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Parents play a vital role in supporting children with learning disabilities, but little is known about their understanding of this diagnosis. The experiences of parents with the diagnostic process and the services their children receive post-diagnosis vary widely. Parents who participated in this study reported that they understand learning disabilities broadly but not their underlying neurobiology. Those who noted understanding the neurobiology indicated that it helped them better support their child, and those who did not understand it wanted to learn more. Parents generally noted that their children received less support during COVID-19 and that they had to seek more private services in order to support their child's academic progress, which caused additional strain on families. Finally, parents reported that having a child with a learning disability negatively affected their mental health, especially when parents feel like they have had to advocate strongly for their child to receive services.

Rates of mental health challenges among children and youth are on the rise. Physical activity has been identified as a promising intervention to improve mental health outcomes for youth. This study aimed to investigate how mental health clinicians perceive and utilize physical activity as a mental health intervention for children and adolescents. Seventy-four Ontario mental health clinicians (psychologists, psychotherapists, and social workers) were surveyed about their perspectives and practices related to physical activity as part of mental health care for children and adolescents using a mixed-methods approach. Survey respondents were also asked about barriers to including physical activity in care. Although 100% of clinicians agreed that physical activity was beneficial to their own and to their clients' mental health, only 61% reported prescribing physical activity to their clients. Barriers to prescribing physical activity as a treatment option included lack of training, time, and resources. Clinicians who were more physically active themselves were more likely to view physical activity as beneficial for mental health and were less likely to view time as a barrier to discussing and prescribing physical activity in their practice. Many clinicians expressed a need for more training, knowledge, and resources. The results of this study suggest that with improved access to training and resources, clinicians will be well-positioned to leverage the benefits of physical activity for mental health in their practice.

Machiavellianism is an antisocial interpersonal style involving the use of manipulative, deceptive, and coercive behaviors in the pursuit of self-interest. Although widely studied as a "dark" personality trait in adults, relatively little is known about the developmental correlates of Machiavellian tendencies earlier in life. The present study addressed this knowledge gap by examining associations between Machiavellian behavior and three theoretically relevant social-emotional domains-prosocial emotions, emotion recognition skills, and self-control--in a community sample of 7- and 11-year-old Canadian children (N = 300, 50% female). Of particular interest was the extent to which individual differences in social-emotional capacities were uniquely associated with Machiavellian behavior after controlling for aggression, a relatively well-studied antisocial behavior in childhood. Parents reported on children's Machiavellian behavior and aggression. Social-emotional correlates were assessed via parent and child reports, behavioral tasks, and physiological assessments. Machiavellian behavior and aggression were similarly associated with lower parent-reported prosocial emotions and self-control. Machiavellian (but not aggressive) behavior was associated with lower child-reported guilt (a prosocial emotion), higher resting skin conductance levels (reflecting a general tendency for higher arousal), and better anger recognition. Semipartial correlational analyses indicated that these patterns of association with Machiavellian behaviors held independent of aggression. These findings indicate that, by middle childhood, Machiavellian behavior constitutes a distinct form of antisocial conduct that is associated with a unique social-emotional risk profile.

Background: Delinquent behaviours among youth harms health and social trajectories, and public health broadly. Despite evidence that engaging in and being victimized by delinquent behaviours often cluster, most studies have examined the clustering of delinquent behaviours or victimization experiences independently. Information on patterns of co-occurrence is crucial to design appropriate interventions. Objectives: The primary purpose was to identify latent classes of delinquency and victimization among youth from the general population. The secondary purpose of this study was to examine associations of individual, household, and classroom covariates on latent class membership. Method: The sample consisted of 1948 youth aged 4-14 from the 2014 Ontario Child Health Study. Latent class analysis was performed to identify patterns of delinquent behaviours and experiences of victimization, while multinomial regression was conducted to examine how covariates were associated with likelihood of class membership. Results: The analysis identified four classes of youth in the OCHS sample: (1) low delinquency and low victimization (75.4%), (2) moderate victimization and moderate school delinquency (7.8%), (3) high victimization and moderate home delinquency (11.8%), and high victimization and high home and school delinquency (5.0%). Youth sex, household income, ethnicity, parental education, and parental depression were associated with differences in class membership. Conclusions: Approximately one quarter of youth engaged in delinquent behaviours, with patterns of co-occurrence suggesting these youth engage in delinquent behaviours and are victimized by delinquent behaviours across environments. Interventions should approach youth delinquency and victimization as a spectrum of clustered behaviours and experiences in these environments.

