Background Socioeconomic disparities in children's neurodevelopment constitute a critical yet understudied developmental challenge in low- and middle-income countries (LMICs), yet longitudinal evidence from Sub-Saharan Africa (SSA) remains limited. This study aimed to evaluate the relationship between household wealth and neurocognitive trajectories in a cohort of Tanzanian children aged 6 months to 10 years. Methods We randomly selected 590 children aged 6 months to 10 years in Bagamoyo district, a low to moderate-malaria-endemic area in Tanzania. Participants completed comprehensive, age-appropriate neurodevelopmental assessments. The family's socioeconomic status was derived from their household assets. Standardized, age-adjusted neurodevelopmental scores were regressed on socioeconomic status tertiles and by developmental periods: early childhood (6 months-3 years), preschool (4-5 years), and school age (6-10 years). Results While children from high- and low-Socioeconomic status (SES) families start with similar neurodevelopmental scores, a significant and sustained gap begins to emerge around age 2 years. This divergence results in a substantial disadvantage for children from the poorest households, with scores showing a difference of -0.36 Standard Deviation (SD) (95% CI: -0.64 to -0.08) during the preschool years and -0.41 SD (95% CI: -0.73 to -0.09) at school age. Conclusion Our results suggest that programs targeting the preschool period may be most effective in mitigating disparities in neurodevelopment.
Young children in early childhood education (ECE) settings frequently exhibit social-emotional challenges which can interfere with learning and long-term development. Supporting Trauma Awareness and Nurturing Children's Environments (STANCE) is a multilevel intervention designed to support teachers and caregivers in promoting young children's social-emotional development through evidence-based strategies. The objective of this paper is to describe the effectiveness of this intervention on child and parent outcomes in a rural, primarily Latine community. A hybrid type 2 effectiveness-implementation study design using a stepped-wedge cluster randomized design was conducted across 16 ECE centers. A total of 140 teachers received training and coaching on the Pyramid Model, a tiered framework that supports social-emotional development through universal, targeted, and individualized classroom practices, while 106 caregivers participated in Positive Solutions for Families (PSF) workshops to strengthen parenting practices. Child outcomes were assessed using the Social Skills Improvement System (SSIS) for 888 children at the beginning and end of the school year, while parenting outcomes were collected pre- and post PSF intervention. Using mixed effect models, implementation of the Pyramid Model intervention with teachers was associated with significant increases in children's social skills (Cooperation, Assertion, Empathy, Engagement, Responsibility, Communication, Self-Control, all p < .01). Using paired t-tests, caregivers who participated in PSF demonstrated significant increases in positive reinforcement, emotional literacy, and problem-solving strategies. These findings suggest that multilevel, preventive interventions targeting both teachers and caregivers in ECE settings can strengthen parenting and classroom practices, leading to improvements in children's social-emotional skills, particularly in underserved ECE settings.
Early childhood caries (ECC) is a major pediatric oral health problem that may adversely affect normal occlusal and craniofacial development in children. Therefore, it is of interest to evaluate the relationship between early childhood caries (ECC) and developing malocclusion patterns in young children. A cross-sectional pedodontic-orthodontic assessment was conducted to determine how caries severity influences occlusal development. Data show a significant association between severe ECC and malocclusions such as increased overjet, crossbite and anterior open bite. Behavioral and dietary factors further contributed to this relationship. Early preventive intervention and integrated dental care are essential to reduce long-term developmental issues.
Objective Autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), cerebral palsy (CP), and developmental delay are major childhood neurodevelopmental disorders. Sibling status and birth order may influence neurodevelopmental outcomes, yet population-based evidence remains limited. This study examined their associations with childhood neurodevelopmental disorder risks in a nationwide birth cohort. Methods We analyzed 2,045,178 live births from Taiwan's Birth Registration Database (2004-2014), linked to National Health Insurance and Death Registry records through 2020. CP, developmental delay, ASD, and ADHD were identified using ICD codes. Children were classified by sibling status and birth order using maternal identifiers. Kaplan-Meier and Cox models estimated adjusted hazard ratios (aHRs), controlling for maternal age, birth period, perinatal factors, socioeconomic status, and urbanization. Results Compared with single children, those with siblings generally showed lower risks of CP and ASD, whereas associations with ADHD and developmental delay varied according to birth order. Later birth order was associated with lower recorded risks of ASD and ADHD. Similar patterns were observed after excluding multiple births and in analyses restricted to diagnoses before 6 years of age. Conclusions Family structure, including single-child status and birth order, was associated with childhood neurodevelopmental disorder risks. Compared with children who had siblings, single children generally had higher risks across multiple neurodevelopmental outcomes. These findings suggest that family structure may represent an important early-life context for neurodevelopment and may help inform developmental surveillance in societies experiencing declining fertility rates and delayed childbearing.
