinuous. Remarkably, a 0.12-point reduction in TL attrition was only associated with intergenerational continuation of parent-child separation (95 % CI: 0.04, 0.21, P < 0.01) but not discontinuity. Importantly, the association between intergenerational continuation of parent-child separation with accelerated TL attrition disappeared in offspring with high resilience PRS (ß = 0.07, 95%CI: -0.06, 0.21). CONCLUSION: Our findings highlight the importance of breaking the intergenerational cycle of parent-child separation and the moderating effects of resilience on TL attrition for children exposed to adversity.

Geospatial Analysis of Parental Healthcare-Seeking Behavior in the Vicinity of Multispecialty Hospital in India.

Background and Objective: The healthcare-seeking behavior of vulnerable groups, such as children under five, depends on a multitude of factors, including the caregiver's decision making. Approximately 60% of Indians seek care from private hospitals. Recent health policy in India has favored the establishment of multispecialty hospitals. However, it remains unclear to what extent this policy has changed the number of Indians seeking healthcare from these government-established multispecialty hospitals. The study aims to assess the health-seeking behavior of parents of children under five in the vicinity of a public multispecialty tertiary care hospital. Methods: This was a community-based cross-sectional survey with geospatial mapping conducted among the parents of children under five using a semi-structured questionnaire in Epi-collect mobile app. The study site was an urban slum in a catchment area [within five kilometers (km)] of a multispecialty tertiary care public hospital in the central Indian state of Chhattisgarh. The study was conducted for one year duration from February 2019 to January 2020. A questionnaire was administered to the parents of the children under five (N = 353) after their household confirmation from the nearby Anganwadi center, the community level service providing center under the Integrated Child Development Scheme by the Ministry of Women and Child Development (WCD). The questionnaire included sections for demographic characteristics, the illness pattern among their children, health-seeking decision-making, and more. Descriptive analysis was presented with numbers and percentages. Univariate analysis was used to assess the association between sociodemographic variables and health-seeking characteristics. Statistical significance was considered at p value less than 0.05. We used geospatial mapping using coordinates collected and compiled using the Microsoft Excel version 2021 and analyzed using QGIS (Quantum Geographic Information System) software. Results: Among the parents interviewed patients (N = 353), maternal literacy rates were over 85%. Approximately 54% of the families were below poverty line. Among 95.2% of the families, mothers were part of decision-making regarding their children's health-seeking. Over 92% of the families opted for consultation in a nearby private hospital or dispensary. Geospatial mapping of private hospitals was a favored place for healthcare-seeking by mothers, irrespective of their socioeconomic status or education rather than multispecialty hospital. Conclusion and Global Health Implications: The majority of the parents in the vicinity of public multispecialty hospitals seek care from private clinics for ailments for children under five. The establishment of public multispecialty tertiary care hospitals, which are mandated for tertiary level of care and research, cannot replace primary-level healthcare institutions, showed that private hospitals were the favored places healthcare seeking by mothers. These primary-level institutions are critical for the management of common ailments for children under five near home and reducing the financial burden on the family, even in the vicinity of a multispecialty hospital.

Variations of Eating Behaviors Among Vietnamese Preschool Children and Their Association With Children's Anthropometric Z-Scores: Results From Analyses of the Children's Eating Behavior Questionnaire in 10 000 Children.

Eating behaviors, which are shaped during childhood, are one of the important factors influencing children's growth. This study aimed to investigate the variations in eating behaviors among Vietnamese preschool children aged 3 to 6 years using the Children Eating Behavior Questionnaire (CEBQ) and their association with anthropometric Z-scores. A cross-sectional study was conducted on 10 172 children from 36 to 72 months old, recruited from three different socioeconomic regions of Hanoi. Differentiation of eating behaviors between two sexes was observed across all age groups, but most obvious at 36 to 48 months of age. The subscales of emotional overeating (EOE), enjoyment of food (EF), and desire to drink (DD) were higher in 60- to 72-month age groups and vice versa for slowness in eating (SE) and emotional undereating (EUE) subscales. Analyses using the general linear model showed that CEBQ subscales were associated with anthropometric Z-scores in both girls and boys.

Behavioral characteristics of toddlers later identified with an autism diagnosis, ADHD symptoms, or combined autism and ADHD symptoms.

BACKGROUND: Autism commonly co-occurs with attention-deficit/hyperactivity disorder (ADHD), but less is known regarding how ADHD symptoms impact the early presentation of autism. This study examined early behavioral characteristics of a community sample of toddlers later identified with autism diagnosis, ADHD symptoms, combined autism and ADHD symptoms, or neither condition. METHODS: Participants were 506 toddlers who were part of a longitudinal study of children's behavioral development. Parents completed questionnaires about their children's behavior at two time points. Four groups were identified based on study measures or medical record: autism diagnosis (n = 45), elevated ADHD symptoms (n = 70), autism and ADHD symptoms (n = 30), or neurotypical development (n = 361). Relationships between early parent report of autism- and ADHD-related behaviors, social-emotional and behavioral functioning, and caregiver experience and subsequent group designation were evaluated with adjusted linear regression models controlling for sex. RESULTS: Significant group differences were found in measures of autism-related behaviors, ADHD-related behaviors, externalizing and internalizing behaviors, and parent support needs (p < .0001). Pairwise comparisons indicated toddlers later identified with combined autism diagnosis and ADHD symptoms had higher levels of autism-related behaviors, externalizing and internalizing behaviors, and autism-related parent support needs compared to the other groups. Toddlers with subsequent elevated ADHD symptoms or combined autism diagnosis and ADHD symptoms exhibited similar levels of ADHD-related behaviors, while both groups displayed more ADHD-related behaviors than toddlers subsequently identified with autism or those with neither condition. CONCLUSIONS: In this community sample, toddlers for whom combined autism diagnosis and ADHD symptoms were subsequently identified showed a distinct presentation characterized by higher early autism-related behaviors, broader behavioral concerns, and higher parent support needs. Presence of ADHD symptoms (alone or in combination with autism) was associated with higher parent-reported ADHD-related behaviors during toddlerhood. Results indicate that ADHD-related behaviors are manifest by toddlerhood, supporting screening for both autism and ADHD during early childhood.