Chinese Journal of Child Health Care

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Guidelines of health nurturing care for children under 3 years old (trial implementation)

National Health Commission of the People′s Republic of China

Chinese Journal of Child Health Care 2023, 31 (1): 1-9. DOI: 10.11852/zgetbjzz2022-1446

Abstract （374）

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Status and challenges of early recognition and early diagnosis of autism spectrum disorder

KE Xiaoyan

Chinese Journal of Child Health Care 2023, 31 (3): 238-240. DOI: 10.11852/zgetbjzz2023-0013

Abstract （230）

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Autism spectrum disorder(ASD) is a neurodevelopmental disorder that seriously impacts the development of children. It has become a clinical consensus that early identification and early intervention are effective means. For professional reference, this paper mainly reviews and discusses the progress in early detection, early screening and early diagnosis of autism spectrum disorder in the domestic and overseas researches, as well as the problems in clinical practice.

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Responsive care in early childhood development nurturing care systems

NI Xue-fei, FAN Li-chun

Chinese Journal of Child Health Care 2023, 31 (1): 62-65. DOI: 10.11852/zgetbjzz2022-0049

Abstract （221）

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The early childhood development nurturing care consists of five major contents:child health, adequate nutrition, safety and security, responsive care and early learning opportunities. Among them, responsive care is an important way to promote early childhood development. This article summarizes and reviews the connotation, challenges, implementation and evaluation of responsive care, and explores the influence of responsive care on early childhood development.

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Effect of methylphenidate hydrochloride prolonged-release tablets on the growth of children with attention deficit hyperactivity disorder

LI Rong, LI Nian, WU Dandan, HUANG Rong, CHEN Yinhua

Chinese Journal of Child Health Care 2023, 31 (7): 731-735. DOI: 10.11852/zgetbjzz2022-1339

Abstract （217）

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Objective To analyze the effect of methylphenidate hydrochloride prolonged-release tablets on the growth and nutritionl intake of children with attention deficit hyperactivity disorder (ADHD), in order to provide scientific reference for drug therapy of ADHD. Methods ADHD children in Children′s Hospital of Nanjing Medical University were selected as study subjects, and were divided into treatment group and control group. The treatment group was given methylphenidate hydrochloride sustained release tablets, while the control group received behavior management. Height, weight, body composition measurement and 24 hour dietary survey analysis were monitored regularly. Results The Z scores of weigh-for-age(W/A-Z) ( t= 5.815, 6.708, 5.003, 2.234, P<0.001) andthe Z scores of body mass index-for-age(BMI/A-Z) ( t=3.776, 4.666, 6.431, 7.467, P<0.001), body composition measurement of protein content ( t=3.789, 4.087, 3.098, 2.889, P=0.001), skeletal musclecontent ( t=3.112, 2.890, 4.765, 5.221, P<0.001),fat content ( t=4.329, 3.879, 2.998, 2.567, P<0.001); 24-hour dietary assessment of energy ( t=11.657, 12.887, 5.091, 3.765, P<0.001), protein ( t=12.987, 14.098, 13.777, 12.987, P<0.001), fat ( t= 12.889, 12.012, 14.887, 13.987, P<0.001) and carbohydrate intake ( t= 13.889, 14.889, 15.098, 14.889, P<0.001)after 3-month,6-month,9-month,and 12-month treatmentwere lower than those in control group. The Z scrores of height-for-age (H/A-Z) of children in the treatment groupafter 6-month, 9-month and 12-month treatment were lower than those in control group( t=1.752, 2.625,5.961, P＜0.001). Repeated measurement anova analysis showed that the time effect, intragroup effect and interaction effect of physical assessment, body composition (except for inorganic salts) and 24-hour dietary assessment between the treatment group and control group were statistically significant ( P<0.05). Conclusion The medication of methylphenidate hydrochloride prolonged-release tablets on ADHD children, with the treatment duration increasing, will have an impact on the height, weight, BMI and nutritionl intake of children.

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Cultivate healthy dietary behavior and keep away from childhood obesity

MA Guan-sheng, ZHANG Fan

Chinese Journal of Child Health Care 2023, 31 (1): 10-14. DOI: 10.11852/zgetbjzz2022-1199

Abstract （211）

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Obesity has become an increasingly serious public health challenge endangering the childhood health in China. In recent 30 years, the continuous growth of childhood obesity rate in China is closely related to the improvement of living standards and the changes of dietary behavior. Dietary behavior refers to individuals′ habitual eating activities, including food selection and purchase, eating frequency, eating quantity, cooking method, eating place, etc. Eating frequency and regular eating, dining atmosphere, breakfast, western fast food and other dietary behaviors, drinking and snack eating behaviors are related to childhood obesity. Unhealthy dietary behaviors lead to weight gain and obesity in children by affecting energy intake. Parents, schools, society and the government must work together to create a healthy eating environment for children, help them cultivate healthy dietary behaviors, keep away from obesity, and provide necessary guarantees for the healthy growth of children.

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Validation and norms of the Chinese Toddler Sleep Assessment Scale

FENG Wei-wei, ZHANG Tong, WANG Hui-shan, YANG Yu-feng, XU Zhi-fei, PAN Xiao-ping, WANG Guang-hai, XU Tao, Working Group on Norms Establishment of Chinese Infants and Toddlers Sleep Assessment Scales

Chinese Journal of Child Health Care 2023, 31 (1): 42-45. DOI: 10.11852/zgetbjzz2022-0642

Abstract （189）

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Objective To verify the reliability and validity of Chinese Toddler Sleep Assessment Scale(TSAS), and to establish national norm and cut-off score. Methods Using multistage random sampling, totally 2 816 urban and rural caregivers whose child aged 12 to 35 months were selected in 14 cities of 7 provinces from May to December 2021. The internal consistency reliability, split-half reliability and confirmatory factor analysis were used to verify the reliability and validity of the scale. The percentile norm( P ₅, P ₁₅, P ₅₀, P ₈₅ and P ₉₅) was established, and the total TSAS scores exceeding P ₈₅ and P ₉₇ were determined as the cut-offs for identifying poor sleep and abnormal sleep. Results The Cronbach′s α coefficients of TSAS was 0.73, the split-half reliability was 0.81, and the factor structure models were stable, which showed good reliability and validity. The age norm of TSAS was established. The total score >40 indicated poor sleep, and > 45 indicated abnormal sleep. Conclusions TSAS has stable reliability and validity. The established norm and cut-off can provide Objective reference for its promotion and application.

