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The aim of this study was to understand the quality of diet being consumed among families in Addis Ababa, and to what extent social stratification and perceptions of availability and affordability affect healthy food consumption. Data were collected from 5467 households in a face-to-face interview with mothers/caretakers and analyzed using mixed effect logistic regression models. All family food groups, except fish were perceived to be available by more than 90% of the participants. The food groups cereals/nuts/seeds, other vegetables, and legumes were considered highly affordable (80%) and were the most consumed (>75%). Households with the least educated mothers and those in the lowest wealth quintile had the lowest perception of affordability and also consumption. Consumption of foods rich in micronutrients and animal sources were significantly higher among households with higher perceived affordability, the highest wealth quintile, and with mothers who had better education. Households in Addis Ababa were generally seen to have a monotonous diet, despite the high perceived availability of different food groups within the food environment. There is a considerable difference in consumption of nutrient-rich foods across social strata, hence the cities food policies need to account for social differences in order to improve the nutritional status of the community.

This study leverages naturally occurring lotteries for oversubscribed Boston Public Schools prekindergarten program sites between 2007 and 2011, for 3,182 children (M = 4.5 years old) to estimate the impacts of winning a first choice lottery and enrolling in Boston prekindergarten versus losing a first choice lottery and not enrolling on children's enrollment and persistence in district schools, grade retention, special education placement, and third-grade test scores. There are large effects on enrollment and persistence, but no effects on other examined outcomes for this subsample. Importantly, children who competed for oversubscribed seats were not representative of all appliers and almost all control-group children attended center-based preschool. Findings contribute to the larger evidence base and raise important considerations for future prekindergarten lottery-based studies., (© 2019 Society for Research in Child Development.)

Background: From Early Childhood Education onwards, causal attributions influence explanations of school performance. We performed a systematic review of the available knowledge (1970-2019) about Weiner's (1986) Attribution Theory of the Motivation of Achievement in order to examine studies related to the causal attributions of success and failure at school. We found numerous empirical studies related to Bernard Weiner's theory. However, little research exists about students in Early Childhood Education. Therefore, the aim of this study was to identify the causes to which children attribute their successes and failures during this educational period., Method: A sample of 200 students aged between 3 and 6 years old was selected. To collect the data, an individually implemented Piagetian clinical interview was used., Results: A large volume of qualitative information was collected for classification which exceeded Weiner's traditional causal attributions. Creating a category to group all new attributions implied losing too much information under a non-specific label., Conclusion: A new categorization of the causal attributions was designed, made up of 10 categories -adapted to the 3-6 years age range- which revises and expanding on the categorization created by Weiner.

Importance: Children born preterm are at an elevated risk of academic underachievement. However, the extent to which performance across domain-specific subskills in reading and mathematics is associated with preterm birth remains unclear., Objective: To conduct a systematic review and meta-analysis of academic outcomes of school-aged children born preterm, compared with children born at term, appraising evidence for higher- and lower-order subskills in reading and mathematics., Data Sources: PubMed/MEDLINE, PsycINFO, and the Cumulative Index of Nursing and Allied Health Literature electronic databases from January 1, 1980, to July 30, 2018, were searched for population, exposure, and outcome terms such as child (population), preterm birth (exposure), and education* (outcome)., Study Selection: Peer-reviewed English-language publications that included preterm-born children and a comparison group of term-born children aged 5 to 18 years and born during or after 1980 and that reported outcomes on standardized assessments from cohort or cross-sectional studies were screened. Of the 9833 articles screened, 33 unique studies met the inclusion criteria., Data Extraction and Synthesis: Data were analyzed from August 1 to September 29, 2018. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Two reviewers independently screened the databases and extracted sample characteristics and outcomes scores. Pooled mean differences (MDs) were analyzed using random-effects models., Main Outcomes and Measures: Performance on standardized assessment of higher-order subskills of reading comprehension and applied mathematics problems; lower-order reading subskills of decoding, pseudoword decoding, and word identification; and lower-order mathematics subskills of knowledge, calculation, and fluency., Results: Outcomes data were extracted for 4006 preterm and 3317 term-born children, totaling 7323 participants from 33 unique studies. Relative to children born at term, children born preterm scored significantly lower in reading comprehension (mean difference [MD], -7.96; 95% CI, -12.15 to -3.76; I2 = 81%) and applied mathematical problems (MD, -11.41; 95% CI, -17.57 to -5.26; I2 = 91%) assessments. Across the assessments of lower-order skills, children born preterm scored significantly lower than their term-born peers in calculation (MD, -10.57; 95% CI, -15.62 to -5.52; I2 = 92%), decoding (MD, -10.18; 95% CI, -16.83 to -3.53; I2 = 71%), mathematical knowledge (MD, -9.88; 95% CI, -11.68 to -8.08; I2 = 62%), word identification (MD, -7.44; 95% CI, -9.08 to -5.80; I2 = 69%), and mathematical fluency (MD, -6.89; 95% CI, -13.54 to -0.23; I2 = 72%). The associations remained unchanged after sensitivity analyses for reducing heterogeneity., Conclusions and Relevance: These findings provide evidence that preterm birth is associated with academic underperformance in aggregate measures of reading and mathematics, as well as a variety of related subskills.

Despite reports that over 1.3 million school-age children (ages 5-18) were homeless in 2019, little is known about the effects of homelessness on their overall health and well-being. To better understand where gaps exist, a scoping review of the literature was conducted to identify studies of the physical, mental, and behavioral health risks and outcomes of school-age children experiencing homelessness or housing instability. Following the Joanna Briggs Institute framework and Preferred Reporting Items (PRISMA) guidelines, seven electronic databases were searched using key words: homelessness, children, health, and well-being. Of the 4,372 records, 23 articles met inclusion criteria. Most examined mental health and high-risk activities or behavioral risks related to school achievement. Few studies tracked the long-term health outcomes of homeless school-age children. Findings have implications for school nurses who have contact with children experiencing homelessness and are in position to intervene to prevent negative health sequelae in this vulnerable population.

