Day Care Settings Research Articles

The Importance of Melatonin Detection in Pediatric Deaths.

Melatonin is an endogenous hormone that regulates sleep patterns. It is available in varying formulations and dosages and is marketed as a natural substance that can alleviate insomnia. Recent news reports indicate that melatonin has been administered without appropriate authorization in daycare settings. Even though lethal outcomes have not been solely attributed to exogenous melatonin overdose, it has been relevant to select police and postmortem investigations. A quantitative liquid chromatography-tandem mass spectrometry (LC-MS/MS) assay was developed for the analysis of biological specimens. Results of 22 positive blood samples were evaluated based upon gender, age, and melatonin concentration from cases submitted by clinical, police, and death investigation agencies. Two cases are described. In Case 1, a 9-month-old was found unresponsive after cosleeping with a sibling. Allegations included exposure to an unspecified pesticide and dextromethorphan, and consumption of half a cigarette. There was admitted use of melatonin. Melatonin was quantified in blood and gastric fluid at concentrations of 13 ng/mL and 1200 ng/mL, respectively. In Case 2, a 13-month-old was found nonresponsive in a shared room. Melatonin was found within some of the sippy cups. The infant was extremely warm to the touch. Resuscitative efforts were unsuccessful and death was pronounce3d. Analysis showed a result of 210 ng/mL in blood. The presented quantitative LC-MS/MS method can successfully be applied to evaluate exposure to exogenous melatonin. Toxicology testing can assist in the investigation of these case types by substantiating the purposeful administration of melatonin.

A Multisite Randomized Controlled Two-Phase Trial of the Early Start Denver Model Compared to Treatment as Usual.

This single-blind, randomized, multisite, intent-to-treat study was designed to replicate and extend Dawson etal.'s (Pediatrics. 2010;125: e17-e23) randomized controlled trial testing the effects of the Early Start Denver Model (ESDM), an intensive play- and routines-based intervention delivered in natural settings. A randomized controlled trial was conducted at 3 universities. One hundred eighteen children 14 to 24 months old with autism spectrum disorder were enrolled and randomly assigned to ESDM or community interventions for 27 months. Eighty-one children completed the full treatment course and all assessments; data from all 118 children were used in analyses. Children assigned to the ESDM intervention received 3 months of weekly parent coaching followed by 24 months of 15 hour per week (on average) 1:1 treatment weekly on average in homes or daycare settings from supervised therapy assistants while parents received coaching 4 hours monthly from a certified ESDM therapist. For the primary analyses, there were time-by-group and time-by-group-by-site interactions for language outcome. In the significant 3-way interaction involving site, 2 sites showed a significant ESDM advantage and the third site showed no significant group differences. In the planned 2-way analysis that pooled data across all 3 sites, there was a significant advantage found for the ESDM group. For the secondary analyses, there were no significant differences between the ESDM and community groups involving developmental quotient, autism severity, or adaptive behavior. The treatment effect of group on language outcomes was not moderated by baseline developmental quotient, autism severity, or language. Results of the primary analysis provide a partial replication of Dawson etal.'s 2010 language findings. Intensive Intervention for Toddlers with Autism; https://clinicaltrials.gov/; NCT00698997.

Safety of Pediatric Peripheral Blood Stem Cell Harvest in Daycare Setting: An Institutional Experience.

