Chinese Toddlers Research Articles

Assessment of Water Intake among Chinese Toddlers: The Report of a Survey.

Toddlerhood (aged 13~36 months) is a period of dietary transition, with water intake being significantly influenced by parental feeding patterns, cultural traditions, and the availability of beverages and food. Nevertheless, given the lack of applicable data, it is challenging to guide and evaluate the water intake of toddlers in China. In this study, our objectives were to assess the daily total water intake (TWI), evaluate the consumption patterns of various beverages and food sources contributing to the TWI, determine the conformity of participants to the adequate intake (AI) recommendation of water released by the Chinese Nutrition Society, and analyze the various contributors to the daily total energy intake (TEI). The data for the assessment of water and dietary intake were obtained from the cross-sectional dietary intake survey of infants and young children (DSIYC, 2018-2019). A total of 1360 eligible toddlers were recruited in the analysis. The differences in related variables between two age groups were compared by Mann-Whitney U test and Chi-Square test. The potential correlation between water and energy intake was examined utilizing age-adjusted partial correlation. Toddlers consumed a median daily TWI of 1079 mL, with 670 mL (62.3%, r = 0.752) derived from beverages and 393 mL (37.7%, r = 0.716) from foods. Plain water was the primary beverage source, contributing 300 mL (52.2%, r = 0.823), followed by milk and milk derivatives (MMDs) at 291 mL (45.6%, r = 0.595). Notably, only 28.4% of toddlers managed to reach the recommended AI value. Among these, toddlers obtain more water from beverages than from foods. The median daily TEI of toddlers was 762 kcal, including 272 kcal from beverages (36.4%, r = 0.534) and 492 kcal from foods (63.6%, r = 0.894). Among these, the median daily energy intake from MMDs was 260 kcal, making up 94.6% of the energy intake from beverages (r = 0.959). As the pioneer survey on TWI of toddlers in China based on nationally representative data, attention to the quality and quantity of water intake and actions to better guide parents by both individuals and authorities are eagerly anticipated. Additionally, the revision of the reference value of TWI for Chinese toddlers is urgently required.

Mediating effects of parent–child dysfunctional interactions in the relationship between parenting distress and social–emotional problems and competencies

This study investigated the association between parenting distress and four variables of young children’s social–emotional problems and competencies: externalizing, internalizing, and dysregulation problems, and social–emotional competencies, and whether parent–child dysfunctional interactions mediated these associations. Participants were Chinese toddlers (N = 711) aged 24–36 months in family (44.3%) and center-based (55.7%) care. The results from structural equation modeling showed that parent–child dysfunctional interactions fully mediated the relationship between parenting distress and externalizing, and dysregulation problems, and social–emotional competencies, while partially mediated in the internalizing problems for both groups. Furthermore, multi-group SEM models showed the direct and indirect pathways differed between two groups. The research concludes that parent-child interaction plays a crucial role in mediating the relationship between parenting distress and young children’s social–emotional problems and competencies. For families’ choice of childcare, this study suggests early center-based services provided for toddlers exposed to family risk characteristics such as parents’ poor mental health, and more importantly, low levels of parent–child interactions.

Early-Life Skin Microbial Biomarkers for Eczema Phenotypes in Chinese Toddlers.

Eczema is a common inflammatory skin disorder during infancy. Evidence has shown that skin-microbiome fluctuations may precede eczema development, but their predictive value for eczema phenotypes remains unknown. We aimed to investigate the early-life evolution of the skin microbiome and its temporal associations with different pairs of eczema phenotypes (transient versus persistent, atopic versus non-atopic) in Chinese children. We followed 119 term Chinese infants from birth to 24 months old within a Hong Kong birth cohort. The skin microbes at the left antecubital fossa were serially sampled by flocked swabs at 1, 6, and 12 months for bacterial 16S rRNA gene sequencing. The atopic sensitization at 12 months was strongly associated with eczema persisting to 24 months (odds ratio 4.95, 95% confidence interval 1.29-19.01). Compared with those with non-atopic eczema, the children with atopic eczema had reduced alpha diversity at 12 months (p < 0.001) and transiently higher abundance of the genus Janibacter at 6 months (p < 0.001). Our findings suggest that atopic sensitization at 12 months may predict persistent eczema by 24 months, and atopic eczema at 12 months is associated with unique skin microbiome profiles at 6 and 12 months. Non-invasive skin-microbiome profiling may have predictive value for atopic eczema.

