12~36月龄幼儿胃肠道功能情况及其影响因素研究

目的描述12~36月龄幼儿胃肠道功能情况,探讨潜在影响因素。方法2018年9月—2019年1月在北京市朝阳区某社区卫生服务中心招募12~36月龄幼儿385名,收集幼儿及母亲基本信息,采用简版《婴幼儿胃肠道症状问卷》评估幼儿胃肠道功能。问卷共10个问题,反映幼儿胃肠道症状(6个问题)和相关行为(4个问题)。胃肠道功能总评分为10~60分,其中胃肠道症状6~36分、胃肠道相关行为4~24分,评分越高提示胃肠功能越弱;将总评分等于或高于第二个三分位数(17分)定义为轻度胃肠不适。采用多因素logistic回归分析幼儿轻度胃肠不适的可能影响因素。结果幼儿胃肠道功能总评分、症状评分和相关行为评分的中位数(四分位数间距)分别为13.0(11.0~19.0)分、6.0(6.0~10.0)分和6.0(5.0~8.0)分。小月龄(12~17月龄14.5分,18~23月龄13.0分)比大月龄(24~29月龄12.0分,30~36月龄12.5分)、母亲为初产妇(14.0分)比经产妇(12.0分)的幼儿中位胃肠道功能总评分高(P<0.05)。轻度胃肠不适幼儿124名(32.2%),母亲为初产妇(36.8%)比母亲为经产妇(21.8%)的幼儿轻度胃肠不适发生率显著升高(P=0.004)。多因素logistic回归分析显示,12~17月龄幼儿与30~36月龄幼儿相比(调整OR,2.32;95%CI,1.14~4.71)、母亲为初产妇的幼儿与经产妇的幼儿相比(调整OR,2.05;95%CI,1.19~3.52),轻度胃肠不适风险显著升高。幼儿性别、分娩方式、母乳喂养时长和母亲分娩年龄对轻度胃肠不适发生风险无显著影响。结论幼儿胃肠道功能整体较好,幼儿月龄及母亲产次影响幼儿胃肠功能,小月龄及母亲为初产妇的幼儿易发生轻度胃肠不适。     

Frequency of Sweet and Salty Snack Food Consumption Is Associated with Higher Intakes of Overconsumed Nutrients and Weight-For-Length z Scores During Infancy and Toddlerhood

BackgroundCurrent dietary guidelines recommend avoiding foods and beverages with added sugars and higher sodium before age 2 years.ObjectiveThe aim was to describe daily snack food intake (frequency and total energy) and the associations with overconsumed nutrients (added sugars, sodium, and saturated fats) and child weight-for-length z scores.DesignA cross-sectional, secondary analysis of baseline data from an ongoing longitudinal intervention was conducted.Participants and settingA sample of 141 caregivers with infants (aged 9 to 11 months) and toddlers (aged 12 to 15 months) was recruited in Buffalo, NY, between 2017 and 2019.Main outcome measuresThree 24-hour dietary recalls were used to categorize 'sweet and salty snack foods' or 'commercial baby snack foods' based on the US Department of Agriculture What We Eat in America food group classifications and estimate nutrient intakes. Child recumbent length and weight were measured by trained researchers.Statistical analysisDaily frequency (times/day), energy (kcal/day), and overconsumed nutrients from snack food intake were calculated. Multivariable regression models examined associations between the frequency of and energy from snack food intake with overconsumed nutrients and child weight-for-length z scores.ResultsInfants consumed snack foods on average 1.2 times/day contributing 5.6% of total daily energy, 19.6% of added sugars, and 6.8% of sodium. Toddlers consumed snack foods on average 1.4 times/day contributing 8.9% of total daily energy, 40.0% of added sugars, and 7.2% of sodium. In adjusted models including all children, greater frequency of sweet and salty snack food intake, but not commercial baby snack foods, was associated with higher weight-for-length z scores.ConclusionsSnack foods are frequently consumed by infants and toddlers and contribute to the intake of overconsumed nutrients such as added sugars and sodium. Given the current guidelines to avoid added sugars and higher sodium before age 2 years, additional recommendations related to nutrient-dense snack intake may be beneficial.     