Objectives: Nowadays, attention deficit hyperactivity (ADH) problems are observed commonly among school-age children. However, questionnaires specific to ADH behaviors among preschool children are very few. The aim of this study was to investigate the reliability and validity of the 25-item Behavioral Check List (BCL), which was developed from interviews of parents with children who were diagnosed as having Attention-deficit/hyperactivity disorder (ADHD) and measures ADH behaviors in preschool age., Methods: We recruited 22 teachers from 10 nurseries/kindergartens in Miyagi Prefecture, Japan. A total of 138 preschool children were assessed using the BCL. To investigate inter-rater reliability, two teachers from each facility assess seven to twenty children in their class, and intraclass correlation coefficients (ICCs) were calculated. The teachers additionally answered questions in the 1/5-5 Caregiver-Teacher Report Form (C-TRF) to investigate the criterion validity of the BCL. To investigate structural validity, exploratory factor analysis with promax rotation and confirmatory factor analysis were performed., Results: The internal consistency reliability of the BCL was good (α = 0.92) and correlation analyses also confirmed its excellent criterion validity. Although exploratory factor analysis for the BCL yielded a five-factor model that consisted of a factor structure different from that of the original one, the results were similar to the original six factors. The ICCs of the BCL were 0.38-0.99 and it was not high enough for inter-rater reliability in some facilities. However, there is a possibility to improve it by giving raters adequate explanations when using BCL., Conclusions: The present study showed acceptable levels of reliability and validity of the BCL among Japanese preschool children.

Despite increased international efforts to control schistosomiasis using preventive chemotherapy, several challenges still exist in reaching the target populations. Until recently, preschool-aged children had been excluded from the recommended target population for mass drug administration, i.e. primary school children aged 6-15 years. Our studies and those of others provided the evidence base for the need to treat preschool-aged children that led to recommendations by the World Health Organization to include preschool-aged children in treatment programmes in 2010. The major challenge now lies in the unavailability of a child-size formulation of the appropriate anthelmintic drug, praziquantel.The currently available formulation of praziquantel presents several problems. First, it is a large tablet, making it difficult for young children and infants to swallow it and thus requires its breaking/crushing to allow for safe uptake. Second, it is bitter so it is often mixed with a sweetener to make it palatable for young children. Third, the current formulation of 600 mg does not allow for flexible dose adjustments for this age group. Thus, there is a need to formulate a child-appropriate praziquantel tablet.This paper discusses the target product profile for paediatric praziquantel, as well as knowledge gaps pertinent to the successful control of schistosome infection and disease in preschool-aged children.

Background: Although the prevalence of obesity in young children highlights the importance of early interventions to promote physical activity (PA), there are limited data on activity patterns in this age group. The purpose of this study was to describe activity patterns in preschool-aged children and explore differences by weight status., Methods: Analyses use baseline data from Healthy Homes/Healthy Kids-Preschool, a pilot obesity prevention trial of preschool-aged children who are overweight or at risk for being overweight. A modified parent-reported version of the previous-day PA recall was used to summarize types of activity. Accelerometry was used to summarize daily and hourly activity patterns., Results: "Playing with toys" accounted for the largest proportion of a child's previous day, followed by "meals and snacks" and "chores." Accelerometry-measured daily time spent in sedentary behavior, light PA, and moderate-to-vigorous PA (MVPA) was 412, 247, and 69 minutes, respectively. Percentage of hourly time spent in MVPA ranged from 3% to 13%, peaking in the late morning and evening hours. There were no statistically significant MVPA differences by weight status., Conclusions: This study extends our understanding of activity types, amounts, and patterns in preschool-aged children and warrants further exploration of differences in PA patterns by weight status.

This study examined the classification accuracy of the activPAL, including total time spent sedentary and total number of breaks in sedentary behavior (SB) in 4- to 6-year-old children. Forty children aged 4-6 years (5.3 ± 1.0 years) completed a ~150-min laboratory protocol involving sedentary, light, and moderate- to vigorous-intensity activities. Posture was coded as sit/lie, stand, walk, or other using direct observation. Posture was classified using the activPAL software. Classification accuracy was evaluated using sensitivity, specificity and area under the receiver operating characteristic curve (ROC-AUC). Time spent in each posture and total number of breaks in SB were compared using paired sample t-tests. The activPAL showed good classification accuracy for sitting (ROC-AUC = 0.84) and fair classification accuracy for standing and walking (0.76 and 0.73, respectively). Time spent in sit/lie and stand was overestimated by 5.9% (95% CI = 0.6-11.1%) and 14.8% (11.6-17.9%), respectively; walking was underestimated by 10.0% (-12.9-7.0%). Total number of breaks in SB were significantly overestimated (55 ± 27 over the course of the protocol; p < .01). The activPAL performed well when classifying postures in young children. However, the activPAL has difficulty classifying other postures, such as kneeling. In addition, when predicting time spent in different postures and total number of breaks in SB the activPAL appeared not to be accurate.

