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Background Asymptomatic SARS-CoV-2 infection in children is highly prevalent but its acute and chronic implications have been minimally described. Methods In this controlled case-ascertained household transmission study, we recruited asymptomatic children <18 years with SARS-CoV-2 nucleic acid testing performed at 12 tertiary care pediatric institutions in Canada and the United States. We attempted to recruit all test-positive children and 1 to 3 test-negative, site-matched controls. After 14 days' follow-up we assessed the clinical (ie, symptomatic) and combined (ie, test-positive, or symptomatic) secondary attack rates (SARs) among household contacts. Additionally, post–COVID-19 condition (PCC) was assessed in SARS-CoV-2–positive participating children after 90 days' follow-up. Results A total of 111 test-positive and 256 SARS-CoV-2 test-negative asymptomatic children were enrolled between January 2021 and April 2022. After 14 days, excluding households with co-primary cases, the clinical SAR among household contacts of SARS-CoV-2–positive and –negative index children was 10.6% (19/179; 95% CI: 6.5%–16.1%) and 2.0% (13/663; 95% CI: 1.0%–3.3%), respectively (relative risk = 5.4; 95% CI: 2.7–10.7). In households with a SARS-CoV-2–positive index child, age <5 years, being pre-symptomatic (ie, developed symptoms after test), and testing positive during Omicron and Delta circulation periods (vs earlier) were associated with increased clinical and combined SARs among household contacts. Among 77 asymptomatic SARS-CoV-2–infected children with 90-day follow-up, 6 (7.8%; 95% CI: 2.9%–16.2%) reported PCC. Conclusions Asymptomatic SARS-CoV-2–infected children, especially those <5 years, are important contributors to household transmission, with 1 in 10 exposed household contacts developing symptomatic illness within 14 days. Asymptomatic SARS-CoV-2–infected children may develop PCC. [ABSTRACT FROM AUTHOR]

Preschool programs for socially vulnerable children are believed to affect school readiness and language development but infrequently include follow-up to adolescence; observational measurement of receptive vocabulary is rare. The purpose of this longitudinal cohort study (55 children and 41 parents) was to report the trajectory of receptive vocabulary development for socially vulnerable children of diverse ethnicities (Indigenous, other Canadian-born, and Immigrant) who participated in a two-generation preschool program. English receptive vocabulary scores were measured at 5-time points: (a) program intake, (b) program exit, (c) age 7 years, (d) age 10 years, and (e) adolescence, using the Peabody Picture Vocabulary Test – Third Edition (PPVT-III). For all children, PPVT-III scores increased the most between program intake and exit and positive changes were sustained until adolescence. When the sample was examined by gender, PPVT-III scores were higher for boys than girls at all time points. When the sample was examined by ethnicity, other Canadian-born children scored higher than Indigenous and Immigrant children at all time points. Immigrant children scored lowest until age 7 years, and at age 10 years and adolescence scored higher than Indigenous children. Using mixed-effects modeling, PPVT-III scores increased when English was the primary language spoken at home at intake. PPVT-III scores increased slightly as caregiver age and caregiver Adverse Childhood Experiences score increased. PPVT-III scores were lower for Immigrant girls and Indigenous boys than other sub-groups of children. Differential effects of the two-generation preschool program by gender and ethnicity suggest tailoring programming to increase equitability of receptive vocabulary development for immigrant girls and Indigenous boys. Children with intergenerational adversity may require additional support. [ABSTRACT FROM AUTHOR]

Objectives Asthma is a chronic lung condition that can be exacerbated when triggered by viruses. Pandemic public health restrictions aimed to reduce COVID-19 transmission indirectly effected other circulating viruses. This study assessed the impact of the pandemic and associated public health measures on acute paediatric asthma across four tertiary sites in three Canadian provinces. We queried whether pandemic-related changes would impair preventive care and delay presentation to care, increasing asthma exacerbation severity. Methods This retrospective study compared the frequency of acute care access and severity of presentation to emergency departments (ED) for acute asthma to four tertiary care children's hospitals during the COVID-19 pandemic (from March 17, 2020 to June 30, 2021) to a pre-lockdown control period (July 1, 2018 to March 16, 2020). Data was subjected to interrupted time series and Chi-square analysis. Results Our study included 26,316 acute asthma visits to ED. Sites experienced a 63% to 89% reduction in acute asthma visits during the pandemic, compared with pre-lockdown controls, and a 17% to 85% reduction in asthma, that is out of proportion as a fraction of all-cause ED visits. For asthma, there was no difference in severity measured by rate of ward admission or rate of Paediatric Intensive Care Unit (PICU) admission. Conclusions Public health measures appear to have resulted in a specific protective association on acute asthma with reduced acute care utilization over and above the reduction in all-cause presentations, without an increase in severity upon presentation. Our study indicates an importance to antiviral public health and engineering strategies to reduce viral transmission and thereby asthma morbidity. [ABSTRACT FROM AUTHOR]

Examine beverage intake among families with low income by household participation in federal food assistance programs. Cross-sectional study conducted in fall/winter 2020 via an online survey. Mothers of young children insured by Medicaid at the time of the child's birth (N = 493). Mothers reported household federal food assistance program participation, later categorized as Supplementation Nutrition Program for Women, Infants, and Children (WIC) only, Supplemental Nutrition Assistance Program-Education (SNAP) only, both WIC and SNAP, and neither. Mothers reported beverage intake for themselves and their children aged 1–4 years. Negative binomial and ordinal logistic regression. After accounting for sociodemographic differences between groups, mothers from households participating in WIC and SNAP consumed sugar-sweetened beverages (incidence rate ratio, 1.63; 95% confidence interval [CI], 1.14–2.30; P = 0.007) and bottled water (odds ratio, 1.76; 95% CI, 1.05–2.96; P = 0.03) more frequently than mothers from households in neither program. Children from households participating in WIC and SNAP also consumed soda (incidence rate ratio, 6.07; 95% CI, 1.80–20.45; P = 0.004) more frequently than children in either program. Few differences in intake were observed for mothers or children participating in only WIC or SNAP vs both programs or neither program. Households participating in both WIC and SNAP may benefit from additional policy and programmatic interventions to limit sugar-sweetened beverage intake and reduce spending on bottled water. [ABSTRACT FROM AUTHOR]

BACKGROUND: For 60 y, the people of Asubpeeschoseewagong Anishinabek (Grassy Narrows First Nation) have endured the effects of massive mercury (Hg) contamination of their river system, central to their traditions, culture, livelihood, and diet. In the years following the Hg discharge into the English-Wabigoon River system by a chloralkali plant in the early 1970s, there was a dramatic increase in youth suicides. Several authors attributed this increase solely to social disruption caused by the disaster. OBJECTIVE: This research examined the possible contribution of Hg exposure across three generations on attempted suicides among today's children (5-11 y old) and youth (12-17 y old), using a matrilineal intergenerational paradigm. METHODS: Information from the 2016-2017 Grassy Narrows Community Health Assessment (GN-CHA) survey was merged with Hg biomonitoring data from government surveillance programs (1970-1997). Data from 162 children/youth (5-17 years of age), whose mothers (푛=80) had provided information on themselves, their parents, and children, were retained for analyses. Direct and indirect indicators of Hg exposure included a) grandfather had worked as a fishing guide, and b) mother's measured and estimated umbilical cord blood and childhood hair Hg and her fish consumption during pregnancy with this child. Structural equation modeling (SEM) was used to examine significant links from grandparents (G0) to mothers' exposure and mental health (G1) and children/youth (G2) risk for attempted suicide. RESULTS: Mothers' (G1) median age was 33 y, 86.3% of grandmothers (G0) had lived in Grassy Narrows territory during their pregnancy, and 52.5% of grandfathers (G0) had worked as fishing guides. Sixty percent of children (G2) were <12 years of age. Mothers reported that among teenagers (G2: 12-17 years of age), 41.2% of girls and 10.7% of boys had ever attempted suicide. The SEM suggested two pathways that significantly linked grandparents (G0) to children's (G2) attempted suicides: a) through mothers' (G1) prenatal and childhood Hg exposure and psychological distress, and b) through maternal fish consumption during pregnancy (G1/G2), which is an important contributor to children's emotional state and behavior. DISCUSSION: Despite minimal individual information on G0 and G1 past life experiences, the findings support the hypothesis that Hg exposure over three generations contributes to the mental health of today's children and youth. The prevalence of Grassy Narrows youth ever having attempted suicide is three times that of other First Nations in Canada. [ABSTRACT FROM AUTHOR]