Painful transitions: a study of 1-year-old toddlers’ reactions to separation and reunion with their mothers after 1 month in childcare

ABSTRACT

In this paper, we present findings from the filmed observations of 12 1-year-old toddlers in 10 different Norwegian childcare centres during separations and reunions with their mothers. Separations and reunions are sensitive situations, especially around the age of one, when separation anxiety normally peaks. The observations were conducted when the toddlers were between 13 and 15 months old and had been attending childcare for 1 month. The video recordings were analysed in light of attachment theory, emphasizing expressions of protest, despair and detachment among the children. Findings indicate that all the toddlers struggled with separation anxiety in different phases during the observed transitions. Few employees present in the early mornings and late afternoons often made the transitions more difficult. Implications of the findings are discussed.     

Parenting-related stress and psychological distress in mothers of toddlers with autism spectrum disorders

Background:Parents of children with autism spectrum disorders (ASDs) are at risk for higher stress levels than parents of children with other developmental disabilities and typical development. Recent advances in early diagnosis have resulted in younger children being diagnosed with ASDs but factors associated with parent stress in this age group are not well understood. Aims: The present study examined parenting-related stress and psychological distress in mothers of toddlers with ASD, developmental delay without ASD (DD), and typical development. The impact of child problem behavior and daily living skills on parenting-stress and psychological distress were further investigated. Methods: Participants were part of a larger research study on early ASD intervention. Results: Parent self-report of parenting-related stress and psychological distress was utilized. Parents of toddlers with ASD demonstrated increased parenting-related stress compared with parents of toddlers with DD and typical development. However, psychological distress did not differ significantly between the groups. Child behavior problems, but not daily living skills emerged as a significant predictor of parenting-related stress and psychological distress. This was true for both mothers of children with ASD and DD. Conclusions: These finding suggest that parents’ abilities to manage and reduce behavior problems is a critical target for interventions for young children with ASD and DD in order to improve child functioning and decrease parenting-related stress.     

Investigating and learning from toddler play in a children’s museum

The play needs of under threes is an under-researched area. In this study, 100 parents and carers were surveyed regarding their visit to a children’s museum with a child under three. Using a play taxonomy and observation schedule devised for the study, 50 toddlers were also observed playing with the museum exhibits. The findings showed that whilst there were many reasons for the visit (including play), it was not with the purpose of learning. However on reflection, it was one of the perceived benefits. There were significant differences in types of play engaged in; younger toddlers engaged in more ego play and older toddlers engaged in more pretend and role play. Also, children enjoyed playing and learning with all exhibits despite being arranged for particular age groups. These findings and the tools used in the study will be of interest and use to early years educators and museum educators.     

Personal–social development differences in toddlers diagnosed with autism spectrum disorder: DSM-IV-TR versus DSM-5

Recent changes in diagnostic criteria for autism spectrum disorders (ASD) has stimulated research comparing the differences between those who would no longer meet the criteria for an ASD and those who would according to DSM-5. Previously, researchers have shown that individuals who no longer meet the criteria still have severe deficits in several areas when compared to atypically developing controls. These challenges are often similar in severity when compared to those who retain their diagnosis. The current study sought to compare these groups on a measure of personal and social development using the Battelle Developmental Inventory, second edition (BDI-2). Results were similar to previous research showing that those in the DSM-5 group had the most severe impairments followed by the DSM-IV group and then atypically-developing peers. The participants who no longer met the new criteria (DSM-IV group) were significantly different from both comparison groups but more closely resembled the DSM-5 group. They exhibited severe deficits in areas of personal–social development. These findings support the idea that these individuals do have significant impairments similar to those who would retain their diagnosis and that treatments developed for those with ASD would be beneficial; however, with the new criteria these children may never receive these services.     

