Toddler Years Research Articles

Dermal melanocytosis and associated disorders.

Dermal melanocytosis is commonly seen in the newborn period and is frequently a concern to parents and providers. Four clinically distinct entities are recognized: nevus of Ota, nevus of Ito, Mongolian spots, and dermal melanocyte hamartoma. This article reviews these disorders, with special emphasis on melanocyte biology and important associated systemic disorders such as rare malignant transformations and inborn errors of metabolism. Recent findings have highlighted the increased risk of malignancy in patients with nevus of Ota, especially ocular, central nervous system, and cutaneous tumors. Although rarely seen, cutaneous melanoma occurs in association with nevus of Ito. Extensive, dark, and progressive Mongolian spots may be more likely than isolated lesions to be associated with inborn errors of metabolism, such as Hurler's disease and monosialotetrahexosylganglioside (GM1) gangliosidosis. New laser technology utilizing Q-switched alexandrite lasers has shown promise for the cosmetic improvement of dermal melanocytosis. While most dermal melanocytosis resolves by the toddler years and does not pose long-term risks to the affected individuals, some patients may have underlying associated conditions that pose significant health concerns. Pediatric care providers must be familiar with these associated conditions and refer to a dermatologist when in doubt, to confirm the diagnosis and determine appropriate follow-up care.

Affect dysregulation in the mother-child relationship in the toddler years: Antecedents and consequences

Affect dysregulation in the mother-child relationship in the toddler years: Antecedents and consequences

Permanent neonatal diabetes due to a heterozygous INS mutation

Permanent Neonatal Diabetes Mellitus (PNDM) is a rare disorder where patient presents with diabetes within the first few months of life without autoantibodies associated with type 1 diabetes. The majority of PNDM cases have INS, ABCC8 or KCNJ11 mutations. We present a PNDM case with INS mutation. The proband is a second child of three siblings without family history of diabetes. She was born at term via emergency lower segment caesarean section with good APGAR score. Her birth weight was 2.0kg (<3rd percentile), length 49cm (50th percentile), and head circumference 34cm (50th percentile). She was discharged well at day 3 of life, but readmitted at day 17 of life with hyperglycaemia, sepsis and severe metabolic acidosis, requiring insulin infusion. Despite clinical improvement and resolving sepsis, she remained hyperglycaemic and hence neonatal diabetes was suspected. Her GAD-65 and ICA-512 antibodies were negative. HbA1c and c-peptide at diagnosis were 7.9% and 38 pmol/L (normal range: 297.9–1324) respectively. She was still hyperglycaemic despite receiving total daily insulin (TDI) of 1.5U/kg/day, but not ketotic. She was discharged after 20 days of hospitalization with insulatard administered three times daily (TDI 1.2U/kg/day). During the first 8 months of diagnosis, her metabolic control was good (HbA1c 6.7 - 7.6%) despite low insulin requirement, as low as 0.4U/kg/day. Her metabolic control deteriorated since then (HbA1c 11.9 - 13.2%), with TDI doses ranging 0.7 - 0.9 U/kg/day. Rapid acting insulin was not used due to episodes of hypoglycaemia and unpredictable eating habit and activity levels during her toddler years. Direct DNA sequencing revealed she is heterozygous for p.A24D INS mutation. This mutation has been reported in the literature and known to disrupt preproinsulin processing. Recent evaluation at 51 month showed, negative anti-islet cell antibodies and c-peptide of <30pmol/L (normal range: 297.9–1324). Currently, her developmental milestone is appropriate for her age. However, her height and weight were both below the 3rd centiles. She was recently started on insulin pump to improve her metabolic control and growth. Written informed consent was obtained from the patient for publication of this abstract and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.

