Young Toddlers Research Articles

The infant and toddler with wheezing.

Recurrent wheezing is common in young infants and toddlers, with 50% of all children having at least one wheezing episode in the first 6 years of life. Initial wheezing episodes in young children often are linked to respiratory infections due to viral pathogens, such as respiratory syncytial virus, human rhinovirus, human metapneumovirus, and influenza virus. Bacterial colonization of the neonatal airway also may be significant in the late development of recurrent wheeze and asthma. Wheezing in young children can be classified into specific phenotypes based on the onset and persistence of wheezing. Although some children will only wheeze transiently in early childhood, persistent wheezing is often classified as immunoglobulin E (IgE) associated and/or atopic or nonatopic. By using a modified asthma predictive index, future development of asthma can be interpreted, especially in high-risk populations. It is recommended to follow National Asthma Education and Prevention Program (NAEPP) guidelines for initiation of treatment; however, asthma management of young children often requires tailored regimens. Inhaled corticosteroids used as a daily controller medication have been shown to aid symptoms and exacerbation control; however, these do not change the natural course of the disease or progression to asthma. Although randomized double-blind studies in preschoolers investigated a role of macrolide antibiotics in early infection as well as high-dose inhaled corticosteroids during severe lower respiratory tract infections, more research is needed in this field to understand mechanisms of asthma development and optimal treatment in this young age group.

Do You Do as I Do?: Young Toddlers Prefer and Copy Toy Choices of Similarly Acting Others

Recognizing similarity between one's own and others' actions is important for identifying others with whom to affiliate and from whom to learn. In this study, 40 19‐month‐old toddlers recognized when a puppet chose the same toys as them. Toddlers preferred to affiliate with a puppet who chose the same toys as themselves relative to a puppet who chose other toys and they modified their subsequent behavior by choosing the same toys as that puppet when presented with novel toys. Toddlers' actions were not based on perceivable features of the puppet (e.g., similar accent or language as oneself) or an association between the puppet and the preferred toys (as assessed in a control condition). Results indicate that toddlers identified and recognized the similarity in action choices between themselves and the puppet via comparison between their own and the puppets' actions. Identifying this similarity is critical for children's developing understanding of and engagement in interactions with others.

Fusobacterium necrophorum otitis and mastoiditis in infants and young toddlers

There is an increased recovery of Fusobacterium necrophorum from cases of otitis media and mastoiditis in the pediatric population. These infections may be highly severe, causing local osteomyelitis, bacteremia, and Lemierre's syndrome. The severity and difficulties in providing optimal treatment for these infections may be especially difficult in this age group due to immunological immaturity and delayed presentation. In this review of literature, we present and analyze the clinical presentation, management, and outcome of otic infections caused by F. necrophorum in infants and young toddlers less than 2 years old. Search in Pubmed was conducted for reported cases in the English literature for the time period of the last 50 years. Twelve well-described cases were retrieved with F. necrophorum otitis and mastoiditis and complications reported in all cases. Treatment included both intravenously with antimicrobial agents (beta lactams plus metronidazole) and mastoidectomy. Lemierre's syndrome and Lemierre's syndrome variants developed in 60 % of the patients. Dissemination of the infection as distal osteomyelitis and septic shock were also reported. The outcome was favorable in all the cases. Otitis and mastoiditis infections in children less then 2 years old are invasive infections, and severe complications can occur.

On the Challenge of Maladaptive and Impulsive Aggression in the Clinical Treatment Setting.

