Hair steroid before and after COVID-19 in preschoolers: the moderation of family characteristics

BACKGROUND

Frequent or prolonged exposure to stressors may jeopardize young children's health. The onset of the COVID-19 pandemic, coupled with disruptions in daily routines and social isolation resulting from public health preventive measures, have raised concerns about its potential impact on children' experienced stress, particularly for young children and vulnerable families. However, whether the pandemic was accompanied by changes in physiological stress remains unknown as perceived stress is not a good proxy of physiological stress. This study examined if preschoolers showed increasing hair steroid concentrations following the onset of the COVID-19 pandemic and whether family characteristics may have exacerbated or buffered these changes.

METHODS

136 preschoolers (2-4 years) provided hair for steroid measurement (cortisol, dehydroepiandrosterone (DHEA), cortisone, cortisol-to-DHEA ratio, cortisol-to-cortisone ratio) in October-November 2019 (T0) and in July-August 2020 (T1). A 2-centimeter hair segment was analyzed, reflecting steroid production over the two months leading up to collection. Family income, conflict resolution and lack of cohesion, as well as parents' COVID-19 stress were reported by parents. Linear mixed models for repeated measures and Bayes factors were used.

RESULTS

No significant changes were noted from before to after the onset of the COVID-19 pandemic for most hair steroids. However, a moderating role of family conflict resolution was noted. Children living with parents with a better ability to resolve conflicts had lower levels of DHEA compared to those who had more difficulty managing conflicts. Additionally, lower levels of family cohesion and income were linked to some steroids, especially DHEA, suggesting that these factors may relate to children's physiological stress. Finally, boys had higher DHEA levels than girls.

CONCLUSION

Our findings suggest that stress biomarkers were comparable from before to during the COVID-19 pandemic. This observation holds true despite the pandemic being perceived by many as a novel, unpredictable, and potentially threatening event. Findings further suggest that family characteristics are associated with hair steroid, especially DHEA, which deserves further investigation.

Metacognition as a mediator of the relation between family SES and language and mathematical abilities in preschoolers

The effect of family socioeconomic status (SES) on academic achievement in literacy and numeracy has been extensively studied with educational inequalities already witnessed in preschoolers. This is presumably explained by the effect of family SES on cognitive and socioemotional abilities associated with academic achievement. Metacognition which refers to knowledge and regulation skills involving reflexivity about one's own cognitive processes is one of these abilities. However, most of the studies investigating the association between metacognition and academic achievement have focused on school-aged students and studies with younger students are only emerging. Meanwhile, the association between family SES and metacognition abilities has surprisingly received little attention regardless of participants' age. The aim of this study was to explore the associations between family SES, metacognition, language and mathematical abilities in preschoolers aged 5 to 6. We provide the first evidence that the effect of family SES on preschoolers' language and mathematical abilities is mediated by the effect of family SES on their metacognitive abilities. The implications for future research, education and policies aiming at reducing educational inequalities are discussed.

Perceptual subitizing performance in 3- and 4-year-olds: The impact of visual features of sets

Perceptual subitizing is a pivotal skill in children's mathematical development. It is defined as the rapid identification of small numerosities. Previous studies pointed to the contribution of visual features of sets to perceptual subitizing performance in adults. Insights into the contribution of visual features to subitizing performance in the critical 3- to 4-year age range are scant. This study aimed to address this gap by investigating the impact of visual features on perceptual subitizing performance (accuracy and response time) in 3- and 4-year-olds. Participants (119 3- and 4-year-olds) were offered a subitizing task that incorporated pictures of sets of three to five objects. The pictures systematically varied across four visual features: (a) pictorial context (distractors present vs. absent), (b) set homogeneity (homogeneous vs. heterogeneous objects), (c) set arrangement (linearly vs. randomly arranged objects), and (d) set differentiation (distinct vs. overlapping objects). Pictures with distractors, heterogeneous objects, randomly arranged objects, or overlapping objects were associated with lower subitizing accuracy and longer response times compared with pictures without distractors, homogeneous objects, linearly arranged objects, or distinct objects, respectively. Pictures with randomly arranged or overlapping objects along with distractors were associated with even lower subitizing accuracy. Pictures featuring a simple visual design-without distractors and with homogeneous, linearly arranged, and distinct sets-yielded the best subitizing performance in terms of accuracy and response time. Our findings might be explained by the cognitive processes underlying 3- and 4-year-olds' subitizing performance. The findings offer building blocks for future research in the domain and preschool educational practice.

Meeting the 24-h movement recommendations and its relationship with Mediterranean dietary patterns in early childhood: the SENDO project

The aim of this study was twofold: (1) to assess the association between meeting all three 24-h movement recommendations and adherence to the Mediterranean diet (MedDiet) in early childhood and (2) to examine whether participants who meet all three 24-h movement recommendations have greater adherence to the individual MedDiet foods/components than those who do not meet these recommendations. A cross-sectional study was conducted using a sample of 822 participants from the Seguimiento del Niño para un Desarrollo Óptimo (SENDO) project (Pamplona, Spain). Physical activity was assessed through a questionnaire that covered 17 different types of activities. Screen time was assessed by averaging the daily hours spent on activities such as watching TV, using a computer, or playing video games. Sleep duration was determined by taking the average of sleep durations during both weekdays and weekends. Adherence to the MedDiet was evaluated using the Mediterranean Diet Quality Index in children and adolescents (KIDMED). Greater odds of having an optimal adherence to the MedDiet were found for participants meeting all three 24-h movement recommendations (odds ratio (OR) = 1.96, 95% confidence interval (CI) 1.33-2.87, p = 0.001) in comparison with their counterparts not meeting these recommendations. Specifically, significant differences were found for "fruit or fruit juice every day" (p = 0.012), "second fruit every day" (p = 0.001), and "fresh or cooked vegetables regularly once a day" (p = 0.018) in relation to meeting all three 24-h movement recommendation status.    Conclusions: This study provides further evidence of the potential importance of meeting all three 24-h movement recommendations to adopt a healthier eating pattern. What is Known: • Only a limited number of studies have investigated the joint connection between the 24-h movement recommendations and dietary habits. • Integrating the 24-h movement recommendations with dietary recommendations could potentially yield greater effectiveness compared to promoting these recommendations independently within public health strategies. What is New: • This is the first study in assessing the relationship between 24-h movement recommendations and adherence to the Mediterranean diet in early childhood. • These findings provide further evidence of the potential importance of meeting all three 24-h movement recommendations to adopt a healthier eating pattern.

Autistic traits and ARFID-associated eating behaviors in preschoolers: Mediating effects of sensory processing patterns

OBJECTIVE

This study aimed to examine the association between autistic traits and Avoidant Restrictive Food Intake Disorder (ARFID)-associated eating behaviors in preschool-age children and investigated whether this association was mediated by sensory processing patterns.

METHOD

A cross-sectional, parent-reported study was conducted between July 2022 and March 2023 among 503 preschoolers aged 4-6 years in China. Parents provided assessments of their children's autistic traits using the Social Responsiveness Scale, sensory processing patterns using the Short Sensory Profile 2, and ARFID-associated eating behaviors using the Nine Items ARFID Screen. The mediation model based on ordinary least squares regression was employed to test the mediating effects of sensory processing patterns between autistic traits and ARFID-associated eating behaviors.

RESULTS

The results indicated significant associations among autistic traits, ARFID-associated eating behaviors, and sensory processing patterns. Moreover, mediation analyses revealed that sensory processing patterns played a partial mediating role in the relationship between autistic traits and ARFID-associated eating behaviors. Specifically, autistic traits were observed to weaken ARFID-associated eating behaviors, particularly picky eating and poor appetite, through Registration, while simultaneously fostering them through Sensitivity and Avoiding.

DISCUSSION

Our study is limited to some extent by the inability to draw longitudinal conclusions from cross-sectional data. Nevertheless, it underscores the significance of early identification and intervention for food avoidance/restriction behaviors due to sensory processing abnormalities in children with heightened autistic traits. This proactive approach may contribute to mitigating ARFID-associated eating behaviors that might drive clinical symptoms of ARFID.

Reliability and validity of rapid assessment tools for measuring 24-hour movement behaviours in children aged 0-5 years: the Movement Behaviour Questionnaire Baby (MBQ-B) and child (MBQ-C)

BACKGROUND

The development of validated "fit-for-purpose" rapid assessment tools to measure 24-hour movement behaviours in children aged 0-5 years is a research priority. This study evaluated the test-retest reliability and concurrent validity of the open-ended and closed-ended versions of the Movement Behaviour Questionnaire for baby (MBQ-B) and child (MBQ-C).

METHODS

300 parent-child dyads completed the 10-day study protocol (MBQ-B: N = 85; MBQ-C: N = 215). To assess validity, children wore an accelerometer on the non-dominant wrist (ActiGraph GT3X+) for 7 days and parents completed 2 × 24-hour time use diaries (TUDs) recording screen time and sleep on two separate days. For babies (i.e., not yet walking), parents completed 2 × 24-hour TUDs recording tummy time, active play, restrained time, screen time, and sleep on days 2 and 5 of the 7-day monitoring period. To assess test-retest reliability, parents were randomised to complete either the open- or closed-ended versions of the MBQ on day 7 and on day 10. Test-retest intraclass correlation coefficients (ICC's) were calculated using generalized linear mixed models and validity was assessed via Spearman correlations.

