Toddler Development Research Articles

Evaluation of the implementation stimulation, detection, and early intervention for toddlers growth and development in Nanggalo Health Center

Evaluation of the implementation stimulation, detection, and early intervention for toddlers growth and development in Nanggalo Health Center

Association of Growth During Infancy with Neurodevelopment and Obesity in Children Born Very Preterm: The Environmental Influences on Child Health Outcomes Cohort

To evaluate associations between change in weight z score after neonatal intensive care unit (NICU) discharge and neurodevelopmental outcomes and obesity at 12-48months of age among individuals born very preterm. This secondary analysis used data from infants born very preterm participating in the Environmental influences on Child Health Outcomes cohort (n=1400). Growth during infancy was calculated as change in weight z score between NICU discharge and follow-up at a mean of 27months of age. Very low weight gain was defined as a change in weight z score <-1.67; very high weight gain was a change in weight z score >1.67. Neurodevelopmental outcomes included the Bayley Scales of Infant and Toddler Development, Child Behavior Checklist 1.5-5years, and Modified Checklist for Autism in Toddlers. Multivariable linear regression was used to estimate associations between increase in weight z score and neurodevelopmental outcomes. Very low weight gain between NICU discharge and follow-up (experienced by 6.4% of participants) was associated with lower scores on cognitive (adjusted mean difference: -4.26; 95% CI: -8.55, -0.04) and language (adjusted mean difference: -4.80; 95% CI: -9.70, -0.11) assessments. Very high weight gain (experienced by 13.6% of participants) was associated with an increased obesity risk (adjusted relative risk: 6.20; 95% CI: 3.99, 9.66) but not with neurodevelopmental outcomes. Very high weight gain in the first 12-48months after NICU discharge was associated with a higher risk of obesity at follow-up; very low weight gain was associated with lower scores on cognitive and language assessments.

Safety and feasibility pilot study of continuous low-dose maternal supplemental oxygen in fetal single ventricle heart disease.

Fetuses with single ventricle physiology (SVP) exhibit reductions in fetal cerebral oxygenation, with associated delays in fetal brain growth and neurodevelopmental outcomes. Maternal supplemental oxygen (MSO) has been proposed to improve fetal brain growth, but current evidence on dosing, candidacy and outcomes is limited. In this pilot study, we evaluated the safety and feasibility of continuous low-dose MSO in the setting of SVP. This single-center, open-label, pilot phase-1 safety and feasibility clinical trial included 25 pregnant individuals with a diagnosis of fetal SVP. Participants self-administered continuous MSO using medical-grade oxygen concentrators for up to 24 h per day from the second half of gestation until delivery. The primary aim was the evaluation of the safety profile and feasibility of MSO. A secondary preliminary analysis was performed to assess the impact of MSO on the fetal circulation using echocardiography and late-gestation cardiovascular magnetic resonance imaging. Early outcomes were assessed, including perinatal growth and preoperative brain injury, and neurodevelopmental outcomes were assessed at 18 months using the Bayley Scales of Infant and Toddler Development 3rd edition, and compared with those of a contemporary fetal SVP cohort (n = 217) that received the normal standard of care (SOC). Among the 25 participants, the median maternal age at conception was 35 years, and fetal SVP diagnoses included 16 with right ventricle dominant, eight with left ventricle dominant and one with indeterminate ventricular morphology. Participants started the trial at approximately 29 + 2 weeks' gestation and self-administered MSO for a median of 16.1 h per day for 63 days, accumulating a median of 1029 h of oxygen intake from enrolment until delivery. The only treatment-associated adverse events were nasal complications that were resolved typically by attaching a humidifier unit to the oxygen concentrator. No premature closure of the ductus arteriosus or unexpected fetal demise was observed. In the secondary analysis, MSO was not associated with any changes in fetal growth, middle cerebral artery pulsatility index, cerebroplacental ratio or head-circumference-to-abdominal-circumference ratio Z-scores over gestation compared with SOC. Although MSO was associated with changes in umbilical artery pulsatility index Z-score over the study period compared with SOC (P = 0.02), this was probably due to initial baseline differences in placental resistance. At late-gestation cardiovascular magnetic resonance imaging, MSO was not associated with an increase in fetal cerebral oxygen delivery. Similarly, no differences were observed in neonatal outcomes, including preoperative brain weight Z-score and brain injury, mortality by 18 months of age and neurodevelopmental outcomes at 18 months of age. This pilot phase-1 clinical trial indicates that low-dose MSO therapy is safe and well tolerated in pregnancies diagnosed with fetal SVP. However, our protocol was not associated with an increase in fetal cerebral oxygen delivery or improvements in early neurological or neurodevelopmental outcomes. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Reduction in limb-movement complexity at term-equivalent age is associated with motor developmental delay in very-preterm or very-low-birth-weight infants

