What is this review about?This review gives an overview of research studies that looked at the management of serious allergic reactions in infants and toddlers. An allergic reaction is an overreaction of the immune system (the body’s natural defense system) to generally harmless foreign substances, like food, medications, or insect stings/bites. When the reaction is serious or affects two or more groups of organs, including the cardiovascular system (heart and blood vessels), the gastrointestinal system (stomach and intestines), the skin, and/or the respiratory system (lungs and airway), it is known as anaphylaxis. Life-threatening anaphylaxis is characterized by respiratory and/or cardiovascular involvement and may occur without the involvement of other organs. Serious allergic reactions are treated with epinephrine, the only medication globally approved for them.What were the results?Findings from research studies showed that common signs and symptoms of serious allergic reactions in infants and toddlers include itching, rash, eye swelling, and stomach pain. These findings suggest that modifying the traditional clinical criteria of signs and symptoms in older children and adults to include those unique to infants and toddlers increased the correct identification of serious allergic reactions. Research also showed that epinephrine was not given as often as it should have been for serious allergic reactions in infants and toddlers. However, having an established allergy emergency plan for those with a food allergy increased the chance that epinephrine was given. Finally, parents of infants and toddlers who were trained to give epinephrine for serious allergic reactions during an oral food challenge were more comfortable with using epinephrine.What do the results mean?Some signs and symptoms of serious allergic reactions in infants and toddlers differ from those in older children and adults and are not currently included in the criteria used by healthcare professionals to identify serious allergic reactions. Modifying these criteria in established guidelines may help healthcare professionals better recognize serious allergic reactions in infants and toddlers. Additionally, early evaluation for food allergies and having an allergy emergency plan increases the chance of giving epinephrine to infants and toddlers in a timely manner.
Severe early childhood caries (S-ECC) is a special type of dental decay common among toddlers and young children. This study explored the association between S-ECC and calcium and protein levels in mothers' breast milk in toddlers aged 12‒24 months. This cross-sectional descriptive-analytical study included 33 toddlers aged 12‒24 months, with or without S-ECC. Participants were recruited from mothers who brought their toddlers to healthcare clinics in Kerman City, Iran, for routine check-ups and vaccinations. The inclusion criteria for mothers were ages 18‒45 years during pregnancy and delivery at 37 weeks of gestation or later. Breast milk samples were obtained from the mothers of 17 toddlers with S-ECC and from the mothers of 16 toddlers with healthy teeth. The protein and calcium levels in the samples were measured using the Bradford assay and Flame Atomic Absorption Spectrophotometry assay, respectively. The study found a significantly higher mean protein concentration but no significant difference in calcium concentration in breast milk from mothers whose children were caries-free compared with those whose children had caries. Also, the refined regression model predicted a significant inverse association between protein concentration and dental caries (OR=0.171). Additionally, boys exhibited 14.8 times greater odds of caries compared to girls (OR=14.818). It can be suggested that increased protein intake from breastfeeding in toddlers younger than 24 months, along with being female, is linked to a reduced risk of S-ECC.
We investigated whether Norwegian 21-month-olds (N = 176) hold expectations about agents' dominance based on their distributive fairness (data collected during 2021-2024). Toddlers were presented with two agents who first distributed resources, one acting evenly/fairly and the other selectively/unfairly. Then the agents engaged in territorial competition (Experiment 1). Toddlers looked longer when the unfair, selective agent prevailed and gained center-stage visibility. Experiment 2 ruled out the influence of low-level non-social factors. In Experiments 3 and 4, toddlers watched distributive events like in Experiment 1, but unlike earlier experiments, the test phase did not include competition. Toddlers again looked longer at the selective distributor when it gained center-stage visibility. Overall, these results suggest that toddlers pay special attention to unfair, selective distributors at large, also in the absence of dominance conflict or a clear violation event during the test phase.