A Responsive Feeding Questionnaire Based on Self-Determination Theory for Caregivers of Chinese Toddlers

ObjectiveTo develop and test the psychometric properties of a responsive feeding questionnaire (RFQ) on the basis of Self-Determination Theory for caregivers of toddlers aged 12–24 months in China. DesignItem generation, preliminary evaluation items, refinement questionnaire, and psychometric properties testing. SettingToddlers’ caregivers from Shandong Province, China, were surveyed online between June 2021 and February 2022 (n = 616). Main Outcome MeasureContent, face, and construct validity and reliability of the RFQ. AnalysisContent validity was performed on the basis of expert panel feedback and cognitive interviews among caregivers. Construct validity was evaluated using principal component analysis with varimax rotation. Test-retest reliability was conducted with a sample of 105 caregivers. ResultsOver 3 phases of testing, a new instrument was developed to measure responsive feeding in toddler caregivers. The instrument was reliable, with an internal consistency of 0.87 and an intraclass correlation of 0.92. The principal component analysis identified a 3-factor solution (autonomy support, positive involvement, appropriate response) aligning with a theoretical framework from Self-Determination Theory. The final version of the instrument included 23 items. Conclusions and ImplicationsThe 23-item RFQ has been validated in a Chinese population. Future research needs to validate this instrument in other countries and with children of different ages.

On becoming socially anxious: Toddlers' attention bias to fearful faces.

Early attention bias to threat-related negative emotions may lead children to overestimate dangers in social situations. This study examined its emergence and how it might develop in tandem with a known predictor namely temperamental shyness for toddlers' fear of strangers in 168 Chinese toddlers. Measurable individual differences in such attention bias to fearful faces were found and remained stable from age 12 to 18 months. When shown photos of paired happy versus fearful or happy versus angry faces, toddlers initially gazed more and had longer initial fixation and total fixation at fearful faces compared with happy faces consistently. However, they initially gazed more at happy faces compared with angry faces consistently and had a longer total fixation at angry faces only at 18 months. Stranger anxiety at 12 months predicted attention bias to fearful faces at 18 months. Temperamentally shyer 12-month-olds went on to show stronger attention bias to fearful faces at 18 months, and their fear of strangers also increased more from 12 to 18 months. Together with prior research suggesting attention bias to angry or fearful faces foretelling social anxiety, the present findings point to likely positive feedback loops among attention bias to fearful faces, temperamental shyness, and stranger anxiety in early childhood. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Socioeconomic factors and autism among 16- to 30-month-old children: Evidence from a national survey of China.

Does being born in a family of high socioeconomic status mean a higher risk of being diagnosed with autism? The evidence from the Asian area is lacking. This research was conducted among 6049 toddlers who went through an evaluation-diagnose procedure of autism and whose parents were surveyed during the national survey of China, 2016-2017. Parents reported their education levels, occupations, family income, and ethnic background. We recruited the toddlers and parents from kindergartens, communities, and hospitals in five geographically representative areas of China. On average, these toddlers were 23 months of age. We found toddlers whose mothers had less than 9 years of education (junior middle school or below) had 2.46 times the chance to get a diagnosis of autism, compared with toddlers whose mothers had more than 15 years of education (college or above). We also found that 1.17 toddlers could be diagnosed with autism in each 100 Chinese toddlers. These findings have important implications for providing support to families that have low socioeconomic status, especially families with a mother who did not complete 9 years of education. Early detection programs focused on children from low socioeconomic backgrounds should be promoted.

Motor impairments in Chinese toddlers with autism spectrum disorder and its relationship with social communicative skills.