[Author Affiliation]Daniel F. Connor. Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut.Address correspondence to: Daniel F. Connor, MD, Department of Psychiatry/MC 1410, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030-1410, E-mail: dconnor@uchc.eduClinicians working in the mental health setting have long been challenged by children and adolescents with many different types of psychiatric disorders who are often referred for treatment because of frequent, intense, severe, and maladaptive impulsive aggression. This type of clinical presentation occurs commonly in every type of pediatric mental health treatment setting: Outpatient, inpatient, residential, and/or partial hospitalization. Impulsive aggression is often chronic, but waxes and wanes in response to multiple shifting internal and external factors, and may be extremely stressful for parents and other family members. Although normative in the young toddler and preschooler (the terrible twos), with development, the child begins to achieve emotional and behavioral competence and regulation such that by school entry aggression becomes increasingly verbal and not physical. With school entry, aggression is increasingly associated with understandable and recognizable antecedents, goals, and objectives.Maladaptive aggression is defined as behavior with intent to harm another person; is elicited by minimal or routine environmental cues; is less linked to recognizable and understandable social goals; is characterized by its explosive nature, high frequency rate, and severe intensity; and is associated with significant functional impairment for the child and the child's family (Connor 2002). Impulsive aggression is behavior that occurs rapidly without a delay (a short fuse) that would otherwise allow the child to consider an alternative and more adaptive response to frustration or perceived threat (Jensen et al. 2007). Impulsive aggression is driven by low frustration tolerance or fear of threat (Dodge and Coie 1987).Maladaptive and impulsive aggression in psychiatrically referred children and adolescents is common, denotes illness severity not illness specificity (Connor and McLaughlin 2006), and represents a significant public health problem with high societal costs (Foster and Jones 2005). Aggression is a major cause of referral to outpatient and inpatient child and adolescent psychiatry services (Bambauer and Connor 2005) and emergency psychiatric services (Gabel and Shindledecker 1991), predicts longer stays in psychiatric hospitals, and predicts rehospitalization in youth discharged from inpatient settings (Blader 2004). It is associated with child and adolescent psychiatry staff injury (Cunningham et al. 2003), is associated with off-label pediatric antipsychotic use (Olfson et al. 2015), and predicts combined pharmacotherapy (polypharmacy) use independently of diagnosis in referred children (Connor et al. 1997). Youth with moderate to severe impulsive aggression with and without comorbid attention-deficit/hyperactivity disorder (ADHD) are a major challenge for clinicians working in the clinical setting, as few evidence-based treatments are currently available that address these issues.Progress in developing effective treatments for impulsive aggression has been slowed by the multiple ways of clinically identifying and characterizing the aggressive child. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM 5) diagnoses such as oppositional defiant disorder (temper tantrums), conduct disorder (physical aggression), bipolar disorder (aggression and irritability), intermittent explosive disorder (explosive aggression), and/or disruptive mood dysregulation disorder (irritability and temper tantrums) all may have aggression as part of their symptom criteria, yet are nosologically construed as separate and non-overlapping psychiatric diagnoses (American Psychiatric Association 2013). …

A Daytime Nap Facilitates Generalization of Word Meanings in Young Toddlers.

One of the key processes in language development is generalization--the selection and extension of relevant features and information to similar objects and concepts. Little is known about how sleep influences generalization, and studies on the topic are inconclusive. Our aim was to investigate how a nap affects generalization in 16-mo-olds. We hypothesized that a nap is necessary for successful generalization of word meanings. Twenty-eight 16-mo-old, typically developing toddlers were randomly assigned to nap and wake groups. We trained toddlers with two novel object-word pairs and tested their initial ability to generalize. Toddlers took part in an intermodal preferential looking task, in which they were shown different colored versions of the original objects and heard one of the trained labels. If toddlers understand the label, they are expected to increase their looking time to the target. Looking behavior was measured with an automated eye tracker. Afterward, the nap group went to sleep, while the wake group stayed awake for approximately 2 h. We then repeated the test of their performance on the generalization task. A significant interaction of group and session was found in preferential looking. The performance of the nap group increased after the nap, whereas that of the wake group did not change. Our results suggest that napping improves generalization in toddlers.

Hybrid therapy for treatment of newly diagnosed toddlers with autism spectrum disorders

Abstract Background: Time is of the essence in treating autism spectrum disorders (ASD). Intensive and effective therapies can advance acquisition of adaptive and communication skills during the lag time until entry into a pre-school program. Objective: To jump start treatment in very young toddlers with ASD and good cognitive potential, therapeutic modifications of the Early Start Denver Model (ESDM) were examined. Method: The changes involved more intensive cooperative treatments, with two different therapists (“hybrid”), reinforcing behavioral manipulations with the children. The intensified therapies were to maximize gains over shorter periods of time, dictated by limitations of resources. Results: Thirty children (mean age 24 m., average duration 4.1 m.) improved on their goal attainment scale (GAS) ratings on nearly all functional measures, (p<0.001). Of 23 ADOS scores, 19 improved, the average pre-treatment ADOS score was 17.7 (SD 3.4) and post-treatment 13.3 (SD 5.34). The correlation between GAS and ADOS score improvement was significant (R=0.67, p<0.001). Conclusion: The acceleration in social communication and adaptive skill gains in the treatment of very young children using modifications in treatment therapies already in wide- scale use, indicates the as-yet untapped treatment potential for many young children with ASD.