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Early screening, diagnosis and intervention of learning disabilities in children

CAO Aihua

Chinese Journal of Child Health Care 2023, 31 (6): 590-594. DOI: 10.11852/zgetbjzz2023-0498

Abstract （189）

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Learning disabilities are neurodevelopmental disorders, which are classified as dyslexia, dysgraphia and dyscalculia according to the DSM-5 and ICD-11. Learning disabilities have a significant impact on children's schooling, but they will not be identified until children show poor academic performance at school. Therefore, screening for learning disabilities at preschool age and early intervention is essential. This article focuses on early screening, diagnosis and comorbidity of children with learning disabilities, and summarizes the treatment of learning disabilities in children from three aspects: education, cognitive behavior and medical interventions.

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Chinese Journal of Child Health Care 2023, 31 (9): 929-934. DOI: 10.11852/zgetbjzz2023-0679

Abstract （187）

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Early identification and early intervention of infants and toddlers with faltering growth

MAO Meng

Chinese Journal of Child Health Care 2023, 31 (4): 349-352. DOI: 10.11852/zgetbjzz2023-0083

Abstract （185）

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Faltering growth in infants and toddlers is a common problem in clinical practice, and it can lead to a variety of short- and long-term health outcomes. Early life is a critical window for faltering growth identification and intervention, so a comprehensive understanding of how to identify and intervene faltering growth at early stage is of critical importance for achieving early appropriate catch-up growth and improving the lifetime health of infants and children.

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Changes and clinical significance of serum 25-(OH)D ₃ and vitamin D-binding protein levels in adolescent patients with first-episode depressive disorder

YANG Liu, LIU Yushan, WU Ningbo, SUN Jing

Chinese Journal of Child Health Care 2023, 31 (3): 259-262. DOI: 10.11852/zgetbjzz2022-0902

Abstract （180）

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Objective To test the levels of serum 25-hydroxyvitamin D ₃[25-(OH)D ₃] and vitamin D-binding protein (VDBP) in adolescent patients with first-episode depressive disorder, and to analyze their clinical significance. Method A total of 100 adolescent patients with first-episode depressive disorder admitted to Qinhuangdao First Hospital from April 2021 to March 2022 were selected as the depression group, and 100 healthy adolescents who took physical examinations during the same period were selected as the control group. The levels of serum 25-(OH)D ₃ and VDBP were detected by enzyme-linked immunosorbent assay. Hamilton Depression Scale (HAMD) was used to assess the degree of depression in patients with depression, and then the adolescents were divided into mild group ( n=41), moderate group ( n=32) and severe group ( n=27). The levels of serum 25-(OH)D ₃ and VDBP among depression group, control group and adolescent patients with first-episode depressive disorder with different degrees of depression were compared. The correlation of serum 25-(OH)D ₃ and VDBP levels with HAMD score in adolescent patients with first-episode depressive disorder and the influencing factors of the occurrence of first-episode depressive disorder were analyzed. Results Compared with the control group, the level of serum 25-(OH)D ₃ in the depression group decreased ( t=10.625, P<0.05), while the level of VDBP increased ( t=13.158, P<0.05). The level of serum 25-(OH)D ₃ of children in mild, moderate and severe depression group decreased in turn ( t=58.319, P<0.05), while the level of VDBP increased in turn ( F=18.805, P<0.05). Serum 25-(OH)D ₃ level was negatively correlated with HAMD score and VDBP in adolescent patients with first-episode depressive disorder ( r=-0.517, -0.511, P<0.05), while serum VDBP level was positively correlated with HAMD score ( r=0.498, P<0.05). Serum 25-(OH)D ₃ deficiency( OR=1.775) and high level of VDBP ( OR=1.519) were risk factors for the occurrence of first-episode depressive disorder ( P<0.05). Conclusions The serum 25-(OH)D ₃ level is lower in the adolescent patients with first-episode depressive disorder, and the VDBP level is higher.Serum 25-(OH)D ₃level is negatively correlated with VDBP, both of which were significantly correlated with HAMD scores. Both VDBP and 25-(OH)D ₃ can be used as auxiliary indicators to determine the severity of adolescent depression.

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Brain injury and early assessment in infants

ZHANG Yu-ping

Chinese Journal of Child Health Care 2023, 31 (2): 123-125. DOI: 10.11852/zgetbjzz2022-1560

Abstract （165）

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With the improvement of survival rate of critically ill neonates, the number of infants at high risk of brain injury has also increased.Clinicians need to recognize infant brain injury and grasp the methods of early identification of infant brain injury.In this paper, different types of infant brain injury and their long-term development outcomes are briefly described, and the early assessment of infant brain injury is introduced from three aspects: clinical history, auxiliary examination and standardized evaluation, thereby providing reference for early intervention and improvement of long-term development outcomes of infants with brain injury.

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Treatment and intervention of autism spectrum disorder in China and suggestions for further practice

JING Jin

Chinese Journal of Child Health Care 2023, 31 (9): 939-944. DOI: 10.11852/zgetbjzz2023-0680

Abstract （160）

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Autism spectrum disorder (ASD) is a group of neurodevelopmental disorders with unknown etiology, high heterogeneity and rapidly increasing prevalence. Early education and training is the main method of rehabilitation. The intervention for ASD in China is still developing. Various medical and rehabilitation education institutions have carried out a variety of interventions, hoping to improve the function of ASD and reduce the family and social burden caused by ASD. Based on this, this article analyzes and expounds the progress in evidence-based practice of ASD, the current situation of ASD intervention in China, the limitations and the future development direction.

