Abstract: To analyze the relationship between parenting behaviors and sleep problems of preschool children, so as to provide a strategic decision support for child growth and parenting behavior improvement. Methods: Using the questionnaire data of 27 200 preschool children parents selected from 11 cities in Hubei, Anhui and Jiangsu provinces in October 2017, parents parenting behavior was assessed by Parent Behavior Inventory (PBI), and children s sleep problems were assessed by Children s Sleep Habits Questionnaire (CSHQ). Data were analyzed using descriptive statistics and Logistic regression models. Results: The reporting rate of sleep problems among preschool children was 15.3%. After adjusting for confounding factors, maternal hostile/coercive parenting behavior scores (medium level: OR=1.38; high level: OR=1.86) and paternal hostile/coercive parenting behavior scores (medium level: OR=1.17; high level: OR=1.59) were positively correlated with sleep problems (P<0.05). Hostile/coercive parenting behaviors by their parents (maternal high level: the OR values were 1.75, 2.97, 1.86, and 2.75 respectively; paternal high level: OR values were 1.79, 1.91, 1.69, and 1.79 respectively) were positively associated with sleep problems in preschool children aged 3, 4, 5, and 6. Scores of parental support/engaged (fathers of 4yearold children medium level: OR=0.84; fathers of 5yearold children medium and high level: OR=0.84, 0.82) were negatively correlated with children aged 4 and 5 (P<0.05). High level maternal supportive/engaged and paternal hostile/coercive scores were positively associated with child sleep problems (OR=1.93); high level maternal hostile/coercive and paternal supportive/engaged scores were positively associated with child sleep problems (OR=1.93); high scores of parental hostile/coercive were positively correlated with child sleep problems (OR=2.60) (P<0.05). Conclusion Sleep problems among children are related to parenting behaviors, especially hostile/coercive parenting behaviors that increases the risk of sleep problems among children.

Early life is a critical window period that determines the growth and development of children, but this delicate and complex period is highly susceptible to the disturbance of various exogenous chemicals, which in consequence may lead to short-term or long-term adverse health effects in human beings. The massive use of antibiotics has contributed to widespread exposure in early life, along with the potentially adverse effects on child health, and has caused great concern in public health. This review summarized recent epidemiological studies on the population with early-life antibiotic exposure and associated health outcomes such as growth and development, allergies, and psycho-behavioral problems in children, as well as potential biological mechanisms underlying these associations. Current findings suggested that antibiotic exposure early in life, including pregnancy and infancy, is strongly associated with childhood allergic diseases (e.g., atopic dermatitis and asthma), growth and development (e.g., obesity and birth length), and childhood psycho-behavioral problems (e.g., autism and anxiety). It also suggested that antibiotic exposure may affect individual health through gut microbiota, thyroid function, inflammation factors, mitochondrial function, and epigenetic mechanisms. In the future, more large prospective birth cohorts should be established to determine the levels of internal exposure to different types of antibiotics at multiple time points in early life and to explore their associations with child health outcomes, as well as to further validate relevant mechanisms, aiming to provide high-quality scientific evidence for research on child health associated with environmental exposure in early life.

Objective:To understand the prevalence of occasional hypertension in preschool children in three provinces in the middle and lower reaches of the Yangtze River in China, and analyze the relationship between their sleep status and occasional hypertension.Methods:From October to November 2017, a total of 24 842 preschool children from 109 kindergartens in 11 cities in Hubei, Anhui and Jiangsu provinces were selected by intentional sampling method. A self-made questionnaire was used to collect basic information about the subjects, and the sleep status data was collected by the Children′s Sleep Habits Questionnaire. Physical examinations were performed on the subjects, and height, weight and blood pressure were measured on-site. The difference in occasional hypertension detection rate among preschool children with different characteristics was compared, and the correlation between sleep status and occasional hypertension detection rate was analyzed by the multivariate logistic regression model.Results:The age of the subjects was (4.4±1.0) years, including 12 729 boys (51.2%). The prevalence of occasional hypertension was 31.8% (7 907/24 842). The prevalence of occasional hypertension among preschool children in three provinces of the middle and lower reaches of the Yangtze River was 31.8%. There were statistically significant differences in the detection rate of occasional hypertension among preschool children of different genders, age groups, family residence, family economic status and parents′ education level (all P values<0.05). The detection rate of occasional hypertension in children with less than 10 hours of sleep was higher than those with sufficient sleep, and the difference was statistically significant ( P<0.05). The results of multivariate logistic regression analysis showed that after adjusting for factors such as gender, age, family residence, family economic status, parental education level, parental smoking history, and physical constitution, the ORs (95% CI) for less than 10 hours of sleep, turning on the lights while sleeping, and poor sleep quality were 1.09 (1.03-1.15), 1.17 (1.07-1.28) and 1.04 (0.91-1.18), respectively, compared with the corresponding reference group. Conclusion:The detection rate of occasional hypertension is high in preschool children in the middle and lower reaches of the Yangtze River and there is a positive correlation between insufficient sleep and turning on the light when sleeping and occasional hypertension in preschool children.

