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.

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.

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.

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.

Exploration of the Talent Cultivation Path of New Higher Vocational Compound Childcare Integration

With the continuous development of society,people’s concept of early childhood education is also gradually upgrading.In the report of the 19th National Congress of the Communist Party of China(CPC),“childcare”is listed as one of the seven national key livelihood tasks,and the model of“integration of childcare and early childhood”is gradually being widely used in infant and toddler education.The application of this model not only promotes the development of infant and toddler education but also brings new challenges to the training of talents specialized in childcare in higher vocational colleges.Higher vocational colleges and universities should adjust the talent training mode according to the requirements of the childcare integration mode,so as to build a high-quality skilled personnel team and promote the further development of infant and toddler education.

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.

“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。

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.

Health care experiences in infancy and subsequent frequent illness in 1-year-old children

Background: Parents of infants suffering from frequent episodes of illness demand more acknowledgement from general practice with regard to their observations of these illnesses, which is evident from their tendency to book multiple consultations. Aim: To identify factors relating to illness and health-care experiences in infancy that predict frequent episodes of illness in toddlers. Design of study: A retrospective questionnaire and a prospective diary study including 183 infants born in February 2001 in a district of the capital region of Denmark. Setting: Denmark, primary care. Methods: Infants were recruited from a birth cohort and experiences of illness from birth until the age of 11 months were collected using a questionnaire. Thereafter the infants were followed prospectively from the age of 11 to 14 months using diary cards. The diary data consisted of 1) selected symptoms, 2) doctor-contacts and 3) parent-rated illness severity, information used to form three aspects of a frequently ill child. The analyses explore associations from the infant data with the three indicators of frequent illness. Results: Experiences of restless sleep, earache, otitis media, penicillin usage and use of medicine associated with illness in infancy were highly associated with factors of excess illness during the follow up period. Disturbed sleep in infancy was the factor with the highest probability of frequent illness as a toddler—an unexpected finding. Experiences of acute otitis media (earache, frequent visits to the doctor and antibiotic treatment) were strongly related to frequent illnesses. Asthma or giving the child medicine correlated with a higher parent-rated frequency of illness later on. Conclusions: Sleep problems in infancy can predict frequent illness episodes later on. In clinical practice the GP may benefit from talking about sleep in the consultations in order to learn something more. The three different indicators of frequent illness applied to different aspects of being a frequently ill child.

婴儿选择: Yo-Yoing 糖尿病控制或十分之一单位胰岛素 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.

A Theory-Based Dietary Intervention for Overweight, Postpartum Mothers and Their Children Improves Maternal Vegetable Intake

Objective: To evaluate the effectiveness of a dietary intervention to increase target vegetable intake in overweight, postpartum mothers;and their children. Methods: Overweight mothers attending their six-week postpartum follow-up visit and their infants (n = 104 pairs) were randomized to intervention or usual care groups during the time period 2008-2011. Mothers received four 60 minute education sessions with a nutrition professional and eight monthly follow-up phone calls. Counseling began at the obstetrician office and continued at the regularly scheduled pediatric visits. The primary study outcome was the change in maternal target vegetable intake. Secondary outcomes included child target vegetable intake and whether child vegetable intake was modified by exposure to breastfeeding. Mother/child energy intake and weight indices were also assessed. Outcomes were measured at baseline (6-weeks postpartum), 6, 12 (post-intervention), and 18 (follow-up) months. Mixed-effects models were used to estimate the impact of the dietary intervention on study outcomes relative to usual care. Results: Mothers randomized to the intervention had greater consumption of target vegetables at 6, 12 and 18 months (P P P = 0.03, respectively). There were no differences between groups in maternal energy intake, body mass index, or child target vegetable or energy intake. The child’s target vegetable intake at 12 months was related to the mother’s intake at 6 months (P = 0.03), however, this relationship was not modified by exposure to breastfeeding. Conclusion: A dietary intervention targeting the diet of the mother/child dyad resulted in improved maternal vegetable intake.

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.

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!