Introduction:Children serving as a donor for their siblings will require anesthesia or sedation. In view of shortage of time and space in operating room setting, peripheral blood stem cell (PBSC) harvest is performed as a daycare procedure.Aim:This study aims to find out whether performing PBSC harvest in hematology blood collection area as a daycare procedure is safe or not.Settings and Design:This secondary analysis included 164 pediatric PBSC harvest (154 pediatric donors, of which 10 had repeat harvesting done) donors, performed under anesthesia, in the Department of Hematology, between January 2009 and June 2017.Materials and Methods:Donors were examined, informed consent was obtained, and adequate premedications were ensured. Induction was intravenous for cooperative donors or inhalational sevoflurane followed by intravenous maintenance infusion using either face mask or a laryngeal mask airway (LMA). During the procedure, vitals are monitored with a noninvasive monitor. Normal hemodynamics were ensured before transferring the children to the ward.Statistical Analysis:Statistical analysis was performed using SPSS 16.0 statistical software. Descriptive statistics and frequencies were used for the data description.Results:A total of 137 donors (median age of 5 years) were induced with sevoflurane and LMA was used in 84 children and face mask in 53. Twenty-seven children cooperated for intravenous induction. Various combinations of propofol, dexmedetomidine, and ketamine were used with respiratory and hemodynamic stability. The median duration of anesthesia was 250 (165–375) min. The recovery from anesthesia was smooth with a median wake-up time of 20 (5–60) min.Conclusion:This retrospective analysis demonstrates that nonoperating room anesthesia for pediatric age group for PBSC harvest can be safely and successfully accomplished outside the operation room setting by a consultant anesthesiologist.

Early Friendships: Does a Friend’s Presence in Daycare Promote Toddlers’ Prosocial Behavior Toward Peers?

The current study examined the effect of a friend’s presence on toddlers’ behavior in high child-to-staff-ratio daycare settings. Toddlers (N = 38) were video-observed in the presence or absence of a verified friend in two situations that burden staff: morning separation and lunchtime (overall, 152 video observations). Higher levels of positive social engagement, fewer agonistic behaviors toward peers, and fewer occurrences of distress were observed in the friend’s presence. The duration of morning separations decreased by half and toddlers contacted the caregiver less during separations and exhibited more prosocial behaviors. Overall, toddlers demonstrated greater empathic concern when their friend was present. During lunchtime, they also displayed greater concern toward peers other than their friend. Friendship, even at a very young age, can constitute a meaningful emotional resource for soothing and security.

5.68 Factors Related to Disorganized Attachment Style of Trauma-Affected Young Children in a Therapeutic Daycare Setting

5.68 Factors Related to Disorganized Attachment Style of Trauma-Affected Young Children in a Therapeutic Daycare Setting

Accuracy of Parental Reporting of Preschoolers' Dietary Intake Using an Online Self-Administered 24-h Recall.

Parents are typically relied upon to report young children’s dietary intake. However, there has been limited research assessing the accuracy of such reports captured using novel dietary assessment tools. The purpose of the current study was to assess the validity of the web-based Automated Self-Administered 24-h Dietary Assessment Tool (ASA24-Canada) for capturing dietary intake among children aged two-five years (n = 40), using parental proxy reporting. The study was conducted in a daycare setting, allowing for standardization of foods and drinks offered and direct observation of intake. Parental-reported intake was compared to true intake for lunch and dinner, as well as an afternoon snack, on a single day. Each eating occasion, including plate waste, was unobtrusively documented. Parents were not present for lunch or the afternoon snack, but joined their children at the daycare centre for the dinner meal. The following day, parents reported their children’s intake from the previous 24-h period using ASA24-Canada. For the eating occasions assessed, parents reported exact or close matches for 79.2% (82.3% for lunch, 81.2% for the snack, and 77.4% for dinner) of the foods and beverages truly consumed by children. Estimates of intake for energy and macronutrients examined (carbohydrates, fat, and protein) based on parental reports were higher than those based on true (observed) intake. Our findings suggest that parents are able to report what their preschool children eat and drink relatively accurately. However, the accuracy of portion size estimates is low. Strategies to enhance portion size reporting are needed to improve parental proxy reporting.