ObjectiveMotor impairments are prevalent in children with autism spectrum disorder (ASD) and persistent across age. Our current study was designed to investigate motor deficits in Chinese toddlers with ASD and to explore the relationships between motor deficits and social communication skills.MethodsFor this cross-sectional study, we recruited a total of 210 Chinese toddlers with ASD aged between 18 and 36 months in the study during December 2017 to December 2020. Griffiths Developmental Scales-Chinese (GDS-C), Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) and Communication and Symbolic Behavior Scales Developmental Profile-Infant-Toddler Checklist (CSBS-DP-ITC) were administered in these toddlers to evaluate their development, social communicative skills, and autism severity. We compared the developmental and social communicational profiles of ASD toddlers in different gross and fine motor subgroups, and explored potential associated factors. The univariate generalized linear model tested the relationship of fine and gross motor skills and social communicative skills.ResultsThe prevalence of gross and fine motor deficits were 59.5 and 82.5%, respectively, which are almost equivalent in boys and girls. The motor impairments tended to be more severe with age in toddlers. After adjusting for age, sex, non-verbal development quotient (DQ) and restricted, repetitive behaviors, severer gross motor impairments were significantly related to higher comparison score of ADOS-2 and higher social composite score of CSBS-DP-ITC, without interactions with other variables. Meanwhile, lower fine motor skills were associated with more deficits of social communication and higher severity of ASD, also depending on non-verbal DQ. In the lower non-verbal DQ subgroup, both fine motor deficits and restricted repetitive behaviors (RRBs) might have effects on autism symptomology.ConclusionMotor impairments are common in Chinese toddlers with ASD. Toddlers with weaker gross and fine motor skills have greater deficits in social communicative skills. Gross motor impairment might be an independent predictor of the severity of autism and social communication skills, while the effect of fine motor deficits might be affected by non-verbal DQ and RRBs of toddlers with ASD. We provide further justification for the inclusion of motor impairments in the early intervention for toddlers with ASD.

The associations between residential greenness and allergic diseases in Chinese toddlers: A birth cohort study

BackgroundGreen space in the living environment has been linked to the development of allergic diseases. However, evidence regarding early-onset allergy in toddlers was limited, and the critical exposure window remained unclear. We aimed to investigate associations between residential greenness with allergic diseases in early life. MethodsThis prospective birth cohort study included 522 mother-child pairs in Guangzhou, China. We quantified prenatal, postnatal, and early-life (i.e., the first 1000 days of life) residential greenness, estimated from remote satellite data using normalized difference vegetation index (NDVI), enhanced vegetation index (EVI), and tree cover. We identified physician-diagnosed allergic diseases (eczema, atopic dermatitis, urticaria, allergic rhinitis, allergic conjunctivitis, food allergy, and asthma) based on medical records at age 2 years. Generalized linear regression was conducted to examine the associations of greenness with allergic outcomes. ResultsThe ranges of residential NDVI and EVI values in 500-m buffer during early life were 0.06–0.70 and 0.03–0.46, respectively. We found a 0.1 unit increase of NDVI in 500-m buffer throughout early life was associated with higher odds of any allergic diseases (prenatal: OR [odds ratio], 1.25; 95%CI, 1.02–1.53; postnatal: OR, 1.24; 95%CI, 1.02–1.52; early-life: OR, 1.25, 95%CI: 1.02–1.53) and higher odds of eczema (prenatal: OR, 1.28; 95%CI, 1.04–1.59; postnatal: OR, 1.24; 95%CI, 1.01–1.54; early-life: OR, 1.26, 95%CI: 1.02–1.56). The results were consistent when using EVI as a proxy for greenness. We only observed that prenatal exposure to the highest tertile of NDVI-500 was adversely associated with any allergic diseases (OR, 1.63; 95%CI, 1.03–2.58) and eczema (OR, 1.70; 95%CI: 1.04–2.78) compared with the lowest tertile. ConclusionsThis study identified detrimental associations of residential greenness with allergic diseases especially eczema among toddlers, and pregnancy appears to be the critical exposure window. Our findings highlighted the importance of urban planning to develop friendly-green neighborhood to improve maternal and child health.

Efficacy and moderating factors of the Early Start Denver Model in Chinese toddlers with autism spectrum disorder: a longitudinal study.

Several studies have shown the effectiveness of the Early Start Denver Model (ESDM), but few studies have explored the long-term efficacy of ESDM. This study aimed to explore the efficacy and moderating factors of ESDM in Chinese toddlers with autism spectrum disorder (ASD) in a longitudinal way. A total of 60 toddlers with ASD were recruited and randomly divided into two groups: ESDM group all received 24weeks intervention; Control group were waiting for intervention. Baseline assessment (T0) was conducted before intervention, including Gesell Developmental Scale (GDS) and Psycho-educational Profile-3rd Edition (PEP-3). All toddlers with ASD were examined in the first assessment(T1) at 6months and in the second assessment(T2) at 12months. In T1 assessment, the increments in speech and personal communication development quotient in GDS were significantly larger in theESDM group than in thecontrol group (P = 0.010, 0.047). In T2 assessment, the ESDM group had higher elevation in cognitive verbal/preverbal (CVP), social reciprocity and characteristic verbal behaviors assessed by PEP-3 (P = 0.021, 0.046, 0.014). In addition, the severity of stereotyped behavior was negatively associated with improvement in CVP. Family income was positively associated with improvement in speech and CVP (all P < 0.05). ESDM can effectively improve speech and communication in toddlers with ASD after 24-week intervention. More importantly, ESDM can promote cognition and social interaction and can reduce stereotyped verbal behavior in toddlers with ASD in longitudinal observation. The severity of stereotyped behavior and family ecological factors may be considered as affecting the efficacy of ESDM.

