Evaluation of the Neurodevelopmental Outcome of Toddlers with Spinal Dysraphism after Surgical Repair Using ASQ-3™ Scores

Background: Spinal dysraphism represents a wide spectrum of congenital abnormalities of the spine. Myelomeningocele is considered the most common malformation and the most common we saw in our community, with its morbidity problems seen commonly in the postoperative period. ASQ-3TM Scores are the ages and stages questionnaire, third edition, and represent a tool to assess the development progress, especially in toddlers. Objectives: Evaluation of neurodevelopmental outcome among Sudanese toddlers with spinal dysraphism after surgical closure with or without a VP shunt using ASQ-3TM Scores. Methodology: This is a retrospective hospital-based study of 84 patients who underwent myelomeningocele repair at the National Center for Neurological Sciences (NCNS) during the period from 2017 up to 2019. Data were collected through a constructed questionnaire, including ASQ-3TM Scores. Data were processed and analyzed using the Statistical Package for Social Science (SPSS) computer program. Version 25. Results: 84 patients were included in this study;all patients were diagnosed with spinal dysraphism. Out of them, 51 (60.7%) were 2 years old, 33 (39.3%) were 3 years old, 45 (53.6%) were male, 45 (53.6%) of patients mothers attended ANC irregularly, and 54 (64.3%) their mothers didn’t receive folate supplements. 44 (52.3%) of patients underwent MMC repair only, while 40 (47.7%) underwent MMC repair and VP shunt. The commonest postoperative complication was infection, reported in 12 (14.3%) of patients, followed by VP shunt revision in 9 (10.7%) of patients. Neurological assessment showed that the majority of patients need further assessment with a professional, 57 (67.9%) of children don’t walk, run, or climb like other toddlers as their parent’s state;also, half of patients (42, 50%) had medical problems, and 27 (32.1%) of their parent’s state that they do not talk like other toddlers their age. There was a statistically significant association between post-operative complications and communication development, problem-solving development, and personal social development (P value = 0.05), and a statistically significant association was found between age at repair and neurological development (P value = 0.05). Conclusion: The majority of patients had motor deficiency (particularly gross motor) and poor personal and social skills. Age at repair and postoperative complications significantly influenced the neurological development.

Relationship of sociodemographic factors and low birth weight in toddlers

Objective:This study analyzes the relationship between sociodemographic factors and low birth weight(LBW)in toddlers.Methods:The research design uses a correlational method.The population is 303 mothers with toddlers aged 12-60 months in Lojejer Wuluhan Jember Village,East Java,Indonesia.The cluster sampling took 172 samples in total.The sociodemographic variables measured included the father’s and the mother’s age,the father’s and mother’s education,family income,the father’s occupation,the mother’s occupation,and the child’s gender.Data collection techniques used questionnaires and document studies in the Maternal Child Health(MCH)handbook.Data were analyzed using logistic regression.Results:The results showed that the variable age of the father and mother≥20 years was a protective factor for the incidence of LBW.Family income<IDR 3,000,000 per month,fathers with farm workers and fishermen as occupation,male sex,and low father’s education were predictor factors for LBW.Conclusions:This study concluded that the variable sociodemographic factors related to LBW in toddlers in Lojejer Wuluhan Village,Jember district,East Java Province,Indonesia.Therefore,the government needs to establish stricter policies in terms of maturing the age of marriage to reduce the incidence of LBW.

“三孩”政策背景下托育质量的困境与出路——基于CLASS Toddler的实证研究

“三孩”政策背景下,构建0~3岁幼儿托育服务体系应该兼顾机构数量与托育质量。利用CLASS Toddler,采用分层抽样,选取H省3市78个班级,对我国托育机构的托育质量现状及影响因素进行考察,结果显示,托育质量处于中等水平,且存在显著的地域差异、机构差异与师资差异,而机构收费、教师的专业与教龄能够显著地预测机构托育质量。提升托育质量存在观念困境、实践困境、分布困境,需要从以下三方面着手加以解决:政府主导,持续发展普惠优质的托育服务;分层准入,建设专业化托育教师队伍;资源配套,助力教师理念和实践更新;以评提质,实现托育质量均衡发展。

