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Objective: To investigate and analyze the current status and challenges of infant and toddler nutritional services in urban and rural medical facilities in Sichuan Province. Methods: In 2022, a questionnaire survey was conducted to collect data on infant and toddler nutritional services, including feeding guidance, physical growth assessment, and micronutrient deficiency screening, as well as information on personnel and tools in medical facilities throughout Sichuan Province. The provision of nutritional services was analyzed and the urban-rural disparities were assessed. Results: A total of 2206 medical facilities (29.1% from urban areas and 70.9% from rural areas) were investigated. Only 35.8% of medical facilities provided all three types of nutritional services. Specifically, the overall service provision rates were high for feeding guidance (94.6%) and physical growth assessment (85.0%), but lower for micronutrient deficiency screening (37.4%). Rural facilities exhibited significantly lower rates than their urban counterparts for both physical growth assessment and micronutrient deficiency screening (P<0.05). The provision rates of feeding guidance ranged from 70.6% to 93.2%, with responsive feeding guidance being the least implemented (70.6%), particularly in rural areas compared to urban areas (P<0.05). Rates for physical growth assessment and micronutrient deficiency screening ranged from 75.3% to 81.8% and 23.6% to 30.8%, respectively, both showing lower rates in rural settings compared to urban ones (P<0.05). Nutrition service providers were predominantly nurses (52.3%) and clinical practitioners (43.4%). The availability of dietary assessment tools ranged from 7.7% to 15.9%, significantly lower in rural areas compared to urban areas (P<0.001), while physical measurement tools were widely available at rates of 94.6% to 98.5%. Conclusion: At present, the infant and toddler nutritional service provisions of medical facilities in Sichuan Province are incomplete, particularly so in the implementation of feeding guidance, physical growth assessment, and micronutrient deficiency screening. There is a notable shortage of personnel and necessary tools, with rural areas facing more significant challenges. Enhancing the overall capacity of infant and toddler nutritional services in Sichuan Province is essential, with specific attention needed for rural healthcare settings.

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BACKGROUND: Child diet can influence risk for obesity and other related noncommunicable diseases. Few studies have used the Healthy Eating Index (HEI)-Toddlers-2020 to assess diet quality among toddlers (children aged 12 to 23.9 months). OBJECTIVE: The aim of this study was to examine diet quality among toddlers participating in the Feeding Infants and Toddlers Study, 2016, and determine differences by sociodemographic characteristics. Caregiver perception of how their toddler's diet aligns with HEI-Toddlers-2020 diet quality scores was also assessed. DESIGN: This cross-sectional study used 24-hour dietary records collected in 2016. PARTICIPANTS AND SETTING: Data were collected on toddlers ages 12 to 23.9 months (N = 1133) participating in the Feeding Infants and Toddlers Study, 2016. MAIN OUTCOME MEASURES: Diet quality was assessed using the HEI-Toddlers-2020. STATISTICAL ANALYSES PERFORMED: The population ratio method was used for all analyses using weighted data to estimate HEI-Toddlers-2020 scores overall and within subgroups. To determine significant differences of the HEI-Toddlers-2020 score between subgroups, pairwise t tests were used. Statistical significance at P < .05 was used as a cutoff for all 2-sided P values. RESULTS: Average HEI-Toddlers-2020 score among toddlers ages 12 to 23.9 months participating in the Feeding Infants and Toddlers Study, 2016, was 71.2 out of a possible 100. Total scores (mean, standard error) varied by race and ethnicity with Hispanic toddlers having higher scores compared with non-Hispanic White toddlers (76.4 ± 2.5 vs 69.0 ± 1.2; P = .03) and by federal poverty level with those >200% of the poverty level having higher scores compared with those <100% of the poverty level (74.7 ± 1.5 vs 67.0 ± 2.6; P = .01). CONCLUSIONS: Opportunities for improvement in dietary intake were identified using the new HEI-Toddlers-2020 to assess diet quality among children ages 12 to 23.9 months. Scores were indicative of toddlers consuming excess added sugars and lower-than-recommended amounts of seafood and plant proteins, greens and beans, whole grains, and vegetables. Interventions to improve diet quality in toddlers may benefit from focusing on foods children should eat more of along with foods to consume in moderation.