2465 Enhancing outcomes for young children with behavior disorders: A model for coordinated care

OBJECTIVES/SPECIFIC AIMS: (1) Identify current barriers to coordinated care between behavior consultation and PCIT services. (2) Identify current facilitators to coordinated care between behavior consultation and PCIT services. (3) Utilize this knowledge to create and pilot a coordinated care model that will enhance PCIT and behavior consultation service outcomes. METHODS/STUDY POPULATION: Objectives 1 and 2: Two focus groups consisting of 8–10 behavior consultants will be conducted to gather initial information on barriers and facilitators to coordinated care. Participants will be recruited from the state-funded behavior consultation team, to represent consultation occurring in rural and urban settings. All focus groups will be recorded and transcribed to capture questions and comments. Focus groups will be provided with an initial 10-minute overview of PCIT, including theory, prescribed strategies, and mode of intervention. A grand tour question will then be asked to elicit consultant perceptions of PCIT (e.g., “What are your thoughts on the compatibility between PCIT and behavior consultation services”), followed by probe questions deigned to elicit more detailed information about any perceived differences based on philosophical approach; differences in what is recommended in childcare settings Versus at home, etc.; and perceived barriers to coordinated care between school and outpatient services (e.g., “What factors make coordinating care with outpatient providers challenging?). Participants will be asked about their willingness to participate in a second focus group to review materials created to enhance coordinated care, based on their feedback. Objective 3. Based on feedback from the focus groups and quantitative data regarding factors associated with PCIT outcomes, we will develop an enhanced childcare component(s) for eventual implementation. To confirm our approach, we will invite the members of both focus groups back for a second session, in which we provide them with the created materials and elicit their feedback. We will start with a grand tour question (e.g., “How do you think parents and teachers would react to these materials?”) and then follow-up with probe questions related to feasibility (e.g., “How do you anticipate using these tools?”), appropriateness (e.g., “How adequately do you feel these materials address concerns with coordinated care?”), and acceptability (e.g., “How likely are you to begin using these tools within your consultation?”). Both focus groups will be recorded and transcribed to capture questions and comments. RESULTS/ANTICIPATED RESULTS: (1) Barriers and facilitators to coordinated care will include individual (e.g., acceptability of PCIT framework) and system-level factors (e.g., ease of communication between providers). (2) There will be significant overlap in coordination between the first phase of PCIT (which focuses on positive parenting strategies) and what is prescribed by behavior consultants. (3) There will be less compatibility between the second phase of PCIT (which focuses on disciplinary strategies) and what is prescribed by behavior consultants. (4) A coordinated are model will be rated as more feasible, appropriate, and acceptable to behavior consultants than PCIT services as currently prescribed. DISCUSSION/SIGNIFICANCE OF IMPACT: Childhood disruptive behaviors are among the most frequent reasons for referral to outpatient child/adolescent mental health clinics (Sukhodolsky et al., 2016). Disruptive and aggressive behaviors are problematic, not only for victims of children who are aggressive but also for aggressive children as they age. Although effective treatments exist, families are often provided with conflicting strategies for behavior management by outpatient clinicians and behavior consultants in the daycare setting, thus providing children inconsistent feedback which will delay their attainment of new skills. These data will provide the initial foundation for the development of a coordinated care model that promotes treatment efficacy by improving the compatibility between clinic-based PCIT and daycare-based behavior consultation services.

Young children’s agency: exploring children’s interactions with practitioners and ancillary staff members in Greek early childhood education and care settings

ABSTRACTMost research in early childhood education and care (ECEC) settings, in Greece and internationally, focuses on children’s relationships with their early years practitioners, but evidence regarding young children’s role in the formation of these relationships is limited. This paper focuses on 10 children, under the age of three, recognizing children’s agency and their significant contribution to the formation of interpersonal relationships with practitioners and ancillary staff members. The paper draws on findings from an ethnographic case study, conducted in two Greek day-care settings over the course of six months, which used an adaptation of the Mosaic Approach. The analysis suggests that children’s relationships with significant adults beyond the home are paramount for children and influence and shape the way they perceive and experience the settings.