Refining Stimulus Parameters in Assessing Infant Speech Perception Using Visual Reinforcement Infant Speech Discrimination: Sensation Level.

Speech perception measures have long been considered an integral piece of the audiological assessment battery. Currently, a prelinguistic, standardized measure of speech perception is missing in the clinical assessment battery for infants and young toddlers. Such a measure would allow systematic assessment of speech perception abilities of infants as well as the potential to investigate the impact early identification of hearing loss and early fitting of amplification have on the auditory pathways. To investigate the impact of sensation level (SL) on the ability of infants with normal hearing (NH) to discriminate /a-i/ and /ba-da/ and to determine if performance on the two contrasts are significantly different in predicting the discrimination criterion. The design was based on a survival analysis model for event occurrence and a repeated measures logistic model for binary outcomes. The outcome for survival analysis was the minimum SL for criterion and the outcome for the logistic regression model was the presence/absence of achieving the criterion. Criterion achievement was designated when an infant's proportion correct score was >0.75 on the discrimination performance task. Twenty-two infants with NH sensitivity participated in this study. There were 9 males and 13 females, aged 6-14 mo. Testing took place over two to three sessions. The first session consisted of a hearing test, threshold assessment of the two speech sounds (/a/ and /i/), and if time and attention allowed, visual reinforcement infant speech discrimination (VRISD). The second session consisted of VRISD assessment for the two test contrasts (/a-i/ and /ba-da/). The presentation level started at 50 dBA. If the infant was unable to successfully achieve criterion (>0.75) at 50 dBA, the presentation level was increased to 70 dBA followed by 60 dBA. Data examination included an event analysis, which provided the probability of criterion distribution across SL. The second stage of the analysis was a repeated measures logistic regression where SL and contrast were used to predict the likelihood of speech discrimination criterion. Infants were able to reach criterion for the /a-i/ contrast at statistically lower SLs when compared to /ba-da/. There were six infants who never reached criterion for /ba-da/ and one never reached criterion for /a-i/. The conditional probability of not reaching criterion by 70 dB SL was 0% for /a-i/ and 21% for /ba-da/. The predictive logistic regression model showed that children were more likely to discriminate the /a-i/ even when controlling for SL. Nearly all normal-hearing infants can demonstrate discrimination criterion of a vowel contrast at 60 dB SL, while a level of ≥70 dB SL may be needed to allow all infants to demonstrate discrimination criterion of a difficult consonant contrast.

Food sources of energy and nutrients in the diets of infants and toddlers in urban areas of China, based on one 24-hour dietary recall

Food sources of nutrients in young children in China have been little investigated. The objective of this study was to understand feeding patterns of young children through an analysis of food sources of energy and nutrients in the diets of infants and toddlers living in urban areas in China. This study was part of the cross-sectional study, Maternal Infant Nutrition Growth (MING). One 24-h dietary recall was completed for a total of 1409 children (infants 6–11 months, younger toddlers 12–23 months, and older toddlers 24–36 months) via face-to-face interviews with the primary caregivers. All food, beverage and dietary supplements that the child consumed on the previous day were recorded and processed with a database including data from Chinese Food Composition tables. All reported foods and supplements were assigned to one of 83 food groups developed for the study. Percent contribution of each food group to nutrient intakes was calculated. Children in all 3 age groups received a majority of energy (52 to 69 %) from few foods including infant formula or growing-up (fortified) milk, rice, noodles, pork and eggs, with rice becoming the number one source of energy by 24 months. Rice and noodles were not only top sources of energy (17 to 26 %) and carbohydrate (27 to 40 %) but also top sources of protein (13 to 16 %), iron (13 to 18 %) and zinc (11 to 18 %). Supplements made substantial contributions to intakes of vitamin A, zinc, iron and calcium. Salt added during home-cooking was the main source of sodium (60 to 80 %). Few foods made up the core of the diets of infants and young toddlers living in urban areas in China. Low nutrient-dense rice and noodles were top sources of many nutrients, which could potentially lead to inadequate intakes of some key nutrients.

Novel word learning: An eye-tracking study. Are 18-month-old late talkers really different from their typical peers?