Reduced complexity during the writhing period can be crucial in the spontaneous movements of high-risk infants for neurologic impairment. This study aimed to verify the association between quantified complexity of upper and lower-limb movements at term-equivalent age and motor development in very-preterm or very-low-birth-weight infants. Video images of spontaneous movements at term-equivalent age were collected from very-preterm or very-low-birth-weight infants. A pretrained pose-estimation model and sample entropy (SE) quantified the complexity of the upper- and lower-limb movements. Motor development was evaluated at 9 months of corrected age using Bayley Scales of Infant and Toddler Development, Third Edition. The SE measures were compared between infants with and without motor developmental delay (MDD). Among 90 infants, 11 exhibited MDD. SE measures at most of the upper and lower limbs were significantly reduced in infants with MDD compared to those without MDD (p < 0.05). Composite scores in the motor domain showed significant positive correlations with SE measures at most upper and lower limbs (p < 0.05). The results show that limb-movement complexity at term-equivalent age is reduced in infants with MDD at 9 months of corrected age. SE of limb movements can be a potentially useful kinematic parameter to detect high-risk infants for MDD.

Evaluation of three-year neurodevelopmental outcomes in infants prenatally exposed to substance use

IntroductionPrenatal exposure to substance use is associated with long-term deficits in the neurodevelopment of children. The objective was to investigate the association between cognitive, motor, and language neurodevelopment at three years of age in infants prenatally exposed to substance use. Material and methodsA prospective matched case-control study was conducted. Biomarkers of fetal exposure were measured in meconium samples. The Bayley Scales of Infant and Toddler Development (BSID-III) were used to calculate neurodevelopment scores. Results32 non-exposed and 32 exposed infants were evaluated, of which 16 were exposed to cannabis, 8 to ethanol, 2 to cocaine and 6 to more than one substance. Normal BSID-III scores ≥85 in all domains, were detected in 23 exposed infants to any substance and 29 infants non-exposed. Neurodevelopmental delay was detected in the language domain, specifically in male infants exposed to cannabis. Two infants exposed to cannabis had a severe developmental delay (score<70). Infants exposed to any substance obtained significantly lower total scores than control infants in all domains. Infants exposed to cannabis obtained significantly lower composite scores in the cognitive and motor domains. Infants exposed to more than one substance had lower scores in motor skills. By gender, only males exposed obtained significantly lower composite scores than non-exposed males in the cognitive domain. ConclusionsThe most common and severe neurodevelopmental delay at 36 months was detected in the domain of language in male infants prenatally exposed to cannabis. Neurodevelopmental disorders detected can enable an early intervention and plan therapeutic strategies.

The Current State of Neonatal Neurodevelopmental Follow-up Programs in North America: A Children's Hospitals Neonatal Consortium Report.

This study aimed to determine neonatal neurodevelopmental follow-up (NDFU) practices across academic centers. This study was a cross-sectional survey that addressed center-specific neonatal NDFU practices within the Children's Hospitals Neonatal Consortium (CHNC). Survey response rate was 76%, and 97% of respondents had a formal NDFU program. Programs were commonly staffed by neonatologists (80%), physical therapists (77%), and nurse practitioners (74%). Median gestational age at birth identified for follow-up was ≤32 weeks (range 26-36). Median duration was 3 years (range 2-18). Ninety-seven percent of sites used Bayley Scales of Infant and Toddler Development, but instruments used varied across ages. Scores were recorded in discrete electronic data fields at 43% of sites. Social determinants of health data were collected by 63%. Care coordination and telehealth services were not universally available. NDFU clinics are almost universal within CHNC centers. Commonalities and variances in practice highlight opportunities for data sharing and development of best practices. · Neonatal NDFU clinics help transition high-risk infants home.. · Interdisciplinary neonatal intensive care unit follow-up brings together previously separated outpatient service lines.. · This study reviews the current state of neonatal NDFU in North America..

