***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: CONTEXT Early childhood introduction of nutritional habits aim ed at atherosclerosis prevention is compatible with normal growth , but its effect on neurological development is unknown . OBJECTIVE To analyze how parental counseling aim ed at keeping children 's diets low in saturated fat and cholesterol influences neurodevelopment during the first 5 years of life . DESIGN R and omized controlled trial conducted between February 1990 and November 1996 . SETTING Outpatient clinic of a university department in Turku , Finl and . PARTICIPANTS A total of 1062 seven-month-old infants and their parents , recruited at well-baby clinics between 1990 and 1992 . At age 5 years , 496 children still living in the city of Turku were available to participate in neurodevelopmental testing . INTERVENTION Participants were r and omly assigned to receive individualized counseling aim ed at limiting the child 's fat intake to 30 % to 35 % of daily energy , with a saturated : monounsaturated : polyunsaturated fatty acid ratio of 1:1:1 and a cholesterol intake of less than 200 mg/d ( n = 540 ) or usual health education ( control group , n = 522 ) . MAIN OUTCOME MEASURES Nutrient intake , serum lipid concentrations , and neurological development at 5 years , among children in the intervention vs control groups . RESULTS Absolute and relative intakes of fat , saturated fatty acids , and cholesterol among children in the intervention group were markedly less than the respective values of control children . Mean ( SD ) percentages of daily energy at age 5 years for the intervention vs control groups were as follows : for total fat , 30.6 % ( 4.5 % ) vs 33.4 % ( 4.4 % ) ( P<. 001 ) ; and for saturated fat , 11.7 % ( 2.3 % ) vs 14.5 % ( 2.4 % ) ( P<.001 ) . Mean intakes of cholesterol were 164.2 mg ( 60.1 mg ) and 192.5 mg ( 71 . 9 mg ) ( P<.001 ) for the intervention and control groups , respectively . Serum cholesterol concentrations were continuously 3 % to 5 % lower in children in the intervention group than in children in the control group . At age 5 years , mean ( SD ) serum cholesterol concentration of the intervention group was 4.27 ( 0.63 ) mmol/L ( 165 [ 24 ] mg/dL ) and of the control group , 4.41 ( 0.74 ) mmol/L ( 170 [ 29 ] mg/dL ) ( P = .04 ) . Neurological development of children in the intervention group was at least as good as that of children in the control group . Relative risks for children in the intervention group to fail tests of speech and language skills , gross motor functioning plus perception , and visual motor skills were 0.95 ( 90 % confidence interval [ CI ] , 0.60 - 1.49 ) , 0.95 ( 90 % CI , 0.58 - 1.55 ) , and 0.65 ( 90 % CI , 0.39 - 1.08 ) , respectively ( P = .85,.86 , and .16 , respectively , vs control children ) . CONCLUSION Our data indicate that repeated child-targeted dietary counseling of parents during the first 5 years of a child 's life lessens age-associated increases in children 's serum cholesterol and is compatible with normal neurological development . JAMA . 2000;284:993 - A r and omized clinical trial was conducted to compare the early development of children with d-transposition of the great arteries ( N=171 ) repaired by an arterial switch operation that used either  predominantly total circulatory arrest or predominantly continuous low-flow cardiopulmonary bypass . The children assigned to the circulatory arrest group scored lower than those assigned to low-flow bypass on the Bayley Scales of Infant Development at 1 year of age . Responses to parental question naires completed when the children were 2.5 years old indicated that the children in the circulatory arrest group , especially those with a ventricular septal defect , also manifested poorer expressive language and were considered to display more internalizing and externalizing problem behaviors . The use of circulatory arrest to protect vital organs during open heart surgery might place children at increased risk of early developmental difficulties , especially in the domains of motor and language function OBJECTIVE To determine the effects of pediatric primary care interventions on  parent-child interactions in families with low socioeconomic status . DESIGN In this r and omized controlled trial , participants were r and omized to 1 of 2 interventions ( Video Interaction Project [ VIP ] or Building Blocks [ BB ] ) or the control group . SETTING Urban public hospital pediatric primary care clinic . PARTICIPANTS Mother-newborn dyads enrolled post partum from November 1 , 2005 , through October 31 , 2008 . INTERVENTIONS In the VIP group , mothers and newborns participated in 1-on-1 sessions with a child development specialist who facilitated interactions in play and shared reading by review ing videos made of the parent and child on primary care visit days ; learning material s and parenting pamphlets were also provided . In the BB group , parenting material s , including age-specific newsletters suggesting interactive activities , learning material s , and parent-completed developmental question naires , were mailed to the mothers . MAIN OUTCOME MEASURES Parent-child interactions were assessed at 6 months with the StimQ-Infant and a 24-hour shared reading recall diary . RESULTS A total of 410 families were assessed . The VIP group had a higher increased StimQ score ( mean difference , 3.6 points ; 95 % confidence interval , 1.5 to 5.6 points ; Cohen d , 0.51 ; 0.22 to 0.81 ) and more reading activities compared to the control group . The BB group also had an increased overall StimQ score compared with the control group ( Cohen d , 0.31 ; 95 % confidence interval , 0.03 to 0.60 ) . The greatest effects for the VIP group were found for mothers with a ninth- grade or higher reading level ( Cohen d , 0.68 ; 95 % confidence interval , 0.33 to 1.03 ) . CONCLUSIONS The VIP and BB groups each led to increased parent-child interactions . Pediatric primary care represents a significant opportunity for enhancing developmental trajectories in at-risk children . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00212576 Background . Whether prompt insertion of tympanostomy tubes in children with persistent early life otitis media prevents or minimizes subsequent developmental impairment has been the subject of conflicting opinions and differing approaches to management . Methods . We r and omly assigned 429 children with persistent middle ear effusion ( MEE ) before the age of 3 years to have  tympanostomy tubes inserted either as soon as possible or up to 9 months later if MEE persisted . In 402 of these children , we found no significant differences at age 3 years between the 2 treatment groups in mean scores on any measure of speech , language and cognition and in 401 of the children no significant differences in measures of psychosocial development . We then examined outcomes within subgroups of children who might have been the most severely affected , namely those who had been r and omized on the basis of bilateral , continuous MEE rather than unilateral and /or discontinuous MEE and those who had the greatest degrees of hearing loss . Results . In none of the subgroups we considered were scores on any outcome measure significantly more favorable in children in the early treatment group than in children in the late treatment group . Conclusions . In otherwise normal children who have MEE , during the first 3 years of life within the duration s we studied , prompt insertion of tympanostomy tubes does not measurably improve developmental outcomes at age 3 years , irrespective of whether MEE has been continuous or discontinuous and unilateral or bilateral and whether or not MEE has been accompanied by mild to moderate hearing loss OBJECTIVES : The goal of this study was to determine if a responsive stimulation and feeding intervention improved developmental and nutritional outcomes compared with a regular information-based parenting program . The hypothesis was that mothers in the intervention would exhibit better parenting skills and children would exhibit better developmental and nutritional outcomes than controls . METHODS : A cluster-r and omized field trial was conducted with 302 children aged 8 to 20 months and their mothers in rural Bangladesh who were r and omly assigned according to village to 1 of 3 groups . The control mothers received 12 informational sessions on health and nutrition . The intervention groups received an additional 6 sessions delivered by peer educators who included modeling and coached practice in self-feeding and verbal responsiveness with the child during play . A second intervention group received , along with the sessions , 6 months of a food powder fortified with minerals and vitamins . Developmental outcomes included the Home Observation for Measurement of the Environment ( HOME ) Inventory , mother-child responsive talk , and language development . Nutritional outcomes included weight , height , self-feeding , and mouthfuls eaten . We used analysis of covariance to compare the 3 groups at the posttest and at follow-up , covarying the pretest levels and confounders . RESULTS : At follow-up , responsive stimulation-feeding groups had better HOME inventory scores , responsive talking , language , mouthfuls eaten , and h and -washing . Micronutrient fortification result ed in more weight gain . CONCLUSIONS : A brief behavior-change program that focused on modeling and practice in stimulation and feeding was found to benefit children 's nutrition and language development . Micronutrients benefited children 's weight but not length This r and omized , controlled trial was design ed to document the effectiveness of Child FIRST ( Child and Family Interagency , Re source , Support , and Training ) , a home-based , psychotherapeutic , parent-child intervention embedded in a system of care .  Multirisk urban mothers and children , ages 6 - 36 months ( N = 157 ) participated . At the 12-month follow-up , Child FIRST children had improved language ( odds ratio [ OR ] = 4.4 ) and externalizing symptoms ( OR= 4.7 ) compared to Usual Care children . Child FIRST mothers had less parenting stress at the 6-month follow-up ( OR = 3.0 ) , lower psychopathology symptoms at 12-month follow-up ( OR = 4.0 ) , and less protective service involvement at 3 years postbaseline ( OR = 2.1 ) relative to Usual Care mothers . Intervention families accessed 91 % of wanted services relative to 33 % among Usual Care . Thus , Child FIRST is effective with multirisk families raising young children across multiple child and parent outcomes This study examined the optimal timing ( infancy , toddler-preschool , or both ) for facilitating responsive  parenting  and the intervention effects on maternal behaviors and child social and communication skills  for children who vary in biological risk . The intervention during infancy , Playing and Learning Strategies ( PALS I ) , showed strong changes in maternal affective-emotional and cognitively responsive behaviors and infants ' development . However , it was hypothesized that a 2nd intervention dose in the toddler-preschool period was needed for optimal results . Families from the PALS I phase were rer and omized into either the PALS II , the toddler-preschool phase , or a Developmental Assessment Sessions condition , result ing in 4 groups . Facilitation of maternal warmth occurred best with the PALS I intervention , while cognitive responsive behaviors were best supported with the PALS II intervention . Behaviors that required responsiveness to the child 's changing signals ( contingent responsiveness , redirecting ) required the intervention across both the early and later periods 
    Output:
    
RESULTS We observed the lack of a st and ardized list of risk factors for language available for health professionals .
The main risk factor mentioned was family dynamics , followed by interaction with parents , immediate social environment , and encouragement given to the child in the first years of life .
It was also observed that organic hazards such as brain injury , persistent otitis media , and cardiac surgery , besides the type of food and parental counseling , may be related to language disorders .