Purpose: Rhyming is a phonological skill that typically emerges in the preschool-age range. Prosody/rhythm processing involves right-lateralized temporal cortex, yet the neural basis of rhyming ability in young children is unclear. The study objective was to use functional magnetic resonance imaging (fMRI) to quantify neural correlates of rhyming abilities in preschool-age children.Method: Healthy pre-kindergarten child-parent dyads were recruited for a study visit including MRI and the Preschool and Primary Inventory of Phonological Awareness (PIPA) rhyme subtest. MRI included an fMRI task where the child listened to a rhymed and unrhymed story without visual stimuli. fMRI data were processed using the CONN functional connectivity (FC) toolbox, with FC computed between 132 regions of interest (ROI) across the brain. Associations between PIPA score and FC during the rhymed versus unrhymed story were compared accounting for age, sex, and maternal education.Results: In total, 45 children completed MRI (age 54 +/- 8 months, 37-63; 19M 26F). Median maternal education was college graduate. FC between ROIs in posterior default mode (imagery) and right fronto-parietal (executive function) networks was more strongly positively associated with PIPA score during the rhymed compared with the unrhymed story [F(2,39) = 10.95, p-FDR = 0.043], as was FC between ROIs in right-sided language (prosody) and dorsal attention networks [F(2,39) = 9.85, p-FDR = 0.044].Conclusions: Preschool-age children with better rhyming abilities had stronger FC between ROIs supporting attention and prosody and also between ROIs supporting executive function and imagery, suggesting rhyme as a catalyst for attention, visualization, and comprehension. These represent novel neural biomarkers of nascent phonological skills.

Background The AAP recommends “shared” reading from early infancy for healthy development. However, many families are uncertain how to read most enjoyably and effectively with infants, especially from underserved backgrounds. Shared reading quality (interactivity) moderates benefits yet is challenging to measure. SHARE/STEP is a new model of shared reading quality at this age incorporating evidence-based behaviors. Objective To test the SharePR parent-report measure of caregiver–infant reading quality. Methods This study involved mother–infant dyads in two unrelated trials in an obstetric (0–2 months old) and pediatric (6–9 months old) clinic. SharePR is a 10-item measure based on the SHARE/STEP model. Analyses involved descriptive statistics, measures of psychometric integrity, and correlations with home literacy environment (HLE). Results There were 99 dyads in the younger (1.2 + 0.5 months) and 108 dyads in the older groups (6.6 + 1.1 months). A majority were of non-white race (73%, 96%) and low-socioeconomic status (56%, 44% in-poverty). SharePR administration time was under 2 min and scores were normally distributed at each age. Psychometric properties were strong in terms of internal consistency and reliability. Scores were positively correlated with HLE for the older group ( p < 0.05). Conclusions SharePR may be an efficient tool to quantify shared reading quality with infants, warranting further investigation. Clinical trials Data for these analyses were collected via two unrelated trials led by the lead author (J.S.H.). For the younger cohort, this is registered on the ClinicalTrials.gov website, ID# NCT04031235. For the older cohort, this is registered on the ClinicalTrials.gov website, ID# 2017-6856. Impact The AAP recommends caregiver–child (“shared”) reading beginning in infancy, yet many families are uncertain how to do so. Verbal and social-emotional interactivity during shared reading (“quality”) moderates benefits and is often low in families from disadvantaged backgrounds, yet is challenging to measure. SharePR is a 10-item parent-report measure of shared reading quality based on a novel conceptual model incorporating evidence-based behaviors (SHARE/STEP). SharePR exhibited promising psychometric properties in two separate samples of mothers of younger and older infants. SharePR is a potentially useful measure of shared reading quality at this formative age, for research and to frame early reading guidance.