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Evaluation and treatment of complex attention deficit hyperactivity disorder in childhood

CHEN Li

Chinese Journal of Child Health Care 2023, 31 (9): 935-938. DOI: 10.11852/zgetbjzz2023-0845

Abstract （150）

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Attention deficit hyperactivity disorder(ADHD) is one of the most common neurodevelopmental disorders in childhood. Complex ADHD in children is relatively unique. These cases differ from typical ADHD cases in various ways, such as the atypical age at which symptoms appear or the presence of complex coexisting conditions. Additionally, the symptoms and functional impairment experienced by children with complex ADHD tend to be more severe.Therefore, these children require comprehensive interdisciplinary evaluation and treatment, as well as long-term standardized follow-up and chronic disease management.

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Case report and literature review of PUF60 gene de novo mutation related Verheij syndrome

ZHONG Yao-yao, ZHANG Li-qin, LI Shuo, JI Yong-juan, LI Jun-xin

Chinese Journal of Child Health Care 2023, 31 (1): 113-116. DOI: 10.11852/zgetbjzz2022-0356

Abstract （150）

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Analysis on the needs of family nurturing guidance for infants

YIN Chun-lan, XI Xiang-yun, TONG Mei-ling, ZHU Ling, ZHANG Hua, LIU Yun-fen, HUANG Yan, ZHANG Yong-hua, ZHANG Li-li, CUI Xin-hua, NI Yu, ZHONG Xin-wen, LI Xia, XU Pei-bin

Chinese Journal of Child Health Care 2023, 31 (1): 32-36. DOI: 10.11852/zgetbjzz2021-1653

Abstract （146）

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Objective To investigate the needs and influencing factors of family nurturing for infants, so as to provide reference for promoting the combination of medical education and care services. Methods From September to November 2020, 3 439 infants were selected from 9 provinces and 12 cities in China for questionnaire survey. Parents were asked to fill in general information and family rearing questionnaire to collect the needs of infant families for nurturing guidance. Results Among 3 439 infants, 29.7% had the need for nurturing guidance, especially for responsive care and early learning opportunities. Logistics regression analysis showed that the main caregivers were father( OR=0.476,95% CI:0.361 - 0.629)and(maternal) grandparents( OR=0.455,95% CI:0.304 - 0.681), farmers( OR=0.395,95% CI:0.240 - 0.649)and retirement( OR=0.612,95% CI:0.500 - 0.750)were protective factors for guidance needs for infants and toddlers family nurturing care. Stem family( OR=1.295,95% CI:1.101 - 1.523), single-parent family( OR=2.631,95% CI:1.405 - 4.927), caregivers with educational level of college/graduate( OR=2.180,95% CI:1.600 - 2.971), postgraduate and above( OR=3.116,95% CI:2.109 - 4.811)and average monthly household income of >10 001 - 20 000 yuan( OR=1.815,95% CI:1.407 - 2.340), above 20 000 yuan( OR=2.846,95% CI:2.125 - 3.813)were risk factors for demand for high guidance needs for infants and toddlers family nurturing care. Conclusions At present, families in China have a certain need for guidance on the nurturing care of infants and toddlers. Medical and health care institutions, especially maternal and child health care institutions, should continue to improve their professional guidance and health services for the nurturing care of infants and toddlers in order to further improve the quality of family care.

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Development andapplication of assessment system for children's physical activity and early development in China

YANG Yufeng

Chinese Journal of Child Health Care 2023, 31 (5): 465-469. DOI: 10.11852/zgetbjzz2023-0399

Abstract （139）

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The ultimate goal of early childhood development is to help children achieve their maximum potential, and to improve the overall quality of the population, thereby achieving the goals of national development and human health. Physical activity in children is the main form and means for early development. With the renewal of the times and the improvement of life quality, there has been a general decrease in physical activity and movement and an accelerated emergence of physical, psychological and behavioral problems in children. Scientific monitoring and assessment is particularly important in order to better promote early development by increasing children's physical activity and movement. This article will introduce the importance of establishing children's physical activity and early development assessment system of China and the common methods of monitoring and assessing children's physical activity and early development.

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Correlation of serum folate acid and vitamin B12 levels with gut microbiota in children with autism spectrum disorder

LI Zheng, XIAO Guiyuan, LUO Yating, HE Chunyan, WANG Nianrong, ZHAO Yan

Chinese Journal of Child Health Care 2023, 31 (3): 246-251. DOI: 10.11852/zgetbjzz2022-0550

Abstract （136）

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Objective To analyze the correlation of serum folate acid and vitamin B12 levels with gut microbiota in children with autism spectrum disorder (ASD). Method From January 2020 to February 2021, totally 79 ASD children aged 2 to 7 years and 79 sex- and age-matched neurotypical children in the outpatient department of Chongqing Maternal and Child Health Hospital were enrolled in this study. Serum folate acid and vitamin B12 levels were detected by Chemiluminescence method. The V3-V4 hypervariable regions of bacterial 16SrRNA gene in fecal samples were sequenced. Results Serum folate acid level of children in the ASD group was significantly lower than that of the healthy control group [33.55 (20.47, 39.73) nmol/L vs. 35.50 (27.80, 41.90) nmol/L] ( Z=-2.114, P=0.035). Serum vitamin B12 level of children in the ASD group was significantly lower than that of the healthy control group [539.0 (422.50, 702.75) pmol/L vs. 632.0 (519.0, 859.0) pmol/L] ( Z=-3.114, P=0.002). There was no difference in the Alpha diversity and Beta diversity of the gut microbiota between the ASD group and control group ( P>0.05). In the genus level, ASD children had significantly increasing abundance of Sutterella and Desulfovibrio and decreasing abundance of Bifidobacterium and Rheinheimera compared with the control group ( P<0.05). Spearman correlation analysis indicated that serum folate acid level was positively correlated with the abundance of Bifidobacterium ( r=0.203) and Prevotella ( r=0.179), and negatively correlated with Escherichia abundance ( r=-0.223, P＜0.05). Serum vitamin B12 level was positively correlated with the abundance of Bifidobacterium ( r=0.172, P=0.048). Conclusion Serum folate acid and vitamin B12 levels are lower in ASD children, which are correlated with the abundance of some gut microbiota.

