Video-Based Anticipatory Guidance on Early Cognitive and Language Development in the First 6 Months: A Randomized Controlled Trial.

This randomized controlled trial showed that video-based anticipatory guidance implemented at well-child visits in the first 6 months increased knowledge of early cognitive and language development (P < .001), which in turn promoted cognitive growth fostering behaviors among parents of low socioeconomic status (95% CI 0.09-0.57). TRIAL REGISTRATION: ClinicalTrials.gov: NCT02812017.

What Parents Know Matters: Parental Knowledge at Birth Predicts Caregiving Behaviors at 9 Months.

OBJECTIVE: To examine the mediating role of socioeconomically disadvantaged parents' knowledge of early cognitive and language development at the first postpartum visit in the relation between education and caregiving behaviors at 9 months. STUDY DESIGN: Parental knowledge was assessed at the 1-week newborn visit (n = 468); anticipatory guidance received and desired at 1-month (n = 212) and 6-month (n = 191) visits were reported; and caregiving behaviors toward infants during a teaching task were observed at 9-month visit (n = 173). RESULTS: We found substantial variation in knowledge and caregiving behaviors. Parents who had more knowledge of infant development at 1 week were more likely to respond to cues (r = 0.18; P < .05) and foster social-emotional (r = 0.17; P < .05) and cognitive growth (r = 0.20; P < .05) at 9 months. Importantly, the indirect effect of education on cognitive growth fostering at 9 months through knowledge at 1 week was significant, controlling for primary language and number of other children in the home (infancy: ß = 0.06; B = 0.07; SE = 0.04; 95% CI, 0.007-0.165; early childhood: ß = 0.04; B = 0.06; SE = 0.03; 95% CI, 0.008-0.152). Open-ended responses indicated that anticipatory guidance in the first 6 months focused on infant physical growth; however, parents did not request additional anticipatory guidance from their pediatricians. CONCLUSIONS: This study sheds light on the importance of promoting parental knowledge about cognitive and language development to foster parental cognitive stimulations and language inputs during the first year of life. This study highlights the important role of anticipatory guidance on cognitive and language development during the earliest well-child visits and the need to better understand parental baseline knowledge to tailor anticipatory guidance to the family strengths and needs.

Parent-directed intervention in promoting knowledge of pediatric nutrition and healthy lifestyle among low-SES families with toddlers: A randomized controlled trial.

OBJECTIVE: The objective of this study is to determine the efficacy of an interactive, home visiting curriculum tailored to low socio-economic status families in improving parental knowledge of paediatric nutrition and healthy lifestyle. METHODS: Parents of toddlers aged 13-16 months living with a household income below 200% of the federal poverty line were randomized into healthy lifestyle intervention and control home visiting curriculum groups. Each curriculum consisted of 12 one-on-one educational sessions with parents facilitated by a trained home-visitor that were administered over a 6-month intervention period. Knowledge assessments were administered before and after the intervention period. RESULTS: Results of a one-way analysis of covariance (ANCOVA) analysis showed that parents in the intervention group (M = 26.05, SD = 4.24) scored significantly higher than control parents (M = 23.84, SD = 4.26) post-intervention, controlling for parent education level, F(1, 102) = 7.494 (95% confidence interval [-3.68, -0.59]). One-way ANCOVA analysis showed no significant mean difference between the parents in the intervention group (M = 24.13, SD = 4.37) and the control group (M = 23.93, SD = 4.16) at baseline, controlling for parent education level, F(1, 163) = 0.002 (95% confidence interval [-1.28, 1.22]). CONCLUSIONS: An interactive healthy lifestyle intervention focused on low-SES families significantly improved parental knowledge of paediatric healthy lifestyle. Changes in parental knowledge is a key preliminary step in behaviour change to ultimately affect behaviour. Informing and encouraging parents of toddlers to guide healthy lifestyle development early remains a promising point of intervention for prevention, rather than remediation, of childhood obesity.

A parent-directed language intervention for children of low socioeconomic status: a randomized controlled pilot study.