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Objective: To explore the clinical value of ultrasound examination in evaluating the presence of ovarian torsion in female infants with inguinal ovarian hernia. Methods: We conducted a retrospective analysis of 91 cases of ovarian hernia diagnosed by ultrasonography at our institution. Among them, 6 cases were identified as ovarian strangulation, while 85 cases were classified as non-ovarian strangulation. All cases underwent high-frequency ultrasound examination. We analyzed whether there were differences in the associated factors between the two groups and compared the disparities in the urgency of surgery between the two groups. Results: Significant differences were observed between the ovarian strangulation group and the non- strangulation group in terms of ovarian volume, ovarian blood flow, and the presence of incarceration. The need for emergency surgery was significantly associated with the presence of incarceration and ovarian torsion. Conclusion: Ultrasound has good clinical value in diagnosing ovarian hernia and determining the presence of ovarian strangulation. It can assist clinical physicians in determining the timing of surgery for children with ovarian hernia.

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Background Melatonin use in the pediatric population is on the rise in the United States, where it is available as an over-the-counter and online supplement. There are no data regarding the safety and efficacy of melatonin in children less than 2 years old. The aim of this study was to examine various aspects of melatonin use by caregivers of infants and toddlers in the US. Methods Caregiver users of the Nanit baby monitoring system with a child aged 0-36 months were invited to complete an online survey regarding melatonin use, sources of information/recommendations about melatonin, formulations used and reasons for administering melatonin to their child. Participants also completed the Brief Infant Sleep Questionnaire-Revised (BISQ-R). Results A total of 3063 caregivers (1.93%) responded to the survey, of whom 1.7% had ever used melatonin for their child. About half of those caregivers had received a recommendation for melatonin from a source other than a healthcare professional. Caregiver perception of 'sleep as a problem' as assessed by the BISQ-R was not significantly different between those who had or had not used melatonin for their child, and reasons for use included non-supported indications such as sleeping later or promoting "more restful and better sleep". Conclusions The results of this study support mounting concerns regarding the widespread use of melatonin in the US pediatric population, especially given the lack of regulatory oversight and the documented inaccuracy of label claims versus actual melatonin content.

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Despite important advancements into the early detection of autism, there are still few empirically supported interventions for children under the age of two years who are showing early signs. Caregiver-mediated interventions have gained in popularity as a method for delivering support to the child and family. The current study builds on current work by enrolling a comparatively large cohort of infants (ages 12-22 months of age) displaying early signs of autism into a randomized controlled intervention program. Infants and parents received a group-based program using a standard early childhood curriculum. In addition, all families were randomly assigned to receive parent training in the form of either parent-mediated Joint Attention Symbolic Play Engagement and Regulation (JASPER) training or psychoeducation. Infants in both classrooms made substantial gains in social-communication, play, and cognition during a brief, 8-week period. All infants gained over an average of 10 points in DQ and increased in standardized measures of social-communication and play, with these gains maintaining at a 2-month follow-up visit. The classroom that also received JASPER increased in child initiated joint engagement and play level during dyadic interactions with their parents, while the classroom that received psychoeducation increased in joint attention during a standardized assessment delivered by an independent assessor. Infant familial risk for autism (older sibling with autism) also moderated the effect of treatment on child initiated joint engagement where infants in the JASPER classroom without familial risk made the most gains from baseline to exit of the program. This study highlights the promise of intervening at the earliest stages to promote positive outcomes for children and families.

