Since the early 2000's, digital reading applications have enhanced the language and literacy skills of typically hearing young children; however, no digital storybook intervention currently exists to ...scaffold the early language and literacy skills of their peers who are deaf or hard of hearing. To address this gap, our research team developed a novel digital storybook intervention called Hear Me Read with the aim of enhancing the therapeutic, language, and literacy benefits of speech-language therapy. This prospective clinical trial (registered at clinicaltrials.gov, NCT#: 05245799) aims to determine the efficacy of adding Hear Me Read to in-person speech-language therapy for children aged three to five years who are deaf or hard of hearing. Fifty caregivers, their child, and their child's treating speech-language pathologist participate in the trial for 12 months. In the first six months, children attend standard-of-care speech-language therapy sessions. In the second six months, children continue to attend standard-of-care speech-language therapy sessions and use the Hear Me Read application, via a study supplied iPad. The primary outcome of this trial is that, compared to in-person speech-language therapy alone, in-person speech-language therapy with Hear Me Read will improve vocabulary, speech, and language outcomes in children aged three to five years who are deaf or hard of hearing. The secondary outcome is that, compared to in-person speech-language therapy alone, in-person speech-language therapy with Hear Me Read will improve literacy outcomes in children aged three to five years who are deaf or hard of hearing. The goal of this intervention is to help children who are deaf or hard of hearing achieve their vocabulary, speech, language, and literacy goals through interactive digital storybook reading.
Aim
The aim of the study was to examine prospective associations of sleep characteristics (duration, timing, quality) with dietary and anthropometric measures among toddlers born preterm (<35 weeks).
...Methods
Children participated in the Omega Tots trial at 10–17 months' corrected age (Ohio, USA; 26 April 2012 to 6 April 2017). Caregivers reported toddlers' sleep at baseline using the Brief Infant Sleep Questionnaire. After 180 days, caregivers reported toddlers' past month diet in a food frequency questionnaire, and anthropometry was measured using standardised protocols. The toddler diet quality index (TDQI: higher scores indicating better quality), and weight‐for‐length, triceps skinfold and subscapular skinfold z‐scores were calculated. Linear and logistic regression assessed adjusted associations with dietary and anthropometric outcomes at 180‐day follow‐up (n = 284), and linear mixed models assessed changes in anthropometry.
Results
Daytime sleep was associated with lower TDQI (βadj per hour = −1.62 (95% CI: −2.71, −0.52)) whereas night‐time sleep was associated with higher TDQI (βadj = 1.01 (95% CI: 0.16, 1.85)). Night‐time awakenings and caregiver‐reported sleep problems were also associated with lower TDQI. Night awakening duration and sleep‐onset latency were associated with higher triceps skinfold z‐score.
Conclusion
Daytime and night‐time caregiver‐reported sleep showed opposite associations with diet quality, suggesting that sleep timing may be important.
Objective To examine the associations of substance fed and mode of breast milk delivery with occurrence of otitis media and diarrhea in the first year of life. Study design At 12 months postpartum, ...women (n = 813; 62% response) completed a questionnaire that assessed sociodemographics, infant occurrence of otitis media and diarrhea, and the timing of starting/stopping feeding at the breast, expressed milk, and formula. Women who intended to “bottle feed” exclusively were not recruited. Logistic and negative binomial regressions were conducted in the full sample (n = 491) and no-formula (n = 106) and bottle-only (n = 49) subsamples. Results Longer duration of expressed milk feeding was associated with increased odds of experiencing otitis media (6-month OR OR6-month 2.15, 95% CI 1.01-4.55) in the no-formula subsample. Longer durations of breast milk feeding (OR6-month 0.70, 95% CI 0.54-0.92; 6-month incidence rate ratio IRR6-month 0.74, 95% CI 0.63-0.91), and feeding at the breast (OR6-month 0.70, 95% CI 0.54-0.89; IRR6-month 0.74, 95% CI 0.63-0.88) were associated with less diarrhea, and longer formula feeding duration was associated with increased risk of diarrhea (IRR6-month 1.34, 95% CI 1.13-1.54) in the full sample. Conclusion Substance fed and mode of breast milk delivery have different contributions to infant health depending on the health outcome of interest. Feeding at the breast may be advantageous compared with expressed milk feeding for reducing the risk of otitis media, and breast milk feeding compared with formula may reduce the risk of diarrhea.
Objectives
The study examined the relations between parent–child interaction in the first year of life to toddlers’ language skills at age 2 years for a sample of children reared in poverty; of ...specific interest was testing the Family Stress Model, which proposes that the conditions of poverty influence children’s language skills through caregiver well-being (e.g., distress, depression) and interaction dysregulation.
Methods
Participants were from the Kids in Columbus Study, a birth-cohort study of children born to urban families experiencing material hardship. Caregiver questionnaires were collected when the child was 4–7 months to document poverty conditions (maternal hardship, institutional resources), caregiver well-being (depression, distress), and dysregulation in parent–child interactions. The Bayley-III assessed receptive and expressive language skills when the children were 2 years.
