Attainment Of Developmental Milestones Research Articles

Social and environmental predictors of gut microbiome age in wild baboons.

Understanding why some individuals age faster than others is essential to evolutionary biology and geroscience, but measuring variation in biological age is difficult. One solution may lie in measuring gut microbiome composition because microbiota change with many age-related factors (e.g., immunity and behavior). Here we create a microbiome-based age predictor using 13,563 gut microbial profiles from 479 wild baboons collected over 14 years. The resulting "microbiome clock" predicts host chronological age. Deviations from the clock's predictions are linked to demographic and socio-environmental factors that predict baboon health and survival: animals who appear old-for-age tend to be male, sampled in the dry season (for females), and high social status (both sexes). However, an individual's "microbiome age" does not predict the attainment of developmental milestones or lifespan. Hence, the microbiome clock accurately reflects age and some social and environmental conditions, but not the pace of development or mortality risk.

Developmental Milestone Attainment in US Children Before and During the COVID-19 Pandemic

Restrictions related to the COVID-19 pandemic disrupted the lives of young children, but the association between the pandemic and any changes in early childhood developmental milestone achievement in the US remains unclear. To determine the association between the COVID-19 pandemic and changes in developmental screening scores among US children aged 0 to 5 years and to investigate whether caregivers self-reported more worries about their children or concerns about children's behavior during the pandemic, regardless of milestone achievement. This was a cohort study using an interrupted time series analysis comparing prepandemic (March 1, 2018, to February 29, 2020), interruption (March 1 to May 31, 2020), and intrapandemic (June 1, 2020, to May 30, 2022) periods among 50 205 children (randomly sampled from a population of 502 052 children) aged 0 to 5 years whose parents or caregivers completed developmental screening at pediatric visits at US pediatric primary care practices participating in a web-based clinical process support system. COVID-19 pandemic period. Age-standardized Ages and Stages Questionnaire, Third Edition (ASQ) domain scores (communication, personal-social, problem-solving, gross motor, fine motor), and rate of caregivers' concerns about the child's behavior or worries about the child as measured on the ASQ. A total of 50 205 children (25 852 [51.5%] male; mean [SD] age, 18.6 [16.0] months) and 134 342 ASQ observations were included. In adjusted models, significant age-specific mean score decreases from prepandemic to intrapandemic were observed in communication (-0.029; 95% CI, -0.041 to -0.017), problem-solving (-0.018; 95% CI, -0.030 to -0.006), and personal-social (-0.016; 95% CI, -0.028 to -0.004) domains. There were no changes in fine or gross motor domains prepandemic to intrapandemic. For infants aged 0 to 12 months, similar effect sizes were observed but only for communication (-0.027; 95% CI, -0.044 to -0.011) and problem-solving (-0.018; 95% CI, -0.035 to -0.001). After accounting for age-standardized ASQ scores, caregiver worries about the child increased slightly in the intrapandemic period compared with the prepandemic period (rate ratio, 1.088; 95% CI, 1.036-1.143), but there were no changes in caregiver concerns about the child's behavior. While changes in developmental screening scores were modest (2%-3%), nationwide, this could translate to more than 1500 additional recommended developmental referrals over baseline each month. Modest changes in developmental screening scores are reassuring in the short term but may tax an already overburdened developmental behavioral pediatrics infrastructure. Continued attention to developmental surveillance is critical since the long-term population- and individual-level implications of these changes are unclear.

Stability of neurodevelopmental trajectories in moderately late and early preterm children born 15 years apart.