Child, Parenting, and Situational Characteristics Associated with Toddlers' Prosocial Behaviour

The infant and toddler years are crucial for the development of prosocial behaviour, such as helping, sharing, comforting and cooperation. Recent evidence suggests that the correlates of different types of prosocial behaviour may differ. The current study investigated whether child, maternal parenting and situational characteristics were differentially associated with toddlers' cooperation and concern with a peer. The sample, drawn from the National Institute of Child Health and Human Development Study of Early Child Care, included the 612 children who participated in the 36‐month dyadic play session and their mothers. The results indicated that girls were more cooperative and expressed more concern than boys. Greater sustained attention to toys was associated with lower cooperation. Children were more cooperative with peers who engaged in more positive social interaction, and expressed more concern with peers that they had a close relationship with. Maternal sensitivity at 24 months was associated with greater cooperation when the peer engaged in more positive social behaviour. Finally, both maternal sensitivity and cognitive stimulation at 15 months indirectly influenced toddlers' cooperation through maternal sensitivity at 24 months, underscoring the predictive power of early parenting when children are rapidly developing the capacity to engage in prosocial behaviour. Overall, the results highlight some differences in the correlates of toddlers' cooperation and concern. Copyright © 2015 John Wiley &amp; Sons, Ltd.

How Similar are Mothers and Fathers of Young Children in Their Parenting Responses and Goals?

The toddler and preschool years present numerous parenting challenges. This study was designed to explore the extent to which mothers and fathers in dual-income families with toddler or preschool age children are similar in their parenting responses and in their parenting goals. Participants were 148 primarily professional, White (84.6 %), dual-income couples (mothers’ M age = 33.1 years; fathers’ M age = 35.5 years) with a first child between the ages of 18–60 months. Parents completed the Child Behavior Vignettes - Toddler and Preschool Version which yielded a measure of parenting responses and a measure of parenting goals. Child adjustment was measured by parent reports on the Child Behavior Checklist. We calculated parenting similarity using Finn’s r. Responses to parenting situations involving child misbehavior and child withdrawn behavior were examined. We found that parents in dual-income families were similar in their parenting responses and in their parenting goals. However the degree of similarity in parenting responses was not related to similarity in goals; furthermore, the degree of similarity was not linked to child adjustment. We offer possible interpretations for these findings and future research directions.

Manual action, fitting, and spatial planning: Relating objects by young children

This study uses motion tracking technology to provide a new way of addressing the development of the ability to prospectively orient objects with respect to one another. A group of toddlers between 16 and 33months of age (N=30) were studied in an object fitting task while they wore reflective markers on their hands to track spatial adjustments in three dimensions. Manual displacements of the handheld object were separated into translations and rotations. Results revealed that younger children largely used a two-step approach in which they initially translate an object to a target and subsequently attempt to rotate the object to match the target. In contrast, older children evidence more advanced spatial planning and integrate translational and rotational components throughout the entire period when they are transporting the object to the target. Additionally, at the oldest ages, children show even further improvements in coordinating translations and rotations by using relatively shorter translations (i.e., covering less distance) and by avoiding unnecessary rotations of the object. More broadly, the results offer insights into how manual problem solving becomes more efficient and planful during the toddler years.

Die frühkindliche Entwicklung sozialkognitiver und metakognitiver Fertigkeiten. Empirische Befunde, theoretische Kontroversen und Implikationen für die Ontogenese des Selbstbewusstseins

Abstract The present paper argues that the early development of social cognitive and metacognitive abilities informs the ongoing theoretical debate on the ontogenesis of the human self concept. To this end, the article provides first an overview on the early development of a self concept in the toddler years. Subsequently, it reviews central empirical findings and theoretical approaches on the early development of social-cognitive and metacognitive abilities from infancy to the preschool years. The paper concludes with a discussion of the implications of these findings and approaches for our understanding of the developmental origins of the human self concept.

