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Aim Methods Results Conclusions Few reports have shown Quality‐of‐Life long‐term outcomes in children with congenital diaphragmatic hernia (CDH) who received extracorporeal membrane oxygenation (ECMO) support. We reviewed the short‐ and long‐term outcomes in CDH patients that were supported with ECMO during their neonatal treatment.Telephone interviews of parents of CDH children were performed. The Functional Status Scale (FSS) and the Paediatric Quality of Life Inventory (PedQL, Version 4.0) were completed with the parents. All children with a CDH and supported with ECMO from 2010 to 2023 were included in the study.Twenty children were identified, with two having two ECMO runs. Birth weight was 3.2 kg (median). ECMO support lasted for (median) 13.6 days (range 3.8 to 39). Twelve patients were alive at the time of the survey. The age (median) at time of the interview was 6.3 years (range 1 to 12). The FSS score showed no impairment (FSS score 6) in any domain in eight patients. Two patients had a score of 7, and two patients had a score of 8 and 9, respectively. The PedQL showed a median score 84.5, with a physical health summary score of 92.5 and a psychosocial health summary score of 78.7. The cardiac specific PedQL inventory score was 77.ECMO support for CDH patients is associated with functional and Quality of Life outcomes that are similar to that in other PICU discharge populations. Denying ECMO support to CDH patients on the basis of predicted poor long‐term outcomes does not appear to be justified. [ABSTRACT FROM AUTHOR]

Background Aim Methods Results Conclusion In situations where a child's mental well‐being is threatened, the parents also need support. The available support has been perceived as insufficient by both parents and professionals.To explore the views of experts‐by‐experience of the support needed by parents when a child's mental well‐being is threatened.A qualitative study with a phenomenological approach was conducted in Finland. The data were collected in six focus group interviews during the autumn of 2022. The participants (n = 26) were adult experts‐by‐experience who had experienced either mental well‐being challenges in their own childhood (before the age of 18 years) or experienced the mental well‐being challenges of a child from the role of a parent. The data were analysed using inductive content analysis.The support needed by parents in situations where the mental well‐being of their child is at risk consists of support for parenting, support for sharing and support for surviving.Parents whose child's mental well‐being is at risk, need support both for their own well‐being and for their ability to support their child's well‐being. Support is needed not only from professionals but also from peers. [ABSTRACT FROM AUTHOR]

Background Darunavir is a potent HIV protease inhibitor with a high barrier to resistance. We conducted a nested pharmacokinetic sub-study within CHAPAS-4 to evaluate darunavir exposure in African children with HIV, taking once-daily darunavir/ritonavir for second-line treatment. Methods We used data from the CHAPAS-4 pharmacokinetic sub-study treating children with once-daily darunavir/ritonavir (600/100 mg if 14–24.9 kg and 800/100 mg if ≥25 kg) with either tenofovir alafenamide fumarate (TAF)/emtricitabine (FTC), abacavir/lamivudine or zidovudine/lamivudine. Steady-state pharmacokinetic sampling was done at 0, 1, 2, 4, 6, 8, 12 and 24 hours after observed darunavir/ritonavir intake. Non-compartmental and population pharmacokinetic analyses were used to describe the data and identify significant covariates. Reference adult pharmacokinetic data were used for comparison. We simulated the World Health Organization (WHO) recommended 600/100 mg darunavir/ritonavir dose for the 25–34.9 kg weight band. Results Data from 59 children with median age and weight 10.9 (range 3.8–14.7) years and 26.0 (14.5–47.0) kg, respectively, were available. A two-compartment disposition model with transit absorption compartments and weight-based allometric scaling of clearance and volume best described darunavir data. Our population achieved geometric mean (%CV) darunavir AUC0–24h, 94.3(50) mg·h/L and C max, 9.1(35) mg/L, above adult reference values and C trough, 1.5(111) mg/L, like adult values. The nucleoside reverse-transcriptase inhibitor backbone was not found to affect darunavir concentrations. Simulated WHO-recommended darunavir/ritonavir doses showed exposures equivalent to adults. Higher alpha-1-acid glycoprotein increased binding to darunavir and decreased apparent clearance of darunavir. Conclusions Darunavir exposures achieved in our trial are within safe range. Darunavir/ritonavir can safely be co-administered with TAF/FTC. Both WHO-recommended 600/100 mg and CHAPAS-4 800/100 mg darunavir/ritonavir doses for the 25–34.9 kg weight band offer favourable exposures. The choice between them can depend on tablet availability. [ABSTRACT FROM AUTHOR]

Background Drug-resistant tuberculosis (DR-TB) is one of the challenging forms of TB to treat, not only in adults but also in children and adolescents. Further, there is a void in the treatment strategy exclusively for children due to various reasons, including paucity of pharmacokinetic (PK) data on anti-TB drugs across the globe. In this context, the present study aimed at assessing the PK of some of the anti-TB drugs used in DR-TB treatment regimens. Method A multicentre observational study was conducted among DR-TB children and adolescents (n  = 200) aged 1–18 years (median: 12 years; IQR: 9–14) treated under programmatic settings in India. Steady-state PK (intensive: n  = 89; and sparse: n  = 111) evaluation of moxifloxacin, levofloxacin, cycloserine, ethionamide, rifampicin, isoniazid and pyrazinamide was carried out by measuring plasma levels using HPLC methods. Results In the study population, the frequency of achieving peak plasma concentrations ranged between 13% (for rifampicin) to 82% (for pyrazinamide), whereas the frequency of suboptimal peak concentration for pyrazinamide, cycloserine, moxifloxacin, levofloxacin and rifampicin was 15%, 19%, 29%, 41% and 74%, respectively. Further, the frequency of supratherapeutic levels among patients varied between 3% for pyrazinamide and 60% for isoniazid. In the below-12 years age category, the median plasma maximum concentration and 12 h exposure of moxifloxacin were significantly lower than that of the above-12 years category despite similar weight-adjusted dosing. Conclusions Age significantly impacted the plasma concentration and exposure of moxifloxacin. The observed frequencies of suboptimal and supratherapeutic concentrations underscore the necessity for dose optimization and therapeutic drug monitoring in children and adolescents undergoing DR-TB treatment. [ABSTRACT FROM AUTHOR]

Introduction: This work aimed to establish the largest UK and Ireland consensus on myopia management in children and young people (CYP). Methods: A modified Delphi consensus was conducted with a panel of 34 optometrists and ophthalmologists with expertise in myopia management. Results: Two rounds of voting took place and 131 statements were agreed, including that interventions should be discussed with parents/carers of all CYP who develop myopia before the age of 13 years, a recommendation for interventions to be publicly funded for those at risk of fast progression and high myopia, that intervention selection should take into account the CYP's hobbies and lifestyle and that additional training for eye care professionals should be available from non‐commercial sources. Topics for which published evidence is limited or lacking were areas of weaker or no consensus. Modern myopia management contact and spectacles are suitable first‐line treatments. The role and provision of low‐concentration atropine needs to be reviewed once marketing authorisations and funding decisions are in place. There is some evidence that a combination of low‐concentration atropine with an optical intervention can have an additive effect; further research is needed. Once an intervention is started, best practice is to monitor non‐cycloplegic axial length 6 monthly. Conclusion: Research is needed to identify those at risk of progression, the long‐term effectiveness of individual and combined interventions, and when to discontinue treatment when myopia has stabilised. As further evidence continues to emerge, this consensus work will be repeated to ensure it remains relevant. [ABSTRACT FROM AUTHOR]

Chorea is a common movement disorder in children, requiring thorough clinical assessment and appropriate tests for etiological diagnosis. Early identification of treatable conditions can lead to effective treatment, reducing morbidity and improving quality of life. To describe the clinical, demographic, and epidemiological characteristics of children and adolescents diagnosed with chorea. A retrospective cross-sectional study of pediatric patients treated in a fourth-level hospital in Bogotá, Colombia, from January 2008 to January 2022. 81 patients with chorea were found. The most frequent etiologies were rheumatic fever (50.6 %), vascular chorea (29.3 %), and chorea secondary to lupus (11.1 %). Patients with chorea secondary to rheumatic fever (Sydenham's chorea) were older compared to other etiologies, 10.36 ± 3.41 years vs 8.29 ± 5.16, p = 0.037. The presence of another movement disorder or abnormalities during the physical examination suggests a different etiology from rheumatic fever. Moreover, the presence of psychiatric symptoms was similar in all etiologies. However, a correlation between age and psychiatric symptoms was observed with an odds ratio of 1.14 95 % CI 1.02–1.29 per year. Red flags in Sydenham's chorea suggesting an alternate etiology are younger age, the presence of other abnormal movements or other findings in the neurological exam or in the magnetic resonance imaging. No significant statistical differences were found between the etiologies with the presence of neuro-psychiatric manifestations. Nevertheless, these manifestations are very frequent in abnormal movements. This study evidenced the positive correlation between age and the presence of psychiatric symptoms. [ABSTRACT FROM AUTHOR]

