Infant and toddler sleep in Australia and New Zealand

Aims: To characterize sleep patterns and sleep problems in a large sample of young children (birth to 36 months) in Australia (AU) and New Zealand (NZ). Methods: Parents and caregivers of 2154 infants and toddlers in AU and NZ completed an expanded version of the Brief Infant Sleep Questionnaire. Results: Overall, young children in AU and NZ go to bed relatively early (19:35), awaken on average 1.08 times per night for an average of 23 min, have a low likelihood of bed‐sharing with parents (7.2%) and obtain an average of 13.24 h total sleep. However, a significant percentage of parents perceive that their child has a sleep problem (30.69%). Sleep patterns in these children demonstrate clear developmental changes, including a decrease in daytime sleep and total sleep time, as well as consolidation of sleep during the night (decrease in night wakings and nocturnal wakefulness). Parents in AU and NZ are also highly likely to encourage independence and self‐soothing, especially after the age of 3 months. Conclusions: These findings provide parents and professionals reference data for assessing sleep in young children, as well as common parenting practices related to sleep behaviours.     

Infant formula and toddler milk marketing and caregiver's provision to young children

The World Health Organization International Code of Marketing of Breast‐milk Substitutes prohibits claims and other marketing that may confuse caregivers about benefits of formula and other milk‐based drinks for infants and toddlers, but such marketing is common in the United States. This study assessed caregivers' provision of milk‐based products to their infants and toddlers and potential confusion about product benefits and appropriate use. Online survey of 1,645 U.S. caregivers of infants (6–11 months) and toddlers (12–36 months). Respondents identified infant formula and toddler milk products they served their child (ren) and provided relative agreement with common marketing claims. Logistic regression assessed relationships between agreement and serving these products, controlling for individual characteristics. Over one‐half of caregivers of infants (52%) agreed that infant formula can be better for babies' digestion and brain development than breastmilk, and 62% agreed it can provide nutrition not present in breastmilk. Most caregivers of toddlers (60%) agreed that toddler milks provide nutrition toddlers do not get from other foods. Some caregivers of infants (11%) reported serving toddler milk to their child most often. Agreement with marketing claims increased the odds of serving infant formula and/or toddler milks. For caregivers of toddlers, odds were higher for college‐educated and lower for non‐Hispanic White caregivers. Common marketing messages promoting infant formula and toddler milks may mislead caregivers about benefits and appropriateness of serving to young children. These findings support calls for public health policies and increased regulation of infant formula and toddler milks.     

Infant and toddler oral- and manual-motor skills predict later speech fluency in autism

Background:  Spoken and gestural communication proficiency varies greatly among autistic individuals. Three studies examined the role of oral- and manual-motor skill in predicting autistic children's speech development.
Methods:  Study 1 investigated whether infant and toddler oral- and manual-motor skills predict middle childhood and teenage speech fluency; Study 2 verified those early infant and toddler predictions with historical home video; and Study 3 assessed the relation between autistic children's current-day oral-motor skill and their speech fluency.
Results:  Infant and toddler oral-motor and manual-motor skills inter-correlated significantly, distinguished autistic children ( N  = 115) from typically developing children ( N  = 44), and distinguished autistic children whose current-day speech was minimally fluent ( N  = 33), moderately fluent ( N  = 39), and highly fluent ( N  = 39). These results were corroborated by analysis of historical home video ( N  = 32) and verified with current-day assessment ( N  = 40).
Conclusions:  The prominent associations among early oral- and manual-motor skills and later speech fluency bear implications for understanding communication in autism. For instance, these associations challenge the common assumption (made even in diagnostic criteria) that manual modes of communication are available to autistic individuals – if simply they choose to use them. These associations also highlight a potential confound from manual-motor skills when assessing autistic cognition, receptive language, and 'nonverbal' social communication.     

