Role of epithelial barrier function in inducing type 2 immunity following early-life viral infection.

BACKGROUND: Preschool wheeze attacks triggered by recurrent viral infections, including respiratory syncytial virus (RSV), are associated with an increased risk of childhood asthma. However, mechanisms that lead to asthma following early-life viral wheezing remain uncertain. METHODS: To investigate a causal relationship between early-life RSV infections and onset of type 2 immunity, we developed a neonatal murine model of recurrent RSV infection, in vivo and in silico, and evaluated the dynamical changes of altered airway barrier function and downstream immune responses, including eosinophilia, mucus secretion and type 2 immunity. RESULTS: RSV infection of neonatal BALB/c mice at 5 and 15 days of age induced robust airway eosinophilia, increased pulmonary CD4+ IL-13+ and CD4+ IL-5+ cells, elevated levels of IL-13 and IL-5 and increased airway mucus at 20 days of age. Increased bronchoalveolar lavage albumin levels, suggesting epithelial barrier damage, were present and persisted following the second RSV infection. Computational in silico simulations demonstrated that recurrent RSV infection resulted in severe damage of the airway barrier (epithelium), triggering the onset of type 2 immunity. The in silico results also demonstrated that recurrent infection is not always necessary for the development of type 2 immunity, which could also be triggered with single infection of high viral load or when the epithelial barrier repair is compromised. CONCLUSIONS: The neonatal murine model demonstrated that recurrent RSV infection in early life alters airway barrier function and promotes type 2 immunity. A causal relationship between airway barrier function and type 2 immunity was suggested using in silico model simulations.

Chilean children's adherence to sustainable healthy diets and its associations with sociodemographic and anthropometric factors: a cross-sectional study.

PURPOSE: To describe adherence to sustainable healthy diets among a sample of 958 Chilean pre-schoolers (3-6 years) and explore associations between adherence and child and maternal sociodemographic and anthropometric characteristics. METHODS: Children's adherence to sustainable healthy diets was calculated from single multiple-pass 24-h dietary recalls using the Planetary Health Diet Index for children and adolescents (PHDI-C). Higher PHDI-C scores (max score = 150 points) represent greater adherence. Adjusted linear regression models were fitted to explore associations between PHDI-C scores and child and maternal characteristics. RESULTS: Children obtained low total PHDI-C scores (median 50.0 [IQR 39.5-59.8] points). This resulted from low consumption of nuts & peanuts, legumes, vegetables, whole cereals, and vegetable oils; a lack of balance between dark green and red & orange vegetables, inadequate consumption of tubers & potatoes and eggs & white meats, and excess consumption of dairy products, palm oil, red meats, and added sugars. Mean PHDI-C total score was significantly higher (50.6 [95%CI 49.6, 51.7] vs 47.3 [95%CI 45.0, 49.5]) among children whose mothers were ≥ 25 years compared to those with younger mothers. Positive associations were observed between scores for fruits and maternal education, vegetables and maternal age, added sugars and child weight status, while negative associations were observed between fruits and child age, and vegetable oils and maternal education. Scores for dairy products PHDI-C component were lower among girls. CONCLUSION: Adherence to sustainable healthy diets was low among this sample of Chilean children and was significantly associated with maternal age, being lower among children whose mothers were younger.

Computerized adaptive testing to screen pre-school children for emotional and behavioral problems.

