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Children in foster care have complexity around medical decision-making because of their unique custody status. When medical decision-making is necessary for a child in foster care, what perspectives are important? What if opinions are not aligned? Who makes the final decision for consent? This Ethics Rounds focuses on a young child in foster care who has had repeated ear infections. Foster caregivers and family of origin are not in agreement on the treatment plan. Two experts, a foster care pediatrician and a child welfare professional, comment on the important considerations for the case, including involvement of legal representation and best interest representation in medical decision-making as well as the variability in child welfare response by state. [ABSTRACT FROM AUTHOR]

Background: Voiding dysfunction (VD) is a frequent reason for primary care referrals to urologists and pediatric urologists. VD symptoms include urine incontinence (UI), urinary tract infection (UTI), hyperactive bladder, and constipation. Early detection of Nocturnal enuresis is critical due to its high frequency and the consequences for families and children regarding psychological and behavioral aspects. Objectives: This study aims to determine the prevalence of voiding disorder in Palestine and its relationship to demographic, family, and behavioral risk factors. Design: A cross-sectional study. Methods: This study administered a 2-part validated questionnaire to the mothers of primary school-age children who had no history of urological disease between December 2022 and March 2023. Results: Out of 169 children; daytime incontinence was found in 39 (23.2%) of the sample, whereas nocturnal enuresis was found in 49 (28.4%). Age was significantly correlated with voiding dysfunction, in which 25 (55.6%) were under the age of 7 years (P =.025). Conclusion: According to our data, VD is a widespread health issue in primary school. Expanding our understanding of voiding dysfunction is important to eliminate the social stigma associated with voiding disorder and encourage parents and children to seek treatments and therapies. Furthermore, raising awareness will aid in early diagnosis, resulting in fewer long-term problems and earlier treatments. Raising awareness can be accomplished through educational programs focusing on primary care screening. [ABSTRACT FROM AUTHOR]

Purpose: Equitable representation of children with hearing loss who are members of marginalized or minority groups in behavioral intervention studies enhances inclusivity in the scientific process and generalizability of results. The goal of this systematic review was to ascertain the percentage of studies conducted in the United States in the past 2 decades that reported relevant demographic variables. Method: Studies were searched across eight databases and clinical trial registries in October 2022. Variations of the following search strings were used to retrieve peer-reviewed published studies and unpublished clinical trials: children, hearing loss, and intervention. Results: Thirty-nine intervention studies met the inclusion criteria. The selected studies were reviewed and coded for the following demographic variables: area and type of intervention, participant age, hearing technology data, sample size, gender, race/skin color and ethnicity, primary/home language(s), additional disabilities, parental education, family income, and parental occupation. Results revealed that many demographic variables were remarkably underreported, with parental education, family income, and parental occupation variables being the least reported data. Conclusions: Demographic data can be an important tool for changing disparities related to intervention outcomes. This systematic review suggests that inclusive research practices should be extended to low-literacy or low-economic resources, non-White, and non--English-speaking groups. Inclusion practices coupled with sufficient sample sizes will ultimately aid in identifying hearing health disparities. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The purpose of this study was to develop, pilot, and evaluate a culturally grounded, family-based program to prevent adverse childhood experiences (ACEs) among low-income and Indigenous children aged 10 to 14. The Tiwahe Wicagwicayapi program (TWP) is a 7-session program that teaches skills to prevent ACEs and is rooted in Lakota culture, language, and history. METHODS: A total of 124 families (124 caregivers [96% Indigenous; 90% reported yearly income <$40 000] with 194 children aged 10 to 14 [93% Indigenous]) were randomly assigned to treatment (N = 66 families and 173 individuals) or waitlist (N = 58 families and 145 individuals) control groups. Caregivers and children completed a baseline, immediate posttest, and 6-month follow-up survey. RESULTS: Treatment effects were detected, indicating, compared with control participants, reductions in the incidence of child ACEs (incidence rate ratio [IRR] = 0.64), bullying victimization (odds ratio = 0.53), depression (d = -0.20), and externalizing behaviors (d = -0.23) and increased parent-child communication (g = 0.27) and child help-seeking behaviors (d = 0.28). For caregivers, the effects indicated that the program prevented intimate partner violence victimization (IRR = 0.36) and perpetration (IRR = 0.45), harsh parenting (g = -0.35), and depression (d = -0.24) and increased emotion regulation (d = 0.37), social support (d = 0.33), and cultural connection (d = 0.34). CONCLUSIONS: The TWP holds great promise in preventing ACEs among low-income, Indigenous children, showing potential promise for widespread public health impact. Future rigorous research on the TWP is warranted. [ABSTRACT FROM AUTHOR]

Purpose: Asian children and youth with disabilities often experience multiple barriers, stigmas and discrimination within and outside their families; yet less is understood about their lived experiences. This systematic review explored the experiences of ableism among Asian children and youth with disabilities and their families. Methods: We conducted a systematic review of qualitative studies and a qualitative meta-synthesis. We searched six databases including Ovid Medline, Embase, PsychInfo, Healthstar, Web of Science, and Scopus. Results: Forty-two articles met our inclusion criteria involving 17 countries and regions over a 22-year period. The findings were synthesized into four themes: (1) individual- and family-level ableism (i.e., stigma, fears, concerns, stress and anxieties, physical abuse, bullying, reduced engagement in community activities); (2) institutional-level ableism (i.e., barriers to accessing and navigating supports, ableist attitudes among service providers, unavailable services); (3) societal-level ableism (i.e., cultural and religious stigma, social rejection, discrimination, environmental and policy barriers); and (4) coping strategies (i.e., self-care activities, supports from family, friends and people with similar conditions, religious beliefs). Conclusions: Our results highlight the ableist experiences that Asian children and youth with disabilities and their caregivers often encounter and the strong need for further supports to address ableism using culturally responsive strategies. IMPLICATIONS FOR REHABILITATION: Asian children and youth with disabilities encounter multiple forms of ableism at the individual, family and institutional levels. It is important for healthcare providers to customize resources that are culturally appropriate and aligned with the cultural and language backgrounds of the clients they serve. Clinicians and service providers should engage in culturally sensitive training and education to understand the barriers faced by the clients they serve. Clinicians and service providers should continue to advocate for marginalized and equity-deserving groups. [ABSTRACT FROM AUTHOR]

Challenging behavior (CB) is a common occurrence in early childhood and frequently occurs in young children with disabilities. CB is also culturally perceived and includes differences in how caregivers understand and define the topography of CB. Despite the cultural interpretation, CB is known to impact the child and their family but there has been little exploration of what marginalized caregivers perceive as the impact of the CB that their young children with disabilities exhibit. We used semi-structured interviews to explore the perceptions of 24 caregivers, who identified as Black, Mexican American, and White, about the impact of their child's CB. Caregivers shared how the CB impacted themselves, their families, their child, and others. Although much of the impact was similar among caregivers, we discuss nuanced differences across ethnic groups. [ABSTRACT FROM AUTHOR]

Real-time attention coordination in parent–toddler dyads is often studied in tightly controlled laboratory settings. These studies have demonstrated the importance of joint attention in scaffolding the development of attention and the types of dyadic behaviors that support early language learning. Little is known about how often these behaviors occur in toddlers' everyday lives. We brought wireless head-mounted eye trackers to families' homes to study the moment-to-moment patterns of toddlers' and parents' visual attention and manual activity in daily routines. Our sample consisted of English- and Spanish-speaking families who all reported being middle- or upper middle-class. Toddlers were 2 to 3 years old. Consistent with the findings from previous laboratory studies, we found variability in how frequently toddlers attended to named objects in two everyday activities—Object Play and Mealtime. We then tested whether parent–toddler joint attention in the seconds before a naming utterance increased toddler's attention on the named object. We found that joint attention accompanied by the attended object being held increased the child's attention to the labeled object during naming. We posit that in the rich, noisy world of toddlers' everyday lives, embodied attention plays a critical role in coordinating dyadic behaviors and creating informative naming moments. Our findings highlight the importance of studying toddlers' natural behavior in the real world. Public Significance Statement: This study used eye-tracking glasses to measure toddler and parent attention at home and to test whether findings from laboratory tasks matter in the real world. Toddlers' attention to an object while it is named by their parent is thought to be important for word learning. We found that toddlers' attention to a named object increases when they and their parent coordinate their attention to held objects, supporting previous lab-based work. [ABSTRACT FROM AUTHOR]