Creation of a Collaborative Disaster Preparedness Video for Daycare Providers: Use of the Delphi Model for the Creation of a Comprehensive Disaster Preparedness Video for Daycare Providers

Eight million American children under the age of 5 attend daycare and more than another 50 million American children are in school or daycare settings. Emergency planning requirements for daycare licensing vary by state. Expert opinions were used to create a disaster preparedness video designed for daycare providers to cover a broad spectrum of scenarios. Various stakeholders (17) devised the outline for an educational pre-disaster video for child daycare providers using the Delphi technique. Fleiss κ values were obtained for consensus data. A 20-minute video was created, addressing the physical, psychological, and legal needs of children during and after a disaster. Viewers completed an anonymous survey to evaluate topic comprehension. A consensus was attempted on all topics, ranging from elements for inclusion to presentation format. The Fleiss κ value of 0.07 was obtained. Fifty-seven of the total 168 video viewers completed the 10-question survey, with comprehension scores ranging from 72% to 100%. Evaluation of caregivers that viewed our video supports understanding of video contents. Ultimately, the technique used to create and disseminate the resources may serve as a template for others providing pre-disaster planning education. (Disaster Med Public Health Preparedness. 2019;13:123-127).

Never too early to learn

Four early childhood educators, along with a university researcher, describe their efforts to implement an antiracist, antibias curriculum in a daycare and preschool setting. Even very young children can learn important lessons about race, diversity, and equity, they argue, and teachers should not shy away from addressing these issues at staff meetings and in the classroom.

Investigation of adult tonsillectomy induction and recovery using propofol and sevoflurane in a day-care setting

Investigation of adult tonsillectomy induction and recovery using propofol and sevoflurane in a day-care setting

Outcomes of Children with Severe Acute Malnutrition in a Tribal Daycare Setting

ObjectiveTo describe the nutritional outcomes of children with severe acute malnutrition (SAM) in a village-level intervention.MethodsThis observational longitudinal study on 179 children aged <3 years was conducted in seven tribal blocks of Central and Eastern India with SAM managed in a comprehensive day care program.Results76% children with SAM showed improvement over a 4-6 months period, with 37% shifting to normal anthrometric status. There was a significant shift in Z scores.ConclusionsThis community-based intervention showed fair results for management of children with SAM at village level.

Second-language-acquisition developmental differences: exploring migrant children’s language production in a daycare setting

ABSTRACTLearning a new language and culture may be particularly difficult for families in the United States supported by migrant workers, who typically work long hours and live a mobile lifestyle. The purpose of this phenomenological study is to describe the interaction patterns (i.e. use of the Spanish and English languages) among native-Spanish-speaking children at a migrant daycare. Twenty-five children (aged two to nine) were observed during various activities across two periods. Interactional patterns were examined among children, employees and children, and parents and children. The essence of interactional patterns found included: (1) information, (2) collective language knowledge, and (3) learning. The children’s use of the English or Spanish language stemmed from their interlocutor and conversational goals.

Effects of an 8-Week Aerobic Dance Program on Health-Related Fitness in Patients With Schizophrenia.

Both psychiatric symptoms and the side effects of medication significantly affect patients with schizophrenia. These effects frequently result in a sedentary lifestyle and weight gain, which increase the risk of cardiovascular disease and premature death. This study developed an aerobic dance program for patients with schizophrenia and then evaluated the effect of this program on health-related fitness outcomes. An experimental research design was used. Sixty patients with schizophrenia were recruited from a daycare ward and rehabilitation center at a psychiatric hospital in Taiwan. Paticipants were assigned randomly into an experimental group, which received the 8-week aerobic dance program intervention, and a control group, which received no intervention. All of the participants were assessed in terms of the outcome variables, which included bodyweight, body mass index, muscular endurance, flexibility, and cardiorespiratory endurance. These variables were measured before the intervention (pretest) as well as at 8 weeks (posttest) and 12 weeks (follow-up) after the intervention. This study used a generalized linear model with a generalized estimating equation method to account for the dependence of repeated measurements and to explore the effects of the intervention on health-related fitness outcomes. Twenty-six participants were in the experimental group, and 28 were in the control group. Significant between-group differences were observed at posttest and in the follow-up for all of the health-related fitness outcomes with the exception of muscular endurance. This study suggests that an 8-week aerobic dance program may be an effective intervention in patients with schizophrenia in terms of improving bodyweight, body mass index, flexibility, and cardiorespiratory endurance for a period of at least 4 months. Furthermore, although muscular endurance was postively affected during the short-term period, the benefits did not extend into the follow-up examination. On the basis of these findings, aerobic dance is recommended as a nonpharmacological intervention for patients with schizophrenia who are in daycare or rehabilitation settings.

