Developmental Milestones

Hungry for nutrition information: Undergraduate students' engagement with nutrition social media nutrition content

Background: Social media is a fast-changing, normalized way through which youth access health and nutrition information. Yet, social media content that lacks expertise or altruistic motives can negatively impact this vulnerable population through mis- or disinformation. Aim: The aims of this study were to 1) assess how adolescents and young adults engage with nutrition information across social media platforms and account types, and 2) describe their preferences for nutrition social media content. Methods: We conducted an exploratory mixed methods study with 57 undergraduate students enrolled in an introductory public health nutrition course. First, we calculated descriptive statistics on close-ended survey data on social media use and sociodemographic variables. Then, we performed thematic analysis on open-ended survey data regarding social media use, preferences, and experiences. Results: The median age of participants was 20 years old; 70% of participants identified as female and 11% identified as male. We found that TikTok and Instagram were highly preferred by participants for weight loss, wellness, diet promotion, and sports and fitness topics. In general, participants reported wanting personalized content that conveys positive nutrition messages that are supported by credible expertise. Conclusion: These findings suggest that the nutrition community can engage adolescents and young adults by presenting information as image- and video-based content on social media. Social media content related to weight loss, wellness, diet promotion, and sports and fitness topics should establish credibility using visible markers and embrace body positive messaging for maximum uptake.

Childhood Developmental Milestones and Risk of Adult Cerebrovascular Disease: The Northern Finland Birth Cohort 1966

INTRODUCTION

To the best of our knowledge, no previous studies have examined the relationship between childhood developmental milestones and risk of adulthood cerebrovascular disease (CeVD). We studied whether the risk of adult CeVD is associated with delayed attainment of motor and language milestones.

METHODS

Within the Northern Finland Birth Cohort 1966, a total of 11,688 persons were followed from birth to either death, moving abroad or 54 years of age. CeVD diagnoses, i.e., ischemic and hemorrhagic strokes and transient ischemic attacks, were extracted from national registers with diagnostic coding based on recommendations of the World Health Organization. Cox proportional hazard models stratified by sex were used to estimate associations of motor development and language milestones between ages 0 and 4 years and adult CeVD women-to-men relative hazard ratios (RHRs) were estimated for each developmental milestone. Analyses were adjusted for family socioeconomic status and birth weight for gestational age.

RESULTS

Altogether 498 (4.3%) CeVDs were recorded during follow-up. Among both sexes, later turning from back to tummy was associated with ischemic CeVD in adulthood with an adjusted hazard ratio (aHR) of 1.25 and 95% confidence interval (CI) 1.06-1.46 for men and an aHR: 1.20 (CI: 1.02-1.42) for women per 1 month delay in achievement. Delayed overall motor development, modeled by motor milestone principal component score, was related to increased risk of ischemic CeVD (aHR: 1.50; CI: 1.03-2.19) among men. Later achievement of making sounds was associated with any CeVD (aHR: 2.74; CI: 1.39-5.40) and especially ischemic CeVD (aHR: 3.41; CI: 1.65-7.06) among men with women-to-men RHR's of 0.17 (95% CI: 0.04-0.81) for any CeVD and RHR 0.18 (95% CI: 0.04-0.89) for ischemic stroke indicating risk to be lower in women compared to men.

CONCLUSIONS

These findings suggest that later achievement of childhood milestones could be a predictor for development of CeVD risk. The results point toward a common neurodevelopmental background and could in part explain lifetime CeVD risk accumulation.

Expanded phenotypic spectrum of neurodevelopmental and neurodegenerative disorder Bryant-Li-Bhoj syndrome with 38 additional individuals

Bryant-Li-Bhoj syndrome (BLBS), which became OMIM-classified in 2022 (OMIM: 619720, 619721), is caused by germline variants in the two genes that encode histone H3.3 (H3-3A/H3F3A and H3-3B/H3F3B) [1-4]. This syndrome is characterized by developmental delay/intellectual disability, craniofacial anomalies, hyper/hypotonia, and abnormal neuroimaging [1, 5]. BLBS was initially categorized as a progressive neurodegenerative syndrome caused by de novo heterozygous variants in either H3-3A or H3-3B [1-4]. Here, we analyze the data of the 58 previously published individuals along 38 unpublished, unrelated individuals. In this larger cohort of 96 people, we identify causative missense, synonymous, and stop-loss variants. We also expand upon the phenotypic characterization by elaborating on the neurodevelopmental component of BLBS. Notably, phenotypic heterogeneity was present even amongst individuals harboring the same variant. To explore the complex phenotypic variation in this expanded cohort, the relationships between syndromic phenotypes with three variables of interest were interrogated: sex, gene containing the causative variant, and variant location in the H3.3 protein. While specific genotype-phenotype correlations have not been conclusively delineated, the results presented here suggest that the location of the variants within the H3.3 protein and the affected gene (H3-3A or H3-3B) contribute more to the severity of distinct phenotypes than sex. Since these variables do not account for all BLBS phenotypic variability, these findings suggest that additional factors may play a role in modifying the phenotypes of affected individuals. Histones are poised at the interface of genetics and epigenetics, highlighting the potential role for gene-environment interactions and the importance of future research.

Exposure to prenatal infection and the development of internalizing and externalizing problems in children: a longitudinal population-based study

BACKGROUND

A large body of work has reported a link between prenatal exposure to infection and increased psychiatric risk in offspring. However, studies to date have focused primarily on exposure to severe prenatal infections and/or individual psychiatric diagnoses in clinical samples, typically measured at single time points, and without accounting for important genetic and environmental confounders. In this study, we investigated whether exposure to common infections during pregnancy is prospectively associated with repeatedly assessed child psychiatric symptoms in a large population-based study.

METHODS

Our study was embedded in a prospective pregnancy cohort (Generation R; n = 3,598 mother-child dyads). We constructed a comprehensive prenatal infection score comprising common infections for each trimester of pregnancy. Child total, internalizing, and externalizing problems were assessed repeatedly using the parent-rated Child Behavioral Checklist (average age: 1.5, 3, 6, 10, and 14 years). Linear mixed-effects models were run adjusting for a range of confounders, including child polygenic scores for psychopathology, maternal chronic illness, birth complications, and infections during childhood. We also investigated trimester-specific effects and child sex as a potential moderator.

RESULTS

Prenatal exposure to infections was associated with higher child total, internalizing, and externalizing problems, showing temporally persistent effects, even after adjusting for important genetic and environmental confounders. We found no evidence that prenatal infections were associated with changes in child psychiatric symptoms over time. Moreover, in our trimester-specific analysis, we did not find evidence of significant timing effects of prenatal infection on child psychiatric symptoms. No interactions with child sex were identified.

CONCLUSIONS

Our research adds to evidence that common prenatal infections may be a risk factor for psychiatric symptoms in children. We also extend previous findings by showing that these associations are present early on, and that rather than changing over time, they persist into adolescence. However, unmeasured confounding may still explain in part these associations. In the future, employing more advanced causal inference designs will be crucial to establishing the degree to which these effects are causal.

Developmental outcomes of children born through ICSI versus conventional IVF (cIVF) in couples with non-male factor infertility

STUDY QUESTION

In non-male factor infertile couples, are there any differences in the developmental outcomes between children born through ICSI and conventional IVF (cIVF)?

SUMMARY ANSWER

In this preliminary study, ICSI and cIVF seem to have a comparable effect on developmental outcomes after 12 months in children born to non-male factor infertile couples.

WHAT IS KNOWN ALREADY

ICSI, an invasive technique, has raised concerns about potential developmental abnormalities in children. Limited data are available regarding the developmental outcomes of ICSI-conceived infants born to non-male factor infertile couples.

STUDY DESIGN, SIZE, DURATION

This prospective cohort study involved a follow-up of all children aged 12 months or older who were born from pregnancies resulting from either ICSI or cIVF as part of a previous randomized controlled trial (RCT) (NCT03428919).

PARTICIPANTS/MATERIALS, SETTING, METHODS

In the original RCT, 1064 women were randomly assigned to the ICSI or cIVF groups (532 women for each group). Follow-up was conducted with 155 couples (195 children) in the ICSI group and 141 couples (185 children) in the cIVF group. The Vietnamese version of the Ages & Stages Third Edition Questionnaires (ASQ-3) and the Development Red Flags questionnaires were completed by the participants. A total of 141 (90.1%) women (177 children) in the ICSI group and 113 (80.1%) women (145 children) in the cIVF group returned fully completed questionnaires. The primary outcomes were the developmental outcomes based on responses to the ASQ-3 and the Red Flags questionnaire.