Epidemiology of functional gastrointestinal disorders in infants and toddlers: A systematic review

AIM: To assess the functional gastrointestinal disorders(FGID) prevalence in infants and toddlers. METHODS: Pub Med, EMBASE, and Scopus were searched for original articles from inception to February 2016. The literature search was made in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA). For inclusion, each study had to report epidemiological data of FGID on children up to 4 years old and contain standardized outcome Rome Ⅱ or Ⅲ criteria. The overall quality of included epidemiological studies was evaluated in accordance to Loney's proposal for prevalence studies of health literature. Two reviewers assessed each study for inclusion and extracted data. Discrepancies were reconciled through discussion.RESULTS: It was identified a total of 101 articles through the databases and two through the manual search. A total of 28 articles fulfilled the eligibility criteria. After reading the full articles, 13 of them were included in the present review. Twelve studies were written in English and one in Chinese, and published between 2004 and 2015. Eight articles(61.5%) were performed in Europe, three(23.1%) in America and two(15.4%) in Asia. Sample size varied between 45 and 9660 subjects. Cross-sectional frequency was reported in majority of studies(k = 9) and four studies prospectively followed the subjects. 27.1% to 38% of participants have met any of Rome's criteria for gastrointestinal syndromes, of those 20.8% presented two or more FGID. Infant regurgitation and functional constipation were the most common FGID, ranging from less than 1% to 25.9% and less than 1% to 31%, respectively. Most included studies were of moderate to poor data quality with respect to absence of confidential interval for prevalence rate and inadequate sampling methods.CONCLUSION: The scarcity and heterogeneity of FGID data call for the necessity of well-designed epidemiological research in different levels of pediatric practice and refinement of diagnostic.

Valproic acid therapy decreases serum 25-hydroxyvitamin D level in female infants and toddlers with epilepsy-a pilot longitudinal study

To evaluate if valproic acid(VPA)therapy is associated with vitamin D deficiency among infants and toddlers with epilepsy,a cross-sectional clinical study was conducted in 25 children with epilepsy taking VPA.Blood levels of calcium,phosphorus,alkaline phosphatase,and 25-hydroxy vitamin D[25(OH)D]and plasma VPA level were measured at 1-to 3-month intervals.At the initial and final measurements,vitamin D deficiency or insufficiency was recognized in 8(32%)and 12(42%),respectively.In girls,a decreasing trend in serum25(OH)D levels(P<0.05)was observed.Polytherapy had a significant negative effect on the longitudinal change of 25(OH)D(P<0.05)in girls.In conclusion,our study indicates that a high proportion of girls after VPA therapy had hypovitaminosis D.

Toddlers’ choice:Yo-Yoing diabetes control or deci-unit insulin dosing?

While the incidence of toddlers’ diabetes is soaring,their mainstay insulins were withdrawn,namely the weak 10% or 20% insulin mixtures (WIM),which were injected only once or twice daily.Consequently,toddlers are coerced to use an insulin pump,multi-dose insulin regime (MuDIR),mix or dilute insulins.This paper highlights the difficulties and proposes a simple solution.While an insulin pump is the best available option,it is not readily available for everyone.Mixing insulins is not sufficiently precise in small doses.Although diluting insulin would allow precise dosing and reduce the dose variability secondary to dribbling after injections,it,like insulin mixing,deprives children from using the pen and related child-friendly accessories.In MuDIR,we inject 4-5 small doses of insulin instead of 1-2 daily larger doses of WIM.Thus,on using a half unit (unit) insulin pen,a dose of 0.5,1,1.5 and 2 units are adjusted in steps of 100%,50%,33% or 25%;unlike the advisable 5%-20%.This does not easily match the tiny erratic meals of grazing toddlers.Maternal anxiety peaks on watching yo-yoing glycemia.Carers have to accept either persistently high sugar or wild fluctuation.The risks of such poor glycemic pattern are increasingly recognized.Using insulin U20 in a unit disposable pen allows deci-unit dosing,with 5%-20% dose-tuning,greater accuracy on delivering small doses and reduction of dose variability from dribbling.Deci-unit dosing may help avoid wide glycemic swings and provide the affordable alternative to insulin pumps for toddlers.Deci-unit pen materializes the Human Rights of Children,a safer and effective treatment.