Infants, 18–24 months old who have difficulty learning words compared to their peers are often referred to as “late talkers” (LTs). These children are at risk for continued language delays as they grow older. One critical question is how to best identify which LTs will have language disorders, such as Specific Language Impairment (SLI) at school age, in order to maximize the opportunity for early and appropriate intervention and support. Recent research suggests that LTs are not only slower to learn and speak words than their peers, but are also slower to recognize and interpret known words in real time.This investigation examined online moment-by-moment processing of novel word learning in 18-month-olds. A low vocabulary, late talking group (LT, N=14) and an age and cognitive-level matched typical group (TYP, N=14) of infants participated in an eye-tracked novel word learning task and completed standardized testing of vocabulary and cognitive ability. Infants were trained on two novel word-picture pairs and then were tested using an adaptation of the looking while listening paradigm. Results suggest that there are differences between groups in the time-course of looking to the novel target picture during testing. These findings suggest that LTs and typical infants developed strong enough representations to recognize novel words using traditional measures of accuracy and reaction time, however interesting group differences emerge when using additional fine-grained processing measures. Implications for differences in emerging knowledge and learning patterns are discussed.Learning outcomes: The reader will be able to understand many benefits of using eye-tracking methods to study young infant and toddler populations with and without language disorders. Readers will learn that examining moment-by-moment time course of novel word learning allows additional insight into different learning patterns. Finally, readers should understand the data from this article suggest late talkers may have different emerging representations of novel words than their typical peers, which may contribute to their difficulty learning new words.

The paradox of early intervention: families’ participation driven by professionals throughout service process

Early intervention conceived as a program for young infants and toddlers with developmental needs and their families, how early intervention practice establishes family participation in the service process - from referral, evaluation, Individualized Family Service Plan (IFSP) meeting, to service delivery - was considered in this article. Employing disability studies perspectives, the study contends that although families have gained legal rights for family participation in the law, the requirements do not guarantee the quality of family participation. Using a qualitative case study approach, this study looked at both participation and perceptions of families in the early intervention service process in the metropolitan area of the US. Three families’ experience in the process of early intervention was observed, and how these parents reflect on their participation in the development of early intervention service planning and delivery was examined through in-depth interviews. Findings showed that the families’ participation varied by service providers. The disparity resulted from variable availability, competency levels, and approaches of individual service providers during the service process. In addition, early intervention professionals who are bounded by the requirements in a professional bureaucracy, including the procedural requirements, often impinge on the quality of family participation and limit families’ opportunities for quality service provision. The paper suggests rethinking about how the practice can be implemented.

OP26 – 2867: Recurrent stroke in toddlers and hemiplegic or atypical migraine in school aged children: Think of Moyamoya!

Objective Characterization of clinical symptoms and disease course in children with Moyamoya angiopathy. Methods Between 2011 and 2014 34 children and adolescents were treated in the Moyamoya Center in Zurich. Evaluation comprised a detailed history, neurologic and developmental status including pediatric stroke outcome measure (PSOM). Cerebral MRI and MR angiography (MRA), conventional cerebral angiography and H215O-PET with acetazolamid challenge were performed followed by individualized treatment. Results Median age at symptom onset was 4 1/2 years (range 6 months–14 years). We found a female preponderance (female/male ratio 1.8/1). Diagnosis was Moyamoya disease in 18 and Moyamoya syndrome in 16 children. 5/16 Moyamoya syndromic children had Neurofibromatosis Type 1. Most but not all children presented with a transitory ischemic attack (TIA) or stroke. In 11 children headaches and migraine were the main complaint. Besides weakness and focal sensory deficits headache was often accompanied by peculiar and unspecific symptoms like short episodes of altered consciousness, involuntary movements, general weakness and falls. On presentation MRI revealed ischemic lesions in 21 cases. Cortical lesions were observed in 11 patients (mean age 2 years), subcortical in 10 patients (mean age 6 1/2 years). In 6 children under 3 years we found a rapid progressive angiopathy. Posterior circulation was involved in 10 patients, all of them were younger than 6 years. PSOM score tended to be higher in young children. Conclusion Early diagnosis and surgical revascularisation are mandatory for stroke prevention in Moyamoya angiopathy, especially in young toddlers. In school aged children with migraines or chronic headaches accompanied by weakness, focal sensory deficits, altered consciousness or involuntary movements it is worthwhile to consider Moyamoya angiopathy as an important differential in the diagnostic assessment.

Involvement of Students in an Integrated Course of Action in the Field of Eating Disorders in the Life Cycle.