MAIN RESULTS AND THE ROLE OF CHANCE

The mean age of children at follow-up was 19.5 ± 5.0 months in the ICSI group and 19.3 ± 5.5 months in the cIVF group. The mean height and weight of children in both groups were similar. The overall proportion of children with any abnormal ASQ-3 score did not differ significantly between the ICSI and cIVF groups (16.9% vs 13.1%, P = 0.34). The proportion of children with Red Flag signs was also comparable between the two groups (6.2% vs 9.2%, P = 0.36, ICSI vs cIVF, respectively).

LIMITATIONS, REASONS FOR CAUTION

Despite a reasonably high follow-up response rate, there is a potential risk of sampling bias, and overall, the number of children with developmental abnormalities was very small. The study relied solely on questionnaires as screening tools, rather than incorporating additional behavioral observations or physical developmental tests; this may have affected the statistical power and the significance of between-group comparisons.

WIDER IMPLICATIONS OF THE FINDINGS

The current findings contribute to the existing evidence and support the comparative safety of ICSI and cIVF regarding early childhood development. However, more extensive and prolonged follow-up data for these children are needed to draw definitive conclusions.

STUDY FUNDING/COMPETING INTEREST(S)

No external funding was received for this study, and no authors reported conflicting interests.

TRIAL REGISTRATION NUMBER

NCT04866524 (clinicaltrials.gov).

Infant neurodevelopment during the COVID-19 pandemic: Associations with maternal pandemic-related experiences, parenting stress, and self-efficacy

BACKGROUND

Although pandemic-related experiences have been linked to the psychological well-being of mothers, the effects of the COVID-19 pandemic on infant neurodevelopmental outcomes have not been sufficiently studied.

AIMS

To assess whether maternal COVID-19-related experiences (i.e., COVID-19-related health, risk, resource worries, and feelings of grief), parenting stress, and maternal self-efficacy are associated with infant neurodevelopment as measured by the Ages and Stages Questionnaire, Third Edition (ASQ-3) maternal report when infants were between 8 to 10 months of age. Furthermore, this study examined the moderating effect of maternal self-efficacy between maternal COVID-19-related experiences and infant neurodevelopment.

METHODS

This cross-sectional study included 122 women who were drawn from the Perinatal Experiences and COVID-19 Effects (PEACE) Study, with online surveys administered between November 2020 and August 2022.

RESULTS

After controlling for maternal anxiety and depression symptoms and demographic factors, hierarchical regression analysis indicated that parenting stress showed no effect on ASQ-3 scores. However, more adverse COVID-19-related experiences and higher levels of maternal self-efficacy were associated with better infant neurodevelopment. Moreover, there was a significant interaction effect between maternal self-efficacy and COVID-19-related experiences on infant neurodevelopment. For mothers with moderate to high levels of self-efficacy, more adverse COVID-19-related experiences were associated with better infant neurodevelopment. For mothers with low levels of self-efficacy, more adverse COVID-19-related experiences were associated with poorer developmental outcomes in infants.

CONCLUSIONS

Under adverse conditions, confidence in caregiving may afford more optimal infant neurodevelopment. Interventions aimed at fostering maternal self-efficacy and addressing specific stressors can be valuable in promoting positive developmental trajectories for infants born during the pandemic.

Association of Screen Time Exposure With Autism Spectrum Disorder in Four to Six-Year-Old Children in Arar City, Saudi Arabia

Background Autism spectrum disorder (ASD) is a psychopathologic disorder caused by several factors. The early signs include poor interaction and communication, delayed milestones, and repeated behavior patterns. This study aimed to assess the relationship between screen time and ASD severity and investigate the types of electronic devices associated with ASD in children aged four to six years in Arar City, Kingdom of Saudi Arabia (KSA). Methodology A cross-sectional study was conducted in primary healthcare centers (PHCs) in Arar City, KSA. The study enrolled all parents with children aged four to six years attending the PHCs in Arar City, KSA. Results The total sample size was 199 participants. Regarding the relationship between screen time exposure and ASD, there were variable screen time exposure durations, with 22.6% of children exposed for less than an hour, 30.7% for one to two hours, and 46.7% for more than two hours. Moreover, the type of electronic devices to which children were exposed varied, with smartphones being the most prevalent (68.3%). In terms of the age of children since exposure to electronic devices, the data indicated that 30.2% were exposed before the age of two, 35.2% between two and three years, and 34.7% after three years of age. Regarding the relationship with sociodemographic characteristics, there was a statistically significant relationship with the mother's age at birth (p = 0.050), mother's education level (p = 0.009), father's education level (p = 0.049), whether the child was suffering from any chronic or neurological disease (p = 0.008), age since the child was exposed to electronic devices (p = 0.049), and screen time exposure duration (p = 0.040). Conclusions The study highlights the significant association between screen time exposure and the development of ASD in children. Public awareness of this associated risk among caregivers is recommended to follow the protective guidelines. Further research and interventions are needed to better understand and address the impact of screen media use on children's neurodevelopment and overall well-being.

Building a maternal and child cohort amidst Lebanon's socioeconomic collapse: preliminary results and navigating research challenges

The impact of conflict and crisis on maternal and child health underscores the need for reliable research in vulnerable populations. Lebanon, amidst ongoing economic collapse, political instability, and healthcare system strain, offers a case study for exploring these impacts, particularly on preterm babies and their development. This study aims to assess the feasibility of establishing a prospective cohort of mothers and their full-term and preterm babies in Lebanon, examining the association between social determinants, preterm birth, and developmental outcomes amidst the nation's multifaceted crises. The planned cohort involves 50 full-term and 50 preterm mother-baby pairs recruited at birth and followed up to 9-12 months post-birth. Data collection spans social determinants, perceived stress, social support, quality of life, and developmental assessments. Challenges in recruitment, follow-up, and data collection in the context of Lebanon's socio-political and economic turmoil are evaluated, alongside ethical considerations for research in vulnerable populations. Preliminary findings highlight substantial recruitment and follow-up challenges, notably due to population mobility, economic instability, and healthcare access issues. Despite these obstacles, 113 mother-baby pairs have been recruited. Early analysis reveals significant stress and reduced quality of life among mothers, particularly those with preterm infants, against a backdrop of declining birth rates and healthcare worker exodus. Conducting research in crisis settings like Lebanon presents unique methodological and ethical challenges but remains crucial for understanding and improving health outcomes in vulnerable populations. The study underscores the importance of adaptable research designs and ethical diligence in crisis research, highlighting the need for interventions tailored to these contexts. Establishing a mother and child cohort in Lebanon's crisis-ridden setting is faced with many challenges but is essential for guiding future interventions. Research in such contexts is needed to address health disparities and supporting vulnerable populations, emphasizing the need for dedicated funding and innovative research approaches in times of crisis.

Neurodevelopment in the Congenital Heart Disease Population as Framed by the Life Course Health Development Framework

BACKGROUND

Adverse neurodevelopment is a common comorbidity associated with congenital heart disease (CHD). The consequences of adverse neurodevelopment are seen across the life course. The cause of adverse neurodevelopment is multifactorial, and use of a life course perspective can assist with understanding and enhancing neurodevelopment in individuals with CHD.

PURPOSE

The purposes of this article are to (1) apply the Life Course Health Development framework to neurodevelopment in the population with CHD and (2) discuss how exposure to the pediatric cardiac intensive care unit (PCICU) environment during infancy is a point of intervention for improving neurodevelopmental outcomes.

CONCLUSION

Individuals with CHD are at an increased risk for adverse neurodevelopment across the life course. The PCICU environment is a point of intervention for improving neurodevelopmental outcomes. Stress can lead to changes in brain structure and function that are associated with negative outcomes in terms of outward behavioral and functional capacity, and the PCICU environment is a source of stressful stimuli. Infancy is a period of rapid brain growth, and the brain is more susceptible to stress during this period of the life course, putting infants receiving care in the PCICU at an increased risk of adverse neurodevelopment.