Restricted repetitive behaviors (RRBs) are prevalent across neurodevelopmental conditions. It has been hypothesized that greater severity of RRBs reflects elevated distress or diminished regulatory capacity. To test these hypotheses, prospective associations between early negative affectivity (NA) and effortful control (EC) and later RRB severity were examined in a transdiagnostic sample of toddlers with and without autism. Participants were 238 toddlers with neurodevelopmental conditions (autism: n = 165; non-autism: n = 73). NA and EC were assessed at time 1 (T1) (mean [SD] age =24.4 [5.2] months) using the Toddler Behavior Assessment Questionnaire or Early Childhood Behavior Questionnaire. At time 2 (T2) (mean [SD] age = 42.2 [7.3] months), severity of RRBs was assessed using the Autism Diagnostic Observation Schedule (ADOS) and Autism Diagnostic Interview-Revised (ADI-R). Multivariate regression models tested whether T1 NA and EC predicted time 2 RRBs, controlling for age, sex, nonverbal developmental quotient, T1 RRBs, and visit year. Higher EC at T1 predicted lower ADI-R RRB scores at T2 (p < .001) but was not associated with ADOS RRB scores (p = .621). Higher EC was associated with ADI-R lower intensity of compulsive adherence to nonfunctional routines or rituals (p = .001), stereotyped repetitive motor mannerisms (p < .001), and preoccupation with parts of objects or their nonfunctional elements (p = .002), but not circumscribed interests (p = .266). T1 NA was not associated with T2 RRBs on either measure. Regulatory and affective traits show differential longitudinal associations with RRBs, highlighting a potential role for EC in their emergence or maintenance. Interpretation of null findings for NA is limited by unmeasured early environmental influences on the development of anxiety. We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper received support from a program designed to increase minority representation in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. Restricted and repetitive behaviors (RRBs) are common in children with autism spectrum disorder and other developmental conditions. This study examined whether distress or difficulty with attention and behavior regulation predicted later repetitive behaviors. Toddlers prone to distress were not more likely to develop more intense repetitive behaviors later on, while toddlers with lower attentional and behavioral regulation skills were more likely to develop intense repetitive behaviors in preschool.
Executive functions (EFs) are higher order cognitive skills that enable individuals to regulate impulses, retain information, filter out distractions, and shift attention in response to changing demands. Various measures have been developed to assess these functions in toddlers across different contexts. However, convergence between these measures has not yet been established. Nor has it been verified whether these measures work in similar ways among children more-likely to experience EF difficulties, such as children at elevated likelihood for autism or ADHD, or already showing autistic traits. Here, we measure associations between performance-based scores (from a battery of five EF tasks), parent ratings of EFs using the Early Executive Functions Questionnaire Cognitive EF (EEFQ-CEF) and emotion regulation (EEFQ-Regulation) scores, and observer-report of self-regulation scores (Adapted Toddler Self-Regulation Assessment) in a neurodiverse sample of 110 toddlers aged 20 months. In addition, we investigate whether these associations are moderated by the likelihood of autism/ADHD or elevated autistic traits. Correlational analyses reveal positive moderate associations between all scores, except for performance-based EF and EEFQ-Regulation (r = .01). Moderation analyses indicate the association between EEFQ-CEF and EEFQ-Regulation is stronger for children with low levels of autistic traits than those with high levels. No other associations were significantly moderated by autistic traits. These results demonstrate that toddler EF can be captured with moderate consistency across different evaluative contexts (parent-rating, child performance, and researcher observations) and populations (neurodivergent or neurotypical), and that (parent-reported) day-to-day emotion regulation does not link with performance on structured tasks, but is associated with day-to-day cognitive EF, particularly among neurotypical toddlers. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Early-life diet may influence immune development and the risk of allergic diseases. This study investigated associations between dietary patterns at 24 months of age and allergic diseases in Korean toddlers. In this cross-sectional study, 433 toddlers from the Korean Mothers and Children's Environmental Health (MOCEH) cohort were included. Dietary intake was assessed using two non-consecutive 24-hour recalls. Factor analysis of 26 food groups identified dietary patterns, and individual pattern scores were categorized into tertiles based on ascending distribution. Allergic diseases were determined by caregiver questionnaires. Multivariable logistic regression was used to assess associations, adjusting for confounders. Three dietary patterns were identified: Pattern 1 (white rice, kimchi, and non-salt-preserved vegetables), Pattern 2 (seasoning, butter, and meat), and Pattern 3 (milk and dairy products). Compared with the lowest tertile, the highest tertile of Pattern 2 was associated with higher odds of other allergic diseases (OR: 7.55; 95% CI: 1.62-35.23), and any allergic disease (OR: 2.03; 95% CI: 1.10-3.73). Pattern 3 was inversely associated with atopic dermatitis (OR: 0.51; 95% CI: 0.27-0.98), while Pattern 1 showed no significant association. Early childhood dietary patterns may influence the development of allergic disease. A pattern characterized by seasoning, butter, and meat was associated with an increased risk of allergic disease, whereas a dairy-based pattern was inversely associated with atopic dermatitis in Korean toddlers.