We examined the categorization of relationships between child complainants and accused perpetrators in cases of child sexual abuse (CSA). Researchers that have focused on complainant-accused relationships and other case variables, often combining two extrafamilial complainant-accused relationship categories: Relationships where the accused is connected to the child through their position in the community (i.e. community connections) and relationships where the non-relative accused is known to the child through a connection to the child's family (i.e. non-relative family connections). Using a database of 4,237 Canadian judicial decisions in cases of CSA, we reviewed a subset of 1,515 judicial decisions to explore differences between these two relationship categories. Compared to cases involving non-relative family connections, cases involving community connections had more male complainants, more multiple complainants, older complainants, higher frequencies of abuse, longer durations, and longer delays. We conclude that community and non-relative family connections are distinct relationships that should be separated for analyses in future research. Practical implications of recognizing the distinctiveness of non-relative family and community connection relationship categories in the context of abuse prevention and treatment are also discussed. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) is a complex and multifactorial public health problem associated with important physical and psychological repercussions. Recent studies suggest that cumulative childhood trauma (CCT) may be related to higher IPV perpetration through dysfunctional communication patterns, but to our knowledge, no study has tested this proposition in a clinical population. This study aimed to explore the direct and indirect links between CCT and perpetrated IPV through dysfunctional communication patterns among 577 men seeking help from community centers specializing in IPV. Prior to receiving services, participants completed a battery of questionnaires including validated brief measures of CCT (sexual, physical, and psychological abuse; physical and psychological neglect; witnessing of physical and psychological parental violence; bullying), communication patterns (demand/demand, partner demands/man withdraws, man demands/partner withdraws), and IPV (psychological, physical, coercive control). Results from a path analysis reveal that having sustained a higher number of different forms of childhood trauma is directly related to men's higher risk of perpetrating psychological IPV. CCT is also indirectly related to higher perpetrated psychological and physical IPV and coercive control through a higher report of the demand/demand communication pattern and a higher report of the man demands/partner withdraws communication pattern. The tested model explains 23% of the variance in psychological IPV, 6% of the variance in physical IPV, and 12% of the variance in coercive control. Results highlight the importance of assessing, in therapy, both distal and proximal variables associated with IPV, including the accumulation of many forms of childhood interpersonal trauma, and to tailor trauma-informed interventions that promote constructive communication strategies. [ABSTRACT FROM AUTHOR]

Clostridioides difficile infection (CDI) among children remains a concerning cause of morbidity in hospital settings. We present epidemiological and molecular trends in healthcare- and community-associated CDI among children in Canadian inpatient and outpatient settings, including those who experienced recurrent infections. [ABSTRACT FROM AUTHOR]

Background: The Canadian 24-Hour Movement Guidelines for Children and Youth (“Guidelines”) not only pioneered the notion of an integrated movement continuum from sleep to vigorous-intensity physical activity but also introduced a new branded Guideline visual identity. Objectives: This study evaluated youths’ (N = 46) attention to and thoughts about the Guidelines and the brand. Design: A cross-sectional between-participants randomized intervention design was used. Sample: Canadian youth between 10 and 17 years of age comprised the study sample. Interventions: Participants were randomly assigned to view either branded Guidelines (n = 26) or unbranded Guidelines (n = 20). Youths’ eye-movements (e.g., dwell time, fixation count) were recorded during Guideline viewing. Participants completed a follow-up survey assessing brand perceptions and Guideline cognitions. Results: The branded Guidelines neither drew greater overall attention nor led to more positive brand perceptions or Guideline cognitions compared to the unbranded Guidelines. Conclusions: Exploratory analyses provide valuable, yet preliminary insight into how branding and Guideline content may shape how Guidelines are perceived and acted upon. These findings inform an agenda for future health education resources. [ABSTRACT FROM AUTHOR]

Objectives. To determine the relationship between exposure to pregestational type 2 diabetes (T2D) and renal size and subcutaneous fat thickness in fetuses during routine obstetrical ultrasound. Methods. This was a case-control study (January 1, 2019 to December 31, 2019). Routine obstetrical ultrasounds performed between 18 and 22 weeks' gestation at a tertiary-care fetal assessment unit were reviewed. "Cases" comprised ultrasounds of fetuses exposed to pregestational T2D in utero. The control group was assembled from ultrasounds of healthy controls. Postprocessing measurements of fetal renal size and abdominal wall thickness from stored images were performed by two independent observers, and findings were compared between groups. Results. There were 54 cases and 428 ultrasounds of healthy controls. The mean maternal age of cases was 32.1 years (SD 6.2) compared to 33.2 years (SD 5.3) for healthy controls, and the majority of ultrasounds were performed in multiparous patients (83%). At the 18 to 22 week ultrasound, there was a significant reduction in renal size amongst fetuses exposed to maternal T2D in utero compared to controls; among cases, the mean renal width was 8.0 mm (95% CI 7.8–8.1) compared to 11.4 mm (95% CI 10.6–12.7) in controls (p < 0.0001); the mean renal thickness among cases was 8.1 mm (95% CI 7.9–8.2) compared to 11.5 mm (95% CI 10.7–12.9) in controls (p = 0.001). There was no obvious difference in estimated fetal weight between groups, yet fetuses exposed to maternal T2D had increased subcutaneous abdominal wall fat thickness at this early gestational age (p = 0.008). Conclusions. Fetal renal size in cases exposed to pregestational T2D is significantly smaller compared to controls, and subcutaneous abdominal wall fat is significantly thicker. Given emerging evidence about the developmental origins of disease, further study is needed to correlate the association between fetal renal size and fat distribution in the fetus and the long-term risk of chronic renal disease and diabetes in these offspring. [ABSTRACT FROM AUTHOR]