Neurodevelopmental trajectories of preterm children may have changed due to changes in care and in society. We aimed to compare neurodevelopmental trajectories in early and moderately late preterm children, measured using the Developmental (D)-score, in two cohorts born 15 years apart. We included early preterm and moderately late preterm children from two Dutch cohorts (LOLLIPOP, 2002-2003 and ePREM, 2016-2017). ePREM counterparts were matched to LOLLIPOP participants by gestational age and sex. D-score trajectories were summarized by a multilevel model with random intercepts and random slopes, and multigroup analyses were used to test if the intercepts and slopes differed across cohorts. We included 1686 preterm children (1071 moderately late preterm, 615 early preterm) from LOLLIPOP, and matched these with 1686 ePREM counterparts. The neurodevelopmental trajectories of the two cohorts were mostly similar. For early preterm children, we found no statistically significant differences. For moderately late preterm children, both the intercept (43.0 vs. 42.3, p < 0.001) and slope (23.5 vs. 23.9, p = 0.002) showed some, but only clinically minor, differences. Developmental trajectories, measured using the D-score, in the first four years of life are comparable and stable across a period of 15 years for both early and moderately late preterm children. Neurodevelopmental trajectories are similar for early and moderately late preterm children born 15 years apart and thus seem quite stable in time. The validated Developmental score visualizes these trajectories based on developmental milestone attainment Because of its stability over time, the Developmental score trajectory may aid clinicians in neurodevelopmental assessment of preterm children as this simplifies monitoring and interpretation, similar to a growth chart.

Digital location tracking in the parent/caregiver-college student dyad.

As college students navigate new developmental milestones, many families rely on digital technology to stay connected and aid in the transition to adulthood. Digital location tracking apps allow for parental monitoring in new ways that may have implications for youth development. Although recent research has begun to examine prevalence and motivations for digital location tracking in adolescence, we know little about how and why families continue to track into the transition to college, and how this may relate to perceptions of helicopter and autonomy supportive parenting. In a cross-sectional study of 706 community college and 4-year university students in the Southeastern United States, we describe prevalence and sociodemographic differences in parent/caregiver digital location tracking of their college student children, and how this may be associated with perceptions of helicopter parenting and parent/caregiver autonomy support. Findings suggest that digital location tracking is a fairly common practice among college students, with nearly half of the sample endorsing currently or previously being digitally location tracked by their parent/caregiver. Younger, White, and higher socioeconomic status students were more likely to be tracked. Those students who were currently being digitally location tracked tended to perceive their primary parent/caregiver as engaging in more helicopter parenting and as less supportive of their autonomy. This brief report provides preliminary insight into parent/caregiver digital location tracking of their college student children. It is our hope that future research will further examine how digital location tracking may be helping or hindering attainment of developmental milestones in the digital age.

What is typical: Atypical in young children's attention regulation?: Characterizing the developmental spectrum with the Multidimensional Assessment Profiles-Attention Regulation Infant-Toddler (MAPS-AR-IT) Scale.

While attention dysregulation is a promising early indicator of neurodevelopmental risk, in particular attention-deficit/hyperactivity disorder (ADHD), it is difficult to characterize clinical concern due to its developmental expectability at the transition to toddlerhood. Thus, explicating the typical:atypical continuum of risk indicators is among the key future directions for research to promote early identification and intervention, and prevent decrements in the attainment of developmental milestones into early childhood. In this paper, we present the Multidimensional Assessment Profiles-Attention Regulation Infant-Toddler (MAPS-AR-IT) Scale, a novel parent-report survey of dimensional, developmentally specified indicators of attention (dys)regulation. Item Response Theory was employed to characterize the typical:atypical spectrum of both normative and more concerning dysregulation (including the contexts in which behavior occurs). We provide evidence of the validity of this measure in capturing the full typical:atypical spectrum via a longitudinal sample of typically developing children at 12-18 months of age (baseline) via concurrent scores on well-validated temperament and clinical measures. We also examine longitudinal stability and predictive validity if the MAPS-AR-IT via a clinical interview of ADHD symptoms at 24-30 months (follow-up). While not diagnostic, we present evidence of the utility of the MAPS-AR-IT in explicating individual neurodevelopmental risk and elucidating the broader typicality of behaviors related to attention (dys)regulation.