Consumption of Added Sugar among Chinese Toddlers and Its Association with Picky Eating and Daily Screen Time.

Objectives: This study aimed to examine the relationship between daily screen time, picky eating, and consumption frequency of sugared foods and sugar-sweetened beverages (SSBs). Methods: The research data came from the Young Investigation (YI) study conducted in 10 cities in China. This study used sociodemographic information, feeding behavior, picky eating reported by parents, and the consumption frequency of sugared foods and SSBs of 879 toddlers aged 1–3 years. The relationship between daily screen time and picky eating behavior was assessed using logistic regression. The zero-inflated negative binomial (ZINB) model was used to fit the consumption frequencies of sugared foods and SSBs. Results: In all, 13.1% (n = 115) of toddlers did not have sugared foods 1 month before the survey, while 73.3% (n = 644) of toddlers did not have SSBs 1 month before the survey. The consumption rate of sugared foods was relatively higher than SSBs (χ2 = 661.25, p < 0.001). After adjusting for social demographic information, no relationship was found between daily screen time and picky eating (OR = 1.437; 95% CI: 0.990,2.092). The ZINB model showed that, among children who ate sugared foods, children who were picky eaters ate them more often (IRR = 1.133; 95% CI: 1.095,1.172), but no association was found between picky eating and the chance of avoiding sugared foods (OR = 0.949; 95% CI: 0.613,1.471). Children who were picky eaters were less likely not to drink SSBs (OR = 0.664; 95% CI: 0.478,0.921). However, among children who consumed SSBs, picky eaters drank them less frequently (IRR = 0.599; 95% CI: 0.552,0.650). Children with a screen time of no less than 1 h/d ate sugared foods more frequently (IRR = 1.383; 95% CI: 1.164,1.644), and they were less likely to avoid sugared foods (OR = 0.223; 95% CI: 0.085,0.587). The longer the screen time per day was, the less likely children did not have SSBs (<1 h/d: OR = 0.272; 95% CI: 0.130, 0.569; ≥1 h/d: OR = 0.136; 95% CI: 0.057, 0.328). Conclusions: The consumption rate of sugared foods was higher than that of SSBs. Picky eating and daily screen time were related to the consumption frequency of added sugar among Chinese toddlers aged 1–3 years. Picky eaters consumed sugared foods more frequently and were more likely to drink SSBs. Children whose daily screen time reached 1 h/d were more likely to eat sugared foods and drink SSBs.

Association of Allergic Symptoms in the First 2 Years of Life With Sleep Outcomes Among Chinese Toddlers.

Background: Previous studies have linked allergic symptoms to sleep in children, but the associations might be different when considering different types of allergic symptoms or sleep outcomes. Moreover, the combined effects of multiple allergic symptoms remain unclear in early life. This study aimed to investigate the associations between multiple allergic symptoms and sleep outcomes in early life.Methods: We included 673 toddlers aged 2 years from a birth cohort in Guangzhou, China. We identified allergic symptoms (skin, eyes and nose, gastrointestinal tract, mouth and lips, and wheeze) within 2 years via standard questionnaires. Sleep outcomes including sleep duration and quality over the past month were assessed based on the Chinese version of the Brief Infant Sleep Questionnaire. Associations between allergic symptoms and sleep outcomes were examined using multivariable linear regression and logistic regression.Results: Compared to children without allergic symptoms, children with allergic nasal and ocular symptoms had higher odds of frequent nighttime awakenings (OR = 1.41; 95% CI: 1.03, 1.93) and irregular sleep (OR = 1.45, 95% CI: 1.05, 2.00); children with allergic gastrointestinal symptoms slept 0.28 h less during nighttime (95% CI: −0.48, −0.07) and 0.25 h less per day (95% CI: −0.43, −0.08), and had 59% higher odds of irregular sleep (95% CI: 1.24, 2.04). We also found significant association of multiple allergic symptoms with shortened nighttime sleep duration and increased irregular sleep. Whereas, allergic skin, mouth and lips, and wheeze symptoms were not significantly associated with sleep outcomes.Conclusion: Allergic symptoms within 2 years of age were adversely associated with sleep outcomes, which highlight the importance of early screening of allergic symptoms in toddlers in order to improve their sleep outcomes.