Long-Term Growth and Neurodevelopmental Outcomes of Neonates Infected with SARS-CoV-2 during the COVID-19 Pandemic at 18–24 Months Corrected Age: A Prospective Observational Study

Introduction: During the early coronavirus disease (COVID-19) pandemic in 2020, researchers cautioned about the potential neuroinvasive capability of the virus and long-term neurological consequences. Although a few preliminary studies have found delayed communication, fine motor, and problem-solving skills in infants after COVID-19 infection, there continues to be a paucity of data on long-term development of neonates diagnosed with COVID-19. Methods: We conducted a prospective study of 20 neonates who acquired severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection during the first wave of the pandemic (April–July 2020). At 18–24 months corrected age, we assessed neurodevelopment by Bayley Scales of Infant and Toddler Development, the third edition (BSID-III), along with growth, hearing, and vision evaluation. Results: The mean corrected age at assessment was 21 months 11 days ± 1 month 28 days. We found developmental delay in nearly half of the children with scores below one standard deviation in either of the BSID-III domains. Mild delay in either motor, cognitive, or language domains was found in 9 (45%) children and moderate delay in 2 (10%). Expressive language, fine motor, and receptive language were predominantly affected. None of the children had hearing impairment, blindness, or significant growth faltering including clinically severe microcephaly. The mean composite cognitive, language, and motor scores were significantly lower in those with neurodevelopmental delay (p value – 0.02, 0.000, and 0.03, respectively) without any differences in their disease characteristics. Conclusion: Neonates infected with SARS-CoV-2 have an increased risk of developmental delays in expressive language, fine motor, and receptive language skills at 18–24 months of age. The severity of delays is predominantly mild.

HUBUNGAN PERILAKU PICKY EATER DAN DURASI TIDUR DENGAN PERKEMBANGAN PADA BALITA

In toddlerhood, children begin to understand the concept of autonomy so they start to choose things they like, one of which is the behavior of choosing food, namely picky eaters. If the nutritional intake is less varied, there’s a possibility that the child won’t get sufficient nutrition that support the development process. In addition to nutritional intake, responsive parenting is essential in meeting children's needs, such as adequate sleep time. Sleep in children facilitates the maturation and repair of body cell functions, including brain cells and hormones that play a role in development. This study used a cross-sectional study design using primary data from 138 toddlers in the Posyandu of Tanjung Duren Utara Village. Assessment of picky eater behavior using the Children’s Eating Behavior Questionnaire (CEBQ), sleep duration using the average questionnaire of sleep duration and child development using the Indonesian pre-screening developmental questionnaire, Kuesioner Pra-Skrining Perkembangan (KPSP). Analysis of bivariate data using the Chi-square test with a significance level of p&lt;0.05. Among the 138 respondents, it was found that the majority had picky eater behavior, namely 93 (67.4%) children, 73.2% children have an adequate sleep duration, and 57.2% children have appropriate development. The relationship between picky eater behavior and development through statistical tests obtained a p = 0.035 (p &lt;0.05) and between sleep duration and development p=0.298 (p&gt;0.05). There is a relationship between picky eater behavior and development in toddlers and no relationship between sleep duration and results in toddlers.

