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[Health education program development for infants, toddlers and preschool children].

PURPOSE: The purpose of this study was to develop a health education program for child care workers of infants, toddlers and preschoolers to improve their care ability. The program provided child care teachers and children with information on how to take care of their health. METHOD: This program development was based on a systematic design of instruction by Dick & Carey(1996). The process included a review of literature, setting an instructional goal, getting advice from various experts, designing instruction and instructional medias, designing formative evaluation, revising the program and making a summative evaluations. RESULT: The products of this program were the 'Teachers Guide Book & CD-ROM.' The guide book included health education programs for infants, toddlers and preschoolers. The infant program included a basic baby care program for teachers. The toddlers and preschoolers program included basic health promotion, dental health, nutrition management, communicable disease prevention, substance abuse prevention and a safety program. CONCLUSION: These programs provided a systematic content of health education for children and their teachers, and useful data which can be applied to child care centers.

Caregivers↗

Object permanence development in infants with motor handicaps.

This study was an investigation of the effects of a motor handicap on the development of object permanence in the young child. Motor abilities were evaluated for 12 infants aged 13 to 29 months. Based on this evaluation, the children were described as manipulators or nonmanipulators in reference to their upper extremity skills. Their stage of object permanence was assessed using traditional and nontraditional assessments. Heart rate and visual tracking were recorded during the nontraditional assessment. Heart rate did not significantly relate to visual fixation or search response. There was, however, a significant difference (p less than .02) between stage achievement with traditional testing and age-appropriate levels. There was no significant difference between the nontraditional assessment and the age-appropriate levels. In addition, there was no significant difference in the development of object permanence between infants described as manipulators and those described as nonmanipulators. The last two findings suggest that infants with motor handicaps may develop object permanence at the expected ages, according to a nontraditional assessment.

Child, Preschool↗

Brief report: birth status, medical complications, and social environment: individual differences in development of preterm, very low birth weight infants.

OBJECTIVE: To assess whether medical complications mediate the relationship between birth status (i.e., birth weight and gestational age) and developmental outcome of preterm, very low birth weight (VLBW) infants, as well as the role of the early social environment (maternal distress and social support) in infant development. METHOD: Birth status and medical complication information was collected during the child's NICU stay. Maternal distress was assessed with the Beck Depression Inventory and the Parenting Stress Index at 4 months corrected infant age. Social support was measured with the Dunst Scales at 4 months corrected age. Child development measures were collected at 4 and 13 months corrected age (Bayley MDI and PDI), and at 36 months chronological age (PPVT-R and Achenbach CBCL). RESULTS: Medical complications mediated the birth status-outcome relationship at 4 and 13 months, but not at 36 months. The 36-month outcomes were predicted by 4-month maternal distress and social support. CONCLUSIONS: Prematurity and VLBW are indirectly related to early developmental outcome through their association with medical complications. However, by 36 months, developmental outcomes are more closely related to aspects of the early social environment than to early physiological factors.

Adult↗

Cigarette smoke exposure and development of infants throughout the first year of life: influence of passive smoking and nursing on cotinine levels in breast milk and infant's urine.

The effects of smoke exposure via mothers' milk and/or via passive smoking during the first year of life were investigated in a prospective longitudinal matched-pair study. The somatic and mental development of 69 infants whose mothers smoked more than five cigarettes per day throughout pregnancy and continued smoking after childbirth were compared with 69 children of non-smoking mothers. At birth, mean body weight of neonates from smoking mothers was significantly lower than the weight of neonates from non-smoking mothers. This weight difference between the two groups was no longer significant in infants at 12 months of age. With the methods employed by the authors, neither psychomotor nor mental development was affected by smoke exposure during pregnancy and early infancy. Infections of the lower respiratory tract were more frequent in the children of smoking mothers. These mothers weaned their babies earlier than non-smokers, but the different feeding behaviour did not influence any of the clinical parameters that were investigated in this study. In order to evaluate the extent of smoke exposure, cotinine was measured in children's urine and in breast milk once a month throughout the first year of life. Cotinine in the urine was significantly dependent on feeding behaviour: infants breast fed showed concentrations 10-fold higher than those who were bottle fed. Cotinine excretion in urine of infants from smoking mothers, who were not breast fed (nicotine exposure via passive smoking only) was even higher than that of adult passive smokers. If infants from smoking mothers were breast fed, their urinary cotinine excretion was in the range of adult smokers.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Fluoxetine in breast-milk and developmental outcome of breast-fed infants.