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Status quo and related factors of Chinese phonological development in children aged 2 to 6 years

SONG Zhixiao, LIU Huijuan, GAO Nannan, QIAO Xiuyun, KE Jiamei, ZHANG Li, SUN Jin, LI Yan

Chinese Journal of Child Health Care 2023, 31 (4): 359-364. DOI: 10.11852/zgetbjzz2022-0556

Abstract （135）

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Objective To assess the phonological development of children aged 2 to 6 years, and to analyze its influencing factors. Methods From July 2021 to February 2022, 198 children aged 2 to 6 years who took regular physical examination in Shandong Province Qianfosha Hospital were included in this study, and were divided into 8 groups by age with 0.5 years intervals. Language Development Assessment Scale for Children aged 2 - 6 Years was used to assess the pronunciation of the participants, and the influencing factors were analyzed. Results 1) The initials ' m', ' b', ' t' and ' j' were level 1; the initials ' x', ' p', ' n', ' h', ' q', ' g' and ' d' were level 2; the initials ' k', ' f', ' l', ' ch', ' sh', ' zh', ' c', ' z' and ' r' were level 3; and the initials ' s' was level 4. Levels 1 to 3 were all met, while level 4 was not. The finals were all up to standard. According to the age group, the initials were partially not up to the standard in children aged 2 - 4 years old, and were up to the standardin children aged 4 to 6 years, the finals reached to the standardin children aged 2.5 to 5.5 years. 2) Picky eating, late age of solid food intake, use of dialect for communication and long screen time were associated with higher rate of initials errors( P＜0.05). Picky eating, semi-liquid diet, primary school education, use of dialect for communication and long screen time on work day were associated with higher rate of finals error( P＜0.05). Conclusions There is a significant correlation between age and Chinese phonetics development. Phonics is learned by the age of 4. Dietary behavior, family language environment, main caregiver and screen time are related to phonetics development of children.

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Associated factors of screen exposure in infants

SHAN Ruijie, HAN Jing, QU Keli, YUE Lei, CUI Naixue

Chinese Journal of Child Health Care 2023, 31 (4): 374-378. DOI: 10.11852/zgetbjzz2022-0829

Abstract （132）

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Objective To explore the correlation of infant and family-related factors with infant screen exposure, so as to provide a scientific basis for reducing infant screen exposure. Methods Infants who visited the Department of Child Healthcare of two tertiary hospitals for routine physical examination in Jinan from December 2020 to April 2022 were recruited using a convenient sampling method.Mothers completed questionnaires of infant screen exposure and questionnaires of associated factors, including infant age, sex and family nurturing environment.Univariate analysis was performed using t test and χ ² test, and multivariate analysis was performed using Logistic regression analysis. Results A total of 362 infants were enrolled in this study, of whom 55.8% had screen exposure.Logistic regression analysis showed that infant age ( OR=1.27, 95% CI:1.16 - 1.38), maternal education level (vocational college vs.bachelor's degree and above, OR=1.89, 95% CI:1.09 - 3.28; high school and below vs.bachelor's degree and above, OR=3.09, 95% CI:1.64 - 5.82), and maternal anxiety ( OR=2.89, 95% CI: 1.11 - 7.52) were risk factors for screen exposure during infancy( P＜0.05). Conclusions Infant screen exposure is common.Low maternal education level and maternal anxiety are the risk factors of screen exposure among infants.It is recommended that screenings for at-risk infants, health education for mothers and other primary caregivers, popularization of the hazards of screen exposure in infancy and the availability of scientific parenting knowledge and skills should be implemented in child healthcare practice, so as to reduce the risk of screen exposure in infancy.

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Trends of malnutrition, overweight and obesity in preschool children in Beijing from 2000 to 2020

YANG Xiao-chen, HE Hui, YUN Qing-ping, LI Yi-chen, CHANG Chun

Chinese Journal of Child Health Care 2023, 31 (1): 21-26. DOI: 10.11852/zgetbjzz2022-0714

Abstract （132）

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Objective To analyze the trends of malnutrition, overweight and obesity of preschool children in Beijing, and to evaluate the urban-rural difference of children′s growth trends. Methods Data were extracted from five national physical fitness surveillance surveys in Beijing from 2000 to 2020, and the growth indicators of 31 117 children aged 3 to 6 years were calculated. Chi-squared and Cochran-Armitage tests were used to estimate trends in these indicators. Results Compared to 2000, the prevalence rates of stunting, underweight and wasting decreased from 1.5%, 1.4%, 0.9% to 0.6%, 0.6%, 0.8%, while the prevalence of overweight and obesity increased from 17.1%, 4.8% to 20.1%, 9.6%, respectively. Less than 1% of boys and girls in both urban and rural areas were stunted or underweight in 2020. Rural boys and girls have shown a higher prevalence of obesity than urban children since 2010, as well as the prevalence of overweight since 2014. From 2000 to 2020, rural boys and girls had declining trends in malnutrition(including stunting and underweight) rates, and rising trends in overweight and obesity rates( P<0.001). Urban girls had polarized nutrition status from 2000 to 2020, with an increasing rate of wasting( Z=2.426, P＝0.015) and an increasing rate obesity( Z=3.405, P=0.001). Conclusions The prevalence of malnutrition decreases among rural children, while the sustained rising prevalence of overweight and obesity had surpassed that of urban children. Therefore, effective nutrition policies and health strategies are warranted to address the urban-rural disparities in child growth and development.