Early childhood caries (ECC) is a major pediatric oral health problem that may adversely affect normal occlusal and craniofacial development in children. Therefore, it is of interest to evaluate the relationship between early childhood caries (ECC) and developing malocclusion patterns in young children. A cross-sectional pedodontic-orthodontic assessment was conducted to determine how caries severity influences occlusal development. Findings show a significant association between severe ECC and malocclusions such as increased overjet, crossbite and anterior open bite. Behavioral and dietary factors further contributed to this relationship. Early preventive intervention and integrated dental care are essential to reduce long-term developmental issues.
Corporal and psychological punishment toward children typically emerges from bidirectional, escalating, and coercive parent-child interactions. These parenting dynamics have been understudied in Latin America, where associations with child emotional development have been found to be significant. This study addressed three questions in a sample of 18,269 typically developing boys and girls, aged 3 to 4 years, from 10 Latin American countries (UNICEF MICS data 2019-2024), regarding corporal punishment (hitting with hand/belt/object or with maximum force, shaking) and psychological punishment (yelling and insulting): (a) Which children, based on their socioemotional adjustment, are at greater risk of receiving corporal punishment? (b) How robust are these associations to unmeasured confounding factors? (c) What contextual factors moderate this relationship? Boys and girls with externalizing behaviors (e.g., hitting others) were more likely to receive punishment. However, associations were significant in only 7 of 10 countries and showed moderate robustness to confounding (E-values: 1.08-1.37). In pooled analyses across all countries, boys showed more consistent negative associations with prosocial behavior. However, substantial cross‑country heterogeneity emerged, and girls exhibited significant associations in several national contexts, sometimes with effect sizes exceeding those for boys. Key protective factors attenuated negative associations: early childhood education attendance, higher maternal education, and greater household wealth. Additionally, three vulnerabilities emerged in the region: 29% poverty, 83% low maternal education, and 43% no early childhood education attendance. The coercion cycle was evidenced among preschool-aged children across Latin America, although with substantial national variation. Effective interventions must extend beyond legal prohibitions. Context‑sensitive public policies that strengthen protective early education and economic resources and implement culturally adapted parenting programs to interrupt coercive cycles, particularly in high‑risk environments for preschool children, are warranted.
The rapid integration of electronic media into daily life has transformed early childhood experiences worldwide. While digital technology offers opportunities for learning, communication, and entertainment, concerns persist regarding its impact on neurodevelopment during the critical early years of life. This narrative review synthesizes current evidence on the association between electronic media exposure and neurodevelopmental outcomes in children under 5 years of age. The literature search of PubMed, Embase, Scopus, Web of Science, and the Cochrane Library identified 21 original studies, 12 review articles (systematic reviews/meta-analyses, scoping reviews, and narrative reviews), and 4 international guidelines/recommendations, which were included in the narrative synthesis. Evidence related to cognitive, language, motor, behavioral, socioemotional development, sleep, and neuroimaging findings was critically reviewed. Overall, excessive and early screen exposure was associated with language delays, impaired attention and executive functioning, socioemotional difficulties, sleep disturbances, and reduced motor activity. Sleep disruption, including shorter sleep duration and delayed sleep onset, may represent an important pathway linking excessive media use with adverse neurodevelopmental outcomes. Neuroimaging studies also suggest reduced white matter integrity in language-related brain pathways, providing biological plausibility for these associations.Developmental outcomes were influenced by parental mediation, content quality, socioeconomic factors, and increased screen exposure during the coronavirus disease 2019 pandemic. Current guidelines from the American Academy of Pediatrics, World Health Organization, and Indian Academy of Pediatrics recommend limiting screen exposure and promoting caregiver-supervised, developmentally appropriate media use. Excessive and unsupervised electronic media use may adversely affect multiple domains of neurodevelopment, particularly when it replaces interactive play, caregiver engagement, and healthy sleep. Further longitudinal studies incorporating objective measures of media exposure, sleep assessment, and neuroimaging are needed to strengthen current evidence and guide pediatric recommendations.
