Cognitive and social-emotional development in the first three years of life is associated with later skills. However, little is known about the paths of developmental delays in both cognitive and social-emotional skills before age 3 or to what extent these paths predict later developmental outcomes. The aim of this study is to examine the associations between the different paths of developmental delays in both cognitive and social-emotional skills of children before age 3 and the levels of development of the children when they are preschool age. Using a longitudinal data collected at three time points from 1245 children and their caregivers in rural China, we identified four different paths of developmental delays in cognitive and social-emotional before age 3 and examined how these paths are associated with different levels of developmental outcomes at preschool age. We used a non-parametric standardization approach and an ordinary least squares model to perform our analyses. Findings show that rates of developmental delays in either cognitive or social-emotional domain or both domains are high at all different time points, ranging from 20% to 55% for cognitive delays and 42% to 61% for social-emotional delays. Over half of children experienced deteriorating levels of either cognitive or social-emotional development before age 3. A large share of children was found to be persistently delayed in either domain. Only a small share of children raised their levels of development in either domain before age 3. In addition, we identified certain socioeconomic status of the family that are associated with never or deteriorating path of child developmental delays. More importantly, we revealed that different paths of developmental delays before age 3 have predictive power on different levels of developmental outcomes at preschool age. Our results suggest that actions are needed at the earliest times to improve child development when children are still infants or toddlers.

UNASSIGNED: This study aimed to develop an efficient tool for assessing children\'s fundamental motor skills, the \"Track style\" Children\'s Fundamental Movement Skills Test (TCFMST), based on theories of motor development integrated with Chinese cultural context and physical education teaching situations.
UNASSIGNED: Starting from a literature analysis, the study selected items from existing fundamental movement skill (FMS) assessments, textbooks, physical education and health standards, and children\'s movement guidelines to construct a pool of test items. Subsequently, the items were screened and optimized using the Delphi method. Finally, the feasibility, discrimination, difficulty, reliability, and validity of the constructed test were examined using testing methods.
UNASSIGNED: The TCFMST includes three dimensions: locomotive skills, body control skills, and manipulative skills, with a total of 10 items. The difficulty and discrimination of each item are appropriate; the correlation coefficients for retest reliability range from 0.789 to 0.943 (p < 0.01). The results of exploratory factor analysis indicate that the common factors align with the hypothesized three dimensions, indicating good structural validity of the test. The concurrent validity results show a correlation coefficient of -0.510 (p < 0.01) between the TCFMST and the total score of TGMD-3, indicating a moderate correlation between the two tests.
UNASSIGNED: The TCFMST developed in this study has good difficulty, discrimination, reliability, and validity. It also features strong operability, a short duration, and high interest. It can serve as an important tool for monitoring children\'s fundamental motor skill levels.