Objective:To understand the prevalence of occasional hypertension in preschool children in three provinces in the middle and lower reaches of the Yangtze River in China, and analyze the relationship between their sleep status and occasional hypertension.Methods:From October to November 2017, a total of 24 842 preschool children from 109 kindergartens in 11 cities in Hubei, Anhui and Jiangsu provinces were selected by intentional sampling method. A self-made questionnaire was used to collect basic information about the subjects, and the sleep status data was collected by the Children′s Sleep Habits Questionnaire. Physical examinations were performed on the subjects, and height, weight and blood pressure were measured on-site. The difference in occasional hypertension detection rate among preschool children with different characteristics was compared, and the correlation between sleep status and occasional hypertension detection rate was analyzed by the multivariate logistic regression model.Results:The age of the subjects was (4.4±1.0) years, including 12 729 boys (51.2%). The prevalence of occasional hypertension was 31.8% (7 907/24 842). The prevalence of occasional hypertension among preschool children in three provinces of the middle and lower reaches of the Yangtze River was 31.8%. There were statistically significant differences in the detection rate of occasional hypertension among preschool children of different genders, age groups, family residence, family economic status and parents′ education level (all P values<0.05). The detection rate of occasional hypertension in children with less than 10 hours of sleep was higher than those with sufficient sleep, and the difference was statistically significant ( P<0.05). The results of multivariate logistic regression analysis showed that after adjusting for factors such as gender, age, family residence, family economic status, parental education level, parental smoking history, and physical constitution, the ORs (95% CI) for less than 10 hours of sleep, turning on the lights while sleeping, and poor sleep quality were 1.09 (1.03-1.15), 1.17 (1.07-1.28) and 1.04 (0.91-1.18), respectively, compared with the corresponding reference group. Conclusion:The detection rate of occasional hypertension is high in preschool children in the middle and lower reaches of the Yangtze River and there is a positive correlation between insufficient sleep and turning on the light when sleeping and occasional hypertension in preschool children.

Objective: To investigate the prevalence of sleep problems and influencing factors among preschoolers, so as to provide a reference for healthy sleep behaviors among preschoolers. Methods: From December 2017 to June 2018, a questionnaires study was administered to parents of 8 456 preschoolers from kindergartens in Yangzhou, Zhenjiang and Xuzhou by using random cluster sampling method. Demographic characteristics, screen time, sleep patterns and the Children s Sleep Habits Questionnaire (CSHQ) were colleted. Results: The average night sleep duration was (9.91±0.64)h, the rate of sleep deprivation was 51.7%, which increased with age ( χ 2 trend =34.19, P <0.01). The total scores of CSHQ were (49.46±5.02), and the prevalence of sleep problems was 95.0%, with the prevalence of specific sleep problems ranged from 2.3% to 76.4%. Multivariate Logistic regression analysis showed that only child, mothers age, parental education, and household economic status was significantly associated the sleep problems ( P <0.05). Conclusion The prevalence of sleep problems among preschool children is more prominent, varies by only child, parental education and household economic status. Parents and society should raise awareness of sleep problems.

