Singaporean Children Research Articles

The link between hours of center-based childcare and child development in 3- to 6-year-olds: Evidence from Singapore

This study examined how the number of hours of early childhood education (ECE) is associated with young children's behavior problems and early academic achievement in Singapore, a non-WEIRD (“Western, educated, industrialized, rich, democratic”) country with families using long ECE hours. We drew data from the Singapore Longitudinal Early Development Study. Participants were 3- to 6-year-old children (N = 2,452). General linear models and spline regressions were utilized to analyze how ECE hours were associated with children's behavior problems and early academic achievement while controlling for child and family characteristics. On average, Singaporean children stayed 41.07 hours per week in ECE centers, with 38 % of the sampled children spending more than 50 hours per week in ECE centers. Notably, we found an inverted-U-shaped relation between ECE hours and child outcomes with a turning point of approximately 35–40 hours per week. Before the turning point, a greater number of hours in ECE was associated with more externalizing problems and higher academic achievement. However, after this point, a greater number of hours was associated with fewer behavior problems, both externalizing and internalizing, as well as poorer academic achievement. These findings demonstrate a complex nonlinear association between ECE hours and child outcomes in a context of children spending prolonged hours in centers.

Younger, not older, children trust an inaccurate human informant more than an inaccurate robot informant.

This study examined preschoolers' trust toward accurate and inaccurate robot informants versus human informants. Singaporean children aged 3-5 years (N = 120, 57 girls, mostly Asian; data collected from 2017 to 2018) viewed either a robot or a human adult label familiar objects either accurately or inaccurately. Children's trust was assessed by examining their subsequent willingness to accept novel object labels provided by the same informant. Regardless of age, children trusted accurate robots to a similar extent as accurate humans. However, while older children (dis)trusted inaccurate robots and humans comparably, younger children trusted inaccurate robots less than inaccurate humans. The results indicate a developmental change in children's reliance on informants' characteristics to decide whom to trust.

Effects of Pedagogical Questioning on Singaporean Young Children’s Learning of Novel Categories

There has been a longstanding debate about the advantages and disadvantages of two polarities of teaching methods: direct instruction and discovery learning. Research has shown that questioning might be a viable pedagogical method that combines the advantages of both. When pre-schoolers in the US explored a novel toy with multiple hidden functions, pedagogical questions – questions asked by a knowledgeable teacher who aims to guide children towards learning – have been shown to facilitate more learning and exploration compared to direct instruction or questions asked by a naïve confederate. The current study investigated whether these effects can be observed in Singaporean children’s learning of novel categories. A total of 30 children aged 5–7 (M = 6.51, SD = 0.45) were recruited and randomly assigned to four conditions. In all conditions, children were asked to find out the rule for categorising two types of novel robots by exploring exemplars. Before children started exploring, a hint was given either by a teacher in the form of a direct instruction, by the teacher through a question, by a confederate through a question, or not given. We then measured how much the children explored the exemplars and whether they categorised new cards and identified the rules correctly. Results showed no significant difference between any of the four conditions, which may be due to the small sample size. If a larger sample can confirm the research hypotheses, it will have implications on teachers’ choice of pedagogical methods in early childhood education.

Effectiveness of Monovalent mRNA Vaccines Against Omicron XBB Infection in Singaporean Children Younger Than 5 Years