130 Heterotopia and Neurodevelopmental Outcomes Patients With Prenatal Diagnosis of Myelomeningocele or Myeloschisis

INTRODUCTION: Gray matter heterotopia is a cortical malformation and a known risk factor for seizures and epilepsy. Historically, presence of heterotopia in one or both cerebral ventricles was a concern for postnatal neurological status in patients undergoing fetal closure of myelomeningocele/myeloschisis. There is little information known regarding the overall impact of heterotopia in this patient population. METHODS: A retrospective chart review was conducted for all patients evaluated at the Center of Fetal Diagnosis and Treatment with a diagnosis of myelomeningocele or myeloschisis between June 2016 to March 2023. Gray matter heterotopia was determined from prenatal US and confirmed with prenatal and postnatal MRI. The Bayley Scales of Infant and Toddler Development (edition III and IV) were used for neurodevelopmental assessments. RESULTS: Of 497 patients evaluated with a prenatal diagnosis of myelomeningocele or myeloschisis, 99 were found to have gray matter heterotopia on prenatal MRI. In the postnatal period, 347 patients ultimately delivered at our institution, of which 26 had confirmed gray matter heterotopia on postnatal MRI as well as underwent neurodevelopmental testing. The median age at neurodevelopmental assessment was 13.3 months. The median cognitive and language scores (95 and 99, respectively) were average in those patients with gray matter heterotopia. CONCLUSIONS: This study suggests that the presence of gray matter heterotopia in patients with prenatal diagnosis of myelomeningocele or myeloschisis is not associated with increased cognitive or language delay on neurodevelopmental testing at approximately 1 year of age. These findings can aid clinicians during prenatal consultation regarding fetal repair of spina bifida.

EFEKTIFITAS MODEL EDUKASI PRAKTIK PENGASUHAN TERHADAP OPTIMALISASI TUMBUH KEMBANG BALITA

In Indonesia, there are still many children who are cared for inappropriately, such as neglect and violence against children, toddlers receive inappropriate care (3.69%), and toddlers experience developmental disorders (16%), both fine and gross motor development, hearing and intelligence loss, and speech delay. The child's condition cannot grow and develop optimally. The research aims to analyze the influence of the parenting practice educational model on the knowledge and growth of children under five. The educational model implemented is the result of previous survey research, so it is more appropriate to conditions in the field. This research used a pre-experimental design in Bogor City on June-August 2023 with 40 respondents. Sample criteria are mothers who have children aged 12-60 months. There were 20 people in each intervention and control group. The intervention was given seven times face to face for seven weeks. The independent variable is the educational model of caring for mothers, and the dependent variable is knowledge of caring for mothers, growth, and toddlers. The results of the Mann-Whitney test showed that there was difference in the median post-test score between the intervention and control groups in the growth variables of 5.5 points (p0.003&lt;0.05), development of 6 points (p0.005&lt;0.05), and knowledge of parenting practices of 10 points (p0.006 &lt; 0.05). These data show a significant influence between the model of implementing parenting education on growth and toddlers and parenting knowledge. More education needs to be done on parenting using various media to improve the growth and development of toddlers.

ANALISIS PENGETAHUAN IBU TENTANG METODE BERMAIN AKTIF DAN MEDIA BERMAIN SEDERHANA SEBAGAI EVALUASI KINERJA KADER POSYANDU DI DESA PAGONGAN

Along with the development of technology, children prefer to spend time playing alone using game media called gadgets. Children who play with gadgets for 30 minutes increase their risk of being late in movement and speech by 49%. Cadres as implementers of posyandu activities have a large role in monitoring the growth and development of toddlers. Efforts that can be made by cadres as the spearhead of Posyandu are by disseminating knowledge about health, one of which is about children's growth and development. Cadres perform well in carrying out their duties as cadres. This is necessary to obtain accuracy in measurements and identify growth deviations, so that management can be carried out as early as possible to prevent stunting. This research aims to determine the knowledge of mothers of toddlers in stimulating development using active play methods and simple play media through evaluating the performance of posyandu cadres. The population in this study were mothers of toddlers in Pagongan Village who attended regular meetings at Posyandu. The instrument used in this research was a questionnaire containing the characteristics of respondents, knowledge of mothers of toddlers and measuring cadre performance. Quantitative data analysis uses descriptive analysis. The results obtained by mothers about active play methods and simple play media were less than 51 people (63.75%) and the majority of mothers assessed that the performance of cadres was still less active in conveying this information, namely 49 people (61.25%). The suggestion is that there needs to be a maximum role for cadres at the posyandu in providing information to mothers, as well as motivating mothers to continue bringing their children to the posyandu regularly.