CLINICAL IMPLICATIONS

Interventions to support optimal neurodevelopment should focus on the PCICU environment during infancy. Developmentally supportive care models should be explored as a means of modifying the PCICU environment. In addition, more research is needed on the relationship between the PCICU and neurodevelopment. The conceptual model introduced can serve as a starting point for this research.

Stability of developmental milestones: Insights from a 44-year analysis

Using standardized test procedures is a reliable way of assessing early childhood development in the pediatric setting. However, normal population's developmental parameters may change over time. The aim of this study was to determine whether a change of developmental percentiles is present in infants in Germany during recent decades. Measured by an established German diagnostic instrument (Münchener Funktionelle Entwicklungsdiagnostik) we cross-sectionally compared developmental data (cognition, expressive language, language comprehension, fine and gross motor skills, social development, daily-living skills) of children aged 0-36 months collected in the 1970s and in 2018. N = 2065 children and their parents were included (1970s sample: N = 1660 and 2018 sample: N = 405). The T-Test of dependent variables showed nonsignificant differences in the developmental scales. We hypothesized an infant Flynn effect, but the results of this study suggest that there are no developmental changes associated with the 50th percentile. Nevertheless, it is critical to emphasize the need for periodic revision and re-norming of developmental test procedures, even in the absence of significant changes in individual items.

Physical, oral, and swallowing functions of three patients with type a xeroderma pigmentosum: a report of three cases

BACKGROUND

Xeroderma pigmentosum (XP) is an extremely rare and severe form of photosensitivity. It is classified into types A-G or V according to the gene responsible for the disease. The progression and severity of symptoms vary depending on the type. Although dysphagia caused by decreased swallowing function and dental malposition due to stenosis of the dentition in the facial and oral regions is common, it has not been reported in detail. We report three cases of type A XP, in which central and peripheral neurological symptoms appeared early on and progressed rapidly. We describe the oral function of these patients, focusing on the swallowing function and dentition malposition.

CASE PRESENTATION

Two males (27 and 25 years old) and one female (28 years old) presented with diverse neurological symptoms. We focused on the relationship between the changes in swallowing and oral functions and conditions due to decline in physical function. Some effects were observed by addressing the decline in swallowing and oral functions. In particular, a dental approach to manage the narrowing of the dentition, which was observed in all three patients, improved the swallowing and oral functions and maintained the current status of these functions.

CONCLUSIONS

In type A XP, early decline in oral and swallowing functions is caused by the early decline in physical function, and it is necessary to monitor the condition at an early stage.

Assessing specific items of Indian VSMS: Perspective of medical and rehabilitation professionals

Background

Adaptive behavior plays a crucial role in daily functioning, involving a complex interplay between individuals and their environment. In India, the Vineland Social Maturity Scale (VSMS) has been the preferred assessment tool for measuring adaptive behaviors, despite its age of over 85 years. However, periodic evaluation is necessary to ensure its continued relevance.

Aim

This study aims to critically evaluate selected items of the Indian version of the VSMS.

Materials and Methods

A survey form was developed through a focus group discussion (FGD), comprising 20 items from the Indian adaptation of the VSMS. The form was converted into a Google Form and distributed to medical and rehabilitation specialists across India. The responses were collected, recorded, and analyzed in an Excel sheet.

Results

Of the 107 responses received, 14 were incomplete and excluded, leaving 93 complete for analysis. The analysis revealed that less than half of the surveyed items and domains received ratings of disagreement from over a quarter of the respondents concerning their frequency, relevance, and diagnostic value.

Conclusion

This study underscores the need for a dynamic approach to defining and assessing adaptive behavior, especially in the Indian context. It highlights the importance of revising existing scales, incorporating technology-related items, and considering societal and cultural norms shifts. While acknowledging its limitations, this research sets the stage for future investigations to gain a more nuanced understanding of adaptive behaviors amidst changing societal dynamics. Ultimately, these efforts aim to develop more comprehensive and relevant assessment tools for adaptive behavior in today's rapidly evolving world.

Prenatal exposure to social adversity and infant cortisol in the first year of life

Exposure to social adversity has been associated with cortisol dysregulation during pregnancy and in later childhood; less is known about how prenatal exposure to social stressors affects postnatal cortisol of infants. In a secondary analysis of data from a longitudinal study, we tested whether a pregnant woman's reports of social adversity during the third trimester were associated with their infant's resting cortisol at 1, 6, and 12 months postnatal. Our hypothesis was that prenatal exposure to social adversity would be associated with elevation of infants' cortisol. Measures included prenatal survey reports of social stressors and economic hardship, and resting cortisol levels determined from infant saliva samples acquired at each postnatal timepoint. Data were analyzed using linear mixed effects models. The final sample included 189 women and their infants (46.56% assigned female sex at birth). Prenatal economic hardship was significantly associated with infant cortisol at 6 months postnatal; reports of social stressors were not significantly associated with cortisol at any time point. Factors associated with hardship, such as psychological distress or nutritional deficiencies, may alter fetal HPA axis development, resulting in elevated infant cortisol levels. Developmental changes unique to 6 months of age may explain effects at this timepoint. More work is needed to better comprehend the complex pre- and post-natal physiologic and behavioral factors that affect infant HPA axis development and function, and the modifying role of environmental exposures.

Visit to the Dentist for Oral Health Prevention at "Age One": A proposed policy report from the Indian perspective

Early childhood caries is a major public health issue in India. The primary reason for poor oral health in children is a lack of awareness about the role of primary teeth and the importance of an early dental visit for infants and toddlers. The primary objectives of an early dental visit are to analyze the child's risk level, provide guidance to parents regarding proper oral hygiene measures, review dietary and eating habits, provide information regarding the infectivity of dental caries, review the risks of traumatic injuries and discuss factors which affect the development of occlusion. Through this paper, we are proposing an "Age One" policy that recognizes dentists, physicians, allied health professionals, community health-care workers, and nongovernmental organizations to work toward a child's overall health as partners to achieve this goal. The expectation is that this policy will provide guidance to childcare centers, pediatric dentists, other health-care professionals, and legislators regarding oral health activities and the promotion of oral health in infants. The purpose of the policy is to lay the foundation for a lifetime of preventive education and dental care, to help ensure optimal oral health beginning in childhood and continuing through the life course.

Increased rates of unattained developmental milestones among Israeli children between 2016 and 2020: a national report

BACKGROUND

The early years of children's lives are critical for their healthy development. Although children's growth and development rates may vary, a significant delay during early childhood could indicate a medical or a developmental disorder. Developmental surveillance is used worldwide by healthcare providers in routine encounters, as well as by educators and parents, to elicit concerns about child development. In this work, we used a national dataset of developmental assessments to describe temporal trends of milestone attainment rates and associations between milestone attainment and various sociodemographic factors.

METHODS

The study included 1,002,700 children ages birth until 6 years with 4,441,689 developmental visits between the years 2016 and 2020. We used the Israeli developmental scale to assess the annual rates of failure to attain language, social and motoric milestones by the entire population, as well as by subgroups stratified by sociodemographic factors. In addition, we evaluated the rates of parental concern for child development and of the nurse's report of development inadequate for age. We used multivariable logistic regression to analyze the impact of different sociodemographic factors on the odds of failure to attain milestones, while controlling for confounding.

RESULTS

Milestone failure rates progressively increased over the examined years in all developmental domains, and most prominently in the language domain. Conversely, the rates of parental concern for developmental delay remained constant. In multivariable analysis, higher risk of milestone attainment failure was observed in children whose mothers were divorced, unemployed, immigrant, had lower education, of Bedouin origin or were over 40 years old when giving birth.

CONCLUSIONS

This report describes national trends of child development in the gross motor, fine motor, language, and social domains. A periodic report of these trends should be published to objectively evaluate subgroups in need for intervention, and to assess the effectiveness of intervention programs in attempt to maximize the developmental potential of children in Israel.