Expanding genotype–phenotype correlations in FOXG1 syndrome: results from a patient registry

BackgroundWe refine the clinical spectrum of FOXG1 syndrome and expand genotype–phenotype correlations through evaluation of 122 individuals enrolled in an international patient registry.MethodsThe FOXG1 syndrome online patient registry allows for remote collection of caregiver-reported outcomes. Inclusion required documentation of a (likely) pathogenic variant in FOXG1. Caregivers were administered a questionnaire to evaluate clinical severity of core features of FOXG1 syndrome. Genotype–phenotype correlations were determined using nonparametric analyses.ResultsWe studied 122 registry participants with FOXG1 syndrome, aged < 12 months to 24 years. Caregivers described delayed or absent developmental milestone attainment, seizures (61%), and movement disorders (58%). Participants harbouring a missense variant had a milder phenotype. Compared to individuals with gene deletions (0%) or nonsense variants (20%), missense variants were associated with more frequent attainment of sitting (73%). Further, individuals with missense variants (41%) achieved independent walking more frequently than those with gene deletions (0%) or frameshift variants (6%). Presence of epilepsy also varied by genotype and was significantly more common in those with gene deletions (81%) compared to missense variants (47%). Individuals with gene deletions were more likely to have higher seizure burden than other genotypes with 53% reporting daily seizures, even at best control. We also observed that truncations preserving the forkhead DNA binding domain were associated with better developmental outcomes.ConclusionWe refine the phenotypic spectrum of neurodevelopmental features associated with FOXG1 syndrome. We strengthen genotype-driven outcomes, where missense variants are associated with a milder clinical course.

Addressing the needs of infants and toddlers exposed to maltreatment: Examining the impact of an integrated early head start & children and youth services program

Tragically, our nation is witness to the increasing prevalence of child maltreatment, with the highest prevalence among children under three years of age (Administration for Children and Families, 2020). For every 1,000 children under the age of one in the U.S., more than 25 of them are victims of maltreatment. Even more shocking is the fact that an estimated 1,840 children die from abuse and neglect with almost half (45.4%) of all fatalities from maltreatment occurring in children under one year of age (US Department of Health and Human Services, 2019). In 2002, the Office on Child Abuse and Neglect established the Early Head Start Child Welfare System Initiative as a joint effort between the Office of Head Start and the Children’s Bureau. Funding was provided to 24 grantee sites to increase integrated delivery of services to infants and toddlers who were involved in the child welfare system. Programs emerging from this initiative reflect the gold standard for integrated care among developmental and health programs. However, empirical understanding about the implementation and effectiveness of integrated services for infants and toddlers is lacking (Manz et al., 2019). Addressing this gap, this study examined the association of dosage indicators and child outcomes for an integrated Early Head Start and Children and Youth Services Program (EHS/CYS) program involving a state-led Children and Youth Services Program and Early Head Start center-based program. Program data were analyzed to determine the relative benefits of this EHS/CYS program for infants and toddlers dependent upon their age and duration of enrollment. The objective of this study was to yield information that could improve service delivery and outcomes. Results suggested that longer enrollment duration led to increased attainment of developmental milestones in the areas of cognitive, language, and social emotional development. Future directions for research as well as implications for policy are presented.

Developmental Variability in Autism Across 17 000 Autistic Individuals and 4000 Siblings Without an Autism Diagnosis

Presence of developmental delays in autism is well established, yet few studies have characterized variability in developmental milestone attainment in this population. To characterize variability in the age at which autistic individuals attain key developmental milestones based on co-occurring intellectual disability (ID), presence of a rare disruptive genetic variant associated with neurodevelopmental disorders (NDD), age at autism diagnosis, and research cohort membership. The study team harmonized data from 4 cross-sectional autism cohorts: the Autism Genetics Research Exchange (n = 3284; 1997-2015), The Autism Simplex Collection (n = 694; 2008-2011), the Simons Simplex Collection (n = 2753; 2008-2011), and the Simons Foundation Powering Autism Research for Knowledge (n = 10 367; 2016-present). The last sample further included 4145 siblings without an autism diagnosis or ID. Convenience sample of 21 243 autistic individuals or their siblings without an autism diagnosis aged 4 to 17 years. Parents reported ages at which participants attained key milestones including smiling, sitting upright, crawling, walking, spoon-feeding self, speaking words, speaking phrases, and acquiring bladder and bowel control. A total of 5295 autistic individuals, and their biological parents, were genetically characterized to identify de novo variants in NDD-associated genes. The study team conducted time-to-event analyses to estimate and compare percentiles in time with milestone attainment across autistic individuals, subgroups of autistic individuals, and the sibling sample. Seventeen thousand ninety-eight autistic individuals (mean age, 9.15 years; 80.8% male) compared with 4145 siblings without autism or ID (mean age, 10.2 years; 50.2% female) showed delays in milestone attainment, with median (IQR) delays ranging from 0.7 (0.3-1.6) to 19.7 (11.4-32.2) months. More severe and more variable delays in autism were associated with the presence of co-occurring ID, carrying an NDD-associated rare genetic variant, and being diagnosed with autism by age 5 years. More severe and more variable delays were also associated with membership in earlier study cohorts, consistent with autism's diagnostic and ascertainment expansion over the last 30 years. As the largest summary to date of developmental milestone attainment in autism, to our knowledge, this study demonstrates substantial developmental variability across different conditions and provides important context for understanding the phenotypic and etiological heterogeneity of autism.