BACKGROUND:Parental feeding styles, including the emotional environment parents create to modify a child's eating behaviors, have been associated with measures of adiposity in cross-sectional studies. The longitudinal relation between parental feeding styles in early infancy and adiposity in later infancy/toddlerhood are scant and have shown mixed results, particularly in families from low-income households. OBJECTIVES:This study examined the relation between parental feeding styles and infant BMI z-score trajectories between 6 and 18 mo in families from low-income households. METHODS:Parent-infant dyads were recruited during the infant's 6-, 9-, or 12-mo well-child visit. Feeding styles were assessed using the Infant Feeding Style Questionnaire (IFSQ). Infant anthropometrics from birth through 18 mo were extracted from the electronic medical record. BMI z-score slopes were estimated for each infant between 0-6 mo and 6-18 mo. Associations between feeding styles and BMI z-score slopes were examined using mixed models controlling for demographic, clinical, and feeding covariates. RESULTS:The final analytic sample included 198 dyads (69% Black; median infant age: 9.0 mo; IQR: 6.8-10.3 mo). The predominant parent feeding styles included the following: laissez-faire (30%), restrictive (28%), responsive (23%), and pressuring (19%). In adjusted models, the predominant feeding style at enrollment was associated with the BMI z-score slope between 6 and 18 mo, with the responsive feeding style exhibiting a steeper increase in BMI z-score than other feeding styles. Infant feeding style was not associated with BMI z-score slope between birth and 6 mo of age. Infants of parents who exhibited restrictive feeding styles were more likely to have a BMI ≥85th percentile at their last measurement. CONCLUSIONS:The predominant parent feeding style during infancy in a low-income population was associated with infant BMI z-score between 6 and 18 mo of age, but not earlier. Further studies are needed to better understand how predictive factors collectively contribute to BMI increase in the first 2 y.

The American Academy of Pediatrics recommends limits on digital media use ("screen time"), citing cognitive-behavioral risks. Media use in early childhood is ubiquitous, though few imaging-based studies have been conducted to quantify impacts on brain development. Cortical morphology changes dynamically from infancy through adulthood and is associated with cognitive-behavioral abilities. The current study involved 52 children who completed MRI and cognitive testing at a single visit. The MRI protocol included a high-resolution T1-weighted anatomical scan. The child's parent completed the ScreenQ composite measure of media use. MRI measures included cortical thickness (CT) and sulcal depth (SD) across the cerebrum. ScreenQ was applied as a predictor of CT and SD first in whole-brain regression analyses and then for regions of interest (ROIs) identified in a prior study of screen time involving adolescents, controlling for sex, age and maternal education. Higher ScreenQ scores were correlated with lower CT in right-lateralized occipital, parietal, temporal and fusiform areas, and also lower SD in right-lateralized inferior temporal/fusiform areas, with substantially greater statistical significance in ROI-based analyses. These areas support primary visual and higher-order processing and align with prior findings in adolescents. While differences in visual areas likely reflect maturation, those in higher-order areas may suggest under-development, though further studies are needed.

BACKGROUND AND OBJECTIVES:The American Academy of Pediatrics recommends literacy and school readiness promotion during well visits. The Reading House (TRH) is a children's book-based screener of emergent literacy skills in preschool-aged children. Vocabulary, rhyming, and rapid naming are core emergent skills, and reading abilities are associated with thicker cortex in the left hemisphere. Our objective was to expand validity of TRH relative to these skills and explore association with cortical thickness. METHODS:Healthy preschool-aged children completed MRI including a T1-weighted anatomic scan. Before MRI, TRH and assessments of rapid naming (Comprehensive Test of Phonological Processing, Second Edition), rhyming (Pre-Reading Inventory of Phonological Awareness), vocabulary (Expressive Vocabulary Test, Second Edition), and emergent literacy (Get Ready to Read!) were administered. Analyses included Spearman-ρ correlations (r ρ) accounting for age, sex, and socioeconomic status (SES). MRI analyses involved whole-brain measures of cortical thickness relative to TRH scores, accounting for covariates. RESULTS:Seventy children completed assessments (36-63 months old; 36 female) and 52 completed MRI (37-63 months; 29 female). TRH scores were positively correlated with Comprehensive Test of Phonological Processing, Second Edition (r ρ = 0.61), Expressive Vocabulary Test, Second Edition (r ρ = 0.54), Get Ready to Read! (r ρ = 0.87), and Pre-Reading Inventory of Phonological Awareness scores (r ρ = 0.64; all P < .001). These correlations remained statistically significant across age, sex, and SES groups. TRH scores were correlated with greater thickness in left-sided language and visual cortex (P-family-wise error <.05), which were similar for higher SES yet more bilateral and frontal for low SES, reflecting a less mature pattern (P-family-wise error <.10). CONCLUSIONS:These findings expand validation evidence for TRH as a screening tool for preschool-aged children, including associations with emergent skills and cortical thickness, and suggest important differences related to SES.

