Background Dental caries and gingivitis are preventable diseases that remain highly prevalent among children globally and, while transmissible through the transfer of oral bacteria typically from mother to child, differ from communicable diseases that are spread through direct contact, air, or vectors. Unlike communicable diseases, dental caries and gingivitis can be effectively prevented through proper oral hygiene practices and dietary modifications. Oral health education (OHE) intends to improve oral hygiene practices and reduce oral health problems. However, evidence of the impact of multiple topics in OHE on preschool children is lacking. This study aimed to examine the effects of single- versus multiple-topic OHE delivered via video presentations on the plaque and gingival status of preschool children. Methods A parallel five-arm cluster randomized controlled trial was conducted on healthy preschool children aged five and six years. Children with chronic illnesses, disabilities, or conditions that could affect their oral health or ability to participate in the OHE intervention were excluded. OHE interventions were given to children from eight of the 10 classes assigned as intervention groups, while two classes served as the control group and received no intervention. The intervention groups received one, two, or three oral health topics using specially developed animation videos, in Malay language: toothbrushing technique (T), toothbrushing technique and the effects of sugar consumption on oral health (TS), toothbrushing technique and pathogenesis of dental caries and gingivitis (TP), and toothbrushing technique, the effects of sugar consumption on oral health, and pathogenesis of dental caries and gingivitis (TSP). Plaque and gingival scores, along with oral health knowledge, attitude, and skills (KAS), were recorded before and after the intervention. The CONSORT guidelines were followed in reporting. The analyses included descriptive statistics, one-way ANOVA, effect sizes, and multivariate analysis of covariance (MANCOVA) at a 5% significance level. Results A total of 160 participants were equally distributed into five groups (n = 32). There were no baseline differences in plaque or gingival scores. All groups showed significantly lower plaque and gingival scores post-intervention (p < 0.05), with effect sizes ranging from -1.1 to -0.7. No changes in oral health (KAS) were observed. The intervention groups had significantly lower plaque and gingival scores compared to the control group (p < 0.05), but no differences were found between them after adjusting for baseline KAS (p > 0.05). Conclusions This study suggests that including multiple topics in OHE programs for preschool children may not necessarily improve oral health outcomes. Simplified OHE may be more advantageous in terms of time, cost, human resources, and organization.

To investigate the association between parenting style and child\'s dental caries. Parents presenting with their children to the Department of Pediatric Dentistry at Tufts University School of Dental Medicine for an initial exam or re-care appointment completed a demographic survey and the parenting styles and dimensions questionnaire. Recruitment of subjects started in May 2019 and ended in February of 2020. Child\'s decayed, missing, and filled teeth (dmft) index, diet score, sex, and age were recorded, as were parent\'s race, education level, and form of payment. Adjustment for confounders was done using multivariable negative binomial regression. The sample size was 210 parent/child dyads. In the multivariable analysis, parenting style and child\'s dmft were not significantly associated (p > 0.05). Parents with an education level less than high school (p = 0.02) and at the high school graduate level (p = 0.008) were significantly associated with children who had higher dmft, compared to parents with a college degree or higher. Children with excellent diet scores had significantly lower dmft than children with a diet score in the \"needs improvement\" category (p = 0.003). There was no significant evidence that parenting style is associated with child\'s dental caries. Parent\'s education level and child\'s diet score were significantly associated with child\'s dmft, less than high school (p = 0.02) and at the level of high school graduate (p = 0.008). Pediatric dental professionals should be aware of these risk indicators.

Infancy and early childhood are periods of dietary transition. Early exposure to specific foods and the establishment of dietary habits during this period can shape long-term food preferences and have lasting effects on health. This study aimed to examine the longitudinal trajectories of sugar-sweetened beverage (SSB) intake in Australian children from birth to age 3 years and identify early-life and socioeconomic factors influencing those trajectories. Mother-infant dyads (n = 934) from the Healthy Smiles Healthy Kids birth cohort study were interviewed on their weekly frequency of SSB intake at 4-month, 8-month, 1-year, 2-year, and 3-year age points. Group-based trajectory modelling analysis was performed to identify trajectories for SSB intake among Australian children. A multivariable logistic regression was performed to identify the maternal and child-related predictors of resulting trajectories. The intake of SSBs showed two distinct quadratic trajectories (high and low) with age. While the two trajectories remained distinctive throughout, the SSB consumption for both groups consistently increased between 4 months and 2 years of age and subsequently stabilised. Compared to low SSB consumers (75%), the high SSB consumers (25%) were significantly more likely to be living in households with three or more children (relative risk (RR): 1.59, 95%CI: 1.02-2.48), had low maternal education (left school < year 12-RR: 1.75, 95%CI: 1.09-2.81; completed year 12-RR: 1.57, 95%CI: 1.02-2.81), and resided in highly/the most socioeconomically disadvantaged areas (highly disadvantaged-RR: 1.89, 95%CI: 1.13-3.18; most disadvantaged-RR: 2.06, 95%CI: 1.25-3.38). Children\'s SSB intake patterns are established early in life as they transition from infancy to preschool age, and the trajectories of intake established during early childhood are strongly influenced by socioeconomic factors. Hence, interventions targeted to limit SSB intake and improve nutrition amongst children should occur in early life.