BACKGROUND: Selective serotonin reuptake inhibitors are currently the most widely prescribed antidepressant drugs. There are only four published studies of breast-feeding mothers and their infants in which the mothers were taking fluoxetine. METHOD: Four mothers who took fluoxetine and their breast-fed infants were studied. Samples of plasma, breast-milk and urine were taken from the mothers and of plasma and urine from infants for assays of drug and metabolite concentrations. Bayley Scales of Infant Development were repeatedly used to assess cognitive and psychomotor development of the infants. RESULTS: Fluoxetine and norfluoxetine were detected in all samples of maternal plasma (range of total concentration 138-427 ng/ml) and in breast-milk (range 39-177 ng/ml). Amounts of both fluoxetine and norfluoxetine in infants' plasma and urine were below the lower limit of detection. All infants were observed to be developing normally and showed no abnormal findings on neurological examination. CONCLUSIONS: Much larger databases are needed but these four cases do not provide any evidence to suggest that women who are maintained on therapeutic doses of fluoxetine should discontinue breast-feeding their infants if they wish to breast-feed.

Breast Feeding↗

Evaluation of Infant Diarrhea Associated with Elevated Levels of Sulfate in Drinking Water: A Case-Control Investigation in South Dakota.

The objective of this study was to assess the association between infant diarrhea and ingestion of water containing elevated sulfate levels. The authors identified 274 mothers of infants born in 19 South Dakota counties with high water sulfate concentrations. Demographic information and seven-day- recall dietary and health data were obtained by telephone interviews. Sulfate in drinking water was measured from samples submitted by the participants. Logistic regression was used to estimate the risk for diarrhea (>/=3 loose stools in 24 hours). Questionnaires were completed for 274 households: 69% drank municipal water and 54% reported using the water in the infants' diets. Thirty-nine infants developed diarrhea. Of the 170 households that submitted water samples, 141 (83%) were using the water in the infants' diets. The median sulfate level of the water samples was 264 mg/L. Twenty-five of the infants developed diarrhea. Average infant daily sulfate intake was not significantly associated with an increased diarrhea rate. There was no significant association between sulfate ingestion and the incidence of diarrhea for the range of sulfate levels studied. There was no evidence of a dose-response or threshold effect. However, because of the small number of the most highly exposed infants, the possibility of such an association should be further evaluated.

Journal Article↗

Pharmacogenetics and development: are infants and children at increased risk for adverse outcomes?

Over the past two decades, pharmacokinetic data have clearly demonstrated that development can markedly influence the absorption, distribution, excretion, and metabolism of xenobiotics. With respect to many of the processes that govern drug metabolism, the underlying pharmacogenetic determinants that may control either the affinity or the capacity of a drug or toxicant substrate for the enzymes responsible for its biotransformation appear to be altered as a function of development by mechanisms that are, for the most part, not well defined. Nonetheless, for many xenobiotics, the pharmacogenetic-developmental interface produces a "pattern" for drug metabolism that, when characterized, supports the pharmacokinetic properties (eg, drug clearance) reported for many agents across the pediatric age spectrum. With the exception of a few relatively well-characterized adverse drug effects (eg, toxicity of 6-mercaptopurine in patients with absent thiopurine methyltransferase activity, increased incidence of hepatotoxicity to valproic acid in young infants), the relationship of development and pharmacogenetics to enhanced toxicity risk from xenobiotic exposure is poorly defined. However, failure to adequately appreciate the pharmacokinetic consequences of the pharmacogenetic-developmental interface and to individualize therapy accordingly may lead to a clinically significant risk of drug therapy, namely, over- or underdosing.

Alcohol Dehydrogenase↗

Effects of cheiloplasty on maxillary dental arch development in infants with unilateral complete cleft lip and palate.

OBJECTIVE: To identify and analyze quantitatively the development of the maxillary dental arch before and after cheiloplasty. DESIGN: Prospective, longitudinal study of maxillary dental arch development at age of 1, 3, 6, and 12 months. SETTING: All patients were treated at a university hospital craniofacial center. PATIENTS: Twenty-seven infants with nonsyndromic, unilateral complete cleft lip and palate. INTERVENTION: Millard's rotation-advancement cheiloplasty was performed between the ages of 3 and 4 months. RESULTS: The anterior portion of the nonclefted segment (I-G), anterior ridge length of the nonclefted segment (I-C), and anterior ridge length of the clefted segment (L-C') continuously increased from 1 to 12 months of age. The anterior cleft width (G-L), anterior arch depth (I perpendicular to CC'), anterior basal angle (angle GC-CC'), and anterior arch curature angle (angle GIC) continuously decreased after the cheiloplasty. CONCLUSIONS: Cheiloplasty could mold the anterior portion of the maxillary dental arch palatally by exerting continuous pressure.