Objective: To investigate the effects of enriched environments on behavioral development at toddler period of preterm who had experienced early repeated operative pain. Methods: A cross-sectional study was conducted. A total of 80 high-risk preterm children of 2 years of age, who had experienced repeated pain stimuli in the neonatal intensive care unit (NICU), were enrolled as preterm group from the High-risk Children Clinic of Children\'s Hospital of Nanjing Medical University from October 2016 to March 2021. Furthermore, 39 full-term healthy children, aged 2 years, who were undergoing routine check-ups during the same period, were selected as the full-term group. The preterm group was further divided into preterm intervention group and preterm non-intervention group based on the implementation of enriched environment interventions. Data of neonatal characteristics from 3 groups were collected. Growth and development indicators at the age of 2 years were measured. Neuropsychological development evaluated by Gesell developmental scale. Behavioral development evaluated by child behavior check list. The salivary cortisol levels in response to novelty (baseline, task, end) were collected. The family environment, including maternal parenting pressure, were evaluated through a survey questionnaire. One-way ANOVA and least significant difference (LSD) tests were used to compare physical development, maternal parenting stress, Gesell neuropsychological development, and behavioral problems among the 3 groups. A repeated-ANOVA and LSD tests were employed to compare the patterns of salivary cortisol secretion. Pearson correlation analysis was used to explore the influencing factors related to neuropsychological and behavioral development and cortisol level. Results: There were 44 cases in the preterm intervention group (17 males, gestational age of (31.3±2.8) weeks), and 36 in the preterm non-intervention group (29 males, gestational age of (32.5±2.6) weeks). The full-term group consisted of 39 children (23 males, gestational age of (39.3±2.1) weeks). At 2 years of age, the height, weight, and head circumference of the preterm intervention group and non-intervention group were all lower than those of the full-term group (all P<0.05).The Gesell developmental schedule showed that the preterm non-intervention group scored all lower in gross motor, fine motor, adaptive, language and personal-social domains compared to the full-term group (91±7 vs. 97±6, 88±9 vs. 94±6, 89±8 vs. 99±8, 84±10 vs. 100±15, 89±7 vs. 95±6), with statistical significance (all P<0.01). The preterm intervention group scored all higher than the preterm non-intervention group in gross motor, fine motor, adaptive and language domains (all P<0.05), with no significant difference compared to the full-term group (all P>0.05). The number of needle painful procedures during hospitalization in NICU of the non-intervention group was negatively correlated to the adaptive development quotient (r=-0.48, P<0.05). Furthermore, the preterm non-intervention group exhibited higher scores in social withdrawal, depression, somatic complaints, aggression, and destructive behaviors compare to the full-term group and preterm intervention group (F=8.07, 5.67, 7.72, 7.90, 7.06; all P<0.05); while the preterm intervention group showed no significant difference compared to full-term group (all P>0.05). Behavioral problems (social withdrawal and depression) in the preterm non-intervention group were positively correlated with maternal parenting stress (r=0.66, 0.50; both P<0.05). In response to novel visual stimuli and cognitive challenges, the preterm non-intervention group had significantly higher salivary cortisol levels compared to the full-term group (P=0.006), which were negatively correlated with the frequency of early painful procedures (r=-0.83, -0.80; both P<0.01). There was no significant difference in cortisol secretion pattern between the intervention group and the full-term group (P=0.772). Conclusion: Enriched environmental interventions can improve neuropsychological development, decrease behavioral problems, and down-regulate consistent high cortisol response to task in preterm infants who have experienced repeated procedural pain in the NICU by the age of 2 years.
