Toddler Age Group Research Articles

A placebo-controlled trial of Lactobacillus GG to prevent diarrhea in undernourished Peruvian children

Objective: Lactobacillus GG (L-GG), an acid- and bile-resistant strain that colonizes the intestinal mucosa, has been used to manage diarrhea in children. Our objective was to evaluate the prophylactic use of L-GG to prevent diarrhea in children at high risk from a developing country in a randomized, placebo-controlled trial. Study design: Two hundred four undernourished children 6 to 24 months old from an indigent peri-urban Peruvian town received either L-GG or placebo in flavored gelatin once daily, 6 days a week, for 15 months. Episodes of diarrhea were documented by daily home visits, and diagnostic studies were done in a subset of cases. Recovery of L-GG in stool from subjects and from family contacts was examined. Results: Subjects in the L-GG group had significantly fewer episodes of diarrhea (5.21 episodes diarrhea/child/year [“ecy”] L-GG group, 6.02 ecy placebo group; P = .028). The decreased incidence of diarrhea in the L-GG group was greatest in the 18- to 29-month age group ( P = .004) and was largely limited to nonbreastfed children (Breastfed: 6.59 ecy L-GG, 6.32 ecy placebo, P = .7; Nonbreastfed: 4.69 ecy L-GG, 5.86 ecy placebo, P = .005). The duration of diarrhea episodes and the causes of diarrhea were similar in both groups, except adenovirus was more common in the placebo group. Conclusion: L-GG supplementation may be useful as a prophylactic measure to control diarrhea in undernourished children at increased risk, especially nonbreastfed children in the toddler age group. (J Pediatr 1999;134:15-20.)

Divergent Trends in Childhood Drowning Rates, 1971 Through 1988

To examine national age-, race-, and sex-specific trends in unintentional drowning rates among US children aged 0 through 19 years. National mortality data published by the National Center for Health Statistics and population data from the US Bureau of the Census were used in calculating age-, race-, and sex-specific drowning rates for 1971 through 1988. Time trends were analyzed using Poisson regression techniques. United States, 1971 through 1988. Rates of death due to unintentional, non-boat-related drowning. From 1971 through 1988, there were 45,680 unintentional, non-boat-related drowning deaths among 0- through 19-year-olds in the United States. Drowning rates declined sharply in older children (-5.8% per year in 10- through 14-year-olds and -5.4% per year in 15- through 19-year-olds), declined only slightly in toddlers (-1.6% per year in 1- and 2-year-olds), and actually increased in infants (+1.6% per year in those children younger than 1 year). Drowning rates in toddlers have changed little over time despite the availability of effective prevention strategies such as pool fencing. In older children, drowning rates have declined dramatically despite the lack of clear preventive initiatives. Prevention interventions targeted specifically at the infant and toddler age groups should receive priority.

Fractures in the under-3-year-old age cohort.

One hundred twenty-four urban children under 3 years of age admitted for fractures were retrospectively reviewed to determine the frequency of accidental and nonaccidental causes in this population. The fractures were categorized according to their mechanisms: motor-vehicle passenger or pedestrian accident, other accidents, or child abuse. There were no differences in the frequency of fractures by race, date of birth, or season in which the injury occurred. Skull fractures were most frequent (62%), followed by femur fractures (11%). There was a 26% increase in fractures between 1987 and 1989, especially in the non-motor vehicle cohort. Caretaker ignorance and/or carelessness was a common cause of fractures in the infant and toddler age group. Injuries were still occurring in spite of infant care seat use. The American public must be educated in preventive medicine and safety to decrease the senseless morbidity of our greatest resource.

New acuity test for toddlers.

Preferential looking is the technique of choice for measuring visual acuity in infants and young children. Most workers agree that the toddler age group, 1 to 3 years, is the most difficult to test. This is because of their short attention span and restlessness, but mostly because they find the grating target used in the test, frankly boring. The concept of the vanishing optotype chart offers alternative test targets, while utilizing the technique of preferential looking. We have designed a test which comprises a familiar shape (house, car etc.) on the upper or lower part of a neutral grey card. The shape is computer generated, and designed to fade completely when beyond the resolution limit. Acuity is determined by the width of the white lines making up the shape. As with conventional preferential looking, the observer notes the child's eye movements to determine the position of the target shape. Although picture naming is not required, the shapes help to maintain the child's interest in the test. The test is quick, and is successful with the toddler age group and older patients with intellectual impairment.

Mushroom poisoning in infants and children: the Amanita pantherina/muscaria group.

The clinical features and management of nine cases of mushroom poisoning due to Amanita pantherina (eight cases) and Amanita muscaria (one case) admitted to a children's hospital are described. Most ingestions were in the toddler age group with males being more frequently involved. Symptoms occurred between 30-180 min with the onset of central nervous system depression, ataxia, waxing and waning obtundation, hallucinations, intermittent hysteria or hyperkinetic behavior. Vomiting was rare. Seizures or myoclonic twitching occurred in 4/9 patients, but was controlled with standard anticonvulsant therapy. No other anticholinergic or cholinergic signs were prominent. Recovery was rapid and complete in all patients.