Literature on vaccine effectiveness of SARS-CoV-2 messenger RNA (mRNA) vaccines for children younger than 5 years is limited. To report the effectiveness of monovalent mRNA vaccines against SARS-CoV-2 infection among Singaporean children aged 1 through 4 years during a COVID-19 pandemic wave of the Omicron XBB variant. This was a population-based cohort study, conducted over a 6-month study period from October 1, 2022, through March 31, 2023, after the implementation of community vaccination among all Singaporean children aged 1 through 4 years. The study period was dominated by the Omicron XBB subvariant. Receipt of SARS-CoV-2 mRNA vaccines. Vaccine effectiveness against confirmed SARS-CoV-2 infection. The adjusted incidence rate ratio for confirmed infections using Poisson regression was reported, with the reference group being those who were unvaccinated. Analyses were stratified by prior documented SARS-CoV-2 infection. A total of 121 628 children (median [IQR] age, 3.1 [2.2-3.9] years; 61 925 male [50.9%]) were included in the study, contributing 21 015 956 person-days of observation. The majority of children (11 294 of 11 705 [96.5%]) received the mRNA-1273 COVID-19 vaccine (Moderna). Vaccine effectiveness against confirmed infection was 45.2% (95% CI, 24.7%-60.2%) in partially vaccinated, infection-naive children and 63.3% (95% CI, 40.6%-77.3%) in fully vaccinated, infection-naive children compared with the unvaccinated group. Among previously infected children, vaccine effectiveness against reinfections in those with at least 1 vaccine dose was estimated at 74.6% (95% CI, 38.7%-89.5%). Study results suggest that completion of a primary mRNA vaccine series provided protection against SARS-CoV-2 infection in children aged 1 through 4 years. Although incidence of hospitalization and severe illness is low in this age group, there is potential benefit of vaccination in preventing infection and potential sequelae.

Associations between prenatal exposure Per- and polyfluoroalkyl substances and liver fat content in Singaporean children

Associations between prenatal exposure Per- and polyfluoroalkyl substances and liver fat content in Singaporean children

Establishing cervical vestibular evoked myogenic potential (cVEMP) normative data in Singapore school-aged children.

The Cervical Vestibular Evoked Myogenic Potential (cVEMP) is often employed in routine clinical practice as part of the vestibular test battery assessments. However, there is currently no well-established paediatric cVEMP normative data in Singapore. Additionally, limited literature has examined the relationship between neck length and cVEMP parameters. The main aims of this study are to 1) establish cVEMP normative data from Singaporean school-aged children aged 6-12 years old, and 2) examine if there is a significant correlation between neck length and cVEMP parameters. 31 healthy children participated in this study. Every participant was screened to ensure that they had normal auditory and vestibular profiles before completing the cVEMP procedure, which involved 500Hz tone burst through insertphones and head elevation from supine position as the method of neck contraction. The response rate in 62 ears was 98.4% at 95 dBnHL and 100% at 100 dBnHL. The mean P1 and N1 latencies were 13.96±1.17ms and 21.50±1.66ms, with a mean corrected P1-N1 amplitude of 0.88±0.34, and mean asymmetry ratio of 13±10%. Median threshold was 80 dBnHL. Significant positive correlation between neck length and both P1, N1 latencies, and significant negative correlation between neck length and corrected P1-N1 amplitude were observed. cVEMP paediatric normative data has been established for Singaporean school-aged children. The study also confirmed that neck length did have a significant influence on both latencies and corrected amplitude.

Number line estimation patterns and their relationship with mathematical performance

There is ongoing debate regarding what performance on the number line estimation task represents and its role in mathematics learning. The patterns followed by children’s estimates on the number line task could provide insight into this. This study investigates children’s estimation patterns on the number line task and assesses whether mathematics achievement is associated with these estimation patterns. Singaporean children (n = 324, Age M = 6.2 years, Age SD = 0.3 years) in their second year of kindergarten were assessed on the number line task (0-100) and their mathematical performance (Numerical Operations and Mathematical Reasoning subtests from WIAT II). The results show that most children’s number line estimation patterns can be explained by at least one mathematical model (i.e., linear, logarithmic, unbounded power model, one-cycle power model, two-cycle power model). But the findings also highlight the high percentage of participants for which more than one model shows similar support. Children’s mathematical achievement differed based on the models that best explained children’s estimation patterns. Children whose estimation patterns corresponded to a more advanced model tended to show higher mathematical achievement. Limitations of drawing conclusions regarding what performance on the number line task represents based on models that best explain the estimation patterns are discussed.