Clinical Characteristics of Neurocysticercosis in a Peruvian Population-Based Epilepsy Cohort: A Descriptive Cross-Sectional Study of Baseline Clinical Intake

(1) Background: This study presents the baseline characteristics of a community-level population of people with epilepsy (n = 1975) living in an area endemic for Taenia solium, the pathogen responsible for neurocysticercosis (NCC). (2) Methods: Participants were sequentially enrolled in a clinical cohort from 2007 to 2020 in Tumbes, Peru. All participants provided demographic and clinical history and received clinical evaluations. Diagnostics, including neuroimaging, cysticercosis serologies, and EEG, were obtained where possible. The data presented are from the cross-sectional baseline assessment of cohort participants. (3) Results: Approximately 38% of participants met the criteria for NCC. Those with NCC were more likely to have adult-onset epilepsy, as well as a longer duration of epilepsy, as compared to their counterparts without NCC. Overall, the data indicate a large treatment gap, with only approximately a quarter of the baseline population with prescriptions for anti-seizure medications. (4) Conclusions: These data reveal a high proportion of NCC among people living with epilepsy in these communities, with limited health care resources. At baseline, 74% of the population were not receiving anti-seizure treatments. Further analyses of these data will clarify the natural history of the disease for this population.

Bridging the Gap: Parents' Knowledge of Childhood Developmental Milestones and the Early Identification of Children With Developmental Delay

Background Monitoring children's acquisition of developmental milestones is integral to pediatric practice. Though pediatricians are responsible for evaluating children's development, parents have a crucial role in addressing delays as early as possible, where early detection of developmental delay can help in early intervention and ultimately potentiate a child's cognitive and social abilities toward an independent life. This study assesses parental knowledge of the warning signs denoting delayed developmental milestone acquisition, in addition to analyzing demographic variables that may influence their level of knowledge. Methods This cross-sectional study included 376 parents of children attending pediatric clinics in National Guard Health Affairs- King Abdulaziz Medical City, in Jeddah, Saudi Arabia. A two-section structured questionnaire was utilized. It included 16 option-based questions with one correct answer, while the other options were either an under or overestimate of the age at which the child should acquire a particularly significant milestone development across different domains. A score of 10 out of 16 was chosen as the minimum to show the appropriate level of knowledge. Results Most participants (n=282; 75%) were women, and 174 (46.27%) were between 29 and 39 years old. The highest reported level of education was college or higher (n=214; 56.91%). Only 41 (11%) parents had the required level of knowledge, while the remaining 335 (89%) fell short of meeting the passing level (mean 6.59, SD= 2.72). The motor domain had the highest level of accuracy, followed closely behind the cognitive domain. The language and social domains exhibited lower levels of accuracy. Conclusions Despite the majority of parents in this group possessing a college education and availing multiple health resources, there is a significant gap in their knowledge of typical trajectories of development milestones. Thus, there is a need for a nationwide initiative to promote the parent's proactive role in monitoring their children's growth.

The Role of Human Milk Oligosaccharides in Myelination, Socio-Emotional and Language Development: Observational Data from Breast-Fed Infants in the United States of America

Infancy is a critical period for neurodevelopment, which includes myelination, synaptogenesis, synaptic pruning, and the development of motor, social-emotional, and cognitive functions. Human milk provides essential nutrients to the infant's developing brain, especially during the first postnatal months. Human milk oligosaccharides (HMOs) are a major component of human milk, and there is growing evidence of the association of individual HMOs with cognitive development in early life. However, to our knowledge, no study has explained these associations with a mechanism of action. Here, we investigated possible mediating associations between HMOs in human milk, brain myelination (measured via myelin water fraction), and measures of motor, language (collected via the Bayley Scales of Infant and Toddler Development (Bayley-III)), and socioemotional development (collected via the Ages and Stages Questionnaire: Social-Emotional Version (ASQ-SE)) in healthy term-born breast-fed infants. The results revealed an association between 6'Sialyllactose and social skills that was mediated by myelination. Furthermore, associations of fucosylated HMOs with language outcomes were observed that were not mediated by myelination. These observations indicate the roles of specific HMOs in neurodevelopment and associated functional outcomes, such as social-emotional function and language development.

Impact of a Nutrient Formulation on Longitudinal Myelination, Cognition, and Behavior from Birth to 2 Years: A Randomized Clinical Trial

Observation studies suggest differences in myelination in relation to differences in early life nutrition. This two-center randomized controlled trial investigates the effect of a 12-month nutritional intervention on longitudinal changes in myelination, cognition, and behavior. Eighty-one full-term, neurotypical infants were randomized into an investigational (N = 42) or a control group (N = 39), receiving higher versus lower levels of a blend of nutrients. Non-randomized breastfed infants (N = 108) served as a reference group. Main outcomes were myelination (MRI), neurodevelopment (Bayley-III), social-emotional development (ASQ:SE-2), infant and toddler behavior (IBQ-R and TBAQ), and infant sleep (BISQ) during the first 2 years of life. The full analysis set comprised N = 67 infants from the randomized groups, with 81 myelin-sensitive MRI sequences. Significantly higher myelination was observed in the investigational compared to the control group at 6, 12, 18, and 24 months of life, as well as significantly higher gray matter volume at 24 months, a reduced number of night awakenings at 6 months, increased day sleep at 12 months, and reduced social fearfulness at 24 months. The results suggest that brain development may be modifiable with brain- and age-relevant nutritional approaches in healthy infants and young children, which may be foundational for later learning outcomes.

4D dynamic system for visual-motor integration analysis

It is very important to evaluate visual-motor integration (VMI), as it is used as an index to evaluate cognitive abilities. However, it is difficult to use the existing paper-based tests to evaluate the dynamic process, including spatial and depth perception abilities. Therefore, this study aims to extract kinematic and dynamic features for dynamic assessment for VMI. We propose a 4D dynamic analysis system that implements a VMI test in a virtual space using Leap motion controller and Unity3D and acquires the time-series data of hand joints and traces. We selected three categories of features: postural control ability, spatial and depth perception ability, and 4D analysis. The degree and patterns of postural maintenance differed between subjects in the VMI and MC tests. In addition, the personal patterns were identified with dynamic features, including their fluency and hesitation in relation to the task figures of the VMI test tool. As such, this system enables dynamic feature extraction and analysis which were previously impossible and presents performance results for healthy adults.

Beyond TORCH: A narrative review of the impact of antenatal and perinatal infections on the risk of disability

Infections and inflammation during pregnancy or early life can alter child neurodevelopment and increase the risk for structural brain abnormalities and mental health disorders. There is strong evidence that TORCH infections (i.e., Treponema pallidum, Toxoplasma gondii, rubella virus, cytomegalovirus, herpes virus) alter fetal neurodevelopment across multiple developmental domains and contribute to motor and cognitive disabilities. However, the impact of a broader range of viral and bacterial infections on fetal development and disability is less well understood. We performed a literature review of human studies to identify gaps in the link between maternal infections, inflammation, and several neurodevelopmental domains. We found strong and moderate evidence respectively for a higher risk of motor and cognitive delays and disabilities in offspring exposed to a range of non-TORCH pathogens during fetal life. In contrast, there is little evidence for an increased risk of language and sensory disabilities. While guidelines for TORCH infection prevention during pregnancy are common, further consideration for prevention of non-TORCH infections during pregnancy for fetal neuroprotection may be warranted.

Developmental Outcomes Following Abusive Head Trauma in Infancy: A Systematic Review

OBJECTIVE

A systematic review of the literature was conducted to identify measures used to evaluate developmental outcomes after abusive head trauma (AHT), as well as describe outcomes among those with AHT, and explore factors and interventions influencing such outcomes.

DESIGN

This systematic review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The protocol is in PROSPERO, registration number CRD42020179592. On April 17, 2020, OVID Medline, Embase, OVID PsycINFO, Web of Science, CINAHL, Cochrane Library, and Google Scholar were searched (since inception). Inclusion criteria included original, peer-reviewed study data; AHT exposure; infants younger than 24 months at time of AHT; and evaluation of developmental outcomes. Reviewers independently evaluated studies for inclusion and assessed risk of bias using the Effective Public Health Practice Project quality assessment tool for quantitative studies. A descriptive synthesis approach was utilized as variability of study designs, follow-up periods, and outcome assessment tools precluded a meta-analytic approach.

RESULTS

Fifty-nine studies were included; 115 assessment tools were used to evaluate developmental outcomes; and 42 studies examined factors influencing outcomes. Two studies evaluated interventions. Five percent of studies ( n = 3) were rated low risk of bias.

CONCLUSIONS

Notable variation was observed in terms of case ascertainment criteria. Developmental outcomes after AHT have been assessed in a manner that limits understanding of how AHT impacts development, as well as the efficacy of interventions intended to improve outcomes. Researchers and clinicians are encouraged to adopt consistent diagnostic and assessment approaches.