Current evidence regarding the protective effect of mouthguard use on symptom severity in children and adolescents who sustain sport-related concussions is insufficient to make clinical recommendations. To compare the association between mouthguard use and symptoms stratified by sex in the first 4 weeks after pediatric sport-related concussion. We hypothesized that mouthguard use would be associated with less severe symptoms. Prospective cohort study. Nine Canadian pediatric emergency departments (EDs). Children aged 5 to 18 years who were assessed within 48 hours of concussions sustained during a collision or contact sport. Injury characteristics were collected using the Acute Concussion Evaluation. The primary outcome measure was symptom score (range = 0–6), measured using age-appropriate versions (5–7, 8–12, or 13–18 years) of the Post-Concussion Symptom Inventory. The independent variable was time postconcussion (initial assessment and 1, 2, and 4 weeks). Of 1019 children (73% male; median [interquartile range] age = 13.43 years [11.01–15.27 years]), 42% wore a mouthguard at the time of injury. No significant group-by-sex-by-time interaction was present for symptoms (\(\def\upalpha{\unicode[Times]{x3B1}}\)\(\def\upbeta{\unicode[Times]{x3B2}}\)\(\def\upgamma{\unicode[Times]{x3B3}}\)\(\def\updelta{\unicode[Times]{x3B4}}\)\(\def\upvarepsilon{\unicode[Times]{x3B5}}\)\(\def\upzeta{\unicode[Times]{x3B6}}\)\(\def\upeta{\unicode[Times]{x3B7}}\)\(\def\uptheta{\unicode[Times]{x3B8}}\)\(\def\upiota{\unicode[Times]{x3B9}}\)\(\def\upkappa{\unicode[Times]{x3BA}}\)\(\def\uplambda{\unicode[Times]{x3BB}}\)\(\def\upmu{\unicode[Times]{x3BC}}\)\(\def\upnu{\unicode[Times]{x3BD}}\)\(\def\upxi{\unicode[Times]{x3BE}}\)\(\def\upomicron{\unicode[Times]{x3BF}}\)\(\def\uppi{\unicode[Times]{x3C0}}\)\(\def\uprho{\unicode[Times]{x3C1}}\)\(\def\upsigma{\unicode[Times]{x3C3}}\)\(\def\uptau{\unicode[Times]{x3C4}}\)\(\def\upupsilon{\unicode[Times]{x3C5}}\)\(\def\upphi{\unicode[Times]{x3C6}}\)\(\def\upchi{\unicode[Times]{x3C7}}\)\(\def\uppsy{\unicode[Times]{x3C8}}\)\(\def\upomega{\unicode[Times]{x3C9}}\)\(\def\bialpha{\boldsymbol{\alpha}}\)\(\def\bibeta{\boldsymbol{\beta}}\)\(\def\bigamma{\boldsymbol{\gamma}}\)\(\def\bidelta{\boldsymbol{\delta}}\)\(\def\bivarepsilon{\boldsymbol{\varepsilon}}\)\(\def\bizeta{\boldsymbol{\zeta}}\)\(\def\bieta{\boldsymbol{\eta}}\)\(\def\bitheta{\boldsymbol{\theta}}\)\(\def\biiota{\boldsymbol{\iota}}\)\(\def\bikappa{\boldsymbol{\kappa}}\)\(\def\bilambda{\boldsymbol{\lambda}}\)\(\def\bimu{\boldsymbol{\mu}}\)\(\def\binu{\boldsymbol{\nu}}\)\(\def\bixi{\boldsymbol{\xi}}\)\(\def\biomicron{\boldsymbol{\micron}}\)\(\def\bipi{\boldsymbol{\pi}}\)\(\def\birho{\boldsymbol{\rho}}\)\(\def\bisigma{\boldsymbol{\sigma}}\)\(\def\bitau{\boldsymbol{\tau}}\)\(\def\biupsilon{\boldsymbol{\upsilon}}\)\(\def\biphi{\boldsymbol{\phi}}\)\(\def\bichi{\boldsymbol{\chi}}\)\(\def\bipsy{\boldsymbol{\psy}}\)\(\def\biomega{\boldsymbol{\omega}}\)\(\def\bupalpha{\bf{\alpha}}\)\(\def\bupbeta{\bf{\beta}}\)\(\def\bupgamma{\bf{\gamma}}\)\(\def\bupdelta{\bf{\delta}}\)\(\def\bupvarepsilon{\bf{\varepsilon}}\)\(\def\bupzeta{\bf{\zeta}}\)\(\def\bupeta{\bf{\eta}}\)\(\def\buptheta{\bf{\theta}}\)\(\def\bupiota{\bf{\iota}}\)\(\def\bupkappa{\bf{\kappa}}\)\(\def\buplambda{\bf{\lambda}}\)\(\def\bupmu{\bf{\mu}}\)\(\def\bupnu{\bf{\nu}}\)\(\def\bupxi{\bf{\xi}}\)\(\def\bupomicron{\bf{\micron}}\)\(\def\buppi{\bf{\pi}}\)\(\def\buprho{\bf{\rho}}\)\(\def\bupsigma{\bf{\sigma}}\)\(\def\buptau{\bf{\tau}}\)\(\def\bupupsilon{\bf{\upsilon}}\)\(\def\bupphi{\bf{\phi}}\)\(\def\bupchi{\bf{\chi}}\)\(\def\buppsy{\bf{\psy}}\)\(\def\bupomega{\bf{\omega}}\)\(\def\bGamma{\bf{\Gamma}}\)\(\def\bDelta{\bf{\Delta}}\)\(\def\bTheta{\bf{\Theta}}\)\(\def\bLambda{\bf{\Lambda}}\)\(\def\bXi{\bf{\Xi}}\)\(\def\bPi{\bf{\Pi}}\)\(\def\bSigma{\bf{\Sigma}}\)\(\def\bPhi{\bf{\Phi}}\)\(\def\bPsi{\bf{\Psi}}\)\(\def\bOmega{\bf{\Omega}}\)\({\rm{\chi }}_3^2\) = 0.27; P =.965). Male mouthguard users reported similar symptom scores in the ED (difference in Post-Concussion Symptom Inventory Δ scores [diff] = −0.07; 95% CI = −0.23, 0.09) and at weeks 1 (diff = −0.02; 95% CI = −0.18, 0.14), 2 (diff = −0.03; 95% CI = −0.19, 0.13), and 4 (diff = −0.13; 95% CI = −0.29, 0.04) compared with males who did not wear a mouthguard. Female mouthguard users described minimally higher symptom scores at week 1 compared with non-mouthguard users (diff = 0.29; 95% CI = 0.01, 0.56). In the ED, symptom scores were not different for females who wore a mouthguard and those who did not (diff = 0.22; 95% CI = −0.04, 0.48) or at weeks 2 (diff = 0.22; 95% CI = −0.06, 0.51) or 4 (diff = 0.08; 95% CI = −0.20, 0.36). Wearing a mouthguard at the time of injury was not associated with reduced acute or subacute symptoms after sport-related concussion in either males or females who were treated in the ED compared with those who did not wear a mouthguard. Athletes are still encouraged to wear mouthguards during sports because overwhelming evidence supports their use in preventing dental injuries. [ABSTRACT FROM AUTHOR]

Background & Aims: Given that standardized language measures alone are inadequate for identifying functionally defined developmental language disorder (fDLD), this study investigated whether non‐linguistic cognitive abilities (procedural learning, motor functions, executive attention, processing speed) can increase the prediction accuracy of fDLD in children in linguistically diverse settings. Methods & Procedures: We examined non‐linguistic cognitive abilities in mono‐ and bilingual school‐aged children (ages 8–12) with and without fDLD. Typically developing (TD) children (14 monolinguals, 12 bilinguals) and children with fDLD (28 monolinguals, 12 bilinguals) completed tasks measuring motor functions, procedural learning, executive attention and processing speed. Children were assigned as fDLD based on parental or professional concerns regarding children's daily language functioning. If no concerns were present, children were assigned as TD. Standardized English scores, non‐verbal IQ scores and years of maternal education were also obtained. Likelihood ratios were used to examine how well each measure separated the fDLD versus TD groups. A binary logistic regression was used to test whether combined measures enhanced the prediction of identifying fDLD status. Outcomes & Results: A combination of linguistic and non‐linguistic measures provided the best distinction between fDLD and TD for both mono‐ and bilingual groups. For monolingual children, the combined measures include English language scores, functional motor abilities and processing speed, whereas for bilinguals, the combined measures include English language scores and procedural learning. Conclusions & Implications: A combination of non‐linguistic and linguistic measures significantly improved the distinction between fDLD and TD for both mono‐ and bilingual groups. This study supports the possibility of using non‐linguistic cognitive measures to identify fDLD in linguistically diverse settings. What this paper adds: What is already known on the subject: Given that standardized English language measures may fail to identify functional language disorder, we examined whether supplementing English language measures with non‐linguistic cognitive tasks could resolve the problem. Our study is based on the hypothesis that non‐linguistic cognitive abilities contribute to language processing and learning. This is further supported by previous findings that children with language disorder exhibit non‐linguistic cognitive deficits. What this paper adds to existing knowledge: The results indicated that a combination of linguistic and non‐linguistic cognitive abilities increased the prediction of functional language disorder in both mono‐ and bilingual children. What are the potential or actual clinical implications of this work?: This study supports the possibility of using non‐linguistic cognitive measures to identify the risk of language disorder in linguistically diverse settings. [ABSTRACT FROM AUTHOR]