Children's time-location patterns are important determinants of environmental exposure and other health-relevant factors. Building on data of the German Environmental Survey for Children (GerES IV), our study aimed at deriving reference values and distributions for time-location patterns of 3-14-year-old German children. We also investigated if GerES IV data are appropriate for evaluating associations with children's health determinants by linking them to data of the National Health Interview and Examination Survey for Children and Adolescents (KiGGS). Parents reported on the time their children usually spend at home, in other indoor environments, and outdoors. This information was characterized by statistical parameters, which were also calculated for different strata concerning socio-demography and the residential environment. Consequently, group differences were evaluated by t-tests and univariate ANOVA. Reference distributions were fitted to the time-location data by a Maximum Likelihood approach to make them also useable in probabilistic exposure modeling. Finally, associations between data on the children's physical activity as well as body weight and their outdoor time were investigated by bivariate correlation analysis and cross tabulation. On daily average, German children spend 15 h and 31 min at home, 4 h and 46 min in other indoor environments, and 3 h and 43 min outdoors. Time spent at home and outdoors decreases with age while time spent in other indoor environments increases. Differences in time-location patterns were also observed for the socio-economic status (SES) and immigration status. E.g., children with a high SES spend 24 min less outdoors than low SES children. Immigrants spend on daily average 20 min more at home and 15 min less outdoors than non-immigrant children. Outdoor time was associated with parameters of the residential environment like the building development. Children living in 1- or 2-family houses spend more time outdoors than children living in building blocks (3 h 48 min vs. 3 h 29 min). Physical activity correlates with outdoor time. For children with diminished age-specific outdoor time, a higher prevalence of obesity was observed (odds ratio: 3.2, 95% CI: 1.5-7.1). GerES IV provides a compilation of current time-location reference values and distributions on German children. This data hint to substantial differences in time-location patterns within the population to be considered in environmental health risk assessment., (Copyright © 2012 Elsevier GmbH. All rights reserved.)

The current study examines 3- and 5-year-olds' representation of the concept we label 'animal' and its two nested concepts -animal(contrastive) (including only non-human animals) and animal(inclusive) (including both humans and non-human animals). Building upon evidence that naming promotes object categorization, we introduced a novel noun for two distinct objects, and analyzed children's patterns of extension. In Experiment 1, children heard a novel noun in conjunction with two non-human animals (dog, bird). Here, both 3- and 5-year-olds readily accessed animal(contrastive) and extended the noun systematically to other (previously un-named) non-human animals. In Experiment 2, children heard a novel noun in conjunction with a human and non-human animal. Here, 5-year-olds (but not 3-year-olds) accessed animal(inclusive) and extended the noun systematically to humans and non-human animals. These results underscore the developmental challenge facing young children as they identify the scope of the fundamental biological term 'animal' and its corresponding, nested concept(s)., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Background: This study evaluates the long-term efficacy of aripiprazole compared to placebo in children with bipolar disorders., Method: Outpatients aged 4 to 9 years meeting DSM-IV criteria for a bipolar disorder (I, II, not otherwise specified, cyclothymia) were eligible to receive up to 16 weeks of open-label treatment with aripiprazole (phase 1). Patients were randomized into the 72-week double-blind phase of the study once they met a priori response criteria for stabilization (phase 2). During phase 2, patients either remained on their current aripiprazole regimen or began a double-blind taper with aripiprazole discontinued and switched to placebo. The primary outcome measure for phase 2 was time to discontinuation due to a mood event., Results: Patients were recruited between May 2004 and November 2008. Following phase 1, in which 96 patients received aripiprazole, 30 patients (mean age = 7.1 years) were randomly assigned to continue aripiprazole and 30 patients (mean age = 6.7 years) were randomly assigned to placebo. The mean (SD) dose of aripiprazole prior to randomization for these patients was 6.4 (2.1) mg/d. Patients randomly assigned to aripiprazole were enrolled significantly longer until time to study discontinuation due to a mood event (6.14 median weeks, SE ± 11.88 weeks; P = .005) and discontinuation for any reason (including mood events) (4.00 median weeks, SE ± 3.91 weeks; P = .003) than those randomly assigned to placebo (mood event, 2.29 median weeks, SE ± 0.38 weeks; any reason, 2.00 median weeks, SE ± 0.31 weeks). Regardless of random assignment, both the aripiprazole and placebo groups showed substantial rates of withdrawal from maintenance treatment over the initial 4 weeks (15/30 [50%] for aripiprazole; 27/30 [90%] for placebo), suggesting a possible nocebo effect (ie, knowledge of possibly switching from active medication to placebo increasing concern about relapse). The most frequently reported adverse events during double-blind aripiprazole therapy included stomach pain (n = 10, 33%), increased appetite (n = 9, 30%), and headaches (n = 9, 30%)., Conclusions: Despite the possibility of a nocebo effect, these results suggest that aripiprazole may be superior to placebo in the long-term treatment of pediatric patients following stabilization with open-label aripiprazole., Trial Registration: clinicaltrials.gov Identifier: NCT00194077., (© Copyright 2012 Physicians Postgraduate Press, Inc.)