This study was conducted to understand the experiences of mothers with limited English proficiency (LEP) and their children with autism during diagnosis and receiving services for their children with autism. A qualitative approach and the health disparity framework were adopted to answer the research questions. Using grounded theory methodology, 16 mothers with LEP and their preschool-aged children with autism were interviewed. Lack of communication during clinical encounters was the main category that arose from the data. Mothers with LEP have difficulties navigating the US healthcare system and autism-related institutions. Patient factors (no support system, stigma around autism, awareness about autism) affected their interactions with autism service providers. Providers of autism diagnosis and services were out of reach, especially because of communication barriers. The health system played a major role in widening the disparities for mothers with LEP and their children with autism with long wait times for diagnoses and services, lack of insurance coverage for services, culturally incompetent staff, and existing complicity in the system. Mothers with LEP felt abandoned by the US healthcare system in receiving diagnoses and services for their children with autism. In the United States, mothers who have LEP encounter significant barriers in accessing diagnosis and early intervention services for their preschool-aged children with autism. The objectives of Healthy People 2030 will not be achieved without addressing the needs of an understudied population of people with LEP. Highlights: Experiences of mothers with limited English proficiency were described using qualitative methodology. Four factors, including patient, provider, health system, and clinical encounters, impacted LEP mothers' experiences of raising a child with autism. Mothers with LEP felt abandoned by the US healthcare system in receiving diagnoses and services for their children with autism. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the relationship between socioenvironmental sugar promotion and geographical inequalities in the prevalence of dental caries amongst 5‐year‐olds living across small areas within England. Methods: Ecological data from the National Dental Epidemiology Programme (NDEP) 2018–2019, comprising information on the percentage of 5‐year‐olds with tooth decay (≥1 teeth that are decayed into dentine, missing due to decay, or filled), and untreated tooth decay (≥1 decayed but untreated teeth), in lower‐tier local authorities (LAs) of England. These were analysed for association with a newly developed Index of Sugar‐Promoting Environments Affecting Child Dental Health (ISPE‐ACDH). The index quantifies sugar‐promoting determinants within a child's environment and provides standardized scores for the index, and its component domains that is, neighbourhood‐, school‐ and family‐environment, with the highest scores representing the highest levels of sugar promotion in lower‐tier LAs (N = 317) of England. Linear regressions, including unadjusted models separately using index and each domain, and models adjusted for domains were built for each dental outcome. Results: Participants lived across 272 of 317 lower‐tier LAs measured within the index. The average percentage of children with tooth decay and untreated tooth decay was 22.5 (SD: 8.5) and 19.6 (SD: 8.3), respectively. The mean index score was (0.1 [SD: 1.01]). Mean domain scores were: neighbourhood (0.02 [SD: 1.03]), school (0.1 [SD: 1.0]), and family (0.1 [SD: 0.9]). Unadjusted linear regressions indicated that the LA‐level percentage of children with tooth decay increased by 5.04, 3.71, 4.78 and 5.24 with increased scores of the index, and neighbourhood, school and family domains, respectively. An additional model, adjusted for domains, showed that this increased percentage predicted by neighbourhood domain attenuated to 1.37, and by family domain it increased to 6.33. Furthermore, unadjusted models indicated that the LA‐level percentage of children with untreated tooth decay increased by 4.72, 3.42, 4.45 and 4.97 with increased scores of the index, and neighbourhood, school, and family domains, respectively. The model, adjusted for domains, showed that this increased percentage predicted by neighbourhood domain attenuated to 1.24 and by family domain rose to 6.47. School‐domain was not significantly associated with either outcome in adjusted models. Conclusions: This study reveals that socioenvironmental sugar promotion, particularly within neighbourhood‐ and family‐environments, may contribute to geographical inequalities in dental caries in children. Further research involving data on individual‐level dental outcomes and confounders is required. [ABSTRACT FROM AUTHOR]

Background: Poverty's impact on children's academic outcome is a cause for concern in most urban Asian cities as education is viewed as one of the main channels of social mobility. Few studies examined how poor children's hope could be enhanced through school social support. Objective: This paper examines how children from low-income families' perceived frequencies and importance of social support from teachers and classmates, influence their levels of hope in academic achievement. Method: Utilizing a partially-mixed sequential design—first, with survey data from a larger study on low-income children (n = 513), this paper explores if perceived frequency of social support is associated with level of hope as well as the role of perceived importance in moderating the frequencies of school social support on sense of hope; second, to enrich the child-reported results, two in-depth focus group discussions with elementary school teachers (n = 10) were conducted. Results: Statistical analysis reveals that the frequency of social support from teachers and classmates is associated with the level of hope in low-income children. Furthermore, when teacher's support was rated important by children, there was a positive association between social support and hope. Integrating statistical results and qualitative insights, this paper extends extant literature on social support typologies with a novel category; 'support in providing opportunities for success'. Conclusion: This paper underscores the important role schools play as a source of social support for children. Such social support aids higher hope levels in low-income children which could translate into better academic outcomes. [ABSTRACT FROM AUTHOR]

This is an overview of the results from 14 countries or jurisdictions in a Global Matrix of Para Report Cards on physical activity (PA) of children and adolescents with disabilities. The methodology was based on the Active Healthy Kids Global Alliance's Global Matrix 4.0. Data were aligned with 10 indicators (Overall PA, Organized Sport, Active Play, Active Transport, Physical Fitness, Sedentary Behavior, Family & Peers, Schools, Community & Environment, and Government) to produce Para Report Cards. Subsequently, there were 139 grades; 45% were incomplete, particularly for Active Play, Physical Fitness, and Family & Peers. Collectively, Overall PA was graded the lowest (F), with Schools and Government the highest (C). Disability-specific surveillance and research gaps in PA were apparent in 14 countries or jurisdictions around the world. More coverage of PA data in Para Report Cards is needed to serve as an advocacy tool to promote PA among children and adolescents with disabilities. [ABSTRACT FROM AUTHOR]

Background: Missed or delayed child healthcare caused by the COVID-19 lockdown has threatened young children's health and has had an unpredictable influence on caregivers' child healthcare preferences. This study investigated caregivers' child healthcare preferences and the factors that influence them among families with young children (0–3 years) during the lockdown in Shanghai. Methods: Participants in this cross-sectional study were enrolled through random encounter sampling. Questionnaires were distributed online from June 1 to November 10, 2022, in Shanghai. A total of 477 valid questionnaires were received. The demographics of caregivers and their families, children's characteristics, COVID-19-related information, and caregivers' healthcare preferences were analyzed. The statistical analyses included frequency and percentage, chi-square tests, and multinomial logistic regression. Results: Caregivers preferred child healthcare professionals in the community health service system (CHS; 47.6%) followed by hospital pediatricians (40.0%) during lockdown. Caregivers with the following characteristics preferred CHS: those with an annual household income of CNY 200,000–300,000, those whose youngest children were aged 8–12 months, and those who experienced early childhood physical development issues. Caregivers preferred hospitals if they had experienced healthcare-seeking-related difficulties in accessing professional guidance from hospital pediatricians. Conclusions: During pandemic lockdowns, policymakers should allocate more resources to CHS to meet caregivers' childcare demands. Moreover, special attention should be given to the healthcare needs for CHS among families with specific demographics. Trial registration: Approval was obtained from the Ethics Committee of Shanghai Jiao Tong University School of Medicine School of Public Health (SJUPN-202,109; June 1, 2022). [ABSTRACT FROM AUTHOR]