Objective: To clarify the distribution of asthma in preschool children aged 3-6 years old and the protective effect of breastfeeding on asthma in three provinces in the middle and lower reaches of the Yangtze river in China. Methods: The parents of 27 200 preschoolers chosen from kindergartens in 11 cities of Hubei, Jiangsu and Anhui Province were investigated with children’s asthma and breastfeeding during October to November in 2017. Results: The asthma detection rate for preschoolers was 4.0%,5.0% for boys and 2.9% for girls. The asthma detection rate for children aged 3,4,5,and 6 years old was 3.2%,3.7%,4.4%,and 4.9%. 3 448 (12.7%) and 7 630 (28.1%) preschoolers were never breastfed or mainly breastfed. The rate of exclusive breastfeeding was 50.0% for 1 to 5 months and only 10.2% over 6 months. Meanwhile,there was a significant protective effect on asthma (OR=0.88,95%CI=0.77-0.89) by exclusive breastfeeding for 1-5 months,which was still statistically significant after adjusting for confounding factors. After adjusting for confounding factors,exclusive breastfeeding over 6 month have significant effected on preschool children aged 4 years old without allergic conjunctivitis history (OR=0.63,95%CI=0.40-0.99). Furthermore,exclusive breastfeeding over 6 month had important effect on preschool children aged 4 years old with eczema history (OR=0.52,95%CI=0.27-0.99). Conclusion Exclusive breastfeeding has protective effect on asthma in preschool children. Exclusive breastfeeding over 6 months even has better protective effect on asthma for the 4-years-old children without the history of allergic conjunctivitis and eczema.

Objective: To explore the correlation between screen time, exposure time to different screens and psychology behaviors of preschool children. Methods: A total of 2 582 children from kindergartens in urban Xuzhou areas were recruited to perform the physical examination, a cluster sampling method being explored. Parent questionnaires were performed to understand the time of screens and children’s psychology behaviors. Multi-linear regression and Logistic regression models were also used to analyze the correlation between them in preschool children. Results: The prevalence of abnormal internalization behavior of preschool children in Xuzhou City was 3.8%, the detection rate of abnormal externalization behavior was 22.4%, and the detection rate of prosocial behavior abnormality was 20.9%. The time spent by the preschool boys on TV time, learning day screen time and one-week video time is significantly higher than the girls (P<0.05). After adjusting for age and gender, the results of multiple linear regression analysis showed that the longer the average screen time, the more serious the problem of internalizing and externalizing problems; and the longer the average screen time of the weekend and the week, the worse the prosocial behavior of children (P<0.05). After correcting multiple covariates, it was found that the average screen time was positively correlated with children’s internal and external behavioral problems (P<0.05). Logistic regression analysis showed that after adjusting for age and gender, the average screen time of study day, weekend and week was a risk factor for preschool children’s internal and external behavior problems, and the average weekly screen time was a protective factor for prosocial behavior (P<0.05). After adjusting for multiple covariates, the learning day and the average weekly screen time were risk factors for children’s internal and external behavior (P<0.05). In addition, the results of association analysis between different types of video time exposure and psychological behavior showed that after adjusting for age and gender, all types of video exposures affected the internal and external behaviors of patients (P<0.05); after correcting multiple covariates The association was still statistically significant (P<0.05). Logistic regression analysis showed that after adjusting for age and gender, the exposure time of each type of video screen was a risk factor for children’s internal and external behavior problems (P<0.05). After correcting multiple covariates, all types of video exposure were internalized behavior problems. The risk factors, and the video time of other electronic products were risk factors for externalization behavior problems (P<0.05). Conclusion Average screen time has a significant positive correlation with psychological behavior, and the exposure time of screens such as TV and mobile phone could increase the incidence of psychological behaviors in preschool children.

Objective:To explore the effect of parental rearing patterns and their consistency on the emotional and behavioral problems of preschool children.Methods:From October to November 2017, 27 987 children aged 3 to 6 years old from 109 kindergartens in 11 cities of Hubei, Anhui and Jiangsu Provinces were selected by using the cluster sampling method. A total of 27 200 valid questionnaires which were completed by subjects' parents were collected. The emotional and behavioral problems of preschool children were collected by "strengths and difficulties questionnaire" and the parental rearing patterns were evaluated by the "Parental Behavior Scale". The differences in emotional and behavioral abnormality rates of preschool children with different characteristics were analyzed; with emotional and behavioral problems as dependent variables and parental support/participation and compulsion/hostility as independent variables, the multivariate logistic regression model was used to analyze the effect of parental rearing patterns and their consistency on the emotional and behavioral problems of preschool children.Results:The age of children was (4.35±0.96) years old, and 51.4% of children were 13 975 males. There were 24 634 (90.6%) urban children and 17 916 (65.9%) only children. Both parents with strong support/participation accounted for 14.9%, and those with poor support/participation accounted for 11.9%; both parents with strong compulsion/hostility accounted for 15.2%, and those with low compulsion/hostility accounted for 11.3%. The rates of emotional symptoms, conduct behavior, hyperactive behavior, peer interaction, total difficulty score, and abnormal prosocial behavior of preschool children were 9.5%, 9.5%, 18.2%, 24.5%, 11.2%, and 10.2%, respectively. The multivariate logistic regression model analysis showed that after adjusting for gender, only child, living area, family economic status, mother′s age and education level, father′s education level, and other factors, compared with fathers/mothers with strong support/participation and low compulsion/hostility and parents with strong support/participation and low compulsion/hostility, preschool children who had fathers/mothers with poor support/participation and strong compulsion/hostility or parents with poor support/participation and strong compulsion/hostility were more likely to have emotional symptoms, conduct behavior, hyperactive behavior, peer interaction, total difficulty score, and abnormal prosocial behavior ( P<0.05). Conclusions:Parental rearing patterns and their consistency are related to the emotional and behavioral problems of preschool children.