Involvement of students in an integrated course of action in the field of eating disorders in the life cycle Lecture representative of a unique project in the area of ??expanding the awareness of eating disorders in early childhood feeding among parents and professionals, caregivers, infants and toddlers. This is an innovative project created by the collaboration between the Academy – and the Eating Disorder ambulatory clinic at the hospital. The populations in treatment are babies and young toddlers with feeding and eating disorders. Graduate students in clinic social work study this course as well as involved in the community for the purpose of study initial diagnosis and raising awareness among the different populations. Activity will be carried out by students and various communities such as clinics, pediatric primary care clinics, day care centers and kindergartens. In the community will use various practices to influence and achieve the desired change. Intervention shall be informal conversations, observations, discussion with parents and children, as well as with teachers and Nurses. Academic activities include training of students, reviewing their positions by research to be performed before the start of training and at the end of training and operations. The lecture will focus on the processes that students go through the community as well as customers. The model included teaching, research and community activities to promote a change. The lecture will include a report on the results of the study as well as the demo movies. Conjunctions Feeding and Eating Disorders Consciousness Diagnosis

Predictors of discipline severity among at-risk toddlers

Parental discipline is a contentious and debated topic among scholars, practitioners, and individual parents. There has been a large amount of scholarly research investigating causes, correlates, and consequences of punishment, but most of this research has focused on corporal punishment (CP) specifically. In reality, parents often use a number of discipline tactics, including verbal reprimands, removal of privileges, distraction, “time-out”, and other forms of physical discipline. The current study investigates family, parent, and child characteristics that predict the use of discipline tactics of distraction, harsh verbal punishment, and CP among young toddlers in at at-risk sample, and assesses the effect of parenting classes as modified by demographic risk. Results indicate that the risk of choosing CP over less severe discipline tactics is increased with more demographic risk factors present. Parenting interventions such as attending parenting classes or group socialization events also reduced the likelihood of choosing CP over less severe discipline. The impact of parenting classes was greater among low risk parents. Implications and future directions from these results are also discussed.

Acute Hemorrhagic Leukoencephalitis (Hurst Disease) Secondary to H1N1 in a Child - A Story of Full Recovery from Qatar, A Case Report

Background: Hurst disease is the rarest yet the most fatal form of acute demyelinating encephalomyelitis. There around 100 cases around the world, 10 of them are pediatric patients. The disease is quite severe in course and aggressive therapy is crucial to help improving the outcome. We are reporting a rather successful story of early recognition and treatment of young toddler with using all lines of known therapies simultaneously and aggressively. Case report: We are reporting 2 ½ years old girl who was previously healthy. She has some viral prodromal illness ended by severe encephalopathy. She has found to have novel H1N1 infection. Early plasma exchange and therapeutic hypothermia have been simultaneously utilized. There was obvious significant fast improvement in clinical status thereafter. Discussion: Immune therapy is advised in treating Hurst disease. One trial of hypothermia has been suggested in one case report. However, Combination of early use of plasma exchange and therapeutic hypothermia has not been reported in literature up to our knowledge. Our patient showed impressive clinical progress following these rarely used procedures. Conclusion: Recognition of autoimmune encephalitis especially the most severe forms is a must. If the patient shows enough clinical and radiological signs suggestive of Hurst disease, then aggressive immunotherapy and therapeutic hypothermia should be considered. A more favorable outcome might be reached using these therapies simultaneously

Electrical injuries of the oral cavity: A menace to mankind

The rarest of its kind, the electrical injuries of the commissure areas of the mouth pose a potential threat in terms of management to the practitioner. The most commonly affected young toddlers, in their teething period, chew onto the female end of the live extension wire cord. Saliva which acts a medium transports the electrical current to the fragile mucosa of the oral cavity thereby leading to the treacherous burn injuries. Since children have an overall lower fat component and different surface area to volume ratio, which impacts on the risk of deep tissue damage compared to adults with equivalent injury. The review outlines: (1) A detailed review of literature reflecting the various treatment modalities proposed by different practitioners worldwide and (2) the prosthetic therapy for the conservative management of the electrical injuries of the oral cavity.

Unilateral Lung Aplasia Presenting with Acute Respiratory Distress Possibly due to milk aspiration in Young Toddler

A 13 month female child with h/o recurrent respiratory tract infection developed cough and breathlessness nearly 30 min after breastfeeding. Chest x-ray showed homogeneously opaque right hemi thorax with hyperlucency of left lung field suggestive of lung agenesis without any features of foreign body. Bronchoscopy revealed oedematous mucosa, thick bronchial secretions, mucus plug and white coagulates (apparently from milk) which were removed from left bronchus; trachea continued as left main bronchus without any stenosis or compression with absent right bronchus. Pulmonary agenesis was confirmed by CT scan in the post-operative period. The child made full recovery.