To examine whether toddlers' IC-related performance differed across classroom periods with and without sound-absorbing materials. A field-based alternating intervention was conducted in a Japanese nursery classroom (N = 30; age = 24.3-39.3 months). Sound-absorbing materials were installed during two phases and removed during an intervening phase. Existing classroom recordings from four days in each phase were analyzed to characterize sound levels and reverberation times were measured across two phases. IC was assessed using a delay-of-gratification task and analyzed using logistic mixed-effects models. Teachers also completed the Self-Regulation Assessment Scale for Early Childhood for a subset of children. Modest reductions in reverberation time and sound levels were observed during the phases with the sound-absorbing materials installed.　Children showed significantly higher odds of task success during both With-installation phases than during the Without-installation phase, although individual response patterns were heterogeneous. The proportion of children waiting successfully for 300 s was lowest during the Without-installation phase, but substantial individual variability was observed. Teacher ratings collected for a limited subset of children showed a broadly similar pattern. Toddlers' IC-related performance differed across classroom periods with and without sound-absorbing materials. These findings provide preliminary field-based evidence that the classroom intervention may have modified multiple aspects of the classroom environment, including teachers' behaviors and teacher-child interactional processes, thereby contributing to variation in toddlers' IC-related performance. Future studies should determine the relative contributions of acoustic and non-acoustic pathways underlying these intervention-related changes.
The mechanisms influencing successful outcomes of oral Immunotherapy (OIT) are poorly understood. This study investigates the role of environmental, microbial, genetic, and immunological factors on the effectiveness of OIT in infants. To identify biological and environmental mechanisms associated with successful OIT in infants by characterizing longitudinal changes in the microbiome and other multi-omic markers and relating these changes to clinical treatment outcomes. The Deep phenotypINg Of infantS And toddlers Undergoing food oral immunotheRapy (DINOSAUR) study is a prospective cohort study with two groups: infants (<18 months) undergoing OIT, and a comparison group (18-36 months) on the OIT waitlist. In the OIT group, biomaterial (blood, stool, urine, throat and skin swabs, skin tape strips, saliva, and nasal lining samples) and extensive information on environmental exposures has been collected at baseline immediately before initiation of OIT and ongoingly at the end of OIT (exit time-point), and has been collected once in the comparison group (age-matched to the exit time-point). Participant recruitment and sample collection were completed at BC Children's Hospital, Vancouver, Canada. Multi-omics analyses of the collected samples are ongoing and will be reported separately.The primary outcome is changes in the composition and functional profile of the oral- and gut microbiome during infant OIT. A total of 81 participants with suspicion of food allergy attending the BC Children's Hospital Allergy Clinic between March 2023 and November 2023 were included; 58 infants in the OIT group and 23 children in the age-matched comparison group awaiting OIT. Of the 58 infants, 5 turned out not to have an IgE-mediated allergy. Their samples were archived and regarded as "non-food allergic controls". In the infant group (n = 53), 66% were male, 85% had atopic dermatitis, and 42% were born by cesarean section. The majority (70%) were of Asian descent and lived in an urban environment (90%). The most common allergies were against peanut (51%), egg (40%) and cow's milk (26%). This prospective cohort study is the first of its kind to employ a systems biology approach to investigate how extensive biological and environmental factors influence OIT outcomes.