RESULTS

Test-retest reliability for the MBQ-B was good to excellent with ICC's ranging from 0.80 to 0.94 and 0.71-0.93 for the open- and closed-ended versions, respectively. For both versions, significant positive correlations were observed between 24-hour diary and MBQ-B reported tummy time, active play, restrained time, screen time, and sleep (rho = 0.39-0.87). Test-retest reliability for the MBQ-C was moderate to excellent with ICC's ranging from 0.68 to 0.98 and 0.44-0.97 for the open- and closed-ended versions, respectively. For both the open- and closed-ended versions, significant positive correlations were observed between 24-hour diary and MBQ-C reported screen time and sleep (rho = 0.44-0.86); and between MBQ-C reported and device-measured time in total activity and energetic play (rho = 0.27-0.42).

CONCLUSIONS

The MBQ-B and MBQ-C are valid and reliable rapid assessment tools for assessing 24-hour movement behaviours in infants, toddlers, and pre-schoolers. Both the open- and closed-ended versions of the MBQ are suitable for research conducted for policy and practice purposes, including the evaluation of scaled-up early obesity prevention programs.

Prospective Associations of Maternal Depressive Symptoms and Emotion Dysregulation with Children's Internalizing Problems: The Moderating Role of Fathers

The occurrence of internalizing symptoms is prevalent among young children and can be observed as early as preschool years. Using a longitudinal approach, this study examined the moderating role of paternal depressive symptoms/emotion dysregulation in the prospective associations between maternal depressive symptoms/emotion dysregulation and children's internalizing problems (depressive and anxiety symptoms). Ninety-four preschoolers and their mothers and fathers participated in the study. Mothers and fathers completed online questionnaires for all variables when their children were 4 years old and one year later. The results indicated that paternal depressive symptoms moderated the association between maternal emotion dysregulation and children's later depressive, but not anxiety, symptoms. Specifically, higher levels of depressive symptoms in fathers exacerbated the negative influence of maternal emotion dysregulation on children's later depressive symptoms, whereas fathers with low levels of depressive symptoms served a protective role. The findings enhance our understanding of the interaction between maternal and paternal psychological characteristics in contributing to children's anxiety and depressive symptoms.

Comparison of Global and Daily Ratings of Associations between Anxiety and Depressive Behaviors and Impairment in Preschool-Aged Children

Anxiety and depressive difficulties can emerge during early childhood and cause impairment in functioning. Anxiety and depressive behaviors and impairment are typically assessed with global questionnaires that require recall of children's behavior over an extended period which could reduce the accuracy of parent report of children's behavior and functioning. The current study compared parents' report of children's anxiety and depressive behaviors and impairment when evaluated with global measures versus a daily diary measure. Participants (N = 901 parents of 3-5-year-old children) completed global and daily measures of children's behavior and impairment during enrollment to the study. Global measures were completed at baseline and the 14 daily diary measures were completed consecutively for two weeks. Across most measures, daily associations between parent-reported anxiety and depressive behaviors and impairment were stronger compared to associations with global measures. These results suggest that daily measures may better capture links between young children's typical behavior and functioning compared to global measures. In addition, daily assessment might be more effective for measuring mild to moderate yet still impairing behaviors that may be missed on global reports that require longer periods of recall.

Evaluation of the association between excessive screen use, sleep patterns and behavioral and cognitive aspects in preschool population. A systematic review

In this review, we analyzed the possible relationship between the excessive use of screens and sleep patterns, and how this may affect certain behavioral and cognitive factors in preschool children. The selection, extraction and synthesis of the data were conducted according to PRISMA guidelines. The search was carried out in the electronic databases Medline (PubMed), PsycINFO (American Psychological Association), Scopus and Web of Science (WOS). Of the 597 articles initially identified, 13 met the inclusion criteria. The risk of bias of the articles selected was evaluated using a specific scale created for this purpose. The results found indicate that excessive use of screens is associated with a negative impact on the duration and quality of sleep-in preschoolers, and this worsening of sleep in infancy is related with a greater probability of the appearance of internalizing and externalizing behavioral problems and certain cognitive problems. The results also suggest that sleep could play a mediating or moderating role as a bioregulatory system that attenuates or increases the onset of behavioral and cognitive difficulties in those children most exposed to digital devices.

Relationship between executive function and autism symptoms in preschoolers with autism spectrum disorder

Executive dysfunction and other symptomatology could have links in preschoolers with autism spectrum disorder (ASD). This study contains three objectives: to explore the difference in executive function between preschoolers with ASD and typically developing individuals (TD), to investigate correlations between executive function and multiple domains of autism symptoms in preschoolers with ASD, and to examine the impact of executive function on symptoms of autism. Participants of this study included preschoolers (4-6 years) with ASD (24 boys, 20 girls) according to DSM-5-TR criteria and TD (24 boys, 20 girls). BRIEF-P (Behavior Rating Inventory of Executive Function-Preschool Version) and CASD-C (Checklist for Autism Spectrum Disorder-Chinese Version) were used as measurement tools. Data were analyzed using MANOVA, ANOVA, Pearson correlations, and simple regression. For the results, the study found results of executive function were significantly lower in preschoolers with ASD than in preschoolers without ASD; the greater the executive dysfunction, the greater the autistic symptomatology, and executive dysfunction predicted 57 % of the variability of autism symptoms. In conclusion, preschoolers with ASD had more executive dysfunction than those without ASD. Based on our findings, the study recommends incorporating executive function into clinical assessment programs to understand how executive function is related to autism symptoms.

Normative values of motor performance and their relationship with BMI status in Hong Kong preschoolers

This study aimed to establish sex- and age-specific reference values for motor performance (MP) in Hong Kong preschoolers aged 3-5 years old and examine the relationship between MP and BMI status. A cross-sectional study was conducted among 5579 preschoolers in Hong Kong. Three MP tests were administered, and height and weight information were collected. GAMLSS was used to compute the normative values of the motor tests. Boys outperformed girls in activities requiring muscle strength and power, while girls outperformed boys in activities requiring balance and coordination. The MP scores increased with age for both overarm beanbag throw and standing long jump for both sexes, while the one-leg balance scores showed larger differences between P50 and P95 in older preschoolers. Children with excessive weight performed worse in standing long jump and one-leg balance compared to their healthy weight peers. This study provides valuable information on the MP of preschoolers in Hong Kong, including sex- and age-specific reference values and the association between BMI status and MP scores. These findings can serve as a reference for future studies and clinical practice and highlight the importance of promoting motor skill development in preschoolers, particularly those who are overweight or obese.

Association between parental feeding styles, body mass index, and consumption of fruits, vegetables and processed foods with mothers´ perceptions of feeding difficulties in children

BACKGROUND

Feeding difficulties (FDs) are complex phenomena influenced by parental factors, feeding behaviour, and cultural factors. However, studies of the influences of these factors on FDs incidence are scarce. Thus, this study aimed to identify the associations between mothers' perceptions of FDs in children and parental feeding styles, body mass index, and the consumption of fruits, vegetables and processed foods.

METHOD

Two hundred and fifty-seven mothers of children aged 1 to 6 years and 11 months participated in this cross-sectional study and self-completed electronic questionnaires on sociographic variables, parental feeding styles, the consumption of fruits, vegetables and processed foods and FDs. Nutritional status was classified by body mass index (kg/m2).

RESULTS

The prevalence of FDs in children was 48.2%, and the mean age was 43.8 (± 17.6) months. The indulgent parental feeding style was the most common (40.1%), followed by the authoritative (31.1%), authoritarian (23.7%), and uninvolved (5.1%) styles. An indulgent parental feeding style (OR: 4.66; 95% CI: 2.20-9.85), a high body mass index (OR: 1.35; 95% CI: 1.09-1.68), and the consumption of processed foods (OR: 5.21; 95% CI: 2.85-9.53) were positively associated with increased odds of the absence of FDs in children. The associations of authoritarian and uninvolved parental feeding styles and the consumption of fruits and vegetables with FDs in children were not significant.

CONCLUSION

This study identified multiple factors that are possibly associated with feeding behaviours in young children. However, further studies need to be undertaken to evaluate how such behaviours affect FDs.

Sleep and Technology in Early Childhood

Research suggests that technology use is associated with poorer sleep outcomes among children less than 6 years of age. These associations are evident regardless of the type of technology studied, although evening exposure may have the greatest impact compared with technology use during other parts of the day. More work is needed, particularly given that technology use is relatively high among young children. Clinicians should assess patients' technology exposure, including before bedtime, to assess whether sleep issues stem from children's technology use. Moreover, clinicians should educate caregivers about the association between technology use and sleep problems among young children.

Evaluation of dietary composition between hemoglobin categories, total body iron content and adherence to multi-micronutrients in preschooler residents of the highlands of Puno, Peru

BACKGROUND

The anemia prevalence is higher in highlands populations. It is assumed that iron deficiency anemia (IDA) in children is mainly due to low dietary intake. However, other suggest that high prevalence of anemia is due to an inappropriate hemoglobin (Hb) adjustment for altitude.

MATERIALS AND METHODS

Cross-sectional study conducted in 338 preschoolers (PSC) from Puno-Peru. Hb was measured in whole blood, and ferritin, Soluble transferrin receptor, and Interleukin 6 in serum.The dietary iron intake was assessed by 24-h dietary recall, using NutriCap Software. Hb concentration was assessed as adjusted or unadjusted for altitude.

