Tongue movements in normal 2- to 8-year-old children: extended profile of an eating assessment

In this study tongue movements of 103 normal 5-, 6-, 7-, and 8-year-old children were measured and compared. The 5-year-olds were compared with children of an earlier study and data were combined for 2- to 8-year-old children. Two different tongue positions were measured as three standard textures of food were presented: first, the position of the tongue as the food was 5 cm away from the lips, and second, the position of the tongue or other oral characteristics as the food was swallowed. For the anticipation of food a significant age-texture (p less than .001) as well as an age-sex-texture interaction was noted (p less than .035). For swallowing, significant age (p less than .0001), texture (p less than .0001), and sex-age interactions (p less than .0001) were found. Although food is anticipated in a similar fashion by both sexes, age and texture differences must be taken into account when swallowing is evaluated. A preliminary developmental curve for the two eating behaviors is presented for children 2 to 8 years old.     

Comparison of chewing cycles in 2-, 3-, 4-, and 5-year-old normal children

Chewing movements of normal 2-, 3-, and 4-year-old children were measured. Chewing movements of 2- and 3-year-olds were compared with those of 4- and 5-year-olds. Measures were taken on 56 children: 17 were 2 years old (8 female, 9 male); 19 were 3 years old (10 female, 9 male); and 20 were 4 years old (10 female and 10 male). Data of twenty 5-year-olds (10 males, 10 females) were taken from a previous study (9). Chewing movements were measured by time (seconds), number of cycles, and a time/cycle ratio. A chewing cycle was defined as an upward and downward movement of the chin. Total time from the moment food was placed in the mouth until the final swallow occurred was divided by the number of cycles counted for the same period. The type of food eaten affected time, cycles, and the time/cycle ratio, but age and sex did not. A comparison of younger (2- and 3-year-olds) and older children (4- and 5-year-olds) showed significant time differences. During maturation, time was shortened. It was shown earlier that under pathologic conditions (Down's syndrome) time was prolonged. Thus, the time/cycle ratio is an excellent indicator of the developmental status of a child.     

Tongue movements in normal preschool children during eating

This study describes tongue movements of normal preschool children during eating, and is the first phase in a long-term project to develop a standardized eating assessment for children. It is hoped eventually to fill the need for an objective measurement tool in pediatric occupational therapy practice. The movements were monitored in 40 children; 20 were 4 years +/- 1 month, and 20 were 5 years +/- 1 month. Each group consisted of 10 boys and 10 girls. Two different tongue positions were quantified: First, as food was presented to the child when the food was 5 cm from the lips; and second, as food was swallowed. Tongue position upon food presentation and upon swallowing was affected by age, sex, and type of food. Both responses showed maturational changes from 4 to 5 years. It is proposed that important maturational changes take place between 4 and 5 years of age, but that adult patterns of swallowing are attained later in development.     

Chewing cycles in 2- to 8-year-old normal children: a developmental profile

Chewing movements of normal 5-, 6-, 7-, and 8-year-old children were measured and compared across age, food textures, and gender. Applesauce, graham cracker, and raisins were used. Measures were taken on 98 children: eighteen 5-year-olds (9 boys, 9 girls); thirty-five 6-year-olds (16 boys, 19 girls); twenty-six 7-year-olds (13 boys, 13 girls); and nineteen 8-year-olds (10 boys, 9 girls). Comparisons were made with data of another twenty 5-year-olds (10 boys, 10 girls) from a previous study. Chewing movements were measured by time, number of cycles, and a time/cycle ratio. Food texture affected time, cycle, and the time/cycle ratio. Age affected time and cycles. Data from earlier studies are used to describe the development of chewing between the ages of 2 and 8 years. Results indicate that eating skills for different food textures mature at different rates. Skills for eating solid foods mature before skills for eating viscous and pureed foods mature. Thus, the consistent use of food textures is important when children's eating skills are evaluated. The normative data presented here may be used by clinicians evaluating children within the given age group.     

Chewing cycles in 4- and 5-year-old normal children: an index of eating efficacy

Eating movements in the preschool child undergo change between the ages of 2 and 5 years. There is a lack of objective clinical data from normal children against which eating movements of feeding-impaired children can be compared. In this study, chewing movements were measured to complement tongue movements described in an earlier study. The movements were monitored in 40 children: 20 were four years old and 20 were five years old. Each group had ten boys and ten girls. Chewing movements were measured by time (sec), number of cycles, and a time/cycle ratio. A chewing cycle was defined as an upward and downward movement of the chin. Total time from the moment food was placed in the mouth until the final swallow occurred was divided by the number of cycles counted for the same period. Age and sex did not affect time, cycles, or the time/cycle ratio. However, the measures were strongly affected by the type of food eaten. These findings suggest that the texture of food strongly influences both the number of chewing cycles performed and the time used for chewing. The occupational therapist administering eating evaluations to children should carefully choose the foods offered for initial evaluations and use the same food consistently during re-evaluations.     