Evaluation of Nutritional Habits of Obese Children in Toddler Period and Their Families

Toddler period is the period that nutritional habits are learnt. This research is a semi-analytical field research that was performed in doctors’ offices 1, 6 and 7 in the provincial center of Konya with the purpose of determining the socio-demographic characteristics of obese pre-school children and their families who volunteered to participate in the research. The cosmos of the research consists of 22 village clinics in Konya provincial center. Obese Cosmos consists of obese children between 1 - 3 years of age and their families who applied to outpatient clinics of the Doctors’ Offices numbered 1, 6 and 7, which were selected with cluster sampling method, for vaccination and who accepted to participate in the research. Data were collected between 01 January 2005 and 31 March 2005 by using a questionnaire and a form of anthropometric measures to enter the measures of height, weight, thickness of skin folds, and waist and hip size. The difference between the increase of weight of the mother during pregnancy and the non-categorized RW outputs of the child in birth was found to be statistically significant (p < 0.05). Variation analysis was performed in order to check whether or not there was a difference between the period of breastfeeding and Standart Deviation Score (SDS) and Relative Weight (RW) values and it was found to be significant (p < 0.05). No statically significant relationship was found between the time child spends watching TV daily and SDS and RW values of the child (p > 0.05). Although there was found no statically significant relationship between the daily play hours of the child and SDS (p > 0.05), there was a significant relationship between RW (p should spend more time playing with their children and increasing the play time. Informing booklets have been prepared and given to parents with the purpose of training.

Feeding Infants and Toddlers--An Intuitive and Simple Action,Is It?

Feeding infants and toddlers is a natural action that can at times be challenging.A chronic illness or a neurodevelopmental problem maybe the source of the initial difficulty.When feeding is also difficult for the parent,an additional component is present which may exacerbate the situation and require therapeutic intervention,including diagnosis and parental counseling.Integrative therapy is essential in the processes of diagnosis and treatment of infants and toddlers and parents with eating and feeding challenges.This is presented in the paper in four cases from the Feeding and Eating Clinic for infants and toddlers.

Radiological Estimation of Age from Hand Bone in Sudanese Infants and Toddlers

Age determination is one of the most important factors for identification. Unfortunately, births are not recorded regularly in Sudan, especially in rural areas. However, identification of age is very important for a variety of reasons, including identifying legal and criminal responsibility, and for many other social events such as beginning a job, marriage, retirement and joining the army. The study aimed to find the reliability of using international methods to estimate bone age of people through hand bone radiograph in Sudanese people by studying the reliability of using hand bone age “the digital atlas of hand age” which depended on Greulich and Pyle (GP) and Tanner and Whitehouse (TW2/3) methods in Sudanese people in exact group of age, and to compare the hand and wrist bone development between Caucasian and Sudanese people. The study was conducted on 48 samples (26 males and 22 females) from the center of Sudan. The study was made by conventional X-Ray taken from Sudanese newborn babies to 2 and 3 years old for males and females respectively. Those images were taken mostly from the emergency and orthopedic outpatient departments. The ages were grouped in the same ways and periods used in the atlas. So the criteria were tested, and the outcomes were compared with international standards in the atlas of hand bone age. There is evidence that skeletal maturation may vary between difference ethnic and socioeconomic groups of children or among children living in various geographical locations. It is found that there is reliability and applicability of using the atlas in Sudanese people with considering that there might be mild variations between Sudanese and Caucasian people’s hand and wrist bone development in which Caucasian people bone growth was earlier than the Sudanese people bones about 1 - 2 months.