International Consensus Statement on the Radiological Screening of Contact Children in the Context of Suspected Child Physical Abuse

Importance

Physical abuse is a common but preventable cause of long-term childhood morbidity and mortality. Despite the strong association between abuse in an index child and abuse in contact children, there is no guidance outlining how to screen the latter, significantly more vulnerable group, for abusive injuries. Consequently, the radiological assessment of contact children is often omitted, or variably performed, allowing occult injuries to go undetected and increasing the risk of further abuse.

Objective

To report an evidence-based and consensus-derived set of best practices for the radiological screening of contact children in the context of suspected child physical abuse.

Evidence Review

This consensus statement is supported by a systematic review of the literature and the clinical opinion of an internationally recognized group of 26 experts. The modified Delphi consensus process comprised 3 meetings of the International Consensus Group on Contact Screening in Suspected Child Physical Abuse held between February and June 2021.

Findings

Contacts are defined as the asymptomatic siblings, cohabiting children, or children under the same care as an index child with suspected child physical abuse. All contact children should undergo a thorough physical examination and a history elicited prior to imaging. Contact children younger than 12 months should have neuroimaging, the preferred modality for which is magnetic resonance imaging, and skeletal survey. Contact children aged 12 to 24 months should undergo skeletal survey. No routine imaging is indicated in asymptomatic children older than 24 months. Follow-up skeletal survey with limited views should be performed if abnormal or equivocal at presentation. Contacts with positive findings should be investigated as an index child.

Conclusions and Relevance

This Special Communication reports consensus recommendations for the radiological screening of contact children in the context of suspected child physical abuse, establishing a recognized baseline for the stringent evaluation of these at-risk children and providing clinicians with a more resilient platform from which to advocate for them.

Sex Differences in Autism: Examining Intrinsic and Extrinsic Factors in Children and Adolescents Enrolled in a National ASD Cohort

Discernment of possible sex-based variations in presentations of autism spectrum disorder (ASD) symptoms is limited by smaller female samples with ASD and confounds with ASD ascertainment. A large national cohort of individuals with autism, SPARK, allowed parent report data to be leveraged to examine whether intrinsic child characteristics and extrinsic factors differentially impact males and females with ASD. Small but consistent sex differences in individuals with ASD emerged related to both intrinsic and extrinsic factors, with different markers for males and females. Language concerns in males may make discernment of ASD more straightforward, while early motor concerns in females may hamper diagnosis as such delays are not identified within traditional ASD diagnostic criteria.

Clinical Manifestations and Outcomes of 20 Korean Hypochondroplasia Patients with the FGFR3 N540K variant

BACKGROUND

Hypochondroplasia is a skeletal dysplasia caused by activating pathologic variants of FGFR3. The N540K variant accounts for 60-70% of reported cases and is associated with severe manifestations. Here, we analyze the clinical manifestations and outcomes of Korean patients with hypochondroplasia harboring the FGFR3 N540K variant.

METHODS

Medical records of 20 unrelated patients with genetically confirmed N540K-related hypochondroplasia were retrospectively reviewed. All individuals were diagnosed with hypochondroplasia by Sanger sequencing for FGFR3, or target-panel sequencing for skeletal dysplasia. The effectiveness of growth hormone therapy was analyzed in 16 patients treated with growth hormones.

RESULTS

Among 20 patients (7 men, 13 women), the mean age at first visit was 3.5±1.0 years, and the mean follow-up duration was 6.8±0.6 years. The patients presented with a short stature and/or short limbs. Genu varum, macrocephaly, and developmental delay were observed in 11 (55.0%), 9 (45.0%), and 5 (25.0%) patients, respectively. Of the 12 patients who underwent neuroimaging, five (41.7%) showed abnormal findings (one required operation for obstructive hydrocephalus). Among 16 growth-hormone-treated patients (two were growth-hormone deficient), the increase in height standard deviation scores was significant after a mean 5.4±0.7 years of treatment (+0.6 and+1.8 using growth references for healthy controls and achondroplasia children, respectively). Four patients underwent surgical limb lengthening at a mean age of 8.8±3.3 years.

CONCLUSIONS

Neurodevelopmental abnormalities are frequently observed in patients with N540K-related hypochondroplasia. Close monitoring of skeletal manifestations and neurodevelopmental status is necessary for hypochondroplasia.

Acquisition of cognitive and communication milestones in infants with Down syndrome

BACKGROUND

Understanding the timing of developmental milestones in typical and clinical populations facilitates intervention planning and the early detection of risk for co-occurring conditions. Normative timing of developmental milestone achievement has been established for typically developing children. However, there is little information regarding the timing of cognitive and communication skill acquisition in young children with Down syndrome (DS). The objectives of this study are to (1) provide foundational information regarding the timing of cognitive and communication skill acquisition in infants with DS and (2) facilitate the early identification of infants with risk for co-occurring conditions.

METHOD

Seventy-four infants with DS (age range: 4-18 months) completed the Bayley Scales of Infant Development-III (Bayley 2006). Individual items from the cognitive and communication scales were selected for analysis. Parents provided information regarding their infant's developmental and family history.

RESULTS

The percentage of infants who attained each skill was calculated within 2-month age bands. For infants who did not show skill acquisition within each age band, the rates of prematurity, heart defects, corrective heart surgery and significant illness were calculated as well.

CONCLUSIONS

This study provides foundational information that can contribute to the formulation of a developmental schedule for cognitive and language milestone acquisition in infants with DS.

Cognitive Development

Cognitive development in children begins with brain development. Early life exposures may both positively and negatively influence cognitive development in children. Infants, toddlers, and children learn best in secure, nurturing environments and when attachment to a consistent caregiver is present. Pediatricians can screen for both social determinants of health and developmental milestones at office visits to address barriers to care and promote positive cognitive and learning outcomes. Pediatricians may model developmental stimulation during office visits to talk with an infant/child, asking questions of a child, singing and pointing to pictures in books, and modeling responsive listening. Pediatricians may support caregivers to talk with their children, read to their children, and avoid/reduce screen time. Pediatricians can help point caregivers to resources for parent training, Head Start, and quality preschool programs. School readiness has both pre-academic and socioemotional components and can have long-term effects on a child's school success, health, and quality of life. School readiness depends on both the child and the caregiver being ready for school, taking into account caregiver and child health and mental health and child cognitive development.

Assessing the Attainment Rates of Updated CDC Milestones Using a New Israeli Developmental Scale

OBJECTIVES

Developmental milestones norms are widely used worldwide and are fundamental for early childhood developmental surveillance. We compared a new Israeli evidence-based national developmental scale with the recently updated Centers for Disease Control and Prevention (CDC) checklists.

METHODS

We used a cohort of nearly 4.5 million developmental assessments of 758 300 full-term born children aged 0 to 6 years (ALL-FT cohort), who visited maternal child health clinics in Israel for routine developmental surveillance. Among the assessed milestones of 4 developmental domains (gross motor, fine motor, language, and personal-social) we identified milestones that had equivalents on the CDC checklists and assessed the attainment rates of the Israeli children at the ages recommended by the CDC, at which ≥75% of the children would be expected to achieve the milestone. The analysis was repeated on a subgroup of 658 958 children who were considered healthy, typically developing by their birth and growth characteristics (NORMAL-FT cohort).

RESULTS

There were 29 milestones, across all developmental domains and assessment ages, whose definitions by both tools were compatible, and could be compared. The attainment rate at the CDC-recommended age was >90% for 22 (76%) and 23 (79%) milestones, and the median attainment rates were 95.2% and 96.3% in the ALL-FT and NORMAL-FT cohorts, respectively.

CONCLUSIONS

For almost all comparable milestones of all domains and all ages, children of the Israeli cohorts achieved the milestones earlier than expected by the CDC-defined threshold age. Evidence-based analysis of milestone norms among different populations may enable adjustments of developmental scales and facilitate more personalized developmental surveillance.

COL1A1 novel splice variant in osteogenesis imperfecta and splicing variants review: A case report

Background

Osteogenesis imperfecta (OI) is a rare heterogeneous genetic disorder commonly autosomal dominant with variants in the COL1A1 and COL1A2 genes. It is characterized by bone fragility and deformity, recurrent fractures, blue sclera, dentinogenesis imperfecta, short stature, and progressive deafness.