Questionnaires to detect emotional and behavioral (EB) problems in preventive child healthcare (PCH) should be short; this potentially affects their validity and reliability. Computerized adaptive testing (CAT) could overcome this weakness. The aim of this study was to (1) develop a CAT to measure EB problems among pre-school children and (2) assess the efficiency and validity of this CAT. We used a Dutch national dataset obtained from parents of pre-school children undergoing a well-child care assessment by PCH (n = 2192, response 70%). Data regarded 197 items on EB problems, based on four questionnaires, the Strengths and Difficulties Questionnaire (SDQ), the Child Behavior Checklist (CBCL), the Ages and Stages Questionnaire: Social Emotional (ASQ:SE), and the Brief Infant-Toddler Social and Emotional Assessment (BITSEA). Using 80% of the sample, we calculated item parameters necessary for a CAT and defined a cutoff for EB problems. With the remaining part of the sample, we used simulation techniques to determine the validity and efficiency of this CAT, using as criterion a total clinical score on the CBCL. Item criteria were met by 193 items. This CAT needed, on average, 16 items to identify children with EB problems. Sensitivity and specificity compared to a clinical score on the CBCL were 0.89 and 0.91, respectively, for total problems; 0.80 and 0.93 for emotional problems; and 0.94 and 0.91 for behavioral problems.    Conclusion: A CAT is very promising for the identification of EB problems in pre-school children, as it seems to yield an efficient, yet high-quality identification. This conclusion should be confirmed by real-life administration of this CAT. What is Known: • Studies indicate the validity of using computerized adaptive test (CAT) applications to identify emotional and behavioral problems in school-aged children. • Evidence is as yet limited on whether CAT applications can also be used with pre-school children. What is New: • The results of this study show that a computerized adaptive test is very promising for the identification of emotional and behavior problems in pre-school children, as it appears to yield an efficient and high-quality identification.

Eye care following pre-school vision screening: Data from the Growing Up in New Zealand study.

AIM: This study aimed to determine adherence with follow-up from the New Zealand pre-school vision screening programme. The study also examined associations between pre-school vision screening outcomes and cognitive measures assessed at the 54-month follow-up in the Growing Up in New Zealand study cohort. METHODS: A cross-sectional retrospective record review of pre-school vision screening outcomes and hospital ophthalmology records with linkage to Growing Up in New Zealand cohort study data. RESULTS: Of 176 children referred from vision screening, 21.6% did not attend a referral appointment. Of 138 children who attended a referral appointment, 21.0% did not attend one or more follow-up appointments. Ethnic differences were observed in attendance at referral appointments (attended Maori 13%, Pacific 22.5%, European/Other 64.5%; not attended Maori 26.3%, Pacific 28.9%, European/Other 44.7%; P = 0.04) and follow-up appointments (attended Maori 11.9%, Pacific 15.6%, European/Other 72.5%; not attended Maori 17.2%, Pacific 48.3%, European/Other 34.5%; P = 0.001). Vision screening outcome was significantly associated with letter naming fluency scores (P = 0.01) but not name and numbers scores (P = 0.05). CONCLUSIONS: Non-attendance at referral and follow-up appointments limits the efficacy of vision screening, particularly for children of Maori and Pacific ethnicity. Children referred from vision screening achieve lower scores on letter naming fluency, a key predictor of reading ability in later childhood. Equity-based improvements are required to ensure that all children referred from vision screening receive appropriate follow-up eye care.

Pre-school hearing screening is necessary to detect childhood hearing loss after the newborn period: a study exploring risk factors, additional disabilities, and referral pathways.

OBJECTIVE: To explore strategies for detecting childhood hearing loss, aside from newborn hearing screening. DESIGN: A retrospective review of medical records on the modes of detection of hearing loss, risk factors for late-onset hearing loss, hearing loss degree, aetiology, additional disabilities, and timelines from referral to intervention. STUDY SAMPLE: Children, born 2006 to 2015, enrolled for intervention whose hearing loss was detected up to age 7 years but not from newborn hearing screening (n = 326). RESULTS: Universal pre-school hearing screening detected 38% of the cohort at 4-5 years of age. Risk factors for late-onset hearing loss were present in 36% of children, 80% of whom had a reported family history. Sixty-nine percent had mild bilateral or unilateral hearing loss. Children with additional disabilities faced significantly longer delays from referral to intervention. Children self-referred due to parent concern had more severe degree of hearing loss than those referred from screening. CONCLUSION: Most children with hearing loss detected after the newborn period do not have any known risk factors for late-onset hearing loss. Pre-school hearing screening is needed for comprehensive detection of hearing loss in early childhood. More work is needed towards improving timely diagnosis and intervention for children with additional disabilities.