Participation in authentic research in the field and online through Community and Citizen Science (CCS) has shown to bring learning benefits to volunteers. In online CCS, available platforms present distinct features, ranging from scaffolding the process of data collection, to supporting data analysis and enabling volunteers to initiate their own studies. What is yet not well understood is how best to design CCS programmes that are educational, inclusive, and accessible by diverse volunteers, including young people and those with limited prior science experiences who are rather few in CCS. In this study, we interviewed 31 young people, aged 7-20 years old, who used iNaturalist, an online biodiversity monitoring platform, and identified how different forms of participation online and in the field facilitated (or inhibited) certain forms of learning, as defined by the Environmental Science Agency framework. Findings revealed that iNaturalist enabled participation of young people including those with limited science experiences and facilitated science learning such as the development of science competence and understanding. A blended learning framework for biodiversity monitoring in CCS is presented as a means to support the development of hybrid, educational, and inclusive CCS programmes for young people.

Objective: This study aims to delineate the characteristics of severe self-injurious behaviors (SIB) in a cohort of children with autism and unspecified intellectual developmental disorder (UIDD) (intellectual disability) and examine potential risk factors for developing SIB. Methods: A retrospective chart review studied characteristics of severe SIB in 30 children with autism spectrum disorder (ASD) and UIDD referred to a tertiary care center. Characteristics examined include genetic syndromes, brain MRI abnormalities, verbal ability, adaptive functioning, SIB frequency and severity, age of onset, number of psychopharmacological agents, irritability, hyperactivity, stereotypy, psychiatric and physical comorbidities, among others. Descriptive and bivariate analysis were applied to explore potential relationships between factors. Results: Children with severe SIB exhibit this behaviour with high frequency, inflicting moderate to severe injury. Most children in the study sample are non-verbal and have ASD (93.3%; n = 28) with psychiatric (96.7%; n = 29) and physical (90%; n = 27) comorbidities. Overall SIB improvement using the Clinical Global Impression, Improvement Score (CGI-I) was 3.0 (minimally improved). A minority were much or very much improved following appropriate intervention. Conclusions: The severity of SIB is much higher in this sample than previously noted in the literature. Severe SIB is associated with ADHD, early onset mood disorders, tics, avoidant restrictive food intake disorder and Obsessive-Compulsive Disorder.

This article examines how participants enrolled in teacher education and childhood studies courses represented their understandings of childhood through a selection of artefacts discussed in focus groups at four sites: Montréal, New York City, Ottawa, and Toronto. To situate our inquiry, we theorise nostalgia in relationship to the construction of childhood innocence, with a focus on children's everyday objects and playthings in upholding this ideal. We further trace the construction of innocence to discourses of social exclusion and defences against difficulty. While participants used their artefacts to represent personal memories and social contexts that disrupted an idealised category of childhood, they also returned to a nostalgic trope of innocence, which was particularly pronounced in their understandings of childhood under COVID-19. We advocate for the creation of time and space for prospective and practicing teachers to mourn the idealisation of innocence and to examine the unequal conditions of vulnerability that both children and teachers live.