Background: Oral sensory hypersensitivity has been linked with fussy eating predominantly in non-typically developing children. We hypothesized that child 'Oral' (touch, smell and taste in the mouth) and 'Social-Emotional' (response to social expectations) sensory processing are associated with child appetitive traits in typically developing preteen children. Additionally, we explored relationships between maternal sensory profiles and their offspring's sensory profile. Methods: This is secondary analysis of 130 mother-child dyads from the 9–11-year-old follow-up of the ROLO longitudinal birth cohort study. The Dunn Sensory Profile (Adolescent/Adult) and the Dunn Child Sensory Profile 2 were used to assess maternal and child sensory profiles, respectively. The Children's Eating Behaviour Questionnaire was used to assess child appetitive traits. Multiple linear regression examined associations between 'Oral' and 'Social-Emotional' segments of the child sensory profile and child appetitive traits. Associations between maternal and child sensory profiles were examined using sensory profile quadrants (Dunn's sensory processing framework). These refer to four distinct patterns of sensory processing that indicate how an individual responds to sensory input. Results: In total, 130 mother-child dyads were included. In adjusted analysis child 'Oral' sensory processing was associated with higher mean scores in the appetitive traits 'Desire to Drink' (B = 0.044, 95% CI = 0.025,0.062) and 'Food Fussiness' (B = 0.080, 95% CI = 0.059,0.101) and with lower mean scores in 'Enjoyment of Food' (B=-0.038, 95% CI -0.055,-0.022). Child 'Social-Emotional' responses were associated with higher mean scores in 'Desire to Drink' and 'Food Fussiness'. Higher scores in the maternal sensory profile quadrants of 'Sensitivity', 'Avoiding' and 'Registration' were positively associated with higher scores in the corresponding child sensory profile quadrants. Conclusion: Our findings suggest that in typically developing children presenting with fussy eating, oral sensory hypersensitivity and higher scores in social-emotional responses to sensory processing may be an underlying determinant. The relationship observed between 'Oral' and 'Social-Emotional' sensory processing segments and 'Desire to Drink' requires further research to ascertain the type of drinks being consumed and how this impacts appetite. Further research is also required to explore the influence of maternal sensory profile on their offsprings response to sensory input. [ABSTRACT FROM AUTHOR]

This systematic review aims to report on the use of Statement Validity Analysis (SVA) with minors involved in criminal justice proceedings. We conducted a literature search of six bibliographic databases up to March 2024. Additional searches were performed using citation tracing strategies. Nineteen studies published between 1991 and 2023 were retained. Most were published between 1991 and 2000, mainly in the USA. A scientific gap was observed for 10 years before studies resumed between 2011 and 2022. These 19 studies involved 2931 children; most were girls (n = 2080; 71%). The mean age was 9.4 years (SD = 2.40; min = 2; max = 17.5). Most studies did not mention the nature of the relationship between the child and the alleged perpetrator of sexual violence, three studies involved intra‐family violence and six studies involved victims of intra‐ and extra‐family violence. Nearly 75% of the interviewers were trained with SVA methods. Most were mental health professionals (52.6%) or police officers (15.8%). No study used the SVA as a whole, 10 studies used 19 criteria of the Criteria‐Based Content Analysis (CBCA), and no study used the Validity Check List (VCL). Most studies performed SVA on interview transcripts (n = 8), and two studies performed their analysis on both verbatims and video. The conclusion of our literature review highlights the methodological weaknesses of these studies and encourages more research about the use of SVA in the judicial field to reduce the risk of misleading the judiciary. [ABSTRACT FROM AUTHOR]

There is emerging evidence of the detrimental impact of the pandemic and associated restrictions on young people's mental health in the UK, but to date, these data have been largely quantitative. The aim of the current study was to gain a deeper understanding of young people's experiences in relation to their mental health and wellbeing during the pandemic. Seventeen young people, aged 11 to 16 years, sampled for diverse characteristics, and living in the UK, were interviewed virtually between December 2020 and February 2021. Reflexive thematic analysis was carried out by the research team, which included two young people, and five themes were developed: (1) positives; (2) worries and anxiety; (3) sadness and anger about losses; (4) mental exhaustion; and (5) support from others. Aspects of young people's individual circumstances (e.g., pre-existing mental health difficulties, special educational needs, and neurodevelopmental disorders) appeared to play a role in their experiences. Continued measurement of young people's mental health, initiatives to identify young people who have been struggling, and the provision of support (including evidence-based and accessible interventions) will be important for protecting young people from future adversities as we emerge from the pandemic. [ABSTRACT FROM AUTHOR]

Objective: To describe the experience of implementing social robotics as an adjuvant during the hospitalization process in pediatric oncology patients. Methods: Before and after cohort study, applying an intervention with the Lego Mindstorms EV3 kit in patients between 8 and 17 years old that are hospitalized with a cancer diagnosis. We excluded patients from the intensive care unit or when their treating physician recommended so. The intervention consisted of a three-phase workshop: an open architecture story, building a car robot using the Lego Mindstorm EV3 kit, and cooperative playing activities such as races and passing obstacles. Results: Thirteen patients received the intervention with robotic lego. The median age was 15 years (IQR = 3), and 84.6% of the population (n = 11) were male. We found significant improvement in the language (topic management p =.011 and communicative intention p =.034). Other characteristics improved, but not significantly (self-care activities index, catching). No adverse events occurred during the intervention. Conclusions: The results of this pilot study suggest that implementing social robotics during hospitalization in children with cancer is a therapeutic adjuvant and safe intervention that promotes better communication, self-care, and a physical activity improvement. For future studies, the impact of this intervention could be measured in hospitalized pediatric cancer patients. [ABSTRACT FROM AUTHOR]

Aim: To examine the long‐term results and treatment effectiveness of liver transplantation (LT) in the treatment of homozygous familial hypercholesterolemia (HoFH) in children and adolescents. Method: Patients who underwent LT due to HoFH between 2007 and 2023 were included in the study. The patients' demographic data, clinical findings, preoperative and postoperative laboratory examinations, transplantation complications, and postoperative disease courses were evaluated. Results: There were five boys with an average age of 6.2 (median: 6, range 4–10) years in the study. The average total cholesterol level of the patients before transplantation was 923 (median: 950, range: 780–1002) mg/dL and the average LDL‐cholesterol level was 864 (median: 852, range: 770–957) mg/dL. No patients died of transplant‐related complications. After an average follow‐up of 9.2 (median: 9, range: 1.5–16) years, the average total cholesterol level of the patients was 197 (median: 164, range: 137–359) mg/dL, and the average LDL‐cholesterol level was 138 (median: 92, range: 85–313) mg/dL. Four (80%) patients developed atherosclerotic cardiovascular disease during follow‐up, and two (40%) died of this cause. Conclusion: LT in the treatment of HoFH did not help our patients reach the target LDL‐cholesterol level after transplantation and did not prevent the development of cardiovascular disease. Therefore, LT alone is not curative in the treatment of HoFH. [ABSTRACT FROM AUTHOR]

Background: The survival of pediatric chronic kidney disease (CKD) patients has improved in recent decades due to advances in dialysis and transplantation. However, cardiovascular disease (CVD) emerges as the main cause of mortality in patients with CKD. Objectives: To estimate cardiovascular risk in children with CKD at least 1 year after kidney transplantation. In addition, the possible association of cardiovascular risk with classic biochemical markers and potential new markers of this outcome was investigated. Methods: An observational ambidirectional (retrospective capture of risk factors and prospective study of outcomes) research including 75 patients who underwent renal transplant between 2003 and 2013 with postoperative follow‐up of at least 1 year was conducted. The outcome variables adopted were the LV mass Z‐score and the presence of coronary calcification on computed tomography using calcium Agatston score. Result: Only one patient had an elevated calcium score, and three children (4%) had an LV mass Z‐score ≥ 2.0. After multivariable analysis, only gender, serum triglyceride, and serum renalase concentration remained significantly associated with LV mass. Conclusion: The low incidence of cardiovascular changes in the population studied confirms the benefit of transplantation for the cardiovascular health of children. Nevertheless, long‐term follow‐up of these patients is recommended, given the limited duration of kidney function provided by transplantation and the high likelihood of further dialysis and kidney transplants being required in these children. [ABSTRACT FROM AUTHOR]