Background: Mental health and health-related quality of life (HRQoL) in children and adolescents deteriorated during the COVID-19 pandemic. The aim of this population-based longitudinal study was to explore whether distinct mental health trajectories in youths can be identified over the course of the pandemic. Methods: Mental health problems (MHP), psychosomatic symptoms and HRQoL were assessed at five time points between May 2020 and October 2022 in 744 children and adolescents aged 7 to 20 years using established instruments. We used generalized mixture modeling to identify distinct mental health trajectories and fixed-effects regressions to analyse covariates of the identified profiles of change. Results: We found five distinct linear latent trajectory classes each for externalising MHP and psychosomatic symptoms and four trajectory classes for internalising MHP. For HRQoL, a single-class solution that indicates a common development process proved to be optimal. The largest groups remained almost stable at a low internalising and externalising symptom level (64 to 74%) and consistently showed moderate psychosomatic symptoms (79%), while 2 to 18% showed improvements across the pandemic. About 10% of the youths had consistently high internalising problems, while externalising problems deteriorated in 18% of youths. Class membership was significantly associated with initial HRQoL, parental and child burden, personal resources, family climate and social support. Conclusions: The mental health of most children and adolescents remained resilient throughout the pandemic. However, a sizeable number of youths had consistently poor or deteriorating mental health. Those children and adolescents need special attention in schools and mental health care. [ABSTRACT FROM AUTHOR]

Accessible housing is a fundamental human right and yet many children and youth with disabilities live in inaccessible, insecure, unaffordable and poor quality housing. The aim of our study was to understand the barriers and facilitators to obtaining accessible housing among children, youth and young adults with disabilities and their families. We conducted a scoping review involving seven international literature databases from 2000 to 2022 that identified 38 studies meeting our inclusion criteria. The reviewed studies involved 10 countries over a 22-year period. Our review emphasized the following key trends: (1) barriers to obtaining accessible homes (i.e. common types of accessibility barriers, rates of inaccessible housing, factors affecting home accessibility), and negative impacts of inaccessible housing; and (2) rates and facilitators to obtaining accessible housing (i.e., common types of home modifications, enablers of home modifications) and positive impacts of accessible housing. Our findings highlight the barriers and enablers of obtaining accessible housing among children, youth and young adults with disabilities and their families and the critical need to support them in securing appropriate housing. Evidence suggests that clinicians and community service providers should support youth with disabilities and their parents to make home modifications and secure accessible housing. Clinicians should consider advocating for accessible housing and help to remove barriers for children with disabilities and their families with particular attention to marginalized and equity-deserving groups. Clinicians and service providers should involve families in the process of making accessible home modifications and help them to connect with relevant housing stakeholders. [ABSTRACT FROM AUTHOR]

Executive function is an underlying mechanism linking family socioeconomic status (SES) and academic achievement. Previous studies mainly investigated either the mediating or moderating role of executive function within this relationship, which either overlook the individual differences that are independent of the environment or neglect the influence of the environment on shaping personal factors. To avoid a piecemeal approach to theory, the current study aimed to test the mediating and moderating roles of executive function in a single analytic model. Two hundred and thirty-six Chinese fifth graders (Mage = 10.70 years, SD = 0.49, range = 10.23–11.75 years, and 40.30% girls) were recruited. Their executive function performance was measured using eight different tasks, and their Chinese literacy skills and mathematics achievement were assessed by routine school evaluations. One year after the initial assessment, children's academic achievements were evaluated again. Results demonstrated that parental SES positively predicted children's academic achievement when controlling for prior academic achievement, and children's executive function mediated this relationship. Also, executive function moderated the association between SES and academic achievement in that, the negative predictive effect of low SES on academic achievement was only significant for children with lower levels of executive function, which is not shown in children with higher levels of executive function. By demonstrating the dual roles of executive function in the SES-achievement link, this work provides evidence for supporting the optimal development of children from diverse socioeconomic backgrounds and emphasizes the significance of developing individualized intervention strategies on executive function to mitigate the negative effect of low SES on children's academic achievement. [ABSTRACT FROM AUTHOR]

Background: Cancer treatments may affect adolescents' and young adults' reproductive systems. Although some side effects may be temporary, infertility can be lifelong. The American Society of Clinical Oncology 2018 Guideline suggests all oncology health care providers be prepared to discuss infertility as a possible late effect of a patient's treatment (Oktay et al., 2018). However, oncology providers continue to report a lack of familiarity and confidence in discussing fertility preservation options and processes. Objectives: Objectives of this literature review were to provide a clinical overview for oncology nurse practitioners discussing fertility preservation options with patients, and to address the importance of the oncology nurse practitioner's role in this field. Method: A literature review was performed using PubMed and CINAHL for publications within the last 10 years. The search terms fertility preservation and pediatric oncology, oncology nurse practitioner, and role yielded 216 articles. A total of 17 articles were identified as relevant to this review and are synthesized in the article. Results: An overview of clinical information, including fertility preservation options and related topics, was identified. However, although the literature describes the role of nurses providing direct patient care and the oncologist in fertility preservation for children and young adults with cancer, limited literature describes the nurse practitioner's role. The author applied the literature describing the role of the nurse practitioner in pediatric oncology to their role in fertility preservation for these patients. Conclusion: The nurse practitioner's ability to spend extended time with patients, an integral role in patient education, and experience with care coordination position them to be the ideal designated fertility preservation provider. [ABSTRACT FROM AUTHOR]

We examine the cost-effectiveness of treating epilepsy with anti-epileptic medicines in autistic children, looking at impacts on healthcare providers (in England, Ireland, Italy and Spain) and children's families (in Ireland). We find carbamazepine to be the most cost-effective drug to try first in children with newly diagnosed focal seizures. For England and Spain, oxcarbazepine is the most cost-effective treatment when taken as additional treatment for those children whose response to monotherapy is suboptimal. In Ireland and Italy, gabapentin is the most cost-effective option. Our additional scenario analysis presents the aggregate cost to families with autistic children who are being treated for epilepsy: this cost is considerably higher than healthcare provider expenditure. [ABSTRACT FROM AUTHOR]

Summary: Objective: To evaluate the preliminary effects of a theory‐based, multi‐component intervention on improving healthy lifestyle behaviours and preventing obesity amongst low‐income preschoolers. Methods: A cluster randomised controlled trial was conducted at 10 daycare centres. The 16‐week FirstStep2Health intervention, grounded in the Actor‐Partner Interdependence Model and the Social Cognitive Theory, included five components: a Facebook‐based parent programme, three virtual parent meetings, three weekly motivational text messages, parent–child learning via weekly child letters and daycare centre‐based child programme. Results: A total of 95 preschoolers (53 intervention and 42 control) participated. Preschoolers' mean age was 49.27 months, with 57.9% being female, 12.6% being Hispanic and 40% being African American. The intervention significantly decreased intervention preschoolers' fat intake (B = −33.76, p = 0.047) and % body fat (B = −1.18, p = 0.036) compared to the control. During year 2, there were significant intervention effects on increasing skin carotenoids (B = 87.06, p = 0.035). Although not statistically significant, the intervention showed positive effects on increasing preschoolers' fruit/vegetable intake; and decreasing screen time, body mass index z‐score and proportion of overweight/obesity. Conclusions: Even with some potential limitations (small sample size, measurement concerns and confounding with Coronavirus Disease 2019 pandemic), the study's results support the preliminary efficacy of the FirstStep2Health intervention in preventing obesity amongst low‐income racially diverse preschoolers. [ABSTRACT FROM AUTHOR]

Severe acute malnutrition (SAM) is the most serious form of acute malnutrition and is associated with high mortality risk among children under 5. While the Community‐based Management of Acute Malnutrition (CMAM) approach, recommended for treating cases of uncomplicated SAM, has increased treatment coverage and recovery outcomes, high relapse rates have been reported. Several risk factors for SAM relapse, such as insufficient food intake and high infectious disease burden in the community, have been identified. However, the role of household water, sanitation and hygiene (WASH) conditions remains unclear. This systematic review: (1) assesses the effectiveness of WASH interventions on preventing SAM relapse and (2) identifies WASH‐related conditions associated with relapse to SAM among children aged 6–59 months discharged as recovered following SAM CMAM treatment. We performed electronic searches of six databases to identify relevant studies published between 1 January 2000 and 6 November 2023 and assessed their quality. After deduplication, 10,294 documents were screened by title and abstract, with 13 retrieved for full‐text screening. We included three studies ranging from low‐ to medium‐quality. One intervention study found that providing a WASH kit during SAM outpatient treatment did not reduce the risk of relapse to SAM. Two observational studies found inconsistent associations between household WASH conditions—unimproved sanitation and unsafe drinking water—and SAM relapse. Despite the paucity of evidence, the hypothesised causal pathways between WASH conditions and the risk of relapse remain plausible. Further evidence is needed to identify interventions for an integrated postdischarge approach to prevent relapse. Key messages: This systematic review highlights a paucity of evidence on the relationship between household water, sanitation and hygiene (WASH) conditions and the prevention of severe acute malnutrition (SAM) relapse.There are limited high‐quality studies assessing the effectiveness of household‐level WASH interventions in preventing uncomplicated SAM relapse among children 6–59 months discharged from outpatient programmes.Equally, there are very few studies and of limited quality on household WASH risk factors associated with relapse to SAM.While it is biologically plausible that household WASH conditions could influence the risk of SAM relapse, additional and high‐quality research is needed to investigate if and how postdischarge WASH interventions might reduce this risk. [ABSTRACT FROM AUTHOR]