Ethnic Disparities in Early Autism Assessment: A Large Scale Screening Study of Infants and Toddlers

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder with origins early in development. Early identification and intervention are vital to improving prognosis for individuals with this disorder, and diagnosis of ASD during the toddler years has become increasing more accurate. However, many factors impact the age at first assessment, in turn impacting the likelihood of accessing early intervention services, including geographic factors, socioeconomic status, and symptom severity. Research on the impact of ethnicity and early diagnosis has thus far produced mixed results. This study investigates the impact of ethnicity and referral for autism assessment in 7,464 toddlers ages 17–37 months who were assessed by a government supported, state-wide program.

The A, B, C'S of Recent Work on Shyness and Social Withdrawal: Assessment, Biology, and Context

The A, B, C'S of Recent Work on Shyness and Social Withdrawal: Assessment, Biology, and Context

Infectious diseases in early education and child care programs.

1. Timothy R. Shope, MD, MPH* 1. *Department of Pediatrics, Division of General Academic Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA. * Abbreviations: AAP: : American Academy of Pediatrics CFOC3: : Caring for Our Children , 3rd ed ECE: : early care and education RSV: : respiratory syncytial virus Out-of-home care and education are the norms for most young children and lead to increased exposure to infectious diseases. Pediatricians need to be aware of strategies to reduce the risk of infection and guidelines for determining exclusion and return to care for mildly ill children who participate in group care arrangements. After completing this article, readers should be able to: 1. Recognize the risks of infectious diseases in children who participate in early care and education programs. 2. Understand methods for reducing infectious diseases in early care and education settings. 3. Identify which infectious diseases require exclusion from early care and education programs. Two-thirds of children younger than 6 years participate in nonparental out-of-home early education and child care. Demographic trends during the past several decades reflect an increased desire and need to work for men and women who are parents. During the first 2 years of participation, children enrolled in early care and education (ECE) programs experience a higher incidence of respiratory and diarrheal infections, otitis media, and antibiotic-resistant bacteria compared with their peers primarily cared for at home. The types of infection generally reflect common respiratory and gastrointestinal viruses in circulation in the community. However, there are some infectious diseases that can cause outbreaks or clusters of infections in ECE settings. When ill children are excluded from an ECE facility, parents may miss work, lose income, and seek health care services in an effort to return their children to child care. Pediatricians need to be aware of the infectious disease risks of child care attendance and various strategies for reducing them. In addition, pediatricians need to be knowledgeable about rational exclusion and return …

Defining Perceptions of Picky Eating Obtained through Focus Groups and Conjoint Analysis

AbstractPicky eating is a challenging mealtime behavior prevalent during the toddler years. An operational definition of picky eating does not exist in the scientific literature, which makes it difficult to consistently quantify the degree of picky eating. Yet, those who talk about picky eating, especially mothers, “know it when they see it, or when it is described.” This study used focus groups and conjoint analysis in a novel approach to investigate the perceptions of picky eating.Four categories were developed from three focus groups (N = 19): “before mealtime behaviors,” “during mealtime behaviors,” “general mealtime preferences” and “food sensory‐dependent preferences.” The focus groups were followed by a conjoint analysis study which revealed four segments: “The Sensory Dependent” (n = 72), “The General Perfectionists” (n = 159), “The Behavioral Responders” (n = 54) and “The Preferential Eaters” (n = 74). The segments differed in the specific elements driving the description of a child considered a picky eater. The study develops a classification method to define picky eaters, and suggests innovative interventions for each of the four segments of picky eating.Practical ApplicationsThe findings from this study demonstrate that picky eating is neither defined nor experienced in the same way by every parent. Parents believe that picky eating is not only defined by the food the child eats, but also by the child's overall behaviors and attitudes toward mealtime. The participants of the focus group study provided unique detailed experiences and perceptions that may not be captured by quantitative surveys or food diary assessments. The information from combined focus group and conjoint analysis in this study categorize characteristics of picky eating and define and segment how people perceive picky eaters. Results can be further used for novel approaches to remedy mealtime difficulties resulting from picky eating behaviors.