Case presentation

We present a novel splicing mutation in the COL1A1 gene (c.2398-1G > C) in a 6-year-old Ecuadorian girl with fractures after light pressure and blue sclera. We identified the pathogenic variant, performed a literature review of splice variants, and recognized their location in the COL1A1 functional domains.

Conclusion

We describe the first clinical description of a patient with OI type 1 caused by a splice variant in intron 34 of COL1A1 gene and identify that most of them are localized in the triple-helical region domain. We suggest that the splice variant in signal peptide, von Willebrand factor type C, and nonhelical regions maintain their functionality or that individuals affected with severe cases die early in development and are not reported.

Development of children born after in vitro maturation with a prematuration step versus natural conception: a prospective cohort study

PURPOSE

IVM preceded by a prematuration step (capacitation [CAPA]-IVM) improves the acquisition of oocyte developmental competence and can enhance embryo quality. There is currently no follow-up data on babies born from CAPA-IVM. This study investigated developmental outcomes in children born after CAPA-IVM versus natural conception.

METHODS

This prospective cohort study was conducted at a fertility clinic in Vietnam in August/September 2019. Children born after CAPA-IVM were propensity score-matched with those born after natural conception. All parents were asked to complete the Developmental Red Flags and Ages & Stages Third Edition (ASQ-3) questionnaires.

RESULTS

A total of 46 parents (23 in each group) of 55 babies (31 CAPA-IVM and 24 natural conception) were included in the study. Baseline characteristics, including mother's age and body mass index, gestational age at delivery, and birth weight, were comparable. The mean age of children at the end of follow-up was 15 months. The overall proportion of children with any abnormal ASQ-3 score was 6.5% in the CAPA-IVM group and 20.8% in the natural conception group (p = 0.24). The proportion of children with a developmental red flag did not differ significantly between the CAPA-IVM and natural conception groups (9.7% vs. 4.2%; p = 0.80).

CONCLUSIONS

The use of CAPA-IVM did not have any significant impact on childhood physical and mental development compared with children born as a result of natural conception.

Secular trends in early motor development between 1980 and 2010 in Japan

OBJECTIVE

Recent changes in birth characteristics in Japan may have a potential influence on children's developments. Therefore, we investigated secular trends in gross motor milestones.

DESIGN

Data were collected from an official Japanese nationwide serial cross-sectional survey conducted every 10 years since 1960. 22 320 participants aged 2-18 months were identified from the four surveys from 1980 to 2010.

OUTCOMES

We assessed whether or not a child achieved four gross motor milestones including rolling over (rolling), sitting without support (sitting), standing with support (standing) and walking alone (walking). The target age was defined as the age when the attainment rate ranged from >5% to >95% of the total. Multivariate logistic regression models were fitted.

RESULTS

The final cohort included 20 570 children. The target ages were determined as follows: 3-6 months for rolling; 5-9 months for sitting; 6-11 months for standing; and 9-15 months for walking. The attainment rates of sitting, standing and walking in 1990 were higher than those in 2010, even after adjusting for child characteristics (sitting: adjusted OR (aOR)=2.07 (95% CI 1.62 to 2.65); standing: aOR=1.63 (95% CI 1.32 to 2.02); and walking: aOR=1.61 (95% CI 1.34 to 1.95)).

CONCLUSIONS

The proportion of children who attained three motor milestones (sitting, standing and walking) by set target ages decreased between 1990 and 2010. The contribution of birth characteristics including a decrease in gestational age and fetal growth, as well as changes in other child characteristics, failed to explain why this decrease occurred.

Evidence-Informed Milestones for Developmental Surveillance Tools

The Centers for Disease Control and Prevention's (CDC) Learn the Signs. Act Early. program, funded the American Academy of Pediatrics (AAP) to convene an expert working group to revise its developmental surveillance checklists. The goals of the group were to identify evidence-informed milestones to include in CDC checklists, clarify when most children can be expected to reach a milestone (to discourage a wait-and-see approach), and support clinical judgment regarding screening between recommended ages. Subject matter experts identified by the AAP established 11 criteria for CDC milestone checklists, including using milestones most children (≥75%) would be expected to achieve by specific health supervision visit ages and those that are easily observed in natural settings. A database of normative data for individual milestones, common screening and evaluation tools, and published clinical opinion was created to inform revisions. Application of the criteria established by the AAP working group and adding milestones for the 15- and 30-month health supervision visits resulted in a 26.4% reduction and 40.9% replacement of previous CDC milestones. One third of the retained milestones were transferred to different ages; 67.7% of those transferred were moved to older ages. Approximately 80% of the final milestones had normative data from ≥1 sources. Social-emotional and cognitive milestones had the least normative data. These criteria and revised checklists can be used to support developmental surveillance, clinical judgment regarding additional developmental screening, and research in developmental surveillance processes. Gaps in developmental data were identified particularly for social-emotional and cognitive milestones.

Standardization of a Developmental Milestone Scale Using Data From Children in Israel

IMPORTANCE

Routine developmental screening tests for children are used worldwide for early detection of developmental delays. However, assessment of developmental milestone norms lacks strong normative data, and there are inconsistencies among different screening tools.

OBJECTIVE

To establish milestone norms and build an updated developmental scale.

DESIGN, SETTING, AND PARTICIPANTS

This is a cross-sectional, population-based study conducted between 2014 and 2020. Developmental assessments were conducted by trained public health nurses, documented in national maternal child health clinics, known as Tipat Halav, which serve all children in Israel. Participants included all children born between January 2014 and September 2020, who were followed at the maternal child health clinics from birth to age 6 years. Exclusion criteria were preterm birth, missing gestational age, low birth weight (<2.5 kg), abnormal weight measurement (<3% according to standardized child growth charts), abnormal head circumference measurement (<3% or >97% according to standardized child growth charts), and visits without developmental data or without the child's age. Data analysis was performed from September 2020 to June 2021.

EXPOSURES

In total, 59 milestones in 4 developmental domains were evaluated, and the achievement rate per child's age was calculated for each milestone.

MAIN OUTCOMES AND MEASURES

A contemporary developmental scale, the Tipat Halav Israel Screening (THIS) Developmental Scale, was built, presenting the 75%, 90%, and 95% achievement rates for each milestone. The THIS scale was compared with other commonly used screening tests, including the Denver Developmental Screening Test II (Denver II), the Alberta Infant Motor Scale (AIMS), and the Centers for Disease Control and Prevention (CDC) Developmental Assessment.

RESULTS

A total of 839 574 children were followed in the maternal child health clinics between January 2014 and September 2020 in Israel, and 195 616 children were excluded. A total of 3 774 517 developmental assessments were performed for the remaining 643 958 children aged 0 to 6 years (319 562 female children [49.6%]), resulting in the establishment of new developmental norms. In terms of the comparable milestones, THIS milestones had a match of 18 of 27 (67%) with the Denver II, 7 of 7 (100%) with AIMS, and 10 of 19 (53%) with the CDC Developmental Assessment. The remaining unmatched milestones were achieved earlier in the THIS scale compared with other screening tools.

CONCLUSIONS AND RELEVANCE

The THIS developmental scale is based on the largest population evaluated to date for developmental performance, representing the heterogeneous, multicultural population comprising this cohort. It is recommended for further evaluation worldwide.

Metabolic proteins at birth predict early childhood mental health symptoms

Child mental health disorders are the leading cause of disability in children and adolescents worldwide. Biological correlates predict psychosocial outcomes throughout human development; however, less is known about metabolic proteins. Drawing from a longitudinal birth cohort study, Born in Bradford (BiB), we examined the role of infant metabolic proteins at birth in predicting early childhood mental health symptoms at 3 and 5 years. We found that higher leptin predicted more prosocial behavior at age 3. Additionally, a higher leptin-to-adiponectin ratio predicted increased total symptom difficulties. At age 5, we found that higher adiponectin predicted a decreased likelihood of being rated by teachers as meeting or exceeding expectations in the domain of "managing feelings and behaviors" and marginally predicted lower competency in "making relationships" on national developmental milestone evaluations. To our knowledge, this is among the first few studies to prospectively predict mental health symptoms from cord blood metabolic proteins, and the first examining this association with a leptin-to-adiponectin ratio. Our results provide support for the possibility that metabolic proteins at birth forecast risk for mental health symptoms in early childhood.