Results
On average, receptive language skills were nearly
1 SD
below the normative mean. Path models showed a significant effect of caregiver-child dysregulated interactions on toddlers’ language skills, and an indirect effect of maternal distress on parent–child interactions and, in turn, toddlers’ language skills.
Conclusions for Practice
This study confirmed the theoretical Family Stress Model as a viable representation of the effects of poverty on the language skills of toddlers reared in homes experiencing socioeconomic disadvantage.
Children born preterm are at increased risk of autism spectrum disorder (ASD). n–3 (ω-3) Combined with n–6 (ω-6) fatty acids including γ-linolenic acid (GLA) may benefit children born preterm showing ...early signs of ASD. Previous trials have reported that docosahexaenoic acid (DHA) promotes cognitive development in preterm neonates and n–3 fatty acids combined with GLA improve attention-deficit–hyperactivity disorder.
The objectives of the pilot Preemie Tots Trial were 1) to confirm the feasibility of a full-scale trial in toddlers born very preterm and exhibiting ASD symptoms and 2) to explore the effects of supplementation on parent-reported ASD symptoms and related behaviors.
This was a 90-d randomized, fully blinded, placebo-controlled trial in 31 children 18–38 mo of age who were born at ≤29 wk of gestation. One group was assigned to daily Omega-3-6-9 Junior (Nordic Naturals, Inc.) treatment (including 338 mg eicosapentaenoic acid, 225 mg DHA, and 83 mg GLA), and the other group received canola oil (124 mg palmitic acid, 39 mg stearic acid, 513 mg linoleic acid, 225 mg α-linolenic acid, and 1346 mg oleic acid). Mixed-effects regression analyses followed intent-to-treat analysis and explored effects on parent-reported ASD symptoms and related behaviors.
Of 31 children randomly assigned, 28 had complete outcome data. After accounting for baseline scores, those assigned to treatment exhibited a greater reduction in ASD symptoms per the Brief Infant Toddler Social Emotional Assessment ASD scale than did those assigned to placebo (difference in change = − 2.1 points; 95% CI: − 4.1, − 0.2 points; standardized effect size = − 0.71). No other outcome measure reflected a similar magnitude or a significant effect.
This pilot trial confirmed adequate numbers of children enrolled and participated fully in the trial. No safety concerns were noted. It also found clinically-significant improvements in ASD symptoms for children randomly assigned to receive Omega-3-6-9 Junior, but effects were confined to one subscale. A future full-scale trial is warranted given the lack of effective treatments for this population. This trial was registered at www.clinicaltrials.gov as NCT01683565.
To examine how expressed milk feeding diverges from feeding at the breast in its association with neurodevelopment and behavior. We hypothesized that longer and exclusive feeding at the breast only ...(ie, no formula, no feeding expressed milk) would be associated with the optimal cognitive developmental, executive function, and eating behaviors and that expressed milk feeding would be associated with less-optimal outcomes.
The Moms2Moms cohort (Ohio, US) reported infant feeding practices at 12 months postpartum and children’s global cognitive ability, executive function, and eating behaviors at 6 years. Linear and log-binomial regression models estimated associations with durations of feeding at the breast, expressed milk, human milk (modes combined), and formula.
Among 285 participants, each month of exclusive feeding at the breast only was associated with a decreased risk of clinically meaningful executive function (working memory) deficit (adjusted relative risk RR 0.78, 95% CI 0.63-0.96) but was unassociated with inhibition (adjusted RR 0.92, 95% CI 0.85-1.01). Feeding expressed milk was not clearly related to executive function outcomes. No associations with global cognitive ability were observed. Weak associations were observed with eating behaviors for some feeding practices.
Feeding at the breast may offer advantages to some aspects of executive function that expressed milk may not. Large, prospective studies exploring mechanisms could further distinguish the effect of feeding mode from that of nutrients.
Prenatal marijuana exposure (PME) negatively impacts child development and behavior; however, few studies have examined these associations at early ages among children exposed to today's highly ...potent marijuana. Using a prospective prenatal cohort (Columbus, Ohio, USA), PME was determined from maternal self-report, medical chart abstraction, and urine toxicology from prenatal visits and delivery. At age 3.5 years, 63 offspring children completed tasks assessing executive function (EF), visual spatial ability, emotion regulation, and aggressive behavior. Caregivers reported on children's EF and problem behaviors. Logistic regressions and analyses of covariance controlling for key variables were used to examine associations between PME and child outcomes. Compared to non-exposed children, children with PME had more sleep-related problems, withdrawal symptoms, and externalizing problems, including aggressive behaviors and oppositional defiant behaviors. Children with and without PME did not differ in terms of executive functioning. Findings suggest behavioral problems associated with PME may manifest by age 3.5.
•Children with PME were more aggressive than children without PME.•Differences in executive functioning between PME groups were not observed.•Children with PME had more behavioral problems compared to children without PME.•Results strengthened by comprehensive assessment of marijuana use during pregnancy.