The impact of milk on bone health in rural preschoolers is under-researched. This study, through a clinical trial and a meta-analysis, finds that milk supplementation enhances forearm and calcaneus bone acquisition in children, supporting the benefits of daily milk consumption.
OBJECTIVE: This study evaluated the impact of dairy supplementation on bone acquisition in children\'s limbs through a cluster-randomized controlled trial and a meta-analysis.
METHODS: The trial involved 315 children (4-6 year) from Northwest China, randomized to receive either 390 ml of milk daily (n = 215) or 20-30 g of bread (n = 100) over 12 months. We primarily assessed bone mineral density (BMD) and content (BMC) changes at the limbs, alongside bone-related biomarkers, measured at baseline, the 6th and 12th months. The meta-analysis aggregated BMD or BMC changes in the forearm/legs/calcaneus from published randomized trials involving children aged 3-18 years supplemented with dairy foods (vs. control group).
RESULTS: Of 278 completed the trial, intention-to-treat analysis revealed significant increases in BMD (4.05% and 7.31%) and BMC (4.69% and 7.34%) in the left forearm at the 6th and 12th months in the milk group compared to controls (P < 0.001). The calcaneus showed notable improvements in BMD (2.01%) and BMC (1.87%) at 6 months but not at 12 months. Additionally, milk supplementation was associated with beneficial changes in bone resorption markers, parathyroid hormone (- 12.70%), insulin-like growth factor 1 (6.69%), and the calcium-to-phosphorus ratio (2.22%) (all P < 0.05). The meta-analysis, encompassing 894 children, indicated that dairy supplementation significantly increased BMD (SMD, 0.629; 95%CI: 0.275, 0.983) and BMC (SMD, 0.616; 95%CI: 0.380, 0.851) (P < 0.05) in the arms, but not in the legs (P > 0.05).
CONCLUSIONS: Milk supplementation significantly improves bone health in children\'s forearms, underscoring its potential as a strategic dietary intervention for bone development. Trial registration NCT05074836.

UNASSIGNED: Pediatric pneumonia presents a significant global health challenge, particularly in low- and middle-income countries. This study aimed to investigate the incidence of pneumonia in preschool children in Urumqi and its association with indoor environmental factors.
UNASSIGNED: This case-control study collected data from December 2018 to December 2019 on 1522 preschool children in Urumqi (779 boys and 743 girls) who were diagnosed with pneumonia by a physician. A control group of children who had never had pneumonia was matched in a 1:1 ratio based on gender, age, and ethnicity. Using questionnaires, data were collected on children\'s general characteristics, passive smoking, types of housing, flooring materials, and indoor dampness, analyzing potential factors associated with the incidence of pediatric pneumonia.
UNASSIGNED: Multivariate analysis revealed that cesarean birth (odds ratio [OR] = 1.27; 95 % confidence interval [95%CI] = 1.08-1.48), being an only child (OR = 1.32; 95%CI = 1.13-1.55), antibiotic treatment during the first year of life (OR = 2.51; 95%CI = 1.98-3.19), passive smoking during the mother\'s pregnancy (OR = 1.62; 95%CI = 1.24-2.13), living in multi-family apartment housing (OR = 1.64; 95%CI = 1.28-2.10) and other types of housing (OR = 1.47; 95%CI = 1.09-1.99), laminate flooring (OR = 1.31; 95%CI = 1.01-1.72), and tile/stone/cement flooring flooring (OR = 1.31; 95%CI = 1.06-1.61), and dampness in dwelling (during first year of mother\'s pregnancy) (OR = 1.30; 95%CI = 1.04-1.63) were risk factors for pediatric pneumonia. The use of fresh air filtration systems in children\'s residences (OR = 0.66; 95%CI = 0.50-0.86) was identified as a protective factor.
UNASSIGNED: This study underscores the importance of indoor environmental factors in the prevention of pediatric pneumonia. Public health strategies should consider these factors to reduce the incidence of pneumonia in children. Future research needs to be conducted over a broader geographical range and consider a more comprehensive range of factors influencing pediatric pneumonia.