Clinical Presentation of Toddlers With New Intracranial Space-Occupying Lesions: A Case Series

OBJECTIVE

Intracranial space occupying lesions (ICSOLs) like tumors and abscesses can be life-threatening conditions. It can be especially difficult to diagnose these conditions in toddlers. We aimed to describe symptoms and signs present in a sample of toddlers with ICSOLs.

METHODS

We performed a retrospective chart review of 15 toddlers with intracranial tumors, abscesses, or infected cysts. We collected data on the presence of various signs and symptoms on presentation to the emergency department.

RESULTS

Eight toddlers (53%) presented with vomiting. A change in behavior was the second most common symptom (6, 40%). Seven children (47%) had motor weakness, and 5 (33%) had ataxia. Eleven of the 12 children with tumors (92%) had documented abnormal neurologic signs on initial physical examination.

CONCLUSIONS

Vomiting, a change in behavior, and an abnormal neurologic examination were common signs and symptoms in our sample of toddlers with ICSOLs. An accurate history and appropriate neurologic examination can help physicians make this challenging diagnosis in this age group.

Are pediatric surgery clinics LGBTQ+ inclusive?

PURPOSE

Creating inclusive LGBTQ+ environments is important in the provision of inclusive care. This cross sectional study assessed whether patient intake forms in pediatric surgery departments were LGBTQ+ inclusive (L-I).

METHODS

North American pediatric surgery departments affiliated with pediatric surgery fellowships or general surgery residencies were contacted to retrieve patient intake forms. Forms were assessed for LGBTQ+ inclusivity using a novel L-I scoring system consisting of 6 criteria: preferred name, pronouns, preferred language, gender identity, sex assigned at birth, and l-I guardianship. Institutions without intake forms were invited to comment on their use of l-I intake questions.

RESULTS

59/125 programs responded to our query, 10 of which provided intake forms. Median l-I score was 2/6 points (range 1-4). l-I guardianship was the most common question asked. No intake form asked for pronouns. Of the 49 institutions without forms, 30.5% reported asking l-I questions during initial visits. Narratives from these institutions varied widely. Some institutions supported routine l-I questions while others stated l-I questions were unnecessary, irrelevant, and/or offensive.

CONCLUSIONS

Few North American pediatric surgery departments consistently ask l-I questions during the intake process. Comments questioning the appropriateness and necessity of l-I questions highlight the need for LGBTQ+ education.

LEVEL OF EVIDENCE

Level III.

TYPE OF STUDY

Cross sectional study.

Case Report: Off-Label Liraglutide Use in Children With Wolfram Syndrome Type 1: Extensive Characterization of Four Patients

Aims: Wolfram syndrome type 1 is a rare recessive monogenic form of insulin-dependent diabetes mellitus with progressive neurodegeneration, poor prognosis, and no cure. Based on preclinical evidence we hypothesized that liraglutide, a glucagon-like peptide-1 receptor agonist, may be repurposed for the off-label treatment of Wolfram Syndrome type 1. We initiated an off-label treatment to investigate the safety, tolerability, and efficacy of liraglutide in pediatric patients with Wolfram Syndrome type 1. Methods: Pediatric patients with genetically confirmed Wolfram Syndrome type 1 were offered off-label treatment approved by The Regional Network Coordination Center for Rare Diseases, Pharmacological Research IRCCS Mario Negri, and the internal ethics committee. Four patients were enrolled; none refused nor were excluded or lost during follow-up. Liraglutide was administered as a daily subcutaneous injection. Starting dose was 0.3 mg/day. The dose was progressively increased as tolerated, up to the maximum dose of 1.8 mg/day. The primary outcome was evaluating the safety, tolerability, and efficacy of liraglutide in Wolfram Syndrome type 1 patients. Secondary endpoints were stabilization or improvement of C-peptide secretion as assessed by the mixed meal tolerance test. Exploratory endpoints were stabilization of neurological and neuro-ophthalmological degeneration, assessed by optical coherence tomography, electroretinogram, visual evoked potentials, and magnetic resonance imaging. Results: Four patients aged between 10 and 14 years at baseline were treated with liraglutide for 8-27 months. Liraglutide was well-tolerated: all patients reached and maintained the maximum dose, and none withdrew from the study. Only minor transient gastrointestinal symptoms were reported. No alterations in pancreatic enzymes, calcitonin, or thyroid hormones were observed. At the latest follow-up, the C-peptide area under the curve ranged from 81 to 171% of baseline. Time in range improved in two patients. Neuro-ophthalmological and neurophysiological disease parameters remained stable at the latest follow-up. Conclusions: We report preliminary data on the safety, tolerability, and efficacy of liraglutide in four pediatric patients with Wolfram Syndrome type 1. The apparent benefits both in terms of residual C-peptide secretion and neuro-ophthalmological disease progression warrant further studies on the repurposing of glucagon-like peptide-1 receptor agonists as disease-modifying agents for Wolfram Syndrome type 1.

Families' Perceptions of the Motor Development and Quality of Life of Their Children Aged 0-3 Years during Home Confinement Due to the COVID-19 Pandemic. A Descriptive Study

The child's interaction with the natural environment allows different learning opportunities and favors their motor development, which may be affected after a period of environmental deprivation, a consequence of home confinement due to the COVID-19 pandemic. The main objective of the study was to analyze the different areas of motor development, as well as the quality of life of children aged 0 to 3 years old after home confinement by COVID-19 and the possible correlation between both variables, and the influence of parental stimulation on motor development during this time of exclusive interaction with the immediate environment (home and family). A descriptive study was performed. A simple and anonymous questionnaire was created for parents of children between 0 and 3 years old who lived in Spain during the period of home confinement due to COVID-19 (March to June 2020). The measurement instrument used was a questionnaire made in "Google Forms", where the variables were collected: Motor development (measured through the Ages & Stages Questionnaire, ASQ3), Quality of life (assessed with the Pediatric Quality of Life Inventory, PedsQL) and other variables, such as stimulation, performed during home confinement. Eighty-eight questionnaires were validated. The highest score in the motor development domains were obtained in children 2-3 years old. The motor domain of children aged 2-3 years old that obtained the highest score was communication (M = 54.69 ± 10.03) and the highest score in the quality of life was obtained in children aged 0-1 years old (M = 85.47 ± 12.39), also acquiring the lowest score in the emotional domain in all age groups (0-1, 1-2 and 2-3 years old). The assessment of motor development and quality of life after home confinement due to the COVID-19 pandemic did not determine low values, so it would not have been affected during this period of lack of interaction with the natural environment. Emphasizing that the emotional aspect within quality of life was the lowest score, this indicates that children from 0 to 3 years old need more emotional support in situations of variability of daily routines and of family stress.

Did you say my name? Congruency of 12-month-old infants' behavioral and cardiac responses to name

Reduced orienting to name is an early behavioral risk marker for neurodevelopmental disorders. However, individual instances of infants' behavioral responses to name are limited in both reliability and predictive validity. Physiological responses such as heart rate (HR) deceleration may serve as more sensitive metrics than behavioral methods. As a first step toward validating HR deceleration as a candidate psychophysiological measure of name processing, we examined the congruency of behavioral and cardiac responses to name in 12-month-old typically developing infants. Infants exhibited greater median HR deceleration and spent a larger proportion of time in HR deceleration when they behaviorally oriented to their names than when they failed to do so; however, maximum HR deceleration was not related to behavioral responses. These findings provide preliminary evidence that specific HR deceleration metrics may be useful indices of infants' responses to name and may inform psychophysiological mechanisms underlying behavioral responses.

The Association Between Screen Time Exposure and Autism Spectrum Disorder-Like Symptoms in Children

Research problem Advances in technology have ensured its inevitable integration in our life. Children, being at a vulnerable age period of development, are spending more time on electronic devices. Some studies reported negative effects on sleep, physical health such as obesity and vision problems, and behavioral changes such as aggressive behavior with exposure to violent media content. Research significance We will study the effect of using electronic devices on communication skills in children in Saudi Arabia. Our findings can be used to raise awareness on this matter. Research objectives The aim of our study is to examine the association between screen time and social communication skills among children of four years to six years of age in Saudi Arabia. Research methodology A cross-sectional study was conducted to investigate the relationship between social skills development and screen time by using a validated Arabic version of the Social Communication Questionnaire (SCQ). The sample in this study consists of 308 children from four to six years of age. Research results The results showed that the hours spent using the electronic device were significantly associated with having an SCQ score ≥ 15 (P < 0.05). A high SCQ score was prevalent in 19.7% (n = 31) of children who spent >3 hours using an electronic device compared to 10.2% (n = 5) and 7.84% (n = 8) of children who spent an hour or <2 hours using electronic devices, respectively. Conclusion Our study highlighted a significant association between the daily hours spent on devices and having an SCQ score above 15, which suggests a deficit in social skill development and having autism spectrum disorder-like symptoms.

