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Objective: To assess the evidence presented in a set of articles that use the Canadian Maternal–Infant Research on Environmental Chemicals (MIREC) study database to claim that community water fluoridation (CWF) is associated with harm to foetal and infant cognitive development. Methods: Critical appraisal of measurements and processes in the MIREC database, and articles derived therefrom. MIREC's cohort is approximately 2000 pregnant women recruited in 10 centres across Canada, 2008–2011, leading to measuring 512 children aged 3–6 years in six cities. Fluoride exposure was measured by city fluoridation status, self‐reports and maternal spot urine samples. Intelligence Quotient (IQ) was measured using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI‐III) by different assessors in each city. Results: MIREC's fluoride and IQ measurements are invalid and therefore cannot support the claim that CWF is associated with IQ decline in children. Conclusions: The MIREC fluoride‐IQ articles' results should be considered unacceptable for legal and policy purposes; other water fluoridation studies and systematic reviews show no effect of fluoridation on cognition. [ABSTRACT FROM AUTHOR]

We investigated the longitudinal associations among maternal pre- and postnatal depression, maternal anxiety, and children's language and cognitive development followed from 15 to 61 months. Furthermore, we assessed the protective role of children's early print experiences with books against the adverse effect of maternal depression on language development. Data for mothers and children (51.7% boys, 95% White, N = 11,662) were from the Avon Longitudinal Study of Parents and Children. Prenatal maternal depression held an adverse association with child language (β = −.16, p =.002). Moreover, the risk was greater for girls than boys (β =.19, p =.02). In addition, prenatal depression was significantly and negatively associated with child verbal intelligence quotient (β = −.11, p =.02) and performance intelligence quotient (β = −.12, p =.01). In contrast, postnatal depression or anxiety were not unique predictors of child outcomes. Importantly, children's early experiences with books, as measured by the reported frequency of parent–child shared reading, moderated the negative association between maternal depression and child language development (β =.30, p <.001). Although modest in size, these findings inform models of child risk and resilience related to maternal psychopathology. The results also have implications for clinical programs as well as for prevention and intervention studies focusing on at-home early literacy. Public Significance Statement: This study highlights the adverse impact of maternal mental health, particularly prenatal depression, on children's cognitive and language development. The findings also suggest that reading to children and children's access to books protect them against this adverse effect. Parents should be encouraged to read to their children and help them access books. This simple solution may help lessen some of the harmful effects of maternal depression on child language development. [ABSTRACT FROM AUTHOR]

Serious games (i.e., digital games designed for educational purposes) can foster positive learning attitudes and are increasingly used as educational tools. Foodbot Factory is a serious game application (app) that helps children learn about healthy eating based on Canada's Food Guide principles and has demonstrated to increase nutrition knowledge among this group. This paper describes the process followed to expand Foodbot Factory's educational content and integrate immersive technologies and innovative features into the app. The revision process, which was guided by the Obesity-Related Behavioral Intervention Trials model, included the following phases: first, an interdisciplinary team of nutrition scientists, education experts, and computer scientists analyzed data from the original pilot study, recently published literature, and feedback from stakeholders to define areas to improve Foodbot Factory. The five original Foodbot Factory modules were evaluated by the team during weekly meetings, where the educational content, interactive features, and other elements that required updates (e.g., aesthetics and accessibility) were identified. Second, prototypes were created and refined until a final version of Foodbot Factory was approved. Nineteen children tested the updated Foodbot Factory and found it "easy to use" (89%) and "fun" (95%). The new version of Foodbot Factory contains 19 learning objectives, including 13 original and six new objectives. Interactive engagement features in the updated Foodbot Factory included augmented reality incorporated into two learning modules; new mini-games were created, including a memory game; an overhaul of the aesthetics; (e.g., new food images); and accessibility features were included to support users with cognitive and vision disabilities. [ABSTRACT FROM AUTHOR]