This study examined the associations between napping characteristics and seizure frequency in toddlers and preschool-aged children with epilepsy. A secondary analysis was conducted using data from 139 children with epilepsy aged 1.5-6 years recruited from pediatric neurology clinics at a medical center in northern Taiwan. Sleep was objectively measured by 7-day actigraphy, with daily seizure frequency recorded in caregiver diaries. Children were categorized as habitual nappers (≥6 days per week) or non-habitual nappers. Habitual nappers were further categorized as early or late nappers according to whether their naps ended before or after 5:00 p.m. Habitual nappers had longer daily sleep than non-habitual nappers (561 vs. 533 min, p = 0.03). Among habitual nappers, early nappers experienced fewer daily seizures (0.03 vs. 0.10, p = 0.04) and fewer daytime seizures (0.02 vs. 0.07, p = 0.02) compared with late nappers. Multiple linear regression analyses showed that later nap end times significantly predicted more daytime seizures (β = 0.24, p = 0.04), independent of age, nocturnal sleep and antiseizure medication use. These findings suggest that earlier nap timing, rather than nap presence alone, was associated with reduced daytime seizures. Our findings highlight the potential clinical importance of promoting earlier and more consistent napping schedules as part of behavioral strategies for seizure management. Future research with larger and more diverse pediatric epilepsy populations is needed to confirm these associations and to elucidate the underlying mechanisms linking circadian rhythms, sleep regulation, and seizure susceptibility.
Behavioural interventions remain the cornerstone of evidence-based practice for addressing the core symptoms of autism spectrum disorder (ASD). The Skill Training Program for Parents with ASD Children (STPAC) is a group intervention programme for parents and the first parent-mediated intervention programme developed by Chinese clinical practitioners. This study was conducted to evaluate the feasibility and effectiveness of STPAC within the context of routine child healthcare services in China. This is a real-world, multi-site implementation study employed a single-arm, pre-post design. Between July 2023 and June 2025, 128 families of toddlers (aged 18-54 months) with suspected or diagnosed ASD were enrolled from two child healthcare settings. Participants received the 8-week, group-based parent training programme, which integrated didactic lessons, video modelling and individualised coaching. Outcomes were assessed at baseline and post-intervention using parent-reported measures: the Knowledge of Autism Intervention Questionnaire (KAIQ), the Communication and Symbolic Behavior Scales Developmental Profile (CSBS DP) and the Parenting Stress Index-Short Form (PSI-SF). Statistical analysis included paired-samples t-tests to evaluate within-group changes, with effect sizes (Cohen's d) calculated to quantify the magnitude of improvement. Parental knowledge of autism intervention strategies increased substantially (mean improvement=6.26 points, p<0.001; d=1.17). Child communication and symbolic skills also improved, with the CSBS DP total score rising from 35.30 to 40.88 (p<0.001; d=0.99), representing an overall improvement rate of 85.7%. Furthermore, parenting stress decreased from clinically significant to normal levels (mean reduction=3.70 points, p=0.005). The intervention was equally effective across diverse family demographics, and baseline child communication ability was the strongest predictor of post-intervention gains. Despite an attrition rate of approximately 30%, STPAC demonstrated feasibility as a parent-mediated intervention delivered by trained local clinicians within routine child healthcare settings. Participation in the programme was associated with improvements in parental knowledge, child social communication and parenting stress. These findings provide preliminary evidence supporting the potential of STPAC to expand access to early ASD intervention, though confirmation in a randomised controlled trial is warranted.
Traumatic experiences in early childhood trauma are increasingly recognized as a major public health concern, with infants and toddlers particularly vulnerable because of their rapidly developing brains. Repeated or prolonged exposure to trauma is shown to disrupt neurodevelopment, particularly in brain regions responsible for emotion regulation, executive functioning, stress-response processing, and memory. While it is well established that early childhood trauma negatively impacts social, emotional, and cognitive development, growing evidence demonstrates that early trauma also contributes to long term physical health challenges. In young children, trauma frequently manifests through physiological and bodily symptoms due to their limited capacity to communicate psychological distress. As a result, trauma may present as heightened arousal, somatic issues, sleep disturbances, and feeding difficulties. These concerns are commonly encountered in pediatric healthcare settings, though they may be overlooked or misattributed because of their overlap with other medical conditions. Early childhood represents a critical time for identification and intervention. Pediatric providers are uniquely positioned to identify these early physiological signs of trauma in young children because of their frequent touch points with families. A greater understanding of the manifestations of early trauma in health is needed to improve diagnostic accuracy and promote early intervention. In this paper, we review the effects of early trauma on the physical health of infants and toddlers, highlighting the critical role of pediatric providers in early identification and the integration of trauma-informed care within pediatric settings.
