The sibling effect on neurodevelopment of preschoolers under China's newly relaxed child policy: A national retrospective cohort study.

Introduction: The change in Chinese fertility policy brings new challenges and considerations for children's health outcomes; however, very little is known about the interaction between siblings, family socioeconomic status (SES), and neurodevelopment in the Chinese preschool-age population. Therefore, this study aimed to develop a new explanatory pathway from sibling effect to early childhood development and explored the mediation effect of family SES in the pathway. Methods: From April 2018 to December 2019, we conducted a national retrospective cohort study in 551 cities in China, and a total of 115,915 preschool-aged children were selected for the final analysis. Children's neurodevelopment, including Communication, Gross motor, Fine motor, Problem-solving, and Personal-social, was assessed with the Ages & Stages Questionnaires, Third Edition (ASQ-3). Hypothesis tests and multilevel regression models were used to assess the associations and their strength between sibling effect and neurodevelopmental delay. Pathway analysis was used to verify the mediation effect of SES. Results: The results showed that there were significant risk effects of a sibling on preschoolers' overall neurodevelopment including communication, gross motor, fine motor, and problem-solving delay. The adjustment of family SES, however, brought a reversal of this association. The results of the mediation model illustrated a direct, protective effect of one-sibling status (ßASQ-delay = -0.09; ßASQ-scores = 0.07; p < 0.001), and an indirect, risk effect from one-sibling status through family SES to neurodevelopment outcomes (ßASQ-delay =0.12; ßASQ-scores = -0.12; p < 0.001). The total sibling effect was weakened but remained negative (ßASQ-delay =0.03; ßASQ-scores = -0.05; p < 0.001). Discussion: This study concluded that family SES mediated the negative effects of one sibling on early child development. To enhance the positive influence of sibling addition, we suggested providing more resources and instructions to the families with less educated and poorer employed parents under the coming multi-child era.

Differentiating the cognitive development of early-term births in infants and toddlers: a cross-sectional study in China.

OBJECTIVES: This study aimed to explore the cognitive development of low-risk children during early childhood for early-term births at 37 and 38 weeks of gestation compared with full term births at 39-41 weeks of gestation. SETTING AND PARTICIPANTS: We conducted a cross-sectional study in Shanghai, one of the largest cities in China. A total of 1444 children from singleton pregnancies born at term gestation were included in the study. MEASURES: The cognitive outcomes of the subjects were measured using the cognitive subtest of Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) across three cities in China. We analysed the association between gestational age and cognitive development during infancy and toddler stages using multivariate linear modelling. RESULTS: The cognitive development scores for infants born at 37 gestational weeks were significantly lower than those born at 39-41 gestational weeks (ß=-2.257, 95% CI -4.280 to -0.235; p<0.05) after adjusting for children's and maternal characteristics, as well as socio-economic factors. However, there were no significant differences in cognitive ability between infants born at 38 gestational weeks compared with their full-term counterparts (p>0.05). Moreover, these effects were not found in toddlers (between 17 and 48 months of age) after adjusting for the possible confounders (p>0.05). CONCLUSIONS: Infants born at 37 weeks of gestation exhibited weaker cognitive ability compared with those born at 39-41 weeks of gestation. Our findings provide evidences for the close monitoring of potential developmental problems in early-term children, especially those born at 37 gestational weeks.

The reliability and validity of Bayley-III cognitive scale in China's male and female children.

BACKGROUND: Since publication in 2006, the Bayley-III scale has been used widely in pediatric populations worldwide; however, there have been very few studies which examined the usefulness and the potential sex differences in a Chinese context. AIMS: To assess the reliability and validity of the Bayley-III cognitive scale, and detect possible sex differences in term children so as to provide evidence for clinical and research use in China. STUDY DESIGN: Cross-sectional study PARTICIPANTS AND OUTCOME MEASURES: Of the 1589 children from 3 healthcare institutions that were initially recruited, a total of 1444 children were included in the final analysis. We randomly selected 5-10% children from the total sample to evaluate the test-retest, inter-rater and criteria-related reliability in order to meet the psychometric criteria of Bayley-III scale. Inter-item consistency, test-retest and inter-rater reliability of the scale were estimated using Split-half method and Intra-class Correlation Coefficient (ICC). The content validity was evaluated by the Item-level Content Validity Index (I-CVI). The Mann-Kendall trend test was performed to assess trends of cognitive development, and post-hos Least Significant Difference test was used to detect age-appropriateness of items. RESULTS: Six developmental pediatricians were trained to administer the Bayley-III cognitive scale. Inter-item consistency (n = 1444) with Guttman split-half coefficient was above 0.8, while test-retest (n = 144) and inter-rater reliability (n = 74) had good to excellent ICCs of over 0.9. The criteria-related validity (n = 74) of Bayley-III was acceptable, and associations with Gesell Developmental Schedules (GDS) were mainly above 0.8. The raw score of Bayley-III scale in total subjects (n = 1444) showed an increased trend across all months of age (p < 0.05), and only the score in age group of 35M16D to 36M15D declined in females (p < 0.05, n = 722). Female children presented a higher score than male children in all subjects and in the 18-23 months age group (p < 0.05). CONCLUSIONS: Our findings provide important evidence that the Bayley-III cognitive scale is a valid measurement which could be used in Chinese population, as well as the consideration of sex differences when used in a Chinese context.

Movement coordination ability among preschool children in Shanghai / 中国学校卫生

Objective@#To investigate the preschool children’s movement coordination ability in Shanghai and to provide the evidence for formulating a scientific sports strategy@*Methods@#During May to June of 2018, 9 833 preschool children aged 3-6 years were selected from 174 kindergartens of 4 districts (Jing’an, Pudong, Songjiang and Minhang) in Shanghai. Motor coordination ability was assessed by using Little Developmental Coordination Disorder Questionnaire.@*Results@#n this study, the total scores of movement coordination ability, motor control, fine motor/writing and general coordination were 67.96±8.44,23.01±2.92,22.85±2.97 and 22.10±3.12，respectively,which gradually increased with age(P<0.01), and girls sorced higher than boys(each P<0.01). The incidence of developmental coordination disorder was 4.4% and the rate of suspected developmental coordination disorder was 7.9%. The incidences of developmental coordination disorder in students in the age group between 3 and 6 were 7.0%，4.7%，3.5% and 2.7% , which gradually decreased with age(χ2=92.04, P<0.01). The incidence rates of boys and girls were 5.3% and 3.4%, respectively，boys had a higher incidence of developmental coordination disorders than that of girls(χ2=31.70, P<0.01). @*Conclusion@#Preschool children in Shanghai have fine movement coordination ability which varies by age and sex.