Comparison of parent report and direct assessment of child skills in toddlers

BackgroundThere are unique challenges associated with measuring development in early childhood. Two primary sources of information are used: parent report and direct assessment. Each approach has strengths and weaknesses, particularly when used to identify and diagnose developmental delays. The present study aimed to evaluate consistency between parent report and direct assessment of child skills in toddlers with and without Autism Spectrum Disorder (ASD) across receptive language, expressive language, and fine motor domains.Method109 children were evaluated at an average age of two years; data on child skills were collected via parent report and direct assessment. Children were classified into three groups (i.e., ASD, Other Developmental Disorder, or Typical Development) based on DSM-IV-TR diagnosis. Mixed design ANOVAs, with data source as a within subjects factor and diagnostic group as a between subjects factor, were used to assess agreement. Chi square tests of agreement were then used to examine correspondence at the item level.ResultsResults suggested that parent report of language and fine motor skills did not significantly differ from direct assessment, and this finding held across diagnostic groups. Item level analyses revealed that, in most cases of significant disagreement, parents reported a skill as present, but it was not seen on direct testing.ConclusionsResults indicate that parents are generally reliable reporters of child language and fine motor abilities in toddlerhood, even when their children have developmental disorders such as ASD. However, the fullest picture may be obtained by using both parent report and direct assessment.     

Adaptive behavior profiles in young children with autism spectrum disorder diagnosed under DSM-5 criteria

BackgroundThis study explored adaptive behavior profiles in a clinical sample of well-characterized children aged one to three years with ASD.MethodProfiles were compared to a sample of children with non-ASD developmental delays. Cluster analyses were performed to determine whether differences in adaptive skills effectively distinguished children with ASD from other young children presenting for assessment due to behavioral or other concerns, but who received other non-ASD diagnoses.ResultsA profile of motor > daily living > socialization > communication skills was found in both children with ASD and children with non-spectrum diagnoses, showing that this profile is not unique to young children with ASD. A two-group cluster solution was found which differentiated children by developmental functioning level rather than by diagnosis.DiscussionThe results of this study provide support for two developmental profiles for adaptive functioning in children with ASD: an average to borderline delayed profile and a borderline to more severely delayed profile that may remain stable or worsen over time. They additionally highlight the importance of delivering early targeted interventions to children with ASD who have greater deficits in adaptive functioning due to their association with poorer long-term outcomes.     

Test-retest and inter-rater reliability for the Comprehensive Developmental Inventory for Infants and Toddlers diagnostic and screening tests

BACKGROUND: Reliability information for the Comprehensive Developmental Inventory for Infants and Toddlers diagnostic (CDIITDT) and screening tests (CDIITST) is inadequate. AIM: To assess the test-retest and inter-rater reliability of the CDIITDT and CDIITST. STUDY DESIGN: A repeated measures design was selected. SUBJECTS: Non-disabled term (n=15; mean age 8.4+/-1.6 months) and preterm infants (n=16; mean age 9.3+/-2.9 months), and children with developmental disabilities (n=15; mean age 24.7+/-11.8 months) were recruited. A single rater assessed the children twice in 3 days to examine the test-retest reliability; and a second rater observed and scored performance while the same rater conducted the first assessment for the inter-rater reliability analysis. OUTCOME MEASURES: The raw score, developmental age (DA) and developmental quotient (DQ)/Z score for the six subtests, two motor subdomains and the whole test were used as outcome measures for the CDIITDT and CDIITST. RESULTS: The test-retest reliabilities for the CDIITDT were rated good for the three pediatric groups (ICC 0.76-1.00), with the exception of moderate ratings for the self-help subtest for the term infants and for the social, self-help and fine-motor DQs for the preterm group. The CDIITDT inter-rater reliabilities were good for the three groups (ICC 0.76-1.00), with the exception of only moderate reliability for the cognitive DQs for the preterm infants. The reliabilities for the whole CDIITST for the three groups were high (ICC 0.93-1.00). CONCLUSION: The reliabilities for the whole CDIITDT and its various subtests and the whole CDIITST are acceptable for clinical use.     

Promoting Joint Attention in Toddlers with Autism: A Parent-Mediated Developmental Model

Joint attention, a foundational nonverbal social-communicative milestone that fails to develop naturally in autism, was promoted for three toddlers with early-identified autism through a parent-mediated, developmentally grounded, researcher-guided intervention model. A multiple baseline design compared child performance across four phases of intervention: focusing on faces, turn-taking, responding to joint attention, and initiating joint attention. All toddlers improved performance and two showed repeated engagement in joint attention, supporting the effectiveness of developmentally appropriate methods that build on the parent–child relationship. A complementary qualitative analysis explored family challenges, parent resilience, and variables that may have influenced outcomes. Intervention models appropriate for toddlers with autism are needed as improved early identification efforts bring younger children into early intervention services.