Assessment of Temperament in the Toddler Age Group

We used the Toddler Temperament Scale with large representative samples of younger (mean age = 20.5 months; N = 1188) and older (mean age = 35.4 months; N = 1360) Australian toddlers. There were significant sex differences on 6 of the temperament dimensions for the young group, and on 5 of the 9 dimensions for the older group. Older boys were also more likely to be categorized clinically as having a "difficult" temperament and less likely to have an "easy" temperament. Each group was divided into quartiles according to socioeconomic status. For the younger toddlers there were significant differences in 3 of 9 temperament dimensions, and for the older group there were significant differences in 7 of 9 dimensions. Groups with higher socioeconomic status had temperament ratings which were more likely to make them easier to manage, and to be categorized clinically as having an easy temperament, but toddlers with low socioeconomic status were more likely to have a difficult temperament. There were significant differences in temperament dimension scores between Australian toddlers and those studied in an American setting. These results indicate that toddler temperament ratings differ according to age, sex, social class, and cultural context. Great caution needs to be taken in interpreting individual temperament profiles utilizing comparison data obtained from different sociocultural settings. Future temperament "norms" may need to specify characteristics of the group of children from which they were derived to allow more valid comparisons.

Epidemiology of Human Bites to Children in a Day-care Center

The purpose of this study was to examine the epidemiology of human bites to children in a day-care center over a one-year period. This was a cohort study based on the injury log maintained on a daily basis by staff of the day-care center, as required by state II-censure law. A total of 224 children was enrolled in the center during the study period: 29 infants (ages 0 to 16 months), 62 toddlers (16.1 to 30 months), and 133 preschoolers (30.1 to 72 months). One hundred four children were bitten one or more times by other children in the center, with a total of 347 bites. The bite rates (defined as number of bites per 100 child days of enrollment in the center) varied significantly by age group but not by gender for initial or first-time bites, with toddlers having the highest rate and preschoolers the lowest (infants, 0.7129; toddlers, 1.3672; preschoolers, 0.4193). Total bite rates (which took into account multiple bites per child over the 12-month study period) varied significantly by age group, with toddlers having the highest rate per 100 days of enrollment and preschoolers the lowest (infants, 2.1931; toddlers, 3.1300; preschoolers, 0.5611). Males and females differed significantly in total bite rates per 100 enrollment days within the toddler age group (males, 3.6683; females, 2.3096) but not within the other two age groups. None of the demographic characteristics available in this study distinguished between children who were bitten compared with those who were not bitten with the exception of number of days of enrollment. The circumstances surrounding the biting events were examined with respect to the activity of the child when bitten, the victim's location when bitten, body part bitten, and treatment by staff. The results of this study raise policy questions about treatment protocols for human bites of children in group child-care settings, the routine recording of biting events, and the ethics and practice of reporting such events to parents.

Measurement of Temperament in One to Three Year Old Children

Temperament in the toddler age group has received relatively little attention in the developmental literature, and there is a clear need for well-established, culturally-appropriate measurement instruments. To this end, the Toddler Temperament Scale (TTS) of Fullard, McDevitt and Carey (1984) was administered to a sample of 397, 1 to 3 year old Australian children. Older and younger toddlers showed developmentally related differences on a number of dimensions, emphasising the need for them to be regarded as separate groups in temperament research. Relationships between temperament classification and maternal and day-caretakers' reports of behaviour problems provided some evidence of concurrent validity of the measures. While some dimensions of the TTS were less than satisfactory psychometrically, the content of the questionnaire seemed suitable for Australian use; Australian normative data is provided for the two age groups.

Diarrheal illness among infants and toddlers in day care centers. I. Epidemiology and pathogens

We conducted a 2-year prospective study of diarrheal illness in children ages 0 to 36 months in 22 day care centers in Maricopa County, Arizona. In 7464 child-months of observation, 465 sporadic cases and 170 outbreak-associated cases of diarrhea were identified. Enteric pathogens were identified in 20% of diarrhea episodes. Giardia lamblia, rotavirus, and Campylobacter jejuni were the most common pathogens. Giardia was significantly more common in toddlers than in infants and was found in 19% of asymptomatic child contacts of symptomatic infected children. Rotavirus was significantly more common in infants than in toddlers. In outbreaks, shorter duration of child enrollment was associated with illness. Comparison of day care center characteristics revealed that only a lower score in standardized observations of hygiene and child-handling practices was associated with greater risk of diarrhea. Infectious diarrhea appears to be common in diaper-age children in day care centers, but the patterns of disease differ for different pathogens and for the infant and toddler age groups.