Extracorporeal membrane oxygenation (ECMO) support of critically ill pediatric patients is associated with increased risk of thromboembolic events, and unfractionated heparin is used commonly for anticoagulation. Given reports of acquired antithrombin (AT) deficiency in this patient population and associated concern for heparin resistance, AT activity measurement and off‐label AT replacement have become common in pediatric ECMO centers despite limited optimal dosing regimens. We conducted a retrospective cohort study of pediatric ECMO patients (0 to <18 years) at a single academic center to characterize the pharmacokinetics (PK) of human plasma‐derived AT. We demonstrated that a two‐compartment turnover model appropriately described the PK of AT, and the parameter estimates for clearance, central volume, intercompartmental clearance, peripheral volume, and basal AT input under non‐ECMO conditions were 0.338 dL/h/70 kg, 38.5 dL/70 kg, 1.16 dL/h/70 kg, 40.0 dL/70 kg, and 30.4 units/h/70 kg, respectively. Also, ECMO could reduce bioavailable AT by 50% resulting in 2‐fold increase of clearance and volume of distribution. To prevent AT activity from falling below predetermined thresholds of 50% activity in neonates and 80% activity in older infants and children, we proposed potential replacement regimens for each age group, accompanied by therapeutic drug monitoring. [ABSTRACT FROM AUTHOR]

Background: Paediatric acute kidney injury (AKI) is associated with significant adverse outcomes such as increased mortality, progression to chronic kidney disease and longer length of stay in hospital. Postoperative AKI is a common and recognized complication after surgery in adults. In the paediatric population, AKI postoperatively to cardiac surgery has been extensively studied. However, the incidence of postoperative AKI after non‐cardiac surgery is less clear. Therefore, we aim to assess the available literature on this topic. Methods: We will conduct a systematic review of observational and randomized controlled trials assessing the incidence of paediatric postoperative AKI after non‐cardiac surgery. Pairs of reviewers will independently screen the literature and extract data and assess risk of bias from eligible studies. The databases Pubmed, Cochrane and Web of Sciences will be searched. We will conduct the review in accordance with the Preferred Reporting Items for Systematic Review and Meta‐Analysis (PRISMA) guidelines and the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach. If sufficient homogeneity within the included trials we will conduct meta‐analyses. Discussion: This systematic review aims to investigate the incidence of postoperative AKI in the paediatric non‐cardiac surgery population. The results of this review will provide a foundation for future research in the field of paediatric postoperative AKI. [ABSTRACT FROM AUTHOR]

Prevention of chronic pain is a major challenge in this area of clinical practice. To do this, we must be able to understand who is most at risk of developing chronic pain after an injury. In this study, we aimed to identify risk factors of chronic pain onset, disability, and pain interference after a lower limb musculoskeletal injury in children and adolescents between 8 to 16 years of age. We assessed biopsychosocial factors including age, sex, pubertal status, anxiety, depression, fear of pain, pain worry, adverse life events, and sleep in children. We also assessed risk factors in parents including parent anxiety, depression, parent pain catastrophising, and protective behaviours. Logistic and hierarchical linear regressions identified risk factors assessed immediately postinjury for outcomes assessed at 3 months postinjury. Fourteen percent (17/118 children) reported chronic pain 3 months after injury. There were significant betweengroup differences in children with and without chronic pain at baseline. Children with chronic pain reported higher pain intensity, disability, pain interference, child depression, fear of pain, and catastrophic thinking about their pain. Regressions showed child depression and fear of pain at baseline independently predicted chronic pain onset at 3 months, parent protectiveness predicted child pain interference at 3 months, and child depression, poor sleep, parent anxiety and pain catastrophising predicted disability. Most children recover after a lower limb injury, but a minority develop chronic pain predicted by important psychosocial risk factors, which could be addressed to prevent the onset of treatment-resistant chronic pain and disability. [ABSTRACT FROM AUTHOR]

Aim: To explore how overcrowding affects children's health, environment and schooling. Methods: A qualitative study was conducted with individual interviews among 20 participants with occupational experience from overcrowded Stockholm areas but diverse in professions, locations and employers. The interviews were recorded, transcribed and analysed with Systematic Text Condensation. Results: Almost all participants expressed that overcrowding has a negative impact on children's health, environment and schooling – based on perceptions of precarious and different living conditions for children in overcrowded areas, for example, substandard homes, vulnerability, stress, exclusion, limited resources, lack of learning opportunities, gender differences, confinement, shame, insecurity, conflicts, risk of criminality, and bodily impact, both physical and psychological. Conclusions: Our qualitative evidence suggest that overcrowding has a negative impact on children's health, environment and schooling. [ABSTRACT FROM AUTHOR]

The aim of this study is to evaluate the feasibility and acceptability of a newly developed online psychoeducation intervention on childhood anxiety for school staff using a within groups pre‐post design. The intervention is informed by cognitive behavioural therapy principles. Seventy six participants volunteered to attend a brief online training, and complete two brief questionnaires pre and post the training. Following the intervention, school staff reported that they were significantly less likely to respond to children's anxious behaviours with anxiety‐promoting responses (i.e., sanctions, avoidance reinforcement and overprotection), and were more likely to respond with autonomy‐promoting responses in line with cognitive behavioural theory (i.e., problem‐solving, reward and encouragement). On average, participants found the intervention engaging, useful, suitable, appropriate and easy‐to‐access. Participants also reported that they felt more confident in understanding childhood anxiety and implementing anxiety strategies in their work following the intervention. Areas of development were noted regarding the drop‐out rates of the online intervention. Overall, the novel, online intervention appears to be a feasible and acceptable method for those who participated. In addition, the preliminary outcomes show promise and warrant further investigation. Limitations of the study are discussed with suggestions for future research and areas for improvement. Practitioner points: School staff reported that they were significantly more likely to respond with actions in line with Cognitive‐Behavioural Theory following the psychoeducation training.School staff felt more confident in understanding childhood anxiety and implementing anxiety strategies in their work following the psychoeducation training.The novel, online psychoeducation training appears to be a feasible and acceptable method for those who participated. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to interpret plasma renin concentrations (PRCs) correctly in a clinical setting, it is essential to understand to what extent physical activity influences the concentration. Reference values for different postural positions exist for adults, but data for children are sparse. In this study, the effect of 30 min of rest on plasma renin concentrations in paediatric patients was examined. Methods: In total, 41 paediatric patients, undergoing either arginine or clonidine provocation tests for growth hormone deficiency, were included. For each stimulation test, two blood samples were drawn. One at time 0 min and one after 30 min of rest. In total, renin concentrations were determined in 86 serum samples. Results: Renin concentrations decreased from 0 to 30 min with a median value of −20.5% (inter‐quartile range: −33.0% to −12.8%). This decrease was not dependent on sex, age, medication or comorbidity, and the variance of renin did not differ between 0 and 30 min. Conclusion: Renin concentrations in children differ according to postural position, which is comparable to adults. Thus, the clinical interpretation of renin results needs to consider the preanalytical conditions applied in the local reference population. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the perceptions of parents/caregivers about the impact of oral conditions on the oral health-related quality of life (OHRQoL) of children/adolescents with autism spectrum disorder (ASD) compared to the perceptions of parents/caregivers of children/adolescents without ASD. Methods: A comparative cross-sectional study was conducted involving 80 children/adolescents with ASD three to 16 years of age matched by sex and age with 80 children/adolescents without ASD and their parents/caregivers. Clinical examinations were performed for the diagnosis of dental caries experience (DMFT/dmft), clinical consequences of untreated dental caries (PUFA/pufa), visible plaque (VPI), bleeding on probing (BPI), malocclusion and traumatic dental injury (TDI). Parents/caregivers answered a questionnaire addressing sociodemographic characteristics and the Brazilian version of the Parental-Caregiver Perceptions Questionnaire (P-CPQ), which measures OHRQoL from the perspective of parents/caregivers. Data analysis involved the Wilcoxon test, chi-squared test and Poisson regression. Results: Dental caries experience impacted OHRQoL in the group with ASD regarding the total P-CPQ score (p < 0.001) as well as the "oral symptoms" (p = 0.011) and "wellbeing" (p < 0.011) domains. No differences were found between the perceptions of parents/caregivers of children/adolescents with ASD and perceptions of parents/caregivers of children/adolescents without ASD (p = 0.721). Conclusion: Dental caries experience can have a negative impact on the OHRQoL of children/adolescents with ASD. [ABSTRACT FROM AUTHOR]

Earlier reviews to discover research on interventions for children after neglect have concluded little was available, despite the well-documented prevalence and harmful effects of neglect on children. We revisited this question through a systematic literature review to discover the state of research on interventions for children who have experienced neglect. We searched MEDLINE, PsycINFO, ERIC, Sociological Abstracts and EMBASE for studies published between 2003 and 2021. Studies were included if neglect could be distinguished, and child outcomes reported. Eight reports describing six studies about six interventions were identified. These studies differed in interventions, age-groups, definitions of neglect, and outcomes. Four studies reported positive child outcomes though with varying degree of quality. More research is needed to inform a coherent theory of change following neglect. There remains an urgent need for research on interventions to help children recover from neglect. [ABSTRACT FROM AUTHOR]