Innovative products using amrutham nutrimix and its popularization among young mothers

Under nutrition in children is a widespread health problem in our country. ICDS that addresses the problem of malnutrition has been unsuccessful even after three decades of implementation. Amrutham nutrimix - a nutritious supplementary food given for malnourished children is not utilized due to monotony in its preparation. Hence an attempt was made to formulate nutritious amrutham based recipes. Twenty common recipes including sweet dishes and savories were prepared. Acceptability of all the developed products was assessed by a taste panel. Iron and protein content was analysed for the 6 most accepted products. All the formulated products were affordable and ranged from 50p (murukku) to Rs.3/-(sweet balls) per 100g. The recipes were displayed and popularized among young mothers as they are the prime caregivers of young toddlers and are willing to change food behavior for the welfare of their children. Recipes and its health benefits were discussed with the participants. The education program was very effective in imparting nutrition knowledge as there was significance in the pre and post test scores. Hence, amrutham nutrimix can be an affordable and acceptable nutritional substitute to WHO recommended ready to use therapeutic food (RUTF) for Severe Acute Malnutrition (SAM) especially when used in diverse forms as suggested in the current study. Keywords: Amrutham nutrimix, Malnutrition, SAM, RUTF

Julia Ivanova, director. Family Portrait in Black and White. 2011. 85 minutes. In Ukrainian and English, with English subtitles. Canada. Interfilm Productions. $24.99.

Julia Ivanova, director. Family Portrait in Black and White. 2011.85 minutes. In Ukrainian and English, with English subtitles. Canada. Interfilm Productions. $24.99.In rural Ukraine, Olga Nenya is a foster mother to twenty orphans, among them sixteen biracial children who were abandoned by their Caucasian mothers because they represented unacceptable relations with African students in a society where 99 percent of the population (according to the 2001 Census) is white. Left in orphanages, these mixed race kids would likely have remained unadopted. The film's opening features local neo-Nazis declaring that white people produce imbeciles when they mix with subhumans (namely, anybody who is not white) and bragging that the police let them beat up black people with impunity. One African student, describing the high level of racism to which Africans are subjected, says, Living in Ukraine as an African is quite difficult. [Skinheads] want to harass you, anytime they see you. They see us as people who shouldn't be here.Hence, this is certainly not the ideal environment for these unwanted children. Yet because Ukraine is the only place they can call home, they simply do not have a choice. They live in a village, where their neighbors do not perceive them as 100 percent though these orphans can only think of themselves as Ukrainians. Sometimes they even adopt the local racist views on Africa and Africans, as is the case with Sashka, aged fourteen. He is certainly the most patriotic one in the family. He willingly tells how much he loves his homeland, and how much he wants to live there. He even turns out to be just as prejudiced as ethnic Ukrainians, especially against Arabs and Africans. He refuses to talk to blacks on the streets, declaring, What would I have in common with those niggers! Those foreigners come in [to our country] to sleep with our Ukrainian chicks! Ironically, a couple of years later even Sashka admits that he is aware of the racism and is getting tired of it. He knows that people feel that he does not belong there, which is why he hopes to leave Ukraine when he turns eighteen.With Olga, too, it seems that the children have no choice, as she is the only one who volunteered to care for them. She took them in when they were just young toddlers, and raised them as the only mother the majority of them would ever know. Julia Ivanova followed this atypical family over the course of three years and offers a very interesting portrait of their improbable matriarch. Olga is presented at first as a positive, kindhearted person who sacrifices herself to provide a home for the children, whom she calls precious diamonds. …

Teacher–Child Interactions During Mealtimes: Observations of Toddlers in High Subsidy Child Care Settings

In the U.S., experiences of infants and toddlers in group care are often overshadowed by the policy and research focus on preschool education just prior to formal school entry. When infant–toddler care is studied, it is often described relative to the global quality of classroom environments. Little research has focused on the day-to-day experiences of very young children in routine situations and contexts in group care. The current study sought to examine the experience of a small group of toddlers (n = 11) in low-income child care centers that were deemed high quality by the state’s Quality Rating and Improvement System (QRIS). Using a focal observation technique in combination with qualitative methods, young toddlers were observed during a typical mealtime experience in their classroom. Data from this pilot study suggest that minimal teacher–child interactions occurred during observed mealtimes. Of particular concern is the low level of teacher vocalizations and responses to children during meals. Implications for policy, practice, and future research are discussed.

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 …