Objective:To explore the relationship between multiple health-risk behaviors and emotional and behavioral problems in preschool children.Method:From October to November 2017, 27 987 children aged 3 to 6 years from 109 kindergartens of 11 cities from Hubei, Anhui and Jiangsu Provinces in the middle and lower reaches of the Yangtze River were selected by using the cluster sampling method. Finally, 27 200 valid questionnaires were collected. A questionnaire was used to investigate the demographic characteristics, video time and outdoor activities, eating behavior, sleep time, emotional and behavioral problems of parents and children. Multivariate logistic regression model was used to quantify the association between multiple health-risk behaviors and emotional and behavioral problems.Results:Emotional symptoms, conduct problems, hyperactivity, peer problems, total difficulties and prosocial behavior abnormalities were detected in 9.5% (2 587), 9.5% (2 590), 18.2% (4 958), 24.5% (6 670), 11.2% (3 058) and 10.2% (2 770), respectively. Three groups of low, medium and high scores of multiple health-risk behaviors were accounted for 30.6% (8 316), 60.9% (16 568) and 8.5% (2 316), respectively. Multivariate logistic regression model analysis showed that after controlling for the confounding factors, compared with those in the low score group, preschool children in the middle and high score groups had higher risks of emotional symptoms, conduct problems, hyperactivity, peer problems, total difficulties and prosocial behavior (all Pvalues<0.05). Conclusion:Health-risk behaviors are associated with the emotional and behavioral problems of preschool children.

Objective:To explore the effect of parental rearing patterns and their consistency on the emotional and behavioral problems of preschool children.Methods:From October to November 2017, 27 987 children aged 3 to 6 years old from 109 kindergartens in 11 cities of Hubei, Anhui and Jiangsu Provinces were selected by using the cluster sampling method. A total of 27 200 valid questionnaires which were completed by subjects' parents were collected. The emotional and behavioral problems of preschool children were collected by "strengths and difficulties questionnaire" and the parental rearing patterns were evaluated by the "Parental Behavior Scale". The differences in emotional and behavioral abnormality rates of preschool children with different characteristics were analyzed; with emotional and behavioral problems as dependent variables and parental support/participation and compulsion/hostility as independent variables, the multivariate logistic regression model was used to analyze the effect of parental rearing patterns and their consistency on the emotional and behavioral problems of preschool children.Results:The age of children was (4.35±0.96) years old, and 51.4% of children were 13 975 males. There were 24 634 (90.6%) urban children and 17 916 (65.9%) only children. Both parents with strong support/participation accounted for 14.9%, and those with poor support/participation accounted for 11.9%; both parents with strong compulsion/hostility accounted for 15.2%, and those with low compulsion/hostility accounted for 11.3%. The rates of emotional symptoms, conduct behavior, hyperactive behavior, peer interaction, total difficulty score, and abnormal prosocial behavior of preschool children were 9.5%, 9.5%, 18.2%, 24.5%, 11.2%, and 10.2%, respectively. The multivariate logistic regression model analysis showed that after adjusting for gender, only child, living area, family economic status, mother′s age and education level, father′s education level, and other factors, compared with fathers/mothers with strong support/participation and low compulsion/hostility and parents with strong support/participation and low compulsion/hostility, preschool children who had fathers/mothers with poor support/participation and strong compulsion/hostility or parents with poor support/participation and strong compulsion/hostility were more likely to have emotional symptoms, conduct behavior, hyperactive behavior, peer interaction, total difficulty score, and abnormal prosocial behavior ( P<0.05). Conclusions:Parental rearing patterns and their consistency are related to the emotional and behavioral problems of preschool children.