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Poison centers (PCs) in Germany are medical facilities that serve as points of contact for cases of poisoning or suspected poisoning and are available by phone 24 h a day. Consultations are provided by physicians who have completed specialized training in toxicology. Members of the public, healthcare professionals, and institutions with questions regarding toxicology can seek advice from the PCs. Over-the-counter medicines play an important role when contacting the PCs. These include pseudoephedrine (PSE), an indirect sympathomimetic, which is used in Germany as a combination preparation for the treatment of cold and flu symptoms and for the symptomatic treatment of allergic rhinitis. In Germany, PSE is combined with acetylsalicylic acid, acetaminophen, or ibuprofen, as well as with first- and second-generation H1 receptor antagonists. PSE has a decongestant effect on the mucous membranes of the nose and sinuses but also has stimulating effects and causes a feeling of alertness. This study includes an analysis of PSE poisoning cases reported to German PCs. They were asked to provide information on documented cases of PSE poisoning. Three of the seven centers surveyed provided their data (Erfurt 136 cases, Göttingen 175 cases, and Munich 210 cases, overall n = 521). The individual cases were then analyzed in terms of various aspects. The patient cases analyzed revealed age-related differences, with a higher incidence in childhood, particularly among children under 6 years of age. There were also indications of gender-specific differences. At the PC Erfurt, cardiovascular and neurological events predominate, with a male dominance. In Munich, neurological and gastrointestinal symptoms predominated. However, a high proportion of cases with unknown gender made gender-specific classification difficult. In Germany, young children up to the age of six are more severely affected despite contraindications and account for a significant proportion of inquiries to PCs. In recent years, PCs in Germany have reported an increase in cases of poisoning involving PSE combination preparations. A variety of symptoms have been observed in connection with PSE poisoning. As a preventive measure, it would be advisable for physicians-particularly pediatricians-and pharmacists to provide better patient education to raise awareness of the risks. Public platforms could also be used to conduct more educational outreach. Overall, the clinical relevance of PSE poisoning is evident from the present findings, which therefore require increased attention. PCs play an important role in this regard by providing acute consultation and systematically collecting data. However, the present findings should be interpreted in light of the limited data available to PCs.
Play interactions between caregivers and their toddlers provide a critical context for the emergence of joint engagement, a state that supports early learning andsocial communication. Differences in toddler's developmental characteristics and caregiver experiences may influence how joint engagement is established during these interactions. This study examined whether toddler characteristics, including age, cognitive abilities, language abilities (expressive and receptive), and caregiver stress attenuated or amplified the association between caregiver strategy use and joint engagement in toddlers with autism. Participants include 80 toddlers with autism (M age = 26.26 months) and their caregivers. Toddler cognitive and language abilities were assessed at baseline (prior to any intervention) using the Mullen Scales of Early Learning, and caregiver stress was measured using the Parenting Stress Index. Caregiver strategies and child engagement were observationally coded during a 10-min caregiver-child free-play interaction. Results indicated that age, cognitive abilities, expressive and receptive language significantly moderated the association between caregiver strategy use and joint engagement. The positive association between higher quality caregiver strategies and joint engagement was stronger for toddlers who were older and had more advanced cognitive and language abilities. In contrast, caregiver stress attenuated this relationship, such that higher quality caregiver strategies were less predictive of joint engagement at higher levels of stress. These findings suggest that the impact of caregiver strategies on engagement is shaped by both toddler developmental capacities and caregiver well-being, highlighting the importance of tailoring caregiver-mediated interventions to account for individual differences in the toddler - caregiver dyad to optimize joint engagement outcomes.
A retrospective study was conducted to analyze the profile and outcomes of trauma patients admitted to pediatric intensive care unit in a tertiary hospital. The three-month postevent outcome was evaluated based on the Glasgow outcome scale. A total of 118 patients were enrolled. Vehicular accidents ( n = 52; 44.5%) and falls ( n = 51; 43.2%) were the main trauma modes. The incidence of unrestrained passengers in vehicular accidents was high (98%). Unsupervised play in toddlers was the main mechanism of falls. Ambulance transport was done in 48.3% of patients. Abnormal computed tomography head was seen in 72.9% ( n = 86) patients. Mortality rate was 8.5%. On multivariate analysis, Glasgow coma scale (GCS) <8 and injury severity score (ISS) >17 predicted unfavorable outcomes. Screening for head trauma is important in all sick pediatric trauma patients requiring intensive care unit. The study identifies the need for increasing awareness on child-proofing and supervision of toddlers' play and restraining passengers in high-speed vehicles to prevent serious injuries. Ensuring safe ambulance transport may improve trauma outcomes.