Importance Literacy has been described as an important social determinant of health. Its components emerge in infancy and are dependent on genetic, medical, and environmental factors. The American Academy of Pediatrics advocates a substantial role for pediatricians in literacy promotion, developmental surveillance, and school readiness to promote cognitive, relational, and brain development. Many children, especially those from minority and underserved households, enter kindergarten unprepared to learn to read and subsequently have difficulty in school. Observations Emergent literacy is a developmental process beginning in infancy. Component skills are supported by brain regions that must be adequately stimulated and integrated to form a functional reading network. Trajectories are associated with genetic, medical, and environmental factors, notably the home literacy environment, which is defined as resources, motivation, and stimulation that encourage the literacy development process. Eco-biodevelopmental models are advocated by the American Academy of Pediatrics, and these models offer insights into the neurobiological processes associated with environmental factors and the ways in which these processes may be addressed to improve outcomes. Emergent literacy is well suited for such a model, particularly because the mechanisms underlying component skills are elucidated. In addition to cognitive-behavioral benefits, the association of home literacy environment with the developing brain before kindergarten has recently been described via neuroimaging. Rather than a passive approach, which may subject the child to stress and engender negative attitudes, early literacy screening and interventions that are administered by pediatric practitioners can help identify potential reading difficulties, address risk factors during a period when neural plasticity is high, and improve outcomes. Conclusions and Relevance Neuroimaging and behavioral evidence inform an eco-biodevelopmental model of emergent literacy that is associated with genetic, medical, and home literacy environmental factors before kindergarten, a time of rapid brain development. This framework is consistent with recommendations from the American Academy of Pediatrics and provides insights to help identify risk factors and signs of potential reading difficulties, tailor guidance, and provide direction for future research.

Objective To estimate feasibility, usability and efficacy of a mobile parenting app (Rx for Success; RxS) to enhance reading guidance provided to parents of young children during well-visits. Methods This trial was conducted at a clinic serving primarily families of Hispanic ethnicity and low-socioeconomic status (SES) where Reach Out and Read (ROR) is standard practice. It involved 252 parent-child dyads in 2 age groups (~6-months old, ~18-months old) randomized during well-visits to receive RxS or a children's book modeling alternatives to screen time (Control) by research coordinators. RxS involves videos, activities and “push” messages. Follow-up assessments were conducted approximately 6 months later, including impression and use, shared reading behaviors, child language and screen time. Results A total of 217 dyads completed both visits (110 RxS, 107 Control). Time to introduce RxS was under 3 minutes and 32% of parents experienced largely minor performance issues. Parent impression of RxS was favorable for both age groups at baseline and follow-up, though use was infrequent, attributable to a desire for more relevant and updated content. Significant findings favoring RxS included shared reading as a favorite activity, more frequent shared reading reported at 12 months and higher language scores at 24 months. Screen time was equivalent between cohorts, exceeding American Academy of Pediatrics guidelines. Conclusions A mobile app introduced to parents of young children from low-SES backgrounds was feasible during well-visits, rated as helpful, and effective to enhance shared reading at younger and language at older ages. While a potentially impactful enhancement to ROR, features needing improvement were identified.

OBJECTIVES: Sharing books with preschoolers is known to improve kindergarten readiness. Both Reach Out and Read (ROR) and Dolly Parton's Imagination Library (DPIL) have shown positive effects on book sharing at home. We developed a novel combined ROR/DPIL program and examined the effect on kindergarten readiness assessment (KRA) scores. METHODS: At urban ROR primary care sites, patients <5 years living in the city school district were enrolled from July 2015 through January 2019 in the ROR/DPIL program when seen for a clinic visit. The literacy subtest of the KRA was examined for participants entering kindergarten in the fall of 2016, 2017, and 2018. The "on-track" rate of participants was compared with nonparticipant groups. RESULTS: A total of 797 kindergarten-aged ROR/DPIL participants were matched to Ohio KRA scores for 2016, 2017, and 2018 school years. The percentages of students "on-track" on KRA literacy subtests increased significantly by cohort (2016, 42.9% [95% confidence interval (CI): 34.9%-50.9%] versus 2017, 50.9% [95% CI: 44.9%-56.9%] versus 2018, 58.3% [95% CI: 53.3%-63.3%], P = .004). ROR/DPIL participants were compared with a proportionate stratified random sample of 1580 non-ROR/DPIL peers. On-track in literacy did not significantly differ between groups (2016 [P = .262], 2017 [P = .653], 2018 [P = .656]), nor did they differ after restricting analysis to economically disadvantaged children (2016 [P = .191], 2017 [P = .721], 2018 [P = .191]). CONCLUSIONS: With these results, we suggest that a program combining literacy anticipatory guidance at clinic visits and more books in the home can potentially improve kindergarten readiness. Pediatric health care providers can play an important role in promoting kindergarten readiness through literacy promotion.