EPA-0836 – Maternal depression timing and trajectories, socioeconomic position and child problem behavior at age five – results from the EDEN mother-child cohort

Maternal depression is an important risk factor for child behavioral and psychological problems. Both timing and chronicity of depression may interfere with developmental tasks during infancy or the toddler years. The aim of the present research is to assess whether maternal depression timing and depression trajectories predict child emotional and behavioral problems at 5 years, and to examine whether there are differential effects according to parental socioeconomic status. Analysis of prospective data from 1183 children participating in the EDEN mother–child cohort study. Maternal depressive symptoms were determined in pregnancy ( prenatal ); 4, 8 and 12 months after birth ( postpartum ) and at 3 and 5 years ( toddler ) using the CESD and EPDS scales. Children's emotional and behavioral problems at age five were assessed using the Strengths and Difficulties Questionnaire (SDQ). Trajectories of maternal depressive symptoms were modeled with a group-based technique. A series of multiple regression models were used to examine the association between maternal depression timing and trajectories and SDQ scores. Children exposed to maternal depression in the postpartum or toddler period presented more emotional and behavioral problems at age five. The same pattern was found for children exposed to chronic symptoms of maternal depression. Postpartum depressive symptoms were associated with more conduct problems, hyperactivity/inattention and overall problem behavior at age five in children whose mothers had a low educational level. Maternal depression timing and chronicity may have detrimental emotional and behavioral effects on young children, especially for those from more disadvantaged backgrounds.

Functional Morphemes and Early Language Acquisition

AbstractIn this article, I discuss the acquisition of functional morphemes during the first years of life. Infants begin to process functional items at birth. They start encoding functional elements and their structural relations in phrases and sentences long before they can produce these items. Functional items also assist various language acquisition tasks. These findings demonstrate the initial acquisition of functional morphemes and early grammatical knowledge, challenging the view that no syntactic structures are represented before the end of the toddler years. The findings have important implications for theories of language acquisition and for the debate concerning nature versus nurture in development.

Early life predictors of preschool overweight and obesity: a case–control study in Sri Lanka

BackgroundChildhood obesity increases the risk of obesity in adulthood and is associated with cardiovascular disease risk factors. Our aim was to assess the early life risk factors associated with overweight and obesity among preschool children.MethodsIn this case–control study, from the 1087 preschool children measured, age, sex and ethnicity matched 71 cases and 71 controls were recruited. Cases and controls were defined according to the WHO 2006 growth standards. The birth and growth characteristics were extracted from the child health development records. Infant feeding practices and maternal factors were obtained from the mother. Rapid weight gain was defined as an increase in weight-for-age Z score (WHO standards) above 0.67 SD from birth to 2 years. The magnitude and significant difference in mean values of the variables associated with overweight and obesity were evaluated using logistic regressions and paired t-test, respectively.ResultsCases had significantly shorter duration (months) of breastfeeding (19.4, 24.6, p = 0.003), and smaller duration (months) of exclusive breastfeeding (3.7, 5.1, p = 0.001) compared to controls. Rapid weight gain (OR = 6.3, 95% CI = 2.04–19.49), first born status (OR = 3.6, 95% CI = 1.17-10.91) and pre-pregnancy obesity (OR = 4.0, 95% CI = 1.46-10.76) were positively associated with overweight and obesity. Breastfeeding more than 2 years (OR = 0.2, 95% CI = 0.06-0.57) was negatively associated with overweight and obesity.ConclusionRapid weight gain within first two years, first–born status and pre-pregnancy obesity of the mother contributed for preschool obesity. Our results suggest that intervention may be indicated earlier in infancy and during the toddler and preschool years to tackle the increasing prevalence of obesity.