Background: Modern locking plates are widely used for the treatment of adult orthopaedic and trauma patients. Sporadic descriptions of their advantages now exist for paediatric trauma patients. Publications concerning their implantation in paediatric orthopaedic and neuroorthopaedic patients are still scarce even though it is well known that the compliance of children and adolescents is limited and that rapid mobilisation is essential for patients with disorders of neurological origin or bone metabolism to avoid developmental setbacks and perioperative fractures., Patients and Methods: The principle of the locking plate system also described as internal fixateur is based on the thread bolting of the screwheads within the plate. This results in high initial stability and thus high initial loading capacity. Furthermore, it is possible to preserve soft tissue and periosteum which leads to less impaired biological bone healing. Between February 2008 and March 2010 locking plates were used for osteosynthesis in our department in 16 paediatric patients with 20 corrective osteotomies. All patients suffered from either neurological disorders or diseases with alteration of the bone metabolism. The outcome was analysed concerning safety, complications, practicability, mobilisation, consolidation of the osteotomy, loss of correction, as well as complications with the removal of the implants., Results: Seven of the treated patients suffered from neurological disorders such as cerebral palsy or spina bifida, 9 patients had diseases with local or systemic alteration of their bone metabolism such as vitamin D deficiency and phosphate diabetes. The average age of the patients at the time of surgery was 11.18 (5-18) years. Implant-associated complications were not seen in this patient group, especially no implant failures. Mobilisation was achieved without cast treatment with at least partial weight-bearing within the first postoperative week in most cases. Loss of correction or problems with implant removal did not occur. 18 of the 20 osteotomy sites were completely healed at the 12 week follow-up., Conclusion: Locking plates are a safe and effective treatment device not only for adult trauma patients but also for the treatment of children and adolescents. When stabilisation of corrective osteotomies is performed with locking plates especially young patients benefit from this technique since mobilisation can be started earlier as compared to the use of non-angle stable plates or wires and cast immobilisation becomes unneccessary. The surgeon needs to know the range of products to pick the best implant regarding the growing skeleton's special anatomy. When choosing implants for patients with reduced bone density or impaired motor abilities as in cerebral palsy, spina bifida, and other systemic disorders, locking plates have to be taken into account to facilitate mobilisation and to avoid setbacks in motor development as well as pressure ulcers from casts. Clinical studies have to evaluate if early mobilisation combined with shorter inpatient treatment and less time and cost consuming postoperative physiotherapy or rehabilitation justify the use of the more expensive locking plates for the treatment of otherwise healthy patients., (© Georg Thieme Verlag KG Stuttgart · New York.)

The number of circulating B-cells in peripheral blood plateaus between 2 and 24 months of age, and thereafter declines gradually. How this reflects the kinetics of the precursor B-cell pool in the bone marrow is of clinical interest, but has not been studied thoroughly in humans. The authors analyzed bone marrow (n = 37) from healthy children and adults (flow cytometry) searching for age-related changes in the total precursor B-cell compartment. In an age-matched cohort (n = 25) they examined age-related global gene expression changes (Affymetrix) in unsorted bone marrow with special reference to the recombination activating gene 1, RAG1. Subsequently, they searched the entire gene set for transcripts correlating to the RAG1 profile to discover other known and possibly new precursor B-cell related transcripts. Both methods disclosed a marked, transient increase of total precursor B-cells at 6-20 months, followed by a rapid decrease confined to the first 2 years. The decline thereafter was considerably slower, but continued until adulthood. The relative composition of total precursor B-cells, however, did not change significantly with age. The authors identified 54 genes that were highly correlated to the RAG1 profile (r >or= .9, p < 1 x 10(-8)). Of these 54 genes, 15 were characteristically B-lineage associated like CD19, CD79, VPREB, EBF1, and PAX5; the remaining 39 previously not described as distinctively B-lineage related. The marked, transient increase in precursor B-cells and RAG1 transcriptional activity is not reflected by a similar peak in B-cells in peripheral blood, whereas the sustained plateau concurs in time.

Preschool age is a biological stage of intensive longitudinal growth with high plasticity of the growing body and of body postures. It is the period where children learn to persist in a sitting posture for a longer time and to use furniture like chairs or other body supporting systems. The growing body shows a special sensitivity for the manifestation of inappropriate postures. In this study the development of body measurements and sitting behaviour of preschool age children is investigated as a precondition for an optimal adjustment of seats and desks to the growing body. Accordingly to the instructions of Knussmann (1988) and Jiirgens (1988) 6 body measurements were taken from 122 German children aged 3 to 7 years from Potsdam, Province Brandenburg. Additionally, every child was videotaped for 10 minutes while crayoning in a sitting position of its own choice using a chair and a desk. To analyse the tapes, the software Noldus Observer was used and examined, picture by picture, to define the different types of sitting postures as well as the duration of persistence in a posture and the number of changes of postures. The used chairs and desks were also measured. Furthermore, the data of the furniture guideline DIN ISO 5970 (DIN, 1981), which regulates the dimensions of furniture for sitting in educational institutions, were compared with the results of the body measurements and with the dimensions of the furniture used by the children.

Exceeding weight gain in childhood is a prevailing issue in industrialised countries, such as in Germany. The aim of this study was to detect a critical age for exceeding weight gain. It is assumed that especially in the early years of life, the years of nursery school age, the individual development of weight is fundamental for the prediction of obesity. The data of 638 children (324 boys and 314 girls) and the data of additional 1390 children of a preceding longitudinal study were analysed. The results show that overweight newborns are not at higher risk of becoming overweight children later, in the first place. But the results identify a high risk of becoming overweight for children 4.5-years-old through a BMI rebound. In addition, this comparably earlier BMI rebound is linked with an increasing percentage of body fat. This leads to the assumption, that a comparably early BMI rebound is remarkably atypical for healthy child development. The results are also interrelated with the test person's sex. Endangered girls are of pyknomorphic body type. In contrast, the boys' results are independent of the body type. Obesity of boys therefore is strongly assumed to be caused by environmental factors.

Comparative analysis of the efficacy of a playful-narrative program to teach mathematics at pre-school level. In this paper, the effectiveness of a programme comprising several components that are meant to consolidate mathematical concepts and abilities at the pre-school level is analyzed. The instructional methodology of this programme is compared to other methodologies. One-hundred 5-6 year-old children made up the sample that was distributed in the following conditions: (1) traditional methodology; (2) methodology with perceptual and manipulative components, and (3) methodology with language and playful components. Mathematical competence was assessed with the Mathematical Criterial Pre-school Test and the subtest of quantitative-numeric concepts of BADyG. Participants were evaluated before and after the academic course during which they followed one of these methodologies. The results show that the programme with language and playful components is more effective than the traditional methodology (p<.000) and also more effective than the perceptual and manipulative methodology (p<.000). Implications of the results for instructional practices are analyzed.