Objective To assess whether a citywide structured book-sharing program (NICU Bookworms) designed to promote reading to infants while admitted in the neonatal intensive care unit (NICU) would increase parental reading behaviors (>= 3-4 days/week) in the NICU and after discharge home, including high-risk parents who do not themselves enjoy reading. Study design The NICU Bookworms program comprised staff training, parent education, and building a literacy-rich environment. In this quasi-experimental intervention study, parents of medically high-risk NICU graduates <6 months of age were administered a questionnaire at their first NICU follow-up clinic visit. The survey incorporated questions from the StimQ-I READ subscale to assess home reading environment and shared reading practices. Results A total of 317 infants were enrolled, 187 in an unexposed comparison group and 130 in the intervention group. Parents exposed to Bookworms were significantly more likely to read >= 3-4 days per week while in the NICU (34.5% vs 51.5%; P = .002; aOR, 2.2; 95% CI, 1.2-4.0), but reading at home did not differ (67.9% vs 73.1%; P = .28; aOR, 0.99; 95% CI, 0.5-1.8). However, among parents who did not themselves enjoy reading, frequency was significantly higher both in the NICU (18.4% vs 46.1 %; P = .009; aOR, 5.0; 95% CI, 1.2-21.5) and at home (36.9% vs 70%; P = .003; aOR, 3.7; 95% CI, 1.1-12.9). A qualitative thematic analysis found that Bookworms decreased parental stress, enhanced bonding, and supported positive parent-infant interactions. Conclusions A book-sharing intervention in the NICU increased parent-reported reading aloud during hospitalization and among parents disinclined to read for pleasure, both in the NICU and following discharge. This change may have been mediated by enhancement of parent-infant interactions.