Cochlear Implantation in Noonan Syndrome With and Without Multiple Lentigines: A Case Report and Systematic Review.

To describe outcomes after bilateral cochlear implantation (CI) in a patient with a pathologic PTPN11 variant associated with Noonan syndrome (NS) and Noonan syndrome with multiple lentigines (NSML). Additionally, to assess the utility of CI in this specific population based on our outcome and previous reports. Retrospective case report with literature review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A young boy with various multiorgan abnormalities, speech and language delay, and persistent hearing loss who was found to have a heterozygous PTPN11 gene mutation at age 2. Bilateral tympanostomy tube placement, diagnostic imaging, and eventual staged bilateral CI. Objective audiometric testing and developmental milestone attainment. Bilateral CI was successfully completed over a 2-month period. The patient illustrated significant improvement in objective audiologic measurement. However, he continues to sign as his main form of communication without significant speech progression. Early diagnostic and therapeutic intervention in patients with NS/NSML can help improve long-term audiologic and speech development. Given the heterogeneity of NS/NSML, a multidisciplinary approach is needed for optimal outcomes.

Effect of in utero exposure to SARS-CoV-2 infection on pregnancy outcomes and growth and development of infants: protocol for a multicentre ambispective cohort study in India

IntroductionPoor pregnancy and neonatal outcomes in infants born to COVID-19 positive mothers have been reported, but there is insufficient evidence regarding subsequent growth and development of these children. Our study...

Developmental milestones in early childhood and genetic liability to neurodevelopmental disorders.

Timing of developmental milestones, such as age at first walking, is associated with later diagnoses of neurodevelopmental disorders. However, its relationship to genetic risk for neurodevelopmental disorders in the general population is unknown. Here, we investigate associations between attainment of early-life language and motor development milestones and genetic liability to autism, attention deficit hyperactivity disorder (ADHD), and schizophrenia. We use data from a genotyped sub-set (N = 25699) of children in the Norwegian Mother, Father and Child Cohort Study (MoBa). We calculate polygenic scores (PGS) for autism, ADHD, and schizophrenia and predict maternal reports of children's age at first walking, first words, and first sentences, motor delays (18 months), and language delays and a generalised measure of concerns about development (3 years). We use linear and probit regression models in a multi-group framework to test for sex differences. We found that ADHD PGS were associated with earlier walking age (β = -0.033, padj < 0.001) in both males and females. Additionally, autism PGS were associated with later walking (β = 0.039, padj = 0.006) in females only. No robust associations were observed for schizophrenia PGS or between any neurodevelopmental PGS and measures of language developmental milestone attainment. Genetic liabilities for neurodevelopmental disorders show some specific associations with the age at which children first walk unsupported. Associations are small but robust and, in the case of autism PGS, differentiated by sex. These findings suggest that early-life motor developmental milestone attainment is associated with genetic liability to ADHD and autism in the general population.