Objective: While much is now known about depression during school age and adolescence, whether clinical depression can onset even earlier in development during the preschool period remains under explored. The earliest possible identification of depression may be important for the design of prevention and early developmental intervention programs. This study investigated functional impairment associated with depression, symptoms that served as the best markers of depression vs. other disorders, as well as depression severity between two depressed sub-groups and other diagnostic comparison groups., Method: Three hundred and five preschoolers between the ages of 3.0 and 6.0 and their primary caregivers were recruited using a depression screening checklist distributed at community sites. The Preschool Age Psychiatric Assessment (PAPA) was used to derive psychiatric diagnoses in the study sample. Multivariate analyses of covariance were used to investigate the effects of depression on independent measures of functional impairment while controlling for the effects of co-morbidities., Results: Functional impairment specifically associated with depression was found in multiple domains and contexts, however depressed preschoolers were not developmentally delayed. The symptoms of guilt and extreme fatigue were found to be highly specific for preschool depression. A statistically significant hierarchy of depression severity was found between diagnostic comparison groups, in the expected direction with the highest in a melancholic subgroup., Conclusions: Validation for preschool depression with associated functional impairment across contexts was found in preschool children. These findings replicate and extend earlier evidence for validity of MDD diagnosed in the preschool period and highlight the need for clinical attention. The finding that these depressed and impaired preschoolers were not yet developmentally delayed may have important public health significant significance as it suggests a possible window of opportunity for early intervention. Study findings were limited by reliance on parent and teacher informants and a cross-sectional view.

Atypical diurnal patterns of hypothalamic-pituitary-adrenal (HPA) axis activity have been observed in samples of individuals following early life adversity. A characteristic pattern arising from disrupted caregiving is a low early-morning cortisol level that changes little from morning to evening. Less well understood is the plasticity of the HPA axis in response to subsequent supportive caregiving environments. Monthly early-morning and evening cortisol levels were assessed over 12 months in a sample of 3-6-year-old foster children enrolled in a randomized trial of a family-based therapeutic intervention (N=117; intervention condition, n=57; regular foster care condition, n=60), and a community comparison group of same-aged, non-maltreated children from low-income families (n=60). Latent growth analyses revealed stable and typical diurnal (morning-to-evening) cortisol activity among non-maltreated children. Foster children in the intervention condition exhibited cortisol activity that became comparable to the non-maltreated children over the course of the study. In contrast, children in regular foster care condition exhibited increasingly flattened morning-to-evening cortisol activity over the course of the study. In sum, improvements in caregiving following early adversity appear to have the potential to reverse or prevent disruptions in HPA axis functioning.

The publication of some forty years ago of the landmark work by Philippe Aries, entitled Centuries of childhood, in its widely-read English translation, unleashed decades of scholarly investigation of that once-neglected target, the child. Since then, historians have uncovered the traces of attitudes toward children- were they neglected, exploited, abused, cherished?- and patterns of child-rearing. They have explored such issues, among others, as the varieties of European household structure; definitions of the stages of life; childbirth, wetnursing, and the role of the midwife; child abandonment and the foundling home; infanticide and its prosecution; apprenticeship, servitude, and fostering; the evolution of schooling; the consequences of religious diversification; and the impact of gender. This essay seeks to identify key features and recent trends amid this abundance of learned inquiry.

Aim: The aim of the study was to assess the caries inhibition effect of fluoride varnishes among preschool children with high caries risk. At the same time, the suitability of this measure should be examined in the frame of group prevention programmes in kindergartens., Method: This was an examiner-blind, clinically controlled 2-year study with 200 randomly selected 2- to 4-year-old preschool children with high caries risk. At the baseline, caries-free surfaces, initial caries lesions as well as the caries status (dmfs) were recorded. After the baseline, all subjects were divided into 3 groups. Subjects of group A received every 6 months (altogether four times) applications with the fluoride varnish Fluoridin N5 (VOCO GmbH, Cuxhaven, Germany), children of the group B received every 6 months (altogether four times) applications with Duraphat (Colgate Palmolive GmbH, Hamburg, Germany), while the subjects of group C did not receive any fluoride varnish applications and constituted the control group. A final examination was performed after two years similar to the baseline. Statistical analysis was based on the SPSS programme at a significance level of 95%., Results and Conclusions: The results confirmed the caries inhibition efficacy of both fluoride varnishes. This is shown as well in the almost constant number of caries-free surfaces and initial caries lesions in the two F-groups during the observation period. The caries-free surfaces in group C were significantly reduced along with an increase of initial caries lesions. The caries reduction, based on the control group, amounted in group A to 56% and in group B to 57%. The results documented the caries inhibition effect of both fluoride varnishes which are suitable for intensive group prevention programmes for pre-school children.

Objective: A cross-sectional study was conducted in a rural area of the Northeastern region in Thailand. The study aimed to investigate factors influencing nutritional status and to explore the pattern of snack consumption., Material and Method: Subjects were 85 normal and 85 undernourished pre-school children with ages ranging from 2-6 years old. The authors collected demographic data including socio-economic status and family background by using an interview administered questionnaire. A 5-day food record was used to evaluate nutritional intake., Results: The results indicated that children in both groups preferred crispy snacks between breakfast and lunch. Energy, protein, fat, carbohydrate, calcium and sodium intake derived from snacks and overall intake were significantly lower in undernourished children than those in normal children (p-value < 0.01). The results indicated that energy intake in pre-school malnourished children (2-3 years) as percentage of recommended daily allowance was lower than the recommended level. High sodium intake was observed in the presented study children and the results supported the observation that snack foods contribute to excessive sodium intake., Conclusion: The present results have highlighted the impact of snack consumption. Programmes aimed at increasing nutritional knowledge and information for parents and guardians are important. Furthermore, promotion of nutritious snack consumption among children is important.