Optimal educational practices that relate to development of curriculum, its implementation, and tools for its assessment are essential to effectively develop in trainees the necessary skills to care for patients. However, these practices are poorly understood, and performance assessment efforts to ensure these skills are acquired demonstrate variability.1Govaerts M.J. van der Vleuten C.P. Schuwirth L.W. Muijtjens A.M. Broadening perspectives on clinical performance assessment: rethinking the nature of in-training assessment.Adv Health Sci Educ Theory Pract. 2007; 12: 239-260Crossref PubMed Scopus (198) Google Scholar, 2Govaerts M. Schuwirth L.W.T. van der vleuten C.P.M. Muijtjens A.M.M. Workplace-based assessment: effects of rater expertise.Adv Health Sci Educ. 2011; 16: 151-165Crossref PubMed Scopus (144) Google Scholar, 3Kogan J.R. Conforti L. Bernabeo E. Iobst W. Holmboe E. 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Medical school faculty discontent: prevalence and predictors of intent to leave academic careers.BMC Med Educ. 2007; 7: 37Crossref PubMed Scopus (154) Google Scholar Education research units (ERUs) are the prevailing method for developing capacity within institutions to promote both the development of research skills for educationally oriented faculty as well as define an institution's proficiency in health professions education research.14Varpio L. O'Brien B. Hu W. Ten Cate O. Durning S.J. van der Vleuten C. et al.Exploring the institutional logics of health professions education scholarship units.Med Educ. 2017; 51: 755-767Crossref PubMed Scopus (25) Google Scholar,15Varpio L. O'Brien B. J Durning S. van der Vleuten C. Gruppen L. Ten Cate O. et al.Health Professions Education Scholarship Unit Leaders as Institutional Entrepreneurs.Acad Med. 2017; 92: 1189-1195Crossref PubMed Scopus (15) Google Scholar However, formal ERUs are uncommon in the US, and we are not aware of any that exist in pediatrics. Successful ERUs require infrastructure, mentorship, and funding to reach their ultimate goal, recognition as a leader of health professions education. The Cincinnati Children's Education Research Unit (CERU) is the education research arm of the Cincinnati Children's Hospital Pediatric Education Center, developed in 2018, to provide a comprehensive structure to effectively align education outcomes across the continuum of physician training. Funding and infrastructure planning for CERU began in 2018 and resulted in hiring a program manager and research assistant and providing protected time to the directors. CERU's efforts formally began in early 2019. Critical to the development of CERU was funding and engagement from Cincinnati Children's Hospital Pediatric Education Center and Cincinnati Children's Hospital Medical Center (CCHMC) leadership. An internal grant mechanism funded CERU; funding similar efforts at other institutions may be achieved by strategic planning conversations with institutional leaders (eg, department chair, vice chair of education, or faculty development). Early on, clear objectives, curricula, and short- and long-term outcomes were defined using a logic model.16McLaughlin J.A.J. Gretchen B. Using logic models.in: Handbook of practical program evaluation. Jossey-Bass, San Francisco2004: 62-87Google Scholar Our main goals included (1) developing research skills among education-focused faculty to subsequently garner external funding and (2) facilitating internal and external collaborative research to become a leader in developing and evaluating education and training that improves child health. Our focus on patient outcomes, less common in education, is important for long-term funding, sustainability, filling gaps in current training, and, most important, improving the health of patients.17Rees C.E. Monrouxe L.V. Theory in medical education research: how do we get there?.Med Educ. 2010; 44: 334-339Crossref PubMed Scopus (67) Google Scholar, 18Palermo C. King O. Brock T. Brown T. Crampton P. Hall H. et al.Setting priorities for health education research: a mixed methods study.Med Teach. 2019; 41: 1029-1038Crossref PubMed Scopus (5) Google Scholar, 19Laksov K.B. Dornan T. Teunissen P.W. Making theory explicit–an analysis of how medical education research(ers) describe how they connect to theory.BMC Med Educ. 2017; 17: 18Crossref PubMed Scopus (28) Google Scholar To achieve these goals, it was critical to create a robust infrastructure. The CERU team is composed of a project manager, research coordinator, statistician, and key educational research faculty. An advisory board of internal and external consultants was established to guide and promote CERU's efforts. Board members were selected based on their expertise in key fields: innovation and technology, funding, education, biomedical informatics, and ERU development. Although CERU supports a wide range of education research efforts at CCHMC, an Education Research Scholars Program (ERSP) was created as the hallmark program of CERU to support education and career development of junior faculty with medical education research pursuits. The 1-year ERSP is structured to provide mentorship, career development, and sponsorship, a concept focused on connecting junior faculty to senior leaders both inside and outside the institution, promoting visibility, and unlocking career opportunities.20Hewlett S.A. The real benefit of finding a sponsor. Harvard business review.https://hbr.org/2011/01/the-real-benefit-of-finding-aDate: 2011Date accessed: October 14, 2019Google Scholar In addition, protected research time and administrative, research, and statistical support for an educational research project are provided. Two applicants are selected each year for an ERSP scholarship through an application-based selection process to ensure that candidates and their professional aspirations align with the ERSP aims. The application requires written testimony of their goals as a medical education researcher, a research project proposal, a letter of recommendation, and a statement of support from their division director. All candidates must have already completed a Masters of Education (or comparable degree) and demonstrated evidence of scholarship. Candidates have the opportunity to meet with CERU program directors to discuss career and project goals before submitting the application. Thus, although a competitive process, selection is also a mentored effort to increase the quality of work submitted from the first stage of the selection process. Learning objectives for scholars include to (1) define relevant, publishable, and innovative research questions, (2) describe research paradigms in medical education, (3) delineate methods to answer questions within these paradigms, (4) characterize quality criteria in qualitative and quantitative medical education research, (5) complete and disseminate project outcomes in high impact journals, and (7) submit a research grant. The ERSP scholars participate in an education research curriculum provided by internal and external experts presenting topics key to successful medical education research, such as defining a research question, conceptual frameworks, grant tips and techniques, qualitative research, validity evidence in research, responding to reviewers, reviewing manuscripts, technology in education research, and ethics in research. These topics were initially identified by ESRP program directors and collaborators as important areas of focus for medical education researchers, and topics will be modified based on input from the ESRP scholars. Defining metrics of success early is important to program evaluation. In establishing the CERU, program directors identified multiple, measurable short- and long-term outcomes associated with education and innovation, research, and leadership (Figure). The short-term outcomes pertaining to education and innovation include improved recruitment and retention of education research faculty at CCHMC, developing innovative approaches to teaching and faculty development, and building a community of educational researchers.21Pololi L.H. Krupat E. Civian J.T. Ash A.S. Brennan R.T. Why Are a quarter of faculty considering leaving academic medicine? A study of their perceptions of institutional culture and intentions to leave at 26 representative U.S. medical schools.Acad Med. 2012; 87: 859-869Crossref PubMed Scopus (177) Google Scholar,22Speck R.M. Sammel M.D. Troxel A.B. Cappola A.R. Williams-Smith C.T. Chittams J. et al.Factors impacting the departure rates of female and male junior medical school faculty: evidence from a longitudinal analysis.J Womens Health. 2012; 21: 1059-1065Crossref PubMed Scopus (28) Google Scholar The defined long-term educational and innovative outcomes of success are confirmation of CCHMC as a nationally recognized center for educational research and innovation. Short-term research outcome measures of success include increased educational research publications from the ERSP scholars and the institution, increased submissions for external funding, external recognition of educational research expertise, and trajectory of promotion of educator faculty comparable with that of other scholarship-driven faculty. In the CERU's first year, the directors and ERSP scholars have published 34 peer-reviewed articles, have 10 active external grants, and plans to submit 6 new grants before the end of the current academic year. Return on investment through increased external funding and increased research productivity of educator faculty is the long-term research outcome. Leadership outcomes are also a primary focus of the CERU. Generating education faculty with institutional leadership positions and education research expertise recognized via editorial positions, national boards, and committees are the more immediate leadership outcome aims. The long-term leadership outcome is defined as an increased number of scholars with national educational leadership roles. The initial implementation of the CERU depended on key departmental champions, including the department chair, the associate director of the research foundation, and the outgoing and incoming associate chairs for education. Plans for sustainability of the CERU have been a key consideration. It will be important to garner external funding (eg, Patient-Centered Outcomes Research Institute, Agency for Healthcare Research and Quality) to support the resources initially invested and ESRP graduates' protected time for future research. Future directions also include forming a training academy for educators, thereby expanding the curriculum to other health professions with an interest in education research. Improvements in medical education research are necessary to drive high quality care. The establishment of well-structured ERUs provide the resources, training, and mentorship required to produce high-quality medical education that aims to impact patient outcomes.