RESULTS

With unadjusted Hb, the anemia prevalence was 4.7%, whereas after Hb correction, the prevalence raised-up to 65.6% (p < 0.001). Reciprocally, erythrocytosis proportion decreased from 20.35 to 0.30% (p < 0.001). Total Body Iron (TBI) showed that 7.44% had ID and 0.32% had IDA. PSC with normal unadjusted Hb levels have more protein and micronutrients intake than anemic ones. PSC with erythrocytosis consumed less fat, and more niacin and ascorbic acid than anemics. Total iron intake was lower in anemic than the other groups, but without statistical significance due to the standard deviation of the data in a small number of anemic PSC (n = 16). TBI, unadjusted Hb, and adjusted Hb were not different between groups consuming or not multimicronutrients.

CONCLUSIONS

The consumption of iron and iron status in children who live at high altitude is adequate, and that anemia could be due to other micronutrient deficiencies and/or that the adjustment of Hb by altitude is inappropriate.

The emergence of young children's tolerance for inequality: With age, children stop showing numerically sensitive fairness

One persistent and pernicious feature of outstanding social inequality is that even relatively extreme forms of inequality can be justified with reference to merit-based considerations. One key feature of fairness with respect to resource allocation is that it is numerically sensitive; greater (more extreme) inequalities are generally seen as less fair than less extreme ones. This work sought to document the emergence of numerically sensitive fairness in children aged 4 to 8 years. A total of 81 4- to 8-year-olds completed a series of within-participants fairness judgment trials in which they observed two characters receive either equitable or inequitable shares of resources-ranging from 50/50 (completely fair) to 0/100 (completely unfair)-in two contexts: one in which the two characters were described as working the same amount (equality context) and one in which one character was described as working harder than the other character (merit context). Children of all ages showed numerically sensitive fairness in the equality context. However, whereas younger children continued to show numerically sensitive fairness in the merit context, older children approved even relatively extreme inequalities when one person was described as working harder. This effect emerged with age, suggesting a double-edged sword to acquiring beliefs in merit-based fairness; as children get older, they may begin to accept even relatively extreme forms of inequality when presented in a merit context. Results are discussed with respect to the acquisition of meritocracy as a normative belief of fairness.

Novel Insights into Obesity in Preschool Children with Autism Spectrum Disorder

Obesity is present in 8-32% of the children with Autism Spectrum Disorder (ASD). However, most studies are performed in school-aged children from the USA. The current study compares obesity rates of Dutch preschoolers with ASD with children from the Dutch general population and explores which child- and parental factors are related to obesity in children with ASD. This cross-sectional study is part of the ongoing Tandem Study (Dutch Trial register: NL7534). Seventy-eight children with ASD aged 3-7 years and their parents (77 mothers, 67 fathers) participated. Child factors are: Body Mass Index (by physical measurement), child eating behavior (Child Eating Behavior Questionnaire), child problem behavior (Child Behavior Checklist), and ASD severity (Autism Diagnostic Observation Scale 2). Parental factors are: BMI (by physical measurement), parental eating behavior (Dutch Eating Behavior Inventory), parenting stress (The Parenting Stress Questionnaire) and highest completed educational level (SES). Children with ASD were 8 times more often obese (16.8%) than children from the general population (2.0%). Child BMI correlated positively with child food approach behavior and maternal BMI, and correlated negatively with child 'Slowness in eating'. There was no correlation between child BMI and ASD severity, problem behavior, parental eating behavior, parental stress and SES. Thus, Dutch, preschool children with ASD have 8 times higher obesity rates than children from the general population. More attention to obesity risk in research and clinical care could contribute to the quality of life of individuals with ASD and their families. CLINICAL TRIAL REGISTRATION: Dutch Trial register, NL7534, https://trialsearch.who.int/Trial2.aspx?TrialID=NL7534 .

Association between screen time and physical activity on mental health among preschoolers: a cross-sectional study from Southwest China

BACKGROUND

Screen time and physical activity behaviors undergo development during early childhood and impact mental health. However, there is limited knowledge regarding the associations between physical activity, screen time, and mental health problems (MHP) in preschoolers. This study examines these associations using a large sample size and brief measures.

METHODS

A multistage cluster stratified sampling method was used to conduct an observational cross-sectional study of 19,015 Chinese preschoolers in 2020. Information on physical activity, and screen time was collected by a self-administered questionnaire; MHP was assessed by the parent-reported Strengths and Difficulties Questionnaire (SDQ). Logistic regression models were used to obtain the odds ratios (ORs) and 95% confidence intervals (95% CIs) of preschoolers' MHP associated with screen time, total physical activities, moderate to vigorous physical activity (MVPA), and outdoor physical activities.

RESULTS

A total of 19,015 participants from the 19,548 recruited population were included in the analyses (missing rate: 2.73%), 52.60% were boys. 64.01%, 57.96%, 35.98%, and 82.64% of preschoolers were reported to meet total physical activities, MVPA, and outdoor activities with screen time recommendations level. The results of multivariable-adjusted ORs (95% CIs) of preschoolers' MHP for comparisons of different levels of screen time (< 2 h/day, 2-4 h/day,≥4 h/day) show that screen time positively associated with MHP after adjusting for confounders (P < 0.05), but the association was not significant among girls with screen time ≥ 4 h/day. In addition, increased engagement in physical activity was reversely linked to MHP (P < 0.05). A stronger association between MHP and MVPA was observed in boys, however, this association was weakened when the total time spent engaging in MVPA exceeded two hours per day (P < 0.05).

CONCLUSION

Less physical activity and more screen time positively relate to MHP, but the relationship differs by type of physical activity, total time, and gender. These findings provide novel insights and evidence supporting for guidelines on physical activity, screen time, and improvement of mental health for preschoolers.

Brief Report: A Randomized Controlled Trial of a Digital Working Memory Intervention for Preschoolers Displaying ADHD Symptoms

PURPOSE

This study aimed to investigate the effects of a self-paced digital working memory (WM) intervention on preschoolers with ADHD symptoms and explore the relation between WM and time perception (TP) through a randomized controlled trial.

METHOD

Fifty preschoolers between four-to-six years of age (M = 4.93 years) were randomly assigned to three groups: a WM training group (WM; n = 14), a social-emotional (SE) training active control group (n = 15), and a waitlist control group (n = 21). Both the WM and SE groups received fifteen 10-min self-paced digital training sessions over five consecutive weeks.

RESULTS

The digital WM training was effective in improving children's digit span performance compared to the waitlist control group only. Within-group comparisons across two time points indicated a near-significant improvement in numeration and trends of reduced ADHD symptoms and improved TP tasks in the WM group at the post-test, but between-group differences were not observed.

CONCLUSION

The study showed limited effects of the WM training on preschoolers displaying ADHD symptoms. However, the results implied an association between working memory and time perception that awaits further investigation.

Urinary antibiotic levels and risk of overweight/obesity in preschool children: A biomonitoring-based study from eastern China

There is limited evidence linking antibiotic exposure, particularly from contaminated food or drinking water, to childhood obesity. The study aimed to investigate the association between urinary antibiotic levels and overweight/obesity in preschool children. In the case-control study, 121 overweight/obese preschoolers and 242 controls (aged 3-6 years) from eastern China were enrolled in 2022 based on age, sex, and study site matching. Overweight/obesity was determined using body mass index (BMI) and weight for height (WFH) criteria derived from national data. A total of 50 antibiotics from 8 categories were analyzed using ultra-performance liquid chromatography and tandem mass spectrometry (UPLC-MS/MS). We identified major dietary patterns using principal component analysis (PCA) and examined the associations of antibiotic exposure with childhood overweight/obesity using multivariate logistic regression. Twenty-four individual antibiotics were detected in more than 10 % of the samples, and overall detection rates were up to 100 %. Overweight/obese children had a higher exposure to veterinary antibiotics (VAs) than normal weight children. PCA analysis showed that children who were overweight/obese had higher scores of "Aquatic products preferred dietary pattern" and "Cereals preferred dietary pattern" compared to children with normal weight. Multivariate logistic regression analyses indicated that exposure to elevated levels of deoxytetracycline (OR: 1.72; 95 %CI: 1.00-2.93) and quinolones (OR: 1.63; 95 %CI: 1.04-2.57) was significantly related to an increased risk of BMI-based overweight/obesity. Quinolones exposure was also significantly associated with WFH-based overweight/obesity, primarily in boys. After adjustment for all covariates, higher exposure to ofloxacin (of the quinolones) was significantly related to overweight/obesity in girls. Exposure to certain antibiotics, especially quinolones, may increase the risk of overweight/obesity in preschoolers. More prospective, well-designed studies are needed to clarify these findings.

Developmental delay and its demographic and social predictors among preschool-age children in Palestine

PURPOSE

This study was designed to assess the developmental outcomes among preschool-aged children and its associated factors in Palestine.

METHODS

A cross-sectional, descriptive-correlational design involved a representative sample of preschool-aged children from kindergarten in Ramallah governorate. Data were collected using the Ages and Stages Questionnaire, Arabic version-3. Associations between developmental delay (DD), parent, child and family characteristics were analyzed utilizing SPSS-25 version.

RESULTS

A total of 249 preschoolers participated in the study. The overall rate of children with Global Developmental Delay (GDD) was 23.7%. The most prevalent DD were in gross motor, personal social, and fine motor skills (25.3%, 17.7%, and 16.5%, respectively). Binary logistic regression analysis revealed that the male gender of a child (OR = 2.66, 95% CI [1.37, 5.19]), the mother's part-time work (OR = 6.01, 95% CI [1.68, 21.52]), low family income (OR = 3.67, 95% CI [1.05, 12.73]), and families with three or more children (OR = 1.43, 95% CI [1.15, 1.781]) were statistically significant independent predictors of GDD.