The major sources of published anthropometric data on children are now over two decades old. Due to concern being expressed regarding the continued validity of such data, changes in the body sizes of the UK child population over the past three decades have been considered. Comparisons were also made between the size of the current UK child population to the current US child population, and to the most comprehensive source of measured data on US children (but which are now over 20 years old). The growth of children in the UK and US over the past three decades was assessed for an indication of secular growth trends. Stature increases were found to have generally been less than body weight increases (as a percentage) at 5th percentile, mean and 95th percentile levels for UK children, and UK children were found to be closer in size to US children now than they were 30 years ago.

Prevention and control of damage to health, crops, and property by insects, fungi, and noxious weeds are the major goals of pesticide applications. As with use of any biologically active agent, pesticides have unwanted side-effects. In this review, we will examine the thesis that adverse pesticide effects are more likely to occur in children who are at special developmental and behavioral risk. Children's exposures to pesticides in the rural and urban settings and differences in their exposure patterns are discussed. The relative frequency of pesticide poisoning in children is examined. In this connection, most reported acute pesticide poisonings occur in children younger than age 5. The possible epidemiological relationships between parental pesticide use or exposure and the risk of adverse reproductive outcomes and childhood cancer are discussed. The level of consensus among these studies is examined. Current concerns regarding neurobehavioral toxicity and endocrine disruption in juxtaposition to the relative paucity of toxicant mechanism-based studies of children are explored.

Objective: This study investigated to what extent young kindergarten children already benefit from training phonological awareness., Methods: The training program used here was the German "Würzburg training program of phonological awareness". The control group participated in the regular kindergarten program. A total of 80 children, one and two years before entering school, participated in the study. Tests of phonological awareness were assessed before and after the training as well as after six months., Results: Young kindergarten children (two years before entering school) compared to preschoolers (one year before entering school) had significant lower phonological awareness skills. However both cohorts showed noticeable significant training effects, but preschoolers benefited significantly more from training phonological awareness. Long-term effects were obtained for both cohorts., Conclusions: Already young kindergarten children do benefit effectively from preschool phonological awareness training. Effects of this training on reading and spelling in school will be investigated further.

The use of cochlear implants in born-deaf infants addresses the issues of disability, proxy consent, and potential ethnocide of the Deaf culture. The ethical issues explored in this paper are: 1) the disability versus trait argument of deafness, 2) parents versus Deaf community in proxy consent, 3) justification for surgical intervention in a non-life threatening condition, and 4) justification for ethnocide. Decisions for non-competent individuals should be made to assure the child of an open future, with rights that need to be protected now, so that the child can exercise them later as an adult. Cochlear implants provide the potential of an open future and are morally justified on that basis.

The aim of our investigation was to find out how do pre-school aged children felt themselves in kindergarten and what factors their well-being depended on. The survey was carried out in 1999 and 2000. A sample of 631 children aged 6-7 years was interviewed in 12 randomly selected kindergartens of Kaunas. The children were divided into two groups. The children who said that they liked to be in kindergarten more than at home belonged to the first group (n = 361 or 57.3%). They answered that they liked their group mates, like to speak with their teacher, to learn, to sing, to play quiet games, they heard good words about themselves in kindergarten more often. The children who enjoyed to be at home more than in kindergarten belonged to the second group (n = 269 or 42.7%). They said that they did not like to obey the tasks of their teacher, to sleep after dinner more often in comparison with the first group. Factorial analysis of the data indicated that children with positive factor of well-being through they were better than their group friends, thought they could do things better than their group mates, they had less complaints of various pains. A statistically significant correlation between the common factors of well-being and self-esteem was estimated.

Objective: The purposes of the study were threefold: (a) to determine whether a measurement system based on facial expression would be useful in the assessment of post-operative pain in young children; (b) to examine construct validity in terms of structure, consistency, and dynamics of the facial display; and (c) to evaluate concurrent validity in terms of associations with global judgments of the children's pain., Patients: One hundred children between the ages of 13 and 74 months were video-taped for a maximum of 1 hour after arrival in the postanesthesia care unit (PACU) at British Columbia's Children's Hospital., Outcome Measures: Videotapes were edited into 20-second blocks, randomly selected from each 2-minute time period taped during the hour following surgery, and coded for the presence or absence of 13 facial actions in the Child Facial Coding System (CFCS)., Results: Facial expressions were characterized primarily by the following constellation of actions: open lips, lowered brows, a deepened nasolabial furrow, mouth stretched wide in both horizontal and vertical directions, eyes squeezed shut or squinted, and raised cheeks. A principal components analysis indicated that these actions comprised a single factor, accounting for 55% of the variance in CFCS actions. Facial action summary scores were correlated with a visual analog rating of global pain, confirming that the CFCS has convergent validity. Facial action summary scores, i.e., pain displays, were at their lowest immediately after admittance to the PACU and just before the child's release from the PACU., Conclusions: The present study demonstrated that the CFCS serves as a valid measurement tool for persistent pain in children.

The purpose of this study was to select effective tests of motor ability based on pass-or-fail criteria for use with preschool children. 37 items selected by examining theoretical validity and the results of preliminary tests were administered to preschool children (3 yr.: M = 3.7 yr., SD = 0.28; 4 yr.: M = 4.7 yr., SD = 0.28; 5 yr.: M = 5.7 yr., SD = 0.28). A skilled tester and each child's homeroom teacher rated whether the child's performance passed certain criteria or not. With agreement on two trials as an index of test-retest reliability, the mean agreement among the three grades ranged from 69% to 99% for Locomotion, 59% to 95% for Manipulation; and 66% to 100% for Stability. Disagreement on two trials may reflect instability in movement, practice effects, and so on. With agreement between two testers as an index of objectivity for 37 items, 33 showed interrater agreement of 80% or more for all three grades. No significant increase in pass rate with age was found on 10 items. In examining the three conditions mentioned above 27 items were selected as tests of motor ability: 14 items for Locomotion, 7 items for Manipulation, and 6 items for Stability.