Bilateral motor coordination in 5- to 9-year-old children: a pilot study

The purpose of this study was to collect normative data on and to assess the clinical usefulness of scales designed to measure the quality of children's ability to perform three bilateral motor coordination tasks: jumping jacks, symmetrical stride jumps, and reciprocal stride jumps. One hundred children, aged 5 to 9 years, were tested according to the scales developed for this study. Results indicated that scores tended to increase with age and that sex differences were not significant. Jumping jacks were found to be the most reliable and the easiest of the three tasks. Reciprocal stride jumps were the most difficult. Quality of performance was assessed, and the number of jumps in a 10-sec trial was recorded for each age. The data from this study may be useful in comparing the performance of children with motor deficits to the performance of normal children of the same age.     

Body part identification in 1- to 4-year-old children

The purpose of this study was to examine the sequence in which body parts are learned and can be identified by very young children. The 101 children tested were divided into four age groups: 1-year-olds, 2-year-olds, 3-year-olds, and 4-year-olds. The children were requested to point to 20 body parts on a doll. Analysis of the results indicated significant differences in the ability to identify body parts by age and sex. The greatest increase in scores occurred between the ages of 1 and 2 years, with girls achieving a slightly higher score in each age group. The percentage of subjects at each age who identified different body parts is presented, indicating the sequence in which body parts are learned.     

The zone of proximal development in in-hand manipulation skills of nondysfunctional 3- and 4-year-old children

The purpose of this study was to assess the influence of verbal and visual cues on 28 nondysfunctional 3- and 4-year-old children's performance of in-hand manipulation skills. During the uncued version of the test (pretest), the children were presented with play activities known to elicit in-hand manipulation skills in young children but were given no cues for specific manipulative skill use. Within 1 week of the pretest, after the children were randomly assigned to groups, a posttest was given in which the children were provided with verbal or visual cues. The results indicate that both visual and verbal cues were effective in increasing the groups' test scores, but no significant differences were found based on the type of cue provided. Approximately 30% of the children in the study showed marked improvement on the posttest scores, whereas the others showed little change. The children who had lower pretest scores showed greater score increases on the posttest than did the children who scored somewhat higher initially. The use of an uncued test followed by a cued test may be an effective method for the identification of those children who are most likely to show improvement in these manipulation skills with intervention. This study's findings lend tentative support to Vygotsky's (1978) zone of proximal development theory and extends the application of his work into the domain of fine motor skills.     

Body part identification in 1- to 2-year-old children

The purpose of this study was to examine the developmental sequence of body part identification in very young children, 11 to 25 months of age. In the first part of the study, 113 children, divided into five age groups (12-month-olds, 15-month-olds, 18-month-olds, 21-month-olds, and 24-month-olds), were asked to point to 20 body parts on a doll. The results indicated a positive correlation between number of parts correctly identified and increasing age. No sex differences or Sex X Age interactions were found. In the second part of the study, the difference between pointing to body parts on the self and pointing to body parts on a doll was examined in two groups of 2-year-olds. The results indicated no significant difference between the ability to point to body parts on a doll and the ability to point to body parts on the self. Factors that may contribute to the development of body part identification in 1- to 2-year-olds and the sequence in which body parts are learned are discussed. The results help provide diagnostic criteria for children with suspected delays in cognitive, language, or body scheme development.     

Chewing cycles in 4- and 5-year-old Down's syndrome children: a comparison of eating efficacy with normals

Chewing movements of Down's syndrome children were measured and compared with those of normal preschool children. Twenty-six Down's syndrome children were monitored: 14 were 4 (8 males, 6 females) and 12 were 5 years old (6 males, 6 females). Chewing movements were measured by time (in seconds), number of cycles, and a time/cycle ratio. A chewing cycle was defined as an upward and downward movement of the chin. The time/cycle ratio is the total time, from the moment food was placed in the mouth until the final swallow occurred, divided by the number of cycles counted for the same period. The children's ages and gender did not affect time, cycles, or the time/cycle ratio. However, the measures were strongly affected by the type of food eaten. Children with Down's syndrome chew at a rate comparable to that of normal children. However, the duration of chewing is significantly prolonged per bite of food. This may be attributed to these children's lack of chewing vigor or their inability, at the ages studied, to chew solid foods. Time/cycle ratios are an excellent index to document such differences. How much sensory differences or deficits contribute to these findings is not known.     