An important and unresolved question in the context of the implementation of coordinated specialty care (CSC) for early psychosis in the United States is the extent to which youth and young adults from marginalized backgrounds are able to equitably access CSC services. In this brief report, we describe pathways between a county hybrid juvenile competency restoration and mental health problem-solving court ('Court'), serving youth with high rates of psychosis and multiple risk factors for poor long-term outcomes, and local CSC services. We found that the Court was overall successful in linking youth with psychosis to care, but in the majority of cases this was not CSC programming more specifically. Drawing on Court and CSC records as well as family interviews, we report on factors contributing to low linkage to CSC, including family-side barriers (lack of transportation, preference for lower intensity / lower demand services) and provider-side barriers, including eligibility criteria such as duration of psychosis, that ultimately exclude otherwise eligible Court-involved youth. [ABSTRACT FROM AUTHOR]

Background: Epidemiological and nutritional modifications are causing an increase in stunting in many low‐ and middle‐income countries (LMIC), which will eventually result in juvenile diseases and mortality. Therefore, this study aimed to identify the influential factors contributing to stunting among under‐five children in Cambodia. Methods: A secondary dataset consisting of 3268 under‐five children was extracted from the latest Cambodian Demographic and Health Survey (CDHS)‐2021/2022 dataset. The Chi‐square test and Boruta algorithm were used for covariate selection, and logistic regression approaches were used to determine the influence of demographic, socioeconomic and other factors on the presence of stunting. Results: Findings revealed that about 21% of under‐five children were stunted, and the prevalence of stunting was higher in rural areas than in urban areas. The prevalence of child stunting was lower in families with highly educated parents. A child whose father had a secondary education had 0.71 times lower (adjusted odds ratio [AOR]: 0.71, 95% CI: 0.520–0.969) chance of stunting than a child whose father had no education. Findings revealed that Ratnak Kiri, Mondul Kiri, Stung Treng, Pursat and Kampot had a greater prevalence of stunting than other places, ranging from 27.11% to 35.70%, whereas Banteay Meanchey, Phnom Penh and Kandal had the lowest rates, ranging from 12.80% to 16.00%. Results of the Boruta algorithm and logistic regression suggested that under‐five stunting is significantly influenced by factors such as the child's age, size at birth, mother's age at first birth, mother's body mass index (BMI), father's educational status, cooking fuel, and wealth index. Conclusions: It is necessary to take initiatives for reducing the prevalence of stunted children prioritising the identified factors that ultimately help to reduce the burden of child health. The authors believed that the findings of this study will be helpful for policymakers in designing the appropriate policies and actions to achieve the Sustainable Development Goals (SDGs) by reducing stunting among under‐five children in Cambodia. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic is a historic event impacting children around the globe. Prior research on the educational experiences of children during the COVID-19 pandemic focused almost exclusively on spring 2020. This article extends this literature past the initial shock of spring 2020, capturing the first full school year (2020–2021) during the COVID-19 pandemic. This registered report study utilized a national sample of 1,666 United States twins in kindergarten through 12th grade from 43 states to provide the current descriptive report of children's educational experiences during this time, as reported by their parents. Specifically, we reported on school format, parents' role in education, parent–teacher interactions, schoolwork struggles, technology access, and school services. About half of children attended in-person schooling, with many children switching from online to in-person throughout the school year. Parents saw the pandemic as a risk to their children's education. During the 2020–2021 school year of the pandemic, parents felt they had a larger role in their children's education and were less satisfied in their interactions with teachers than what they experienced during the prepandemic part of the 2019–2020 school year. Children experienced more schoolwork struggles than they had in previous years, and this was similar across age groups. For most constructs, results were equivalent across age group, but parents of younger children tended to provide more schoolwork help. Overall, this article highlights the disruptions in their educational environments that children continued to experience through the first full school year (2020–2021) of the COVID-19 pandemic. Public Significance Statement: This study provides important insights into what the educational experiences were of U.S. families with K-12 children during the first full school year (2020–2021) of the coronavirus disease 2019 pandemic, in many cases how this differed from the prepandemic part of the 2019–2020 school year. [ABSTRACT FROM AUTHOR]

Few studies have looked at the impact of parental cohabitation changes on adolescents' dating behaviors and relationship quality. Using data from the Fragile Families and Child Wellbeing Study, we examined whether mother's cohabitation changes with the child's biological father over the first nine years of life were associated with adolescents' dating behaviors at age 15. Data analysis included ordinal logistic, logistic regression and ordinary least square regression models to test the relationship between maternal-reported cohabitation changes with the biological father and adolescent dating behaviors. Our findings suggest that the type of maternal cohabitation stability, as well as the amount of cohabitation instability, are associated with whether adolescents had ever dated, the number of romantic partners they had, and whether they ever had sex. Cohabitation stability and instability were not associated with adolescents' perceived relationship quality with their current partner. We conclude that researchers and practitioners should consider how the dating behaviors children observe from their parents at a young age can affect their romantic relationships in adolescence. Relationship programs and interventions already in place can be enhanced by focusing specifically on the impact of participants' past experiences with parental break-ups and new partnerships. Highlights: We examined whether mother's cohabitation changes with the child's biological father over the first nine years of life were associated with adolescents' dating behaviors. Nearly one-third of adolescents in our sample had experienced a relationship transition between their mother and biological father. Adolescents who experienced one cohabitation transition between their biological mother and father had an increased likelihood of dating and having sex prior to age 15. Mothers' dating behaviors, such as cohabitation transitions, may negatively affect their children's dating behaviors in adolescence. [ABSTRACT FROM AUTHOR]

Introduction: Since the majority of hospitalisations due to RSV occur in young children, the illness profoundly influences the entire family. However, comprehensive evidence regarding its overall effects remains limited. The ResQ Family study aims to investigate the burden of RSV-induced pediatric hospitalisation on affected families. Methods: Spanning the 2022–2023 RSV season, an interdisciplinary, observational study was conducted in Germany, France, Italy and Sweden. Using an online questionnaire, parents and caregivers of children (< 24 months of age) with an RSV-induced hospitalisation were recruited. Information was gathered on topics related to RSV and parental health-related quality of life (HRQoL) during the acute infection phase (t0) and 6 weeks later (t1). Descriptive evaluations of the data set were performed during t0 and regarding a potential change over the observation period (t0 vs. t1). Subgroup analysis aimed to further identify differences across the countries. Results: A total set of 138 affected parents/caregivers were included in the study, with 59 participants responding to the follow-up survey (t1). Particularly during the acute infection phase, parental HRQoL was shown to be negatively influenced by the child's RSV infection [total score (p < 0.001, d = 0.54), parent HRQoL summary score (p < 0.001, d = 0.67) and family functioning summary score (p = 0.007, d = 0.33)]. Significant disparities in disease awareness and support structures were observed across Europe, with France and Sweden showing notably higher levels. Conclusion: The ResQ Family study provides convincing evidence that RSV-associated hospitalisations in young children across Europe generate a multifaced burden for the entire family, partly even beyond the acute infection phase. Standardised approaches for disease prevention at societal, educational and policy levels are needed to guarantee every newborn the best possible start into life. Trial Registration: ClinicalTrials.gov, identifier, NCT05550545. [ABSTRACT FROM AUTHOR]