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Infants born low birth weight (LBW) and preterm are at risk for developmental delay and cognitive deficits. These deficits can lead to lifelong learning difficulties and high-risk behaviors. Preterm (PT) and full-term (FT) groups were compared across infant and toddler measures of behavior and development to extract early indicators of executive function (EF). The goal was to extract indicators of EF from standardized infant assessments. PT (<2500 grams and <37 weeks) and FT (> 2500 grams and >37 weeks) were compared across assessment and EF components were identified from the BSID-III. A multivariate linear model was used to examine group differences. All children (99 PT and 46 FT) were administered the Bayley III and the DMQ assessments for session 1 (6-8 months). During session 2, N=78 PT and 37 FT (18-20 months), the CBCL was added to previous assessments, and the BRIEF-P was added to previous assessments in session 3, N= 52 PT and 36 FT for session 3 (See Table 1). Significant change scores were found on BSID-III subtests and EF components across all 3 sessions. The PT group also showed significantly more behavioral concerns on the CBCL at 18 months and 36 months and had lower scores on the BRIEF-P than their FT peers. The number of children born PT (N = 27, 52%) who were in Early Intervention (EI) increased across the 3 sessions. Examining early indicators of EFs supported the development of early identification that could lead to decrease adverse outcomes often associated with preterm birth.

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Background: Early feeding practices have a critical role in the future not only in health but also in modulating eating habits. This study aimed to assess breastfeeding and complementary feeding practices and the nutritional status of Portuguese toddlers aged 0-36 months. Methods: EPACI Portugal 2012 is a cross-sectional study of a national representative sample. Trained interviewers collected data about early feeding practices and anthropometrics. Body mass index was classified according to World Health Organization criteria. Frequencies and survival analysis were used to characterize variables. Results: More than 90% of children were initiated breastfeeding, around 20% were exclusively breastfed for six months, and about 20% were breastfed at 12 months while complementary feeding was taking place. Exclusive breastfeeding was determined by maternal prepregnancy body mass index (HR 1.01; 95% CI 1.00, 1.03, P=.03) and low birth weight (HR 1.61; IC 95% 1.21, 2.15, P=.001) of the infants. About 90% were initiated complementary feeding between four and six months, and almost 10% were introduced to cow's milk before 12 months. In the second year of life, 83.2% and 61.6% of toddlers have already consumed nectars and sweet desserts, respectively. About one-third of Portuguese toddlers showed a body mass index z-score >1, and 6.6% were overweight/obese (z-score >2). No association was found between the duration of breastfeeding or timing of complementary feeding and the body mass index z-score in children. Conclusions: Despite the low prevalence of exclusive breastfeeding at six months, Portuguese infants effectively comply with dietary recommendations during the first year of life. The transition to the family diet must be carefully made. There is a high prevalence of Portuguese toddlers at least at overweight risk. The duration of breastfeeding or timing of complementary feeding was not associated with the expression of overweight/obesity.

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BACKGROUND: Although considerable concern has been expressed about the nutritional implications of infant food pouches, how they impact infant diet has not been examined. OBJECTIVES: The objective of this study was to determine the contribution of infant food pouches specifically, and commercial infant foods generally, to nutrient intake from complementary foods in infants. METHODS: Two multiple-pass 24-h diet recall data were collected from 645 infants (6.0-11.9 mo) in the First Foods and Young Foods New Zealand studies. Detailed information was obtained on commercial infant food use, including pouches, and nutrient composition was calculated through recipe modeling. RESULTS: The diverse sample (46.1% female; 21.1% Maori, 14.1% Asian, and 54.6% European) was aged (SD) 8.4 (0.9) mo. More than one-quarter of households had high socioeconomic deprivation. Almost half (45.3%) of infants consumed an infant food pouch on ≥1 recall day [mean (SD), 1.3 (0.9) times/d], obtaining 218 (124) kJ of energy on each eating occasion. Comparable numbers for all commercial infant and toddler foods (CITFs) were 78.0%, contributing 2.2 (1.6) and 140 (118) kJ of energy. Infant food pouches provided 25.5% of the total energy from complementary foods in those infants who consumed pouches on the recall days but just 11% in all infants. Median percentage contribution of infant food pouches to nutrient intake from complementary foods in consumers ranged from <1% (added sugars and retinol) to >30% (carbohydrate, total sugars, fiber, vitamin A, and vitamin C). CITF contributed 21.4% of energy from complementary foods for infant consumers, with median percentage contribution ranging from 0.1% (retinol) to 40.3% (iron). CONCLUSIONS: Infant food pouches make relatively small contributions to energy intake in infants but are important sources of carbohydrates, fiber, and vitamins A, C, and B-6. Almost half of the total sugars consumed from complementary foods is provided by these pouches. This trial was registered at the Australian New Zealand Clinical Trials Registry as ACTRN12620000459921.

