Associations of dietary patterns with common infections and antibiotic use among Finnish preschoolers

Background

Preschoolers suffer frequently from infections. Although nutrition plays a key role in immune function, very little is known about the impact of overall diet on preschoolers' infections.

Objective

To assess the associations between dietary patterns, common infections and antibiotic use among Finnish preschoolers.

Design

The study included 721 3-6-year-old preschoolers participating in the cross-sectional DAGIS survey. Parents retrospectively reported the number of common colds, gastroenteritis episodes and antibiotic courses their children had acquired during the past year. Food consumption outside preschool hours was recorded using a food frequency questionnaire. Dietary patterns were derived from the consumption frequencies using principal component analysis. Associations between the thirds of the dietary pattern scores and the outcomes were analysed using logistic and negative binomial regression models.

Results

Prevalence of common colds was lower in moderate and high adherence to the sweets-and-treats pattern than in low adherence (prevalence ratio [PR]: 0.89, 95% confidence interval [CI]: 0.80-1.00, and PR: 0.88, 95% CI: 0.79-0.99, respectively) and higher in high adherence to the health-conscious pattern than in low adherence (PR: 1.13, 95% CI: 1.01-1.27) after adjusting for age, sex, number of children living in the same household, frequency of preschool attendance, family's highest education and probiotic use. The risk of ≥1 gastroenteritis episode and the prevalence of antibiotic courses were lower in moderate adherence to the sweets-and-treats pattern than in low adherence (odds ratio [OR]: 0.63, 95% CI: 0.44-0.92 and PR: 0.77, 95% CI: 0.59-1.00, respectively).

Conclusions

The results were unexpected. Parents who were most health-conscious of their children's diet might also have been more aware of their children's illness.

Child temperament is associated with energy intake and its day-to-day variability among preschoolers-Results from a cross-sectional DAGIS study

BACKGROUND

Although research has linked children's temperament with weight outcomes, the associations between temperament and dietary outcomes, particularly energy intake, remain understudied. Furthermore, little is known about how temperament is associated with diet in the early childhood education and care (ECEC) context, which is an important environment for many children.

OBJECTIVES

This study examined whether temperament is associated with mean energy intake and its day-to-day variability. In addition, the associations were examined separately in the contexts of home and ECEC.

METHODS

The study used data from 505 Finnish children from a cross-sectional DAGIS study conducted in 2015-2016. Parents reported their child's temperament with a questionnaire and food consumption with a food record for two weekdays (outside daycare hours) and one weekend day. Early educators at an ECEC centre reported the child's food consumption during the daycare hours on the same weekdays as the parents kept food records at home. Associations were examined with linear regression models.

RESULTS

Children with higher surgency had a higher mean daily energy intake. When examined separately at home and in the ECEC centre, the association was found only in the ECEC centre. Children with higher negative affectivity had greater day-to-day variability in energy intake. This association, however, was not observed when examined separately at home and at the ECEC centre.

CONCLUSIONS

The results indicate that temperament may shape children's energy intake. Moreover, the role of the ECEC context in children's eating may be different depending on a child's temperamental dispositions, which warrants further research.

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

AIM

This study investigated whether parental congruency regarding screen time (ST) is associated with ST in pre-school children. In addition, we investigated whether parental education levels moderated this relationship.

METHODS

A cross-sectional study was conducted in 2015-2016 in Finland (N = 688). Parents completed a questionnaire reporting their children's sedentary behaviour, their parental congruency regarding ST rules, and their educational level. Associations were examined using linear regression.

RESULTS

Children of parents with higher congruence regarding ST rules engaged in less ST, this was moderated by parental education levels. Children whose parents had a high level of education and parents' who strongly agree or somewhat agree on ST rules was negatively associated with ST. Furthermore, children whose parents had a medium level of education and parents' who strongly agree on ST rules was negatively associated with ST.

CONCLUSION

Children of parents who agree on ST rules engaged in less ST compared with children of parents who do not agree on ST rules. Providing advice to parents regarding parental congruency could be the focus of future interventions.

A Mobile App to Increase Fruit and Vegetable Acceptance Among Finnish and Polish Preschoolers: Randomized Trial

Background

Early childhood education and care (ECEC) centers are ideal venues for food education. As smartphones and tablets are becoming increasingly popular in ECEC centers, technology can be used to deliver such pedagogical content. Evidence suggests that video games can affect fruit and vegetable (FV) consumption among 9- to 12-year-old children, but studies among preschoolers are scarce.