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Validation and evaluation of the structure of Chinese Preschoolers′ Caregivers′ Feeding Behavior Scale based on network analysis

ZHANG Hao, ZHANG Hai-yue, YUAN Jing, ZHANG Yu-hai, JIANG Xun, SHANG Lei

Chinese Journal of Child Health Care 2023, 31 (1): 15-20. DOI: 10.11852/zgetbjzz2022-0879

Abstract （131）

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Objective To validate and evaluate the structure of Chinese Preschoolers′ Caregivers′ Feeding Behavior Scale(CPCFBS) using network analysis, so as to provide reference for further improvement and revision of the scale. Methods Network structure was estimated using Gaussian Graphical Model with a dataset of feeding behaviors in 768 preschoolers′ caregivers. Dimensionality was detected using exploratory graph analysis(EGA). The network structural consistency was tested using EGA bootstrap. Structural reliability and validity were examined using model fit indices and reliability coefficients. Results Based on the network loadings and structure consistency results, a seven-dimensional EGA network containing 34 items was explored. Compared with the original scale structure, one unstable item was deleted, and some items of the dimensions of "Encourage Healthy Eating" and "Behavior-restricted Feeding" were re-clustered, while the rest of the network dimensions remained unchanged. The structure consistency evaluation indexes were all greater than 0.75, meaning that the structure was stable. The absolute fit and relative fit of EGA structure were better than the original structure. The EGA structure had better reliability than the original structure. Conclusion After optimizing the structure of CPCFBS and improving the stability of the scale by network analysis, the revised CPCFBS is more applicable to the evaluation of feeding behaviors in China.

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Nutrition and physical development status of school-age children aged 10 to 12 years in rural Linxia Prefecture, Gansu

YIN Li-mei, WANG Yan-ling, ZHU Xiao-nan, ZHENG Jing, CAO Yong-qin, SUN Wei, FEI Xiu-lan, CHEN Guo-hua

Chinese Journal of Child Health Care 2023, 31 (2): 215-219. DOI: 10.11852/zgetbjzz2022-0471

Abstract （125）

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Objective To investigate the physical development and nutrition status of rural school-age children in Linxia Hui Autonomous Prefecture, Gansu Province, so as to provide data support for improving children′s health in ethnic minority areas. Methods School children aged 10 to 12 years in Linxia Hui Autonomous Prefecture of Gansu Province in 2019 were selected in this cross-sectional survey. Height and weight of the participants were measured, then body mass index(BMI) was calculated. The detection rates of malnutrition, growth retardation, overweight and obesity were analyzed to assess children′s growth and development. Results The average weight was 33.3 kg and 31.7 kg for 10-year-old boys and girls in rural Linxia, which was 33.8 kg and 33.2 kg for 11-year-old boys and girls, 34.6 kg and 35.2 kg in 12-year-old boys and girls. The average height was 139.8 cm and 138.7 cm for 10-year-old boys and girls in rural Linxia, which was 141.1 cm and 141.7 cm for 11-year-old boys and girls, 143.2 cm and 143.8 cm in 12-year-old boys and girls. The detection rate of malnutrition was 35.1%(36.9% for boys and 33.0% for girls), including moderate malnutrition of 23.4%, mild malnutrition of 11.7%, overweight of 4.7% and obesity of 4.6%. There was no statistically significant difference in nutritional status among different gender and age groups( Z=368 213.0, H=0.132, P＞0.05). The growth retardation rate increased with age, and the overall rate was 5.8%(4.2% for boys and 7.4% for girls). There were significant differences in growth retardation rate( χ ²=99.000, 198.000, P<0.001) and height( Z=346 398.0, H=150.97, P<0.05) among different gender and age groups. Conclusion The physical development level of rural school-age children in Linxia Prefecture, Gansu Province lags behind, so it is supposed to strengthen the growth and development of children, and take effective measures to promote the healthy development of children.

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Expert recommendations for prevention and coping strategies on psychological and behavioral problems of children and adolescents during home quarantine/online learning (the 2nd Version)

Chinese Journal of Child Health Care 2023, 31 (2): 117-122. DOI: 10.11852/zgetbjzz2022-1469

Abstract （119）

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Children and adolescents are vulnerable to major public health stress events. Since the outbreak coronavirus disease 2019 (COVID-19) in December 2019, home quarantine and online learning have been adopted to contain the spread of COVID-19. In view of the increasing social and psychological behavioral problems of children and adolescents during the COVID-19 pandemic, as well as the long-term or intermittent home quarantine and online learning in the post-COVID-19 period, the Developmental Behavior Pediatrics Group of Chinese Pediatric Society formulated this recommendation, which is based on "Psychological impact of coronavirus disease 2019 on children and adolescents and recommendations for family intervention(1st version)" in 2020 and the current domestic situation. It is hoped that social and psychological support will be provided to children of all ages during home quarantine/online learning from family, school and health, and continue to implement coping strategies in the prevention and treatment of children′s social and behavioral problems in special periods.

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Research progress in executive function of adolescents with adverse childhood experiences and the influencing factors

PENG Lianhua, LIU Dongdong, LONG Nannan, XU Ping, CHEN Yang, MAO Ping

Chinese Journal of Child Health Care 2023, 31 (3): 299-303. DOI: 10.11852/zgetbjzz2022-0317

Abstract （116）

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As a global public health problem, adverse childhood experiences (ACEs) can seriously damage the executive function of adolescents, resulting in inhibition and control disorders, working memory impairment and cognitive flexibility impairment. Executive dysfunction can significantly increase the risk of adolescent psychopathology and health risk behavior, resulting in a huge economic burden to themselves and society. This review summarizes the executive function status of adolescents with ACEs and the influencing factors, in order to provide reference for the improvement of executive function of adolescents with ACEs and promote the development of adolescents' physical and mental health.

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Research progress in neurodevelopmental disorder caused by KIF5C gene mutation

CHEN Yi-ru, CHEN Wen-xiong

Chinese Journal of Child Health Care 2023, 31 (2): 171-175. DOI: 10.11852/zgetbjzz2022-0476

Abstract （113）

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KIF5C gene is the candidate gene of neurodevelopmental disorder such as autism spectrum disorder(ASD). KIF5C gene encodes KIF5C kinesin, which helps to transport cargos required for neurite maturation along microtubules for a long distance, and is important for neuronal development. The structure of KIF5C kinesin includes the head motor domain, stalk dimerization domain and tail domain. The exonic region of head motor domain is a common region of gene mutation, and intron mutation is occasionally reported. The c.709G>A is a hot spot mutation site, causing p.glu237lys amino acid mutation. KIF5C gene mutation causes the common neurodevelopment disorder in children, including malformation of cortical dysplasia (MCD), microcephaly, epilepsy, development delay/intellectual disability, autism-like features and so on. The mechanism of neurodevelopmental disorder caused by KIF5C gene mutation is not clear yet,but it might affect the ability of head motor domain to hydrolyze ATP. It is important to study the pathogenic mechanism of KIF5C gene mutation and its novel therapeutic interventions in depth. KIF5C gene therapy needs further study.