CONCLUSION

The study findings revealed higher rate of DD among preschoolers in Palestine than regional areas, especially in gross motor, fine motor, and personal social skills, which has consequences for both national and global health. According to the results, factors related to the child, the mother and the family are associated with the cumulative risk of preschoolers having DD.

IMPLICATIONS

It is a crucial role for pediatric nurses to detect DD early and its related risk factors through screening programs to limit the burden of problems in childhood and later adulthood.

An experimental task to measure preschool children's frustration induced by having to wait unexpectedly: The role of sensitivity to delay and culture

The ability to manage frustration induced by having to wait for valued outcomes emerges across childhood and is an important marker of self-regulatory capacity. However, approaches to measure this capacity in preschool children are lacking. In this study, we introduced a new task, the Preschool Delay Frustration Task (P-DeFT), designed specifically to identify children's behavioral and emotional markers of waiting-induced frustration during the imposed wait period and after the release from waiting. We then explored how waiting-induced frustration relates to individual differences in delay sensitivity and whether it differs between two cultural groups thought to have different attitudes toward children's conduct and performance: Hong Kong (HK) and the United Kingdom (UK). A total of 112 preschool children (mean age = 46.22 months) completed the P-DeFT in a quiet laboratory. Each trial had two stages; first, a button press elicited a Go signal; second, this Go signal allowed children to go to a "supermarket" to pick a target toy. On most trials, the Go signal occurred immediately on the first press. On 6 trials, an unexpected/unsignaled 5- or 10-s pre-Go-signal period was imposed. Frustration was indexed by performance (button presses and press duration), behavioral agitation, and negative affect during the pre-Go-signal wait period and the post-Go-signal shopping task. Parents rated their children's delay sensitivity. Waiting-related frustration expressed during both the pre-Go-signal wait period and the post-Go-signal task varied with (a) the length of wait and (b) individual differences in parent-rated delay sensitivity. UK children displayed more negative affect during delay than their HK counterparts, although the relationship between delay sensitivity and frustration was culturally invariant.

A Tale of Age and Abilities: Analyzing Narrative Macrostructure Development in Chinese Preschoolers Through the Lens of Story Grammar

The aim of this research was to explore the progression of narrative macro-structure in Chinese children between the ages of 3 and 6 in preschool. To investigate the narratives of young children in a Chinese prefecture-level city kindergarten, the study selected the wordless picture book "Frog, Where Are You?" as their material. They employed the story grammar analysis method and examined the storytelling of 41 preschoolers (aged 3-4), 47 preschoolers (aged 4-5), and 66 preschoolers (aged 5-6). Significant disparities were observed among age groups in terms of both the total score for story grammar ability and the specific indicators associated with story grammar ability scores, as highlighted by the study. Notably, substantial variances were observed in the total story grammar ability score between children aged 3-4 and 4-5, between children aged 4-5 and 5-6, and between children aged 3-4 and 5-6, as evidenced by p-values of 0.000. Furthermore, substantial dissimilarities were evident in the specific indicators of story grammar ability scores, encompassing "story background, story cause, attempt, and story results," when comparing children aged 3-4 years with those aged 4-5 years (p-values of 0.001, 0.000, 0.025, and 0.008, correspondingly). Moreover, significant differences were identified between children aged 4-5 years and children aged 5-6 years (all p-values of 0.000). However, there were no significant differences in the "internal response" indicator between different age groups (p-value of 0.777 > 0.05). The study found that Chinese preschoolers' narrative macrostructure development showed extremely strong age effects, and their narrative macrostructure ability increased with age. Furthermore, the study identified that the development of narrative macrostructure in Chinese preschoolers may be related to their own cause-and-effect logical reasoning abilities.

Behavioral regulation and approaches to learning: Moderators of the association between extracurricular involvement and academic readiness

Participation in organized extracurricular activities (EAs) has become increasingly common among preschool-aged children. Prior studies have shown inconsistent findings on the association between young children's involvement in EAs and their subsequent developmental outcomes. Moving beyond examining the main effects of EA participation, this study focused on whether children's behavioral regulation and approaches to learning-two important domain-general skills closely linked to learning-would moderate the association between EA participation and academic readiness. Participants included 317 Chinese preschoolers residing in Shanghai. The breadth of EA participation positively predicted children's early math skills, but only for those demonstrating relatively lower behavioral regulation or less positive approaches to learning. The findings provide support for the compensatory hypothesis that participation in EAs is more beneficial for children at greater developmental risk. Unexpectedly, the intensity of EA participation negatively predicted receptive vocabulary beyond certain thresholds among children with relatively poor behavioral regulation or approaches to learning (B = -2.272, p = .032, effect size (ES) = 0.423), but this relationship was not significant for children with better learning behaviors (B = 0.111, p = .712, ES = 0.021). According to the findings, children with worse behavioral regulation and approaches to learning were actually more vulnerable to the negative effects of intensive participation in EAs (B = -15.698, p = .022, ES = 1.797). EA participation did not predict children's Chinese word reading (ps > 0.05). The findings revealed a complex pattern of relationships between preschoolers' EA participation and academic readiness and have highlighted the importance of considering child characteristics when examining the developmental effects of EA involvement.

Parental Imitations and Expansions of Child Language Predict Later Language Outcomes of Autistic Preschoolers

Both the amount and responsiveness of adult language input contribute to the language development of autistic and non-autistic children. From parent-child interaction footage, we measured the amount of adult language input, overall parent responsiveness, and six discrete parent responsive behaviours (imitations, expansions, open-ended questions, yes/no questions, comments and acknowledgements) to explore which types of responsiveness predicted autistic preschoolers' language five months later, after controlling for adult language input. We found expansions and particularly imitations to be more important for later language than overall responsiveness. This study emphasises the need to capture what exactly about parent language input influences child language acquisition, and adds to the evidence that imitating and expanding early language might be particularly beneficial for autistic preschoolers.

Factor analysis of neuropsychological domains in a preschool clinic

INTRODUCTION

The clinical practice of preschool neuropsychology assumes that our assessment tools are measuring underlying neuropsychological functions, and that these functions are negatively impacted by early life neurological injury, disease, and disorder. This study hypothesized that general intellectual capacity and specific cognitive skills, both "broad" neuropsychological domains and "specific" subdomains within those broader clusters, would be differentiable in a preschool-age clinical population.

METHODS

Using neuropsychological data from 580 children (6 and 71 months) seen for a clinical neuropsychological evaluation in the Preschool and Infant Neuropsychological Testing (PINT) Clinic, exploratory factor analyses (EFA) were conducted. Results: A one-factor model provided a good fit when considering verbal, nonverbal, and adaptive functions. Consideration of one- versus two-factor solutions for broad neuropsychological domains indicated that a 2-factor solution provided a significantly better fit for the data. Factor 1 was defined by motor, language, and nonverbal reasoning abilities; Factor 2 was defined by inhibitory control and attention. Further consideration of specific neuropsychological functions also supported a 2-factor solution. Factor 1 ("thinking") was defined by nonverbal reasoning, receptive language, and expressive language; Factor 2 ("processing") was defined by impulse control, inhibitory control, inattention, visual-motor integration, and visuo-constructional abilities. Motor skills cross-loaded onto both factors. Secondary analyses suggest these models provide the best fit for preschool-aged children with > 70 overall intellectual functioning and no comorbid medical diagnosis.

CONCLUSIONS

In a clinical sample of preschool-age children, neuropsychological assessment data appears to assess a general level of intellectual capacity or functioning. Further differentiation between assessing "thinking" (knowledge and reasoning skills) and "processing" (cognitive attention and processing of information) can be considered clinically. Next steps include more recent clinical sample replication, consideration of whether neuropsychological profiles are detectable in the preschool-age range and whether the results of early life assessment are predictive of future functioning.

Child characteristic correlates of food rejection in preschool children: A narrative review

Dietary habits formed in early childhood are key for establishing a healthy diet later in life. Picky eating and food neophobia - the two main forms of food rejection in young children - form an important barricade to establishing such healthy habits. Understanding these types of food rejection is thus essential for promoting healthy eating behaviour in both children and adults. To this end, the present narrative review aims to provide an overview of food rejection research in preschool-aged children, focusing on recent advances in the cognitive literature. Specifically, we evaluate the link between children's cognitive development, chemosensory perception and affective evaluation of food, food knowledge, decision-making strategies, anxiety and disgust sensitivity, and food rejection behaviour. Longitudinal and experimental studies are necessary to establish how the relationships between food rejection and cognitive processes develop over time and to determine their causal directions.

Determination of Streptococcus Mutans and Lactobacillus Counts and their Association with Resting pH of Saliva and Dental Caries in Preschool Children in Lagos

BACKGROUND

Caries is controlled by several factors including exposure to diets rich in carbohydrates, tooth susceptibility, and the presence of some oral flora bacteria such as Streptococcus mutans (S. mutans) and Lactobacilli sp. Tooth demineralisation occurs when the pH in the oral cavity is lower than the critical pH of 5.5 which occurs because of the production of acid by the acidogenic bacteria in the oral flora when they break down sugars (substrate) for energy.

OBJECTIVE

The objective of this study was to determine the salivary Streptococcus mutans and Lactobacillus counts and their association with resting pH of saliva and dental caries in pre-school children in Lagos.