Preliminary feasibility and effectiveness of a novel community language intervention for preschool children in the United Kingdom.

BACKGROUND: Very young children from lower socioeconomic status (SES) backgrounds often show poorer language development. Whilst there have been attempts to provide early intervention programmes, these sometimes miss the most disadvantaged groups. AIMS: This report presents preliminary feasibility and effectiveness data for a novel language intervention designed for parents of toddlers in the United Kingdom. METHODS AND PROCEDURES: In total, 43 UK families of 2-4-year-olds were recruited to the study, half of whom completed an 8-week course (Tots Talking) focussed on parent interaction, and half of whom acted as wait-list controls. RESULTS AND OUTCOMES: Results suggest that such programmes are feasible for families with 86% staying in the intervention. In addition, greater changes in underlying communication skills such as joint attention and gesture were evident compared to wait-list controls. CONCLUSIONS AND IMPLICATIONS: We conclude that pre-verbal skills may be more important to measure as initial outcomes than language or vocabulary change in this population. WHAT THIS PAPER ADDS: What is already known on the subject Children from lower socioeconomic status (SES) backgrounds are at higher risk of communication difficulties and there is a need for community intervention programmes for very young children. What this study adds This study suggests that such programmes can be feasible and effective, but that very early/basic communicative skills (such as joint attention) may be boosted first rather than language or vocabulary. What are the clinical implications of this work? Children's centres and other community services could feasibly run short parent facing courses emphasising contingent communication in low SES families and other diverse groups. These may be more successful run with younger preschoolers. Joint attention may be a better focus of intervention before expecting vocabulary or language change. Community health professionals may find this information useful in referring and supporting families in need.

Autism Spectrum Disorder: Brain Areas Involved, Neurobiological Mechanisms, Diagnoses and Therapies.

Autism spectrum disorder (ASD), affecting over 2% of the pre-school children population, includes an important fraction of the conditions accounting for the heterogeneity of autism. The disease was discovered 75 years ago, and the present review, based on critical evaluations of the recognized ASD studies from the beginning of 1990, has been further developed by the comparative analyses of the research and clinical reports, which have grown progressively in recent years up to late 2023. The tools necessary for the identification of the ASD disease and its related clinical pathologies are genetic and epigenetic mutations affected by the specific interaction with transcription factors and chromatin remodeling processes occurring within specific complexes of brain neurons. Most often, the ensuing effects induce the inhibition/excitation of synaptic structures sustained primarily, at dendritic fibers, by alterations of flat and spine response sites. These effects are relevant because synapses, established by specific interactions of neurons with glial cells, operate as early and key targets of ASD. The pathology of children is often suspected by parents and communities and then confirmed by ensuing experiences. The final diagnoses of children and mature patients are then completed by the combination of neuropsychological (cognitive) tests and electro-/magneto-encephalography studies developed in specialized centers. ASD comorbidities, induced by processes such as anxieties, depressions, hyperactivities, and sleep defects, interact with and reinforce other brain diseases, especially schizophrenia. Advanced therapies, prescribed to children and adult patients for the control of ASD symptoms and disease, are based on the combination of well-known brain drugs with classical tools of neurologic and psychiatric practice. Overall, this review reports and discusses the advanced knowledge about the biological and medical properties of ASD.

Body composition and associated factors among 5-7-year-old children with moderate acute malnutrition in Jimma town in southwest Ethiopia: A comparative cross-sectional study.