Exploring the Impact of Television Watching on Vocabulary Skills in Toddlers

With the rising incidence of television consumption in children, the aim of the present study was to investigate the impact of such habits on vocabulary skills in young children. Very little research has targeted a key cognitive skill—vocabulary—during the toddler years, which represent a critical developmental period. We recruited toddlers, aged two to three, from British child care centers. Parents indicated the television watching habits of their children in different genres (educational, cartoons, baby DVDs, adult entertainment) in order to investigate potential differential effects. We also included other key variables linked to vocabulary acquisition: short-term memory (verbal and visuo-spatial) and reading habits (fiction and educational books). The findings indicated that television did not impact vocabulary scores, either positively or negatively. Instead, reading educational books and short-term memory skills predicted vocabulary performance.

Prediction of toddlers’ expressive language from maternal sensitivity and toddlers’ anger expressions: A developmental perspective

Despite evidence for the importance of individual differences in expressive language during toddlerhood in predicting later literacy skills, few researchers have examined individual and contextual factors related to language abilities across the toddler years. Furthermore, a gap remains in the literature about the extent to which the relations of negative emotions and parenting to language skills may differ for girls and boys. The purpose of this longitudinal study was to investigate the associations among maternal sensitivity, children's observed anger reactivity, and expressive language when children were 18 (T1; n=247) and 30 (T2; n=216) months. At each age, mothers reported on their toddlers’ expressive language, and mothers’ sensitive parenting behavior was observed during an unstructured free-play task. Toddlers’ anger expressions were observed during an emotion-eliciting task. Using path modeling, results showed few relations at T1. At T2, maternal sensitivity was negatively related to anger, and in turn, anger was associated with lower language skills. However, moderation analyses showed that these findings were significant for boys but not for girls. In addition, T1 maternal sensitivity and anger positively predicted expressive language longitudinally for both sexes. Findings suggest that the relations between maternal sensitivity, anger reactivity and expressive language may vary depending on the child's developmental stage and sex.

Association between prescribing hypnotics for parents and children in Norway

ObjectiveTo describe the dispensing of the hypnotic alimemazine to children aged 0–3 years and investigate the association between dispensing of alimemazine to children and dispensed hypnotics to their parents.DesignAn observational...

Childhood Infections and Adult Height in Monozygotic Twin Pairs

Adult height is determined by genetics and childhood nutrition, but childhood infections may also play a role. Monozygotic twins are genetically matched and offer an advantage when identifying environmental determinants. In 2005-2007, we examined the association of childhood infections with adult height in 140 height-discordant monozygotic twin pairs from the California Twin Program. To obtain information on childhood infections and growth, we interviewed the mothers of monozygotic twins who differed in self-reported adult height by at least 1-inch (2.5 cm). Within-pair differences in the relative frequency of childhood infections were highly correlated, especially within age groups. A conditional logistic regression analysis demonstrated that more reported episodes of febrile illness occurred in the twin with shorter stature (odds ratio = 2.00, 95% confidence interval: 1.18, 3.40). The association was strongest for differences in the relative frequency of infection during the toddler years (ages 1-5: odds ratio = 3.34, 95% confidence interval: 1.47, 7.59) and was similar when restricted to twin pairs of equal birth length. The association was not explained by differential nutritional status. Measures of childhood infection were associated with height difference in monozygotic twin pairs, independent of genome, birth length, and available measures of diet.

Deformational plagiocephaly is associated with developmental delay in toddlers

Deformational plagiocephaly is associated with developmental delay in toddlers

Maternal parenting as a mediator of the relationship between intimate partner violence and effortful control.

The current study examined the relationship between intimate partner violence (IPV), maternal parenting behaviors, and child effortful control in a diverse sample of 705 families living in predominantly low-income, rural communities. Using structural equation modeling, the authors simultaneously tested whether observed sensitive parenting and/or harsh-intrusive parenting over the toddler years mediated the relationship between early IPV and later effortful control. Results suggest that parenting behaviors fully mediate this relationship. Although higher levels of IPV were associated with both higher levels of harsh-intrusive parenting and lower levels of sensitive supportive parenting, only sensitive supportive parenting was associated with later effortful control when both parenting indices were considered in the same model.