MATERIALSAND METHODS

Fifty preschoolers with and without caries were recruited from the dental clinic and staff primary school in Lagos University Teaching Hospital, Idi-araba respectively. Saliva was collected in Thioglycollate media. The resting pH of the saliva was measured immediately in the clinic with a pH meter (Jenway pH meter, PHS 25). In the laboratory, the samples were streaked on Mitis salivarius bacitracin agar (MSB) and Rogosa agar for S. mutans and Lactobacillus respectively and incubated anaerobically for 48 hours at 37°C. Biochemical tests and morphological characteristics of colonies were used to identify S. mutans and Lactobacillus.

RESULTS

The children were aged between 45 to 71 months with a mean age of 56.66 7.17 months. The mean age of the caries-free group was 55.48 7.57 months and that of caries active group was 57.84 6.76 months. The caries-active subjects recorded significantly higher bacterial counts of S. mutans and Lactobacillus compared to the cariesfree subjects. Streptococcus mutans and Lactobacillus showed a negative and highly significant correlation with resting pH (r = - 0.38 and r = - 0.32 value respectively).

CONCLUSION

The resting pH of saliva in both groups was within normal values. Streptococcus mutans and Lactobacillus counts were significantly inversely correlated to the resting pH value of saliva. Streptococcus mutans and Lactobacillus counts were significantly higher in the caries active group.

CONTEXTE

La carie est contrôlée par plusieurs facteurs dont l'exposition à des régimes riches en glucides, la sensibilité des dents et la présence de certaines bactéries de la flore buccale telles que Streptococcus mutans (S. mutans) et Lactobacilli sp.. La déminéralisation des dents se produit lorsque le pH dans la cavité buccale est inférieur au pH critique de 5,5 qui se produit à la suite de la production d'acide par les bactéries acidurogènes dans la flore buccale lorsqu'elles décomposent les sucres (substrat) pour l'énergie.

BUT ET OBJECTIF

L'objectif de cette étude était de déterminer le nombre de Streptococcus mutans et de Lactobacillus et leur association avec le pH au repos de la salive et des caries dentaires chez les enfants d'âge préscolaire à Lagos.

MATÉRIEL ET MÉTHODES

Cinquante enfants d'âge préscolaire avec et sans caries ont été recrutés respectivement à la clinique dentaire et à l'école primaire du personnel de l'hôpital universitaire de Lagos, Idiaraba. La salive a été recueillie dans un milieu au thioglycolate. Le pH au repos de la salive a été mesuré immédiatement en clinique avec un pHmètre (Jenway pH meter, PHS 25).Au laboratoire, les échantillons ont été striés sur gélose bacitracine Mitis salivarius (MSB) et gélose Rogosa pour S. mutans et Lactobacillus respectivement et incubés en anaérobiose pendant 48 heures à 37°C. Des tests biochimiques et des caractéristiques morphologiques des colonies ont été utilisés pour identifier S. mutans et Lactobacillus.

RÉSULTATS

Les enfants étaient âgés de 45 à 71 mois avec un âge moyen de 56,66 ± 7,17 mois. L'âge moyen du groupe sans carie était de 55,48 ± 7,57 mois et celui du groupe avec carie active était de 57,84 ± 6,76 mois. Les sujets actifs carieux ont enregistré un nombre de bactéries significativement plus élevé de S. mutans et Lactobacillus par rapport aux sujets sans caries. Streptococcus mutans et Lactobacillus ont montré une corrélation négative et hautement significative avec la valeur du pH au repos (r = - 0.38 et r = - 0.32 respectivement) .

CONCLUSION

Le pH au repos de la salive dans les deux groupes était dans les valeurs normales. Les numérations de Streptococcus mutans et de Lactobacillus étaient significativement inversement corrélées à la valeur du pH de la salive au repos. Les numérations de Streptococcus mutans et de Lactobacillus étaient significativement plus élevées dans le groupe actif carieux.

Mots-clés

Numération bactérienne, Streptococcus mutans, Lactobacillus, pH delasalive,Enfants d'âgepréscolaire.

Longitudinal Associations from Maternal and Paternal Internalizing Symptoms to Preschooler's Problem Behavior and Social Competence in China: The Mediating Role of Executive Function

By using a two-year longitudinal design, the current study recruited 199 preschoolers and their parents in Beijing to examine the effects of parental internalizing symptoms (T1) on children's internalizing and externalizing problem behavior and social competence (T3), and further explore whether executive function (EF, T2) may act as the mediator. The results showed that maternal internalizing symptoms and paternal internalizing symptoms at T1 separately had significant direct predictive effect on children's internalizing and externalizing problem behavior but not on social competence at T3 after controlling family socioeconomic status. Further analysis indicated that children's inhibitory self-control at T2 mediated the association between maternal and paternal internalizing symptoms at T1 and children's externalizing problem behavior at T3, and metacognition at T2 could mediate the influence of maternal internalizing symptoms at T1 on children's internalizing problem behavior, externalizing problem behavior and social competence at T3. These findings to some extent highlight the importance of including both parents and exploring mother-father differences in effective interventions aiming to promoting child development. Metacognition and self-control skill training would be helpful to reduce children's problem behavior or to improve their social competence.

Research on the intelligent internet nursing model based on the child respiratory and asthma control test scale for asthma management of preschool children

BACKGROUND

Childhood asthma is a common respiratory ailment that significantly affects preschool children. Effective asthma management in this population is particularly challenging due to limited communication skills in children and the necessity for consistent involvement of a caregiver. With the rise of digital healthcare and the need for innovative interventions, Internet-based models can potentially offer relatively more efficient and patient-tailored care, especially in children.

AIM

To explore the impact of an intelligent Internet care model based on the child respiratory and asthma control test (TRACK) on asthma management in preschool children.

METHODS

The study group comprised preschoolers, aged 5 years or younger, that visited the hospital's pediatric outpatient and emergency departments between January 2021 and January 2022. Total of 200 children were evenly and randomly divided into the observation and control groups. The control group received standard treatment in accordance with the 2016 Guidelines for Pediatric Bronchial Asthma and the Global Initiative on Asthma. In addition to above treatment, the observation group was introduced to an intelligent internet nursing model, emphasizing the TRACK scale. Key measures monitored over a six-month period included the frequency of asthma attack, emergency visits, pulmonary function parameters (FEV1, FEV1/FVC, and PEF), monthly TRACK scores, and the SF-12 quality of life assessment. Post-intervention asthma control rates were assessed at six-month follow-up.

RESULTS

The observation group had fewer asthma attacks and emergency room visits than the control group (P < 0.05). After six months of treatment, the children in both groups had higher FEV1, FEV1/FVC, and PEF (P < 0.05). Statistically significant differences were observed between the two groups (P < 0.05). For six months, children in the observation group had a higher monthly TRACK score than those in the control group (P < 0.05). The PCS and MCSSF-12 quality of life scores were relatively higher than those before the nursing period (P < 0.05). Furthermore, the groups showed statistically significant differences (P < 0.05). The asthma control rate was higher in the observation group than in the control group (P < 0.05).

CONCLUSION

TRACK based Intelligent Internet nursing model may reduce asthma attacks and emergency visits in asthmatic children, improve lung function, quality of life, and the TRACK score and asthma control rate. The effect of nursing was significant, allowing for development of an asthma management model.

Inhibitory control associated with the neural mechanism of joint attention in preschoolers: An fNIRS evidence

Joint attention (JA) is fundamental to the development of children's social functioning; both its response and initiation are closely related to executive function (EF), but the relationship between JA and EF has been relatively rarely studied. The present study aimed to investigate the between-condition differences in brain activation and synchronization of JA under four conditions: (1) stranger-Initiating Joint Attention (Stranger-IJA); (2) teacher-Initiating Joint Attention (Teacher-IJA); (3) stranger-Responding to Joint Attention (Stranger-RJA); and (4) teacher-Responding to Joint Attention (Teacher-RJA). It also aimed to explore the relationships between neuroimaging data and children's inhibitory control levels. To address these two goals, the present study employed 41 (aged 58.61 ± 8.64 months, 24 boys) preschool children through behavioral and functional Near-Infrared Spectroscopy (fNIRS) brain imaging assessment to measure children's EF and brain function under JA, respectively. The results revealed that: (1) a significantly higher prefrontal cortex (PFC) activation was triggered in IJA than RJA; (2) a significantly higher brain activation was triggered in JA with a stranger than with a teacher; (3) a significantly higher index of synchronization asymmetry was evoked in the left and right PFC during interaction with the teacher than with the stranger; and (4) preschoolers' brain activation and synchronization were correlated with their inhibitory control level. The findings advance our understanding of preschoolers' social cognitive development with a biological aspect, offer an opportunity to understand the potential risk of the neural disorder in preschoolers, and provide a basis and insight for preventing neural developmental disorders.

Combining forces for causal reasoning: Children's predictions about physical interactions

Reasoning about causal relations is essential for children's early cognitive development. The current study investigated 4-year-olds' (N = 58) reasoning about complex causal physical interactions in terms of predicting the endpoint of motion. In an online task, children were presented with four configurations that involved different interactions of forces and consequently different patterns of motion. These were Cause (one force moving an object), Enable (a secondary force promoting the motion), Prevent-180° (an opposing force hindering the motion), and Prevent-90° (two-dimensional; a perpendicular force altering the motion). Each prediction was made in terms of either the Distance or Direction of the motion, which was novel in this task compared with previous assessments. Results revealed differences between the configurations, with Cause being the easiest and Prevent-90° being the most difficult to predict. Furthermore, predictions were more accurate when options were about the motion's Direction, whereas Distance options may have aggravated reasoning. The current study extends previous findings on children's intuitive physics and causal cognition by showing that accuracy in reasoning not only is dependent on the number of forces and dimensions at work but also interacts with estimating the motion's Distance and Direction.