Child homicides are rare occurrences, but when they occur, they often cause significant outrage. This paper examines the role of varying degrees of intimacy between victims and perpetrators in determining characteristics in child homicide cases. Focusing on 533 cases of child homicide between 1985 and 2012 in Ontario, Canada, characteristics of intrafamilial and extrafamilial cases, biological and step/foster parents, and maternal and paternal perpetrators are compared. Results show that characteristics of the child homicide vary depending on the degree of intimacy between victims and perpetrators, including: perpetrator and victim age, weapon use, suicide following the offence, sexual violence and use of excessive force. These findings provide support for developmental victimology and a routine activities theoretical perspective. Suggestions for future research and policy implications are also discussed. 'Examines the role of varying degrees of intimacy between victims and perpetrators in determining characteristics in child homicide cases' Key Practitioner Messages: Younger children are at a greater risk of homicide from family members, while older children are at a greater risk of homicide from individuals outside the family.Developmental victimology and routine activities theory can contribute to a better understanding of the dynamics between victims and perpetrators in child homicide.Collaboration should take place between researchers, child death review committees, mental health services, social services and policymakers to improve child homicide prevention and intervention initiatives. [ABSTRACT FROM AUTHOR]

This study aimed to examine the association between breastfeeding and childhood obesity. A multinational cross‐sectional study of 4,740 children aged 9–11 years was conducted from 12 countries. Infant breastfeeding was recalled by parents or legal guardians. Height, weight, waist circumference, and body fat were obtained using standardized methods. The overall prevalence of obesity, central obesity, and high body fat were 12.3%, 9.9%, and 8.1%, respectively. After adjustment for maternal age at delivery, body mass index (BMI), highest maternal education, history of gestational diabetes, gestational age, and child's age, sex, birth weight, unhealthy diet pattern scores, moderate‐to‐vigorous physical activity, sleeping, and sedentary time, exclusive breastfeeding was associated with lower odds of obesity (odds ratio [OR] 0.76, 95% confidence interval, CI [0.57, 1.00]) and high body fat (OR 0.60, 95% CI [0.43, 0.84]) compared with exclusive formula feeding. The multivariable‐adjusted ORs based on different breastfeeding durations (none, 1–6, 6–12, and > 12 months) were 1.00, 0.74, 0.70, and 0.60 for obesity (Ptrend =.020) and 1.00, 0.64, 047, and 0.64 for high body fat (Ptrend =.012), respectively. These associations were no longer significant after adjustment for maternal BMI. Breastfeeding may be a protective factor for obesity and high body fat in 9‐ to 11‐year‐old children from 12 countries. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine the impact of auditory training in noise on auditory behaviors and life habits in children with auditory processing disorder. Methods: Ten children with auditory processing disorder underwent an auditory training program in noise and six children with auditory processing disorder comprised a control group. Before and after training, participants were tested on sentence identification in noise and auditory evoked late latency responses. Participants teachers completed two questionnaires on children's auditory behaviors and life habits. Results: Participants were more tolerant to noise as the training sessions progressed. Significant between-group differences were found in P1 and N2 latency measures, independent of measurement time. The observed data trends suggest that some participants improved their performance on the sentence identification task in noise as well as on some electrophysiological parameters. No significant differences in questionnaire scores were found between groups or measurement times. However, one questionnaire showed significant between-group differences for certain questions. Conclusions: Listening in noise can improve with training for children with auditory processing disorder. However, this training program might be beneficial for some, but not all, children with auditory processing disorder. More data are needed to verify individual data trends. A structured program was developed to improve the ability of children with auditory processing disorder to listen in noise. Intervention can be beneficial for improving auditory behaviors in some children with auditory processing disorder. A limited number of questions on children's auditory behaviors asked to teachers appears to be more sensitive to intervention-related improvement compared to questions on life habits. [ABSTRACT FROM AUTHOR]

This study aimed to assess the oral health status of refugee children in comparison with that of Canadian children. In addition, we investigated the extent to which demographic factors are associated with caries experience in this population. Children with a confirmed refugee status and Canadian children (control group) matched for age and sex composed the study population. A comprehensive review of dental charts was completed to assess children's demographic data, caries experience, oral hygiene and gingival health status. The majority of refugee children had never seen a dentist before their arrival to Canada. Refugee children had significant higher dmft/DMFT scores than Canadian children (7.29 ± 5.1 and 4.47 ± 5, respectively; p < 0.0001). Furthermore, individual factors, such as refugee status (OR = 5.08; 95% CI = 2.31–11.1) and child age (OR = 2.17; 95% CI = 1.04–4.51) were significantly associated with caries experience. Access to appropriate dental care to refugee children should be a key priority for health care providers and policy makers. [ABSTRACT FROM AUTHOR]

Previous research on gender differences and delay of disclosure of child sexual abuse is inconclusive; some research has found that male victims are more likely to delay disclosure than female victims, while other studies have found no gender difference. The present archival study investigated this inconsistency by examining factors that interact with delay. Judicial outcomes of child sexual abuse cases were coded (N = 4237) for variables related to the offense, the complainant-accused relationship, and court proceedings. Males and females differed with respect to delay only when the relationship between the complainant and the accused was established in the community (e.g., sports coach) or was a stranger to the child. When the accused was a parent, other relative, or a non-relative connected to the child through the family, there was no difference in delay between males and females. Further, males were more vulnerable in the community, as evidenced by a higher proportion of accused community members with male than female complainants, even though males represented fewer than 25% of cases in the database. These findings may help explain inconsistencies in gender differences in delayed disclosure. Implications regarding education about child sexual abuse are discussed, with a focus on male victims. [ABSTRACT FROM AUTHOR]

BACKGROUND: Some Canadian schools have modified their daily schedules from the traditional school day (TSD) schedule (two 15‐minute breaks and one 60‐minute break) to a balanced school day (BSD) schedule (two 40‐minute breaks). While this change increases daily planning and instructional time, it also changes the amount of time available for moderate‐vigorous physical activity (MVPA). METHODS: This study uses a case‐control design to examine differences in objectively measured MVPA between children in 3 schools using a BSD schedule and 3 schools using a TSD schedule. Study participants (aged 10‐12 years) were recruited from schools in Ontario, Canada. RESULTS: Regardless of schedule type, girls had lower MVPA than boys, and as both boys and girls got older their MVPA significantly decreased. The findings indicate there was no statistically significant difference in the total minutes of in‐school MVPA between children from BSD schools and children from TSD schools. MVPA was significantly higher for older girls attending BSD schools than older girls attending TSD schools, suggesting that implementing a BSD may help curb declining MVPA as girls enter adolescence. CONCLUSION: Despite encouraging findings, more rigorous studies (ie, pre‐post experiments with control) are needed to better understand how changing schedules impacts children's health. [ABSTRACT FROM AUTHOR]