Urinary tract infections caused by Aerococcus urinae have rarely been reported in children, and the clinical characteristics remain unclear. We reviewed medical records of children whose urine cultures grew A. urinae (≥104 CFU/mL) at a tertiary children's hospital in Tokyo, Japan. We found 17 pediatric patients in a review of 22,769 urine cultures between June 2006 and May 2022. The median age of 17 patients was 10.7 years (IQR 8–13 years), and males represented 76.5 % of the patients. Sixteen patients (94.1 %) had underlying urological conditions (neurogenic bladder, vesicoureteral reflux, urethral stenosis, bladder exstrophy, or urinary catheterization). The chief symptoms were fever (35.3 %), malodorous urine (23.5 %), nausea (11.8 %), and back pain (5.9 %). Ten patients were asymptomatic. Pyelonephritis was diagnosed in five male patients. All of them had underlying abnormal conditions of the bladder, and two had malodorous urine. All patients had favorable outcomes after 10–14 days of ampicillin/amoxicillin-based antimicrobial therapy. [ABSTRACT FROM AUTHOR]

Background: Oral sensory hypersensitivity has been linked with fussy eating predominantly in non-typically developing children. We hypothesized that child 'Oral' (touch, smell and taste in the mouth) and 'Social-Emotional' (response to social expectations) sensory processing are associated with child appetitive traits in typically developing preteen children. Additionally, we explored relationships between maternal sensory profiles and their offspring's sensory profile. Methods: This is secondary analysis of 130 mother-child dyads from the 9–11-year-old follow-up of the ROLO longitudinal birth cohort study. The Dunn Sensory Profile (Adolescent/Adult) and the Dunn Child Sensory Profile 2 were used to assess maternal and child sensory profiles, respectively. The Children's Eating Behaviour Questionnaire was used to assess child appetitive traits. Multiple linear regression examined associations between 'Oral' and 'Social-Emotional' segments of the child sensory profile and child appetitive traits. Associations between maternal and child sensory profiles were examined using sensory profile quadrants (Dunn's sensory processing framework). These refer to four distinct patterns of sensory processing that indicate how an individual responds to sensory input. Results: In total, 130 mother-child dyads were included. In adjusted analysis child 'Oral' sensory processing was associated with higher mean scores in the appetitive traits 'Desire to Drink' (B = 0.044, 95% CI = 0.025,0.062) and 'Food Fussiness' (B = 0.080, 95% CI = 0.059,0.101) and with lower mean scores in 'Enjoyment of Food' (B=-0.038, 95% CI -0.055,-0.022). Child 'Social-Emotional' responses were associated with higher mean scores in 'Desire to Drink' and 'Food Fussiness'. Higher scores in the maternal sensory profile quadrants of 'Sensitivity', 'Avoiding' and 'Registration' were positively associated with higher scores in the corresponding child sensory profile quadrants. Conclusion: Our findings suggest that in typically developing children presenting with fussy eating, oral sensory hypersensitivity and higher scores in social-emotional responses to sensory processing may be an underlying determinant. The relationship observed between 'Oral' and 'Social-Emotional' sensory processing segments and 'Desire to Drink' requires further research to ascertain the type of drinks being consumed and how this impacts appetite. Further research is also required to explore the influence of maternal sensory profile on their offsprings response to sensory input. [ABSTRACT FROM AUTHOR]

This study investigates the effect of problem‐solving training on the interpersonal problem‐solving skills of mothers of children with special needs. The parallel randomised controlled trial was conducted between August 2021 and March 2022. A priori power analysis was conducted, and 98 mothers who met the inclusion criteria were included in the study. The analysis indicated that a sample size of 39 participants per group was required. Data were collected using a personal information form and the Interpersonal Problem Solving Inventory. The mothers were divided into control and experimental groups. The participants in the experimental group were given a problem‐solving training program, while the control group was not exposed to any intervention. There was no significant difference in the pre‐training test scores for any of the dimensions (p > 0.05). However, the post‐training test scores in the experimental group were significantly higher than post‐training test scores in the control group (p < 0.05). There were significant differences between the pre‐training and post‐training test scores in the experimental group (p < 0.05). Interpersonal problem‐solving skills can be improved by providing problem‐solving training to the mothers of children with special needs. Based on the findings of this study, it is recommended that psychiatric nurses provide training to protect and improve the wellbeing of children with special needs and their families. [ABSTRACT FROM AUTHOR]

Background: Forearm shaft fractures are common injuries, often caused by falling from a fully-upright position or falling off a bike. They can be treated nonoperatively or surgically with intramedullary nailing or plates. The method of choice for treating pediatric forearm shaft fractures is the application of elastic stable intramedullary nailing (ESIN)|. The aim of the study was to evaluate ESIN in pediatric patients with forearm shaft fractures based on radiological images, and determine the etiology and complication rate associated with the injury. Methods: The study included 201 patients, 30.5% female 69.5% male, aged 1 to 17 years (mean 9.1 years; SD = 3.2), all had been diagnosed with a fracture of the forearm shaft and had been treated surgically with ESIN. In addition, all possessed a complete set of X-ray images and had attended a minimum six-month follow-up examination of the forearm. Axial alignment was evaluated retrospectively in the anatomical (AP) and lateral (LAT) positions. In total, 402 radiographs were examined. Of the injuries, 68% occurred during sports activity and 75% involved both the radius and the ulna. Results: Union was observed in all cases. Mean axial alignment values in AP and LAT X-ray or both the ulna and radius were satisfactory. Axial alignment values were not influenced significantly by age, type of surgery, type of fracture or etiology. Plaster cast application (9.8% of cases) significantly influenced radius axial alignment. The complication rate was 11.4% (n = 23). Significantly more complications were observed in patients receiving open reduction internal fixation (ORIF) (p = 0.0025). Conclusion: The ESIN technique is an effective treatment for forearm diaphyseal fractures in children, with good results regarding reduction and bone healing, indicated by x-ray. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Methods Results Conclusions Childhood primary dentition caries prevalence and experience is higher among Qatari than non‐Qatari nationality children in Qatar but only this bivariate association has been described.There were two objectives. First, to understand the variation of primary dentition caries among 4‐ to 8‐year‐old children in Qatar across nationality classified into four groups, and second, to explore whether the association persisted in the presence of socio‐demographic and behavioural indicators.The study used data from the Qatar Child Oral Health Survey 2017 (QCOHS 2017). Detailed information was collected through a parental dual‐language questionnaire and an oral epidemiological examination conducted by calibrated dentist examiners. Children in 20 kindergartens and 40 schools across Qatar were recruited. Data were weighted to represent the Qatar child population.Overall, 1154 children aged 4–8 years old (48.9% female, 51.1% male) participated. Qatari children made up 26.3%, Non‐Qatari (N‐Q) Arabic children 44.2% N‐Q Indian sub‐continent 16.4% and N‐Q Other 13.1%. There were no significant differences by nationality for age or sex, but differences existed for kindergarten/school type and parents' highest level of education. Among behavioural indicators, Qatari and N‐Q Arabic children began toothbrushing later, and more N‐Q Other children brushed 2+ times a day and had made a check‐up visit in the last 12 months. More Qatari children were in the highest tertial for sugar intake and drank bottled water with no fluoride. All N‐Q children had a significantly lower prevalence and experience of caries. The means ratio (95% CI) for N‐Q Arabic (0.78; 0.65–0.94), Indian (0.58; 0.46–0.72) and other children (0.61; 0.42–0.88) were all significant against Qatari nationality children. Multivariable models showed an attenuation of the association with caries with the means ratio for N‐Q Arabic (0.92; 0.73–1.16), Indian (0.79; 0.57–1.11) and other children (0.94; 0.61–1.44) being non‐significant compared to Qatari nationality children. The variables which were significantly associated with caries were parental education, toothbrushing frequency, sugar intake and check‐up visiting in the last 12 months in the multivariable models.Primary dentition caries in children resident in Qatar differed by nationality. The association of primary dentition caries with nationality was markedly attenuated and non‐significant in the presence of socio‐demographic and behavioural variables, pointing towards the importance of these variables as the pathways to improving primary dentition caries prevalence and experience of children in Qatar. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusionCaregivers are key stakeholders in management of children with Type 1 Diabetes (T1D), but their perspectives have remained understudied, especially in the developing countries. This study explores their perspectives on the barriers and facilitators of management of a child with T1D in a resource-constrained setting.This qualitative study, conducted in a tertiary level diabetes clinic in India, included parents of children with T1D, selected from subgroups varying in disease duration, education, habitat, and socioeconomic status, who participated in one of the five Focused Group Discussions (FGDs) of 60–90 min duration. The topic guide included questions like "What are the barriers you face related to diabetes care of your child at home or school?" and "What do you think helps you in managing a child with diabetes?" FGDs were audio-recorded, transcribed verbatim, and inductive coding was done independently by two authors.Twenty-eight parents (nineteen mothers and nine fathers, mean age: 35.1 years) of children aged between 2–13 years, were recruited till data saturation. Themes related to barriers of management were, ‘balancing nutrition and glycemic control is challenging’, ‘diabetes management involves psychological burden’ and ‘operational challenges’. Parents opined that family support, gaining decision-making and problem-solving attitude and optimal school-time management helped.Parents living in resource-constrained circumstances perceive unique challenges during management of T1D in their children like social stigma, illiteracy, financial and logistic issues like procuring and storing essential supplies. A better understanding of these factors can aid healthcare professionals in managing them. [ABSTRACT FROM AUTHOR]