Reliability, validity and developmental sensitivity of the Language Use Inventory (LUI) in the Chinese context

BackgroundPragmatics has generally been defined as the ability to use language in social situations, it is commonly regarded as the third major component of language ability. To date, there is no tool for assessing early pragmatic development of Chinese‐speaking children.AimsTo describe the translation of the Language Use Inventory (LUI) from English to Mandarin Chinese and to report findings on the Chinese version's reliability, validity and developmental sensitivity.Methods & ProceduresThe original English version of the LUI was translated into Mandarin Chinese. Parents of 177 typically developing (TD) toddlers and preschool children completed the inventory to examine its internal reliability and construct validity and how scores differed across ages and sexes. A total of 31 parents out of the 177 completed the LUI‐Mandarin, again within 4 weeks, to assess test–retest reliability. To examine discriminative validity, 43 parents of age‐ and sex‐matched TD children and children with autism spectrum disorder (ASD) recruited from Nanjing Brain Hospital affiliated with Nanjing Medical University completed the LUI‐Mandarin.Outcomes & ResultsCronbach's alpha values for the LUI‐Mandarin's three parts and for 11 of 12 LUI‐Mandarin subscales were 0.707–0.992, with most values in the 0.825–0.992 range. Test–retest reliability ranged from 0.66 to 0.95, indicating good to excellent reliability. Factor analysis of the LUI‐Mandarin revealed two different factors, and the total variance explained was 74.38%. The LUI‐Mandarin total scores and subscale scores increased with age for both boys and girls, providing evidence of the inventory's developmental sensitivity. Girls, however, had higher total scores than boys at earlier ages (18–23 months). The results of the discriminant validity study revealed that performance was significantly lower in the ASD group than in the TD group with respect to LUI total scores and subscale scores (except for subscale A).Conclusions & ImplicationsThe LUI‐Mandarin is the first and only questionnaire available in China that evaluates the pragmatic language skills of children aged between 18 and 47 months. The results of the study show that the LUI‐Mandarin is a valid and reliable tool for Chinese toddlers and preschool children.What this paper addsWhat is already known on this subjectThe LUI is a parent‐report questionnaire that can provide comprehensive information about very young children's communicative competence. It is widely used both for assessment and to guide intervention. Additionally, it has been translated into French, Italian, Polish, Arabic, Portuguese and Norwegian and it shows good reliability and validity.What this paper adds to existing knowledgeIn the present study we describe the translation of the LUI from English to Mandarin Chinese and report findings on the Chinese version's reliability, validity and developmental sensitivity.What are the potential or actual clinical implications of this work?The LUI‐Mandarin is the first and only questionnaire available in China that can evaluate pragmatic language skills of children aged between 18 and 47 months. The results show that the LUI‐Mandarin is a valid and reliable tool for use with Chinese toddlers and preschool children.

Feeding Difficulty Among Chinese Toddlers Aged 1-3 Years and Its Association With Health and Development.

Feeding problems are biopsychosocial in nature and have a great influence on children's growth. The aim of this study was to profile the status and possible influencing factors of feeding difficulty among normal Chinese toddlers, and to investigate its association with health and development. This study is a part of the Young Investigation (YI study) conducted in 10 cities in China. Data from 924 children aged 1–3 years were analyzed. Data on socio-demographic factors, feeding behaviors, self-reported diseases, and anthropometry parameters were collected. Blood samples were drawn to determine hemoglobin levels. Feeding difficulty was evaluated by the Montreal Children's Hospital Feeding Scale (MCH-FS). Ages and Stages Questionnaires, Third Edition (ASQ-3) were used to assess developmental progress. Multivariable analyses were performed to explore the potential associations. The mean total score of the MCH-FS was 35.21 ± 12.90 and the highest scored item was “acting up/making a big fuss during mealtimes.” Feeding difficulty occurred more often among children with picky eating behavior or whose caregivers once used the strategy of pre-mastication. Children with feeding difficulty had lower intakes of cereals, vegetables, and fruits, and were more likely to suffer from diarrhea (OR, 2.04; 95%CI: 1.32, 3.11) or constipation (OR, 2.04; 95%CI: 1.27, 3.24), but not anemia. Feeding difficulty was also negatively associated with weight, height, head circumference and mid-upper-arm circumference-related Z-scores (P all < 0.05). In addition, it was related to poorer fine motor skills, personal and social skills, and total scores of ASQ-3 (β, −9.00; 95%CI: −15.11, −2.89). Feeding difficulty assessed by MCH-FS showed a negative association with children's health and development, supporting the need for early identification.