PURPOSE: This study aimed to 1) investigate the convergent and discriminant validity, internal consistency, and test-retest reliability of the Canadian English version of the Computer-Based instrument for Low motor Language Testing (C-BiLLT-CAN), and 2) explore feasibility of the C-BiLLT assessment for children with cerebral palsy (CP) and complex communication needs in the Canadian health care context. METHODS: Eighty typically developing children between 1.5 and 8.5 years of age completed the C-BiLLT-CAN, the Peabody Picture Vocabulary Test-IV (PPVT-4), the receptive language sub-test of the New Reynell Developmental Language Scales (NRDLS), and/or the Raven's 2. Correlations between raw scores were calculated for estimates of convergent and discriminant validity. Internal consistency was calculated for all items and separately for items pertaining to vocabulary and grammar. To calculate the standard error of measurement (SEM) and intraclass correlation coefficient (ICC), 33 participants were re-tested with the C-BiLLT within three weeks. Feasibility was explored with nine participants with CP. RESULTS: C-BiLLT-CAN's convergent validity was good to excellent (Spearman's rho > 0.78) and discriminant validity was higher than hypothesized (Spearman's rho > 0.8). Internal consistency (Cronbach's alpha = 0.96), test-retest reliability (ICC > 0.9), and measurement error (SEM < 5%) were excellent. The feasibility study could not be fully completed due to the COVID-19 pandemic. Preliminary data demonstrated some technical and practical barriers for using the C-BiLLT in children with CP in Canada. CONCLUSION: The C-BiLLT-CAN showed good to excellent psychometric properties in a sample of typically developing children, indicating that it is an adequate test for measuring language comprehension in English-speaking Canadian children. Further research is needed to investigate the feasibility of the C-BiLLT-CAN in children with CP. [ABSTRACT FROM AUTHOR]

Background: Pediatric intensive care unit (PICU)-associated delirium contributes to a decline in postdischarge quality of life, with worse outcomes for individuals with delayed identification. As delirium screening rates remain low within PICUs, caregivers may be able to assist with early detection, for which they need more education, as awareness of pediatric delirium among caregivers remains limited. Objective: This study aimed to develop an educational tool for caregivers to identify potential delirium symptoms during their child's PICU stay, educate them on how to best support their child if they experience delirium, and guide them to relevant family resources. Methods: Web-based focus groups were conducted at a tertiary pediatric hospital with expected end users of the tool (ie, PICU health care professionals and caregivers of children with an expected PICU length of stay of over 48 h) to identify potential educational information for inclusion in a family resource guide and to identify strategies for effective implementation. Data were analyzed thematically to generate requirements to inform prototype development. Participants then provided critical feedback on the initial prototype, which guided the final design. Results: In all, 24 participants (18 health care professionals and 6 caregivers) attended 7 focus groups. Participants identified five informational sections for inclusion: (1) delirium definition, (2) key features of delirium (signs and symptoms), (3) postdischarge outcomes associated with delirium, (4) tips to inform family-centered care, and (5) education or supportive resources. Participants identified seven design requirements: information should (1) be presented in an order that resembles the structure of the clinical discussion around delirium; (2) increase accessibility, recall, and preparedness by providing multiple formats; (3) aim to reduce stress by implementing positive framing; (4) minimize cognitive load to ensure adequate information processing; (5) provide supplemental electronic resources via QR codes; (6) emphasize collaboration between caregivers and the health care team; and (7) use prompting questions to act as a call to action for caregivers. Conclusions: Key design requirements derived from end-user feedback were established and guided the development of a novel pediatric delirium education tool. Implementing this tool into regular practice has the potential to reduce distress and assist in the early recognition and treatment of delirium in the PICU domain. Future evaluation of its clinical utility is necessary. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine the association between early screen time (7-10 days postinjury) and postconcussion symptom severity in children and adolescents with concussion, as compared to those with orthopedic injury (OI). METHODS: This was a planned secondary analysis of a prospective longitudinal cohort study. Participants were 633 children and adolescents with acute concussion and 334 with OI aged 8 to 16, recruited from 5 Canadian pediatric emergency departments. Postconcussion symptoms were measured using the Health and Behavior Inventory at 7 to 10 days, weekly for 3 months, and biweekly from 3 to 6 months postinjury. Screen time was measured by using the Healthy Lifestyle Behavior Questionnaire. Generalized least squares models were fit for 4 Health and Behavior Inventory outcomes (self- and parent-reported cognitive and somatic symptoms), with predictors including screen time, covariates associated with concussion recovery, and 2 3-way interactions (self- and parent-reported screen time with group and time postinjury). RESULTS: Screen time was a significant but nonlinear moderator of group differences in postconcussion symptom severity for parent-reported somatic (P = .01) and self-reported cognitive symptoms (P = .03). Low and high screen time were both associated with relatively more severe symptoms in the concussion group compared to the OI group during the first 30 days postinjury but not after 30 days. Other risk factors and health behaviors had stronger associations with symptom severity than screen time. CONCLUSIONS: The association of early screen time with postconcussion symptoms is not linear. Recommending moderation in screen time may be the best approach to clinical management. [ABSTRACT FROM AUTHOR]