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Research progress on the influencing factors and treatment of communication disorder in children with cerebral palsy

WU Xi-xi, HAO Chao-li, ZENG Pei, GUO Jin

Chinese Journal of Child Health Care 2023, 31 (1): 52-57. DOI: 10.11852/zgetbjzz2022-0325

Abstract （113）

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Cerebral palsy(CP) is a common neurological disorder in children, and its core manifestation is abnormal postural development and motor disturbance. Communication disorder, as a common accompanying disorder in children with cerebral palsy, has a high incidence rate and a serious impact on their mental health and social communication. In recent years, how to effectively improve the communication ability of children with cerebral palsy is a key point of rehabilitation therapy. On the other hand, communication disorder is caused by multiple factors and has various clinical manifestations, so early assessment and interventions are particularly important. The article reviews the influencing factors, clinical manifestations, assessment and treatment of communication disorder in children with cerebral palsy, so as to provide more clinical ideas for improving the communication of children with cerebral palsy.

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Nutrition intervention for faltering growth in children under 6 years old

YU Xiaodan

Chinese Journal of Child Health Care 2023, 31 (10): 1048-1050. DOI: 10.11852/zgetbjzz2023-0914

Abstract （113）

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A report published in 2020 on the Nutrition and Chronic Disease Status of Chinese Residents revealed that the rate of faltering growth in Chinese children under 6 years old is 4.8%. This paper focuses primarily on the influence of weight deviation and nutrient deficiency on height (length) in children, and proposes early intervention measures, in order to provide valuable insights for healthcare professionals in the early prevention and treatment of faltering growth in clinical practice.

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Research advances in tummy time during infancy

WANG Xiao-tong, CHANG Jia-hui, LIU Ai-hua, ZHANG Jian, WU Qiong, ZHANG Yan-feng, ZHANG Ting, ZHU Zong-han

Chinese Journal of Child Health Care 2023, 31 (1): 58-61. DOI: 10.11852/zgetbjzz2021-1813

Abstract （112）

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Tummy time is defined as awake prone positioning that is encouraged and supervised by an adult and infants can move unrestrictedly. Since the positive association with gross motor development and prevention of plagiocephaly, promotion of tummy time in China is of great significance. This review combs the concept, research advances and guidelines of tummy time, aiming to provide reference for further research and guideline development of tummy time in China.

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Behavioral and language characteristics of chidren with language development delay

LIU Huiyan, SONG Yanyan, ZHANG Shuqin, XIAO Wanqi

Chinese Journal of Child Health Care 2023, 31 (4): 365-368. DOI: 10.11852/zgetbjzz2022-0682

Abstract （112）

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Objective To analyze the characteristics of children with language development delay at diffierent ages, so as to provide scientific basis for early clinical detection and intervention. Methods A study was conducted in children aged 1.5 to 6 years with questionnaire survey during January 2020 to January 2021.The S-S linguistic retardation assessment was adopted.Then the language development characteristics and influencing factors were analyzed. Results 1) The age of delayed speech visits was mainly between 1.5 and 3.5 years old, with an average of 2.6 years old, and significantly more boys than girls.Among children with delayed speech visits, 52.48% had an expressive vocabulary of less than 10 words, and 12.38% visited the hospital because they did not speak, the level of language comprehension was mainly at the symbolic stage of things, 80.20% had behavioral problems, 58.29% had dietary behavioral problems.And 62.87% were exposed to electronic screens for more than 1h/d, 50.99% parent-child interaction was less than 2h/d.2) The proportion oflanguage comprehension delay and operational task delaywere significantly different among different age groups ( χ ²=13.68, 17.62, P<0.01).The proportion of delayed language comprehension gradually increased with age, and the difference was most significant around 2 years old.The rate of operational task delay was higher in each age groups.3) Multivariate Logistic regression analysis showed that higher education level of the main caregiver was a protective factor for language comprehension ( OR=0.81, 95% CI:0.67 - 0.97, P＜0.05), while behavioral problems increased the risk of operational task delay ( OR=2.84, 95% CI:1.21 - 6.65, P＜0.05). Conclusions Language development delays mostly occur in children around 2.5 years of age and are prone to behavioral problems.After 2 years of age, in addition to language delays, children are more likely to have a combination of comprehension delays and operational delays, and behavioral problems increase the risk for operational delays.Therefore, early screening and targeted interventions are necessary, and scientific parenting and favorable behavior habits may help to children's early language development.

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Cranial morphological characteristics and influencing factors of plagiocephaly in infants

ZHANG Lei, HU Yao-fang, GE Yu-jia, DONG Jing, LIU Pan-ting, CHI Xia, TONG Mei-ling, QIAN Jun

Chinese Journal of Child Health Care 2023, 31 (2): 200-204. DOI: 10.11852/zgetbjzz2022-0911