Mixed Reality for Pediatric Brain Tumors: A Pilot Study from a Singapore Children’s Hospital

Mixed reality (MR) platforms for neurosurgical education, training, and clinical use have gained popularity in recent years. However, their use in pediatric neurosurgery is comparatively unexplored. We designed a study to explore the use of an MR-based application for pediatric brain tumors. The primary aim is to determine if the use of MR provides the neurosurgical team with a better understanding of the visuospatial anatomy of neoplasms in pediatric craniums and to guide operative planning. Secondary aims include exploring its use as an educational tool for junior doctors and medical students. Methods: Three-dimensional anatomical models of selected pediatric brain tumors are created and uploaded to an MR application. The processed data is transferred into designated MR head-mounted devices. At the end of the trial, users are required to fill in an evaluation form. Results: A total of 30 participants took part in this study. Based on the collated feedback data, all of them agreed that the MR platform was useful as a tool in different aspects of understanding the selected pediatric brain tumors. Conclusions: This study demonstrates a proof of concept of the feasibility of MR platforms for a better understanding of pediatric brain tumors. Further development is needed to refine the current setup to be more versatile.

Role of bilingual experience in children's context-sensitive selective trust strategies

AbstractEarly bilingual language experience can enhance children's social-cognitive skills for effective communication. This study examined whether individual variability in bilingual language diversity, measured by language entropy, influenced 3- to 5-year-old children's engagement of contextual information in their selective trust strategies. One-hundred-and-forty Singaporean children (58 girls, Mage = 53.64 months, 97.1% Asian) were presented with an informant who provided either accurate or inaccurate information in a context with either adequate or limited information access. Bilingual children with greater language diversity, compared to those with less language diversity, were more likely to adapt their accuracy-based selective trust strategy to the informant's circumstances (i.e, information access). Results provide new insights into the role of diverse linguistic experiences in shaping children's social cognitive development.

Adherence to 24-hr Activity Guidelines and Quality of Life in Singapore Children: A Self-Reported Survey Study

There are limited data on how the lifestyle behaviours of school-aged children in Singapore fare against the Singapore Integrated 24-hr Activity Guidelines. One hundred and thirty-eight children ages 9 to 13 years self-reported their recreational screen time, moderate-to-vigorous physical activity (MVPA), night-time sleep duration, and health-related Quality of Life (HRQoL) in a survey package. Their lifestyle behaviours were then benchmarked against the Singapore Integrated 24-hr Activity Guidelines recommendations, specifically, (i) at least 1 hr/day of MVPA, (ii) no more than 2 hr/day of recreational screen time, and 7-9 hr/day of sleep. Association between the number of guideline recommendations met and HRQoL z-scores were explored. Of the 138 children, 6.5% met all three guideline recommendations while 29.0% did not meet any guideline recommendations. MVPA guideline recommendation was least adhered to followed by recreational screen time and sleep. The number of guideline recommendations met was significantly associated with children’s HRQoL, with an increase of 0.289 in HRQoL z-score (5.9%) for every additional guideline met. The 24-hr activity behaviours of Singapore children was sub-optimal in which the proportion of children who did not meet any guideline recommendations is higher than those who met all guideline recommendations. Nonetheless, larger cohort studies are needed to establish its prevalence. Greater dissemination of the guidelines and ameliorative programs targeted at different groups of children should be made to help support children in adopting healthy lifestyle habits.

Physical discipline as a normative childhood experience in Singapore

BackgroundThe cultural normativeness theory posits that specific parenting behaviors can be interpreted as displays of appropriate parenting in contexts where they are deemed normative. Previous studies suggest high acceptance of physical discipline in Singapore, where strict parenting could be interpreted as care for the child. However, there is a lack of studies on the local prevalence and implications of physical discipline. This study aimed to investigate the prevalence of Singaporean children experiencing parental physical discipline, longitudinal changes in this prevalence, and how exposure to physical discipline relates to children’s evaluation of their parents’ parenting.MethodsParticipants were 710 children with parental reports of physical discipline at one or more assessments at ages 4.5, 6, 9, and 11 years in the Growing Up in Singapore Towards healthy Outcomes birth cohort study. Parental reports of physical discipline were obtained using the Parenting Styles and Dimensions Questionnaire or the Alabama Parenting Questionnaire across the four assessments. Child reports of their parents’ care and control were obtained using the Parental Bonding Instrument for Children at the age 9 assessment. Prevalence was specified as being exposed to at least one physical discipline at any frequency. A generalized linear mixed model was performed to examine whether children’s age predicted their exposure to physical discipline. Linear regression analyses were conducted to investigate whether children’s exposure to physical discipline predicted their evaluation of their parents’ parenting.ResultsThe prevalence of children experiencing at least one physical discipline was above 80% at all ages. There was a decrease in this prevalence from age 4.5 to 11 years (B = − 0.14, SE = 0.01, OR = 0.87, p < 0.001). The more frequent the paternal physical discipline children were exposed to, the more likely they were to report lower levels of care (B = − 1.74, SE = 0.66, p = 0.03) and higher levels of denial of psychological autonomy by fathers (B = 1.05, SE = 0.45, p = 0.04). Maternal physical discipline was not significantly associated with children’s evaluation of their mothers’ parenting (ps ≥ 0.53).ConclusionsPhysical discipline was a common experience among our Singaporean sample, consistent with the notion that strict parenting could be regarded as a form of care. However, exposure to physical discipline did not translate to children reporting their parents as caring, with paternal physical discipline being negatively associated with children’s evaluations of paternal care.