Baby-led weaning in Italy and potential implications for infant development

Baby-led weaning is an approach to complementary feeding that emphasizes an infant's ability to self-feed rather than being spoon fed, and to eat minimally-processed foods rather than puréed foods. This study aimed to investigate the variability in infant feeding practices and the possible association with developmental milestones in an Italian population. A sample of 1245 mothers of 6–12 month-old infants completed an online survey about complementary feeding and their infant's attainment of developmental milestones. Infants' eating of family food was positively related to self-feeding and to a lower consumption of puréed foods. As in previous studies in the UK and New Zealand, a baby-led weaning style was positively associated with breastfeeding, exposure to complementary foods around six months of age, earlier exposure to both finger and family foods, and higher interest in family food and shared family meals. Infants who were introduced to solid foods using a baby-led weaning approach were more likely to have met important developmental milestones; when controlling for covariates, percentage of family feeding was positively associated with sitting unsupported at an earlier age and a low spoon-feeding style was associated with crawling at an earlier age. These data suggest that baby-led weaning should be defined more comprehensively. Moreover, its potential influence on developmental domains beyond diet and eating behavior warrants future targeted exploration.

Growth Faltering and Developmental Delay in HIV-Exposed Uninfected Ugandan Infants: A Prospective Cohort Study.

HIV-exposed but uninfected (HEU) infants are at increased risk of impaired early linear growth and cognitive development. We examined associations between prenatal and postnatal growth and subsequent neurodevelopment in Ugandan HEU infants, hypothesizing that early insults may explain alterations in both somatic growth and brain development. We prospectively followed a cohort of HEU infants from birth to 18 months of age, and measured length/height, weight, head, and arm circumference longitudinally. The Malawi Development Assessment Tool (MDAT, 12 and 18 months) and the Color Object Association Test (18 months) were used for developmental assessments. Among 170 HEU infants, the prevalence of low-birth weight and failure to thrive was 7.6% and 37%, respectively. HEU infants had MDAT scores that were similar to the reference population. The mean (SD) score on the Color Object Association Test was 5.5 (3.1) compared with 6.9 (5.3) in developmentally normal children. Developmental ability at age 18 months showed strong cross-sectional correlation with weight-for-age (ρ = 0.36, P < 0.0001), length/height-for-age (ρ = 0.41, P < 0.0001), head circumference-for-age (ρ = 0.26, P = 0.0011), and mid-upper arm circumference-for-age (ρ = 0.34, P = 0.0014). There was a statistically significant correlation between birth weight and MDAT z-score at 18 months (ρ = 0.20, P = 0.010). Failure to thrive was associated with lower MDAT z-score [median -0.13 (IQR -0.75 to +0.14) versus +0.14 (IQR -0.44 to +0.63), P = 0.042]. Growth faltering in HEU infants was associated with lower attainment of developmental milestones at age 18 months. Our findings point to a simple screening method for identifying HEU infants at risk for developmental intervention.

First permanent molars with accentuated line patterns: Assessment of childhood health in an urban complex of the fifth millennium before the present

ObjectivesThe objectives are 1) to calculate the position of highly accentuated lines in dental enamel of a group of individuals from Shahr-i-Sokhta, a thriving urban centre in Bronze Age South West Asia; 2) to identify peak frequencies of physiologically stressful periods during early childhood of these individuals; and 3) to relate these peak frequencies to developmental milestones at population level. DesignWe analysed highly accentuated lines in the enamel of nine (n = 9) permanent mandibular first molars of nine individuals from the 5th millennium before the present urban and long-distance-trading complex, Shahr-i Sokhta (Iran). Age at death ranged between 4.5 years and 18−20 years. Permanent mandibular first molar enamel begins to mineralise before birth, and is normally completed sometime between 2.1–3.3 years, giving us insight to early childhood physiological stress, the ages at which it occurs, and any peaks in the frequencies in highly accentuated line formation, through histological sections investigated using transmitted light microscopy. ResultsHighly accentuated line peak frequencies occur in the sample at c. four, nine, eleven, and twelve months. After 1 year of age, no more peaks occur. ConclusionThe peak frequencies coincide with the timing timing of the type of developmental milestones which may have exposed the individuals to an increased pathogen load, injury, or sub-optimal diet. We note similarity in peak timings in the few published, disparate populations, suggest a potential link with attainment of developmental milestones connected with morbidity, and propose reporting standardised statistics to enable exploration of differences between populations in terms of postnatal health-related stress.