Patients with phenylketonuria (PKU) present signs of impaired executive functioning and bone health in adolescence and adulthood, depending in part on the success of therapy in childhood. Therefore, nine children with well-treated PKU (4-7 years old, 22.2% ♀, seven with a full set of data, two included into partial analysis) and 18 age-, gender- and season-matched controls were analyzed for differences in executive functioning and bone parameters in plasma. Plasma was analyzed with commercially available kits. Cognitive performance in tonic alertness, visuo-spatial working memory, inhibitory control and task switching was assessed by a task battery presented on a touch screen. Regarding cognition, only the performance in incongruent conditions in inhibitory control was significantly better in children with PKU than in controls. No further differences in cognitive tests were detected. Furthermore, no significant difference in the bone turnover markers osteocalcin, undercarboxylated osteocalcin and CTX were detected between children with PKU and controls, while children with PKU had a significantly higher vitamin D concentration (69.44 ± 12.83 nmol/L vs. 41.87 ± 15.99 nmol/L, p < 0.001) and trended towards lower parathyroid hormone concentrations than controls (48.27 ± 15.16 pg/mL vs. 70.61 ± 30.53 pg/mL, p = 0.066). In this small group of well-treated preschoolers with PKU, no impairments in cognitive performance and bone turnover were observed, while vitamin D supplementation of amino acid supplements seems to be sufficient to achieve good vitamin D status.

OBJECTIVE: The identification and diagnosis of children with attention deficit hyperactivity disorder (ADHD) traits is challenging during the preschool stage. Neuropsychological measures may be useful in early assessments. Furthermore, analysis of event-related behavior appears to be an unmet need for clinical treatment planning. Conners\' Kiddie Continuous Performance Test (K-CPT) is the most popular well-established neuropsychological measurement but lacks event markers to clarify the heterogeneous behaviors among children. This study utilized a novel commercially available neuropsychological measure, the ΣCOG, which was more game-like and provided definite event markers of individual trial in the test.
METHODS: Thirty-three older preschool children (14 were diagnosed with ADHD, mean age: 66.21 ± 5.48 months; 19 demonstrated typical development, mean age: 61.16 ± 8.11 months) were enrolled and underwent comprehensive medical and developmental evaluations. All participants underwent 2 versions of neuropsychological measures, including the K-CPT, Second Edition (K-CPT 2) and the ΣCOG, within a short interval.
RESULTS: The study indicated the omissions and response time scores measured in this novel system correlated with clinical measurement of the behavioral scales in all participants and in the group with ADHD; additionally, associations with the traditional K-CPT 2 were observed in commissions and response time scores. Furthermore, this system provided a within-task behavioral analysis that identified the group differences in the specific trial regarding omission and commission errors.
CONCLUSIONS: This innovative system is clinically feasible and can be further used as an alternative to the K-CPT 2 especially in research by revealing within-task event-related information analysis.

BACKGROUND: Vitamin A (VA) remains a core micronutrient as VA Deficiency (VAD) in children has persisted as a public health problem in parts of Africa with adverse effects. Caregivers of children are essential in the control of VAD; however, there is a paucity of data on their knowledge of VA, dietary sources, and VAD. This study sought to assess the level of VA-related nutrition knowledge (VANK) and its predictors among caregivers of preschool children in Eastern Uganda.
METHODS: A cross-sectional analytical design was used. Both socio-demographic and knowledge and attitude (KA) data were collected using a structured questionnaire partly adapted from the FAO model Knowledge, Attitude and Practice (KAP) questionnaire. A sample size of 256 was used. Caregivers of 24-59 months-old children were selected from Bukwo District in Eastern Uganda using purposive and random sampling methods. Knowledge scores (%) based on responses to ten questions were determined and eventually classified as low (≤ 40%) and moderate or high (˃40%). Descriptive and inferential statistics were computed using SPSS (version 24). Logistic regression was used to identify predictors with p < 0.05 considered significant.
RESULTS: The study had 247 caregivers with a mean age of 30.9 ± 7.7 years. The majority were female (90%), married, subsistence crop farmers and had primary-level education or lower. The mean VANK score was 18.9 ± 24.7%. Overall, most of the caregivers had low VANK as only about 20% had moderate or high. The proportions that knew the different aspects of VANK were correspondingly small. About half of the caregivers (46.6%) knew VA itself and only 27% knew any of its sources. Those who knew VAD, its causes, signs/symptoms and prevention measures were 31, 22, 13 and 24% respectively. The caregivers\' VANK was significantly associated with their overall VA-related attitude, age and level of education. However, education and age were the significant predictors.
CONCLUSIONS: Caregivers had very low VANK. They barely knew VA and its food sources or VAD. The main predictors of VANK were caregiver age and level of education. The study recommends education of caregivers about VA for effective VAD control which contributes to achievement of the Sustainable Development Goal (SDG) 2.