The Impact of Stress on Acne

Introduction: Despite general acknowledgment of a link between stress and acne, few research have been conducted to evaluate this link. The purpose of this study was to discover the link between stress and acne severity.&#x0D; Method: The research was carried out on adolescent students chosen from Singapore's Choa Chu Kang Secondary School. A total of 94 (59%) of the 160 students invited to participate in the study accepted (43 males and 51 women), and all participants provided parental informed agreement. Mid-year exams at schools were chosen as the stress model for the study. Singaporean children undergo an intensive school examination process. The outcome of such tests has a significant impact on children's long-term employment possibilities. The Perceived Stress Scale (PSS) was utilized in this study to assess acne severity in relation to stress using the global acne grading system (GAGS). The questionnaire also contained some confounding factors related to the severity of acne.&#x0D; Conclusions: According to the findings of this study, it is concluded that stress has a favorable correlation with acne severity.&#x0D;

COVID-19 and bilingual children's home language environment: Digital media, socioeconomic status, and language status.

Input is considered crucial in bilingual children's language development. This is especially true for bilingual children's mother tongue language learning given its common reduction in input opportunities due to the dominance of one language within society, as seen in countries and regions from Wales to Singapore. Previous studies tend to focus on the quantity and quality of conventional active communication and resources (e.g., speaking and reading with parents) on bilingual children's language development, and substantially, fewer studies have explored this topic from the perspective of digital media. However, the COVID-19 pandemic has accentuated the critical role of digital media in various aspects of life, including bilingual children's home language environment. Thus, to holistically understand bilingual children's daily language input patterns, it is imperative to explore both their conventional and digital media input resources. The current study focuses on English-Mandarin bilingual children in Singapore and would like to explore (1) whether their conventional and digital media language environments have been affected by the COVID-19 pandemic and (2) whether the societal status of a language and familial socioeconomic status (SES) would affect bilingual children's conventional and digital media input. Survey data from 162 parents of English-Mandarin bilingual preschoolers (3 to 6 years old) were used to explore the two research questions. Two online parental questionnaires were employed for data collection. One-way repeated-measures MANOVA and path models were used to address the questions. The results indicated that input patterns from nuclear family members had not been affected by COVID-19; however, the amount and frequency of conventional and digital media materials and activities increased significantly since COVID-19. Higher-SES families possessed more conventional materials and conducted conventional activities more often, while lower-SES families possessed more digital media materials. Both conventional and digital media materials and activities were richer in English than in Mandarin. Higher-SES families perceived digital media usage for learning to be of less importance than lower-SES families. The implications for early bilingual learning following COVID-19 are discussed.

Paediatric ventriculoperitoneal shunt failures: 12-year experience from a Singapore children's hospital.

Cerebrospinal fluid (CSF) shunt failures in children are devastating. The primary aims of this study are to, firstly, review our institutional series of ventriculoperitoneal shunt (VPS)insertions and identify factors associated with shunt failure. This is a single-institution, retrospective study conducted over a 12-year period. All patients under 18years old with VPS inserted were included. Variables of interest such as patient characteristics, hydrocephalus aetiology, shunt implant details, and outcomes were subjected to statistical analyses. A total of 214 VPS patients were selected for this study. The mean age at VPS insertion was 6months with a mean follow-up duration of 44months. The most common type of hydrocephalus was obstructive (n = 142, 66.4%), and the most frequent aetiology was tumour-related (n = 66, 30.8%). The 30-day shunt failure rate was 9.3%: 9 infections (4.2%), 7 occlusions (3.3%), and 4 others (1.9%). After multivariable analysis, only recent central nervous system (CNS) infection prior to VPS insertionremained significant (OR 15.4 (1.3-175), p = 0.028). This is the first, large-scale local study focused on the shunt failure in Singaporean children. Significant findings in our study demonstrate that recently treated CNS infection is a factor associated with 30-day shunt failure while the values of CSF constituents were not contributory.