This study draws on Michel Foucault's framework on power relations to explore the power of parents, as evidenced by various resistance strategies, in relating to teachers of their children with attention-deficit hyperactivity disorder (ADHD). This qualitative study had seven focus group interviews, involving 58 caregivers from 47 Chinese families of children with ADHD. Thematic analysis was used and three themes were identified: (1) cognitive resistance, (2) behavioral resistance, and (3) the transcendent vision of education. Resulting from the study, a culturally sensitive three-dimensional empowerment model is proposed for social workers to engage in advocacy that can facilitate a transformation of family–school power relations. [ABSTRACT FROM AUTHOR]

In the present research. we provide empirical evidence for the process of symbolic integration of number associations, focusing on the development of simple addition (e.g., 5 + 3= 8), subtraction (e.g., 5 - 3 = 2). and multiplication (e.g.,5 x 3= 15). Canadian children were assessed twice, in Grade 2 and Grade 3 (N = 244; 55% girls). All families were English-speaking, and parent education levels ranged from high school to postgraduate, with a median of community college. In Grade 2, children completed general cognitive tasks (i.e., receptive vocabulary, working memory, nonverbal reasoning, and inhibitory control). In both grades, children completed single-digit addition and complementary subtraction problems. In Grade 3, they completed single-digit multiplication problems and measures of applied mathematics, specifically, word-problem solving, algebra, and measurement. We found that addition and subtraction were reciprocally related (controlling for cognitive skills). Subtraction fluency predicted multiplication in Grade 3, whereas addition fluency did not. In Grade 3, both subtraction and multiplication fluency were predictors of applied mathematics, with multiplication partially mediating the relation between subtraction and applied mathematics performance. These findings support the view that learning arithmetic associations is a hierarchical process. As students practice each new skill, individual differences reflect the integration of the novel component into the developing associative network. [ABSTRACT FROM AUTHOR]

Research on the bilingual development of refugee children is limited, despite this group having distinct characteristics and migration experiences that could impact language development. This study examined the role of language environment factors, alongside age and cognitive factors, in shaping the Arabic as a first/heritage language and English as a second language of recently arrived Syrian refugee children in Canada (N = 133; mean age = 9 years old; mean family residency = 23 months). We found that Arabic was the primary home language with some English use among siblings. Children did not engage frequently in language-rich activities in either language, especially not literacy activities in Arabic. Parent education levels were low: most had primary school only. Hierarchical regression models revealed that stronger nonverbal reasoning skills, more exposure to English at school, more sibling interaction in English, more frequent engagement in language-rich activities in English, and higher maternal and paternal education were associated with larger English vocabularies and greater accuracy with verb morphology. Arabic vocabulary and morphological abilities were predicted by older age (i.e., more first/heritage language exposure), stronger nonverbal reasoning skills and maternal education. We conclude that proximal environment factors, like language use at home and richness, accounted for more variance in the second language than the first/heritage language, but parent factors accounted for variance in both languages. [ABSTRACT FROM AUTHOR]