Early developmental milestones in Duchenne muscular dystrophy.

To investigate the differences in attainment of developmental milestones between young males with Duchenne muscular dystrophy (DMD) and young males from the general population. As part of the case-control 4D-DMD study (Detection by Developmental Delay in Dutch boys with Duchenne Muscular Dystrophy), data on developmental milestones for 76 young males with DMD and 12414 young males from a control group were extracted from the health care records of youth health care services. The characteristics of DMD were acquired from questionnaires completed by parents. Logistic regression analyses were performed with milestone attainment (yes/no) as the dependent variable and DMD (yes/no) as the independent variable, with and without adjustment for age at visit. The mean number of available milestones was 43 (standard deviation [SD]=13, range: 1-59) in the DMD group and 40 (SD=15, range: 1-60) in the control group. The presence of developmental delay was evident at 2 to 3months of age, with a higher proportion of young males with DMD failing to attain milestones of gross/fine motor activity, adaptive behaviour, personal/social behaviour, and communication (range age-adjusted odds ratios [ORs]=2.3-4.0, p<0.01). Between 12 and 36months of age, differences in the attainment of developmental milestones concerning gross motor activity increased with age (range age-adjusted ORs=10.3-532, p<0.001). We also found differences in developmental milestones concerning fine motor activity, adaptive behaviour, personal/social behaviour, and communication between 12 and 48months of age (range age-adjusted ORs=2.5-9.7, p<0.01). We found delays in the attainment of motor and non-motor milestones in young males with DMD compared to the control group. Such delays were already evident a few months after birth. Developmental milestones that show a delay in attainment have the potential to aid the earlier diagnosis of DMD.

Double Jeopardy in Contemporary China: Intersecting the Socioeconomic Gradient and Geographic Context on Early Childhood Development

Family socioeconomic status (SES) differences in early childhood development (ECD) are well documented, as are the neighborhood effects in early development outcomes. However, little is known about whether the SES gradient in ECD outcomes varies across geographic contexts by county-level variables in contemporary China. This study examines the effects of county-level socioeconomic background on inequalities in the developmental outcomes of young Chinese children. Individual-level child development data based on four early development milestones—taking a first step, first sentences, counting 10 objects, fully independent toileting—were combined with family- and county-level socioeconomic data from the China Family Panel Studies (CFPS). Using a hierarchical linear model (HLM) to examine how the broader socioeconomic context plays a role in the attainment of developmental milestones at expected times as young children grow and develop, we have found significant cross-level interaction effects between family SES and county-level variables in relation to developmental milestone attainment. The family SES gradient in the achievement of children’s developmental milestones is steeper for those in the under-developed regions than their counterparts in the more developed regions. Our findings suggest that low-SES children who are living in socioeconomically deprived regions suffer from a double disadvantage in terms of early development outcomes. Further research would be needed to contextualize the observed interactions and better explain the underlying mechanisms.

Determinants of infant carrying behavior in rural Papua New Guinea

The determinants of variability in infant carrying within and across societies is an understudied area within parental investment research. Carrying has positive and negative consequences as it may protect the infant from predators and pathogens but is energetically costly for caregivers. Moreover, carrying may delay independent locomotor development and exposure to antigens necessary for immunological competence. The purpose of this study is to compare infants' ages and developmental milestone attainment as predictors of carrying behavior and to identify other determinants of carrying behavior among traditional forager-horticulturalists in Papua New Guinea. We analyze quantitative data collected among 107 infant-caregiver dyads during 354 hours of focal follows on infant carrying. Random effects logistic regression was used to model carrying behavior in these dyads. Infants' chronological age and milestone achievement are equally reliable predictors of abatement of carrying and increased time on the ground. Further, the presence or absence of the mother and the location of the infant-caregiver pair are significantly associated with carrying behavior. Indices of mother's and infants' condition such as anthropometric measures were not predictive of carrying behaviors. Mothers vary the amount of carrying based on assessment of infant and local environmental conditions. Age and milestone attainment are equally predictive of time on the ground and therefore increased exposure to antigens, pathogens and other dangers. High levels of infant carrying function as offspring protection by increasing exposure to ground level pathogens gradually, thus allowing for the naïve immune system to develop immunocompetence incrementally.