This study examined the variation among ethnic populations in prevalence of anemia, vitamin D and B12 deficiencies among refugee children. A retrospective chart review of 388 government assisted refugee children ≤ 16 years of age, seen at the Refugee Health Clinic in Kitchener, Canada from January 2009 to December 2014 was conducted. Vitamin D levels were only collected until December 1st 2010 (116 children). 15.7% were anemic (25% < 5 years, 8.7% 5-11 years, and 18.3% 12-16 years old) with Somali children having the lowest hemoglobin levels compared to those from Iraq, Afghanistan and Myanmar. 53.5% were vitamin D deficient (25(OH)D < 50 nmol/L), seen most commonly in Iraqis and Afghans. 11.2% had vitamin B12 levels < 150 pmol/L. Providers’ knowledge of prevalence of nutritional deficiencies related to region of origin, can guide appropriate screening and treatment options to promote longer term cognitive, physical and developmental health. [ABSTRACT FROM AUTHOR]

Purpose: This study investigates how the variables of culture and hearing status might influence the amount of parent-child talk families engage in throughout an average day. Method: Seventeen Vietnamese and 8 Canadian families of children with hearing loss and 17 Vietnamese and 13 Canadian families with typically hearing children between the ages of 18 and 48 months old participated in this cross-comparison design study. Each child wore a Language ENvironment Analysis system digital language processor for 3 days. An automated vocal analysis then calculated an average conversational turn count (CTC) for each participant as the variable of investigation. The CTCs for the 4 groups were compared using a Kruskal-Wallis test and a set of planned pairwise comparisons. Results: The Canadian families participated in significantly more conversational turns than the Vietnamese families. No significant difference was found between the Vietnamese or the Canadian cohorts as a function of hearing status. Conclusions: Culture, but not hearing status, influences CTCs as derived by the Language ENvironment Analysis system. Clinicians should consider how cultural communication practices might influence their suggestions for language stimulation. [ABSTRACT FROM AUTHOR]

Objective: To assess the effectiveness of the self-regulatory Canadian Children's Food and Beverage Advertising Initiative (CAI) in limiting advertising of unhealthy foods and beverages on children's preferred websites in Canada.Design/Setting/SubjectsSyndicated Internet advertising exposure data were used to identify the ten most popular websites for children (aged 2-11 years) and determine the frequency of food/beverage banner and pop-up ads on these websites from June 2015 to May 2016. Nutrition information for advertised products was collected and their nutrient content per 100 g was calculated. Nutritional quality of all food/beverage ads was assessed using the Pan American Health Organization (PAHO) and UK Nutrient Profile Models (NPM). Nutritional quality of CAI and non-CAI company ads was compared using χ 2 analyses and independent t tests.Results: About 54 million food/beverage ads were viewed on children's preferred websites from June 2015 to May 2016. Most (93·4 %) product ads were categorized as excessive in fat, Na or free sugars as per the PAHO NPM and 73·8 % were deemed less healthy according to the UK NPM. CAI-company ads were 2·2 times more likely (OR; 99 % CI) to be excessive in at least one nutrient (2·2; 2·1, 2·2, P<0·001) and 2·5 times more likely to be deemed less healthy (2·5; 2·5, 2·5, P<0·001) than non-CAI ads. On average, CAI-company product ads also contained (mean difference; 99 % CI) more energy (141; 141·1, 141·4 kcal, P<0·001, r=0·55), sugar (18·2; 18·2, 18·2 g, P<0·001, r=0·68) and Na (70·0; 69·7, 70·0 mg, P<0·001, r=0·23) per 100 g serving than non-CAI ads.Conclusions: The CAI is not limiting unhealthy food and beverage advertising on children's preferred websites in Canada. Mandatory regulations are needed. [ABSTRACT FROM AUTHOR]

There is a need to identify barriers to participation as well as recruitment strategies to engage minority parents of young children in health-oriented research. This paper offers insights on strategies and challenges in recruiting black immigrant mothers living in Ottawa (Canada) for a community-based health-oriented research project among 6-to-12-year-old children. We recruited 259 mother-child dyads. Most participants were recruited by team members during community events, fairs, religious gatherings, etc. Other successful strategies included referral from participants, community partners, and through research team members' networks. Mass media strategies were mostly ineffective. Instant and meaningful incentives, developing community partnerships, building and ensuring study legitimacy and trust, placing convenience of participants ahead of that of research team members, doing community outreach, and taking contact information on the spot, as well as using word-of-mouth were essential to recruiting. This study clearly indicates the importance of adopting multiple recruitment strategies. [ABSTRACT FROM AUTHOR]

Aims To examine the effect of a pre-operative DVD on parents' knowledge, participation and anxiety and on children's distress, pain, analgesic requirements and length of recovery after same-day surgery. Background Very few parents are adequately prepared to participate in their child's care during a same-day surgery. An educational DVD was developed to educate parents on how to actively support their child in the recovery room. Design Single-blind, post-test randomized controlled trial. Study is registered at ClinicalTrials.gov NCT02766452. Methods Between September 2011-September 2012, 123 parent-child dyads where the child underwent an ENT or dental same-day surgery were recruited in a Canadian paediatric hospital. Dyads were randomly assigned to either the intervention ( DVD and standard preparation) or control group (standard preparation). Parents and children were videotaped in the recovery room where parental participation and anxiety and children's distress were measured. Data on parents' knowledge, children's postoperative pain, analgesic requirements and length of recovery were measured. Independent and paired t-tests, chi square and repeated measures anova were used to analyse the data. Results Parents in the intervention group gained greater knowledge of and used more positive reinforcement and distraction and relaxation methods than those in the control group. Children's postoperative pain in the day-care surgery unit was significantly lower among the intervention group compared with the control group. Conclusion A pre-operative DVD can increase parents' participation in the recovery room and decrease children's postoperative pain. [ABSTRACT FROM AUTHOR]

Background: Data guiding the timing of dialysis initiation in children are limited. We sought to determine current practice and secular trends in Canada with respect to the timing of dialysis initiation in children based on estimated glomerular filtration rate (eGFR). Methods: This observational study included incident chronic dialysis patients aged ≤21 years identified from the Canadian Organ Replacement Register who started dialysis in Canada between January 2001 and December 2010 at any of the nine participating Canadian centers ( n = 583). Youth were categorized utilizing CKiD Schwartz eGFR into ≥10.5 (higher) or <10.5 ml/min/1.73 m (lower) eGFR groups. Differences at dialysis initiation by facility and region were examined, and secular trends were determined. Results: Median eGFR at dialysis initiation was 8.1 (interquartile range 5.4-11.0) ml/min/1.73 m. Overall, 29 % of the patients started dialysis with an eGFR of ≥10.5 ml/min/1.73 m. The proportion of children starting with higher eGFR increased from 27.3 % in 2001 to 35.4 % in 2010 ( p = 0.04) and differed by treatment facility (12-70 %; p = 0.0001). Factors associated with higher eGFR at dialysis initiation in the adjusted regression model were female sex [odds ratio (OR) 1.48; 95 % confidence interval (CI) 1.02-2.14], genetic cause of end-stage kidney disease (OR 2.77; 95 % CI 1.37-5.58) and living ≥50 km from treatment facility (OR 1.47; 95 % CI 1.01-2.14). Conclusions: One-third of the children were found to have initiated dialysis with an eGFR ≥10.5 ml/min/1.73 m, however significant practice variation exists with respect to timing of dialysis initiation by treatment facility. More data is required to evaluate the clinical implications of this practice variation. [ABSTRACT FROM AUTHOR]