目的： 探讨丰富环境对早期经历反复操作性疼痛早产儿幼儿期行为发育的影响。 方法： 横断面研究，纳入2016年10月至2021年3月在南京医科大学附属儿童医院高危儿门诊建档并随访至2岁的80例高危早产儿（既往在新生儿重症监护病房经历反复疼痛刺激），作为早产儿组；选取同期本院儿童保健科门诊体检的39名足月出生的2岁健康儿童，作为足月儿组。早产儿组根据丰富环境具体实施情况，分为早产儿干预组和早产儿对照组。收集3组儿童出生资料，测量2岁时生长发育指标，Gesell发育量表评估神经心理发育，儿童行为量表评估行为发育情况，收集唾液检测面对新奇事物不同时间点（基线、任务态、结束时）皮质醇水平，通过调查问卷评估家庭环境包括母亲育儿压力等。采用单因素方差分析和最小显著差异法（LSD）检验比较3组儿童体格发育情况、母亲育儿压力、神经心理发育和行为问题；重复方差分析和LSD检验比较3组唾液皮质醇的分泌变化；运用Pearson相关分析法分析儿童神经心理以及行为发育和皮质醇分泌的相关影响因素。 结果： 早产儿干预组44例，其中男17例，出生胎龄（31.3±2.8）周；早产儿对照组36例，其中男29例，出生胎龄（32.5±2.6）周；足月儿组39名，其中男23名，出生胎龄（39.3±2.1）周。早产儿干预组和早产儿对照组在2岁时的身长、体重和头围均低于足月儿组（均P<0.05）。早产儿对照组儿童Gesell发育量表评估大动作、精细动作、适应性、语言和个人社交的发育商均低于足月儿组（91±7比97±6，88±9比94±6，89±8比99±8，84±10比100±15，89±7比95±6，均P<0.01）；早产儿干预组在大动作、精细动作、适应性和语言方面发育商均高于早产儿对照组（均P<0.05），与足月儿组差异均无统计学意义（均P>0.05）。早产儿对照组的新生儿重症监护病房经历针刺性操作次数与2岁时适应性发育商呈负相关（r=-0.48，P<0.05）。早产儿对照组儿童社交退缩、抑郁、躯体不适、攻击行为及破坏性行为得分均高于足月儿组和早产儿干预组（F=8.07、5.67、7.72、7.90、7.06，均P<0.05）；早产儿干预组与足月儿组差异均无统计学意义（均P>0.05）。早产儿对照组的行为问题（社交退缩、抑郁）均与母亲育儿压力呈正相关（r=0.66、0.50，均P<0.05）。在面对视觉新奇事物时，早产儿对照组唾液皮质醇随任务时间变化分泌水平持续高于足月儿组（P=0.006），与早产儿在新生儿重症监护病房经历的致痛性操作次数以及针刺性疼痛次数均呈负相关（r=-0.83、-0.80，均P<0.01）。早产儿干预组皮质醇随时间变化趋势与足月儿组差异无统计学意义（P=0.772）。 结论： 丰富环境干预可改善在新生儿重症监护病房经历反复操作性疼痛的早产儿2岁时神经心理发育，纠正不良行为问题，下调任务态时皮质醇的高分泌水平。.

BACKGROUND: Arsenic pollution is widespread worldwide. The association between gestational arsenic exposure and adverse birth outcomes has been demonstrated in previous studies; however, few investigations have examined whether gestational arsenic exposure has adverse effects on infant growth and development after birth.
OBJECTIVE: Our study was designed to evaluate particular associations between gestational arsenic exposure during pregnancy and newborn birth size and to investigate whether these associations continue to affect infants after birth.
METHODS: An ongoing prospective cohort study of 1100 pregnant women was conducted at the Wuxi Maternity and Child Health Care Hospital. The total urinary arsenic concentrations in the 2nd and 3rd trimester were determined using atomic fluorescence spectrometry. The relationships between urinary arsenic concentration and foetal growth parameters (birth weight, head circumference, length, and ponderal index), SGA (Small for gestational age), and physical growth of infants within one year after birth were analysed.
RESULTS: Urinary arsenic concentration in the 3rd trimester was associated with an increased incidence of SGA [adjusted model: OR = 2.860 (95% CI: 1.168, 7.020), P = 0.021)]. Arsenic exposure in late pregnancy had an adverse effect on the physical development of infants before the age of 1 year, and there was an interaction effect with the sex of infants. The weight and length of boys at 6 and 12 months negatively correlated with maternal urinary arsenic levels during late pregnancy.
CONCLUSIONS: In addition to affecting foetal growth, exposure to arsenic in the 3rd trimester also negatively affected the growth of offspring within the first year of life.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder. Early diagnosis in the critical period is important for ASD children. Recent studies of neurodevelopmental behavioral features and joint attention in high-risk infants showed there are some special cues which can distinguish ASD from typical development infant. But the findings of high-risk population may not be applicable to the general population. It is necessary to \"analogically\" study the potential warning traits of ASD in infancy in the general population. We did a nested case-control study from June 2019 to November 2022 in Tianjin, China, including 76 general infants whom completed the neurodevelopmental evaluation, the Checklist for Autism in Toddlers-23 (CHAT-23) screening, and eye tracking task. Social behavior quotient in infancy was negatively correlated to CHAT-23 total scores in toddlerhood. Social behavior quotient in infancy was positively correlated to initiating joint attention in toddlerhood. Regression model showed that high fine motor scale and social behaviour scale quotient in infancy were associated with an decreased risk of the total score of CHAT-23 ≥ 2 in toddlerhood. The Receiver operating characteristic curve showed the social behaviour in infancy alone and the combination of fine motor and social behaviour in infancy contributed to auxiliary diagnosis of higher level of autistic traits in toddlerhood. These findings suggest that Impaired development of fine motor and social behavior in infancy are potential warning features of high autistic traits in general population.