Naming is a personal and powerful action, often tied to the identity of an individual. In the Gospel of Matthew, Jesus’ name is chosen with great care, only to be almost immediately cast aside in favor of the generic form “the child” throughout his childhood in exile. This article reads Matthew 2:13-23 through a childist lens, combining migration theory with attention to the obfuscation of the child Jesus’ identity to elucidate both the experiences represented in the Gospel account, as well as its enduring significance for generations of migrant communities living into their identities today. Seeking to read Matthew 2 together with refugee communities today, this reading highlights the limits of constructed identities such as borders, nation states, and even names, while tracing the child Jesus’ development in the infancy narrative of Matthew. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the relationship between chronotype, video game addiction, and sleep quality in school-age children using structural equation modeling. It was performed using structural equation modeling, with 545 secondary school students in northern Turkey meeting the inclusion criteria. Data were collected through face-to-face interviews utilizing the Personal Information Form, the Morningness Eveningness Scale for Children (MESC), the Video Game Addiction Scale for Children (VASC), and the Sleep Quality Scale. The findings revealed that the average video game addiction score of children was 55.22, which was associated with poor sleep quality and efficiency. Additionally, chronotype was found to mediate the relationship between video game addiction and both sleep quality (β = 0.024; p < 0.001) and sleep efficiency (β = −0.068; p < 0.001). The model was found to be close to acceptable levels for the variables according to the fit indices. [ABSTRACT FROM AUTHOR]

Background: Latinx children in the United States experience disparities in asthma control and asthma-related functional outcomes compared to non-Latinx White children, including more school absences, emergency department visits, and hospitalizations for asthma. Stress appears to play a role in asthma control, but interventions designed to address the role of stress in asthma control for Latinx children are limited. Method: The current randomized controlled trial tests the effects of Adapt 2 Asthma (A2A), a family-based coping skills and asthma management intervention tailored to the stressors, strengths, and cultural beliefs of Latinx families, compared to an asthma self-management control arm (the Asthma Plan for Kids; APK). Latinx families of children ages 8 to 14 years old with asthma (target N = 280) are identified and enrolled from primary care clinics and randomly assigned to either A2A or APK. The intervention is delivered by lay health workers trained and receiving ongoing consultation from the study team. The primary outcome is child- and parent-reported asthma control, while secondary outcomes are child's quality of life, lung function, school absences, and emergency department visits, and child and parent coping and family asthma management behaviors. Participants will be assessed at baseline, post-intervention, and at 6- and 12-month follow-up timepoints. Discussion: This study has the potential to provide new evidence regarding the effects of culturally relevant coping and asthma management intervention strategies for Latinx children with asthma. Trial Registration: Clinicaltrials.gov NCT05118282. Registered on 11 November 2021. [ABSTRACT FROM AUTHOR]

Background: Multiple cartilaginous exostoses (MCE) are a rare genetic disorder characterized by multiple osteochondromas in the metaphysis of long bones. Case Presentation. We report a 15-year-old male patient, his father, and his brother, all presenting varied severity of the same symptom. The patient exhibited symptoms since infancy, with osteochondromas affecting mobility and causing joint deformities. Whole exome sequencing identified a pathogenic NM_000127.3(EXT1):c.1056 + 2 T > G and a likely pathogenic NM_000127.3(EXT1):c.1047G > T variant in the EXT1 gene, both novel. Conclusions: Despite three decades since the discovery of the EXT1 gene, MCE diagnosis may be delayed until adolescence or adulthood. This report contributes to clinical understanding, emphasizing the importance of early diagnosis, genetic analysis, and potential treatment approaches, to mitigate long-term deformities and complications in MCE patients. [ABSTRACT FROM AUTHOR]

In recent decades, global rates of overweight and obesity have surged, posing significant health challenges, Maternal obesity is particularly concerning because of its potential adverse effects on women, foetuses, and children. The intrauterine environment plays a crucial role in shaping long-term health outcomes, with maternal factors significantly influencing childhood obesity and related health markers. This review synthesises current evidence on the associations between macrosomia, maternal weight, pregnancy weight gain, and offspring obesity risk. It explores how maternal weight status during pregnancy may impact a child’s susceptibility to obesity later in life, examining potential underlying mechanisms. By consolidating these findings, the review aims to deepen our understanding of the complex relationships between maternal health, prenatal factors, and childhood obesity. This knowledge can inform future research and public health strategies aimed at addressing this global health issue effectively. [ABSTRACT FROM AUTHOR]

In the past few years, a significant decline in vaccination coverage has been noted, leading to measles outbreaks. Mothers' adherence or reluctance to undergo childhood immunization is a major contributing factor to a substantial population of children who remain unvaccinated or inadequately vaccinated. This study aimed to investigate adherence to children's vaccination by investigating mothers' personal and contextual factors in addition to knowledge and attitudes scores. A cross-sectional analytical design was employed, and data were collected from a sample of 533 mothers in Jordan between May and July 2023. The statistical analysis included descriptive analysis, t-test, ANOVA, and Pearson r correlation. The results demonstrated that adherence to vaccination was associated with several factors, including knowledge score (r = 0.33, p < 0.01), the ability to access and understand health information (r = 0.16, p < 0.01), income level (F = 11.88, p < 0.01), education level (F = 5.71, p < 0.01), employment (t = 2.41, p < 0.05), and working in a medical field (t = 4.5, p < 0.01). Scheffe post hoc analysis was performed to evaluate adherence outcomes according to the different categories of education and income levels. Mothers' adherence to vaccination needs improvement, with special attention given to contributing factors. Strategies should be developed to target mothers with low incomes and educational levels and limited ability to access and understand health information to enhance maternal knowledge and eventually adherence to children's vaccination. [ABSTRACT FROM AUTHOR]

\nIntroduction: Stepwise oral food challenge (OFC) tests begin with low doses of allergens and progress to full doses. We previously reported the safety and efficacy of stepwise OFC for reintroducing hen eggs. In this study, we discuss its application for cow’s milk (CM) allergy. Methods: We included 927 children (median age, 3.2 years) who underwent CM-OFC between 2017 and 2021. The target challenge dose was classified as low (<10 mL), middle (≥10 mL but <100 mL), or full. When participants reacted to the low dose, they underwent a very low-dose OFC using baked milk or <1 mL of CM. Results: Positive reactions occurred in 210 cases (22.7%), including 69 anaphylactic reactions (7.4%). A lower target dose resulted in more positive OFC results (p < 0.001) and anaphylaxis (p = 0.001). The lower dose group included more children with complete elimination of CM (p < 0.001), with numerous histories of anaphylaxis induced by CM (p < 0.001), and higher levels of total IgE (p = 0.033) and CM-sIgE (p < 0.001). A multivariate analysis indicated that in the low-dose-OFC group, higher CM-sIgE levels (p = 0.034), younger age (p = 0.005), and complete elimination of CM (p = 0.002) were associated with positive OFC results. Conclusion: The stepwise OFC could reintroduce small amounts of CM, even in cases with high CM-sIgE levels or a history of anaphylaxis. Performing CM-OFC at younger ages, specifically from infancy, with very low doses, might facilitate the safe reintroduction of CM. Stepwise oral food challenge (OFC) tests begin with low doses of allergens, progressing to full doses. This is one of the strategies used to avoid anaphylactic reactions to the reintroduction of allergens. We previously reported the safety and efficacy of hen egg OFC. In this study, we discuss it for cow’s milk (CM) allergy. We included 927 children (median age, 3.2 years) who underwent CM-OFC between 2017 and 2021. The target challenge dose was classified as low (<10 mL), middle (≥10 mL but <100 mL), or full. When the participants reacted to low doses, they underwent very low-dose OFC using baked milk or <1 mL of CM. Positive reactions developed in 210 cases (22.7%), including 69 anaphylactic reactions (7.4%). A lower target dose resulted in more positive OFC results and anaphylaxis. Multivariate analysis indicated that only in low-dose OFCs, higher CM-specific IgE (CM-sIgE) levels, younger age, and complete CM elimination were associated with positive OFC results. Food ladders, an approach to reintroduce allergens, are becoming increasingly popular. Although we believe that OFC is a safer strategy to reintroduce CM to children with CM allergy, our CM-OFCs appeared to develop more anaphylactic reactions than milk ladders. The stepwise OFC reintroduced small amounts of CM, even in cases with high CM-sIgE levels or a history of anaphylaxis. Performing CM-OFC at a younger age, preferably from infancy, with very low doses, similar to milk ladders, may facilitate the safe reintroduction of CM. [ABSTRACT FROM AUTHOR]