Previous research has demonstrated that pediatric-onlyhospitals (POHs) and combined pediatric-adult trauma centers (CPACs) have comparable outcomes in generalized pediatric trauma populations. However, infants and toddlers have distinct injuries and physiology that may be infrequently seen at CPACs. This study compared pediatric trauma patients (PTPs) ≤2 years old treated at POHs versus CPACs, hypothesizing similar associated risk of mortality and in-hospital complications between hospital types. The 2017 to 2023 TQIP database was queried for PTPs ≤2 years old. Patients were grouped by treatment at POHs or CPACs. Hypotension was defined as systolic blood pressure <70 mm Hg, tachypnea as respiratory rate >40 breaths per minute, and tachycardia as heart rate >190 beats per minute (bpm) for PTPs ≤1 year old and >140 bpm for PTPs 2 years old. Bivariate analyses and multivariable logistic regression controlling for age, injury severity score (ISS), and vitals on arrival were performed. Of 39,373 PTPs ≤2 years old, 26,412 (67.1%) were treated at POHs and 12,961 (32.9%) at CPACs. Demographics, ISS (4 vs. 4), and rates of emergent operation (12.1% vs. 12.5%) were similar between cohorts (all p>0.05). On arrival, POH patients were less often hypotensive (0.6% vs. 0.9%, p=0.002) and tachycardic (≤1 y old: 1.4% vs. 1.7%, p=0.007; 2 y old: 27.9% vs. 32.9%, p<0.001), but more commonly tachypneic (3.8% vs. 2.4%, p<0.001). The CPAC cohort had increased complications (1.3% vs. 1.0%, p=0.03); however, this was not significant after multivariable analysis (OR 0.87, CI: 0.71-1.08, p=0.21). Mortality rate (1.3% vs. 1.6%, p=0.07) and associated risk (OR 1.08, CI: 0.86-1.37, p=0.51) were also similar between groups. This seven-year national analysis demonstrated that in PTPs ≤2 years old, the associated risks of in-hospital mortality and complications were similar between POHs and CPACs. These findings reinforce that trauma verification is maintaining similar outcomes across both hospital types, even among infants and toddlers. Retrospective database. Therapeutic/care management; Level IV.
Drowning is a leading cause of pediatric death in the United States, yet data characterizing these arrests is limited. Our study aimed to describe demographic and emergency medical services (EMS) response characteristics for drowning-related pediatric out-of-hospital cardiac arrests (pOHCAs). Using the 2023 National Emergency Medical Services Information System dataset, we conducted a cross-sectional study of EMS-attended 9-1-1 responses involving children 1 day-17 years old who experienced a drowning-related pOHCA. We used descriptive statistics and multivariable logistic regression (adjusted odds ratio; 95% confidence intervals) to identify factors associated with return of spontaneous circulation (ROSC). Our study included 753 drowning-related pOHCAs. Most arrests were toddlers aged 1-4 years (57.8%), males (64.5%), at private residences (72.5%), and in urban settings (83.7%). EMS clinicians were commonly dispatched during the summer (46.7%) and between 12:00 and 17:59 (47.4%). Arrests were often unwitnessed (73.7%) and received bystander cardiopulmonary resuscitation (CPR) (81.3%). Fifty-four percent of adolescent arrests were unwitnessed compared to 80.5% among toddlers (P < 0.001). Most arrests (81.3%) received bystander CPR. Shockable rhythms were uncommon (4.6%). EMS-witnessed ROSC was obtained in 42.0% of arrests. In multivariable regression, adolescent age (3.25; 1.25-8.79), witnessed arrests (1.59; 1.03-2.45), and bystander CPR (2.83; 1.67-4.96) were associated with higher odds of ROSC. Most drowning-related pOHCAs involved young children, with age-based differences in scene characteristics and pre-EMS arrival factors. Adolescent arrests were more frequently witnessed and more likely to obtain ROSC. Opportunities exist to improve drowning prevention among children and enhance the chain of survival.