Deception is an essential part of children\'s moral development. Previous developmental studies have shown that children start to deceive at the age of 3 years, and as age increased to 5 years, almost all children were able to deceive for their own benefit. Although behavioral studies have indicated that the emergence and development of deception are related to cognitive abilities, their neural correlates remain poorly understood. Therefore, the present study examined the neural correlates underlying deception in preschool-aged children (N = 89, 44 % boys, age 3.13 to 5.96 years, Han Chinese) using functional near-infrared spectroscopy. A modified hide-and-seek paradigm was applied to elicit deceptive and truth-telling behaviors. The results showed that activation of bilateral dorsolateral prefrontal cortex was positively associated with the tendency to deceive an opponent in a competitive game in the 3-year-olds. In addition, 3-year-olds who showed a high tendency to deceive showed the same brain activation in the frontopolar area as 5-year-olds did when engaged in deception, whereas no such effect was found in 3-year-olds who never engaged in deception. These findings underscore the link between preschoolers\' deception and prefrontal cortex function.

It is well-accepted that multisensory integration (MSI) undergoes protracted maturation from childhood to adulthood. However, existing evidence may have been confounded by potential age-related differences in attention. To unveil neurodevelopmental changes in MSI while matching top-down attention between children and adults, we recorded event-related potentials of healthy children aged 7 to 9 years and young adults in the visual-to-auditory attentional spreading paradigm wherein attention and MSI could be measured concurrently. The absence of children versus adults differences in the visual selection negativity component and behavioral measures of auditory interference first demonstrates that the child group could maintain top-down visual attention and ignore task-irrelevant auditory information to a similar extent as adults. Then, the stimulus-driven attentional spreading quantified by the auditory negative difference (Nd) component was found to be overall absent in the child group, revealing the children\'s largely immature audiovisual binding process. These findings furnish strong evidence for the protracted maturation of MSI per se from childhood to adulthood, hence providing a new benchmark for characterizing the developmental course of MSI. In addition, we also found that the representation-driven attentional spreading measured by another Nd was present but less robust in children, suggesting their substantially but not fully developed audiovisual representation coactivation process.

OBJECTIVE: This study aimed to analyze the height growth pattern and the incidence of significant growth deceleration in girls with CPP and EFP on GnRHa treatment, and thereby identify relevant predictors of growth deceleration.
METHODS: The data of 99 girls diagnosed with CPP and 47 girls with EFP were included in this retrospective analysis. The incidence of growth deceleration was calculated in both the first and second years. Multivariate logistic regression analysis was used to identify predictors indicative of growth deceleration.
RESULTS: Growth velocity (GV) trajectories showed gradual decreases to the nadir at 18 months of treatment, and then they recovered till the 24th month of treatment, especially in girls with CPP. Nevertheless, the recovery was significantly greater in the CPP group than EFP. In the first year, no significant difference in the incidence of growth deceleration was found between the CPP group and the EFP group [17.35 vs. 25.53 %, p=0.249]; in the second year, the CPP group had a lower incidence than the EFP group [42.86 vs. 76.92 %, p=0.027]. The multivariate logistic regression analysis suggested that bone age (BA) was an independent predictor of growth deceleration (OR=2.264, 95 % CI: 1.268-4.042, p=0.006). The result of ROC curves showed the cut-off value of BA was 11.05 years.