Introduction: Childhood malnutrition is a complex issue with a range of contributing factors. The consequences of malnutrition are severe, particularly for children. This study aims to identify the factors contributing to inequality gaps in childhood malnutrition. Our study provides insights into modifiable elements to inform interventions targeted at distinct contexts and populations to improve child nutrition. Methods: This study utilized data from the Demographic and Health Surveys (DHS) of 27 countries. First, the risk differences (RDs) between the prevalence of childhood malnutrition among the determinant variables, household income, and maternal education categories were calculated. The Blinder‒Oaxaca decomposition was subsequently used to determine the extent to which the difference in childhood malnutrition prevalence between low-income and high-income groups and maternal education levels results from the contributory effects of the explanatory variables: child and maternal individual-level compositional factors. Results: We examined data from 138,782 children in 27 countries from 2015 to 2020. The prevalence of childhood malnutrition (10.5%) varied across countries, ranging from 6.5% in Burundi to 29.5% in Timor Leste. On average, the prevalence of childhood malnutrition was 11.0% in low-income households and 10.7% among mothers without education. Some nations had pro-low-income (i.e., malnutrition concentrated among children from poor households) or pro-no-maternal education (i.e., malnutrition concentrated among children from mothers with no formal education) inequality in childhood malnutrition, but most did not. We found a complex interplay of compositional effects, such as the child's age, maternal education, maternal health behavior, and place of residence, that influence the inequality in childhood malnutrition rates across 10 pro-low-income countries. In addition, we also found that a complex mix of compositional effects, such as the household wealth index, maternal health behavior, and maternal age, contribute to childhood malnutrition inequality between educated and uneducated mothers across the 7 pro-no maternal education countries. Conclusion: The prevalence of childhood malnutrition varies among low-income, high-income, and no maternal education-maternal education groups. This study highlights the need for a country-specific approach to addressing childhood malnutrition, with policies and interventions tailored to each country's specific context. [ABSTRACT FROM AUTHOR]

Objective: To review the current literature about surgical treatments of pediatric bilateral vocal fold paralysis (PBVFP). Methods: A systematic review of the current literature in PubMed, Scopus, and Cochrane Library regarding etiologies and management of PBVFP was performed until November 2023 according to PRISMA statements. Quality assessment was assessed with Methodological Index for Non-Randomized Studies (MINORS) tool. Results: Of the 211 screened articles, 26 were included accounting for 320 patients. The etiologies included idiopathic (42.2%), congenital (19.7%), neurological (16.9%), or post-surgical (9.5%) pediatric bilateral vocal cord paralysis (PBVCP). Patients were decannulated in 76.7% of cases without laryngeal procedure. Decannulation was achieved in 84.6%, 66.6%, 83.3%, 80.0%, and 62.5% of cases of laterofixation of the vocal fold, cricoid split approaches, partial or total arytenoidectomy, uni- or bilateral transverse cordotomy, and selective laryngeal reinnervation, respectively. Dyspnea/stridor relief, swallowing, or voice quality outcomes were used in some studies, which reported conflicting results. Revision and complications varied between studies, with complications mainly involving edema, granuloma, or aspirations. Revision was required in 6.4%, 12.9%, and 40.0% of cases that underwent laterofixation of the vocal fold, arytenoidectomy, and cricoid split procedures, respectively. There was substantial heterogeneity across studies in inclusion criteria, procedures, and outcomes. Conclusion: The management of PBVFP may involve several temporary or permanent surgical procedures that are associated with overall subjective improvements of symptoms, and laryngeal findings. The retrospective design of studies, the small number of cohorts, the lack of objective outcomes, and the differences between teams regarding procedure timing and features limit drawing reliable conclusions about the superiority of one technique over others. [ABSTRACT FROM AUTHOR]

In Brazil, nasal irrigation is a common procedure for children hospitalized with respiratory conditions. However, it often causes stress for both the child and their family. Nurses need to rethink their approach to care, and the use of therapeutic play can be an ally in transforming the stressful context. To understand the family perceptions of nasal irrigation in hospitalized children after an educational intervention mediated by instructional therapeutic play (ITP). This descriptive, exploratory, and qualitative study was conducted from the perspective of Herbert Blumer’s Symbolic Interactionism in a hospital in São Paulo, Brazil. The study included family members of hospitalized children aged 3–6 years who participated in an ITP intervention and remained for 6 hours afterward. Participants self-reported literacy with preserved cognition and verbal communication. This study was conducted between March 2023 and January 2024 using semi-structured interviews with 38 family members. Data were analyzed using Bardin’s thematic content and lexical analysis with IRAMUTEQ® software. The interaction of families with ITP for nasal irrigation in children led to a redefinition of the procedure from distressing to enjoyable. ITP was evaluated as an essential and stimulating method that familiarized the child with the procedure, facilitating the understanding process for both the child and the family. ITP is a caregiving technology that nurses can use to assist with nasal irrigation, re-signifying the experiences of children and their families during the procedure. [ABSTRACT FROM AUTHOR]

Background: Community-acquired pneumonia (CAP) is a major global health threat for children, causing numerous hospitalizations and deaths. CAP is a leading cause of mortality in children under five and results in millions of hospital admissions each year. Identifying reliable prognostic markers is crucial. Mean platelet volume (MPV) and red blood cell distribution width coefficient of variation (RDW_CV) are accessible and cost-effective options for prognosis assessment. This study investigates MPV and RDW_CV as prognostic markers in children with CAP. Methods: This cross-sectional study included 150 children aged 1–15 years diagnosed with CAP upon initial examination and admitted to the hospital. CAP diagnosis was based on clinical symptoms, physical examination, and/or radiographic findings, with hospitalization criteria set for CAP in children. CAP severity was assessed using the Clinical Respiratory Score, categorizing patients into mild, moderate, and severe groups. MPV and RDW_CV were compared among these groups. Results: Among the patients, 71 (47.3%) were girls, and 79 (52.7%) were boys. The average hospitalization duration was 6.24 ± 3.82 days, with a median of 5 days. Disease severity distribution was 58 (38.7%) mild, 54 (36.0%) moderate, and 38 (25.3%) severe. Both RDW_CV and MPV were higher in severe cases and in children hospitalized for more than 10 days (P < 0.001). A significant positive correlation was observed between RDW_CV and MPV (r = 0.636, P < 0.001). Mean RDW and MPV values were significantly elevated in children needing ICU admission and those with pleural effusion (P < 0.001). The RDW_CV cutoff was 13.75, with 97.4% sensitivity and 80.4% specificity. The MPV cutoff was 8.25, with 78.9% sensitivity and 69.6% specificity. Conclusion: Elevated RDW_CV and MPV levels are associated with severe CAP in hospitalized children, providing valuable prognostic insights. RDW_CV is a more precise prognostic indicator than MPV, demonstrating superior predictive value in CAP management. [ABSTRACT FROM AUTHOR]

AbstractThe aim of this study was to compare the kinematics of reaching tasks at different speeds between children with neonatal brachial plexus palsy (NBPP) and unaffected controls. This cross-sectional study included thirteen children with NBPP (10 ± 2 years old, of which six had upper Erb’s palsy and seven had extended Erb’s palsy) matched for age and sex with thirteen unaffected controls. Kinematic data were acquired using a Motion Monitor unit with a 3D motion tracking electromagnetic system (Liberty, Polhemus). Scapular, upper limb, and head were recorded during forward reaching tasks (hand on overhead ball and hand to head) and a backward reaching task (hand on the back pocket). The study revealed reduced shoulder flexion and extension in children with NBPP during hand on ball and on the back pocket tasks compared to unaffected controls. Limited elbow flexion was also observed in children with NBPP during the hand on ball and hand on the head tasks. During the hand to head task, children with NBPP presented increased head flexion compared to unaffected controls. Scapular kinematics analysis showed increased posterior tilt in children with NBPP during forward reaching (the hand on ball and hand to head tasks). In the backward reaching task (hand on the back pocket), the NBPP group exhibited reduced scapular external rotation compared to unaffected controls. These findings indicate distinct kinematics in the scapula, shoulder, elbow, and head during reaching tasks for children with NBPP compared to controls. Furthermore, different execution speeds did not alter the kinematic differences between the groups. [ABSTRACT FROM AUTHOR]