Purpose:To test a model of child, family and service determinants of participation in family and recreational activities for young children with cerebral palsy (CP). Methods:Participants were a convenience sample of 429 children (242 males) with CP, aged 18 to 60 months, representing all levels of the Gross Motor Function Classification System (GMFCS). Children were divided into two groups by GMFCS levels, levels I to II and levels III to V. Data on impairments and gross motor function were collected by therapists; parents provided information about children’s health conditions and adaptive behaviour. Seven months later, parents reported on family life and services received. One year after the beginning of the study, parents reported their children’s participation. Data from the two groups of children were analysed separately using structural equation modelling. Results:The model explained 35% and 40% of the variance of frequency of participation in family and recreation and 28% and 38% of enjoyment in participation, for the two groups of children, respectively. Children’s adaptive behaviour, family ecology, and number of community recreational programs were associated with the frequency of participation for both groups. Gross motor function was only associated with the frequency of participation for children in levels III–V. Adaptive behaviour was associated with enjoyment for both groups. The extent services met children’s needs was associated with enjoyment for children in levels I to II and family ecology was a determinant of enjoyment for children in levels III to V. Conclusion:Supporting children’s adaptive behaviour, family ecology, and access to community recreational programmes may foster participation in family and recreational activities for young children with CP.Implications for RehabilitationParticipation in family and recreational activities for young children with CP is complex and influenced by child, family and environmental factors.Practitioners are encouraged to support children’s adaptive behaviour and access to community programs and family relationships, involvement in community activities and expectations of their children.Optimizing gross motor function for children who have limitations in self-mobility may enhance their participation in family and recreational activities.For children with a good prognosis for walking, providing services perceived by parents to meet their children’s needs may enhance children’s enjoyment of participation. [ABSTRACT FROM PUBLISHER]

Although previous research has explored the efficacy of differential response (DR) programs in child welfare, there have been no studies to date about coding decisions between designations by child protection service agencies. Research has explored client satisfaction with DR as well as rates of recidivism and removal/placement but with limited attention paid to the rationales behind coding decisions and recoding, once an initial designation pathway is assigned. This descriptive study uses data previously gathered by child protection social workers to qualitatively evaluate the fidelity of implementation of family development response (FDR) in British Columbia and the integrity of the program with regard to its stated objectives. Based on a random sample of intakes, decision-making fidelity to code as FDR or investigation (INV) was examined by exploring rationales behind coding at critical decision points and mechanisms for recoding during family involvement with child protective services. Subsequently, this study examined whether cases that had been coded as FDR differed substantially from INVs in terms of service provision, outcomes, and appropriateness of FDR for high-risk cases. [ABSTRACT FROM AUTHOR]

The article discusses a study which aimed to determine the role of religious involvement and related indicators such as religious coping, intrinsic religiosity and forgiveness in reducing the negative impact of early traumatic stress on the mental and physical health of adult survivors.

There are some children who encounter unexpected reading difficulties in the fourth grade. This phenomenon has been described as late emerging reading disabilities (LERD). Using Grade 4 as a starting point, this study examined the reading development of 964 children between kindergarten and Grade 7. The results showed that 72.0% of children had typical reading performance in Grade 4, whereas there was 0.7% with poor word reading, 12.6% with poor reading comprehension, 2.5% with poor word reading and comprehension, and 12.2% with borderline performance. We also showed that there were similar proportions of children who had early versus late emerging reading difficulties; however, most of the late emerging poor readers recovered by Grade 7. Furthermore, our study showed that poor comprehenders showed poorer performance than typical readers on word reading, pseudoword decoding, and spelling between Grade 1 and Grade 7 and poorer performance on a working memory task in kindergarten. Overall, this study showed that most children recover from late emerging reading problems and that working memory may be an early indicator for reading comprehension difficulties. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To compare the rates of catheter-associated bloodstream infection (CABSI) in preterm infants born at <30 weeks' gestation who received a peripherally inserted central catheter (PICC) versus an umbilical venous catheter (UVC) immediately after birth as their primary venous access. METHODS: This retrospective matched cohort study examined data from infants born at <30 weeks' gestation and admitted between January 2010 and December 2013 to neonatal units in the Canadian Neonatal Network. Eligible infants who received a PICC on the first day after birth (day 1) were matched with 2 additional groups of infants, those who received a UVC on day 1 and those who received a UVC on day 1 that was then changed for a PICC after 4 days or more. The primary outcome was number of infants with CABSI per 1000 catheter days, which was compared between the 3 groups using multivariable analyses. RESULTS: Data from 540 eligible infants were reviewed (180 per group). There was no significant difference in infants with CABSI/1000 catheter days between the 3 groups (9.3 vs 7.8 vs 8.2/1000 catheter days, respectively; P > .05) despite lower rates of late onset sepsis in the group of infants who received only a UVC. CONCLUSIONS: There was no significant difference in the incidence of CABSI between very preterm neonates who received a PICC, UVC, or UVC followed by PICC as the primary mode of venous access after birth. A prospective randomized controlled trial is justified to further guide practice regarding primary venous access and reduction of infection. [ABSTRACT FROM AUTHOR]

Background The body of literature on narratives of bilingual children with and without specific language impairment (SLI) is growing. However, little is known about the narrative abilities of bilingual preschool children with SLI and their patterns of growth. Aims To determine the similarities and differences in narrative abilities between preschoolers with and without SLI who are either monolingual or bilingual at two time points. Methods & Procedures Forty children completed a narrative retell task in English at two test points. The mean ages were 52 and 58 months at Times 1 and 2, respectively. We examined performance on measures of narrative macrostructure (narrative information) and microstructure (sentence length, number of different words, verb accuracy, first mentions) in monolingual and bilingual children with and without SLI. The bilingual children were from diverse first-language backgrounds and all spoke English most of the time. Outcomes & Results A series of repeated-measures analyses of variance was used with language ability (typical development or SLI) and bilingual status (monolingual versus bilingual) as the between-subjects factors and time (Times 1 or 2) as the within-subjects factor. Results indicated a significant main effect of time for four measures (i.e., Information Score, lexical diversity, sentence length and verb accuracy). The between-subjects analyses indicated a significant difference between the typically developing children and the children with SLI in all measures and a significant difference between monolingual and bilingual children for verb accuracy only. Conclusions & Implications This study showed that all four groups of children showed growth over a 6-month period and that bilingual children exposed predominantly to English in the home performed similarly to their monolingual peers in measures of narrative information, sentence length, number of different words and first mentions. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to compare parents' expectations for their children crossing streets' with children s actual crossing behaviours and determine how accurately parents judge their own children's pedestrian behaviours to be. Method Using a fully immersive virtual reality system interfaced with a 3D movement measurement system, younger (7-9 years) and older (10-12 years) children's crossing behaviours were assessed. The parent viewed the same traffic conditions and indicated if their child would cross and how successful she/he expected the child would be when doing so. Results Comparing children's performance with what their parents expected they would do revealed that parents significantly overestimated the inter-vehicle gap threshold of their children, erroneously assuming that children would show safer pedestrian behaviours and select larger inter-vehicle gaps to cross into than they actually did; there were no effects of child age or sex. Child and parent scores were not correlated and a logistic regression indicated these were independent of one another. Conclusions Parents were not accurate in estimating the traffic conditions under which their children would try and cross the street. If parents are not adequately supervising when children cross streets, they may be placing their children at risk of pedestrian injury because they are assuming their children will select larger (safer) inter-vehicle gaps when crossing than children actually do. [ABSTRACT FROM AUTHOR]