Background Fine particulate matter air pollution (PM2.5) has been associated with adverse neurodevelopmental outcomes. Yet, evidence from whole-of-population studies examining developmental vulnerability at school entry remains limited, particularly in low-exposure settings. We investigated associations between prenatal and early childhood PM2.5 exposure and developmental vulnerability at school entry in Western Australia. Methods We conducted a population-based cohort study using linked records from the Australian Early Development Census (AEDC), Midwives' Notifications System (MNS), Birth Registrations, and Hospital Morbidity Data Collection (HMDC). Children from the 2009, 2012, and 2015 AEDC waves were assigned daily PM2.5 exposure at the Statistical Area Level 2. Mean PM2.5 concentrations were calculated for prenatal (conception to birth), early childhood (birth to AEDC assessment), and cumulative (conception to AEDC assessment) exposure windows. Developmental vulnerability was defined as scoring below the 10th percentile cut-off established in the 2009 AEDC for each developmental domain. Associations were estimated using Bayesian multilevel logistic regression models. Results Among 54,458 children, mean PM2.5 concentrations ranged from 7.40 to 7.54 μg/m3. Early childhood PM2.5 exposure was associated with increased odds of developmental vulnerability in one or more domains (DV1: OR 1.04, 95% CrI 1.01-1.07), two or more domains (DV2: OR 1.06, 95% CrI 1.03-1.08) per 1 μg/m3 increase. Associations were observed for physical health and well-being, social competence, and language and cognitive skills (school-based). No consistent pattern of associations were observed for prenatal or cumulative PM2.5 exposure. Conclusion Early childhood PM2.5 exposure was associated with increased developmental vulnerability at school entry in this low-exposure setting. Although prenatal and early childhood exposures were highly correlated, precluding identification of a definitive critical exposure period, the greatest associations in this study were observed during the early childhood exposure period. These findings support continued efforts to reduce children's exposure to PM2.5, particularly among socially and biologically vulnerable populations.
Background/Objectives: Post-stroke epilepsy represents one of the most frequent and impactful long-term sequelae of pediatric arterial ischemic stroke. Children are particularly vulnerable to developing seizures and epilepsy after stroke, likely because the immature brain responds differently to ischemic injury than the adult brain. The purpose of this narrative review is to summarize the current evidence regarding the epidemiology, risk factors, mechanisms, and clinical implications of post-stroke epilepsy following pediatric arterial ischemic stroke. Methods: We conducted a narrative review to examine the incidence, determinants, risk stratification, and long-term outcomes of post-stroke epilepsy following childhood arterial ischemic stroke beyond the neonatal period. Results: The reported incidence of post-stroke epilepsy in children varies considerably across studies, ranging from approximately 7% to over 40%. However, recent data suggest that roughly one in four children who experience an arterial ischemic stroke will eventually develop epilepsy, highlighting the substantial long-term burden of this condition. Acute symptomatic seizures, particularly very early seizures and acute status epilepticus, consistently emerge as the strongest predictors of subsequent epilepsy, with recent pediatric meta-analytic data suggesting an approximately fourfold increased risk of post-stroke epilepsy. Cortical involvement and persistent neurological deficits also represent robust predictors of post-stroke epilepsy (PSE), whereas younger age at stroke onset, multifocal infarctions, greater infarct burden, anterior circulation involvement, and focal cerebral arteriopathy have been associated with an increased risk. Emerging evidence further suggests a possible contribution of genetic susceptibility and potentially modifiable biological factors, such as vitamin D deficiency, to epileptogenic risk. Conclusions: This narrative review summarizes current evidence regarding the incidence, determinants, and pathophysiological mechanisms of post-stroke epilepsy following childhood arterial ischemic stroke, highlighting established and emerging risk factors and their implications for long-term risk stratification, clinical management, and future preventive strategies.
Background Food allergy is an important health concern, particularly during infancy and early childhood. Its development reflects complex interactions between genetic susceptibility and early-life nutritional, microbial, epithelial, immunological, and environmental factors. Objective To examine the role of early-life nutrition in the development and prevention of food allergy, with emphasis on its interplay with the gut microbiome, genetic and epigenetic susceptibility, epithelial barrier function, and environmental exposures. Methods A structured literature search was conducted primarily in PubMed, supplemented by relevant articles identified through additional bibliographic databases and literature sources. Evidence was thematically synthesized across maternal nutrition, breastfeeding, complementary feeding, allergenic food introduction, dietary diversity, micronutrients, fatty acids, gut microbiome development, genetic and epigenetic mechanisms, and environmental exposures. Results Early life represents a critical window for immune maturation and the establishment of oral tolerance. Nutritional exposures interact with the gut microbiome, epithelial integrity, and immune pathways, potentially influencing tolerance and sensitization. The most consistent evidence for primary prevention supports the timely introduction and continued ingestion of allergenic foods, particularly peanut and egg, during complementary feeding. Evidence remains insufficient or inconsistent to support maternal allergen avoidance, targeted supplementation, hydrolyzed formulas, probiotics, microbiome-directed interventions, or skin-barrier strategies as established preventive approaches. Associations involving microbiome composition, medication exposure, pollution, and other environmental factors remain heterogeneous and are largely observational. Conclusions Food allergy reflects complex interactions among diet, microbiota, epithelial barriers, host susceptibility, and environmental exposures rather than a single causal factor.