O21‐2: Relationship between wheezing and developmental trajectory of nasopharyngeal microbiome in Chinese toddlers

O21‐2: Relationship between wheezing and developmental trajectory of nasopharyngeal microbiome in Chinese toddlers

Interaction between antibiotic use and MS4A2 gene polymorphism on childhood eczema: a prospective birth cohort study

BackgroundEczema is usually the first allergic manifestation to appear in life attributed to gene–environment interactions. IL13, IL4, MS4A2 and ILR4A are four key inflammatory genes associated with atopy. This study aimed to explore gene-environment interactions on eczema in early life among the above four genes and environmental factors in Chinese Han children.MethodsFive hundred ninety-seven children from a birth cohort who completed two-year follow-up were enrolled and their cord blood was collected. Subjects were genotyped for six polymorphisms in the aforementioned four genes. The children were followed at 6, 12 and 24 months, with epidemiologic information and medical history of eczema collected by questionnaire and eczema assessed by dermatologists.ResultsAmong the 597 children, 168 were diagnosed with eczema and the others were not after 2 years of follow-up. MS4A2 rs569108 GG genotype (P = 1.68E-02, odds ratio (OR) = 4.66) and antibiotic use (P = 3.75E-4, OR = 2.02) were found independently associated with development of childhood eczema. Children with both antibiotic use and MS4A2 rs569108 GG genotype were more likely to develop eczema than those with only antibiotic use or GG homozygote (OR = 6.24 VS. 2.04 or 4.68).ConclusionsMS4A2 rs569108 polymorphism and antibiotic use were solely associated with eczema, and they interacted with each other to increase the risk of developing the disease in Chinese Han toddlers. Long-term follow-up along with functional and replication studies are still needed.

Occurrence of 3- and 2-monochloropropanediol esters in infant formulas in China and exposure assessment

ABSTRACT The presence of 3-monochloropropane-1,2-diol (3-MCPD) esters and 2-MCPD esters in infant formulas have raised a number of food safety concerns. Here, a dietary exposure assessment was conducted for 3-and 2-MCPD esters in infant formulas available for consumption in Chinese infant and toddlers aged 0–3 years old. This work presents the occurrence data for 3-and 2-MCPD ester in 874 infant formulas purchased in China between 2015 and 2017. The concentrations of 3-MCPD esters ranged from ND to 1.469 mg/kg, with concentrations of 2-MCPD esters ranging from ND to 0.218 mg/kg. The LODs of 3-and 2-MCPD esters were 0.027–0.074 mg/kg. The mean exposures of infants and toddlers to 3-MCPD esters from formulas were lower than the tolerable daily intake (TDI, 2 μg/kg bw/day, established by EFSA), while high exposures (95th percentile) to 3-MCPD esters ranged from 0.907 to 2.520 μg/kg bw/day. On the whole, the health risk of Chinese infant and toddlers exposed to 3-MCPD esters was low, but the health risk of some infants aged 0–6 months with high formula consumption (95th percentile) raises some concern.

Social-Emotional Development and Associated Risk Factors in Chinese Toddlers with Cerebral Palsy.

ObjectiveThis study aimed to analyze the social-emotional behaviors of Chinese toddlers with cerebral palsy and to identify the risk factors associated with these behaviors.MethodsA total of 300 Chinese toddlers and their parents were recruited in this study. A Chinese version of the Infant-Toddler Social-Emotional Assessment was used to assess the children and basic information and clinical data were collected using an author-designed questionnaire. The patients were also assessed using a coping style questionnaire and the hospital anxiety and depression scale. Multiple logistic regression analysis was performed to identify risk factors.ResultsThe scores of the externalizing and competence domains for Chinese toddlers with cerebral palsy at different ages were lower compared to healthy children of the same age and gender (p<0.05). For the boys with cerebral palsy aged between 12–17 and 18–23 months, the scores of the internalizing and dysregulation domains were significantly lower compared to the national normal (p<0.01). The effect of perinatal factors on the externalizing and competence domains was more significant compared to other domains, whilst the coping style of the parents significantly affected the dysregulation domain (p=0.001). Multivariate analysis showed that the parental emotional state, education level, coping style and perinatal factors were closely associated with the social-emotional problems of children with cerebral palsy.ConclusionChildren with cerebral palsy are more likely to have behavioral, emotional, and psychiatric issues that are mostly ignored. These children may benefit from early screening and intervention for risk factors to improve rehabilitation and long-term prognosis.