Development of oral side preference during chewing and its relation to hand preference in normal 2- to 8-year-old children

Normative data on skills of the tongue used in eating are presented. Normal children 5 to 8 years old were studied regarding their preference of placing food either on the right or left side of the mouth when starting to eat. A developmental curve spanning 2 to 8 years was generated by including data from an earlier study. Data of oral side preference were correlated with data of preferred hand use. In addition, the ability to move a small piece of food from one side of the mouth to the other was studied. It was found that normal children undergo a transition from placing solid food predominantly on the right side at 2 years of age to placing it on the left side at 4 years of age. The left side preference persists until at least 8 years of age for both viscous and solid food textures. Oral side preference did not correlate with hand preference. The ability to move food from one side of the mouth to the other (lateralizing) was found to undergo a developmental progression: The inability to lateralize in a third of 2-year-olds gave way to rolling movements. Concomitantly, a consistent increase in slow and then smooth movements was found to occur from 2 to 8 years of age. These data provide the clinician with a normative baseline against which eating-impaired children can be compared.     

A study of the needs of parents of hospitalized 2- to 6-year-old children.

The present study uses a qualitative approach to explore and identify areas of needs among parents of 2- to 6-year-old children who are hospitalized. An extensive literature review and informal in-depth interviews with five parents and six pediatric health care professionals were analyzed by content to develop a representative list of statements about needs. Six groups of needs were recognized: (a) the need to be able to trust doctors and nurses, (b) the need for information, (c) needs related to other family members, (d) a need to feel that they are trusted, (e) needs related to human and physical resources, and (e) the need for support and guidance. A congruency is found between statements about needs of parents of hospitalized 2- to 6-year-olds in the literature on the one hand and the needs of parents expressed by parents themselves and pediatric health care professionals on the other hand.     

The parents' postoperative pain measure: replication and extension to 2-6-year-old children

Pain assessment is a difficult task for parents at home following children's surgery. The purpose of the present study was to confirm the psychometric properties of a behavioural measure of postoperative pain developed to assist parents with pain assessment in children aged 7-12 years following day surgery. The study also examined the reliability and validity of the measure with children aged 2-6 years. Participants were 51 parents of children aged 7-12 years and 107 parents of children aged 2-6 years. For the 2 days following surgery, parents completed a pain diary that included global ratings of their children's pain and the 15-item Parents' Postoperative Pain Measure (PPPM). The older children provided self-reports of their pain intensity. The PPPM items showed good internal consistency on the two postoperative days for both samples (alpha's=0.81-0.88) and scores on the PPPM were highly correlated with children's (for the older children) and parents' (for the young children) global ratings of pain (r's=0.53-0.72). As global pain ratings decreased from Days 1 to 2, so did scores on the PPPM. Scores on the PPPM were successful in discriminating between children who had undergone low/moderate and high pain surgeries. The results of this study provide evidence of the reliability and validity of the PPPM as a measure of postoperative pain among children aged 2 through to 12 years.     

Gait cycle duration in 3-year-old children

The gait cycle duration of 11 children who were 3 years old was recorded using cinematography. The variation of cycle duration from cycle to cycle during free walking with each child and the variation of mean cycle duration among the children are reported. I analyzed individual subject characteristics including sex, height, weight, leg length, and age at onset of independent walking for strength of relationship to recorded cycle duration. Results suggest that cycle duration in 3-year-old children during free walking is shorter than that expected for adults. A minimum of variability exists in average cycle duration across subjects at 3 years of age; however, considerable variation of cycle duration from cycle to cycle within individual subjects is not uncommon. I identified no significant relationships between subject characteristics and gait cycle duration. The data reported are consistent with the results of other studies showing a trend of gradually increasing cycle duration and decreasing variability with increasing age in early childhood.     

Parents' knowledge and choice of paracetamol dosing forms in 3- to 6-year-old children

Paracetamol is one of the most common medicines administered to children and is available in suppositories, mixtures, drops and tablets. Orally administered paracetamol is more rapidly and completely absorbed and is, in general, more acceptable to children. In Iceland, the most common route of paracetamol administration is per rectum. The purpose of the study was to explore parents' knowledge and usage of paracetamol for 3- to 6-year-old children. Parents (n = 103) of children in four playschools in Reykjavík participated in this survey research. Paracetamol was most commonly administered via suppository. Some parents were unaware of oral forms of paracetamol and had been advised by doctors, nurses or pharmacy staff to use suppositories. This study provides basic information needed to design appropriate parental education in pain and fever management.     

The development of manual midline crossing in 2- to 6-year-old children

The present study analyzed the development of manual midline crossing in a sample of one hundred sixty 2- to 6-year-old children and considered test construction factors that could affect the test design. The test construction factors addressed were (a) the effect of biasing the hand used for object manipulation and (b) the effect of distance from midline required for task completion on the frequency of manual midline crossing. A pegboard task was used to measure manual midline crossing. The results identified a developmental age trend in crossing the body midline in 2- to 6-year-old children. Biasing the hand used for object manipulation significantly increased the probability of eliciting manual midline crossing. A combination of linear and quadratic trends was found when the effect of distance from midline on the frequency of contralateral responses produced during testing was analyzed.