Associations between Parental Conflict and Externalising Behaviours in Children with ASD in a Local Singaporean Sample: Parenting Style as a Moderating Mechanism

The present study examined the associations between parental conflict and externalising behaviours, specifically in children with Autism Spectrum Disorder (ASD). In addition, parenting styles is explored to moderate the relationship between parental conflict and externalising behaviours in these children with Autism Spectrum Disorder(ASD). Participants comprised of 106 parents of Singaporean children with ASD. Parents were required to complete assessments of autism severity, externalising behaviours, parenting style and interparental conflict. The results from the regression analyses and ANOVA reveal that parenting styles can reduce externalising behaviours in children with ASD, in the context of parental conflict. The findings from the study have implications in designing targeted interventions and parent training programmes to equip parents with appropriate skills to nurture their child, thereby reducing the detrimental outcomes of parental conflict.

Validating the Children's Depression Inventory-2: Results from the Growing Up in Singapore Towards Healthy Outcomes (GUSTO) study.

Childhood-onset depression has adverse consequences that are sustained into adulthood, which increases the significance of detection in early childhood. The Children's Depression Inventory (CDI) is used globally in evaluating depressive symptom severity in adolescents, and its second version, the CDI-2, was developed by taking into account advances in childhood depression research. Prior research has reported inconsistencies in its factor structure across populations. In addition, the CDI-2 has not yet been empirically validated with Southeast Asian populations. This study sought to empirically validate the CDI-2's psychometric properties and evaluate its factorial structure with a Singaporean community sample of non-clinical respondents. A total sample of 730 Singaporean children aged between 8.5 and 10.5 years was used. Psychometric properties of the CDI-2, including internal consistency as well as convergent and discriminant validity, were assessed. Factor analyses were conducted to assess the developers' original two-factor structure for a Southeast Asian population. This two-factor structure was not supported in our sample. Instead, the data provided the best fit for a hierarchical two-factor structure with factors namely, socio-emotional problems and cognitive-behavioural problems. This finding suggests that socio-cultural and demographic elements influence interpretation of depressive symptoms and therefore the emerging factor structure of the construct under scrutiny. This study highlights the need to further examine the CDI-2 and ensure that its interpretation is culture-specific. More qualitative work could also bring to light the idiosyncratic understanding of depressive symptomatology, which would then guide culture-specific validation of the CDI-2.

The relationship between number line estimation and mathematical reasoning: a quantile regression approach

Number line estimation has been found to be strongly related to mathematical reasoning concurrently and longitudinally. However, the relationship between number line estimation and mathematical reasoning might differ according to children’s level of performance. This study investigates whether findings from previous studies that show number line estimation significantly predicting mathematical reasoning replicate, and whether this relationship holds across several points of the mathematical reasoning distribution. Participants include 324 Singaporean children (162 girls, Mage = 74.1 months, SDage = 4.0) in their second year of kindergarten who were assessed on the number line estimation task (0–10 and 0–100) and mathematical reasoning skills. The results replicate previous findings showing that higher accuracy on the number line estimation task is predictive of higher mathematical reasoning, for both the 0–10 and 0–100 number line. Quantile regressions show that performance on the number line task similarly predict mathematical reasoning across the performance distribution. Possible differences between the 0–10 and 0–100 number line’s predictive capacity are discussed.