Acute malnutrition affects not only the growth and development but also the body composition of children. However, its specific effects have not yet been characterized. This study aims to compare the body composition of 5-7-year-old children with moderate acute malnutrition (MAM) to that of their well-nourished (WN) peers and identify associated factors. A school-based comparative cross-sectional study was conducted from June to July 2022 in Jimma town, southwest Ethiopia. The study participants were selected from eight kindergartens and eight primary schools using a simple random sampling technique based on the proportional allocation of the sample to the size of the population in the respective school. Descriptive statistics and multivariable linear regression analyses were used to assess the mean differences and associations between variables and isolate independent predictors of body composition, respectively. The statistical significance was determined using ß-coefficients with 95% confidence intervals and a p value of ≤ 0.05. Data were captured from 388 (194 MAM and 194 WN) children with a response rate of 97.9%. The mean fat-free mass of WN children was significantly higher compared with those with MAM (p < 0.001). The mean (SD) of fat mass of MAM children was 4.23 ± 0.72 kg, 4.36 ± 0.88 kg and 4.08 ± 0.89 kg for 5, 6 and 7-year-olds, respectively. For WN children, the mean (SD) of fat mass was 4.92 ± 0.88 kg for 5 years old, 5.64 ± 1.01 kg for 6 years old and 5.75 ± 1.26 kg for 7 years old (p < 0.001). On the multivariable linear regression analysis after controlling for background variables, WN children exhibited 1.51 times higher fat-free mass compared with MAM children (ß = 1.51, p = 0.003). A unit increase in age of the study participants was associated with a 1.37 increment in fat-free mass (ß = 1.37, p < 0.001). WN children had 1.07 times higher fat mass compared with children with MAM (ß = 1.07, p < 0.001). A unit increase in the age of the child resulted in 0.15 times increment in fat mass (ß = 0.15, p = 0.020), and being female was associated with a 0.37 increase in fat mass (ß = 0.37, p < 0.001). The results showed that the mean fat mass and fat-free mass were significantly lower among moderately acute malnourished children than in WN children showing the loss of both body compartments due to malnutrition. The body mass index for age, age of the child and sex of the child were significantly linked to both fat-free mass and fat mass.

What is the influence of maternal weight gain in different gestational clinical conditions on the prole weight in pre-school age?

The aim of the current study was to assess the influence of maternal weight gain in different clinical gestational conditions on the child's weight at pre-school age. This was a longitudinal observational study of a prospective and controlled multiple cohort of 372 mother-child pairs with four causal groups of different adverse intrauterine environments (smoking, diabetic, hypertensive and intrauterine growth-restricted pregnant women) and a control group, in the period of, from 2011 to 2016 in three hospitals in Porto Alegre (Brazil). Sociodemographic, prenatal and perinatal data were analysed. Gestational weight gain (GWG) was categorised as 'insufficient', 'adequate' and 'excessive'. The generalised estimation equations (GEE) model was used to assess changes in the z-score of the child's body mass index from birth to pre-school age according to the GWG and gestational group. The child's GWG and weight gain were adjusted for maternal age and education, marital status, family income, pregnancy planning, number of children, prepregnancy BMI, prenatal consultations and type of delivery. A triple interaction effect was observed involving the gestational group, weight gain and study time (p = 0.020) through an adjusted model. Maternal weight gain above the recommended is associated with a significant increase in the child's z - BMI score over time, except for children from pregnant smokers. Children from diabetic mothers , hypertensive mothers and the control group who had a weight gain above that recommended during pregnancy changed their nutritional status from eutrophic to overweight, becoming obese in the DM and hypertension groups and overweight in control. Monitoring of the GWG, especially in the presence of hypertensive diseases and DM, should be effective to prevent children from developing overweight or obesity in pre-school age with an important impact on health conditions in the future.

Co-design and content validity of the movement measurement in the early years (MoveMEY) tool for assessing movement behaviour of pre-school aged children.