Purpose: A preschool vision screening program was reviewed to evaluate eccentric photoscreening (EP), visual acuity, and stereopsis in identifying anisometropia., Methods: Patients referred by the screening were examined to assess efficacy of the three screening techniques in a population of preschool children. Testability and comparison of screening results to the classification of anisometropia (> or = 1 D) by retinoscopy obtained during a complete examination were evaluated., Results: Although EP identified 94.5% of the anisometropic children as abnormal, only 27.8% were classified as anisometropic by EP. Of the anisometropic children, 36.1% failed acuity, but only 19.4% failed based on a 2 line or greater interocular acuity difference. Stereopsis correctly identified only 7.3% of anisometropes as abnormal., Conclusions: The sensitivity of EP in identifying anisometropic children as abnormal was superior to acuity and stereopsis, yet its ability to identify anisometropia specifically was poor. Anisometropia of low magnitude or that masked by the dead zone of the EP system was frequently classified as isometropic. Altering the EP referral criterion and/or taking photographs through adequate power plus lenses may improve the sensitivity for specifically identifying anisometropia. However, caution must be exercised when using EP to examine the prevalence of anisometropia in a population or if used to screen for only amblyogenic refractive errors (i.e., anisometropia), because many anisometropes will be missed, resulting in inaccurate prevalence data and significant underreferrals.

In the past few decades, the study of the impact of trauma and disaster on children has grown; however, information about the effects on very young children is still scarce in the literature. In some regards, the characteristics of stress in young children are similar to those of older children and adults; in other ways, their reactions are unique. These characteristics, as well as mediating factors and interventions with young children, are discussed. Suggestions for future research are offered.

Themes of separation from attachment figures are involved when caregivers are integrated into standard theory of mind tasks in which objects or toys are located. Two experiments test the hypothesis that searching for a caregiver would interfere with false belief performance and be related to a child's emotional awareness. Experiment 1 consisted of a cross-sectional study of three- to five-year-old children administered false belief tasks related to object identity, object location, and caregiver location, i.e., false belief tasks where story characters became separated from a parent and had to locate them. As expected, there were age-related improvements in false belief performance to above-chance levels during object identity and object location tasks, but performance on the caregiver location tasks showed no age-related improvement and at age five was poorer than other tasks. Emotional integration also varied with task. Children who were relatively more aware of emotions were more likely to pass tasks involving objects, and queries of emotions during tasks were related to false beliefs about objects but not caregivers. A second study of children five years of age indicated that it was not caregivers per se that disrupted their performance on false belief tasks. Additional tasks showed that this finding was due to caregivers being animate "behaving" objects whose relocation had been self- as opposed to other-directed, which suggests that false belief performance was related to the intent of the sought item. The developing awareness of the minds of others in five-year-olds and emotional content of the task may interfere with performance in false belief tasks that are social.

The study is an ongoing longitudinal and qualitative psycho-social study of the communicative development in 19 preschool children with cochlear implants, using sign language. The children are video-recorded in natural interactional settings. Analysis of patterns of communication show that 16 of the children use sign language in communication with adults and peers. With regard to oral communication, 13 children were observed to utter single words or speech-like sounds upon an adult's request, but seldom used spoken words spontaneously. Six children used single spoken words in dialogues with adults if the content of the dialogue was about the here and now, and if the topic of reference was clear. None of the children in the study were able to take part in age-adequate play activities with peers when speech was used in communication. The results are discussed in reference to early mother-infant interaction, the development of communication and language, and the significance of early close relationships for children's social and emotional development.

To investigate the psychological effects of armed conflict on children, the behavior of preschool Lebanese children exposed to heavy shelling two years prior to data collection was compared to that of Lebanese children who had experienced no direct shelling. Although the quality of the home environment was similar in the two groups, children who lived in the area of heavy shelling had significantly more behavioral problems than did those not exposed to shelling. For children in the shelled area, negative sequelae appear to have been buffered by a positive home environment and what the mother perceived as a more functional family.

Urinary incontinence in children aged 2 to 6 years whose mothers varied in ethnic descent, in level of education, and in immigration status was studied in Israel. Mothers of 302 children were interviewed in well-baby clinics regarding primary and secondary urinary incontinence of their children. A significant age trend was found for attaining primary urinary continence. However, various interactions between mothers' ethnic descent, mothers' level of education, and mothers' immigration status were associated with different rates of primary and secondary urinary incontinence in their children. Moreover, sex differences in rates of primary and secondary urinary incontinence were also associated with mothers' ethnic descent and level of education. It is suggested that different levels of maternal emotional availability to the child in the various subgroups can account for most of the findings.

Background: New, small-target (< 1 degree) random dot stereogram (STRDS) and binocular suppression (STBS) tests appropriate for preschool vision screening were developed to correct the shortcomings of previous such tests, particularly missed cases of anisometropic amblyopia such as found with some RDS-based testing., Methods: In Experiment 1, the tests were administered to 14 patients with current or a recent history of moderate (< or = 20/60) anisometropic amblyopia, or with accommodative esotropia or monofixation syndrome. All subjects had good binocularity (< or = 100" contour stereoacuity). In Experiment 2, the new tests were administered in a screening setting to a group of 112 three- to five-year-olds to determine testability. Visual acuity, cover testing, and photoscreening were administered as control measures., Results: In Experiment 1, eleven of the 14 patients failed both tests. Two anisometropic amblyopes passing one or both tests had an acuity < or = 20/30 in the worse eye and < or = 25" stereoacuity. Three anisometropic amblyopia patients failing the STRDS passed another RDS test with similar disparity but a larger target size, confirming a report34 that anisometropic amblyopes may pass RDS testing with parafoveal stereopsis despite the presence of central suppression. The STRDS and STBS tests indicated 80% and 96% specificity, respectively, with the original methodologies; STRDS specificity increased to 95% with retesting with a different methodology. Administration time was 30 sec to 60 sec per test., Conclusion: Small-target RDS or suppression testing may be more effective for strabismus and amblyopia screening of preschoolers than previous RDS test formats.