BACKGROUND: The objective of this study was to examine individual and concurrent associations between meeting the Canadian 24-Hour Movement Guidelines for Children and Youth (9-11 hours of sleep per night, ≤2 hours of recreational screen time (ST) per day, and at least 60 minutes of moderate to vigorous physical activity per day) and dimensions of impulsivity. METHODS: Data from this cross-sectional observational study were part of the first annual curated release of the Adolescent Brain Cognitive Development Study. Participants included 4524 children between the ages of 8 and 11 years. RESULTS: In analyses, it was shown that adherence to individual movement behavior recommendations as well as combinations of adherence to movement behavior recommendations were associated with each dimension of impulsivity. Meeting all 3 movement behavior recommendations was associated with lower positive urgency (95% confidence interval [CI]: -0.12 to -0.05), negative urgency (95% CI: -0.04 to -0.08), Behavioral Inhibition System (95% CI: -0.08 to -0.01), greater perseverance (95% CI: 0.09 to 0.15), and better scores on delay-discounting (95% CI: 0.57 to 0.94). Meeting the ST and sleep recommendations was associated with less impulsive behaviors on all dimensions of impulsivity: negative urgency (95% CI: -0.20 to -0.10), positive urgency (95% CI: -0.16 to -0.08), perseverance (95% CI: 0.06 to 0.15), Behavioral Inhibition System (95% CI: -0.15 to -0.03), Behavioral Activation System (BAS) reward responsiveness (95% CI: -0.04 to -0.05), BAS drive (95% CI: -0.14 to -0.06), BAS fun-seeking (95% CI: -0.15 to -0.17), and delay-discounting task (95% CI: 0.68 to 0.97). CONCLUSIONS: Findings support efforts to determine if limiting recreational ST while promoting adequate sleep enhances the treatment and prevention of impulsivity-related disorders. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to examine the medical and psychological characteristics of children under the age of 13 years with avoidant restrictive food intake disorder (ARFID) and anorexia nervosa (AN) from a Canadian tertiary care pediatric eating disorders program. Method: Participants included 106 children assessed between 2013 and 2017 using the Diagnostic and Statistical Manual for Mental Disorders, 5th edition (DSM‐5). Data were collected through clinical interviews, psychometric questionnaires, and chart review. Information collected included medical variables (e.g., weight, heart rate, need for inpatient admission, and duration of illness from symptom onset); medical comorbidities (e.g., history of food allergies, infection, and abdominal pain preceding the eating disorder); and psychological variables (e.g., psychiatric comorbidity, self‐reported depression and anxiety, and eating disorder related behaviors and cognitions). Results: Children with ARFID had a longer length of illness, while those with AN had lower heart rates and were more likely to be admitted as inpatients. Children with ARFID had a history of abdominal pain and infections preceding their diagnoses and were more likely to be diagnosed with a comorbid anxiety disorder. Children with AN had a higher drive for thinness, lower self‐esteem, and scored higher on depression. Discussion: This is the first study to look at DSM‐5 diagnosis at assessment and include psychometric and interview data with younger children with AN and ARFID. Understanding the medical and psychological profiles of children with AN and ARFID can result in a more timely and accurate diagnosis of eating disorders in younger children. [ABSTRACT FROM AUTHOR]

The article discusses research which investigated the administration of oral cannabis extracts to pediatric patients in palliative care. Topics explored include the selection of patients with life-limiting or terminal illnesses that would receive medical cannabinoids, the observed improvement in the symptoms reported such as pain and nausea, and the importance of compliance to medical guidance to prevent cases of cannabis overdoses.

Background Neonatal acute kidney injury (AKI) occurs in 40 to 70% of critically ill neonatal intensive care admissions. This study explored the differences in perceptions and practice variations among neonatologists and pediatric nephrologists in diagnostic criteria, management, and follow-up of neonatal AKI. Methods A survey weblink was emailed to nephrologists and neonatologists in Australia, Canada, New Zealand, India, and the United States. Questions consisted of demographic and unit practices, three clinical scenarios assessing awareness of definitions of neonatal AKI, knowledge, management, and follow-up practices. Results Many knowledge gaps among neonatologists, and to a lesser extent, pediatric nephrologists were identified. Neonatologists were less likely to use categorical definitions of neonatal AKI (p < 0.00001) or diagnose stage 1 AKI (p < 0.00001) than pediatric nephrologists. Guidelines for creatinine monitoring for nephrotoxic medications were reported by 34%(aminoglycosides) and 62%(indomethacin) of respondents. Nephrologists were more likely to consider follow-up after AKI than neonatologists (p < 0.00001). Also, 92 and 86% of neonatologists and nephrologists, respectively, reported no standardization or infrastructure for long-term renal follow-up. Conclusion Neonatal AKI is underappreciated, particularly among neonatologists. A lack of evidence on neonatal AKI contributes to this variation in response. Therefore, dissemination of current knowledge and areas for research should be the priority. [ABSTRACT FROM AUTHOR]