Objective

This paper describes the development of the Mole’s Veggie Adventures app and its effectiveness in increasing FV acceptance among Finnish and Polish preschoolers aged 3 to 6 years.

Methods

A multiprofessional team created an app to be used in ECEC centers in groups of 3 to 10 children. The app aimed to increase vegetable acceptance, and it was built using elements that support the development of self-regulation and social skills. Altogether, 7 Finnish and 4 Polish ECEC centers participated in the study. Before randomization, parents reported background factors and their children’s willingness to taste different FVs. The ECEC professionals in the intervention arm were instructed to use the app at least once a week during the 3- to 4-week intervention period. The main outcomes in this unblinded, cluster-randomized study were FV acceptance and relative FV acceptance. The first was calculated as a sum variable describing the children’s willingness to taste 25 different FVs, the second as FV acceptance divided by the number of FVs served. We used analysis of covariance to compare the FV acceptance and relative FV acceptance scores between the intervention and control groups at follow-up.

Results

A total of 221 children were included in the analysis. At follow-up, the intervention group (115/221, 52%) had higher FV acceptance scores (baseline adjusted difference of mean 7.22; 95% CI 1.41-13.03) than the control group (106/221, 48%). The intervention effect was parallel for relative FV acceptance scores (baseline adjusted difference of mean 0.28; 95% CI 0.05-0.52).

Conclusions

The Mole’s Veggie Adventures app has the potential to increase FV acceptance among preschoolers and can be a valuable tool in supporting food education in ECEC centers. Furthermore, the app can be feasibly incorporated into preschool routines in countries with different educational environments.

Trial Registration

ClinicalTrials.gov NCT05173311; https://tinyurl.com/4vfbh283

Training Early Childhood Teachers to Support Children's Social and Emotional Learning: A Preliminary Evaluation of Roundies Program

(1) Background: Implementing social-emotional learning (SEL) programs in Early Childhood Education (ECE) settings is a promising approach that can strengthen overall development and well-being during childhood and into adolescence and adulthood. This study described the development, implementation, and preliminary evaluation of a universal SEL program, i.e., Roundies, in the Finnish ECE context to address the need for professional development opportunities. (2) Methods: The Roundies program was a quasi-experimental pre-test/post-test with intervention and control design. A total of 194 children were assigned to either the intervention group (n = 136) or control group (n = 58) (M_AGE = 60.35 months at pre-test; 48% boys). Teachers rated the children’s behaviors using the Strength and Difficulties Questionnaire (SDQ) at the pre-and post-test. (3) Results: Feedback collected by teachers on the program suggested that teachers were highly satisfied with the overall program and the components. Multilevel models showed significantly increased prosocial behaviors and reduced SDQ total difficulties in the intervention group compared to the control group. (4) Conclusions: These preliminary findings provide evidence of the effectiveness of the Roundies program in improving teachers’ capacity to support early SEL.

Associations between hair and salivary cortisol, salivary alpha-amylase, and temperament dimensions among 3-6-year-olds

Associations between hair cortisol concentration (HCC), diurnal salivary cortisol (sCort) and alpha-amylase (sAA), and temperament dimensions were examined among 3-6-year-old Finnish children (n = 833). Children's hair samples were collected at preschool, while parents collected five saliva samples from children during one weekend day and completed a questionnaire assessing child's temperament dimensions i.e. surgency, negative affectivity, and effortful control (HCC, n = 677; AUCg of sAA, n = 380; AUCg of sCort, n = 302; temperament dimensions, n = 751). In linear regression analysis, diurnal sCort associated positively with HCC, the association persisting after adjustments (β 0.31, 95% CI 0.20-0.42). In logistic regression analysis, increasing scores in effortful control associated with higher likelihood of having high HCC (OR 1.47, 95% CI 1.07-2.03), the association slightly attenuating to non-significant after adjustments. Otherwise, no clear indication for associations between temperament and stress-related biomarkers were found.

Temperament, physical activity and sedentary time in preschoolers - the DAGIS study

Background

Identifying individual characteristics linked with physical activity (PA) and sedentary time (SED) can assist in designing health-enhancing interventions for children. We examined cross-sectional associations of temperament characteristics with 1) PA and SED and 2) meeting the PA recommendation in Finnish children.