Background/Objectives: Early diagnosis of autism spectrum disorder (ASD) is a very important factor for improving the quality of life of people on the spectrum, but it still remains a major problem in Europe, especially concerning girls. In this study, we tried to answer the question of what factors affect the age of diagnosis in Poland. Additionally, we tried to establish the time between the first visit to the mental health center (MHC) and the diagnosis in this population, and what factors affect its length. Methods: 77 children were randomly recruited among the patients who came to local MHC at the Child and Family Health Centre in Sosnowiec. All participants were tested using the ADOS-2 protocol. In addition, the study used the TAS-20 test and BDI. Results: The mean age of the first enrollment in the MHC was 9.09 years for girls and 6.42 for the boys. The time needed to obtain a diagnosis from the first visit was consecutively 2.90 years and 4.29 years, but the difference was not statistically significant (p > 0.05). Obtaining a different psychiatric diagnosis did not affect the average time to diagnosis and the age of diagnosis. Conclusions: The results of the study indicate that the diagnosis of ASD is still a significant problem both in Poland and in the world. Obtaining an accurate diagnosis requires significant time, and it frequently involves consulting multiple specialists. The diagnostic process should be flexible, and the specialist should always take into account the axial symptoms but remain aware that the "overdiagnosis" of ASD can also have harmful consequences for the child. [ABSTRACT FROM AUTHOR]

Background/Objectives: With the advent of the field of pediatric emergency medicine, studies on the differences in treatment patterns between pediatricians and emergency medicine (EM) physicians in various pediatric conditions have been accumulating. This study aimed to compare croup (acute laryngotracheobronchitis) management patterns between pediatricians and EM physicians to enhance pediatric emergency care and inform the training of future specialists. Methods: A retrospective review of medical records was conducted for 1676 previously healthy children diagnosed with croup who visited a single pediatric emergency department (PED) of a tertiary university-affiliated hospital in South Korea, from March 2019 to February 2023. Patient characteristics, management patterns, and the impact of physician specialty on emergency care were analyzed. Results: EM physicians used injected dexamethasone monotherapy in 30.54% of the cases, more frequently than the 3.57% among pediatricians. In contrast, pediatricians used a combination of nebulized epinephrine and dexamethasone in 88.29% of the cases, compared with 67.71% for EM physicians. The appropriate use of nebulized epinephrine based on the Westley Croup Score was significantly higher in the EM physician group (77.64% vs. 57.89%, p < 0.001). Pediatricians also prescribed oral antibiotics and corticosteroids more frequently (25.13% vs. 3.13% and 81.54% vs. 22.69%, respectively; p < 0.001 for both). Despite these differences, there were no significant disparities in PED length of stay or 48 h revisit rates. Conclusions: EM physicians adhered more closely to currently accepted management algorithms for croup management. These findings underscore the need for standardized, evidence-based pediatric emergency care and provide valuable insights for training programs in this field. [ABSTRACT FROM AUTHOR]

AbstractBackgroundObjectiveMethodsResultsConclusionRecurrent respiratory tract infections (RRTIs) in children represent a significant clinical challenge. Although some studies have identified potential risk factors, a comprehensive and systematic overview is lacking.This analysis is carried out to provide more advanced evidence to guide future prevention and health care.This study (PROSPERO: CRD42024576464) was conducted in accordance with PRISMA guidelines. PubMed, Embase, Web of Science, and the Cochrane Library were searched for relevant studies published in English. Subgroup analysis, sensitivity analysis, and publication bias assessments were performed. Data analysis was conducted using Stata 17, and GRADE was employed to assess the quality of evidence. The risk factors identified in the positive results were discussed qualitatively.A total of 29 studies covering 639,078 children were included. Some risk factors: asthma (OR = 3.08, 2.06–4.62), breastfeeding <6 months (OR = 1.26, 1.04–1.52), DCC: day care center (OR = 1.50, 1.16–1.93), have siblings (OR = 1.26, 1.00–1.59), ETS: Environmental tobacco smoke (OR = 1.13, 1.00–1.27), snoring (OR = 1.49, 1.16–1.93) got positive result.This analysis identifies several key risk factors for RRTIs in children, providing enhanced evidence for prevention and management strategies. In particular, asthma warrants closer attention, given its strong association with respiratory infections in pediatrics. [ABSTRACT FROM AUTHOR]

Background Data on the true prevalence of respiratory syncytial virus (RSV) among medically attended acute respiratory illnesses (MAARI) has been limited by the lack of regular clinical testing of mild to moderate illnesses. Here we present a prospective evaluation of the epidemiology of RSV-associated MAARI across age groups and multimorbidity status over 3 seasons, which is informative in light of the recommendations for shared decision making for vaccination in older adults. Methods Ambulatory patients ≥6 months of age meeting a common MAARI case definition were prospectively enrolled in the Michigan Ford Influenza Vaccine Effectiveness (MFIVE) study, a subsite of the US Influenza Vaccine Effectiveness Network. All participants were tested by nasal-throat swab for RSV and influenza, including subtype, independently from clinician-directed testing. Participant illness characteristics and calculated multimorbidity-weighted index (MWI) were collected by in-person survey and electronic medical record review. Results Over 3 surveillance seasons (fall 2017 to spring 2020), 9.9% (n = 441) of 4442 participants had RSV detected. RSV-associated MAARI was more prevalent than influenza for participants 6 months to 4 years of age. Adults with RSV-MAARI had higher median MWI scores overall compared to influenza-MAARI and controls with neither virus (1.62, 0.40, and 0.64, respectively). Conclusions RSV is a significant, underrecognized cause of MAARI in both children and adults presenting for ambulatory care. Multimorbidity is an important contributor to RSV-associated MAARI in outpatient adults, providing information to support shared clinical decision making for vaccination. [ABSTRACT FROM AUTHOR]

Objective: Systemic lupus erythematosus (SLE) constitutes an autoimmune disorder with potential involvement of the gastrointestinal system (GIS). Our objective was to assess the gastrointestinal (GI) manifestations in patients diagnosed with childhood onset SLE. Methods: The study cohort consisted of 123 patients with childhood onset-SLE and GIS involvement from 16 referral departments of pediatric rheumatology. All participants met the Systemic Lupus International Collaborating Clinics criteria. Results: Out of 123 patients, 78 (63.4%) exhibited GIS involvement at the initial SLE diagnosis, whereas the remaining 45 (36.6%) developed GI symptoms after a median duration of 12 (3–140) months. Eighty-two (66.7%) individuals experienced symptoms related to the GI tract, whereas the remaining patients received a diagnosis of GI involvement through laboratory assessments. The predominant initial GIS involvement symptom was abdominal pain, observed in 77 (62.6%) patients, followed by elevated hepatic transaminases in 70 (56.9%), hepatomegaly in 40 (32.5%), diarrhea in 26 (21.1%), and jaundice in 11 (8.9%) patients. The GIS involvement was associated with SLE in 82 (78.6%), while it resulted from drug-related adverse events in 35 (28.5%) patients or comorbidities in 6 (0.5%) patients. Conclusion: GIS involvement should be considered in all childhood onset-SLE patients, especially in the presence of suggestive symptoms or elevated hepatic transaminases. It is also crucial to consider SLE in the differential diagnosis of GIS manifestations in children. Apart from GIS involvement directly associated with SLE, adverse events of drugs should be kept in mind. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the relationship between the amount of ultra‐processed food (UPF) in the diet and low‐grade inflammation in children. This cross‐sectional study was conducted in 50 healthy children recruited from children attending the Social Paediatrics Outpatient Clinic for follow‐up of normal developmental stages. Low‐grade inflammation was calculated by INFLA‐score, dietary intake by three 24‐h dietary recalls and dietary content analyses by BeBiS™ software. The mean age of the 50 children included in our study was 10.18 ± 3.98 years (5–17 years). UPF accounted for 24.5% of the total daily energy intake of children. In children with higher inflammation scores (INFLA‐score ≥ 2), the amount in grams of UPF and the percentage of total energy from UPF were found to be significantly higher (p = 0.030 and p = 0.015, respectively). A weak positive correlation was found between the INFLA‐score and the percentage of daily dietary energy intake coming from UPFs (r = 0.350, p < 0.01), the average daily energy intake from UPFs (r = 0.313, p < 0.05), and the average daily amount of UPF consumed (r = 0.260, p < 0.05). The linear regression model revealed that every one‐unit increase (1%) in the percentage of total daily energy intake coming from UPF caused an increase in β = 0.154‐unit in the INFLA‐score. It was found that obesity was not a mediator in the association between the percentages of total energy intake from UPF on the INFLA‐score, instead, the energy intake from UPF had a significant direct association with the INFLA‐score. The average amount of UPF consumed daily showed an increasing pattern in parallel with inflammation‐score quartile classes (Q1 to Q4) with 33.3% in Q1, 38.5% in Q2, 53.8% in Q3 and 66.7% in Q4 (p = 0.049). In conclusion, a positive association was found between low‐grade inflammation and UPF consumption in children, independent of obesity. [ABSTRACT FROM AUTHOR]