To characterize gaps and factors related to receipt of care within a medical home for toddlers born preterm.
Participants were 202 caregivers of children born at <35 weeks of gestation. At 10-16 ...months of corrected age, caregivers completed the National Survey of Children's Health (2011/2012) medical home module and a sociodemographic profile. Care within a medical home comprised having a personal doctor/nurse, a usual place for care, effective care coordination, family-centered care, and getting referrals when needed. Gestational age and neonatal follow-up clinic attendance were abstracted from the medical record. The Bayley Scales of Infant and Toddler Development, Third Edition assessed developmental status. Log-binomial regression examined factors related to receiving care within a medical home.
Fifty-three percent (n = 107) of the children received care within a medical home. Low socioeconomic status (young caregiver: risk ratio RR = 0.73; 95% CI 0.55, 0.97; low education: RR= 0.69; 95% CI 0.49, 0.98) and delayed language (RR = 0.63; 95% CI 0.42, 0.95) were associated with a lower likelihood of receiving care within a medical home. Degree of prematurity and neonatal clinic follow-up participation were unrelated to receipt of care within a medical home.
Receipt of care within a medical home was lacking for nearly one-half of preterm toddlers, especially those with lower socioeconomic status and poorer developmental status. Discharge from a neonatal intensive care unit may be an optimal time to facilitate access to a primary care medical home and establish continuity of care.
ClinicalTrials.gov: NCT01576783.
Children born preterm experience socioemotional difficulties, including increased risk of autism spectrum disorder (ASD). In this secondary analysis, we tested the effect of combined docosahexaenoic ...acid (DHA) and arachidonic acid (AA) supplementation during toddlerhood on caregiver-reported socioemotional outcomes of children born preterm. We hypothesized that children randomly assigned to DHA + AA would display better socioemotional outcomes compared with those randomly assigned to a placebo.
Omega Tots was a single-site randomized, fully masked, parallel-group, placebo-controlled trial. Children (
= 377) were 10 to 16 months at enrollment, born at <35 weeks' gestation, and assigned to 180 days of daily 200-mg DHA + 200-mg AA supplementation or a placebo (400 mg corn oil). Caregivers completed the Brief Infant-Toddler Social and Emotional Assessment and the Pervasive Developmental Disorders Screening Test-II, Stage 2 at the end of the trial. Liner mixed models and log-binomial regression compared socioemotional outcomes between the DHA + AA and placebo groups.
Outcome data were available for 83% of children (
= 161;
= 153). Differences between DHA + AA and placebo groups on Brief Infant-Toddler Social and Emotional Assessment scores were of small magnitude (Cohen's
≤ 0.15) and not statistically significant. Children randomly assigned to DHA + AA had a decreased risk of scoring at-risk for ASD on the Pervasive Developmental Disorders Screening Test-II, Stage 2 (21% vs 32%; risk ratio = 0.66 95% confidence interval: 0.45 to 0.97; risk difference = -0.11 95% confidence interval: -0.21 to -0.01) compared with children randomly assigned to a placebo.
No evidence of benefit of DHA + AA supplementation on caregiver-reported outcomes of broad socioemotional development was observed. Supplementation resulted in decreased risk of clinical concern for ASD. Further exploration in larger samples of preterm children and continued follow-up of children who received DHA + AA supplementation as they approach school age is warranted.
Neonatal care of preterm infants may include dietary approaches such as high calorie formulas to promote physical growth. However, continuing growth-promoting strategies beyond the point of ...necessity, coupled with poverty and food insecurity which are more common among families of children born preterm, may increase the risk of obesity. Because children born preterm tend to have more pressing health conditions that require ongoing care, obesity may go undiagnosed by providers.
This retrospective cohort study included 38,849 children (31,548 term, 7301 preterm) born from 2010 to 2015, who received clinical care at a large pediatric medical center (Ohio, USA). Electronic medical record data, linked to Ohio birth certificates, were used to identify children with measured obesity (≥2 weight-for-length values ≥95th percentile before 24 months of age or BMI values ≥95th percentile at or after 24 months of age). Children were considered to have diagnosed obesity if their medical record had an obesity-related phrase or billing code recorded. Modified Poisson regression was used to compare risk of obesity undiagnosis among obese children born preterm versus at term.
In total, 13,697 children had measured obesity, 10,273 (75%) of which were undiagnosed. Children born preterm with measured obesity were 8% more likely to be undiagnosed compared to children born at term (adjusted relative risk = 1.08 95% CI 1.05, 1.11). The risk was slightly higher for preterm children born to white women or born to women with higher educational attainment. For both groups, Primary Care and subspecialist clinics were the most common settings for undiagnosed obesity (74.9% and 16.8% of undiagnosed cases, respectively).
Preterm birth was associated with increased risk of undiagnosed obesity in early childhood. This highlights the need to enhance obesity screening in the preterm population and to further explore reasons for this disparity.
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