BACKGROUND: Movement behaviours (physical activity, sedentary behaviour, and sleep) are important for pre-school children's health and development. Currently, no tools with appropriate content validity exist that concurrently capture these movement behaviours in young children. The aim of this study was to co-design and assess the content validity of a novel tool to concurrently measure movement behaviours in pre-school aged children (aged 3-4 years). METHODS: We followed four distinct steps to develop and assess the content validity of Movement Measurement in the Early Years (MoveMEY): (1) We conducted an extensive literature search, to identify pre-existing proxy measurement tools (questionnaires and diaries) to inform the design of a novel tool, which aimed to effectively capture movement behaviour guidelines of pre-school aged children. (2) We facilitated focus group discussions with parents and carers of pre-school aged children (n = 11) and (3) a qualitative survey with free text responses was completed by topic relevant researchers (n = 6), to co-design the measurement tool. (4) We assessed the content validity of the developed tool, MoveMEY, through interviews with parents of pre-school aged children (n = 12) following piloting of the tool. RESULTS: We developed an initial version of MoveMEY based on the format of an existing questionnaire and by mapping the content of questions to the guidelines. Co-design of MoveMEY resulted in changes to the format (e.g. short questionnaire to a seven-day diary) and content (e.g. inclusion of 'general information' questions on illness, disabilities and sleep disturbances; question on screen time before bed). Content validity assessment demonstrated that the items of MoveMEY were relevant and comprehensive for the assessment of children's movement behaviours. MoveMEY was felt to be comprehensible, however, parental suggestions were implemented to finalise and improve MoveMEY (e.g. adding examples to questions aiming to detect moderate to vigorous physical activity). CONCLUSION: MoveMEY is the first co-designed measurement tool that has relevance for assessing the movement behaviour guidelines of pre-school aged children. Parent/carer and topic relevant researcher involvement throughout the development process resulted in a seven-day daily reported activity diary that is comprehensive of children's movement behaviours and comprehensible to parents and carers.

Changes in screen time from 4 to 7 years of age, dietary patterns and obesity: Findings from the Generation XXI birth cohort.

BACKGROUND AND AIMS: Increased screen exposure is associated with unhealthy eating behaviours and obesity. Screen time (ST) changes from pre-school to school age, and associations with dietary patterns (DP) and obesity remain unknown. We, therefore, analysed ST changes from 4 to 7 years of age, associated factors, and the relation with DP and obesity. METHODS AND RESULTS: We included 4531 children evaluated at 4 and 7 years, as part of the Generation XXI birth cohort (Porto, Portugal). ST was assessed for weekdays and weekend, and average daily time was estimated. Associations between covariates and ST changes, and between ST changes and 3 DP previously identified (Energy-dense foods, Snacking, and Healthier) were estimated by odds ratios (OR) and 95% confidence interval (95%CI), using adjusted multinomial regression models. From 4 to 7 years, 31.5% of the children decreased their ST, 21.8% increased, 16.5% maintained low (≤60 min), and 30.2% maintained high (61-120 min or >120 min) ST. After adjustment, lower maternal education (OR = 2.33, 95%CI:1.82-2.99) and lower family income (OR = 1.72, 95%CI:1.35-2.21) were associated with higher odds of increasing ST, while being a girl was associated with 35% decreased odds of increasing ST. Children that increased and those that maintained high ST showed greater odds of presenting a Snacking DP at 7 years (OR = 2.34, 95%CI:1.64-3.35) and (OR = 2.65, 95%CI:1.89-3.72), respectively. No statistically significant differences were found regarding changes in ST and the child's BMI. CONCLUSION: Children increasing screen exposure during this period were more frequently from lower socioeconomic strata and presented unhealthier DP.

Nutrition morbidity interactions in pre-school children.