A Behavioral Epigenetics Model to Predict Oral Feeding Skills in Preterm Infants.

Preterm infants experience a multitude of prenatal and postnatal stressors, resulting in cumulative stress exposure, which may jeopardize the timely attainment of developmental milestones, such as achieving oral feeding. Up to 70% of preterm infants admitted to the neonatal intensive care unit experience challenges while initiating oral feeding. Oral feeding skills require intact neurobehavioral development. Evolving evidence demonstrates that cumulative stress exposure results in epigenetic modification of glucocorticoid-related genes. Epigenetics is a field of study that focuses on phenotypic changes that do not involve alterations in the DNA sequence. Epigenetic modification of glucocorticoid-related genes alters cortisol reactivity to environmental stimuli, which may influence neurobehavioral development, and is the essence of the evolving field of Preterm Behavioral Epigenetics. It is plausible that early-life cumulative stress exposure and the ensuing epigenetic modification of glucocorticoid-related genes impair neurobehavioral development required for achievement of oral feeding skills in preterm infants. The purpose of this article is to build upon the evolving science of Preterm Behavioral Epigenetics and present a conceptual model that explicates how cumulative stress exposure affects neurobehavioral development and achievement of oral feeding skills through epigenetic modification of glucocorticoid-related genes. Using the Preterm Behavioral Epigenetics framework and supporting literature, we present a conceptual model in which early-life cumulative stress exposure, reflected by DNA methylation of glucocorticoid-related genes and altered cortisol reactivity, disrupts neurobehavioral development critical for achievement of oral feeding skills. Future investigations guided by the proposed conceptual model will benefit preterm infant outcomes by introducing epigenetic-based approaches to assess and monitor preterm infant oral feeding skills. Furthermore, the proposed model can guide future investigations that develop and test epigenetic protective interventions to improve clinical outcomes, representing an innovation in neonatal care.

Establishing New Norms for Developmental Milestones.

Pediatric surveillance of young children depends on providers' assessment of developmental milestones, yet normative data are sparse. Our objectives were to develop new norms for common milestones to aid in clinical interpretation of milestone attainment. We analyzed responses to the developmental screening form of the Survey of Well-being of Young Children from 41 465 screens across 3 states. Associations between developmental status and a range of child characteristics were analyzed, and norms for individual questions were compared to guidelines regarding attainment of critical milestones from the Centers for Disease Control and Prevention (CDC). A contemporary resource of normative data for developmental milestone attainment was established. Lower developmental status was associated with child age in the presence of positive behavioral screening scores (P < .01), social determinants of health (P < .01), Medicaid (P < .01), male sex (P < .01), and child race (P < .01). Comparisons between Survey of Well-being of Young Children developmental questions and CDC guidelines reveal that a high percentage of children are reported to pass milestones by the age at which the CDC states that "most children pass" and that an even higher percentage of children are reported to pass milestones by the age at which the CDC states that parents should "act early." An interactive data visualization tool that can assist clinicians in real-time developmental screening and surveillance interpretation is also provided. Detailed normative data on individual developmental milestones can help clinicians guide caregivers' expectations for milestone attainment, thereby offering greater specificity to CDC guidelines.

EP.76Developmental delay in Duchenne muscular dystrophy

Diagnostic delay often occurs in the treatment of Duchenne muscular dystrophy (DMD). As the early course of the disease is defined by developmental delay, detecting this delay may aid timely diagnosis. Our aim is to investigate the differences in attainment of developmental milestones, medical referrals and symptoms between boys with DMD and boys from the general population. Within the 4D-DMD study (detection by developmental delay in Dutch boys with Duchenne muscular dystrophy), data on the attainment of milestones, medical referrals, and symptoms in boys with and without DMD were extracted from the (electronic) health records of the Youth Health Care Service.