Abstract （111）

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Objective To investigate the cranial morphological characteristics and influencing factors of plagiocephaly in infants and children aged 3 to 18 months, so as to provide guidance and basis for the prevention and intervention of cranial anomalies in infants and children. Methods A total of 228 infants with plagiocephaly determined during physical examination in Nanjing Maternal and Child Health Hospital from January to December 2019 were selected as the case group, and 394 infants with normal skull shape were selected as the control group. Gender and age were matched between the two groups. The clinical characteristics of the case group were analyzed, and the influencing factors of plagiocephaly were analyzed by comparing the differences of basic information, maternal pregnancy and childbirth history, sleep posture and bone mineral density between the two groups. Results 1) The proportion of males in plagiocephaly group was higher than that of females. In term of age, the proportion of plagiocephaly in infants aged 6 months ± 7 days was the highest, then the proportion of plagiocephaly decreased with the increase of age. The detection rate of brachycephaly was the highest, and statistically significant difference in the type of cephalic malformations was found among different age ( χ²=34.409) and severity( χ²=11.404) groups( P<0.05). 2) Univariate analysis showed that there were statistical differences in single/twin ( χ²= 4.724), neonatal head injury history ( χ²=8.430), sleep posture ( χ²=23.881) and bone mineral density ( t=2.771) between case group and control group ( P<0.05). 3) Multivariate Logistic regression analysis showed that age(taking 3 months ± 7 days group as the reference, 6 months ± 7 days group OR=3.720, 95% CI:1.959 - 7.16, P<0.05; 8 months ± 7 days group OR =3.181, 95% CI:1.449 - 6.984, P<0.05; 12 months ± 7 days group OR=3.195, 95% CI:1.281 - 7.966, P <0.05) and twins ( OR=3.950, 95% CI:1.227 - 12.717, P<0.05) were risk factors for plagiocephaly, while mixed sleeping posture ( OR=0.209, 95% CI:0.129 - 0.338, P<0.05) and bone mineral density ( OR=0.763, 95% CI:0.636 - 0.917, P<0.05) were protective factors of infant plagiocephaly. Conclusions Age, twins, sleep posture and bone density are important influencing factors of infant plagiocephaly. With the growth of infant age, the plagiocephaly may be improved, and further longitudinal research is still needed to verify the influencing factors of infant plagiocephaly.

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Progress in drug therapy for fragile X syndrome

MEI Lian-ni, HU Chun-chun, XU Qiong

Chinese Journal of Child Health Care 2023, 31 (2): 180-184. DOI: 10.11852/zgetbjzz2022-0958

Abstract （110）

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Fragile X syndrome (FXS) is a neurodevelopmental disorder that is the most common inherited cause of intellectual disability(ID) and the most prevalent monogenic cause of autism spectrum disorder (ASD). FXS is characterized by cognitive deficits, special facial features, behavioral problems and other multi-system abnormalities. This review combs the drugs that regulate abnormal neurobiology of FXS, in order to provide integrative data of the efficacy and safety of drugs therapy in FXS treatment.

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Effect of the program for the education and enrichment of relational skills on school-age children with attention deficit hyperactivity disorder

ZHU Peiying, CHU Liting, MA Chenhuan, PAN Lizhu, GUO Naiqi, LU Dingjie, WANG Yu

Chinese Journal of Child Health Care 2023, 31 (9): 951-956. DOI: 10.11852/zgetbjzz2022-1109

Abstract （110）

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Objective To explore the effect of the program for the education and enrichment of relational skills (PEERS ^®) on the social skills of children with attention deficit hyperactivity disorder (ADHD) aged 6 - 8 years, so as to provide evidence for the clinical application of this project in young ADHD children in China. Methods A total of 74 children aged 6 - 8 years who were diagnosed with ADHD in the Department of Child Health Care of Shanghai Children's Hospital from March to November 2021 were enrolled in this study, and were randomly divided into intervention group and control group. The intervention group received PEERS training for 14 weeks, while the control group did not receive any intervention until the intervention in this study was finished. Social Anxiety Scale for Children (SASC), Social Skills Parent Rating Scale for Primary School Students, Weiss Functional Impairment Rating Scale-Parent Report (WFIRS-P) and Strengths and Difficulties Questionnaire (SDQ) were used for evaluation before and after the intervention. Results After 14 weeks of training, there was a statistically significant decrease in the fear of denial rating ( t=2.35), social avoidance distress score ( t=2.34) and total SASC score ( t=3.35) in the intervention group compared with those before intervention, and the scores were significantly lower than those in the control group( P<0.05). In terms of the Social Skills Parent Rating Scale for Primary School Students, scores of intention to interact ( t=3.70), group prestige ( t=2.84), social sensitivity ( t=6.31), masking ( t=2.34), individual sensitivity ( t=3.10), emotional sensibility ( t=3.33), expression skills ( t=5.95), interaction skills ( t=2.47), social expression and control ( t=7.24), social feelings ( t=7.71), emotional feelings and control ( t=3.78) and total scale score ( t=9.14) after intervention were significantly higher than those before intervention in the intervention group,which were significantly higher than those of the control group after intervention ( P<0.05). In terms of WFIRS-P, the intervention group had significantly higher scores for family ( t=3.06), learning/school ( t=3.65), self-concept ( t=2.44), social activity ( t=3.50), adventure activity score ( t=7.29) and total scale ( t=8.25) after intervention,which were significantly higher than those of the control group after intervention ( P<0.05).Except for conduct problems ( t=1.57, P=0.122) and hyperactive attention inability ( t=1.78, P=0.08),the intervention group had significantly lower scores for emotional symptoms ( t=3.01), peer interaction problems ( t=1.78) and total difficulty score ( t=5.72) after intervention,which were significantly higher than those of the control group after intervention ( P<0.05). After intervention, the hyperactivity-impulsivity score on the SNAP-Ⅳ scale was significantly lower in the intervention group than that before intervention ( t=2.29, P=0.025), and the decrease was more significant compared to the control group ( P<0.05). Conclusion PEERS training can significantly improve the social skills of ADHD children aged 6 - 8 years, and improve social function and some core symptoms of ADHD children.

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Early intervention of emotionalization and socialization on high-risk children

XIONG Zhonggui, ZHENG Xiaoyun, BIAN Xiaoyan, XU Haiqing

Chinese Journal of Child Health Care 2023, 31 (11): 1161-1164. DOI: 10.11852/zgetbjzz2023-0985

Abstract （109）

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High-risk children are confronted with a serial of medical issues, such as early development of emotionalization and socialization, in which there were significant difference in neurobehavioral development between high-risk children and normal children. Early intervention could promote healthy development of high-risk children. This study is aimed at early development of emotionalization and socialization to achieve the optimal potential development on high-risk children.