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Infants go through a transition period before fully adapting to a diversified balanced diet after being breastfed, during which foods introduced other than milk, aimed at supplementing energy and nutrients, are referred to as complementary foods. The process of introducing complementary foods is called complementary feeding (CF). The purpose and significance of adding complementary foods include not only supplementing energy and nutrients, but also promoting the development of eating skills and fine motor functions, establishing healthy eating and food-related psychological behaviors, preventing food allergies and other allergic diseases, and materializing diversity of children′s gut flora. The feeding suggestions of introducing red meat paste first other than iron-fortified baby rice flour at the age of 6 months, and rapidly achieving diversified food exposure, is comply with the above principles. This article analyzes the purpose of infant CF, reviews the historical development of CF, and interprets relevant feeding recommendations based on new concepts of CF.

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【Objective】 To measure and analyze foot development indicators of children under 3 years old, in order to provide basis for the correct clinical assessment of children foot development. 【Methods】 A total of 5 894 children under 3 years old who took physical examination in the Child Health Care Department of Xi′an People′s Hospital from August 2022 to March 2023 were randomly selected. Foot length, foot width, the ratio of foot width to length and arch index were measured by image processing system, and were compared among different age groups and sex groups. 【Results】 1) Foot length, foot width and arch index of children under 3 years old increased significantly with age, while the ratio of foot width to length decreased significantly with age(F=1 345.23, 396.21,184.65, 287.03, P<0.05). 2) There was no statistical significance in foot length, foot width and arch index between left and right foot of children under 3 years old(P>0.05). 3) Foot length and foot width of boys were greater than those of girls in all age groups, and the difference was statistically significant(tfoot length:3.45 - 10.19, tfoot width: 3.77 - 9.21, P<0.05). There was no significant difference in arch index between boys and girls in all age groups(P>0.05). 【Conclusion】 Foot shape of children under 3 years old changes with age, there are differences in foot length and width between boys and girls.

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Both UNICEF and WHO mention that nurturing care is the most direct and effective approach to promoting early childhood development. Nurturing care emphasizes the importance of caregivers creating a suitable nurturing environment for the early development of children to promote their health and potential. The provision of early learning opportunities is an important aspect of creating a high-quality nurturing environment. This review focuses on the importance of establishing early learning opportunities, the methods of establishing early learning environments, implementing supportive strategies, and employing relevant evaluation methods, in order to provide reference and support for the establishment of early learning opportunities in nurturing care.

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【Objective】 To explore the relationship between parental meta-emotion philosophy and family rearing environment in infants and toddlers, in order to provide guidance for building a positive family rearing environment. 【Methods】 The Parental Meta-Emotion Philosophy Scale was used to measure parents′ social emotions. Family rearing environment of infants was investigated by combining demographic data and Family Rearing Environment Scale. Independent sample t-tests, one-way analysis of variance, Spearman correlation analysis, and multiple linear regression were utilized to analyze the relationship between parental meta-emotion philosophy and the family rearing environment. 【Results】 A total of 370 infant caregivers were included in the study. The average age of infants was (27.81±7.76) months, with 192 boys (51.9%) and 178 girls (48.1%). Parents′ education level (F=4.71), whether they were the only child or not (t=8.85), whether the infant attended nursery or not (t=-2.49), and the per capita monthly income of the family (F=4.77) showed statistical significance in relation to the differences observed among the family rearing environments of infants and toddlers (P<0.05). Multivariate analysis indicated that the emotional teaching dimension of parental meta-emotion philosophy had a positive predictive effect on the overall level of the infant′s family rearing environment (β=0.50, 95%CI: 1.11 - 1.59), while the emotional loss dimension had a negative predictive effect (β=-0.15, 95%CI: -0.85 - -0.07). 【Conclusion】 The parental meta-emotion philosophy is closely related to the family rearing environment and serves as an important factor influencing it. It is supposed to improve parents′ emotional literacy and enrich their knowledge of parental meta-emotion philosophy, so as to help build a positive family rearing environment.