Combined music and play therapy resolves chronic toddler sleep issues: a case report

In this article,the author reports on her clients'case study using a play and music therapy intervention to improve family sleep and resolve chronic toddler sleep issues.The author/composer developed a systemised approach,which has been highly successful since the initial trial in 2010 on her toddler,which had infant sleep issues.Using a three steps approach consisting of routine and'filial therapy',re-connection and lullaby lyrics,and ending with relaxation the instrument component of the music therapy intervention,children and parents enjoy improved bonding,less anxiety,improved sleep outcomes and better health.

上海市儿童福利机构孤残婴幼儿依恋类型测试的必要性探讨TheexplorationaboutthenecessityofattachmenttestingoftheabandonedinfantsandtoddlersinShanghaichildren^welfareinstitution

本文概述了婴幼儿及儿奄依恋类型研究中常用的研究方法，进一步具体分析影响儿童福利机构依恋类型测试的影响因素，并提出儿童福利机构内孤残婴幼儿依恋类型测试的相关建汉及措施。

福利多元主义视角下婴幼儿家庭教育指导实践的国际经验与启示

福利多元主义理论认为,当社会福利和服务通过多主体供给时,有利于增强服务供给体系的可持续性。基于福利多元主义理论,选取美国、英国、澳大利亚、新加坡四国18个家庭教育指导项目为研究对象,从理念目标、组织制度、指导方式、指导内容、指导人员和效果评估六个方面分析四国通过多元主体开展婴幼儿家庭教育指导的实践路径。对我国家庭教育指导实践的启示为:树立全面服务理念,关注处境不利婴幼儿家庭;推动多元参与,构建参与式伙伴关系与全面的社会支持网络;采用多元指导策略,发挥数字资源的指导潜能;提升指导内容科学性,增强层级性和可及性;完善资格认证,促进指导队伍多元化构成;整合自我评估与外部评估,提升家庭教育指导质量。

家庭养育环境对高危儿18月龄神经精神发育的影响分析

目的分析家庭养育环境对新生儿重症监护室(NICU)出院的高危儿18月龄时神经精神发育的影响,为改善家庭养育环境、促进高危儿的早期发展提供依据。方法选取2019年1月至2022年1月期间出生并在本院高危儿随访门诊进行系统管理的高危儿,采用家庭养育环境问卷和Gesell量表,评估高危儿家庭养育环境和高危儿18月龄发育商,并分析与发育迟缓的关系。结果共纳入243名高危儿,18月龄时语言能发育迟缓率最高(46.91%),其次为应物能(39.51%)。研究对象家庭养育环境“良好”占56.8%,“中等”占41.6%,“不良”占1.6%。家庭养育环境为“良好”的高危儿,全面发育迟缓率降低13.2%(χ^(2)=4.193,P=0.041)。与家庭养育环境“良好”的高危儿相比,家庭养育环境为“中等/不良”的高危儿,18月龄出现全面发育迟缓的风险增加至2.04倍(OR=2.04,95%CI:1.13~3.69,P=0.018),粗大运动发育迟缓风险增加至4.95倍(OR=4.95,95%CI:1.65~14.89,P=0.004),精细运动发育迟缓风险增加至2.63倍(OR=2.63,95%CI:1.30~5.31,P=0.007),言语能发育迟缓风险增加至2.19倍(OR=2.19,95%CI:1.23~3.89,P=0.008)。结论NICU出院的高危儿在语言能、应物能等方面的发育迟缓发生率高于正常婴幼儿。非良好的家庭养育环境是高危儿出现神经精神发育迟缓的危险因素。高危儿早期干预应重视家庭养育环境这一可干预因素,通过定期评估和持续改善,促进高危儿获得良好的神经发育结局。