Empowering Women by Education about Toddler’s Nutrition in Posyandu Puspa Indah Nabire

Nutrition problems in developing countries, including Indonesia, show an increasing trend, one of which is the problem of stunting. Stunting is a nutritional problem caused by a long-term lack of nutritional intake during the first 1000 days of life, which is a critical period. Resulting in growth disorders in children. The high incidence of stunting is a concern for the government. Some of the causes of stunting itself are a lack of intake that is absorbed by the body from the time it is in the womb until after birth, lack of access to health services, lack of access to clean water and sanitation. Therefore, efforts need to be made to prevent stunting by improving diet and parenting patterns and sanitation. The aim of this community service is to increase mothers' knowledge about the importance of providing balanced nutritional and food intake for their children to prevent stunting. This activity is carried out by providing education with leaflets to mothers of toddlers about Balanced Nutrition. This counseling was carried out at Posyandu Puspa Indah, Nabire Regency. Which was attended by 13 mothers. The results of the counseling showed that mothers of toddlers understood the material provided. It is hoped that further counseling will focus on the growth and development of babies and toddlers.

Efektivitas Program Posyandu untuk Meningkatkan Tumbuh Kembang Balita 0-2 Tahun di Puskesmas Padang Bulan

Golden period for toddler aged 0-5 years old is a period when growth and development increasing rapidly, therefore additional attention is needed from the parents. If on this golden period toddler experience undernutrition, their growth and development would be difficult to resolve. In this case, monitoring the growth and development of toddlers is very important because it has a significant impact on the health, development and quality of life of toddlers. This research aim to know the effectiveness correlation of posyandu program with growth and development of toddler within age of 0-2 years at Padang Bulan Health Center. Samples in this reasearch are 48 samples. Data analysis used is Chi-square test with P &lt; 0,50. Based on the results and discussion of the research, it can be concluded that there is an effective relationship between the posyandu program and the growth and development of toddlers, where the nutrition posyandu has a value of 0.003, the immunization posyandu has a value of 0.017, and routine participation in the posyandu program has a value of 0.001. Therefore, the hypothesis of this research Ho is rejected, Ha is accepted. Posyandu program has an important part in supporting toddler's growth and development through comprehensive care, parents education, and routine evaluation that can help with early health problem detection

EDUCATIONAL PACKAGE FOR DETECTION AND STIMULATION OF TODDLER DEVELOPMENT

Approximately 52.9 million children under 5 globally have developmental disorders. Early detection is crucial for addressing these issues. This study aimed to assess the impact of a detection and stimulation education package on parental knowledge and attitudes. Using a pseudo-experimental, cross-sectional design with cluster random sampling, 78 respondents were analyzed via T-test. Results revealed significant improvement in mothers' knowledge and attitudes following the education package (p=0.001). Providing such packages enhances awareness and understanding of toddler development. Health professionals, particularly midwives, are advised to collaborate in early detection and stimulation programs, ensuring comprehensive education for parents. This collaborative effort can significantly contribute to addressing developmental challenges in young children.

Correlation Study on the Prognostic Value of miR-21 and S-100B Protein Levels in Neonatal Hypoxic-Ischemic Encephalopathy Undergoing Hypothermia Therapy

: Objective To evaluate the variations in serum levels of microRNA-21 (miR-21) and S-100B protein in neonates with hypoxic-ischemic encephalopathy (HIE) after receiving hypothermia therapy and explore the correlation of these biomarkers with the neurodevelopmental prognosis of the infants. Methods This retrospective analysis included 90 neonatal HIE patients diagnosed and treated between January 2019 and December 2022. Real-time quantitative PCR and enzyme-linked immunosorbent assay (ELISA) methods were used to measure miR-21 and S-100B protein levels. Neurodevelopmental assessments were conducted at one year, and follow-up was performed using the Bayley Scales of Infant and Toddler Development third edition. Statistical analysis was carried out using SPSS software, with t-tests for continuous variables, chi-square tests for categorical data, Pearson correlation coefficient for correlation analysis, and multivariate regression analysis to adjust for confounding factors. Results After hypothermia therapy, the observation group showed a significant decrease in miR-21 and S-100B protein levels (P < 0.001), and neurodevelopmental scores were significantly higher than the control group (P < 0.05). Correlation analysis indicated a negative correlation between miR-21 and neurodevelopmental scores (r=-0.62, P < 0.001), as well as a negative correlation between S-100B protein levels (r=-0.76, P < 0.001). Multivariate regression analysis demonstrated that miR-21 levels and S-100B protein levels maintained independent negative correlations with neurodevelopmental scores (P < 0.001). Conclusion Hypothermia therapy significantly reduces serum levels of miR-21 and S-100B protein in neonatal HIE patients and may be associated with better prognosis. miR-21 and S-100B serve as prognostic biomarkers, aiding in predicting and improving the treatment outcomes and long-term prognosis of neonatal HIE.