Autism spectrum disorder (ASD) affects one in 66 children in Canada, and its symptoms may be particularly challenging for parents from a Chinese background. Further, when working with Chinese families, Western-educated service providers may experience difficulty in applying culturally relevant and family-centered care. This study examined the experiences of one Chinese-Canadian family as they receive intervention services for their two children with ASD. This pilot, single-case design, qualitative case study included semi-structured interviews with the parents, grandparents, as well as three service providers' views. Three major themes emerged from the data in the form of tensions: (1) within the family members; (2) within the therapeutic relationships, and (3) in addressing culture in therapy. Results suggested that although the family identified key cultural differences, service providers did not sufficiently address these within the therapeutic relationship, and the need for culturally-relevant and family-centered care was not fulfilled. Chinese-Canadian parents for children with autism spectrum disorder adopt both Chinese and Western values that fit best for their circumstances. Service providers and family members can have conflicting priorities, making family-centered care, culturally-relevant care challenging. Culture plays an important role in family expectations, and should be incorporated with more intention in the rehabilitation process. [ABSTRACT FROM AUTHOR]

Background: Digital behaviour change interventions aiming to improve dietary intakes; specifically fruit and vegetable intake, in low-socioeconomic children are being developed and tested. However there is currently no synthesis of the characteristics or reported effectiveness of these interventions. This systematic review aims to: (1) identify existing digital interventions targeting fruit and vegetable intake in low-socioeconomic status children, (2) identify and synthesise characteristics and reported effectiveness of these interventions using the Behaviour Change Intervention Ontology. Method: CINAHL, ERIC, PubMed, Cochrane Library, ACM Digital Library and Scopus were searched in December 2021 – February 2022 and in February–March 2024. Inclusion criteria for studies were: 1) children of low-SES families, aged between 5–11 years old; 2) Digital intervention to improve fruit and vegetable intake; 3) Comparison groups could be digital or non-digital; 4) Outcome measures were fruit and vegetable intake and antecedents to diet behaviours; 5) Randomised controlled trials (cluster and parallel designs). Characteristics of identified studies were coded using the Behaviour Change Techniques Taxonomy and Modes of Delivery, Setting and Source ontologies of the Behaviour Change Intervention Ontology. Results: Five studies met all inclusion criteria, with majority reporting significant effects of interventions on improving fruit and vegetable intake. Most common Behaviour Change Techniques found were Goal Setting (k = 4), Problem Solving (k = 3), Instruction on how to perform a Behaviour (k = 3), and Prompts and Cues (k = 3). Characteristics relating to intervention source were unclear. Conclusions: Digital interventions had positive outcomes in fruit and vegetable intake in children; particularly more for fruit than vegetable intake. Characteristics in digital interventions which have direct effects on child fruit and vegetable intake in low-socioeconomic families should be further investigated. Furthermore, clearer reporting on intervention characteristics is needed. [ABSTRACT FROM AUTHOR]

Few studies have examined differences in autism spectrum disorder (ASD) phenotype between children from multiplex and simplex families at the time of diagnosis. The present study used an age- and gender-matched, community-based sample (n = 105) from the southwestern United States to examine differences in ASD symptom severity, cognitive development, and adaptive functioning. No significant differences between children from multiplex and simplex families were observed. Exploratory analysis revealed that parents underreported receptive and expressive language and fine motor skills compared to professional observation, especially among children from multiplex families. These findings suggest that diagnosticians may need to consider family structure when choosing and interpreting assessments of receptive language, expressive language, and fine motor skills. [ABSTRACT FROM AUTHOR]

Summary: Objective: To prospectively evaluate the relationship between cumulative environmental stress and cardiometabolic risk in middle childhood, and to examine whether hair cortisol, a measure of hypothalamic pituitary adrenal‐axis activity, mediates this relationship. Methods: In a cohort of children from low‐income households (n = 320; 59% Hispanic, 23% Black, body mass index (BMI) percentile >50th at enrollment), environmental stressors including family and neighbourhood factors representing disadvantage/deprivation, and cortisol concentrations from hair samples, were measured over five timepoints beginning when children were 2–4 years old. Cardiometabolic risk factors (i.e., BMI, blood pressure, lipids, blood sugar, C‐reactive protein) were measured at the final timepoint when children were 7–11 years of age. Results: In adjusted logistic regression models, greater cumulative environmental stress was associated with a higher likelihood of elevated cardiometabolic risk in middle childhood (p = 0.01). Children from minoritized racial/ethnic groups had a higher prevalence of both stressors and cardiometabolic risk factors. Cumulative environmental stress was associated with higher hair cortisol concentrations (p < 0.01). However, hair cortisol was not directly associated with cardiometabolic risk factors and did not explain the association between environmental stress and cardiometabolic risk in causal mediation analysis. Conclusions: The influence of cumulative stress on cardiometabolic health can be observed in middle childhood and may contribute to cardiometabolic health disparities, highlighting the importance of public health interventions to mitigate disadvantage. [ABSTRACT FROM AUTHOR]

Family relations are essential for the bereaved in terms of healing and adjusting to life, especially after experiencing a traumatic death. Although 500 000 people die in drug-related deaths each year, few works focus on family interactions and the help needs of those bereaved by such losses. In this qualitative study, we interviewed 14 parents who had lost their child through a drug-related death. Through a reflexive thematic analysis, we generated three themes: (I) considerable needs in the family become our responsibility, capturing how parents try to mend the disrupted family system and provide adequate care for those who struggle after death, (II) conversations that are important for family connections are obstructed, encompassing how family members sometimes seem afraid of grief emotions and try to protect each other by not talking, and (III) as parents, we can strengthen family connections, encapsulating how parents create space to talk and listen to each other in the family and navigate relational challenges in maintaining relationships. The findings are discussed through the Dual Process Model of Coping with Bereavement as well as family resilience theory. Based on the results, we propose that professional family-oriented help efforts for drug death-bereaved families in two main domains should be considered. The first includes those related to the family's need and ability to adapt roles and relationships to the new reality, and the second involves those connected to creating a space and environment for emotional sharing and joint meaning-making processes in the family. [ABSTRACT FROM AUTHOR]

Throughout the COVID-19 period, families were forced to stay indoors, adapting to online schooling, remote work, and virtual social engagements, inevitably altering the dynamics within households. There was a notable increase in mental health challenges in terms of anxiety and depression in children and adolescents. This study intended to explore the psychosocial effects of the COVID-19 pandemic on Italian families by adopting self- and proxy-report questionnaires on anxiety, anger, and health-related quality of life. The results showed that approximately 20% obtained a clinical anxiety score and only 10% obtained a clinical anger score. There was a difference in the perception of the quality of life reported by the child and that perceived by the parent. A stepwise regression model showed that total anxiety scores were predicted by sex, quality of life scores from the parents' self-report version, and the total anger score. Another stepwise regression model identified physiological and social anxiety as the best predictors that impact quality of life. Parental well-being actively influences the well-being of children, so it is fundamental to implement preventive programs and promote child well-being by providing parents the most adequate support possible. [ABSTRACT FROM AUTHOR]

Objectives Pain affects all children and youth, yet acute and procedural pain remains undertreated in Canadian hospitals. To improve pain management practices in paediatric hospitals, it is necessary to understand how healthcare professionals (HCPs) wish for educational interventions to be designed to improve their pain management practice. Methods Semi-structured interviews were conducted with 18 HCPs between October and December 2020. Snowball sampling was used to first recruit interested members from the hospital's Pediatric Pain Management Committee. Interviews were conducted per participant preference and included Zoom, telephone, and in-person interviews. Recruitment ceased when data were determined sufficiently rich. A thematic analysis of verbatim transcripts and reflexive field notes were used to create a data set focused on knowledge mobilization and clinical education. Results Three core themes were identified: (a) the necessity for just-in-time education for HCPs; (b) the availability of clinical pain champions to educate staff; and (c) the provision of resources to educate children and their families about available pain management interventions. Just-in-time education included suggestions for in-service training, hands-on training, and regular updates on the latest research. Pain champions, including clinical nurse educators, were stressed as being important in motivating staff to improve their pain management practices. Participants noted the lack of resources for patient and family education on pain management and suggested providing more multimodal resources and educational opportunities. Conclusion Having local champions introduce pain management initiatives and just-in-time education positively impacts the implementation climate, which also helps HCPs provide evidence-based education and resources to patients and families. [ABSTRACT FROM AUTHOR]