当代西方国家三种类型婴幼儿托育服务模式比较与启示

丹麦学者安德森根据对政府、家庭、市场三者关系的不同理解,将西方资本主义国家的社会福利制度划分为社会民主主义、保守社团主义和自由主义三种类型。通过比较三种类型下各典型国家婴幼儿托育服务模式的特点、运行机制、配套政策与实施效果,基于其有益经验并结合我国具体国情,提出以下政策建议:推进精准施策,精简管理架构;强化家庭经济支持,广纳社会力量;改进时间政策效能,倡导灵活休假。

Parental behaviors and sleep/wake patterns of infants and toddlers in Hong Kong, China

Background:To describe the sleep patterns of children below 36 months in Hong Kong,and evaluate the associations between parental behaviors and childhood sleep/wake patterns.Methods:Parents of 1049 infants and toddlers completed an internet-based expanded version of the Brief Infant Sleep Questionnaire.Results:Total sleep duration (P<0.001),frequency (P<0.001) and duration (P<0.001) of nocturnal awakenings decreased with age,whereas the longest sleep duration (P<0.001) and nocturnal sleep duration (P<0.001) increased with age.Children who room-or bed-shared with parents had later bedtimes (P<0.001),but similar sleep duration compared with those who had a separate sleep location.Falling asleep independently was associated with longer nocturnal sleep duration (P<0.001) and less sleep awakenings (P<0.001).Full-time employment of parents was associated with shorter total sleep duration of children (P<0.001).Although breastfeeding was associated with more nocturnal awakenings (P<0.001),no association was detected between breastfeeding and shorter sleep duration in children.Conclusions:As infants and toddlers develop,their sleep consolidates.Falling asleep independently was associated with longer nocturnal sleep duration and fewer sleep awakenings,whereas sleep location was not.This is an important finding,especially for families with limited living space where parent/ child room-or bed-sharing cannot be avoided.

婴幼儿食品中有益菌功能及安全性分析

目的:从市售婴幼儿食品中分离筛选益生菌并分析其功能特性和安全性。方法:对30份市售婴幼儿食品进行益生菌分离鉴定,结合体外培养和动物实验,分析分离菌株的存活率、功能特性及安全性。结果:从30份市售婴幼儿食品中分离鉴定出4株优势菌株,包括2株植物乳杆菌(LP-01、LP-02)和2株乳双歧杆菌(BL-01、BL-02)。其中以LP-01菌株表现最佳,在4℃条件下储存6个月的存活率最高;在人工胃液中3 h存活率为85.2%±2.1%;抑菌圈直径为(15.2±0.8)mm,表现出良好的耐受性和抗菌性。同时,添加LP-01可显著提高小鼠肠道屏障功能。安全性实验表明,LP-01在10^(10) CFU·kg^(-1) bw的剂量下,无不良健康效应;除LP-02对四环素和BL-01对红霉素表现出耐药性外,其他菌株对所测试的8种抗生素均敏感,且未检出任何可转移抗性基因。结论:本研究可为建立益生菌安全评估体系和质量控制标准,以及益生菌在婴幼儿食品中的应用提供科学依据。

Toddler Found Safe in Bear's Den After 3 Days

这是一条来自德黑兰的消息。笔者曾经在东北插队落户时,在原始森林中遇见过一只熊瞎子。这场“遭遇”至今余悸不去。今在网上读到此文。真是百感交集!消息只有三四句话。却诉说了一个有惊无险的美丽故事:熊妈妈喂养婴儿!

幼儿父母家庭赋能量表的汉化及信效度检验

目的对日文版幼儿父母家庭赋能量表进行汉化,并检验其信效度。方法获得量表原作者授权,采用Brislin双人翻译-回译法,对日文版量表进行翻译、回译、整合、文化调适及预调查,形成中文版量表。应用中文版幼儿父母家庭赋能量表对539名幼儿父母进行调查,检验量表的信效度。结果中文版幼儿父母家庭赋能量表包括家庭关系、育儿的自我效能感、与当地社区间的联系、父母角色成就感、育儿服务的认知和有效利用5个维度共24个条目,量表的条目水平的内容效度指数为0.857~1.000,量表水平的平均内容效度指数为0.907;探索性因子分析提取出5个公因子,累计方差贡献率为74.956%;验证性因子分析结果显示,χ^(2)/df=1.486,RMSEA=0.048,NFI=0.941,IFI=0.980,TLI=0.977,CFI=0.980,GFI=0.869,AGFI=0.838,整体模型拟合度可接受。量表的Cronbach′sα系数为0.946,各维度的Cronbach′sα系数为0.908~0.949;量表折半信度为0.801。结论中文版幼儿父母家庭赋能量表具有较好的信效度,可以作为幼儿父母家庭赋能筛查的测评工具。