Patterns of infant fecal metabolite concentrations and social behavioral development in toddlers.

Gut-derived metabolites, products of microbial and host co-metabolism, may inform mechanisms underlying children's neurodevelopment. We investigated whether infant fecal metabolites were related to toddler social behavior. Stool samples collected from 6-week-olds (n = 86) and 1-year-olds (n = 209) in the New Hampshire Birth Cohort Study (NHBCS) were analyzed using nuclear magnetic resonance spectroscopy metabolomics. Autism-related behavior in 3-year-olds was assessed by caregivers using the Social Responsiveness Scale (SRS-2). To assess the association between metabolites and SRS-2 scores, we used a traditional single-metabolite approach, quantitative metabolite set enrichment (QEA), and self-organizing maps (SOMs). Using a single-metabolite approach and QEA, no individual fecal metabolite or metabolite set at either age was associated with SRS-2 scores. Using the SOM method, fecal metabolites of six-week-olds organized into four profiles, which were unrelated to SRS-2 scores. In 1-year-olds, one of twelve fecal metabolite profiles was associated with fewer autism-related behaviors, with SRS-2 scores 3.4 (95%CI: -7, 0.2) points lower than the referent group. This profile had higher concentrations of lactate and lower concentrations of short chain fatty acids than the reference. We uncovered metabolic profiles in infant stool associated with subsequent social behavior, highlighting one potential mechanism by which gut bacteria may influence neurobehavior. Differences in host and microbial metabolism may explain variability in neurobehavioral phenotypes, but prior studies do not have consistent results. We applied three statistical techniques to explore fecal metabolite differences related to social behavior, including self-organizing maps (SOMs), a novel machine learning algorithm. A 1-year-old fecal metabolite pattern characterized by high lactate and low short-chain fatty acid concentrations, identified using SOMs, was associated with social behavior less indicative of autism spectrum disorder. Our findings suggest that social behavior may be related to metabolite profiles and that future studies may uncover novel findings by applying the SOM algorithm.

Social withdrawal behaviour in Nepalese infants and the relationship with future neurodevelopment; a longitudinal cohort study.

Social withdrawal in infants may be a signal of distress and a precursor for non-optimal development. To examine the relationship between infant social withdrawal and neurodevelopment up to 4 years in Nepalese children. A total of 597 Nepalese infants 6-11 months old were assessed with the modified Alarm Distress Baby Scale (m-ADBB), and of these, 527 with the Bayley Scales of Infant and Toddler Development 3rd edition (Bayley-III) during early childhood, and the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-IV) and NEPSY-II subtests at 4 years. We examined whether social withdrawal defined by the m-ADBB was associated with neurodevelopmental scores in regression models. Children socially withdrawn in infancy had lower Bayley-III language scores (-2.6 (95% CI -4.5, -0.7)) in early childhood. This association seems to be driven by the expressive communication subscale (-0.7 (95% CI -1.0, -0.3)), but not the receptive communication subscale (-0.2 (95% CI -0.6, 0.1)). There were no differences in the other Bayley-III scores or the WPPSI-IV and NEPSY-II scores at 4 years in children who were socially withdrawn or not. Social withdrawal in infancy was reflected in early language development but not cognitive functioning at 4 years.