BACKGROUND: Early childhood caries (ECC) remain a serious oral health problem on a global scale. Risk-based caries management (RBCM) implemented in some parts of the world has been effective in preventing ECC. However, there is a lack of prospective research on the application of RBCM among Chinese children, and little is known about its effectiveness. The purpose of this study was to evaluate the effectiveness of RBCM in preventing caries among children aged 3-5 years in Wanzhou District, Chongqing Municipality, China.
METHODS: Three- to five-year-old children from four kindergartens in Wanzhou were randomly selected for baseline dental examination and caries risk assessment (CRA) and randomly assigned to the experimental group (EG) or the control group (CG) according to the kindergarten. The EG received caries prevention measures of different intensities based on the child\'s caries risk level. The CG received full-mouth fluoride twice a year according to standard prevention, regardless of their caries risk. One year later, another dental examination and CRA were conducted, to observe changes in the decayed, missing, and filled teeth (dmft) index and caries risk, and to analyze potential factors that may affect the incidence of new caries.
RESULTS: Complete data were collected from 291 children (EG, N = 140, 84.8%; CG, N = 181, 83.4%). A total of 25.7% of the EG and 50.3% of the CG children developed new caries, with newly added dmft scores of 0.54 ± 1.12 and 1.32 ± 1.72, respectively (P < 0.05). Multivariate logistic regression indicated that children living in rural areas, assigned to the CG, and rated as high-risk at baseline were more likely to develop new caries (P < 0.05). The proportion of children with an increased caries risk in the EG was significantly lower than that in the CG (P < 0.05).
CONCLUSIONS: RBCM effectively prevented new caries in 3- to 5-year-old Wanzhou children and reduced the proportion of children at increased risk of caries. It is an effective approach for preventing ECC.
BACKGROUND: This trial was registered in the Chinese Clinical Trials Register. The registration number was ChiCTR230067551 (11/01/2023).

BACKGROUND: Previous studies on maternal parenting styles and children\'s callous-unemotional behavior (CU behavior) have focused on the West, and few studies have examined the longitudinal relationship between maternal parenting styles and CU behavior using Chinese preschoolers as subjects.
OBJECTIVE: Through a 1.5-year longitudinal lens, this study probed the relations between maternal parenting styles and CU behavior in the Chinese cultural setting.
METHODS: Participants were N = 492 Chinese young children (Mage = 52.44 months, SD = 5.00, 48 % girls).
METHODS: At Time 1 (T1), mothers reported their use of authoritative parenting styles (i.e., warmth, reasoning, and autonomy), authoritarian parenting styles (i.e., physical coercion, verbal hostility, and nonreasoning) and children\'s CU behavior. At Time 2 (T2; approximately 1.5 years later), mothers again reported the above variables.
RESULTS: Cross-lagged models indicated that maternal warmth, reasoning, autonomy, and nonreasoning at T1 predicted CU behavior at T2. However, not only did maternal physical coercion and verbal hostility at T1 predict CU behavior at T2, but CU behavior at T1 also predicted maternal physical coercion and verbal hostility at T2. Additionally, there were no gender differences in the relationship between dimensions of maternal parenting styles and CU behavior.
CONCLUSIONS: It underscores the influence of authoritative parenting in potentially mitigating CU behavior, while authoritarian approaches may exacerbate CU behavior. The absence of gender differences suggests these dynamics are broadly applicable across genders. These findings have significant implications for parenting strategies aimed at addressing CU behavior in children, emphasizing the need for warmth, reasoning, and autonomy in parenting practices.