Background & objectives: Research studies in the 1970s reported that in pre-school children, undernutrition increased the risk of infections and infections aggravated undernutrition. Over decades, there has been a reduction in prevalence of undernutrition and improvement in access to healthcare for treatment of infections. A mixed longitudinal study was undertaken to assess whether over time there were any changes from the earlier reported effect of undernutrition prior to infection on the risk of morbidity and effect of morbidity on nutritional status in pre-school children. Methods: Pre-school (0-59 months of age) children from urban low- and middle-income families whose parents were willing to allow their participation in the study were enrolled. Information on sociodemographic profile of the families was collected at enrolment. Weight of all children and length in infants were recorded every month; length/height in children 12-59 months of age was recorded once in three months. Morbidity information was collected through fortnightly visits. Results: 3888 pre-school children were followed up in 74636 home visits. Among these children, underweight and wasting were associated with a small increase in risk of infections. The odds ratio for risk of infection for underweight children was 1.09 (95% CI: 1.02 to 1.16) and for wasting was 1.18 (95% CI: 1.08 to 1.29). The deterioration in Z scores for weight-for-age and body mass index-for-age in children during illness and convalescence was small but significant (P<0.001). Interpretation & conclusions: The increased risk of infections in undernourished children living in overcrowded tenements in areas with poor environmental hygiene was not significant, perhaps because the risk of infection in normally nourished children was also high. The deterioration in nutritional status following infection was small because of the ready access to and utilization of health and nutrition care.

Is medical home care adequacy associated with educational service use in children and youth with autism spectrum disorder (ASD)?

BACKGROUND: The American Academy of Pediatrics (AAP) recommends medical home care for children and youth with autism spectrum disorder (ASD) for health needs. Children and youth with ASD also receive educational services for cognitive, social, and behavioral needs. We measured whether inadequate medical home care was significantly associated with current educational service use, controlling for sociodemographic factors. METHODS: We analyzed the 2016/2017 National Survey of Children's Health (NSCH) on 1,248 children and youth with ASD ages 1-17. Inadequate medical home care was operationalized as negative or missing responses to at least one medical home component. Educational service use was defined as current service use under individualized family service plans (IFSP) and individualized education programs (IEP). RESULTS: Inadequate medical home care was significantly associated with higher likelihood of current educational service use (aOR = 1.95, 95% CI [1.10, 3.44], p = 0.03). After adjustment, older children (aOR = 0.91, 95% CI [0.84, 0.99], p = 0.03), lower maternal health (aOR = 0.52, 95% CI [0.29, 0.94], p = 0.03), and children without other special health care factors (aOR = 0.38, 95% CI [0.17-0.85], p = 0.02) had significantly lower odds of current educational service use. CONCLUSIONS: Inadequate medical home care yielded higher odds of current educational service use. Child's age, maternal health, and lack of other special health care factors were associated with lower odds of current educational service use. Future research should examine medical home care defined in the NSCH and improving educational service use via medical home care.

The role of well-child visits in detecting developmental delay in preschool children.

BACKGROUND: Early detection of developmental delay (DD) in preschool children is crucial for counselling parents, initiating diagnostic work-up, and starting early intervention (EI). METHODS: We conducted a register study of all preschool children referred for EI in the Canton of Zurich, Switzerland, in 2017 (N = 1,785) and used an online survey among primary care physicians (PCPs, N = 271) to evaluate the care service of DD children. RESULTS: PCPs accounted for 79.5% of all referrals by physicians and had correctly referred over 90% of the children in need of EI at an average age of 39.3 months (SD 8.9). In the survey, which represents 59.2% of all pediatricians and 11.3% of all general practitioners in the Canton, PCPs reported performing a mean of 13.5 (range 0-50, SD 10.7) well-child visits per week to preschool children and estimated well-child visits to be the most frequent type of consultation (66.7%) for the identification of DD. Parents' hesitancy in accepting further evaluation or support were reported by 88.7%. CONCLUSIONS: Most preschool children with DD are identified in well-child visits. These visits represent an ideal opportunity for early detection of developmental impairment and initiation of EI. Carefully addressing parents' reservations could reduce the rate of refusal, thus improving early support for children with DD.

The role of parental congruence in pre-school children's screen time, moderated by parental education.