Analysis of Variance↗

Reduced auditory acuity in rat pups from excess and deficient omega-3 fatty acid consumption by the mother.

Consumption of the nutrients omega-3 fatty acids (omega-3 FA) during pregnancy and lactation is considered beneficial to fetal and infant development. It may also reduce the incidence and severity of preterm births by prolonging gestational length. However several recent human and animal studies have reported that over-supplementation with omega-3 FA, especially in the form of fish oil, can have adverse effects on fetal and infant development and the auditory brainstem response (ABR). Our goal was to assess further the effects of omega-3 FA excess and deficiency during pregnancy and lactation on the offspring's auditory acuity as evidenced by their ABR thresholds. Female Wistar rats were given diets that were either deficient, adequate (control) or excess in omega-3 FA from day 1 of pregnancy through lactation. The offspring were ABR-tested at the postnatal age of 24 days. The rat pups in the Excess treatment condition had significantly elevated (worse) ABR thresholds, postnatal growth restriction, and a trend for increased postnatal mortality in comparison to the Control group. The Deficient group was intermediate. In conclusion, excess or deficient amounts of omega-3 FA during pregnancy and lactation in the laboratory rat adversely affected the offspring's auditory acuity. Postnatal thriving was also adversely affected. Consuming or administering large or inadequate amounts of omega-3 FA during pregnancy and lactation seems inadvisable because of the potential for adverse effects on infant development.

Analysis of Variance↗

Studying cross-cultural differences in the development of infant temperament: People's Republic of China, the United States of America, and Spain.

Investigated early development of temperament across three cultures: People's Republic of China (PRC), United States of America (US), and Spain, utilizing a longitudinal design (assessments at 3, 6, and 9 months of age). Selection of these countries presented an opportunity to conduct Eastern-Western/Individualistic-Collectivistic comparisons. The greatest number of significant differences (i.e., involving more temperament dimensions) was anticipated for the US (Western/Individualistic) and PRC (Eastern/Collectivistic) comparisons. The US sample included 66, the PRC group 69, and the Spanish sample, 60 mothers, all of whom completed the Infant Behavior Questionnaire (IBQ) 3 times, when their infants were 3, 6, and 9 months of age. Results related to mean group differences were generally consistent with our hypotheses, demonstrating a greater number of significant differences for US versus PRC, with fewer differences observed for US and Spain. Analyses addressing developmental changes in temperament indicated patterns consistent with a priori expectations and cross-cultural differences.

China↗

Developmental outcomes at one and two years of children conceived by intracytoplasmic sperm injection.

BACKGROUND: Present opinions regarding developmental delay of children conceived with intracytoplasmic sperm injection (ICSI) are variable and without consensus. METHODS: We compared developmental outcome at 1 and 2 years of 50 children conceived by ICSI with 51 spontaneously conceived children. Assessments were performed using the Bayley Scales of Infant Development for motor and mental development and quality of behavior, and the CARE-Index for the quality of parent-child interaction. RESULTS: No difference was present in the motor and mental development of study and control groups, as assessed by the Bayley Scales. However, 1-year-old ICSI children had lower Behavioral Index scores than controls in the "Motor Quality" item (p = 0.04). Regarding interaction with parents, ICSI families had lower "father cooperation" CARE-Index scores (p = 0.02) and lower sensitivity scores (p = 0.007). No significant differences were present between study and control groups for the 2-year-old children. CONCLUSIONS: ICSI conceived children develop normally. When assessed by the Bayley Scales of Infant Development and the CARE-Index, the differences in quality of development and social interaction observed at 1 year of age had no negative effect on the overall level of development, and appeared to be related to developmental processes of the entire family unit rather than to ICSI-related biological effects. Observed differences dissipated with familial adaptation and were not observed at 2 years of age.

Adult↗

Assessment of infant mental development: toward a broader perspective.

The limitations on predictions of intelligence provided by single-point neonatal and infant assessments continue to hamper efforts to certify the clinical outcome of children at risk. Although new methods of clinical assessment show promise of offsetting these limitations, each method alone has not markedly improved predictions. From a developmental perspective, a strategy for assessment should include a broad range of measures combined empirically to form a developmental risk registry. The strategy takes into account evolving changes, as well as levels of competencies of the infant, and considers these within the evolving environmental context of the family.

Child Development↗