The roles of temperamental inhibition in affective and cognitive empathy in Chinese toddlers.

Empathy, crucial to harmonious interpersonal relationships and moral development, has both affective and cognitive components. Previous studies found that toddlers' temperamental inhibition may influence their empathy, but mainly focused on emotional response to others' distress. Little is known about whether inhibited children's poor empathy is due to high reactivity and social withdrawal when sharing others' affective states, such as distress (affective empathy), or to a difficulty in comprehending and inferring others' perspective (cognitive empathy). The current study investigated the role of behavioral inhibition (BI) in affective empathy (response to pain simulation) and cognitive empathy (performance in perspective-taking task) among 163 Chinese toddlers and tested in both only and non-only children. Correlation analyses showed that BI was only negatively associated with affective empathy. The relation between BI and cognitive empathy was moderated by self-regulation and inhibited children who were low in self-regulation presented low cognitive empathy. Additionally, only children presented advanced cognitive empathy but poorer affective empathy than non-only children. These findings imply different roles of BI in affective versus cognitive empathy in early childhood. Although highly inhibited children rarely show positive social expression toward others' distress, caution is needed in inferring that they lack a capacity for cognitive empathy.

Teacher-child relationship quality and Chinese toddlers’ developmental functioning: A cross-lagged modelling approach

This study examined the dynamic association between teacher–child relationship quality and Chinese toddlers’ developmental functioning. The participants, located in Hong Kong, consisted of 82 Chinese toddlers and their teachers. With a two-wave longitudinal design, teachers rated the children’s developmental functioning and their own relationships with each child. The results showed that the relations between teacher-child relationships and developmental functioning differed across aspects of child development. Specifically, teacher–child relationship quality predicted and was predicted by toddlers’ comprehension and personal-social skills; teacher-child relationship quality predicted but was not predicted by motor and self-help skills; finally, expressive language skills predicted but were not predicted by teacher-child relationship quality. Follow-up analyses suggested that the observed relations operated similarly for boys and girls, but differently between younger and older age groups. We conclude by discussing the study’s limitations and offering suggestions for promoting developmentally appropriate childcare experience for toddlers.

A randomized controlled trial of different young child formulas on upper respiratory and gastrointestinal tract infections in Chinese toddlers.

Bioactive proteins and human milk oligosaccharides (HMOs), important ingredients in breast milk, that protect against infections are lacking in young child formula (YCF). This study investigated the effects of new YCFs on respiratory and gastrointestinal infections in toddlers. Four hundred and sixty one healthy Chinese children aged 1-2.5years were recruited in this randomized, controlled, double-blind, parallel-group clinical trial of different YCFs. They were randomly assigned to either standard milk formula (YCF-Ref) or one of three new YCFs containing bioactive proteins and/or the HMO 2'-fucosyllactose (2'-FL) and/or milk fat for six months. Primary outcomes were incidence of upper respiratory tract infection (URTI) and duration of gastrointestinal tract infections (GITI). There were no significant between-group differences in primary outcomes. For secondary outcomes, subjects receiving 2'-FL-supplemented YCF had longer URTI. Subjects receiving YCF supplemented with milk fat and intact bioactive proteins, and 2'-FL at levels found in breast milk, had more GITI episodes and shorter time to first GITI but similar effects on URTI duration than YCF-Ref recipients. No effects on URTI and GITI were observed in toddlers receiving YCF with bioactive proteins at lower levels than breast milk. Occurrence of adverse events and anthropometry were similar in all groups. All three YCFs supplemented with different combinations of intact bioactive proteins, 2'-FL, and milk fat are safe in toddlers. No difference is detected among YCFs on URTI incidence and GITI duration. Further studies are needed to verify these findings especially in infants who may benefit most from the immune-boosting effects of bioactive proteins and HMOs.