Emerging research shows that Acceptance and Commitment Therapy (ACT) may improve mental health for caregivers. Parents of autistic children, adolescents, and adults (N = 54) were randomly assigned to either complete a brief group-based ACT intervention or remain on the waitlist. Participants completed surveys immediately prior to randomization, and 3-, 7-, and 17-weeks post-randomization. The primary outcome was depression symptoms and secondary outcomes included stress, goal attainment, positive affect, ACT psychological processes, child mental health, and family functioning. Mixed effects linear models testing Group × Time interaction indicated the Treatment group (n = 27) demonstrated greater post-intervention improvements than the Waitlist group (n = 27) in parent depression (p = 0.03, d = -0.64) and family distress (p = 0.04, d = -0.57). Treatment group parents also reported greater short-term gains in positive affect (p =< 0.001, d = 0.77) and personal goal attainment (p = 0.007, d = 0.80), compared to the Waitlist group. Although there was no significant Group × Time interaction for other outcomes, stress (b = -2.58, p = 0.01), defusion (b = -3.78, p = 0.001), and experiential avoidance (b = -4.22, p = 0.01) showed improvement for the Treatment group, but not the Waitlist group, at post-intervention. All Treatment group improvements were maintained at follow-up. Results suggest that a brief ACT group intervention is efficacious for improving some aspects of mental health for parents of autistic children.

Reading confers significant benefits to children in both social and academic domains. However, the number of children who read for pleasure is decreasing and has been shown to drop significantly between the ages of 8 and 9. Despite the rising popularity of audiobooks and podcasts, research on children's listening to spoken stories remains in its infancy. Thus, the present study explores how children engage with these realtively novel media. Fifty-two parents of children aged 8-13 years completed an online survey that asked about their children's listening habits. Results showed that 74% of children listen to spoken stories, with the vast majority (92.5%) listening at least 1-2 times per week. While the survey revealed children are engaging with both podcasts and audiobooks, being read aloud to continues to be the most popular format for story listening in this age group (77.4% of listeners). Across platforms, the genre most frequently listened to was fantasy stories (84.9%; more detailed descriptions of popular themes and sub-themes are described in text). In sum, access to technology is becoming an increasingly important part of children's lives. The data described here provide a timely perspective and a basis for informed studies of listening engagement in children.

This study investigated the relationship between traumatic life stress, trust, and prosocial behavior as a positive mental health outcome in Syrian refugee children in Canada. Trust is a resilience factor shown to promote adjustment after resettlement. The specific goals of the study were to test the influence of refugee children's traumatic life stress on their prosocial behavior and the mediating role of trust in this link. Five- to 12-year-old Syrian refugee children (N = 124) and their caregivers (N = 51) who recently resettled in Canada participated in this study. Children retrospectively reported their experiences of traumatic life stressors, and caregivers reported their children's current level of trust and prosocial behavior using questionnaires. Traumatic life stress (e.g., witnessing violence and conflict, separation from family, death of family members) was negatively related to refugee children's trust in others, while trust was related to more prosocial behaviors, confirming its mediating role. These results suggest that experiencing more traumatic life stressors is associated with less prosocial behaviors as a positive mental health outcome through lower levels of trust. The current findings suggest that fostering trust may be a promising avenue for intervention to promote prosocial behavior and resilience in refugee children who are resettling in a new society.

The goals of this study were to investigate (a) the dyadic relations of mothers' and children's perceptions of children's anxiety symptoms across development, (b) whether maternal perceptions of children's anxiety serve as a mediator of the association between maternal anxiety and child anxiety, and (c) whether sensitive/structured parenting moderates these processes. Participants were 180 mother-child dyads (96 female) recruited from Quebec, Canada, and assessed in preschool, middle childhood, and early adolescence. Mothers and children completed questionnaires on children's anxiety, and mothers additionally completed a questionnaire on their own anxiety. Maternal sensitivity/structuring was assessed from an observed interaction task. Results from an actor-partner interdependence model suggest (a) maternal perceptions of children's anxiety in middle childhood predict children's self-perceptions in adolescence, but not vice versa; (b) maternal perceptions in middle childhood mediate the link between maternal anxiety in early childhood and child self-perceptions of anxiety in adolescence; and (c) the indirect effect of maternal perceptions is moderated by maternal sensitivity/structuring such that mothers who perceived more anxiety in their children and who were observed to show lower levels of sensitivity/structuring in middle childhood tended to have children who perceived more anxiety in adolescence. Findings suggest that maternal awareness of children's anxiety may be one mechanism, in the presence of relationships characterized by lower levels of sensitivity, through which anxiety risk is transferred from parent to child over time.