This study aimed to define whether individuals with drug-resistant focal epilepsy also used regions related to cognitive control to facilitate reading. We focused on patients with drug-resistant focal epilepsy in 2011-2014, who were aged 8-20 years and were being treated at the Cincinnati Children's Hospital, USA. They performed a verb generation functional magnetic resonance imaging task known to involve language and cognitive control, as well as a formal reading assessment. The reading scores were correlated with functional connectivity of the anterior cingulate cortex (ACC) using seed-to-voxel analysis. There were 81 potential patients and 13 (seven females) met the inclusion criteria. Their age at seizure onset was 0-13 years, and they had a mean age of 12.66 ± 3.17 years at the time of the study. Individuals with epilepsy demonstrated average intelligence and word reading ability. Their reading scores were positively correlated with functional connectivity between the ACC and regions related to emotional processing (right amygdala), learning and language processing (left cerebellum) and visual processing. Our results support the role that the ACC plays in proficient reading among children with drug-resistant epilepsy, even in those with epileptogenic foci in areas related to language.

AIM:This study aimed to define whether individuals with drug-resistant focal epilepsy also used regions related to cognitive control to facilitate reading. METHODS:We focused on patients with drug-resistant focal epilepsy in 2011-2014, who were aged 8-20 years and were being treated at the Cincinnati Children's Hospital, USA. They performed a verb generation functional magnetic resonance imaging task known to involve language and cognitive control, as well as a formal reading assessment. The reading scores were correlated with functional connectivity of the anterior cingulate cortex (ACC) using seed-to-voxel analysis. RESULTS:There were 81 potential patients and 13 (seven females) met the inclusion criteria. Their age at seizure onset was 0-13 years, and they had a mean age of 12.66 ± 3.17 years at the time of the study. Individuals with epilepsy demonstrated average intelligence and word reading ability. Their reading scores were positively correlated with functional connectivity between the ACC and regions related to emotional processing (right amygdala), learning and language processing (left cerebellum) and visual processing. CONCLUSION:Our results support the role that the ACC plays in proficient reading among children with drug-resistant epilepsy, even in those with epileptogenic foci in areas related to language.