Infant and toddler sleep: a telephone survey of parents in one community

A telephone survey was carried out to determine the prevalence of infant and toddler sleep disturbances. Parents of all 12- to 35-month-old children listed in one community were contacted, and 81% participated. Many children resisted going to bed (42%) or woke and cried during the night (35%). Approximately half the parents had changed their child's diet, naptime, or bedtime and about half these parents found changing routines helpful. Parents frequently reported that pacifiers or bottles in the crib quieted their children. Crying it out, scheduled awakenings, and progressive delay responding were all effective (70% or better) for parents who were aware of these procedures. Satisfaction did not necessarily correspond with effectiveness. Finally, parents were more likely to seek information about sleep from relatives, friends, or books and magazines than from their physician or from a psychologist.     

Infant and toddler drowning in Australia: Patterns,risk factors and prevention recommendations

Drowning is a leading cause of death among infants and toddlers. Unique physiological and behavioural factors contribute to high mortality rates. Drowning incidents predominantly occur during warmer months and holidays. Recent studies link high socio‐economic status and drowning, in contrast to earlier studies. Cardiac arrhythmias, epilepsy and autism are strong risk factors for drowning incidents. Prevention strategies have substantially lowered drowning rates. While legislation‐compliant pool fencing substantially reduces drowning risk, compliance levels are low, and penalties are minor. Active supervision education for parents and carers is an effective drowning prevention strategy. Bystanders provide basic life support in only 30% of cases; strategies to increase training uptake are needed. Fencing costs should be a mandatory inclusion for pool installations, with high penalties for non‐compliance. Basic life support training should be compulsory for pool owners, and tax incentives should be used as a lever to increase training uptake.     

The infant and toddler with diabetes: Challenges of diagnosis and management

Infants and toddlers comprise a small minority of individuals with type 1 diabetes. However, epidemiological data provide evidence of a trend towards diagnosis at a younger age. These very young children pose significant challenges to both the health care professionals involved in their care as well as to their families. At diagnosis, younger children often do not present with classical symptoms of diabetes. Unless health professionals remain alert to the possibility of diabetes being the underlying cause of a child’s illness, the diagnosis may be missed. Once the diabetes has been diagnosed, the major challenge is to set up a treatment regimen that is both reasonable and realistic; in the youngest children, the goal of very tight metabolic control may expose them to episodes of severe hypoglycemia which may lead to subtle cognitive impairments later in life. The therapeutic regimen must balance the naturally erratic eating and exercise patterns of very young children with the need to maintain adequate metabolic control. Setting a blood glucose target range of 6 to 12 mmol/L usually allows this to be accomplished. Diabetes during early childhood creates a psychosocial challenge to the families of these children. Successful management of infants and toddlers with diabetes depends on a well functioning and educated family, the availability of diabetes health care team experienced in the treatment of these youngsters, and the involvement of the extended family, child care personnel and others who play a role in their daily care.     

Amitriptyline-associated seizures in a toddler with Munchausen-by-proxy.

We describe an unusual case of a toddler diagnosed with an idiopathic seizure disorder that later was proved to be caused by deliberate administration of amitriptyline by his custodian. In spite of seizures associated with widened electrocardiographic wave (QRS) and right axis deviation on the electrocardiogram (EKG), the correct diagnosis eluded clinicians through a series of hospital admissions. Unfortunately, clinicians are quite accustomed to the fact that patients previously diagnosed with epilepsy have seizures and may not investigate other causes of seizure. This allowed classic signs of cyclic antidepressant poisoning to go unrecognized.     

Infant botulism.

Infant botulism is a unique neuromuscular disease affecting infants less than six months old. It is the result of intraintestinal toxin production by C. botulinum (toxi-infection). Characteristic symptoms include constipation, lethargy, and decreased feeding. Physical examination often reveals generalized hypotonia with cranial nerve impairment. Recovery is dependent on supportive care in an intensive care setting. The relationship of this disease to the sudden infant death syndrome requires further study.