Articles and issues

Background. Screen use begins early in infancy in many urban settings, but prospective evidence linking toddler screen time to language development in Southeast Asia is limited. Methods. We recruited 642 children at their 12-month well-child visit in six government health clinics in Kuala Lumpur and followed them to 24 months. Screen time was measured with 3-day caregiver time-use diaries at 12 and 18 months. Expressive vocabulary at 24 months was assessed with validated Malay, Mandarin and Tamil adaptations of the MacArthur–Bates Communicative Development Inventories, and late talking was defined as fewer than 50 words or no word combinations. Associations were estimated with modified Poisson and linear regression adjusted for child, family and home language factors. Results. A total of 568 children (88.5%) completed the 24-month assessment. Median screen time at 18 months was 1.6 hours per day (IQR 0.8–2.7), and 208 children (36.6%) used screens for 2 hours or more daily. Late talking occurred in 25.0% of children with 2 hours or more of daily screen time compared with 9.8% of those with less than 1 hour (adjusted risk ratio 2.18, 95% CI 1.29–3.67). Each additional hour per day was associated with a 17-word smaller vocabulary (95% CI 10–24). The association was weaker when caregivers usually co-viewed (p for interaction = 0.038). Conclusions. Higher screen time at 18 months was associated with poorer expressive language at 24 months. Anticipatory guidance during well-child visits should address both the amount of screen use and caregiver engagement during viewing.

Introduction. Infants younger than 12 months with Kawasaki disease often present with incomplete clinical features and are at the highest risk of coronary artery aneurysms, particularly when diagnosis and treatment are delayed. Case presentation. A previously healthy 7-month-old boy presented on illness day 9 with persistent fever, irritability and a transient rash despite oral antibiotics for presumed otitis media. Examination showed bilateral nonexudative conjunctival injection and erythema at his BCG vaccination site, without other principal features. Laboratory tests revealed a C-reactive protein of 186 mg/L, leukocytosis, anemia, hypoalbuminemia, elevated alanine aminotransferase and sterile pyuria. Echocardiography showed a giant aneurysm of the proximal left anterior descending artery (5.4 mm, Z-score +11.2) and a medium aneurysm of the right coronary artery. He received intravenous immunoglobulin, aspirin and adjunctive corticosteroids, followed by infliximab for recrudescent fever, and low-dose aspirin with enoxaparin for thromboprophylaxis. The left anterior descending aneurysm reached a maximum Z-score of +14.8 at 3 weeks, and no thrombus or ischemia had developed by 3 months. Conclusion. Incomplete Kawasaki disease should be considered in any infant with prolonged unexplained fever, even when few clinical criteria are present. Early use of supplementary laboratory criteria and echocardiography can shorten the delay to treatment.