INTRODUCTION Children are vulnerable to secondhand smoke (SHS) exposure, especially those with lower socioeconomic status. This study assesses the changes in prevalence and socioeconomic inequalities in SHS exposure in children younger than 12 years old in Spain between 2016 and 2019. METHODS We conducted two cross-sectional studies among representative samples of households with children aged <12 years in Spain, in 2016 (n=2411) and 2019 (n=2412). Families were interviewed to assess children's SHS exposure in private settings and outdoor public venues and their adoption of home and car smoke-free rules. We used the education level of the home main earner as a proxy for socioeconomic position. Changes over time in the prevalence and socioeconomic inequalities of SHS exposure and smoke-free rules were estimated through adjusted Poisson regression models with robust variance according to sociodemographic covariates (adjusted prevalence ratios, APRs). RESULTS In 2019, 70.5% of children were exposed to SHS in Spain. No changes between 2016 and 2019 were found for overall SHS exposure, exposure at home, and at school entrances. SHS exposure increased at public transport stations (APR=1.24; 95% CI: 1.03-1.49) and outdoor hospitality venues (APR=1.17; 95% CI: 1.07-1.29) while it decreased in cars (APR=0.74; 95% CI: 0.56-0.98) and parks (APR=0.87; 95% CI: 0.77-0.98). Households with lower education level had higher prevalence of SHS exposure at home in 2019 compared with those with university studies (primary: APR=1.30; 95% CI: 1.11-1.51; secondary: APR=1.12; 95% CI: 1.00-1.25) and were less likely to adopt home indoor smoke-free rules (primary: APR=0.88; 95% CI: 0.79-0.99; secondary: APR=0.95; 95% CI: 0.89-1.02). Socioeconomic inequalities in SHS exposure at home persisted between 2016 and 2019 (p>0.05), while decreased in smoke-free rules in cars (p=0.039). CONCLUSIONS Reported SHS exposure among children in Spain remained high between 2016 and 2019. Inequalities persisted at home, highlighting the need for measures to reduce such exposure with an equity perspective. [ABSTRACT FROM AUTHOR]

This study aimed to estimate the prevalence of children aged 0–19 years who have a parent with a history of heart disease and investigate their sociodemographic characteristics. A national register-based study. From the Danish Fertility Register and the Danish National Patient Register information on children of parents with ischemic heart disease, arrhythmia, heart failure and heart valve disease in the period 1981–2018 were obtained. Statistical analyses including descriptive statistics, logistic and linear regression were used to illuminate associations between parental heart disease and sociodemographic characteristics. The study population consisted of 142,480 children aged 0–19 years with at least one parent diagnosed with heart disease, corresponding to every 9th child in Denmark in 2018. The number increased from 4.5% in 2002 to 11.1% in 2018. In the study population most had a father with heart disease (57.8%) and 4.6% had two parents with heart disease. Parents with heart disease had significantly higher odds of being out of work (OR 1.68, 95% CI 1.64; 1.72), in a single-parent household (OR 1.09, 95% CI 1.07; 1.11), divorced or widowed (OR: 1.10, 95% CI 1.08; 1.12), having a lower educational level (OR 1.35, 95% CI 1.33; 1.37), and a lower family income (−42,410 DKR, 95% CI -50,306; −34,514, P < 0.0001) compared to those without heart disease. Children affected by parental heart disease comprise a substantial part of the Danish population. These have significantly different sociodemographic characteristics than children in families without parental heart disease, which might affect social heritage and parental capacity. [ABSTRACT FROM AUTHOR]

A scoping review on Autism Spectrum Disorder (ASD) and its impact on the families of affected children was undertaken due to insufficient information available on the diverse experiences impacting their lives. Using the Joanna Briggs Institute methodology, eligibility criteria were guided by Population (families), Concept (family experiences), and Context (African region). English-language articles were sought from a variety of databases and search engines. The publication date of the identified articles ranged from 2003 to 2021 with most published in 2020 (n = 10), and the majority using qualitative methodologies (n = 51). Most family members involved were parents (n = 51) and their ages ranged from 18 to 75 years. The families experienced various challenges related to their child with regard to education, healthcare, and the broader community including lack of support. Family coping strategies included believing in God, attending counseling sessions, adapting, and accepting the situation. Healthcare professionals should be prepared and positioned to educate families and siblings on various aspects of ASD. There is a need for active, continued research on families within most countries of World Health Organization Afro-region. [ABSTRACT FROM AUTHOR]

Studies exploring associations between children with Autism Spectrum Disorder (ASD) and depression in parents are limited. This study compares healthcare utilization, depression treatment costs, and risk factors, in parents of children with and without ASD. Using a matched case-control, individuals aged 27 to 64 with continuous enrollment from 2017–2019 and a child diagnosed with ASD were selected from nationally representative administrative claims data. Individuals were randomly matched 1:3 to a non-ASD group based on the child's age, gender, and family characteristics. Statistical models were used to evaluate the association between ASD in children, depression in their respective parents, and resulting healthcare utilization and costs incurred by parents. The study consisted of 23,316 families, out of which 5,779 had children with ASD, and 17,337 had children without ASD. Having a child with ASD was a predictor of depression in parents (OR 1.91, 95% CI 1.73 – 2.10). Mothers of children with ASD had a higher risk of having depression (OR 4.0, 95% CI 2.62 – 6.12). Parents having multiple ASD children were also at higher risk of depression (OR 1.6, 95% CI 1.18 – 2.13). The sex and age of the child were not associated with parental depression. While family-level income and education attainment were not associated, urbanicity (rural) had an association with depression. Parents with ASD children are at a higher risk of depression. Findings suggest that parents of children with ASD may benefit from depression screening at the onset of ASD diagnosis in their children. [ABSTRACT FROM AUTHOR]

Australia has limited supports to help families where Fetal Alcohol Spectrum Disorder (FASD) impacts children and young people. National Organisation for Fetal Alcohol Spectrum Disorder Australia (NOFASD), in conjunction with the University of Otago, New Zealand, piloted and established a 7-week online program to assist caregivers to develop strategies and supports to help their families live well in a disabling society. The online program, Families Linking with Families (FLWF), was delivered to 88 caregivers. They participated in the weekly 90-minute online program of talks, activities, and interactive conversations. A brief evaluation was undertaken. Participants reported high levels of satisfaction with the content and helpfulness of FLWF. FLWF helped caregivers increase their knowledge of, and skills in, parenting children with FASD, and equipped caregivers to nurture positive peer-to-peer relationships. Specialist FASD caregiver education and support programs are beneficial for caregivers who care for children and youth with FASD. Further research through a randomised control trial could establish the efficacy of the program. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsConclusionThis systematic review and meta-ethnography aimed to examine how children, adults and families cope with Tourette’s syndrome (TS).A systematic search of four databases was completed in October 2022. Sixteen papers met the inclusion criteria and were synthesised using Noblit and Hare’s (1988) meta-ethnographic approach.Three themes were constructed: redefining the self and social identity, controlling the visible presentation of Tourette’s syndrome, and challenging the narrative.Findings indicate that coping involves the need to integrate TS with identity, to exert control over tics and to challenge the misrepresentations of TS in wider society. A supportive environment provided by parents and friends enables individuals to feel proud that they can control their tics, and this allows for the positive integration of TS into identity. Raising awareness at a societal level through educational campaigns is important when aiming to improve coping with a stigmatised condition. Further research is recommended, for example, to understand how common co-occurring conditions, such as attention deficit hyperactivity disorder, impact coping. [ABSTRACT FROM AUTHOR]

Young refugee populations continue to grow. This scoping review aims to identify and summarize studies of programs that provide linguistically responsive practices for children who are refugees. Secondary aims of this review are: (a) to identify the gaps in the literature, and (b) to suggest future research and policy directions. By studying key features of linguistically responsive practices for children who are refugees, we can better understand the important components of a high-quality inclusive and equitable environment for all children, including those with minority language backgrounds. We conducted an electronic database search and identified 14 studies. Studies varied in location, country of origin, and language support. The findings from this review revealed a critical need to develop, implement, and study linguistically responsive programs for children who are refugees in host countries. [ABSTRACT FROM AUTHOR]