Acute hypoxemic respiratory failure in toddlers is most commonly associated with severe pneumonia, bronchiolitis, or foreign body aspiration. Complete obstruction of a main bronchus by mucus plugs is an uncommon but potentially life-threatening cause of unilateral lung collapse and severe hypoxemia. We report the case of a previously healthy 17-month-old boy who presented with severe respiratory distress after 3 days of fever and cough. Physical examination revealed marked respiratory distress with absent breath sounds over the left hemithorax. Chest radiography and computed tomography demonstrated complete left lung collapse without evidence of pleural effusion or foreign body. Due to rapidly worsening hypoxemia and suspected central airway obstruction, emergency flexible bronchoscopy was performed under general anesthesia via endotracheal intubation. Complete occlusion of the left main bronchus by thick mucus plugs was identified and successfully removed using suction and bronchoscopic forceps, resulting in immediate improvement in oxygenation and rapid radiologic lung re-expansion. The patient recovered fully and was discharged in 5 days without complications. This case highlights the importance of considering mucus plug-induced bronchial obstruction in toddlers presenting with sudden unilateral lung collapse and severe hypoxemia, particularly when foreign body aspiration remains a differential diagnosis. Early bronchoscopic intervention can be lifesaving and may prevent prolonged respiratory failure and associated complications.
Pediatric dietary assessment is challenging, particularly for young children who cannot accurately report their own intake. Many existing measures are burdensome for proxy-reporters, and briefer dietary screeners focus on specific dietary components but not total diet quality. The objective of this study was to develop and evaluate the reliability and validity of an adapted brief parent-reported diet quality screener - rapid Prime Diet Quality Score for Kids (rPDQS-Kids) - in relation to food groups and overall diet quality estimated from repeated Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24) diet recalls for young children. This was a cross-sectional study that evaluated the psychometric properties of the 16-item rPDQS-Kids. Participants of this study included parents of 1-4 year-old children participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (n=175) in the state of Massachusetts from January 2024 to February 2025. Information about consumption frequencies was reported by parents using the rPDQS-Kids screener. Mean intake and overall diet quality were also assessed using two 24-hour recalls. Test-retest reliability and internal consistency of the rPDQS-Kids were evaluated. Criterion validity was assessed by comparing rPDQS-Kids diet quality score with the Healthy Eating Index (HEI) score (HEI-2020 for 2-4y; HEI-Toddlers-2020 for 1 to <2 y). The rPDQS-Kids showed moderate test-retest reliability [Intraclass Correlation Coefficient for total score: 0.69 (95% CI: 0.62, 0.75)]. Consistent with a priori hypotheses, internal consistency reliability was low, with ordinal alpha=0.27 and ordinal alpha=0.34 for the healthy and unhealthy sub-scores, respectively. Further, significant correlation was observed between the rPDQS-Kids traffic light diet quality score and HEI-2020 total score among children 2-4 (n=127) years old (r=0.32) (P<0.001). Among children 1 to <2y (n=48), rPDQS-Kids was not significantly correlated with the HEI-Toddlers-2020 (P>0.05). The parent-reported rPDQS-Kids shows potential as a low-burden tool for measuring young children's dietary quality.
Infants exposed to alcohol and/or drugs (AoD) in utero are at considerable risk for developmental complications which are amenable to early intervention. There are no published guidelines in Australia for the allied health care of infants and toddlers (0-2 years) who have been exposed to AoD in utero. This study aimed to explore the current service delivery and follow-up health services available across Australia for this high-risk population group. A custom-designed survey was distributed via email to the leading contact of hospitals based in Australia that offered a neonatal-based follow-up service (n = 43). Reminders to prompt completion were emailed out at regular intervals over a two-month period. A total of 15 of 43 invited services (35%) provided responses with only 3 of 15 (20%) offering targeted care for infants exposed to AoD and 5 (33%) using any formal developmental or screening tools with this population. Responses indicated inconsistencies with allied health involvement including professions involved and time points for follow-up care. Funding was highlighted as a key barrier to conducting follow-up assessments, with 12 of 15 (80%) health services reporting they received no dedicated funding for this population. Within the responding services, our data reflects the lack of consensus on any standardised process for assessment or follow-up service delivery for this high-risk patient population. Although the response rate was low, it is consistent with previous health professional survey research. There remains a need for further research and the development of clinical care guidelines on best standard protocols for assessing and supporting the development of infants exposed to AoD in utero.