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INTRODUCTION: Pediatric urolithiasis is a less common disease with a steadily increasing incidence of 10.6 % per year. The comprehensive management of pediatric urolithiasis is more challenging than in adults, and published studies of endourological treatment in children have small sample sizes and older mean ages, which may not be representative of the overall pediatric population, especially in infants and toddlers. This study aimed to report results of retrograde ureteroscopy for treating pediatric ureteral stones in infants and toddlers (<3 years) from a single center in China. METHODS: Demographic and surgical data of infants and toddlers with ureteral stones who underwent retrograde URS were retrospectively analyzed from January 2015 to September 2022. RESULTS: The mean age of 100 infants (73 boys and 27 girls) was 19.6 ± 7.6 months and stone burden was 0.27 (0.11-0.52) cm³. 111 procedures were performed for all children due to 11 patients with bilateral ureteric stones were simultaneously treated. Among them, 70.3 % were semi-rigid URS, 12.6 % were Micro-URS and 17.1 % were flexible URS. SFR was up to 96 %, the median operation time and hospitalization days were 35.0 (25.0-50.0) minutes and 6.0 (5.0-6.0) days, respectively. 15 (15.0 %) infants had postoperative fever (Grade I), and complications above grade I were not observed. DISCUSSIONS: This research reported the largest sample size of infant and toddler ureteric stones (under 3 years old) and shared optimal management strategies for these special populations. Compared to other related studies, we had a higher SFR due to diverse management strategies and reasonable application of pre-operative ureteric stents. The most important potential reason why our complication rate was relatively higher might be the younger population under 3 years old. In additionally, the reason of long hospitalization was maybe some patients underwent staged surgeries during one hospitalization. Those results indicated the robust effectiveness of URS for infants. This study has limitations, including its retrospective single-center design, absence of long-term follow-up data, and potential variability in surgical outcomes due to differences in surgeons' experience. CONCLUSIONS: The experience of endourologic procedures for 100 infant and toddler patients with ureteric stones from a Chinese single center was reported. And URS showed its effectiveness and safety for those special populations based on its high SFR and low complication rate.

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The COVID-19 pandemic and the ongoing lockdowns might have had a strong impact on mental health of mothers and their infants/toddlers. For example, families had to deal with health issues and social isolation, which might have affected mental health and parent-child interactions. The aim of this study is to evaluate differences in (1) infantile regulatory disorders, (2) maternal mental health, (3) the impact of maternal mental health on infantile regulatory disorders, and (4) alterations in the mother-child interaction for participants recruited before versus after the onset of the first German lockdown. For this reason, mother-child dyads have been divided into two groups and were compared by analyzing clinical interviews on psychopathology of mother and child (M.I.N.I. & DC:05) and mother-child-interactions (Emotional Availability Scales). Results showed that (1) differences in infantile sleeping disorders emerged (phi = 0.243; p = 0.016) compared to the pre-lockdown group, while (2) the occurrence of maternal panic and anxiety increased in the post-lockdown group (phi = 0.229; p = 0.022). Moreover, there was (3) an association for maternal panic and child's sleep disorder, and (4) specific associations with maternal non-hostility in the mother-child-interaction. In conclusion, the present study highlights the differences of maternal mental health occurrences and infants' regulatory problems, as well as the possible effects of the COVID-19 pandemic for infants. In the pre-lockdown group, maternal non-hostility might have acted as a promotive factor against regulatory disorders, while this mechanism was mitigated in the post-lockdown group.