We designed a parent-directed home-visiting intervention targeting socioeconomic status (SES) disparities in children's early language environments. A randomized controlled trial was used to evaluate whether the intervention improved parents' knowledge of child language development and increased the amount and diversity of parent talk. Twenty-three mother-child dyads (12 experimental, 11 control, aged 1;5-3;0) participated in eight weekly hour-long home-visits. In the experimental group, but not the control group, parent knowledge of language development increased significantly one week and four months after the intervention. In lab-based observations, parent word types and tokens and child word types increased significantly one week, but not four months, post-intervention. In home-based observations, adult word tokens, conversational turn counts, and child vocalization counts increased significantly during the intervention, but not post-intervention. The results demonstrate the malleability of child-directed language behaviors and knowledge of child language development among low-SES parents.

Early Parental Knowledge and Parent-Child Conversations Promote Preschool Language Skills: A Randomized Controlled Trial.

OBJECTIVE: This randomized controlled trial examined the long-term impact of the 3Ts-HV intervention on preschool-aged children's language skills through promoting parental knowledge and parent-child conversational turns during toddlerhood among families from low-socioeconomic status backgrounds, controlling for parental education level, parental language skills, and child's age. METHODS: Ninety two parent-toddler dyads of low socioeconomic status were randomized to receive either the 3Ts-HV intervention (n = 46) or Healthy Lifestyle control (n = 46) curriculum from 14 to 20 months. Parental language skills were assessed at 14 months; parental knowledge was assessed at 14 and 26 months; parent-child conversational turn count was assessed at 14 and 38 months; children's language skills were assessed at 50 months. RESULTS: A significant serial mediation effect (ß = 0.05, 95% CI [0.002; 0.13]) revealed that the 3Ts-HV intervention increased parental knowledge at 26 months, contributed to more frequent parent-child conversational turns at 38 months, and in turn promoted children's language skills at 50 months. CONCLUSIONS: The present study provides empirical evidence illustrating the underlying longitudinal processes from increasing parental knowledge and enriching parent-child linguistic interactions during toddlerhood, to promoting children's language development at preschool age. These findings point to a significant path to supporting families who face socioeconomic challenges early in life to promote equity in children's early language experiences and narrow disparities in children's developmental outcomes.

Shifting parental beliefs about child development to foster parental investments and improve school readiness outcomes.

Socioeconomic gaps in child development open up early, with associated disparities in parental investments in children. Understanding the drivers of these disparities is key to designing effective policies. We first show that parental beliefs about the impact of early parental investments differ across socioeconomic status (SES), with parents of higher SES being more likely to believe that parental investments impact child development. We then use two randomized controlled trials to explore the mutability of such beliefs and their link to parental investments and child development, our three primary outcomes. In the first trial (NCT02812017 on clinicaltrials.gov), parents in the treatment group were asked to watch a short educational video during four well-child visits with their pediatrician while in the second trial (NCT03076268), parents in the treatment group received twelve home visits with feedback based on their daily interactions with their child. In both cases, we find that parental beliefs about child development are malleable. The first program changes parental beliefs but fails to lastingly increase parental investments and child outcomes. By contrast, in the more intensive program, all pre-specified endpoints are improved: the augmented beliefs are associated with enriched parent-child interactions and higher vocabulary, math, and social-emotional skills for the children.

Leveraging the universal newborn hearing screen to impact parental knowledge of childhood speech development in low socioeconomic populations: A randomized clinical trial.