This study extends the research on the preschool home literacy environment (HLE) in the context of the family risk (FR) of reading disability (RD) by examining a multiple-deficit model of RD. A total of 1,171 six-year-old Norwegian children were assessed at school entry, the onset of formal reading instruction in Norway. Their parents completed a questionnaire regarding their own RD, education, and the HLE. The final sample after applying the inclusion criteria was 794 children and their parents. The findings suggest, first, that two HLE factors (access to print and reading-related activities) should be distinguished rather than treated as a single factor (“exposure to print”) as the majority of previous studies have done. This finding suggests a three-factor HLE model that includes parents’ reading interests and habits, reading-related activities, and access to print. Second, family risk of RD is related to some extent to the HLE, even after controlling for parents’ education. Third, children’s experiences in their home environments and their emergent literacy may not be independent of their family risk of RD. More importantly, this study highlights the potential protective role of the HLE, especially when there is a history of RD within the family. The reason is that the positive association between the HLE and children’s code-related emergent literacy remains significant when controlling for family risk of RD (access to print → emergent literacy: 0.39 [0.01, 0.68], p < 0.01; reading-related activities → emergent literacy: 0.37 [0.02, 0.35], p < 0.01; parents’ reading interests and habits → emergent literacy: 0.26 [0.001, 0.15], p < 0.01). This finding supports that children’s emergent literacy can be improved via a modifiable, dynamic factor such as the HLE. [ABSTRACT FROM AUTHOR]

Interest in using cannabis products for a medical purpose in children under the age of 18 years is increasing. There are many medical cannabis products available that can include cannabidiol (CBD) or delta-9-tetrahydrocannabinol (THC), or both. Despite many therapeutic claims, there are few rigorous studies to inform the dosing, safety, and efficacy of medical cannabis in paediatric clinical practice. This statement reviews the current evidence and provides recommendations for using medical cannabis in children. Longer-term (2-year) reports support the sustained tolerability and efficacy of cannabidiol therapy for patients with Lennox-Gastaut and Dravet syndromes. CBD-enriched cannabis extracts containing small amounts of THC have been evaluated in a small number of paediatric patients, and further research is needed to inform clinical practice guidelines. Given the widespread use of medical cannabis in Canada, paediatricians should be prepared to engage in open, ongoing discussions with families about its potential benefits and risks, and develop individualized plans that monitor efficacy, reduce harms, and mitigate drug–drug interactions. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to identify the main processes and outcomes related to family‐centred care (FCC) in neuromotor and functional rehabilitation of preschool children with cerebral palsy (CP). Background: FCC is considered a reference for best practices in child rehabilitation. CP is the most common cause of physical disability in childhood with repercussions on functionality. There is a gap in knowledge of the practical principles of FCC, and it is necessary to develop a reference model for the practice of child rehabilitation professionals. Methods: In this scoping review, the main databases selected were as follows: LILACS; Pubmed; Embase; The Cochrane Library; CINAHL (EBSCO); Scopus; Web of Science; PEDro (Physiotherapy Evidence Database); Open Gray and other banks of thesis. The terms combined in the search strategy were as follows: 'Family‐centered', 'Family‐centred' and 'CP'. Inclusion criteria are as follows: studies on preschool‐aged children with CP, undergoing family‐centred functional therapeutic interventions (FCFTI) with outcomes on bodily structures and functions and/or activities and/or participation. Results: The main participatory care methods identified were home intervention, environmental enrichment, collaborative realistic goal setting, planning of home‐based activities and routine, child assessment feedback, family education/training, family coaching, encouraging discussion, observation of therapist and supervised practice. The main relational care qualities identified were as follows: respect, active listening, treat parents as equals, clear language, respect parents' ability to collaborate, demonstrate genuine care for the family, appreciate parents' knowledge and skills, demonstrate competence, experience and commitment. The main outcomes identified in children were improvement in motor and cognitive function and the child's functional ability. The main parentaloutcomes identified were empowerment, feeling of competence, self‐confidence, motivation and engagement. Conclusion: The main differences in FCFTI programs refer to the parental education/guidance component and the amount of intervention carried out by parents. It is possible that the elements chosen by the therapist in a FCFTI depend on characteristics of the child and caregivers. [ABSTRACT FROM AUTHOR]

Simple Summary: This cross-sectional study analyzed how multilevel social factors affect patient-reported outcomes in children under 18 who survived cancer. Study participants include 293 pairs of these survivors who received survivorship care at a U.S.-based comprehensive cancer center between 2017 and 2018 and their primary caregivers. Findings indicate that higher caregiver anxiety is linked to worse depression, stress, fatigue, sleep problems, and lower positive affect in survivors of pediatric cancer. The study also found that family conflicts are associated with sleep issues in childhood cancer survivors. Furthermore, survivors living in socioeconomically deprived areas experience poorer sleep quality, and those residing in environments with high physical deprivation experience more psychological stress and fatigue, alongside reduced positivity and mobility. These results highlight the significant impact of parental, familial, and neighborhood factors on a range of patient-reported outcomes among young cancer survivors, suggesting these social factors as crucial targets for intervention. In this study, the social determinants of patient-reported outcomes (PROs) in young survivors of childhood cancer aged <18 years are researched. This cross-sectional study investigated social determinants associated with poor PROs among young childhood cancer survivors. We included 293 dyads of survivors receiving treatment at St. Jude Children's Research Hospital who were <18 years of age during follow-up from 2017 to 2018 and their primary caregivers. Social determinants included family factors (caregiver-reported PROs, family dynamics) and county-level deprivation (socioeconomic status, physical environment via the County Health Rankings & Roadmaps). PROMIS measures assessed survivors' and caregivers' PROs. General linear regression tested associations of social determinants with survivors' PROs. We found that caregivers' higher anxiety was significantly associated with survivors' poorer depression, stress, fatigue, sleep issues, and reduced positive affect (p < 0.05); caregivers' sleep disturbances were significantly associated with lower mobility in survivors (p < 0.05). Family conflicts were associated with survivors' sleep problems (p < 0.05). Residing in socioeconomically deprived areas was significantly associated with survivors' poorer sleep quality (p < 0.05), while higher physical environment deprivation was associated with survivors' higher psychological stress and fatigue and lower positive affect and mobility (p < 0.05). Parental, family, and neighborhood factors are critical influences on young survivors' quality of life and well-being and represent new intervention targets. [ABSTRACT FROM AUTHOR]

Objectives: To better understand impacts of the COVID-19 pandemic and resulting economic and social disruptions on families, we analyzed qualitative data capturing perspectives from parents of young children. Methods: This study analyzes interviews of parents of children aged 1-3.5 years at enrollment, recruited from four primary care systems serving mainly lower-income Hispanic families in Los Angeles, California. Interviews were conducted over 15 months beginning September 2020. Analyses focused on the open-ended question: Please describe in your own words how the COVID-19 pandemic has affected you and your family. We used iterative, multi-step processes to identify emergent qualitative themes. Results: A total of 460 parent responses were collected and coded. Key themes and subthemes were tested for interrater reliability, with Kappa ranging from 0.74 to 0.91. Thematic analysis revealed two groups of responses, one emphasizing stress and one emphasizing "silver linings." Parents cited a range of stressors, from fear of COVID-19 to social isolation. Those emphasizing "silver linings" also referenced formal or informal supports – especially government/community assistance programs and childcare access – that enabled stronger family ties and positive lifestyle modifications. Conclusions for Practice: Experiences of families with young children during COVID-19 were not uniform. Economic stability and reliable childcare may be critical mediators of family stress. Results affirm that the pandemic's impacts were distributed through channels largely built on, and possibly exacerbating, existing disparities. For lower-income families with young children, funding for public and private programs that target economic stability and childcare assistance may merit prioritization in future socio-economic disruptions. Significance: Most qualitative studies on this topic rely on small cohorts of families from Europe and Canada. This study contributes to the knowledge base by capturing perspectives from 460 parents of young children, in mainly low-income, Hispanic households, in Los Angeles, California. [ABSTRACT FROM AUTHOR]