The purpose of this study was to investigate the developmental differences in pursuit eye movements among preschool children. The subjects were 28 children aged 3 to 6 years old and 5 adults aged 22 to 37 years. The target was moved sinusoidally on the horizontal plane at 0.3-, 0.5-, and 0.7-Hz stimulus frequency. The power ratio which represented the smoothness of eye movements and the phase difference between eye movements and target movement was calculated. The power ratio decreased with increased stimulus frequency for all subjects, indicating that eye movements became less smooth. At all stimulus frequencies, the power ratio was higher for adults than for children. Among the three age groups of children, there was no statistically significant difference on this parameter. The phase shifted from a small amount of lead for no lag to the lag with faster stimulus frequency in adults, but the gap was not statistically significant. For children, there was a statistically significant difference across age groups on change in the phase difference. These findings may suggest that the developmental differences in pursuit eye movements of children across ages 3 to 6 years were clear in what related to the phase difference.

The aim of this research was the empirical study of the development of object representations among preschool and fourth-grade children. Psychometric properties and age differences on structural and qualitative dimensions of parental descriptions are reported. The relationships between the dimensions of object representations and children's self-perceptions and interpretations of situations depicting typical interferences of ongoing parent-child relations were explored. Our findings point to multidimensional representations, underlying the importance of the structural dimensions of the representation. More mature representations were related to more advanced conflict resolution strategies. More positive perceptions of self in middle childhood and less idealized self-concept among preschoolers were associated to higher conceptual levels of parental representations. The constraints, as well as the possibilities, inherent to research based on narrative models of object representations are discussed.

Fourteen children aged 6 years received screening for educational risk status and formal measures of academic performance. These children have been followed prospectively from birth for their otitis media status. Seven of the children were considered positive for otitis media in year one (recurrent episodes bilaterally), while 7 were considered otitis free. Academic status was related to early hearing acuity (as determined by repeated ABR assessment). Moreover, teachers' ratings of academic risk status were related to a measure at 4 years that examined the children's capacity to listen in background noise.

Children with specific language impairment (SLI) have particular difficulty acquiring bound morphemes. To determine whether these morphological deficits spring from impairments of rule-induction or memory (storage/access) skills, 25 preschool-age children with normal language (NL) and 25 age-matched children with SLI were presented with a novel vocabulary and novel bound-morpheme learning task. A chi square analysis revealed that the children with SLI had significantly lower vocabulary learning levels than NL children. In addition, there was tentative evidence that a dependency relationship existed in some children between success in vocabulary learning and proficiency in generalizing a trained bound morpheme to untrained vocabulary stems. These findings are predicted by the storage/access but not the rule-induction theory of specific language impairment. They suggest that intervention targeting bound-morpheme skills acquisition in children with SLI might include attention to vocabulary development.

Fourth year optometry students screened 745 preschoolers using a slightly altered Modified Clinical Technique (MCT) under the supervision of a faculty doctor. Children who failed the MCT were randomly selected and then matched by age, sex, and ethnic origin to children who had passed the screening battery. The 61 screening failures and 45 matched controls were later given full eye examinations with cycloplegia by University of Alabama at Birmingham faculty doctors who were unaware of the screening results. The positive predictive value (PPV) (0.52) and negative predictive value (NPV) (0.78) of the MCT were calculated directly from the 2 x 2 contingency table crossing screening results and a standard diagnosis. Sensitivity [0.50, k(1,0) = 0.29], specificity [0.79, k(0,0) = 0.30], efficiency [0.70, k(0.5,0) = 0.29] of the MCT, and the prevalence (0.30) of children failing the standard diagnosis were estimated using statistics appropriate to the prospective sampling design. The reproducibility of the diagnosis, estimated by analyzing multiple, independent diagnosis of each study child by seven doctors was moderate (kappa D 0.58). Statistics summarizing the agreement between the MCT and the diagnosis by the individual study doctor are similar to those obtained with comparison to the standard diagnosis. The characteristics of the MCT may be generalized only to similar populations that are screened by clinicians with similar experience, using the same tests.

Methods: Data from a large longitudinal study of boys who were between kindergarten and age 13 years were used to (1) test whether Gray's and Cloninger's personality dimensions measured in kindergarten predicted the early onset of stable, highly delinquent behavior; (2) test whether 1, 2, or 3 dimensions were needed; and (3) test the predictive value of a categorical approach., Results: The impulsivity dimension was the best predictor of the early onset of stable, highly delinquent behavior. Anxiety and reward dependence made significant but weaker contributions. The categorical approach corroborated Cloninger's suggestion that boys who are high in impulsivity, low in anxiety, and low in reward dependence would be more at risk for delinquent involvement. Boys who were high in impulsivity and low in anxiety but high in reward dependence were much less at risk for delinquency. Differences in antisocial behavior among extreme kindergarten personality groups were stable from ages 11 to 13 years., Conclusions: The behavioral activating system appears to be the major dimension underlying the propensity toward early onset of antisocial behavior, but both the behavioral inhibition system and the need for social rewards play important roles. The behavioral style (personality) that results from the interplay of these systems is clearly in place by the kindergarten year. Preventive efforts should target preschool children with at-risk behavior profiles. However, longitudinal-experimental studies with at least yearly assessments between birth and school-entry age are needed to understand the extent to which the behavioral styles are antecedent to preschool disruptive behavior disorders.