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BACKGROUND: The Infants and Toddlers Dermatology Quality of Life (InToDermQoL) is the dermatology-specific proxy health-related quality of life (HRQoL) instrument for children from birth to 4 years. The aim of the present study was to confirm the responsiveness and establish minimal clinically important difference (MCID) for the InToDermQoL. METHODS: Parents of children with skin diseases were asked to fill in the InToDermQoL at the initial visit (T1) and subsequent consultation (T2). We hypothesized that correlations between change scores of the InToDermQoL and change scores of global assessment of clinical severity by dermatologists and by patients' parents should be above 0.3. The receiver operating characteristic (ROC) curves method was also used for confirmation of responsiveness and determination of MCIDs of the InToDermQoL. The area under the ROC curve (AUC) was used as an indicator of responsiveness. RESULTS: Results of 442 patients were included. Correlations between change scores of age-specific versions of the InToDermQoL and change scores of global assessment of clinical severity by dermatologists and by patients' parents were above 0.3 (0.46-0.74). AUCs for age-specific versions of the InToDermQoL were acceptable (above 0.7) or excellent (above 0.8). Estimated MCIDs for the InToDermQoL were as follows: 3 points of total score change for 0-11 months, 5 for 1-2 years and 3 or 4 for 3-4 years version. Estimated MCIDs for the InToDermQoL version for 1-2-year-old children was higher than MCIDs for the 3-4-year-old version despite the higher number of items in the latter. Therefore a MCID of 5 was recommended for both these versions. CONCLUSIONS: Responsiveness for all age-specific versions of the InToDermQoL questionnaire was confirmed. MCIDs for the InToDermQoL are proposed as follows: 3-point change of the total score for age version 0-11 months and 5-point for the age versions 1-2 years and 3-4 years.

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Early childhood is a critical period for developing children's abilities. Non-cognitive abilities are comparable to or even stronger than cognitive abilities in predicting many socioeconomic outcomes. Usually, most scholars take personality as the core indicator of non-cognitive abilities. While temperament is also an important component of children's non-cognitive abilities, it was often ignored in previous studies. Based on the panel data from the 2018 and 2020 China Family Panel Studies (CFPS), this study investigates the effects of parental marital satisfaction on the non-cognitive development of children aged one to three; meanwhile, the heterogeneous effects and mechanisms were also examined. The results show that young children exhibit more negative emotions when their parents reported dissatisfaction with their marriages. Parental depression was an important mechanism of parental marital satisfaction affecting children's non-cognitive development, while the frequency of parent-child interaction was not. The effects of marital dissatisfaction on non-cognitive abilities were heterogeneous across child age and gender, as well as parental genders and education levels. The findings shed some light on the early interventions and offer important reference values for public policies aimed at improving family welfare and children's non-cognitive development.

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Evidence suggests autistic individuals at elevated familial likelihood of autism spectrum disorder (by virtue of having an autistic sibling) have stronger cognitive abilities on average than autistic individuals with no family history of the condition, who have a low familial likelihood of autism. Investigating phenotypic differences between community-referred infants and toddlers with autism symptoms at elevated or low familial likelihood of autism may provide important insight into heterogeneity in the emerging autism phenotype. This study compared behavioral, cognitive, and language abilities of community-referred infants and toddlers with confirmed autism symptoms at elevated (EL) or low familial likelihood of autism (LL). Participants were 121 children aged 12 to 36 months who participated in two larger randomized trials of parent-mediated interventions for children with autism symptoms. Behavioral phenotypes were compared across three groups: children with at least one autistic sibling (EL-Sibs, n = 30), those with at least one older, non-autistic sibling and no family history of autism (LL-Sibs, n = 40), and first-born children with no family history of autism (LL-FB, n = 51). EL-Sibs had less severe autism symptoms and stronger cognitive abilities than children in LL groups. While the rate of receptive language delay was similar across groups, the rate of expressive language delay was markedly lower among EL-Sibs. After controlling for age and nonverbal cognitive ability, EL-Sibs were significantly less likely to present with expressive language delay than LL-Sibs. Familial likelihood of autism may play an important role in shaping the emerging autism phenotype in infancy and toddlerhood.