1.5 Factors Impacting the Resilience of Trauma-Affected Young Children in a Therapeutic Daycare Setting

1.5 Factors Impacting the Resilience of Trauma-Affected Young Children in a Therapeutic Daycare Setting

Unmet Expectations in Alzheimer's Family Caregiving: Interactional Characteristics Associated With Perceived Under-Contribution.

Perceptions about family members not contributing enough to caregiving are documented to create psychological stress among caregivers. This study investigated whether individuals' perception that family members are under-contributing in caregiving processes was associated with their psychological well-being and explored the factors that may contribute to such perception borrowing concepts from a previous study: malfeasance, nonfeasance, and uplift. Seventy-two members of 30 families recruited through residential and adult daycare settings provided information about 960 familial network members (e.g., family, friends). Perceived levels of participation in caregiving about each network member, whether the level met respondents' expectations, and interactions representing malfeasance, nonfeasance, and uplift were assessed. Number of family members respondents identified as under-contributing in caregiving was associated with higher, whereas numbers of family participating in caregiving and supportive staff were associated with lower distress (Center for Epidemiologic Studies Depression Scale [CES-D]). Factor analyses identified a set of social interactions among familial network members capturing three constructs: malfeasance, nonfeasance, and uplift. Network members for whom respondents reported higher levels of nonfeasance were more likely to be identified as under-contributing in direct care (odds ratio [OR] = 1.92), care decision making (OR = 1.89), and social support (OR = 1.74) compared with those identified as contributing enough. Members with higher levels of malfeasance were more likely to be identified as under-contributing in direct care (OR = 1.19) than those identified as contributing enough. Social interactions characterized as nonfeasance may explain the perception of unmet expectations in caregiving within families and may represent a potential focus of family-level interventions.

Outside belonging: A study of bullying in a daycare institution

In this study of bullying during children’s play and other interactions in a daycare setting, the empirical data are based on interviews with staff and notes from discussions with staff and with two special education teachers. The results confirm that bullying is a complex phenomenon, as many and varied forces, both human and non-human, were found to play a role in the construction of bullying in this daycare setting.

Design and methods for a cluster-controlled trial conducted at sixty-eight daycare facilities evaluating the impact of \u201cJolinchenKids \u2013 Fit and Healthy in Daycare\u201d, a program for health promotion in 3- to 6-year-old children

BackgroundThe prevention of overweight and obesity during infancy is a highly relevant public health topic given the significant impact of childhood obesity on acute and chronic diseases, general health, and well-being in later stages of life. Apart from the family setting, daycare facilities (DFs) represent a key setting for health promotion among children under the age of six years. “JolinchenKids – Fit and Healthy in Daycare” is a multi-component program promoting physical activity (PA), healthy eating, and mental well-being in 3- to 6-year-old preschoolers at DFs, originally designed by the German health insurance AOK. To evaluate program effectiveness, a cluster-controlled trial involving 68 DFs is currently conducted. The objective of this article is to describe the background, study design, and aims of this trial.Methods/designSixty-eight DFs across Germany will be recruited to take part in the study, half of them serving as intervention DFs and half of them as delayed intervention control DFs (which receive the program upon completion of the study). At each DF, height, weight, and body composition, as well as motor skills, will be assessed in twenty 3- to 6-year-old children. Children’s eating and PA habits, and mental well-being will be assessed via parental questionnaires. A subsample of children (i.e., at 24 DFs which are randomly selected within a geographic region) will be asked to wear accelerometers at their wrists to objectively measure PA over the course of seven days. To compare changes in body composition, motor skills, eating and PA habits, and mental well-being of children at intervention DFs with those observed among children at delayed intervention control DFs over one year, all measurements will take place at baseline and twelve months after the launch of the program at all DFs.DiscussionThis study investigates the influence of a health promotion program in the daycare setting on various outcomes, including body composition and objectively measured PA, in a nationwide sample of 3- to 6-year-old preschoolers. This study will provide evidence regarding the effectiveness of a multi-component program for health promotion in this setting and may provide insights into new strategies for preventing obesity in early life.Trial registrationGerman Clinical Trials Register DRKS00011065 (Date of registration 16–09-2016).