Summary To explore the association between the severity of sleep‐disordered breathing, different types of respiratory events, peripheral oxygen saturation (SpO2), age and sleep stage on cerebral oxygen saturation (rSO2) in children. We enrolled children aged 4–14 years who were treated for snoring or mouth breathing at the Sleep Center of Beijing Children's Hospital, from February 2022 to July 2022. All children completed polysomnography, and SpO2, rSO2, and heart rate (HR) were recorded synchronously. A total of 70 children were included, including 16 (22.9%) with primary snoring, 38 (54.3%) with mild obstructive sleep apnea (OSA), and 16 (22.9%) with moderate‐to‐severe OSA. There were no significant differences in the mean rSO2 or minimum rSO2 among the primary snoring, mild OSA, and moderate‐to‐severe OSA groups (all p > 0.05). A total of 1119 respiratory events were included in the analysis. Regardless of the type of respiratory event, rSO2 and HR changes occur prior to fluctuations in SpO2. A mixed‐effects model showed that ΔrSO2 was positively correlated with ΔSpO2, duration of respiratory event, mixed and obstructive apnea, central apnea, while negatively correlated with age and rapid eye movement (REM) sleep stage (all p < 0.05). Larger rSO2 fluctuations were impacted by a greater ΔSpO2, longer duration of respiratory events, younger age, apnea‐related respiratory events and non‐REM sleep stage. Thus, sleep disordered breathing in younger children warrants more attention. More research is needed to determine whether REM sleep has special protective effects on rSO2. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the serum level of 25-hydroxyvitamin D (25(OH)D) in children with febrile seizures (FS) in Luzhou, Sichuan Province, China, and in particular its association with gender and age. This should inform possible strategies for supplementation with vitamin D, and hence for prevention of FS in the local pediatric population. The Febrile seizures group consisted of 747 children hospitalized with FS at the Southwest Medical University Affiliated Hospital from January 2020 to January 2024. The healthy control group was comprised of 750 children aged from 0 to 8 years who underwent health checkups during this period. The serum 25(OH)D level was analyzed in relation to gender and age to explore its association with FS. The median serum vitamin D level in the FS group (28.8 ng/mL; IQR 21.64, 33.64) was significantly lower than in the healthy control group (37.51 ng/mL; IQR 31.05, 37.51). The incidence of vitamin D deficiency in the FS group was 10.8%, which was significantly higher than in the healthy control group (P < 0.05). In addition, the serum vitamin D level in children with FS varied in different age groups, with significantly lower levels observed in older children (P < 0.05). ROC curve analysis revealed that a serum vitamin D level of 35.28 ng/mL showed 60.0% sensitivity and 84.7% specificity for predicting FS (P < 0.05). In this study cohort, the serum vitamin D level in children with FS was at the lower limit of the physiological range, and significantly lower than in healthy children. Furthermore, this level decreased with age in children with FS. Regular supplementation with vitamin D for 6 months after birth and outdoor sun exposure for more than 2 h per day can improve the serum vitamin D level in children with FS. [ABSTRACT FROM AUTHOR]

Introduction Aim Methods Results Conclusions The Child Hemophilia Treatment Experience Measure (Child Hemo‐TEM) was developed to capture the treatment burden experience of children with haemophilia (CwH).Describe the development of this novel haemophilia‐specific measure.Interviews were conducted with clinical experts, CwH and CwH's caregivers. Interviews were analysed according to adapted grounded theory principles. Based on the analysis, a preliminary measure was developed and debriefed. Psychometric analyses were performed according to an a priori analysis plan using data collected in a cross‐sectional web survey and a final measure was generated.Interviews with four clinical experts, 25 CwH ages 8 to <12 years, and 25 caregivers of CwH <12 years were conducted. Concepts endorsed by ≥10% of CwH and caregivers were: adherence, ease of use, emotional impacts, physical impacts, treatment concerns, and interference with daily life. Cognitive debriefing assessments were conducted to ensure participant understanding and item relevance. Caregivers found the measure to be understandable, comprehensive, and relevant. However, several issues with CwH completing the measure were identified and it was decided to only develop an observer‐reported outcome version. Data for psychometric validation was collected in a web survey (N = 187). Item reduction dropped 12 items. Factor analysis generated a single, 7‐item, internally consistent (α = .855) factor, which consisted of items covering all relevant a priori concepts. The majority of a priori convergent and all known groups validity hypotheses were confirmed.The study findings provide evidence that the Child Hemo‐TEM is a brief, well‐designed, and valid and reliable measure of haemophilia treatment burden. [ABSTRACT FROM AUTHOR]

It is well documented that children and young people are disproportionately represented in missing person reports, frequently as repeat cases. However, inconsistent definitions around age groupings have compromised our ability to compare across studies, or meaningfully synthesise the available evidence. This study sought to explore the relationship between age at first missing and police contacts in a sample of 2,125 Australian children (0–12 years), adolescents (13–17 years), and young adults (18–25 years) who went missing for the first time in 2005. Individuals were followed-up over a 10-year period using police records. A comparison of justice involvement across the three age groups revealed key differences in missing person episodes and other justice-related involvement. Collectively, the findings offer further insights into the characteristics and justice trajectories of young people who go missing to help inform further evidence-based, risk assessment and related police responses. [ABSTRACT FROM AUTHOR]

Background: Common clinical sense would suggest that individuals with milder obsessive-compulsive disorder (OCD) symptoms should be the most suitable for guided internet-delivered cognitive behaviour therapy (CBT), with more intensive forms of treatment reserved for more severe or complex cases. Results: In this secondary data analysis of a non-inferiority clinical trial comparing internet-delivered CBT with in-person CBT for young people with OCD (N = 152), we found that higher baseline symptom severity predicted worse treatment outcomes in the in-person group but not the internet-delivered CBT group. Additional analyses showed that among individuals with milder symptoms, internet-delivered CBT was associated with worse outcomes than in-person CBT. Conclusions: If replicated, these results would question the axiom that internet-delivered CBT is most suitable for milder cases. Trial registration: The original trial was registered at ClinicalTrials.gov ID NCT03263546. Date of registration 2017–08–28. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and methodsResultsConclusions\nImplications for rehabilitationTo investigate impact of International Classification of Functioning, Disability and Health (ICF) personal factors on pain, function, or quality of life following lower limb orthopaedic surgery in children with cerebral palsy (CP).Systematic review of prospective studies of lower limb orthopaedic surgery in children with CP reporting relationships between ICF personal factors, and pain, function, or quality of life.Eight prospective studies reporting various orthopaedic procedures (median follow-up 2.1 years) were eligible, but not sufficiently homogenous for meta-analysis. Functional outcomes most reported (n = 6), then pain (n = 3) and quality of life (n = 1). Personal factors were age (n = 3), sex (n = 4), child education (n = 1), and co-morbidities (n = 1). Older children had lower function (p < 0.01), and children in “special education” greater improvement in function compared to those in “regular” education (p = 0.001) post-single-event multi-level surgery (SEMLS). Age and sex not associated with function, pain, or quality of life post-single-joint procedures (p > 0.05), except females with higher pain intensity (p = 0.019) and lower function (p = 0.018) post-Schanz procedure. No association between sex and function post-SEMLS (p > 0.05).Further prospective cohort studies are needed to understand the influence of personal factors identified in this review and investigate the effect of other personal factors on pain, quality of life, and function.Outcomes of lower limb orthopaedic surgery in children with cerebral palsy are influenced by personal factors, and these should be considered by health professionals when planning peri-operative care.Age influences outcomes such that older children have lower levels of function post-single-event multi-level surgery (SEMLS) than those younger.Sex may influence outcomes such that girls report higher pain intensity, and lower function post-Schanz procedure than boys.Educational environments may also influence outcomes such that children in special education show greater functional improvements post-SEMLS than children in regular education.Outcomes of lower limb orthopaedic surgery in children with cerebral palsy are influenced by personal factors, and these should be considered by health professionals when planning peri-operative care.Age influences outcomes such that older children have lower levels of function post-single-event multi-level surgery (SEMLS) than those younger.Sex may influence outcomes such that girls report higher pain intensity, and lower function post-Schanz procedure than boys.Educational environments may also influence outcomes such that children in special education show greater functional improvements post-SEMLS than children in regular education. [ABSTRACT FROM AUTHOR]