OBJECTIVE: To determine the impact of a video intervention administered at the time of the universal newborn hearing screen on caregiver knowledge of infant cognitive and language development in low socioeconomic status English-speaking parents. METHODS: A parallel-group, single-blind randomized clinical trial was conducted from April to August 2016. Eligible participants were at least 18 years, delivered a singleton neonate, English speaking, and designated as low socioeconomic status based on household income and level of education. A total of 112 patients, 54 treatment and 58 control, completed the study and were included in the analysis. The Baby Survey of Parent/Provider Expectations and Knowledge, a validated 24-item questionnaire assessing child development knowledge, was the primary study outcome. The survey was conducted at baseline, 1 day after intervention, and 4-6 weeks later. A one-way, repeated measures analysis of variance (ANOVA) was employed to evaluate for differences in the three time points. RESULTS: The average age of participants was 25.6 years and 85% identified as African-American. There was no significant difference in scores prior to and following the intervention for the control group (N = 58, F = 1.67, p = 0.19); however, a significant difference in scores was found in the treatment group (N = 54, F = 7.95, p < 0.001). Post-hoc analysis showed a significant improvement in scores 1 day after intervention, but no difference 4-6 weeks later. CONCLUSION: Educational video intervention for low socioeconomic mothers at the time of the universal newborn hearing screen can positively increase knowledge related to hearing and language development in the short term. TRIAL REGISTRATION: Pilot Study of Novel Postpartum Educational Video Intervention NCT02267265 https://clinicaltrials.gov/ct2/show/NCT02267265.

Educating Parents About Infant Language Development: A Randomized Controlled Trial.

A total of 427 women (aged 18-45 years) who delivered a singleton neonate without serious medical complications were randomized to watch either an educational intervention (n = 225) or the sudden infant death syndrome (n = 202) video. Linear mixed models showed that the intervention women significantly gained knowledge over time. Knowledge gain was largest among high-socioeconomic status (high-SES) and middle-SES English-speaking, smaller among low-SES Spanish-speaking, and nonsignificant among low-SES English-speaking women. Analysis of deviance revealed that the intervention women of all SES learned strategies fostering secure attachment and language acquisition. Participants considered watching an educational video alongside the universal newborn hearing screening (UNHS) conveniently timed. The intervention women were more likely than the control women to recognize the importance of timely UNHS follow-up.

Improved infant swallowing after gastroesophageal reflux disease treatment: a function of improved laryngeal sensation?

OBJECTIVE: The objective of this study was to describe improvements in pediatric swallowing after gastroesophageal reflux treatment. STUDY DESIGN: The authors conducted a retrospective database and chart review at two tertiary care children's hospitals. PARTICIPANTS: Patients (21 males, 7 females) ranged in age from 1 to 32 months. All patients had clinical evidence of gastroesophageal reflux disease (GERD) as well as evidence of dysphagia with aspiration (laryngeal vestibule and/or trachea) or hypopharyngeal pooling on flexible endoscopic evaluation of swallowing and sensation testing (FEESST) or videofluoroscopic swallow study (VSS). INTERVENTION: Each child underwent either medical or surgical intervention for control of their GERD. OUTCOME MEASURES: Outcome measures were change in laryngopharyngeal sensation and swallowing function with repeat swallow evaluation after GERD treatment. RESULTS: A significant improvement in both swallow function and sensory testing was demonstrated after GERD treatment. CONCLUSIONS: GERD may result in decreased laryngopharyngeal sensitivity, which may contribute to pediatric swallowing dysfunction. Control of GERD may improve swallow function. These findings have important clinical implications that need further study.

Project ASPIRE: Spoken Language Intervention Curriculum for Parents of Low-socioeconomic Status and Their Deaf and Hard-of-Hearing Children.

OBJECTIVE: To investigate the impact of a spoken language intervention curriculum aiming to improve the language environments caregivers of low socioeconomic status (SES) provide for their D/HH children with CI & HA to support children's spoken language development. STUDY DESIGN: Quasiexperimental. SETTING: Tertiary. PATIENTS: Thirty-two caregiver-child dyads of low-SES (as defined by caregiver education ≤ MA/MS and the income proxies = Medicaid or WIC/LINK) and children aged < 4.5 years, hearing loss of ≥ 30 dB, between 500 and 4000 Hz, using at least one amplification device with adequate amplification (hearing aid, cochlear implant, osseo-integrated device). INTERVENTION: Behavioral. Caregiver-directed educational intervention curriculum designed to improve D/HH children's early language environments. MAIN OUTCOME MEASURES: Changes in caregiver knowledge of child language development (questionnaire scores) and language behavior (word types, word tokens, utterances, mean length of utterance [MLU], LENA Adult Word Count (AWC), Conversational Turn Count (CTC)). RESULTS: Significant increases in caregiver questionnaire scores as well as utterances, word types, word tokens, and MLU in the treatment but not the control group. No significant changes in LENA outcomes. CONCLUSION: Results partially support the notion that caregiver-directed language enrichment interventions can change home language environments of D/HH children from low-SES backgrounds. Further longitudinal studies are necessary.