This article presents a case study to illustrate how children with attention-deficit/hyperactivity disorder (ADHD) can be assessed and successfully trained using neurofeedback. There is established efficacy for using neurofeedback to treat ADHD (Arns, De Ridder, Strehl, Breteler, & Coenen, 2009; Gani, Birbaumer, & Strehl, 2009; Gevensleben et al., 2009). Indeed, the American Academy of Pediatrics gave biofeedback Level 1 efficacy in its 2012 review (American Academy of Pediatrics, 2012), the same level of efficacy as is given to medications. The other condition that has sufficient randomized controlled studies to establish efficacy for electroencephalogram biofeedback is epilepsy (Tan et al., 2009). This case is presented to share techniques that will help clinicians conduct neurofeedback appropriately so that good results are obtained. The future of our field depends on every practitioner doing a quality job with excellent outcomes. [ABSTRACT FROM AUTHOR]

Sex differences were examined in 3-year-olds with autism spectrum disorders (ASD) ascertained from a high-risk cohort, and high- and low-risk comparison groups. Participants included 319 high-risk siblings and 129 low-risk controls. Eighty-five siblings were diagnosed with ASD, including 57 of 176 boys (32.4 %) and 28 of 143 girls (19.6 %), implying a relative odds of ASD of 1.65 in boys versus girls. There were modest sex differences on cognitive and adaptive skills and ASD symptom severity at age 3, but differences between boys and girls with ASD mirrored those in the non-ASD groups. The lower than expected male-to-female ratio, and the relatively high cognitive level among diagnosed children, suggest that we have identified an unanticipated number of higher-functioning girls with ASD. [ABSTRACT FROM AUTHOR]

We use data from Cycles 1 to 3 of the National Longitudinal Survey of Children and Youth to examine whether and how much housing and neighbourhood quality affect child outcomes. Home ownership, housing assistance, the need for major repairs, residential stability, underhousing, and neighbourhood quality are used as explanatory variables in population-averaged panel data and endogenous treatment models to estimate the impact of these variables on child cognitive, behavioural, and emotional outcomes. We find positive impacts of home ownership on reading scores, and positive impacts of housing subsidies on boys' behavioural scores, but negative impacts of subsidies on girls' emotional scores after controlling for other factors. Both girls and boys fare worse in housing requiring major repairs, but boys are negatively affected by housing instability, while girls are negatively affected by poor neighbourhood quality. [ABSTRACT FROM AUTHOR]

Background: The associations between cardiorespiratory fitness (CRF) and physical literacy in children are largely unknown. The aim of this study was to assess the relationships between CRF, measured using the 20-m shuttle run test (20mSRT), and components of physical literacy among Canadian children aged 8-12 years.Methods: A total of 9393 (49.9% girls) children, with a mean (SD) age of 10.1 (±1.2) years, from a cross-sectional surveillance study were included for this analysis. The SRT was evaluated using a standardized 15 m or 20 m protocol. All 15 m SRTs were converted to 20mSRT values using a standardized formula. The four domains of physical literacy (Physical Competence, Daily Behaviour, Motivation and Confidence, and Knowledge and Understanding) were measured using the Canadian Assessment of Physical Literacy. Tertiles were identified for 20mSRT laps, representing low, medium, and high CRF for each age and gender group. Cohen's d was used to calculate the effect size between the low and high CRF groups.Results: CRF was strongly and favourably associated with all components of physical literacy among school-aged Canadian children. The effect size between low and high CRF tertile groups was large for the Physical Competence domain (Cohen's d range: 1.11-1.94) across age and gender groups, followed by moderate to large effect sizes for Motivation and Confidence (Cohen's d range: 0.54-1.18), small to moderate effect sizes for Daily Behaviour (Cohen's d range: 0.25-0.81), and marginal to moderate effect sizes for Knowledge and Understanding (Cohen's d range: 0.08-0.70).Conclusions: This study identified strong favourable associations between CRF and physical literacy and its constituent components in children aged 8-12 years. Future research should investigate the sensitivity and specificity of the 20mSRT in screening those with low physical literacy levels. [ABSTRACT FROM AUTHOR]