AIM: This study investigated whether parental congruency regarding screen time (ST) is associated with ST in pre-school children. In addition, we investigated whether parental education levels moderated this relationship. METHODS: A cross-sectional study was conducted in 2015-2016 in Finland (N = 688). Parents completed a questionnaire reporting their children's sedentary behaviour, their parental congruency regarding ST rules, and their educational level. Associations were examined using linear regression. RESULTS: Children of parents with higher congruence regarding ST rules engaged in less ST, this was moderated by parental education levels. Children whose parents had a high level of education and parents' who strongly agree or somewhat agree on ST rules was negatively associated with ST. Furthermore, children whose parents had a medium level of education and parents' who strongly agree on ST rules was negatively associated with ST. CONCLUSION: Children of parents who agree on ST rules engaged in less ST compared with children of parents who do not agree on ST rules. Providing advice to parents regarding parental congruency could be the focus of future interventions.

Mothers' descriptions of their feeding strategies in response to fussy eating with children of different levels of trait fussiness.

Parent feeding practices influence a child's dietary intake. Many studies examining how parents react to children's fussy eating behaviours have been limited to questionnaire measures, which assess a limited number of feeding practices. There is a lack of research exploring the range of strategies parents use when their child is being fussy and/or refusing to eat. Therefore, the aims of this study are to describe the strategies used by mothers when their child is being fussy or refusing to eat, and to assess differences in the strategies depending on the child's trait fussiness levels. In 2018, 1504 mothers of children aged 2-5 years completed an online survey. Trait fussiness was assessed using the Children's Eating Behaviour Questionnaire. Mothers were also asked the open-ended question "What are the strategies you use when your child is being fussy or refusing to eat?". Inductive thematic analysis was conducted using NVivo. Themes were compared by child trait fussiness levels. Seven main themes were identified: child-led feeding/trust in child's appetite, spectrum of pressure, home or family strategies, different types of food offerings, communication, avoid certain strategies, and never or rarely fussy. Mothers of children with severe trait fussiness levels reported more pressuring or persuasive strategies. This study provides novel information regarding the diverse range of feeding practices parents use in response to children's fussy eating behaviours. Mothers used more feeding strategies typically associated with unhealthy dietary intake for children of high levels of trait fussiness. It is important that future interventions tailor the information to provide support to parents of children with high levels of trait fussiness regarding the use of feeding practices recommended to support healthy dietary intake.

Evaluating the influence of low birth weight on food parenting practices in preschool children.

Food parenting practices, especially Autonomy Support practices and Structure practices, have not been comprehensively studied among parents of children born with low birth weight in Asia. The aim of this study was to investigate food parenting practices among parents of preschoolers who were born with low (<2500 g) and normal birth weight (≥2500 g) in Singapore. We recruited 197 parents of pre-school children (aged 3-5 years) who completed a socio-demographic questionnaire and the HomeSTEAD questionnaire, which examined food parenting practices. Among parents, 98 (49.8%) and 99 (50.2%) had children who were normal (NBW) and low birth weight (LBW) respectively. Parents of children with LBW had lower scores in one Autonomy Support practice (Encouragement) and three Structure practices (Meal setting, Planning and preparation of healthy meals, Rules and limits around unhealthy foods), after controlling for ethnicity and parental education. Parents of children with LBW also scored higher in one Autonomy Support practice (Guided choices: when food is given). There were no significant differences in Coercive Control practices between parents of both groups. Healthcare professionals could use this information to assess parental needs when facilitating parents' positive food parenting practices, especially among children with low birth weight.

Pre-school wheeze hospital presentations: A demographic profile and review of clinical management.