The Influence of the Toddler Mother Class on Increasing Knowledge of Stimulation of Toddler Development at the Kanda Health Center

Age 0-5 years is the golden age where children need to pay attention to growth and development. The optimal growth and development of toddlers depends on how active the role of the family, especially parents, in stimulating the development of toddlers. Mothers who provide optimal early stimulation, will significantly affect the child's motor development. Health workers also play a role in monitoring the development of toddlers by running an integrated posyandu program by activating family development activities and providing IEC to parents to stimulate the development of their toddlers, namely with classes for mothers of toddlers. This study aims to determine the influence of the toddler mother class on increasing knowledge of stimulation of toddler development aged 1-5 years at the Kanda Health Center, Jayapura Regency. This type of research is quasi-experimental with a pretest posttest design with control group. The sample used was 32 respondents with probability sampling techniques. Statistical test using independent sample t-test. The results showed that there was an influence of the toddler mother class on increasing knowledge of developmental stimulation of toddlers aged 1-5 years at the Kanda Health Center with a p-value of 0.001 &lt; 0.05. The conclusion of this study showed that there was a difference in knowledge of mothers of toddlers before and after the class of mothers of toddlers with an average of 49.64 to 92.27. This study suggests that health workers and mothers of toddlers take an active part in classes to monitor the development of toddlers

Pain Exposure and Brain Connectivity in Preterm Infants

Early-life exposure to painful procedures has been associated with altered brain maturation and neurodevelopmental outcomes in preterm infants, although sex-specific differences are largely unknown. To examine sex-specific associations among early-life pain exposure, alterations in neonatal structural connectivity, and 18-month neurodevelopment in preterm infants. This prospective cohort study recruited 193 very preterm infants from April 1, 2015, to April 1, 2019, across 2 tertiary neonatal intensive care units in Toronto, Canada. Structural connectivity data were available for 150 infants; neurodevelopmental outcomes were available for 123 infants. Data were analyzed from January 1, 2022, to December 31, 2023. Pain was quantified in the initial weeks after birth as the total number of invasive procedures. Infants underwent early-life and/or term-equivalent-age magnetic resonance imaging with diffusion tensor imaging to quantify structural connectivity using graph theory measures and regional connection strength. Eighteen-month neurodevelopmental outcomes were assessed with the Bayley Scales of Infant and Toddler Development, Third Edition. Stratifying by sex, generalized estimating equations were used to assess whether pain exposure modified the maturation of structural connectivity using an interaction term (early-life pain exposure × postmenstrual age [PMA] at scan). Generalized estimating equations were used to assess associations between structural connectivity and neurodevelopmental outcomes, adjusting for extreme prematurity and maternal education. A total of 150 infants (80 [53%] male; median [IQR] gestational age at birth, 27.1 [25.4-29.0] weeks) with structural connectivity data were analyzed. Sex-specific associations were found between early-life pain and neonatal brain connectivity in female infants only, with greater early-life pain exposure associated with slower maturation in global efficiency (pain × PMA at scan interaction P = .002) and local efficiency (pain × PMA at scan interaction P = .005). In the full cohort, greater pain exposure was associated with lower global efficiency (coefficient, -0.46; 95% CI, -0.78, to -0.15; P = .004) and local efficiency (coefficient, -0.57; 95% CI, -1.04 to -0.10; P = .02) and regional connection strength. Local efficiency (coefficient, 0.003; 95% CI, 0.001-0.004; P = .005) and regional connection strength in the striatum were associated with cognitive outcomes. In this cohort study of very preterm infants, greater exposure to early-life pain was associated with altered maturation of neonatal structural connectivity, particularly in female infants. Alterations in structural connectivity were associated with neurodevelopmental outcomes, with potential regional specificities.

Effect of complementary feeding using the baby-led weaning method on development in toddlers: a narrative review

Background: The baby-led weaning (BLW) approach can introduce complementary food to six-month-old infants. This method offers large pieces of solid foods such as vegetables, meat, and fruit. BLW can encourage children's development, especially motor skills such as chewing and speaking. This literature review aimed to determine the definition and technique of the BLW in giving complementary feeding and identify the effect of using the BLW method on toddler development. Methods: The type of research was a literature review based on the review process of research articles that discuss the effect of BLW on toddler development. The search for articles was done from the Google Scholar and PubMed databases. Results: The author found infants were introduced to complementary feeding late from standard weaning. Initially, the baby is offered finger food and allowed to eat alone. BLW significantly affects children's development, especially in helping to form independence, preventing picky eater behaviour, stimulating children's fine motor skills, and improving oral motor skills. Conclusion: The mother offered late complementary feeding with different types of food and techniques from the standard method. The BLW could significantly influence toddler development.