Clinical study of botulinum-A toxin in the treatment of sialorrhea in children with cerebral palsy.

OBJECTIVE: To assess the safety and efficacy of intraglandular (parotid and submandibular) botulinum-A toxin (BTX-A) in the treatment of sialorrhea in children with cerebral palsy (CP). STUDY DESIGN: Prospective, open-label, dose-escalation study. SETTING: Tertiary care Children's Hospital. PATIENTS: Twenty-two subjects between 8 and 21 years of age with CP and significant sialorrhea. INTERVENTION/TECHNIQUE: The first 12 subjects were injected in only the submandibular gland and the second 10 in the submandibular and parotid glands. Injections were performed under ultrasound localization. The first group (divided into 3) received a total of 10, 20, or 30 units of BTX-A. The second group (divided into 3) received a standard of 30 units in the submandibular gland and 20, 30, or 40 units in the parotid glands. MAIN OUTCOME MEASURE(S): Drool quantification using a pre- and postinjection "drool rating scale," dental roll weights, and "drool quotient." Swallowing was evaluated pre- and postinjection with a formal speech therapy evaluation. RESULTS: All subjects successfully underwent BTX-A injections without local or systemic complications. There were no adverse effects on swallowing. Objective "drool quantification" with dental rolls was extremely difficult in this population. Most indicative of results was the "drool rating" questionnaire and the "drool quotient." CONCLUSIONS: BTX-A is a potentially safe and promising, minimally invasive treatment for sialorrhea in children with cerebral palsy.

Orbitofacial masses in children: an endoscopic approach.

OBJECTIVE: To describe an endoscopic approach for pediatric orbitofacial masses. DESIGN: A retrospective medical chart review. SETTING: Tertiary-care children's hospital. PARTICIPANTS: Patients (4 boys, 7 girls) ranged in age from 6 months to 11 years. All children underwent endoscopic excision of an orbitofacial mass. INTERVENTION: A single port approach was used in all but the initial case. The scalp incision was placed approximately 2.0 cm behind the frontal hairline. A subgaleal dissection was performed to minimize risk of nerve injury. Under endoscopic visualization, the mass was resected. MAIN OUTCOME MEASURES: Ability to successfully excise the mass endoscopically, and the incidence of complication. RESULTS: All lesions were successfully resected endoscopically. The surgical time varied from 30 to 105 minutes (mean, 50.5 minutes). Pathologic examination revealed 10 dermoid cysts and 1 neurofibroma. Two children had transient frontalis branch palsies that resolved spontaneously. There was 1 unilateral frontal hypoesthesia in the patient with the neurofibroma (an expected result). There were no other complications. CONCLUSIONS: An endoscopic approach to pediatric orbitofacial tumors is safe and effective. Although the risk of nerve injury may be higher, a thorough knowledge of frontotemporal anatomy and careful dissection will minimize this risk. The distinct advantage of an endoscopic approach is the absence of any facial scar in these young patients.

Predictors of persistent sleep apnea after surgery in children younger than 3 years.