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Clinical features and influencing factors of feeding intolerance in premature infants

SUN Xing, HU Xiao-shan, LIU Feng, LIU Bei-bei

Chinese Journal of Child Health Care 2023, 31 (1): 109-112. DOI: 10.11852/zgetbjzz2022-0292

Abstract （109）

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Objective To analyze the clinical features and influencing factors of feeding intolerance(FI) in preterm infants with gestational age ＜37 weeks, in order to provide reference for early identification and early intervention in clinic. Methods The clinical data of 814 premature infants with gestational age ＜37 weeks who were hospitalized in Nanjing Maternal and Child Health Hospital from January to December 2020 were retrospectively analyzed. Infants were divided into FI group and feeding tolerance group. The clinical characteristics and influencing factors of FI in premature infants were analyzed. Results There were 128(15.7%) infants in FI group and 686(84.3%) infants in feeding tolerance group. The prevalence rates of FI in infants with gestational age ＜32 weeks, 32～＜34 weeks and ≥34 weeks were 30.3%(70/231), 20.4%(28/137) and 6.7%(30/446), respectively. The prevalence rates of FI in infants with birth weight ＜1 500 g, 1 500 - ＜ 2 500 g and ≥2 500 g were 32.6%(56/172), 12.7%(64/503), and 5.8%(8/139), respectively. The smaller the gestational age and the lower birth weight, the higher prevalence rate of FI( χ²=66.593, 50.621, P＜0.001). The clinical manifestations of FI were mainly gastric retention(85.9%), abdominal distension(66.4%) and vomiting(43.8%). The clinical manifestations of FI in super/extremely preterm infants were mainly gastric retention and abdominal distension, which were mainly abdominal distention and vomiting in late preterm infants.Univariate analysis showed that the average gestational age and average birth weight of infants in FI group were significantly lower than those in feeding tolerance group( t=8.028, 8.588, P＜0.001). The proportions of asphyxia, intrauterine infection, invasive respiratory support within 24 hours after birth, non-invasive continuous postive airway pressure(CPAP) support within 24 hours after birth, apnea, small-for-gestational-age infants and abnormal umbilical cord in FI group were significantly higher than those in feeding tolerance group( χ ²=16.676, 24.771, 7.961, 83.757, 86.275, 3.878, 5.259, P＜0.05).Multivariate Logistic regression analysis showed that non-invasive CPAP support within 24 hours after birth( OR=3.269, 95% CI:1.821 - 5.868) and apnea( OR=3.405, 95% CI:2.106 - 5.505) were independent risk factors of FI in premature infants( P＜0.05). Conclusions The prevalence rate of FI in preterm infants decreases with the increasing gestational age and birth weight, and the clinical manifestations also vary according to gestational age. Non-invasive CPAP support within 24 hours after birth and apnea are independent risk factors of FI in preterm infants. Infants with those risk factors should be intervened early as soon as possible to improve feeding tolerance.

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Early identification of Chinese developmental dyslexia should be valued

LI Xiuhong

Chinese Journal of Child Health Care 2023, 31 (6): 586-589. DOI: 10.11852/zgetbjzz2023-0429

Abstract （109）

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Developmental dyslexia (DD) is a persistent neurodevelopmental disorder that is usually diagnosed only when children experience severe learning difficulty after 2 to 3 years of enrollment. This late diagnosis not only leads to academic failure in children, but also has a serious impact on their mental health, career achievements, etc. If DD can be diagnosed before enrollment, its intervention will be more effective. Considering the prognostic benefits of earlyidentification and intervention, as well as many adverse consequences that can be avoided or mitigated, identifying early risks of DD is of great value. But how to early identify DD has always been a challenge. The article aims to introduce how to early identify DD, so as to provide reference for clinical practice.

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Validity of capillary dried blood spot for assessment of vitamin A nutritional status in preschool children

MI La-la, ZHANG Shu-yi, ZHANG Min, WU Yi-ran, XIE Jun

Chinese Journal of Child Health Care 2023, 31 (1): 37-41. DOI: 10.11852/zgetbjzz2022-0847

Abstract （108）

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Objective To assess the reliability and validity of dried blood spot(DBS) in the diagnosis of marginal vitamin A deficiency(MVAD) in preschoolers, in order to provide reference for scientifically assessing vitamin A nutritional status. Methods A total of 130 children aged 2 to 7 years were selected in the Zhao county in 2018 and their capillary bloods were collected to prepare DBS, of whom 48 children also collected venous plasma at the same time. The retinol levels in the 2 biological matrices were measured using high-performance liquid chromatography-tandem mass spectrometry method(HPLC-MS/MS). Two calibration methods were applied to convert DBS retinol to its homologous plasma retinol level. The agreement of the converted retinol with plasma retinol level was assessed using the intra-group correlation coefficient(ICC) and Bland-Altman analysis. The validity for the diagnosis of MVAD was assessed by sensitivity, specificity, accuracy index(AI), positive predictive value(PPV) and negative predictive value(NPV). Results After correction, DBS retinol was in good agreement with the level in homologous plasma, with ICC values greater than 0.8. Factor-corrected DBS retinol was closer to its plasma level. The prevalence of MVAD in the target population diagnosed by factor-corrected DBS retinol was 45.00%, which was close to the prevalence of MVAD diagnosed by plasma retinol(45.83%). The sensitivity, specificity, AI, PPV and NPV of factor-corrected DBS retinol predicting MVAD were 77.78%, 81.82%, 80.00%, 77.78% and 81.82%, respectively. The prevalence rates of VAD and MVAD in 130 children aged 2 to 7 years in Zhao county were 3.08% and 45.38%, respectively. Children aged 5 to 7 years had a higher prevalence rate of MVAD(51.22%, t=1.975, P=0.359). Conclusion Corrected DBS retinol can be used in the diagnosis of MVAD and the prevalence rate of MVAD is high in preschoolers in Zhao county.

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