Methods

Altogether, 697 children (age: 4.7 ± 0.9 years, 51.6% boys) within the Increased Health and Wellbeing in Preschools (DAGIS) study were included. Parents responded to the Very Short Form of the Children’s Behavior Questionnaire consisting of three temperament dimensions: surgency, negative affectivity, and effortful control. PA and SED were assessed for 7 days (24 h per day) using a hip-worn ActiGraph accelerometer, and the daily minutes spent in light PA (LPA), moderate PA (MPA), vigorous PA (VPA), and SED were calculated. The PA recommendation was defined as having PA at least 180 min/day, of which at least 60 min/day was in moderate-to-vigorous PA. Adjusted linear and logistic regression analyses were applied.

Results

Surgency was associated with LPA (B = 3.80, p = 0.004), MPA (B = 4.87, p < 0.001), VPA (B = 2.91, p < 0.001), SED (B = − 11.45, p < 0.001), and higher odds of meeting the PA recommendation (OR = 1.56, p < 0.001). Effortful control was associated with MPA (B = − 3.63, p < 0.001), VPA (B = − 2.50, p < 0.001), SED (B = 8.66, p < 0.001), and lower odds of meeting the PA recommendation (OR = 0.61, p = 0.004). Negative affectivity was not associated with PA, SED, or meeting the PA recommendation.

Conclusion

Children’s temperament should be considered when promoting PA in preschoolers. Special attention should be paid to children scoring high in the temperament dimension effortful control.

Does temperament make children differently susceptible to their home physical food environment? A cross-sectional DAGIS study on 3-6 year old Finnish children's food consumption

Consistently linked with children's food consumption are food availability and accessibility. However, less is known about potential individual differences among young children in their susceptibility to home food environments. The purpose of the study was to examine whether the association between home food availability and accessibility of sugar-rich foods and drinks (SFD) or fruits and vegetables (FV) and children's consumption of these foods differ according to their temperament. The study used two cross-sectional datasets collected as part of the Increased Health and Wellbeing in Preschools (DAGIS) study: 1) a cross-sectional data of 864 children aged 3-6 years old collected between fall 2015 and spring 2016, and 2) an intervention baseline data of 802 children aged 3-6 collected in fall 2017. Parents reported their children's temperament, consumption of FV and SFD, and home availability and accessibility of SFD and FV. Examination of whether associations between home availability and accessibility of FV and their consumption differ according to children's temperament involved using linear regression models. Similar models were used to examine association between home availability and accessibility of SFD and their consumption, and the moderating role of temperament. The association between home accessibility of SFD and their consumption frequency was dependent on the level of children's negative affectivity. More frequent consumption of SFD was observed with higher home accessibility of SFD. The association was stronger in children with higher scores in negative affectivity. No other interactions were found. Children with higher negative affectivity are possibly more vulnerable to food cues in the home environment than children with lower negative affectivity. Consideration of children's individual characteristics is necessary in supporting their healthy eating.

Are associations between home environment and preschool children's sedentary time influenced by parental educational level in a cross-sectional survey?

Background

Childhood obesity is a major public health concern, especially in low socioeconomic groups. Sedentary time (SED) is an important predictor of obesity. To be able to diminish SED it is important to find modifiable predictors of sedentary behavior. The home environment associated with children’s SED may vary by parental socioeconomic status. This study aims to clarify the association between parental educational level (PEL) and the home environment of 3–6-year-old children, and to examine how home environment associates with children’s SED, and whether PEL modifies these associations.

Methods

A cross-sectional Increased health and wellbeing in preschools (DAGIS) study was conducted in 2015–2016 in Finland. The parents (n = 809) filled in questionnaires assessing PEL, and the home physical and social environment related to children’s SED. Children’s SED was measured with accelerometers, which the children (n = 745) wore for 1 week.

Results

High PEL was associated with a home environment restraining sedentary behaviour compared with low PEL. Stricter descriptive norms about screen time, considering it important to limit the child’s screen time, and satisfaction about the child’s screen time associated with children’s lower SED. The association with parental psychological control and SED was influenced by PEL. In the PEL stratified analyses, however, the associations between psychological control and SED did not reach statistical significance.