In 2018, the child welfare system in Ontario, Canada, expanded the age of protection to include 16 and 17 year olds for the purpose of mitigating risk of harm for older adolescents. To date, there is little information regarding investigations of older adolescents, particularly in Ontario; this study will address this gap. Data used for this analysis were drawn from the Ontario Incidence Study of Reported Child Abuse and Neglect‐2018. The Ontario Incidence Study of Reported Child Abuse and Neglect‐2018 sample data were weighted to derive an annual incidence estimate of 155 649 maltreatment‐related investigations conducted in Ontario in 2018. Child, caregiver, household, and investigation characteristics were compared across three age groups: children (0–10), younger adolescents (11–15), and older adolescents (16–17). Characteristics and differences in the likelihood of a service response (referral to nonchild welfare services, transfer to ongoing child welfare services, or placement in out‐of‐home care during the investigation) were examined descriptively and using chi‐square automatic interaction detection. Half of investigations involving older adolescents received a service response, and they were more likely to receive a service response when there were concerns about future risk of harm, where there were concerns about the relationship between the adolescent and their caregivers, where internalizing or externalizing symptoms were noted, where caregivers had few social supports, and where the household experienced economic hardship. These findings suggest that older adolescents are being triaged for circumstances that reflect concerns about their vulnerability, including mental health needs, attachment concerns, and caregiver isolation. [ABSTRACT FROM AUTHOR]

Child malnutrition is a global public health problem which causes irreversible damage to physical and cognitive development in early childhood. In 2015, the National Survey of Nutrition reported that Boyacá, Colombia had a prevalence of chronic malnutrition of 11.6% above the national average, considering that Boyacá is predominantly rural territory. This article analyzes the risk factors that influenced the diets of children between 16 and 38 months among 27 rural families. Through a descriptive cross-sectional study, a survey of the socio-family characterization and knowledge, attitudes, and practices (KAP) were applied with participating families. It was found that among the nutritional risk factors in early childhood are low levels of maternal schooling, low economic income, and barriers to accessing health and education services. The results of this research enable contributions to the contextualization of public policies in health and nutrition with a territorial approach that allow the improvement of the quality of life in early childhood in rural areas. [ABSTRACT FROM AUTHOR]

Childhood adversity can have detrimental impacts on life course mental and physical health. Timing, nature, severity, and chronicity of adversity are thought to explain much of the variability in health and developmental outcomes among exposed individuals. The current study seeks to characterize heterogeneity in adverse experiences over time at the individual, family, and neighborhood domains in a cohort of predominantly Black children (85% Black and 15% White, 46.2% girls, 67.2% free/reduced lunch in first grade), and to examine associations with mental health from sixth grade to age 26. Participants were part of a randomized universal preventive interventions trial in first grade with prospective follow-up through early adulthood. Separate models characterized heterogeneity in adversity in elementary, middle, and high schools. Changes in adversity over time and relationships with mental health (anxiety, depression, suicidal behaviors) were investigated using a random-intercept latent transition analysis (RI-LTA). We identified three-class solutions in early childhood, middle school, and high school. Generally, both a higher and a lower poly-adversity class were observed at each time point, with varying nature of adversity characterized by the third class. RI-LTA indicated prevalent within-individual changes in adverse exposure over time and differential associations with mental health and suicidal behaviors. Results suggest that treating adverse exposures as a static construct may limit the ability to characterize salient variation over time. Identifying complexity in adverse experiences and their relation to health and well-being is key for developing and implementing effective prevention and early intervention efforts to mitigate negative effects through the life course. Public Significance Statement: Children are exposed to changing forms of adversity across development with differential impacts on mental health. Focusing on repeated, adaptive, coordinated, and multilevel preventive mental health efforts will be crucial to support the well-being of children and adolescents throughout the life course. [ABSTRACT FROM AUTHOR]

Aims: To find clinical and immunological signatures of the SARS‐CoV‐2 and the COVID‐19 pandemic on children newly diagnosed with type 1 diabetes (T1D). Methods: A single‐centre, retrospective, observational study comparing the clinical and immunological characteristics of children diagnosed with T1D the year before and during the first 2 years of the COVID‐19 pandemic. Data extracted from the medical records included clinical and demographic parameters, COVID‐19 PCR results and the presence of anti‐islet, thyroid and celiac‐related antibodies. Also obtained from the medical records was a family history of T1D, celiac disease and autoimmune thyroid disease in a first‐degree family member. Results: A total of 376 children were diagnosed with T1D during the study period. A total of 132 in the pre‐COVID era and 246 in the first 2 years of the pandemic. At diagnosis, the pH in children with DKA was lower, and HbA1c tended to be higher in the COVID‐19 group compared to the pre‐COVID‐19 group (7.30 [7.18, 7.35] vs 7.33 [7.19, 7.36], p = 0.046) and (110.9 [86.9, 129.5] vs 100 [80.3, 129.5], p = 0.067]) respectively. Multiple islet antibodies (IA) were significantly more common among patients in the pre‐COVID‐19 group compared to the COVID‐19 group (72% vs 61%, p = 0.032). Tissue transglutaminase antibodies were more common among children diagnosed in the COVID‐19 compared to the pre‐COVID group (16.6% vs 7.9%, p = 0.022). Conclusions: Our findings suggest that SARS‐CoV‐2 and the environmental alterations caused by the pandemic affected the clinical characteristics and the immunological profile of children diagnosed with T1D. It is, therefore, plausible that the virus plays a role in the autoimmune process causing T1D. [ABSTRACT FROM AUTHOR]

Service coordinators (SCs) play a vital role in assisting families in accessing and navigating the system of Early Intervention services that provide vital support to young children with disabilities and/or developmental delays (YCwD/DD). The study reports findings of focus group interviews with 14 SCs in three states in the United States that were subsequently coded and analyzed using a thematic analysis framework. SCs identified many ways that libraries support YCwD/DD through provisions of materials, services, spaces, and collaborative partnerships with community agencies. However, they pointed to additional measures libraries could take to better serve YCwD/DD and their families. Libraries might consider implementing changes to aspects of their policies and collaborative relationships in order to improve their responsiveness to the needs of YCwD/DD and their families. [ABSTRACT FROM AUTHOR]

Identify and describe diet patterns of children during early childhood using confirmatory factor analysis (CFA). Longitudinal data were drawn from the STRONG Kids 2 program. Mothers were surveyed about their child's diet at 24 (n = 337), 36 (n = 317), and 48 (n = 289) months old. The Block Food Frequency Questionnaire for children aged 2–7 years was used to derive diet patterns; 23 food groups were created for analyses. Principal component analysis was used to obtain preliminary factor loadings, and loadings were used to form a priori hypotheses for CFA-derived diet patterns. Independent samples t tests were used to compare food groups, nutrient intakes, and child and family characteristics by CFA pattern scores above vs at/below the median. Three diet patterns consistently emerged: (1) processed meats, sweets, and fried foods; (2) vegetables, legumes, and starchy vegetables; and (3) grains, nuts/seeds, and condiments (only 24 and 36 months). Patterns were related to differences in added sugars, dietary fiber and potassium intakes, maternal education, and household income. Opposing healthful vs Western patterns, extant in child and adult literature, were observed across all ages. The third pattern differed between 24/36 and 48 months, representing a potential shift in food choices or offerings as children age. [ABSTRACT FROM AUTHOR]

This systematic review examines the effectiveness of interventions in family child care (FCC) on (1) children's dietary intake, physical activity levels and weight, and (2) FCC health-promoting environments, policies, and practices. Quasi-experimental studies measuring these outcomes were included. All available articles up to July 2023 were searched using MEDLINE, ERIC, CINAHL, Embase, Scopus, and A+ Education, and 15 interventions were included. Methodological quality was assessed with the Effective Public Health Practice Project Assessment tool. Thirteen studies were weak, and 2 strong in quality. Four interventions included children's dietary intake as an outcome measure, 2 included physical activity, and 3 weight status. Twelve interventions assessed nutrition and 7 physical activity environmental outcomes. Interventions in FCC improved children's dietary intake, but their impact on physical activity and weight status was inconclusive. Furthermore, positive impacts were observed in environmental outcomes related to nutrition, whereas research on physical activity environmental outcomes was limited. Future research could replicate interventions to validate effectiveness and understand positive outcome mechanisms. Future interventions might use FCC stakeholders' input, incorporate innovative physical activity components, enhance FCC providers' position as role models, involve parents, and target those groups that are at a high risk of being obese. [ABSTRACT FROM AUTHOR]