牙科全麻技术在不同阶段低龄儿童牙科治疗中的应用

目的:分析婴幼儿及学龄前两个阶段牙科全麻技术(DGA)应用的临床效果。方法:收集牙科治疗中需要进行全身麻醉的儿童647例,按照年龄段分为两组。婴幼儿组(3岁以下)135例,学龄前组(3~6岁)512例,分析其性别、年龄、合并疾病、就诊原因、治疗牙数、治疗内容、治疗时间、麻醉效果及术后并发症情况。结果:总中位数年龄47(38~56)月,并发其他疾病者占比32.25%,两组间比较无统计学差异(P>0.05)。就诊原因主要为疼痛和猛性龋,组间比较有统计学差异(均P<0.05)。治疗牙数中位数14(12~16)颗,治疗时间中位数110(95~130)min,婴幼儿组均低于学龄前组(均P<0.05)。治疗内容包括窝沟封闭、拔牙、充填治疗和牙髓治疗,组间比较有统计学差异(均P<0.05)。麻醉效果评价为优者占比96.91%,组间比较无统计学差异(P>0.05)。术后婴幼儿组烦躁比例高于学龄前组(P<0.05),但口渴、进食困难发生率低于对照组(均P<0.05)。结论:3岁以下婴幼儿较3~6岁学龄前儿童DGA下治疗牙数量更少,时间更短,虽然术后烦躁发生率较高,但是疼痛、口渴和进食困难发生率更低。对于3岁以下婴幼儿牙科疾病,DGA技术是较为安全、高效的解决办法。

淮安市218批婴幼儿食品中蜡样芽胞杆菌毒力基因检测和耐药性分析

目的 了解淮安市婴幼儿食品中蜡样芽胞杆菌污染现状及其对药物敏感、主要毒力基因携带情况。方法2022~2023年抽取淮安市七个县区的婴幼儿奶粉及婴幼儿辅助食品共218批,根据GB4789.14-2014《食品安全国家标准食品微生物学检验蜡样芽胞杆菌检验》蜡样芽胞杆菌平板计数法(第一法)进行检测,并进行药物敏感性试验,采用荧光定量PCR对检出的蜡样芽胞杆菌进行溶血性(hblC)基因、非溶血性基因(nheB)、呕吐毒素基因(ces)检测。结果 218批婴幼儿食品中蜡样芽胞杆菌检出39批次,检出率达17.89%。在23种药物敏感性试验中,蜡样芽胞杆菌对庆大霉素、阿米卡星、替考拉宁、万古霉素、氯霉素、利奈唑胺、呋喃妥因、利福平、左氧氟沙星、莫西沙星、诺氟沙星敏感率100%,对环丙沙星、米诺环素、四环素、红霉素、克林霉素、莫匹罗星高浓度、复方新诺明、苯唑西林敏感率分别为97.44%、92.31%、89.74%、82.05%、38.46%、23.08%、20.51%、5.13%,对达托霉素非敏感,对头孢洛林、氨苄西林、青霉素全部耐药。溶血性hblC基因携带率高达100%,非溶血性基因nheB携带率为58.97%,本次试验未检出呕吐毒素基因ces。结论 婴幼儿食品蜡样芽孢杆菌检出率较高且检出菌中携带至少一种毒力基因的概率高达100%。对头孢洛林、氨苄西林、青霉素全部耐药,对达托霉素、苯唑西林等药物敏感性差,可为临床用药方案提供指导。