AIM: Pre-school wheeze is a common hospital presentation in Australasia. The aim of this study was to describe the regional hospital presentation and cost of pre-school wheeze. METHODS: Audit of children diagnosed with pre-school wheeze at two hospitals in Auckland, New Zealand from October 2017 to September 2019. Guideline adherence was determined. RESULTS: One hundred and ninety-two children made 247 pre-school wheeze hospital presentations. Pre-school wheeze accounted for a larger proportion of acute hospital presentations for Maori versus non-Maori children (rate ratio 1.76, 95% confidence intervals 1.32-2.31). Hospital representations with pre-school wheeze occurred in 38/192 (20%) children. The proportion with a pre-school wheeze representation was larger for Maori than non-Maori (30% vs. 16%, P = 0.02). Pre-school wheeze event median length of stay increased as household deprivation increased (P = 0.01). Clinical severity of 247 pre-school wheeze episodes was mild (n = 64, 26%), moderate (n = 153, 62%) and severe (n = 30, 12%). Of 244 episodes, inhaled bronchodilators only were given for 149 (61%), oxygen for 54 (22%) and intravenous treatment for 41 (17%). Hospital guideline use was evident in 164/247 (66%) episodes. Neither clinical severity nor treatment intensity varied with child sex, age or ethnicity or household deprivation. The estimated median (interquartile range) direct medical costs of each pre-school wheeze episode were NZ$1279 (NZ$774-2158). CONCLUSIONS: In Auckland, pre-school wheeze accounts for a larger proportion of acute hospital presentations for Maori compared with non-Maori and Maori children have increased odds of pre-school wheeze readmissions. Length of hospital stay for pre-school wheeze episodes increased with household deprivation. In this audit pre-school wheeze guideline adherence was poor.

Factors associated with physical inactivity among the pre-school children: A cohort of 1681 participants.

AIM: To investigate the risk factors associated with physical inactivity of young children in Hong Kong. METHODS: This follow-up study was part of a prospective cohort study named Studying Impact of Nutrition on Growth (SING) initiated in 2015. Subjects were recruited from randomly selected local nurseries and kindergartens in Hong Kong. Self-administrated questionnaires were distributed to parents in 2016-2017 to collect information on: (i) socio-economic background; (ii) health-related factors, including gestation at time of birth, and hospitalisation of the child since birth; (iii) types of leisure activities, including time spent on electronic games and physical activity. RESULTS: A total of 1681 responses were collected. A higher likelihood of physical inactivity on weekdays was associated with being female, not being the firstborn, having been hospitalised three or more times since birth, and having physically inactive care givers. Meanwhile, children whose mother was unemployed/retired, and who spent more than 1 h on electronic games per day were significantly less likely to be physically inactive. Similarly, being female, being the secondborn or the thirdborn, and having a care giver with low physical activity level were associated with a higher chance of physical inactivity on weekends. CONCLUSIONS: Parental support could play a pivotal role in determining a child's physical activity level. Public health policies should be implemented to promote family-based physical activities.

Preschool Behavioral Problems: Links with Maternal Oxytocin and Caregiving Sensitivity in the Postnatal Period, and Concurrent Maternal Psychopathology and Attachment State-of-Mind.

This study investigated maternal oxytocin, caregiving sensitivity and mother-to-infant bonding at 3-months postpartum as predictors of child behavior and psychological outcomes in the preschool years, when controlling for concurrent maternal negative emotional symptoms and adult attachment state-of-mind. Forty-five mother-child dyads were assessed at 3-months and 3.5 years postpartum using mix of questionnaires, observational, interview and biological methods. Results showed that lower levels of maternal baseline oxytocin at 3-months postpartum significantly predicted emotional reactivity in the child at 3.5 years. When maternal adult attachment state-of-mind and negative emotional symptoms were included, lower levels of maternal baseline oxytocin at 3-months postpartum significantly predicted withdrawn child behavior. In addition, unresolved adult attachment and maternal negative emotional symptoms were significantly associated child behavioral disturbance in a range of areas. Findings highlight maternal postnatal oxytocin as a potential indicator of children who may be more likely to show emotional reactivity and withdrawn behavior in the preschool years.