An emerging body of mental health research provides evidence that callous-unemotional (CU) traits explain significant and meaningful variance among children with disruptive behavior disorders. However, the classroom behavior of students with CU traits has not yet been adequately studied. This study examined this issue using teacher-recorded classroom rule violations (RVs). Participants were 648 children (346 boys; M age = 8.14) from 28 classrooms (kindergarten-sixth grade) distributed across three schools participating in a schoolwide behavioral intervention. Teachers completed rating scales approximately 4 to 6 weeks after the start of the school year, prior to initiating the schoolwide intervention. After completing ratings, teachers recorded daily frequency counts of RVs for each student in their classroom for the remainder of the school year. Growth curve modeling analyses indicated that (a) CU traits were associated with elevated rates of RVs at the start of the school year even after taking attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder/conduct disorder (ODD/CD) into account and (b) CU traits were associated with a significant decrease in rates of RVs across the school year. CU traits appear to explain significant and important variance in classroom RVs among elementary school age students. [ABSTRACT FROM AUTHOR]

Little is known about the influence of different forms of added sugar intake on diet quality or their association with obesity among youth. Dietary intake was assessed by three 24-h recalls in 613 Canadian children (aged 8-10 years). Added sugars (mean of 3-day intakes) were categorized according to source (solid or liquid). Dietary intake and the Canadian Healthy Eating Index (« HEI-C ») were compared across tertiles of solid and liquid added sugars separately as were adiposity indicators (body mass index (BMI), fat mass (dual-energy X-ray absorptiometry), and waist circumference). Cross-sectional associations were examined in linear regression models adjusting for age, sex, energy intake, and physical activity (7-day accelerometer). Added sugar contributed 12% of total energy intake (204 kcal) on average, of which 78% was from solid sources. Higher consumption of added sugars from either solid or liquid source was associated with higher total energy, lower intake of micronutrients, vegetables and fruit, and lower HEI-C score. Additionally liquid sources were associated with lower intake of dairy products. A 10-g higher consumption of added sugars from liquid sources was associated with 0.4 serving/day lower of vegetables and fruit, 0.4-kg/m2 higher BMI, a 0.5-kg higher fat mass, and a 0.9-cm higher waist circumference whereas the associations of added sugars from solid sources and adiposity indicators tended to be negative. In conclusion, higher consumption of added sugar from either solid or liquid sources was associated with lower overall diet quality. Adiposity indicators were only positively associated with added sugars from liquid sources. [ABSTRACT FROM AUTHOR]

Objective This study aims to identify the incidence, risk factors, and outcomes of late-onset sepsis in preterm neonates in Canadian neonatal intensive care units (NICUs). Study Design This retrospective analysis included preterm infants born at < 32 weeks' gestation and admitted to 29 NICUs in the Canadian Neonatal Network during the years 2010 and 2011. Infants were classified into three groups: no infection, gram-positive infection, and gram-negative infection. Late-onset sepsis was defined as positive blood and/or spinal fluid cultures after 3 days of birth. Risk factors and the primary outcome of mortality or bronchopulmonary dysplasia (BPD) were compared between the groups. Results Out of the 7,509 neonates, 6,405 (85%) had no infection, 909 (12%) had gram-positive, and 195 (3%) had gram-negative infections. Lower gestation, higher Score for Neonatal Acute Physiology, version II scores, the presence of central catheters for > 4 days, parenteral nutrition for > 7 days, and prolonged duration of nothing by mouth were associated with late-onset sepsis. After controlling for confounders, the odds ratio (OR) of mortality/BPD were higher in infants who had gram-negative (OR 2.79, 95% confidence interval [CI] 1.96-3.97) and gram-positive (OR 1.44, 95% CI 1.21-1.71) sepsis as compared with no infection. Conclusions Bacterial late-onset sepsis in very preterm neonates was associated with mortality and BPD. Neonates with gram-negative sepsis had the highest risk of adverse outcomes as compared with gram-positive sepsis or no sepsis. [ABSTRACT FROM AUTHOR]

Eating disorder clinicians from various disciplines participated in one of two surveys: the “self” group (n= 143) completed a survey assessing the negative influence of emotions on their own clinical decisions, while the “other” group (n= 145) completed a parallel version of the survey that assessed their perceptions of the negative influence of emotion in their colleagues. Both groups endorsed this phenomenon to some degree, although differences in reporting were noted between groups. The perceived negative influence of emotion with regards to specific treatment decisions fell within three categories: decisions regarding food and weight, decisions regarding the involvement of the family in treatment, and decisions related to autonomy and control. Decisions regarding the involvement of the family were perceived to be the most emotionally charged, in particular the involvement of a critical or dismissive parent. [ABSTRACT FROM PUBLISHER]

Parents ( n = 140) of children 2 to 7 years responded to an online survey regarding their children's experiences and conversations about death. A total of 75% of parents indicated that they had spoken to their child about death, and the majority of conversations were first initiated when children were between 3 and 3.5 years of age. Binary logistic regression analysis was used to explore factors that could predict conversations about death. Parents ( n = 88) provided narratives of the explanations of death that they gave their child and subsequently reported their level of satisfaction with their explanation. The content of the explanations was coded and examined in relation to children's age and parental satisfaction. Results revealed that parents who provided explanations to a continued existence after death reported significantly higher levels of satisfaction than those parents who discussed the absence of a future physical relationship after death. Finally, explanations of a continued existence were not always in reference to an afterlife and could include discussing the memory of the deceased or their continued impact even after death. Thus, when talking to young children about death, parents may feel greater satisfaction in finding ways to discuss the continued legacy of those who have died compared to more biological explanations. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective The aim of the article is to review the effectiveness of neonatal noninvasive high-frequency ventilation (NIHFV) in preventing endotracheal mechanical ventilation. Study Design Retrospective case series including all 79 instances of NIHFV use at four participating centers between July 2010 and September 2012. Results In 73% of cases, NIHFV was used as rescue after another noninvasive mode, and prophylactically (postextubation) in the remainder. In 58% of cases, infants transitioned to another noninvasive mode, without requiring intubation. There were significant reductions in the mean (SD) number of apneas, bradycardias, or desaturations (over 6 hours) (3.2 [0.4] vs. 1.2 [0.3]; p < 0.001), FiO2 (48 [3] vs. 40 [2]%; p < 0.001) and CO2 levels (74 [6] vs. 62 [4] mm Hg; p ¼ 0.025] with NIHFV. No NIHFVrelated complications were noted. Conclusions NIHFV is a promising NIV mode that may help prevent or delay intubation and deserves further clinical research. [ABSTRACT FROM AUTHOR]

Children with autism spectrum disorder (ASD) and structural language impairment (LI) may be at risk of more adverse social-developmental outcomes. We examined trajectories of early social competence (using the Vineland-II) in 330 children aged 2-4 years recently diagnosed with ASD, and compared 3 subgroups classified by: language impairment (ASD/LI); intellectual disability (ASD/ID) and ASD without LI or ID (ASD/alone). Children with ASD/LI were significantly more socially impaired at baseline than the ASD/alone subgroup, and less impaired than those with ASD/ID. Growth in social competence was significantly slower for the ASD/ID group. Many preschool-aged children with ASD/LI at time of diagnosis resembled 'late talkers' who appeared to catch up linguistically. Children with ASD/ID were more severely impaired and continued to lag further behind. [ABSTRACT FROM AUTHOR]