BACKGROUND Screen-based media use is prevalent in children and is associated with health risks. American Academy of Pediatrics (AAP) recommendations involve access to screens, frequency, content, and co-viewing. The aim of this study was to test the ScreenQ, a composite measure of screen-based media use. METHODS ScreenQ is a 15-item parent report measure reflecting AAP recommendations. Range is 0-26, higher scores reflecting greater non-adherence. With no "gold standard" available, four validated measures of skills and parenting practices cited as influenced by overuse were applied as the external criteria, including expressive language, speed of processing, emergent literacy, and cognitive stimulation at home. Psychometric analyses involved Rasch methods and Spearman's rho correlations. RESULTS Sixty-nine families were administered ScreenQ. Child age ranged from 36 to 63 months old (52 +/- 8; 35 girls). Mean ScreenQ score was 9.6 (+/- 5.0; 1-22). Psychometric properties were strong (r(Co-alpha) = 0.74). ScreenQ scores were negatively correlated with CTOPP-2 (Comprehensive Test of Phonological Processing, Second Edition) (r(rho) = -0.57), EVT-2 (Expressive Vocabulary Test, Second Edition) (r(rho) = -0.45), GRTR (Get Ready to Read!) (r(rho) = -0.30) and StimQ-P (r(rho) = -0.42) scores (all p <= 0.01). CONCLUSIONS ScreenQ shows potential as a composite measure of screen-based media use in young children in the context of AAP recommendations. ScreenQ scores were correlated with lower executive, language and literacy skills, and less stimulating home cognitive environment.

This Viewpoint characterizes literacy as a unique domain of child development separate from spoken language acquisition that can be promoted and monitored through early pediatric primary care intervention.

Objectives To compare prevalence and severity of diaper dermatitis (DD) in infants and toddlers (babies) across three countries (China, USA, and Germany), including diapered skin measures and caregiver practices. Methods A cross-sectional study of 1791 babies (600 from each country) was recruited at each clinical site. Based on regional toilet-training habits, exclusively diaper-wearing infants were recruited between ages 2-8 months in China and 2-18 months in the USA and Germany. DD was measured, as well as skin pH, transepidermal water loss (TEWL), and relative humidity (RH) in the diapered region. Caregiver habits were collected via a questionnaire and included information on hygienic practices. Results Diaper dermatitis was highest in the perianal area, followed by the intertriginous, genital, and buttock regions. In general, DD was significantly lower in babies in China, highest in Germany, and intermediate in the USA. This rank ordering of DD by geography was also observed in baby age 2-8 months. The lower DD observed in China was associated with lower skin pH and TEWL on diapered skin and decreased RH in the diaper. Chinese caregivers had the highest rate of prophylactic topical product usage, the most robust cleaning of the diapered area, lack of cleansing after urine-only diaper changes, and Chinese infants spent the least time in an overnight diaper. Conclusions These data suggest caregiver behaviors including prophylactic use of topical products, thorough cleaning after stooling and reduced time in an overnight diaper are associated with less DD, lower superficial skin pH, and enhanced skin barrier.

This Viewpoint characterizes literacy as a unique domain of child development separate from spoken language acquisition that can be promoted and monitored through early pediatric primary care intervention.

The objective of this study was to determine the relationship between infant feeding styles (the attitudes and behaviors parents use to direct their child's eating) and infant BMI z-score in a low-income, predominately non-Hispanic Black population. Parent-infant dyads were recruited during the infant's 6, 9, or 12 month well-child visits from two urban primary care clinics that primarily serve a Medicaid population (89%). Feeding styles were measured using the Infant Feeding Style Questionnaire (IFSQ) and categorized into: pressuring, restrictive, responsive, or laissez-faire. Predominant feeding style was defined by selecting the style with the greatest deviation from the mean score of each style. Infant anthropometrics were extracted from the electronic medical record from birth through 18 months. Infant BMI z-scores were calculated based on WHO growth charts. Associations between feeding styles and BMI z-scores were examined using mixed models controlling for multiple measures per person, demographics and feeding covariates. Data from 198 dyads were analyzed for this study (Table 1). Parents identified as mothers (n = 196), non-Hispanic Black (n = 136), with a median age of 27 years (IQR 23.0 – 30.0). Half the infants were male (n = 99) with a median age at enrollment of 8.98 months [IQR 6.8-10.3]. Parent's predominant feeding style were (in descending order): Laissez-faire: 30%; Restrictive: 28%; Responsive: 23%; and Pressuring: 19%. Predominant feeding style at enrollment was not associated with BMI z-score between 0–18 months, but there was a significant sex differences in BMI z-score for the Laissez-faire and Restrictive feeding styles (Figure 1). Additionally, parents with higher education and a predominately Restrictive feeding style had children with higher BMI z-scores whereas parents with higher education and a Laissez-faire or Pressuring feeding style had children with lower BMI z-score (Figure 2). Parent's predominant feeding style during infancy in a low-income population is not associated with infant's BMI in the first two years of life, but some styles demonstrate differences by sex or parental education. Further studies are needed to better understand the modifiable factors for increased BMI in the first 2 years. NIH T32 Institutional grant.