Association of physical activity and fitness with executive function among preschoolers

It is well-documented in the literature that high levels of regular physical activity (PA), low levels of sedentary behavior (SB), and high levels of cardiorespiratory fitness (CRF) are associated with superior cognitive functioning, especially with regard to older populations. However, concerning other age groups (e.g., preschoolers) the available evidence documenting such a positive relationship is relatively scarce. Thus, this study aimed to investigate the association of time spent in different PA intensity zones and CRF with executive functions (EFs) in preschool-age children. To this end, preschoolers (n = 127) aged 3 to 6 years were recruited from 9 kindergarten classes in 2 districts of Shenzhen, China. The amount and the intensity of PA were assessed via accelerometry, and the CRF level was quantified by the 20-meter shuttle run test. EFs including inhibitory control and working memory were assessed using the one-on-one iPad-based Early Year Toolbox. Results suggested that children who had a higher CRF level ("impulse control" scores: β = 0.34, p < .001; "Go" accuracy: β = 0.31, p < .001; "No-Go" accuracy: β =0.28, < .001) and spentmore time in moderate-to-vigorous physical activity (MVPA) ("impulse control" scores: β = 0.50, p < .001; No-Go" accuracy: β = 0.52, p < .001) had higher scores on inhibitory control tasks, and those who had a higher CRF level had higher scores on a working memory task (β = 0.24, p < .05). The findings are discussed in light of the positive roles of MVPA and CRF for promoting EFs, but also consider the disproportionate association of PA and CRF with working memory relative to inhibition.

Using Nvivo to Analyze the Impact of Computer Simulation of Parent-Child Cooperative Art Activities on the Growth of Preschool Children

Psychology originally defined parent-child conflict in terms of interpersonal relationships, where parent-child conflict is a process of inconsistent attitudes between parents and children that occurs in a family setting. For this end, we aims to investigate the influence of parental awareness on preschoolers' perception of parent-child conflict and the mediating role of preschoolers' self-esteem. This paper proposes a dynamic parent-child relationship discovery algorithm based on the impact of parent-child cooperation activities on preschool children's development. We applied SPSS and Mplus statistical software for data processing and analysis, and Nvivo 11.0 qualitative software for validation and analysis. The reliability of preschool children's perceived parent-child conflict and sub-dimensions were: 0.901, 0.799, 0.791, 0.811, 0.729; the total scale and the retest reliability of each dimension were: 0.914, 0.837, 0.836, 0.792, 0.711. Validated factor analysis using Mplus: RMSEA = 0.075, TLI = 0.856, CFI = 0.876, SRMR = 0.064.

Influence of pretreatment exposure to pediatric dental care using the "Tiny dentist" game on 4-7 years old children's pain and anxiety: a parallel randomised clinical trial

There have been no experiments on interactive modelling through computer games, although there have been a few on modelling a pre-exposure method for managing anxiety among preschoolers. The impact of partaking in a dental simulation game prior to the dental treatment on pain and anxiety in kids aged 4 to7 years during their first appointment was studied. A total of 156 kids who required unilateral pulp therapy and preformed crowns on their mandibular primary molars were enrolled in this double-blind, randomized clinical trial. They were then randomly assigned to intervention and control groups. The intervention group engaged in the game three times/day for 07 days prior to the anticipated appointment. The Wong-Baker Faces Rating Scale (WBFRS) was used to record their pre- and post-operative pain experienced during the dental procedure. Additionally, a finger pulse oximeter was used to record heart rate (HR) at each of the six treatment phases: baseline (the first session, two weeks prior to treatment) and stages 2-6. Playing video games considerably lowered the heart rate. Playing and the treatment period interacted in a major way. On comparing the groups at every time point, the intervention group displayed lower HR during injection, tooth preparation with an air-rotor and biomechanical preparation with endodontic rotary files.The results suggest that engaging in specific dental simulation games prior to the 1st dentist visit could help preschoolers feel less anxious during routine dental operations.

Age-related differences in eating location, food source location, and timing of snack intake among U.S. children 1-19 years

BACKGROUND

Snacking is nearly universal and contributes significant energy to U.S. children's diets. Little is known, however, about where and when snacking intake occurs and if such patterns change with age. This research evaluated age-related differences in eating location, food source location, and timing of snacking among U.S. children aged 1-19 years (y).

METHODS

A cross-sectional analysis of snacking among 14,666 children in the 2007-2018 U.S. National Health and Nutrition Examination Survey was conducted using a single 24-hour dietary recall. Snacking was participant-defined and included all eating occasions outside of meals. Linear regression and analysis of covariance were used to examine the effects of age (toddler 1-2 y, preschooler 3-5 y, school-age 6-11 y, adolescent 12-19 y) on the percentage of daily snack energy consumed by eating location (at home vs. away from home), food source location (grocery store, convenience store, school/childcare, restaurant, from someone else (i.e. "socially"), and other), and time of day (morning, 6am-12pm; early afternoon, 12pm-3pm; late afternoon/afterschool 3pm-6pm; evening 6pm-9pm, late-night 9pm-12am, and overnight 12am-6am).

RESULTS

On average, U.S. children consumed most of their daily snacking energy at home (71%), from foods and beverages obtained from grocery stores (75%), and in the late afternoon/afterschool (31%). Toddlers and preschoolers consumed a greater percentage of their daily snack energy during the morning hours compared to school-age children and adolescents (both p < 0.001); school-age children consumed the most in the evening (27%, p < 0.001), and adolescents consumed the most in the late-night period (22%, p < 0.001). Age-related increases were seen in the percentage of daily snacking energy eaten outside the home (p < 0.001), and obtained socially (p < 0.001), from restaurants (p < 0.001), and convenience stores (p < 0.001).

CONCLUSION

Findings reveal age-related differences in eating location, food source location, and timing of snack intake among U.S. children aged 1-19 y. Younger children consume a greater percentage of snacking calories in the morning and at home relative to older children. School-age children and adolescents show greater snacking in the evening and at night and from foods obtained and eaten outside the home. Efforts to promote healthy snacking behaviors among children should consider developmental differences in snacking patterns.

Urinary antibiotic concentrations in preschool children from eastern China and health risk assessment

Despite limited biomonitoring studies suggesting extensive antibiotic exposure in general population, the body burden of antibiotics in young children and their potential health risks remain unclear. To assess the antibiotic exposure levels in young children, 508 preschoolers aged 3-6 years were recruited from eastern China in 2022, and a total of 50 representative antibiotics from 8 categories, including 17 human antibiotics (HAs), 4 antibiotics preferred as HAs (PHAs), 16 veterinary antibiotics (VAs), and 13 antibiotics preferred as VAs (PVAs), were analyzed by UPLC-MS/MS. Hazard quotient (HQ) and hazard index (HI) were calculated to evaluate the health risks, and multivariate logistic regression was applied to examine diet with antibiotic exposure. Our results showed that there were 41 antibiotics detected in children's urine, and the overall detection frequency was as high as 100%. Sulfonamides, macrolides, β-lactams, quinolones, and azoles were the predominant categories of antibiotic detected. Among the studied children, 6.5% had a sum of estimated daily intake (EDI) of all VAs and PVAs larger than 1 μg/kg/day. Notably, 10.0% of the children had a microbiological HI value exceeding 1, primarily contributed by ciprofloxacin. Children with higher consumption of seafood had a relatively increased exposure to multiple categories of antibiotics, including HAs, VAs, quinolones, azoles, and others. Principal component analysis suggested that "Aquatic products and viscera preferred dietary pattern" scores were positively correlated with the exposure levels of ciprofloxacin (OR: 1.23; 95% CI: 1.02-1.47) and carbadox (OR: 1.32; 95% CI: 1.10-1.59), and a relatively increased exposure of PHAs was realized in children with higher "Meat-egg preferred dietary pattern" scores (OR: 1.24; 95% CI: 1.03-1.50). In conclusion, there was a widespread exposure to antibiotics among preschool children from eastern China, and children who consumed more animal-derived foods may had an increased exposure to antibiotics.

Racial and ethnic disparities in insufficient sleep among US in infants and preschoolers

OBJECTIVE

To examine racial and ethnic disparities and associated factors of insufficient sleep among children from infancy to preschool-aged.

METHODS

We analyzed parent-reported data on US children ages 4 months-5 years (n = 13,975) from the 2018 and 2019 National Survey of Children's Health. Children who slept less than the age-specific minimum hours recommended by the American Academy of Sleep Medicine were classified as having insufficient sleep. Logistic regression was used to estimate unadjusted and adjusted odds ratios (AOR).

RESULTS

An estimated 34.3% of children from infancy to preschool-aged experienced insufficient sleep. Socioeconomic factors (poverty [AOR] = 1.5, parents' education level [AORs] from 1.3 to 1.5); parent-child interaction variables (AORs from 1.4 to 1.6); breast feeding status (AOR = 1.5); family structure (AORs from 1.5 to 4.4); and weeknight bedtime regularity (AORs from 1.3 to 3.0) were significantly associated with having insufficient sleep. Non-Hispanic Black (OR = 3.2) and Hispanic children (OR = 1.6) had significantly higher odds of insufficient sleep compared to non-Hispanic White children. Racial and ethnic disparities in insufficient sleep between non-Hispanic White children and Hispanic children were largely attenuated by adjusting for social economic factors. However, the difference in insufficient sleep between non-Hispanic Black and non-Hispanic White children remains (AOR = 1.6) after adjusting socioeconomic and other factors.