Conclusions

Future interventions aiming to decrease SED should pay attention to relevant factors in children’s sedentary behaviour home environment. It is important to acknowledge the possible PEL differences in these factors.

Relationship between screen time and sleep among Finnish preschool children: results from the DAGIS study

STUDY OBJECTIVES

To examine the associations between screen time, the time spent on different screen devices, and sleep in a sample of Finnish preschool children.

METHODS

The current study analyzed cross-sectional data from the DAGIS study carried out in Finland in 2015-2016 on 736 children aged 3-6 years. Parents reported in a 7-day diary the durations the child used screen devices daily, with separate details about watching TV or DVDs, using tablets or smartphones, and using computers. In addition, parents reported children's bedtimes and wake-up times, which were further used in calculating sleep duration. Parents answered questions regarding their child's sleep consistency. Statistical analyses included adjusted general linear modeling.

RESULTS

An hourly increase in total screen time was associated with 11 min later bedtime (p < 0.001) and 10 min shorter sleep duration (p < 0.001). More TV/DVD watching was associated with later bedtimes (p = 0.016) and a shorter sleep duration (p = 0.001). More smartphone/tablet use was associated with later bedtimes (p = 0.005), later wake-up times (p = 0.038), and weaker sleep consistency (p = 0.024). More computer use was associated with later bedtimes (p = 0.046). Results did not differ between genders.

CONCLUSIONS

Increased screen time was associated with later bedtimes and shorter sleep duration among preschool children. Adverse associations with sleep outcomes were found for each screen device. Attention should be paid to promoting balanced use of screens and regular sleep habits in young children.

Do stressed children have a lot on their plates? A cross-sectional study of long-term stress and diet among Finnish preschoolers

We examined the association between hair cortisol concentration (HCC) - an indicator of long-term stress - and diet among preschoolers in a cross-sectional design. The participants were 597 Finnish 3-6-year-olds, and the data were collected in 2015-16. We used 4-cm hair samples to analyze HCC during the past four months. Food consumption was assessed using a food frequency questionnaire, and we used consumption frequencies of selected food groups as well as data-driven dietary pattern scores in the analyses. The parents of the participating children reported their educational level and family income. The researchers measured the children's weight and height. We examined the associations between HCC and diet using multilevel linear mixed models adjusted for age, gender, the highest education in the family, household relative income, and child BMI. Higher HCCs were associated with less frequent consumption of fruit and berries (B estimate -1.17, 95% CI -2.29, -0.05) and lower scores in a health-conscious dietary pattern (B estimate -0.38, 95% CI -0.61, -0,14). Higher HCCs were also associated with more frequent consumption of sugary beverages (B estimate 1.30, 95% CI 0.06, 2.54) in a model adjusted for age, gender and highest education in the family, but the association attenuated after further adjustments. Our results are parallel with previous studies that show a link between stress and unhealthy diet. In the future, longitudinal studies are needed to establish a causal relationship between stress and diet among children.

Individual-, home- and preschool-level correlates of preschool children's sedentary time

BACKGROUND

Prechoolers' significant portions of sedentary time (ST) is a public-health concern due to its high prevalence and negative health consequences. However, few studies have explored correlates of preschoolers' ST covering individual-, home- and preschool- factors within one study. The aim of this study was to identify the associations between multiple individual-, home- and preschool-level factors and preschoolers' ST. In addition, it was studied how much individual-, home- and preschool-level factors explained the variance in children's ST.

METHODS

A total of 864 children aged three to six, their parents and 66 preschools participated in the cross-sectional DAGIS study, which occurred between 2015 and 2016. The children wore an accelerometer for 1 week. Guardians, principals and early educators completed questionnaires covering the potential correlates of children's ST, for example, temperament, practices, self-efficacy and regulations. Multilevel regression analyses were conducted in multiple steps; calculation of marginal and conditional R² values occurred in the final phase.

RESULTS

Of the 29 studied correlates, the following factors remained significant in the final models. Being a boy (p < 0.001) and having high levels of surgency temperament (p < 0.001) were associated with lower ST. Regarding the home setting, frequent co-visits in physical activity (PA) places (p = 0.014) were associated with lower ST. Higher parental perceived barriers related to children's outside PA (p = 0.032) was associated with higher ST. None of the preschool setting factors remained significant in the final model. Approximately 11% of the variance in children's ST was attributed to factors related to the individual level whereas 5% was attributed to home-level factors; and 2% to preschool-level factors.