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Baseline child characteristics may predict treatment outcomes in children with or at elevated likelihood of developing autism (EL-ASD). Little is known about the role of child sensory and language features on treatment outcome. Participants were randomly assigned to a parent-mediated intervention or control condition. Analyses explored the relationship between baseline child sensory and language characteristics and changes in ASD symptoms over approximately 9 months. Higher baseline sensory hyporeactivity was significantly related to less improvement in social communication (SC) for the treatment group only. More baseline atypical vocalizations were significantly related to less improvement on SC across treatment and control groups. This work provides an initial framework to encourage the tailoring of interventions for EL-ASD children, suggesting sensory reactivity and atypical vocalizations may be useful behaviors to consider in treatment planning.

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OBJECTIVES: To assess maternal knowledge, attitude, and practices toward vitamin D supplements in Saudi infants and toddlers. In addition, we investigated predictors of maternal knowledge, attitude, and practices related to vitamin D supplements. METHODS: Cross-sectional data of 156 Saudi infants and toddlers were collected from mothers via online survey. Data collected included sociodemographics, maternal knowledge, attitude, and practices toward vitamin D supplements. RESULTS: Our data show a limited maternal knowledge toward vitamin D. Maternal knowledge and attitude as well as maternal knowledge and practices were not correlated. Spearman correlation between maternal attitude and practices was positively low (rs= 0.47). Child's age and family monthly income predicted maternal knowledge towards vitamin D. Maternal age and maternal education level predicted maternal attitude toward vitamin D supplements. Order of the child, maternal age, and maternal employment status predicted maternal practices toward vitamin D supplements in infant and toddlers. CONCLUSIONS FOR PRACTICE: Maternal knowledge, attitude, and practices toward vitamin D supplements can be predicted by certain sociodemographic characteristics. Interventions that focus on improving maternal knowledge, attitude, and practices toward vitamin D supplements are urgently needed.

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BACKGROUND: Responsive feeding is important for helping children to develop healthy eating behaviors. Verbal feeding interactions between caregivers and children may reflect caregiver's responsiveness and contribute to children's developing lexical networks related to food and eating. OBJECTIVES: This project aimed to: 1) characterize what caregivers say to infants and toddlers during a single feeding session and 2) test the associations between caregiver's verbal prompts and food acceptance by children. METHODS: Filmed interactions of caregivers and their infants (N = 46 infants aged 6-11 mo) and toddlers (N = 60 toddlers aged 12-24 mo) were coded and analyzed to explore the following: 1) what caregivers said during a single feeding session and 2) whether caregiver's verbalizations were associated with child food acceptance. Caregiver verbal prompts were coded during each food offer and summed across the feeding session; prompts were categorized as supportive, engaging, and unsupportive. Outcomes included accepted tastes, rejected tastes, and rate of acceptance. Mann-Whitney's U tests and Spearman's correlations tested bivariate associations. Multilevel ordered logistic regression tested associations between verbal prompt categories and the rate of acceptance across offers. RESULTS: Verbal prompts were largely supportive (41%) and engaging (46%), and caregivers of toddlers used significantly more verbal prompts than caregivers of infants (mean ± SD: 34.5 ± 16.9 compared with 25.2 ± 11.6; P = 0.006). Among toddlers, more engaging and unsupportive prompts were associated with a lower rate of acceptance (ρ = -0.30, P = 0.02; ρ = -0.37, P = 0.004). For all children, multilevel analyses revealed that more unsupportive verbal prompts were associated with a lower rate of acceptance (b = -1.52; SE = 0.62; P = 0.01) and individual caregiver use of more engaging and unsupportive prompts than usual was associated with a lower rate of acceptance (b = -0.33; SE = 0.08; P < 0.001: b = -0.58; SE = 0.11; P < 0.001). CONCLUSIONS: These findings suggest that caregivers may strive for a supportive and engaging emotional setting during feeding, although verbalization category may change as children exhibit more rejection. Furthermore, what caregivers say may change as children develop more advanced language capabilities.

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