CONCLUSIONS

More than one-third of the sample reported insufficient sleep. After adjusting for socio-demographic variables, racial disparities in insufficient sleep decreased but persistent disparities existed. Further research is warranted to examine other factors and develop interventions to address multilevel factors and improve sleep health among racial and ethnic minority group children.

Exploring factors influencing young children's learning from storybooks: Interactive and multimedia features

Electronic storybooks are increasingly popular with preschoolers. The purpose of our research was to investigate the effects of interactive and multimedia features in electronic storybooks on preschoolers' learning. We assigned 4- to 6-year-old children to different reading conditions in two experiments. Children were required to complete tests for learning outcomes and answer questions about the reading experience. In Experiment 1, children in the interactive (self-paced) group needed to turn the pages by a button on the page, whereas the pages were turned automatically in the non-interactive (system-controlled) group. We found that children in the system-controlled condition performed better in inference making than children in the self-paced condition. In Experiment 2, we used a 2 (Animation: present or non-present) × 2 (Background Music: present or non-present) between-participants design. We found that children's scores of learning and interest in groups with animations were higher than those in groups without animations. This research suggests that electronic books with animations congruent with the learning content promote learning for both adults and young children. Thus, we offer suggestions for designers of electronic books. Moreover, the study provides implications for educators and parents, and we suggest that multi-featured electronic storybooks for preschoolers should be carefully selected.

Effect of intake of iron-fortified milk on levels of ferritin and hemoglobin in preschoolers: A systematic review and meta-analysis

BACKGROUND

Food fortification is often the simplest way to increase iron intake on a broad and sustainable basis. It is one of the most cost-effective global development efforts.

OBJECTIVE

To systematize data from randomized and nonrandomized controlled trials investigating the effect of consumption of iron-fortified milk (IFM) on serum iron status in preschoolers.

METHODS

The trials were systematically searched in five electronic databases that evaluated the effect of iron-fortified milk (IFM) consumption on hemoglobin and ferritin in children aged 1-6 years. The randomized the meta-analysis model was used to calculate total and stratified effects.

RESULTS

Seven trials representing 1210 preschoolers showed a significant effect of IFM on hemoglobin [difference in means (MD) 0.33 g/dL (95% CI 0.23, 0.44; I² = 3.85%, p (Q statistic) < 0.01)] and ferritin concentrations [effect size (SMD) 0.57 (95% CI 0.19, 0.95; I² = 84.63%, p (Q statistic) < 0.01)]. In stratified analyses, hemoglobin showed an increase when subjects received iron with other co-interventions [MD 0.35 g/dL (95% CI 0.22, 0.48; I² = 11.01%; p (Q statistic) = 0.36)]; and when the iron dose was above 5 mg/day [MD 0.34 g/dL (95% CI 0.23, 0.45; I² = 2.33%; p (Q statistic) = 0.37)] and the intervention time was over 6 months [MD 0.39 g/dL (95% CI 0.18, 0.60; I² = 37.90%; p (Q statistic) = 0.20)]. For ferritin, stratified analyses showed a larger effect size when they used dose higher than 5 mg/day [SMD 0.60 (95% CI 0.02, 1.18; I² = 91.06, p (Q statistic) < 0.01)] and intervention was conducted longer than 6 months [SMD 0.96 (95% CI - 0.16, 1.76; I² = 93.38%, p (Q statistic) < 0.01)].

CONCLUSIONS

Our findings indicate that although milk iron fortification modestly increases serum hemoglobin levels or the effect size of serum ferritin of participants, it cannot be considered in the coadjuvant treatment for anemia. Register: CRD42020213604.

Treatment of preschool children with obsessive compulsive disorder

The aim was to examine the clinical features of Obsessive-Compulsive Disorder (OCD) in preschool and the effectiveness of aripiprazole with a standardized Cognitive-Behavioral Family Therapy (CBFT) in the treatment of preschoolers with OCD. Twelve preschool children, 36-72 months of age were diagnosed with OCD according to the Diagnostic and Statistical Manual of Mental Disorders, the Fifth Edition criteria by a fellowship-trained child and adolescent psychiatrist. They were evaluated with Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime version and Childhood Yale-Brown Obsessive Compulsive Scale (CY-BOCS) at baseline, at the end of the 12th and 24th weeks of treatment. The baseline mean of total CY-BOCS score decreased from 33.67 to 13.83 at the 12th week and 5.58 at the end of the 24th week of treatment. Also, 66.7% of them had at least one psychiatric comorbidity. Overall, this study revealed the effect of aripiprazole with CBFT in preschool-aged children with OCD. Also, the presence of comorbidity that is seen frequently in preschoolers with OCD may complicate the treatment. Therefore, there is a need to increase awareness of OCD and its comorbidities in preschoolers to supply treatment at an early age.

Preschoolers selectively trust and selectively share with others based on their past accuracy and intentions

This study investigated whether preschool-age children consider both an individual's past accuracy and intentions when deciding whether to trust and share with that individual. The participants, 3- to 5-year-olds (N = 168), played a searching game with partners who varied in both accuracy (accurate or inaccurate) and intentions (prosocial or antisocial). Children received advice from partners about where to look for a hidden object, earning prizes for correct guesses. Then they were given an opportunity to share their prizes with their partner. Results indicated that children trusted sources who provided accurate advice (regardless of intentions) and shared with sources who provided accurate advice or demonstrated prosocial intentions. These findings suggest that children attend to both an individual's accuracy and intentions when deciding how to interact with social partners and may weigh this information differently to make different social decisions.

Food Allergen Immunotherapy in Preschool Children: Do We Have the Evidence?

Standard care for the management of food allergies previously centered on allergen avoidance and the treatment of adverse reactions after allergen exposure. An increase in the development of immunotherapy treatments for food allergy has occurred over the past 2 decades, with many centers now offering immunotherapy. Previous studies mainly focused on school-age children in whom food allergies are likely to be persistent. However, there is increasing evidence that delivering immunotherapy for food allergy to preschool-age children may deliver higher rates of success, and that peanut allergen immunotherapy leads the way. Conversely, the natural resolution of food allergies occurs primarily in these younger age groups, resulting in challenges to selecting patients who will ultimately benefit from these treatments. Both immunotherapy and natural history studies reveal the inherent plasticity of the immune system in early life, which may be more amenable to intervention, but this raises a delicate yet unknown balance between the optimal timing of intervention versus waiting for natural resolution of the food allergy. Here we review the evidence for early food allergen immunotherapy in preschoolers, and present the pros and cons of this approach while acknowledging important research gaps in this age group.

Behavioral and social determinants of early childhood caries among Palestinian preschoolers in Jerusalem area: a cross-sectional study

BACKGROUND

This study came to determine the prevalence of Early Childhood Carries (ECC) among preschoolers in a marginalized population and describe the influence of behavioral and social determinants on the development of ECC.

METHODS

This is a cross-sectional study that was carried out in four random preschools in the Jerusalem Governorate of the Occupied Palestinian Territories. All children aged 3-5 years old in the selected schools were screened for ECC using the decayed, missing, and filled teeth index (dmft). Data on children's socio-economic, feeding habits, hygiene habits, access to care, parental level of stress, social support, and locus of control were collected by a validated questionnaire sent to the children's main caregivers. Descriptive statistics were generated and bivariable and multivariable analyses were used to explain the influence of different behavioral and social determinants on ECC levels.

RESULTS

Four hundred and fifty-seven preschoolers completed the questionnaire and the clinical screening. Ninety-seven percent (n = 447) had experienced dental decay, with an average dmft score of 6.6 ± 4.3. After accounting for potential confounding, parents' internal locus of control was associated with lower dental caries among children (IRR = 0.97, 95% CI = 0.97, 0.98). Having routine, preventive visits versus never seeing a dentist were associated with lower dmft scores (IRR = 0.42, 95% CI = 0.33, 0.52). Night feeding habits (putting things other than water in the baby bottle at night, having children sleep while being breastfed at night) were positively associated with children's dental caries (IRR = 1.06, 95% CI = 1.04, 1.09: IRR = 1.15, 95% CI = 1.03, 1.29, respectively). Not adding sugar to the bottle was negatively associated with children's dental caries (IRR = 0.86, 95% CI = 0.74, 1.00).

CONCLUSIONS

Preschoolers in this study suffered from high dental caries experience. Although infant feeding habits were key factors in explaining the elevated level of the disease, system and socio-psychological factors were also detrimental to ECC prevalence. Policies and interventions to alleviate the burden of ECC need to address socioeconomic determinants of health in addition to feeding and hygiene practices.

Free sugar intake from snacks and beverages in Canadian preschool- and toddler-aged children: a cross-sectional study

BACKGROUND

Excess consumption of free sugar (FS) increases the risk of dental caries and unhealthy weight gain. However, the contribution of snacks and beverages to young children's FS intake is not well understood. The purpose of this study was to determine FS intake from snacks and beverages among preschool-aged Canadian children.

METHODS

This cross-sectional study examined baseline data from 267 children 1.5 to 5 y enrolled in the Guelph Family Health Study. Dietary assessment was completed over a 24-h period using ASA24-Canada-2016 to, 1) estimate the proportion of children whose FS intake from snacks and beverages consumed exceeded 5% total energy intake (TE) and 10% TE, and 2) identify the top snack and beverage sources of FS.