This study aimed to assess the communicative skills of children and young adults with ring 14 syndrome and linear 14q deletions, investigating the relationships among their language development and their genetic, clinical, psychomotor and behavioural characteristics. Participants were 36 individuals with chromosome 14 aberrations whose parents completed a questionnaire, specifically developed in five languages, to assess their son's/daughter's development. Data analysis showed that chronological age does not account for the high individual variability found in the participants' skills. The comparison between participants with ring 14 syndrome and participants with 14q linear deletions showed that the former were characterised by a higher occurrence of epilepsy, abnormalities of the retina and autism. The participants with smaller amounts of deleted genetic material were those who had a higher level of language development. Because ring 14 syndrome is a rare genetic disease, the collection of data from a large group of individuals could be helpful to create expectations about the possible developmental outcomes of these children. [ABSTRACT FROM AUTHOR]

Introduction: Emergency department (ED) crowding is a significant problem in Canada and has been associated with decreased quality of care in general and pediatric emergency departments (PEDs). Although boarding of admitted patients in the ED is the main contributor to adult ED overcrowding, factors involved in PED crowding may be different. The objective of this study was to report the trend in PED services use and to document the degree of overcrowding experienced in a Canadian PED. Methods: A retrospective cohort study was conducted using administrative data from a tertiary care PED from 2002 to 2011. The primary outcome was PED use (total volume of visits and case severity per triage levels using the Canadian Triage and Acuity Scale [CTAS] score and admissions). Secondary outcomes included measures of PED overcrowding, such as rates of patients leaving without being seen (LWBS) and length of stay (LOS). Results: Total volumes increased by 30% over the 10-year study period, whereas hospitalizations remained stable at approximately 10%. Trends in CTAS levels did not indicate meaningful changes in the severity of cases treated at our PED. LWBS proportions among CTAS 3, CTAS 4, and CTAS 5 groups and LOS for all CTAS groups progressively and statistically increased from year to year. Conclusions: Over the course of the study period, there was a substantial increase in PED visits, which likely contributed to the worsening markers of PED flow outcomes. Further study into the effects of PED crowding on patient outcomes is warranted. [ABSTRACT FROM AUTHOR]

• Motor sequence learning was evaluated using performance, recognition, and recall metrics in children with persistent developmental stuttering, children who had recovered from developmental stuttering and typically developing controls. • Early in practice, children with persistent developmental stuttering performed the motor sequence task with the lowest accuracy. • Late in practice, children with persistent developmental stuttering reached performance levels similar to those of children who had recovered and control children. • Developmental stuttering is associated with subtle fine motor performance limitations, but motor sequence learning may be intact. Previous studies have associated developmental stuttering with difficulty learning new motor skills. We investigated non-speech motor sequence learning in children with persistent developmental stuttering (CWS), children who have recovered from developmental stuttering (CRS) and typically developing controls (CON). Over the course of two days, participants completed the Multi-Finger Sequencing Task, consisting of repeated trials of a10-element sequence, interspersed with trials of random sequences of the same length. We evaluated motor sequence learning using accuracy and response synchrony, a timing measure for evaluation of sequencing timing. We examined error types as well as recognition and recall of the repeated sequences. CWS demonstrated lower performance accuracy than CON and CRS on the first day of the finger tapping experiment but improved to the performance level of CON and CRS on the second day. Response synchrony showed no overall difference among CWS, CRS and CON. Learning scores of repeated sequences did not differ from learning scores of random sequences in CWS, CRS and CON. CON and CRS demonstrated an adaptive strategy to response errors, whereas CWS maintained a high percentage of corrected errors for both days. Our study examined non-speech sequence learning across CWS, CRS and CON. Our preliminary findings support the idea that developmental stuttering is not associated with sequence learning per se but rather with general fine motor performance difficulties. [ABSTRACT FROM AUTHOR]

Background: Recreation and sport facilities often have unhealthy food environments that may promote unhealthy dietary patterns among children. In response, some Canadian provinces have released voluntary nutrition guidelines for recreation and sport facilities, however implementation has been limited. Organizational capacity building may overcome barriers to implementing guidelines. Eat, Play, Live was a randomized controlled trial embedded within a natural experiment that tested the impact of an 18 month capacity building intervention (CBI) in enhancing implementation of provincial nutrition guidelines, and whether nutrition guidelines were associated with positive changes. Primary outcomes were facility capacity, policy development and food environment quality. Methods: Recreation and sport facilities in three guideline provinces were randomized into a guideline + CBI (GL + CBI; n = 17) or a guideline only comparison condition (GL-ONLY; n = 15). Facilities in a province without guidelines constituted a second comparison condition (NO-GL; n = 17). Facility capacity, policy development, and food environment quality (vending and concession) were measured and compared at baseline and follow-up across conditions using repeated measures ANOVA and Chi-square statistics. Healthfulness of vending and concession items was rated as Do Not Sell (least nutritious), Sell Sometimes or Sell Most (most nutritious). Results: There were significant time by condition effects, with significant increases in facility capacity (mean ± SD: 30.8 ± 15.6% to 62.3 ± 22.0%; p < 0.01), nutrition policy development (17.6% developed new policies; p = 0.049), overall quality of the concession food environment (14.7 ± 8.4 to 17.5 ± 7.2; p < 0.001), and in the proportion of Sell Most (3.7 ± 4.4% to 11.0 ± 9.0%; p = 0.002) and Sell Sometimes vending snacks (22.4 ± 14.4% to 43.8 ± 15.8%; p < 0.001) in GL + CBI facilities, with a significant decline in Do Not Sell vending snacks (74.0 ± 16.6% to 45.2 ± 20.1%; p < 0.001). Conclusions: Significant improvements in facility capacity, policy development and food environment quality occurred in recreation and sport facilities that were exposed to nutrition guidelines and participated in a CBI. Outcomes did not improve in facilities that were only passively or not at all exposed to guidelines. Ongoing capacity building may enhance implementation of voluntary nutrition guidelines, however food environments remained overwhelmingly unhealthy, suggesting additional scope to enhance implementation. Trials registration: Clinical trials registration (retrospectively registered): ISRCTN14669997 Jul 3, 2018. [ABSTRACT FROM AUTHOR]

Background: Food and beverage marketing has been identified as an environmental determinant of childhood obesity. The purpose of this study is to assess whether the Uniform Nutrition Criteria established and implemented by companies participating in the self-regulatory Canadian Children's Food and Beverage Advertising Initiative (CAI) had an impact on the healthfulness of food and beverage advertising during television programming with a high share of children in the viewing audience. Methods: Data on food advertising were licensed from Numeris for 27 television stations for Toronto for May 2013 and May 2016 (i.e. before and after the implementation of the nutrition criteria). First, television programs that had a child audience share of ≥35% (when the nutrition criteria applied) were identified. Ten percent of these programs were randomly selected and included in the study. After identifying the food and beverage ads that aired during these programs, the nutritional information of advertised products was collected and their healthfulness was assessed using the Pan-American Health Organization (PAHO) and UK Nutrient Profile Models (NPM). The healthfulness of CAI products advertised in May 2013 and 2016 was compared using Chi-square tests. Results: Although in May 2016, products advertised by CAI companies were more likely to be categorized as healthier by the UK NPM (21.5% versus 6.7%, χ2(1) = 12.1,p = 000) compared to those advertised in May 2013, the frequency of advertised products considered less healthy in May 2016 remained very high (78.5%) and comparable to that of products advertised by companies not participating in the CAI (80.0% categorized as less healthy). Furthermore, in both May 2013 and May 2016, 99–100% of CAI advertisements featured products deemed excessive in either fat (total, saturated, trans), sodium or free sugars according to the PAHO NPM. Conclusions: Despite modest improvements noted after the implementation of the CAI's Uniform Nutrition Criteria, the healthfulness of most products advertised during programs with a high share of children in the viewing audience remains poor. Mandatory regulations are needed. [ABSTRACT FROM AUTHOR]