Parental warmth moderates the relation between children’s lying and theory-of-mind

Lying is a prevalent and normative behavior in young children. Conceptually, it is strongly linked with children’s theory-of-mind development. However, empirical studies show that the link between children’s lying and theory-of-mind is heterogeneous. This study examined whether parental control and parental warmth moderate the link between children’s lying and theory-of-mind understanding. Three- to six-year-old Singaporean children (N = 116, Mage = 59 months, 59 male, 81.0% Chinese) participated in the temptation resistance paradigm, in which they were asked to guess the identity of a toy but instructed not to peek at it when left alone. Parental control and parental warmth were assessed via a parent–child interactive game. Results showed that the relation between children’s maintenance of their initial lie and general theory-of-mind understanding was moderated by parental warmth. Specifically, there was a negative relation between children’s lying and theory-of-mind for dyads with high parental warmth, but a positive relation between children’s lying and theory-of-mind for dyads with low parental warmth. Overall, the findings suggest that children’s lying behavior is the outcome of a complex interaction between cognitive and social factors.

Determinants of influenza and pneumococcal vaccine uptake among preschool children in Singapore.

Young children are at increased risk of severe illness from influenza and pneumococcal infections. The World Health Organization (WHO) recommends vaccination with influenza and pneumococcal conjugate vaccine (PCV). However, in Singapore, vaccine uptake remains suboptimal relative to other routine childhood immunisations. Limited information exists regarding determinants of influenza and pneumococcal vaccine uptake in children. We estimated vaccine uptake and investigated factors associated with influenza and pneumococcal vaccination status by age group using data from a cohort study on acute respiratory infections in children attending preschools in Singapore. We recruited children aged two to six years at 24 participating preschools from June 2017 to July 2018. We determined the proportion of children immunised with influenza vaccine and PCV, and investigated socio-demographic factors associated with vaccine uptake using logistic regression models. Among 505 children, 77.5% were of Chinese ethnicity, and 53.1% were male. History of influenza vaccination was 27.5% of which 11.7% had been vaccinated within the past 12 months. In multivariable analyses, factors associated with influenza vaccine uptake were 'children living in landed property' (aOR = 2.25, 95% CI [1.07-4.67]) and 'history of hospitalisation due to cough' (aOR = 1.85, 95% CI [1.00-3.36]). Nearly three-quarters of participants (70.7% 95%CI: [66.6-74.5]) reported prior PCV vaccination. PCV uptake was higher for younger children. 'Higher parental education' (OR = 2.83, 95% CI [1.51,5.32]), 'household income' (OR = 1.26, 95% CI [1.08,1.48]) and 'smokers in household' (OR = 0.48, 95% CI [0.31,0.74]) were significantly associated with PCV uptake in univariable analyses. Only 'smokers in household' remained significantly associated with PCV uptake (aOR = 0.55, 95% CI [0.33,0.91]) in the adjusted model. Our results indicate that episodes of severe respiratory illness are a cue to influenza vaccination suggesting that doctors are more likely to recommend influenza vaccines to high-risk children. For PCV, our findings suggest overall greater awareness and education on the benefit of PCV vaccination is required.

Self-regulation and academic achievement among Singaporean young children: A cross-cultural comparison in a multicultural Asian society

Cultural contexts influence the development of self-regulation. However, cross-cultural variations and consistencies in different aspects of self-regulation and their academic outcomes within the Asian context are less clear. This study investigated (1) the extent to which the development of hot and cool Executive Function (EF) might differ among children from different cultural backgrounds in a multicultural Asian society, and (2) whether and how the predictive power of hot and cool EF on academic skills might vary across subcultures within the nation. Longitudinal data were collected over two waves from a national probability sample of 2,527 young children in Singapore, consisting of ethnic Chinese, Malays, and Indians. Working memory (WM), Delay of Gratification (DoG), and parent-reported self-control were measured during their preschool years (3–6 years of age) in Wave 1. Reading and mathematical skills were assessed approximately 2 years later in Wave 2. Results demonstrated that ethnic Chinese children typically delayed gratification at age 4, whereas Malay and Indian children only started to delay gratification at age 6. Chinese children also outperformed their Malay and Indian counterparts in WM tasks and standardized achievement tests in reading and mathematics. Parent-reported child self-control did not differ by ethnicity. Across subcultures in Singapore, WM was a robust predictor of reading and mathematical skills and explained the longitudinal relations of DoG to academic skills. Our findings suggest that the developmental gaps in EF during early childhood can contribute to later gaps in academic achievement among ethnic groups. Nurturing self-regulation during the preschool years is essential for promoting children’s school readiness.