Connecting inside out: Development of the social brain in infants and toddlers with a focus on myelination as a marker of brain maturation

Early childhood is a sensitive period for learning and social skill development. The maturation of cerebral regions underlying social processing lays the foundation for later social‐emotional competence. This study explored myelin changes in social brain regions and their association with changes in parent‐rated social‐emotional development in a cohort of 129 children (64 females, 0–36 months, 77 White). Results reveal a steep increase in myelination throughout the social brain in the first 3 years of life that is significantly associated with social‐emotional development scores. These findings add knowledge to the emerging picture of social brain development by describing neural underpinnings of human social behavior. They can contribute to identifying age‐/stage‐appropriate early life factors in this developmental domain.

Systematic Review of Visual Motor Integration in Children with Developmental Disabilities

Original research articles regarding visual motor integration skills in children with developmental disabilities and the impact of occupational therapy were identified, appraised, and synthesized. Twenty-four articles were chosen for this review. Themes were noted during the critique of articles. Three themes emerged: "age," "gender," and "diagnosis." Regarding the impact on visual motor integration, there was strong evidence for age, moderate evidence for gender, and strong evidence for diagnosis. Future research investigating visual motor integration in children should control for age and diagnosis.

Gait Disorders

As a child matures so does the child's gait pattern. Gait changes in pediatric patients will be expected and sequential as developmental milestones. Gait changes may also represent normal variations along an appropriate spectrum. There are times when changes in gait are due to urgent orthopedic or medical conditions, and those should not be overlooked. A good understanding of pediatric gait development and a basic understanding of gait assessment are critical for the primary care physician who cares for children.

Pediatric opioid fatalities: What can we learn for prevention?

The aim of this study was to highlight 19 cases investigated by the North Carolina Office of the Chief Medical Examiner over the last 12 years involving accidental or undetermined manner of death opioid ingestions leading to fatalities in young children. These pediatric ingestions have closely mirrored the opioid epidemic in adults transitioning from prescription medications to illicit drugs including fentanyl and fentanyl analogues. Unlike a typical adult ingestion for purposes of self-harm or pleasure, poisonings in toddlers and infants are usually the result of curiosity, exploration, a decreased sense of danger, or imitation of adult or older sibling behavior. Eleven of the decedents were between the ages of 8 and 24 months. Among the cases were 12 prescription opioid exposure deaths and 7 illicit drug poisonings. A majority of the decedents were found unresponsive in an unkept home and/or in unsafe sleeping spaces with easy access to drugs or drug materials, which stresses the importance of safe pediatric sleeping conditions. After a complete pathological investigation, several of the cases had physical or scene evidence demonstrating that foil, plastic, or paper small enough to be ingested can contain enough potent opioid to cause death. Details from the toxicological investigation are included for each case to provide postmortem whole blood drug concentrations for forensic practitioners. Accidental pediatric poisonings are preventable. Risk reduction through improving awareness and education of the dangers of opioids is a key factor in mitigating these tragedies.

A Focus on the Cerebellum: From Embryogenesis to an Age-Related Clinical Perspective

The cerebellum and its functional multiplicity and heterogeneity have been objects of curiosity and interest since ancient times, giving rise to the urge to reveal its complexity. Since the first hypothesis of cerebellar mere role in motor tuning and coordination, much more has been continuously discovered about the cerebellum’s circuitry and functioning throughout centuries, leading to the currently accepted knowledge of its prominent involvement in cognitive, social, and behavioral areas. Particularly in childhood, the cerebellum may subserve several age-dependent functions, which might be compromised in several Central Nervous System pathologies. Overall, cerebellar damage may produce numerous signs and symptoms and determine a wide variety of neuropsychiatric impairments already during the evolutive age. Therefore, an early assessment in children would be desirable to address a prompt diagnosis and a proper intervention since the first months of life. Here we provide an overview of the cerebellum, retracing its morphology, histogenesis, and physiological functions, and finally outlining its involvement in typical and atypical development and the age-dependent patterns of cerebellar dysfunctions.

Housing environment and early childhood development in sub-Saharan Africa: A cross-sectional analysis

BACKGROUND

The influence of the safety and security of environments on early childhood development (ECD) has been under-explored. Although housing might be linked to ECD by affecting a child's health and a parent's ability to provide adequate care, only a few studies have examined this factor. We hypothesized that housing environment is associated with ECD in sub-Saharan Africa (SSA).

METHODS AND FINDINGS

From 92,433 children aged 36 to 59 months who participated in Multiple Indicator Cluster Survey (MICS) in 20 SSA countries, 88,271 were tested for cognitive and social-emotional development using the Early Childhood Development Index (ECDI) questionnaire and were thus included in this cross-sectional analysis. Children's mean age was 47.2 months, and 49.8% were girls. Children were considered developmentally on track in a certain domain if they failed no more than 1 ECDI item in that domain. In each country, we used conditional logistic regression models to estimate the association between improved housing (housing with finished building materials, improved drinking water, improved sanitation facilities, and sufficient living area) and children's cognitive and social-emotional development, accounting for contextual effects and socioeconomic factors. Estimates from each country were pooled using random-effects meta-analyses. Subgroup analyses were conducted by the child's gender, maternal education, and household wealth quintiles. On-track cognitive development was associated with improved housing (odds ratio [OR] = 1.15, 95% CI 1.06 to 1.24, p < 0.001), improved drinking water (OR = 1.07, 95% CI 1.00 to 1.14, p = 0.046), improved sanitation facilities (OR = 1.15, 95% CI 1.03 to 1.28, p = 0.014), and sufficient living area (OR = 1.06, 95% CI 1.01 to 1.10, p = 0.018). On-track social-emotional development was associated with improved housing only in girls (OR = 1.14, 95% CI 1.04 to 1.25, p = 0.006). The main limitations of this study included the cross-sectional nature of the datasets and the use of the ECDI, which lacks sensitivity to measure ECD outcomes.

CONCLUSIONS

In this study, we observed that improved housing was associated with on-track cognitive development and with on-track social-emotional development in girls. These findings suggest that housing improvement in SSA may be associated not only with benefits for children's physical health but also with broader aspects of healthy child development.

Attainment of smiling and walking in infancy associates with developmental delays at school entry in moderately-late preterm children: a community-based cohort study

Background

Moderately-late preterm (MLP) children (gestational age [GA] 32–36 weeks) are followed-up within community services, which often use developmental milestones as indicators of delay. We aimed to examine associations of parental report of smiling-age and walking-age with developmental delay upon school entry for MLP and full-term children.

Methods

This study regards a community-based cohort study, including 1241 children. Parent-reported smiling-age (n = 514) and walking-age (n = 1210) were recorded in preventive child healthcare. To determine developmental delay at school entry (at age 4) we used the Ages and Stages Questionnaire (ASQ) total and domain scores. We assessed the association of smiling-age and walking-age with dichotomized ASQ-scores, using logistic regression analyses.

Results

For MLP children, each week later corrected smiling-age was associated with a relative increased likelihood of delays of 31, 43, 36 and 35% in the personal-social, problem-solving, gross motor and general developmental functioning, respectively. Each month later corrected walking-age was associated with a relative increased likelihood of delays of 10, 15 and 13% in the personal-social, gross motor and general developmental functioning, respectively. All corrected smiling-ages and walking-ages were within normal full-term ranges. For full-term children, we only found that later walking-age was associated with delays in the personal-social and gross motor domains.

Conclusions

Smiling-age and walking-age are associated with developmental delay in several domains for MLP and full-term children. Professionals could use these milestones to identify children that may benefit from closer monitoring of their development.

Trial registration

Clinical Trial Registry name and registration number: controlled-trials.com, ISRCTN80622320.