CONCLUSIONS

This study identified a set of correlates of preschool children's ST. Interventions aimed at reducing children's ST should develop strategies targeting established correlates of preschoolers' ST covering individual-, home- and preschool-level factors. The preschool-level factors included in this study explained little the variance in children's ST. However, the included measures may not have captured the essential preschool-level factors that specifically influence children's ST. Therefore, more studies are needed regarding potential preschool-level factors.

Preschool group practices and preschool children's sedentary time: a cross-sectional study in Finland

OBJECTIVES

Preschool is an important setting for regulating sedentary time (ST). The preschool day in Finland follows daily structures by having morning and afternoon slots for group-based activities that can encourage children for movement (eg, free play and outdoor time) or be still (eg, teacher-led sessions and sitting-based circles). This study aims to explore if the weekly routines in preschool and if more frequent visits in places encouraging physical activity (PA) are associated with children's ST during preschool hours.

DESIGN

Cross-sectional DAGIS (Increased Health and Wellbeing in Preschools) study in the years 2015 and 2016.

SETTING

In Finland.

PARTICIPANTS

864 children (48% girls, 4.7 years) from 159 preschool groups in 66 preschools OUTCOME MEASURES: A total of 778 children wore required lengths of time (at least 240 min per preschool day, at least 2 days) the accelerometer during preschool hours. Each preschool group reported their weekly schedule during the week, and one early educator completed a questionnaire covering practices. The following five measures related to weekly structures were formed; times of outdoors (times per day), teacher-led sessions (times per day), free play (low, middle or high), organised PA lessons (no lessons at all/others) and mixed activities (no lessons at all/others), and the following five measures about the frequencies of visits in places encouraging PA; nature trips (times per week), play parks (times per week), neighbourhood sport facilities (no visits at all/others), visits to gym or other indoor facility (no visits at all/others) and field trips to neighbourhoods (times per week). Multilevel linear regression analyses were conducted to measure the associations.

RESULTS

Of all the tested associations, only more frequently conducted nature trips were associated with lower children's ST during preschool hours (β=-1.026; 95% CI -1.804 to -0.248).

CONCLUSION

Frequent nature trips in preschools may be important due to its association with lower preschool children's ST.

Development of the DAGIS intervention study: a preschool-based family-involving study promoting preschoolers' energy balance-related behaviours and self-regulation skills

Background

Preschoolers’ energy balance-related behaviours (EBRBs) and self-regulation skills are important for their later health. Few preschool-based interventions aiming to promote preschoolers’ EBRBs and self-regulation skills, simultaneously reducing differences in EBRBs, due to children’s socio-economic status (SES) background, have been conducted. This study will present the Increased Health and Wellbeing in Preschools (DAGIS) intervention development process applying the Intervention Mapping (IM) framework.

Methods

The development of the DAGIS intervention study, a preschool level clustered randomized controlled trial (RCT), was based on the IM framework. The protocol in IM guides the development process of an intervention through six steps: needs assessment and logic model of the problem, programme outcomes and objectives, design of the programme, production, implementation plan, and evaluation plan.

Results

The needs assessment, part of the step 1 in IM, yielded the base for the DAGIS logic model of change. The model includes objectives related to changes in children’s EBRBs, self-regulation skills, and in psychosocial and physical environment that is determined by parents and early educators. A 22-week programme was developed, and materials for preschools and families were produced. A feasibility study of the recruitment processes, acceptability of the materials and methods, and implementation was conducted. The DAGIS intervention study was conducted September 2017–May 2018 as a clustered RCT including a comprehensive effectiveness and process evaluation. The process evaluation was run throughout the intervention targeting preschools and families.

Conclusion

A preschool-based family-involving programme was developed in the DAGIS intervention study by applying the IM protocol. It was a time- and resource-consuming process. However, the systematic planning, development, and running of the programme have reinforced a comprehensive evaluation, which is a strength in the intervention. The results from the evaluation will enhance the knowledge of how to promote EBRBs and self-regulation skills among preschoolers, and diminish SES differences in them.

Trial registration

ISRCTN57165350 (Prospectively registered January the 8th, 2015).