CONCLUSIONS: GV varies at different periods during GnRHa treatment. GnRHa should be used with more caution for EFP treatment than for CPP. BA can be used to predict the occurrence of growth deceleration during GnRHa treatment.

UNASSIGNED: Vitamins A and D are essential for the health of pregnant women and infants. Nevertheless, the relationship between umbilical cord blood vitamins A and D levels and the physical growth of exclusively breastfed infants remains uncertain.
UNASSIGNED: This cohort study aims to examine the relationship between cord blood vitamins A and D levels and the physical growth of exclusively breastfed infants aged 0-6 months.
UNASSIGNED: 140 singleton mother-infant pairs were recruited in total. Questionnaires were used to collect maternal and infant information, and liquid chromatography was utilized to quantify the levels of vitamins A and D in the umbilical cord blood. Anthropometric measurements were conducted at birth, at 3 and 6 months of age, and the weight-for-age z-score (WAZ), length-for-age z-score (LAZ), head circumference-for-age z-score (HAZ), and BMI-for-age z-score (BMIZ) were calculated. Univariate and multivariate linear regression models were used for the analysis.
UNASSIGNED: The average concentration of vitamins A and D in cord blood was 0.58 ± 0.20 μmol/L and 34.07 ± 13.35 nmol/L, both below the normal range for children. After adjusting for confounding factors, vitamin A levels in cord blood positively correlated with HAZ growth in infants aged 3-6 months (β= 0.75, P < 0.01) while vitamin D levels negatively correlated with LAZ growth (β= -0.01, P = 0.01) and positively correlated with BMIZ growth (β= 0.02, P < 0.01).
UNASSIGNED: Higher Vitamin A levels at birth promote HAZ growth in infants aged 3-6 months while higher vitamin D levels at birth promote BMIZ growth in infants aged 3-6 months.
UNASSIGNED: https://register.clinicaltrials.gov, identifier NCT04017286.

The current study aimed to explore the combined and individual effects of vitamin D (VitD) status in three trimesters during pregnancy and cord blood (CB) on child growth trajectories from birth to 4 years of age. Pregnant women (n = 1100) were recruited between 2013 and 2016 in the Shanghai Birth Cohort (SBC) Study. A total of 959 mother-child dyads were included. VitD status was measured by LC-MS/MS at three trimesters (T1, T2, T3) and CB. Children\'s weight, length/height, and head circumference were assessed at birth, 42 days, 6, 12, 24 months, and 4 years of age, and standardized into z-scores [weight-for-age z-score (WAZ), length-for-age z-score (LAZ), head circumference-for-age z-score (HCZ) and weight-for-length z-score (WLZ)]. Using the group-based trajectory model (GBTM), the trajectories of the four growth parameters were categorized into discrete groups. The generalized estimating equation (GEE) was employed to analyze the mixed effect of 25(OH)D throughout pregnancy on growth trajectories. The association between 25(OH)D status and each growth trajectory group was examined by multivariable logistic regression. Each 10 ng/mL increase in 25(OH) throughout three trimesters was not associated with four anthropometric parameters. Each 10 ng/mL increase in VitD in T3 was associated with a lower risk in the WAZ high-increasing trajectory (aOR: 0.75; 95% CI: 0.62, 0.91; p < 0.01). Each 10 ng/mL increase in VitD in CB was associated with a lower risk in the WAZ high-increasing trajectory (aOR: 0.57; 95% CI: 0.43, 0.76; p < 0.01). No significant association was found between maternal or CB VitD and LAZ or HCZ. Three trimesters\' VitD throughout pregnancy had no persistent effect on the offspring\'s growth trajectory. However, higher VitD status in the third trimester and CB related to a lower risk of high-increasing WAZ from birth to 4 years of age. Elevated VitD levels in late pregnancy and cord blood may protect against continuous early-life weight growth at high levels.