OBJECTIVES:Dialogic reading (DR) is a shared storybook reading intervention previously shown to have a positive effect on both literacy and general language skills. The aim of this study was to examine the effect of DR compared to screen-based intervention on electrophysiological markers supporting narrative comprehension using EEG.METHODS:Thirty-two typically developing preschoolers, ages 4 to 6 years, were assigned to one of two intervention groups: Dialogic Reading Group (DRG, n = 16) or Screen Story Group (SSG, n = 16). We examined the effect of intervention type using behavioral assessment and a narrative comprehension task with EEG.RESULTS:The DRG showed improved vocabulary and decreased functional connectivity during the stories-listening task, whereas the SSG group showed no changes in vocabulary or connectivity. Significantly decreased network strength and transitivity and increased network efficiency were observed in the DRG following intervention. Greater network strength and transitivity at follow-up were correlated with increased vocabulary.CONCLUSIONS:The results suggest the beneficial effect of DR in preschool-age children on vocabulary and EEG-bands related to attention in the ventral stream during narrative comprehension. Decreased functional connectivity may serve as a marker for language gains following reading intervention.SIGNIFICANCE:DR intervention for preschool-age children may reduce interfering connections related to attention, which is related to better narrative comprehension.

INTRODUCTION:Feeding styles, the attitudes and behaviors parents use to direct their child's eating, shape a child's ability to self-regulate food intake and affects their future risk of obesity. This study examined how parental intuitive eating, where parents follow their own hunger and satiety cues, relates to infant feeding styles in a low-income, predominately Black population. METHODS:Parents of healthy infants aged 5.5-12.5 months were recruited during well-child visits at two urban primary care clinics. Parent's intuitive eating behaviors and infant feeding styles were measured using the Intuitive Eating Scale-2 (IES-2) and the Infant Feeding Style Questionnaire (IFSQ), respectively. Multivariable regression analysis, controlling for maternal and child demographic variables, was conducted to determine the relationship between parent intuitive eating behaviors and five infant feeding styles: restrictive, pressuring, indulgent, laissez-faire, and responsive. RESULTS:201 parents completed the study, 90% were mothers and 69% were Black. Average infant age was 8.8 ± 2.0 months. Parents who reported relying on their own hunger and satiety cues when eating were more likely to feed their infant in a responsive style (β 0.10 ± 0.04, p < 0.05). Parents who reported eating unconditionally, not labeling foods as forbidden, were more likely to feed their infant in a laissez-faire (β 0.16 ± 0.06, p < 0.05) and indulgent (β 0.09 ± 0.03, p < 0.05) feeding style. CONCLUSIONS:Parental intuitive eating behaviors are associated with both responsive and non-responsive infant feeding styles. Future studies should examine how parental intuitive eating and infant feeding styles affect infant growth trajectories.

This study involved preliminary validation of a specially designed children’s book for screening emergent literacy skills in 3- and 4-year-old children during well-child visits. BrightcoveDefaultPlayer10.1542/6138655434001PEDS-VA_2018-3843 Video Abstract BACKGROUND: The American Academy of Pediatrics recommends literacy promotion and developmental assessment during well-child visits. Emergent literacy skills are well defined, and the use of early screening has the potential to identify children at risk for reading difficulties and guide intervention before kindergarten. METHODS: The Reading House (TRH) is a children’s book designed to screen emergent literacy skills. These are assessed by sharing the book with the child and using a 9-item, scripted scoring form. Get Ready to Read! (GRTR) is a validated measure shown to predict reading outcomes. TRH and GRTR were administered in random order to 278 children (mean: 43.1 ± 5.6 months; 125 boys, 153 girls) during well-child visits at 7 primary care sites. Parent, child, and provider impressions of TRH were also assessed. Analyses included Rasch methods, Spearman-ρ correlations, and logistic regression, including covariates age, sex, and clinic type. RESULTS: Psychometric properties were strong, including item difficulty and reliability. Internal consistency was good for new measures (rCo-α = 0.68). The mean TRH score was 4.2 (±2.9; range: 0–14), and mean GRTR was 11.1 (±4.4; range: 1–25). TRH scores were positively correlated with GRTR scores (rs = 0.66; high), female sex, private practice, and child age (P < .001). The relationship remained significant controlling for these covariates (P < .05). The mean TRH administration time was 5:25 minutes (±0:55; range: 3:34–8:32). Parent, child, and provider impressions of TRH were favorable. CONCLUSIONS: TRH is a feasible, valid, and enjoyable means by which emergent literacy skills in 3- and 4-year-old children can be directly assessed during primary care.