Increased Health and Wellbeing in Preschools (DAGIS) Study-Differences in Children's Energy Balance-Related Behaviors (EBRBs) and in Long-Term Stress by Parental Educational Level

This paper describes the Increased Health and Wellbeing in Preschools (DAGIS) survey process and socioeconomic status (SES) differences in children's energy balance-related behaviors (EBRBs), meaning physical activity, sedentary and dietary behaviors, and long-term stress that serve as the basis for the intervention development. A cross-sectional survey was conducted during 2015⁻2016 in 66 Finnish preschools in eight municipalities involving 864 children (3⁻6 years old). Parents, preschool personnel, and principals assessed environmental factors at home and preschool with questionnaires. Measurement of children's EBRBs involved three-day food records, food frequency questionnaires (FFQ), seven-day accelerometer data, and seven-day sedentary behavior diaries. Children's long-term stress was measured by hair cortisol concentration. Parental educational level (PEL) served as an indicator of SES. Children with low PEL had more screen time, more frequent consumption of sugary beverages and lower consumption of vegetables, fruit, and berries (VFB) than those with high PEL. Children with middle PEL had a higher risk of consuming sugary everyday foods than children with high PEL. No PEL differences were found in children's physical activity, sedentary time, or long-term stress. The DAGIS intervention, aiming to diminish SES differences in preschool children's EBRBs, needs to have a special focus on screen time and consumption of sugary foods and beverages, and VFB.

Cognitive performance and attachment patterns at four years of age in extremely low birth weight infants after early intervention

This study aims at assessing the effects of an early occupational therapy intervention on the cognitive development and the development of attachment patterns in ELBW infants. The intervention, given weekly at home from six months to 12 months, aimed at supporting parent-child interaction and enhancing motor control and coordination. The study population consisted of 100 ELBW infants matched in pairs in accordance to their pre-perinatal risk scores and allocated successively to intervention or non-intervention groups. Cognitive development was assessed with the Bayley Scales at age two and with the WPPSI at age four. Attachment to primary caregiver was assessed with the Preschool Assessment of Attachment (PAA). Cognitive performance was within age norms in both groups at both ages. Intervention did not show any effect on cognitive performance at the age of two years. At the age of four years, cognitive level was overall, and most notably for verbal performance, higher in the intervention group than in the control group. There was an over-representation of the so-called atypical attachment patterns (those not fitting the normative A, B, or C categories) in the control group. The results are discussed in terms of finding more global ways to support the development of at risk pre-term children.

Cognitive development, temperament and behavior at 2 years as indicative of language development at 4 years in pre-term infants

This study focuses on the early temperamental (TTQ = toddler temperament questionnaire), behavioral (IBR = infant behavior record), and cognitive precursors of impaired language functioning in preschool-age pre-terms infants. The study group consisted of 63 pre-term infants with a mean birth weight of 1246 +/- 437 g born in 1989-1991 in the University Central Hospital of Helsinki. Children with major disabilities (CP or mental retardation) were excluded. At the age of 4 years, 22% showed impaired language function. Logistic regression analysis showed that the Bayley MDI score was the best predictor in identifying an increased risk for language impairment. Behavioral characteristics were more strongly associated with subsequent language impairment than temperament.

Neurological development up to the age of four years of extremely low birthweight infants born in Southern Finland in 1991-94

A total of 142 infants with birthweights of less than 1000 g were examined at the age of 4 y by a child neurologist, by a neuropsychologist and by an occupational therapist in order to establish the rate of neurological disorders. A total of 57 (40%) of the children had normal neurological development, 52 (37%) had minor neurological disorders, 27 (19%) were diagnosed with cerebral palsy, and 6 (4%) were mentally retarded (IQ <71) with no motor disability. The rate of cerebral palsy was identical with the figure at age 2 y, but the rate of minor neurological disorders increased from 25% to 37%. Compared with international rates, we found a higher rate of cerebral palsy, but the incidence of minor neurological disorders corresponded with figures published previously.

Neurodevelopment until the adjusted age of 2 years in extremely low birth weight infants after early intervention--a case-control study

A total of 104 infants with birth weights of less than 1000 grams were enrolled in this prospective case-control study in order to examine the effect of occupational therapy based on sensory integration (SI) and neurodevelopmental therapy (NDT) on neurological development. The children were grouped as matched pairs on the basis of a set of developmental risks assessed at the age of 3 months. The intervention children had a weekly session of 60 minutes of occupational therapy from the corrected age of 6 months up to 12 months. All the children were examined at the corrected age of 3, 6, 9, 12, 18 and 24 months. The neurodevelopment of the cases and the controls did not differ essentially and the only significant difference was found in the social development of the children at the age of 12 months to the advantage of the intervention group. It is concluded that this amount of occupational therapy in at-risk children does not have a relevant effect on neurological development.