Descriptive analysis of preschool physical activity and sedentary behaviors \u2013 a cross sectional study of 3-year-olds nested in the SKOT cohort

BackgroundFurther collection of surveillance data is warranted, particularly in preschool populations, for optimizing future public health promotion strategies. This study aims to describe physical activity (PA) and sedentary behavior (SB) across different settings, including time in and out of daycare, and to determine the proportion of children complying with suggested PA recommendations in a high income country.MethodsValid PA was assessed in 231 children (36.4 ± 1.1 months) with the Actigraph GT3X accelerometer, and information regarding date and time of dropping-off/picking-up children in daycare was provided by parents. Mean total PA (i.e., counts per minute (CPM)), moderate-to-vigorous physical activity (MVPA), SB time, and non-SB time was generated and compared across settings. Post hoc, PA and SB were examined in subgroups of low-active (1st quartile) and high-active (4th quartile) children.ResultsOverall, boys and girls spent 1.4 ± 0.3 h/day and 1.2 ± 0.4 h/day in MVPA, respectively. Likewise, boys and girls accumulated 6.7 ± 0.8 h and 6.8 ± 0.9 h of SB time per day, respectively. Higher PA levels consistently co-occurred with lower SB time in the daycare setting. Girls accumulated less SB time in daycare than before and after daycare (β = −12.2%, p < 0.001 & β = −3.8%, p < 0.001, respectively). In boys, daycare-days contained more PA and less SB than non-daycare-days (CPM: β =29, p = 0.046, %MVPA: β = 0.83, p = 0.007, %SB: β = −2.3, p < 0.001, respectively). All children fulfilled recommendations of at least 3 h of daily non-SB. Eighty-nine percent of boys and 72% of girls met the daily 1-h MVPA recommendation for 5 year-olds. Lower proportions of children, especially boys, fulfilled MVPA recommendation on days with no daycare attendance. Generally, large mean differences in MVPA and SB were observed across all settings between the most active and the least active children, and only 7% of the low-active girls and 59% of the low-active boys fulfilled MVPA recommendations.ConclusionsOverall, the majority of children fulfilled MVPA guidelines for 5 year-olds, and all children complied with suggested recommendations of 180 min of daily activity. Daycare time was found to represent an important setting for PA. Substantial and consistent differences observed in the amount of time spent physically active between high- and low-active children across all settings indicate substantial variations in young children’s PA levels irrespective of the context.

Effective preventive interventions to support parents of young children: Illustrations from the Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD)

ABSTRACTSecure attachment relationships are essential for children’s current and later development. From attachment theory and research, it can be derived that sensitive parenting is the key to positive parent-child relationships. Is it possible to design effective interventions to enhance sensitive parenting? In this article, we review elements that are crucial for effective attachment-based interventions, and we proceed with illustrations from the Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD). We describe how this intervention program was developed, how it has been implemented in practice in different types of families and in daycare settings, and how effective the program is. We conclude that intervention programs like the VIPP-SD could play an important role in the community by serving families in need of parenting support.