IMPORTANCE: Obstructive sleep apnea (OSA) is a common disorder in children and can lead to important sequelae. Predictors of persistent OSA after adenotonsillectomy (T&A) in younger children are not well studied. OBJECTIVE: To evaluate residual OSA in a subgroup of children younger than 3 years after T&A and identify predictors of postoperative residual disease. DESIGN, SETTING, AND PARTICIPANTS Retrospective review of medical records at a tertiary academic children's hospital involving children younger than 3 years who had OSA documented by polysomnogram(PSG) and underwent T&A during the period October 1, 2002, through June 30, 2010. Some of these children had both preoperative and postoperative PSGs. MAIN OUTCOMES AND MEASURES Effect of T&A on sleep study parameters and predictors of persistent disease after surgery. RESULTS A total of 283 patients (mean [SD] age, 22 [7] months) underwent a preoperative PSG, with 70 of these patients having both a preoperative and postoperative PSG. In the group who had preoperative and postoperative PSGs, there were statistically significant improvements in mean (SD) apnea hypopnea index (AHI) (34.8 [40.7] to 5.7 [13.8]; P < .001), baseline oxygen saturation (96.6%[2.1%] to 97.2%[1.4%]; P = .05), minimum oxygen saturation (77.2%[11.4%] to 89.9%[6.8%]; P < .001), and sleep efficiency (84.7%[14.9%] to 88.7%[9.1%]; P = .02) after T&A. When AHI greater than 5 was used as the definition of OSA, 21% of the patients (15 of 70) had residual OSA. The most consistent predictor of residual OSA after T&A was the severity of preoperative OSA (P = .02). CONCLUSIONS AND RELEVANCE In a subgroup of children younger than 3 years with OSA, we found a high rate of residual OSA after T&A. Predictors of residual disease include severity of preoperative OSA as determined by PSG result. Postoperative PSGs might be indicated in these patients.

Effect of fluticasone furoate on interleukin 6 secretion from adenoid tissues in children with obstructive sleep apnea.

OBJECTIVE: To determine the effect of intranasal corticosteroid therapy on T-regulatory cells and other inflammatory cytokines in adenoid tissues in children with obstructive sleep apnea syndrome. DESIGN: Randomized, prospective, exploratory study. SETTING: Academic pediatric otolaryngology practice in a tertiary care children's hospital. PATIENTS: Participants included 24 children between the ages of 2 and 12 years who were undergoing adenotonsillectomy for polysomnogram-documented obstructive sleep apnea syndrome. INTERVENTION: Children were randomized to either no treatment (n = 13) or treatment with fluticasone furoate nasal spray, 55 µg/nostril daily (n = 11), for 2 weeks before adenotonsillectomy. Adenoid tissue was obtained at the time of the procedure. MAIN OUTCOME MEASURES: The number of tissue T-regulatory cells, as determined by staining with FOXP3, CD4, and CD25, was the primary outcome measure. Staining for interleukin (IL)-10 and transforming growth factor-ß protein by immunohistochemistry, and adenoid mononuclear cell spontaneous and induced release of cytokines (IL-10, IL-6, IL-12, IL-13, tumor necrosis factor, and transforming growth factor ß) were secondary outcomes. RESULTS: Cells isolated from fluticasone furoate nasal spray-treated adenoid tissue released significantly less IL-6 spontaneously as well as upon stimulation with anti-CD3 monoclonal antibody (P = .05) compared with nontreated adenoid tissue. There were no significant differences in the number of CD4/FOXP3-, CD25/FOXP3-, or transforming growth factor ß-positive cells. Intensity of staining for IL-10 was also comparable between the groups. CONCLUSIONS: In this study, we show reduction of IL-6, a proinflammatory cytokine, in adenoid tissue obtained from children with obstructive sleep apnea syndrome treated with fluticasone furoate nasal spray. This reduction could contribute to the clinical efficacy of this class of medications in the treatment of childhood obstructive sleep apnea syndrome.

Near-complete tracheal ring deformity: a case report.

Long-segment near-complete tracheal ring deformity is a rare condition with few documented cases. We present the case of a 7-week-old male with total anomalous pulmonary venous return and long-segment near-complete tracheal rings. We discuss the presentation, evaluation, and management of near-complete and complete tracheal rings.