Temperament profiles and their role in neurodevelopmental assessed preterm children at two years of age

The aim of this study was to determine whether preterms (n = 80, mean birth weight 1,205 g) differ from full-terms (n = 80) in temperament profile at 24 months of age and to explore the relationship between temperament, neurodevelopment, and behavior. Temperament was assessed using the Toddler Temperament Questionnaire, which defines nine temperament dimensions: activity, rhythmicity, approach/withdrawal, adaptability, mood, intensity, distractability, persistence, and sensory threshold. Neurodevelopment was assessed by the Bayley Scales of Infant Development and by neuropediatric examination. Behavior was assessed using the Infant Behavior Record, which is a part of the Bayley Scales. When temperament was considered, the preterms were significantly less active, more adaptive, more positive in mood, less intense, and lower in threshold to respond than the controls. The results on IBR showed that preterms were significantly less goal directed, less attentive, and lower in endurance than the controls. The preterms performed significantly less well than the controls on the Bayley test. Low Bayley scores correlated with temperament scores of high rhythmicity, positive mood, low persistence, and high threshold and with IBR scores of poor social orientation, negative emotional tone, poor co-operation, short attention span, and poor endurance.

Health and development of children born after oocyte donation compared with that of those born after in-vitro fertilization, and parents' attitudes regarding secrecy

The health, growth and development of a cohort of children (n = 59) aged 6 months to 4 years and born after oocyte donation (OD) was compared with that from a group of children born after in-vitro fertilization (IVF) (n = 126). The study was performed by questionnaire, and the response rate was 100% in the OD group and 95% in the IVF group. All OD children were healthy. Three IVF children had a neurological disorder. Surgical intervention had been carried out in 8% of the OD and 13% of the IVF children. Height and weight development were normal, and eating and sleeping disorders were uncommon in both groups of children. The IVF mothers more often expressed concern about the child's behaviour than did the OD mothers. Thirty-eight percent of the OD parents and 60% of the IVF parents intended to tell the child about the nature of its conception (P < 0.01). Although oocyte recipients appear to have more complications during their pregnancies than conventional IVF patients, the general health status of OD children aged <5 years is at least as good as that of IVF children. Growth and development in both groups of children is similar to that of the general population.

Randomized study of the effect of antenatal dexamethasone on growth and development of premature children at the corrected age of 2 years

The objective of the series was to study the effect of prenatal dexamethasone therapy on the growth and neurological development of preterm children until the age of 2 years. Eighty-two children with a mean gestational age of 30 (24-33) weeks and a mean weight of 1291 (530-2360) g at birth, treated antenatally with either dexamethasone (n = 50) or placebo (n = 32), were examined at the adjusted age of 24 months by a paediatric neurologist, a neuropsychologist and a speech therapist. Neurological development was defined as normal if all scores of neuropaediatric, neuropsychological and verbal tests were within the normal range. Normal neurological development was found in 52% of the dexamethasone-treated and in 34% of the placebo-treated children. The incidence of cerebral palsy was 10% in the dexamethasone group and 22% in the placebo group. Minor developmental delay was found in 42% of dexamethasone-treated and in 53% of placebo-treated children. Our follow-up results indicate that the beneficial effect of prenatal glucocorticoid treatment on cerebral complications (intraventricular haemorrhage or periventricular leucomalacia) demonstrated during the neonatal period may be followed by a lower incidence of cerebral palsy in surviving premature children.

Event-related brain potential of human newborns to pitch change of an acoustic stimulus

We report here event-related potentials (ERPs) of human newborns to occasional pitch changes in a repetitive sequence of tone pips. These pitch changes elicited a large slow negative ERP component which resembles the mismatch negativity (MMN) generated by the adult brain under similar conditions. This MMN-type of negativity in newborns suggests that already at this early ontogenetic stage the brain monitors the acoustic environment for a possible change in any of its repetitive aspects. Apart from its theoretical interest, this finding might provide a new way to test the development of the central nervous system and to diagnose cerebral dysfunction at a very early stage.