RESULTS

FS contributed 10.6 ± 6.9% TE (mean ± SD). 30 and 8% of children consumed ≥ 5% TE and ≥ 10% TE from snack FS, respectively. Furthermore, 17 and 7% of children consumed ≥ 5% TE and ≥ 10% TE from beverages FS, respectively. Snacks and beverages accounted for 49 ± 30.9% of FS energy. Top snack sources of FS (% children, children's %TE from FS) were bakery products (55%, 2.4%), candy and sweet condiments (21%, 3.0%), and sugar-containing beverages (20%, 4.1%). Top sugar-containing beverage sources of FS (48%, 5.3%) were 100% fruit juice (22%, 4.6%) and flavored milk (11%, 3.1%).

CONCLUSIONS

Snacks and beverages contributed nearly half of FS intake among a sample of young children in Canada. Thus, long-term monitoring of snacking behavior and consumption of FS is warranted. These findings may help inform nutritional strategies and public policies to improve diet quality and FS intake in preschool-aged children.

TRIAL REGISTRATION

The Clinical Trial Registry number is NCT02939261 from clinicaltrials.gov. Date of Registration: October 20, 2016.

Coordination strategies of lower limb muscles during curve-turning tasks in preschool children

BACKGROUND

Preschoolers are within their critical time in motion development; while muscles are the fundamental units in motion control and by monitoring activated intensity and duration of muscles, preschooler's motor ability which would disclose their potential pathogenesis quality can be objectively and quantitatively assessed. Although a large number of studies were available on this issue, questions still being there: what are the patterns and characteristics of lower limb muscles when they are facing with the curve walking(CW) tasks; and then how individual muscle or muscle groups coordinated while turning curves. Our purpose of this study is first to portray the patterns and characteristics of lower limb muscles of healthy preschoolers while CW and then to insight their muscles' coordination mechanism and "neuro-musculo-skeletal" feedback during motion.

METHOD

35 healthy preschoolers and 35 healthy adults' lower limbs surface electromyography (sEMG) were collected while left and right CW and four muscle groups (Tibialis Anterior, Lateral Gastrocnemius, Rectus Femoris, and Biceps Femoris) were recorded. sEMG variables such as Muscle Activation Time, Total Duration of Activity Time, Average Muscle Activation Rate and Average Rate of Change were calculated. Paired sample t-test was used to explore the differences of sEMG variables between preschoolers and adults when turning curves.

RESULTS

Preschoolers would adjust the gait by changing the activation time and activation rate to fulfill the curve turning tasks; but they also showed variations in coordination mechanism when contrasting with the adults group. Those findings in preschoolers would support to build muscles' coordination mechanism and further insight to neuro-muscular skeletal feedback regulation.

CONCLUSION

Although preschoolers performed good enough to switching gait from normal walking to CW, but gaps in their abilities were still apparent when compared to adults. Hence, with the help of highly recognizable muscle coordination mechanism in CW, motor dysfunction in lower limbs of preschool children can be effectively identified.

Lower-limbs' muscle coordination mechanism of healthy preschoolers while walking across obstacles

RESEARCH BACKGROUND

The obstacle-crossing task is a complex gait task, it requires an advance predict of the obstacle for posture adjustment and accurate control of bilateral legs to ensure crossing the obstacles successfully. By monitoring the activated intensity and duration of muscles in this process, preschoolers' motor ability could be assessed objectively and quantitatively, as well as disclose their potential pathogenesis quality eventually.

SCIENTIFIC QUESTION

what are the patterns and characteristics of lower limb muscles when they are facing the obstacle-crossing walking (OW) tasks, and how they coordinate their individual muscle or muscle groups of lower-limbs muscles while walking across obstacles? Thereby, the purpose of this study was first to portray the patterns and characteristics of lower limb muscles of healthy preschoolers while OW motion and second to assess the muscles' coordination mechanism.

METHOD

35 healthy preschoolers and 35 healthy adults' lower limbs' surface electromyography (sEMG) were collected while left and right OW and four muscle groups (Tibialis Anterior, Lateral Gastrocnemius, Rectus Femoris, and Biceps Femoris) were recorded. sEMG variables such as Muscle Activation Time, Total Duration of Activity Time, Average Muscle Activation Rate, and Average Rate of Change were calculated. The paired sample-t-test was used to explore the differences of sEMG variables between preschoolers and adults when obstacle-crossing.

RESULTS

Preschoolers would adjust the gait by changing the activation time and activation rate to fulfill the obstacle crossing tasks, but they also showed variations by contrasting to adults. Further, synergy between muscles in leg and thigh were also found.

CONCLUSION

Although preschoolers performed well enough to finish the OW tasks, ability gaps were still apparent when compared to adults. Hence, with the help of a deeply recognizable muscle coordination mechanism in OW, motor dysfunction in the lower limbs of preschool children can be effectively identified.

Using the Flanker Task to Examine Genetic and Environmental Contributions in Inhibitory Control Across the Preschool Period

The limited research exploring genetic and environmental influences on inhibitory control (IC) in preschoolers has relied on parent ratings or simple delay tasks and has produced mixed results. The present study uses a cognitively-challenging Flanker task to examine genetic and environmental contributions to the development of early IC in a longitudinal sample of 310 same-sex twin pairs (123 MZ; 187 DZ; 51% female) assessed at ages 3, 4 and 5 years. IC was significantly heritable at each age (a²: age 3 = .36; age 4 = .36; age 5 = .35). Stability was entirely accounted for by genetic influences, and change was explained by genetic and nonshared environmental factors. No significant shared environmental influences were observed.

The plural counts: Inconsistent grammatical number hinders numerical development in preschoolers - A cross-linguistic study

The role of grammar in numerical development, and particularly the role of grammatical number inflection, has already been well-documented in toddlerhood. It is unclear, however, whether the influence of grammatical language structure further extends to more complex later stages of numerical development. Here, we addressed this question by exploiting differences between Polish, which has a complex grammatical number paradigm, leading to a partially inconsistent mapping between numerical quantities and grammatical number, and German, which has a comparatively easy verbal paradigm: 151 Polish-speaking and 123 German-speaking kindergarten children were tested using a symbolic numerical comparison task. Additionally, counting skills (Give-a-Number and count-list), and mapping between non-symbolic (dot sets) and symbolic representations of numbers, as well as working memory (Corsi blocks and Digit span) were assessed. Based on the Give-a-Number and mapping tasks, the children were divided into subset-knowers, CP-knowers-non-mappers, and CP-knowers-mappers. Linguistic background was related to performance in several ways: Polish-speaking children expectedly progressed to the CP-knowers stage later than German children, despite comparable non-numerical capabilities, and even after this stage was achieved, they fared worse in the numerical comparison task. There were also meaningful differences in spatial-numerical mapping between the Polish and German groups. Our findings are in line with the theory that grammatical number paradigms influence. the development of representations and processing of numbers, not only at the stage of acquiring the meaning of the first number-words but at later stages as well, when dealing with symbolic numbers.

Poor conceptual knowledge in the food domain and food rejection dispositions in 3- to 7-year-old children

Previous research established that children with poorer taxonomic knowledge in the food domain display increased levels of food rejection. However, the food domain heavily lends itself to script and thematic conceptual knowledge (e.g., pancakes at breakfast), to which young children already attend. This series of studies investigated the development of conceptual knowledge, specifically in the food domain, and the link with food rejection. Study 1 used a nonconflicting triad task testing children's knowledge of four subtypes of script and thematic associations (food-food pairs, food-utensil pairs, event scripts, and meal scripts) with children aged 3-6 years living in the United States (18 males and 14 females). Study 2 employed the same design along with a measure of food rejection in 3- to 6-year-olds living in France (67 males and 62 females). There was significant conceptual development in both groups, but thematic food concepts are acquired earlier than meal script concepts. Study 3 investigated the link between thematic and script cross-classification and food rejection in 39 females and 33 males living in France (4- to 7-year-olds). Results demonstrate that children as young as 3 years old are already attending to thematic and script structures to inform food-based decision making. Even more critically, Study 3 showed that increased food rejection tendencies are negatively related to script and thematic understanding in the food domain. Such seminal studies illustrate the importance of conceptual knowledge in children's interpretation and acceptance of food, highlighting promising avenues for knowledge-based interventions to foster dietary variety.

Integrated versus trial specific focus improves decision-making in older preschoolers

This study explored the effect of integrated-focus (focusing on a depiction of overall gains/losses) versus trial-focus (focusing on gains/losses at each trial) on choice in a preschool variant of the Iowa Gambling task. Participants included 65 preschoolers (M = 47.82, SD = 7.29). Children completed two versions of the Preschool Gambling task, three cool executive function tasks, a moral reasoning task, and an affective perspective taking task. The results indicated that while the integrated-focus condition led to improvement in the awareness of the game, the condition effect was moderated by age for decision-making choice; older preschoolers showed improvement in decision-making in the integrated focus condition, while younger preschoolers showed no condition effect. Further analysis indicated that differences in the increase of advantageous choice across blocks and the condition effect were partly explained by these differences in awareness. Furthermore, a component of cool executive function (shifting) was associated with the latter phase of decision-making. The findings additionally indicated an association of advantageous decision-making with moral/emotional measures, suggesting that the PGT may be a potentially useful clinical tool for early assessment. Finally, the findings of the current study have implications for how hot and cool executive function abilities may work together to enable adaptive decisions.