Background: Most health and developmental issues affecting young people are interrelated. However, few interventions address multiple behavioral domains simultaneously or are based on theories that encompass a holistic perspective of youth development. Aim: The purpose of this scoping review was to identify and describe the range of theory-based, multibehavioral health interventions aimed at improving two or more of the following behavioral youth outcomes: (1) sexual and reproductive health; (2) education and employment; (3) violence; and (4) substance use. Methods: Interventions conducted worldwide and published in English or Spanish between January 2000 and July 2020 were identified using four databases: PubMed, PsycINFO, LILACS, and SciELO. Results: A total of 11,084 articles were identified, of which 477 were retrieved and assessed for eligibility. Twenty-three articles (evaluating 21 interventions) ultimately met the inclusion criteria. Most interventions were conducted in the United States and addressed two behavioral domains of interest, although seven interventions incorporated three domains, and one incorporated all four. Substance use was the most common domain (16 interventions) but only in the United States/Canada, followed by sexual and reproductive health (14 interventions). All produced significant improvement in at least one outcome or for at least one subgroup of youth. The most common theoretical foundations were positive youth development and social learning theory. Conclusion: Integrated interventions that are theory based and evidence informed can support positive development and empower youth to make healthy decisions. Further efforts are needed to address structural and policy issues that affect young people's developmental opportunities and health outcomes.

A strength-based approach to childhood attention-deficit/hyperactivity disorder (ADHD) research highlights children's positive attributes that can support their areas of difficulty. However, research on perceptions of a child's positive attributes is understudied. Specifically, there is little research that examines strength-based perceptions of children with ADHD, and only one known article addresses parent perceptions of their children with ADHD. As such, this study analyzed parent and child-reported strengths in children with ADHD. Parent and child-reported strengths were measured using the Behavioral and Emotional Rating Scale--Second edition, Parent Form and Child Form (BERS-2). Results indicated that parents and children perceived strengths in the interpersonal, intrapersonal, and affective domains to be similar, falling in the Average range. However, children indicated their family involvement and school functioning fell within the Average range, whereas parents rated these domains below average. Positive parental perspectives of their children may promote positive parent-child interactions and serve as an overall protective factor for children with ADHD. Domains which parents and children see as strengths should be utilized to support areas of weakness. Strength-based research for children with ADHD and positive interventions utilizing strengths may benefit families with ADHD, as well as classroom teachers and school psychologists.

Executive function (EF) is critical to students' academic behaviors and well-being. Environmental influences, particularly teacher-student interaction (TSI), play a key role in enhancing EF development. Previous studies have linked TSI quality to children's EF, yet the relationships between subdimensions of TSI--such as closeness, conflict, dependency, emotional support, classroom management, and instructional support--and EF outcomes remain unclear. Moreover, it is unclear whether these relations hold true across different cultural contexts. From an initial pool of 14,915 articles, in this meta-analysis, we considered 84 empirical studies across 18 cultural regions, revealing that TSI subdimensions are consistently related to EF with small-to-medium effect sizes. The analysis also identified statistically significant moderating factors, such as individualism, power distance, EF type, EF instrument, and socioeconomic status. Notably, stronger TSI-EF correlations were found among children from cultures with low-individualism and high-power-distance, as well as among children from higher socioeconomic backgrounds. These patterns were particularly pronounced in studies measuring hot EF through adult-reported data. This comprehensive meta-analysis bridges knowledge gaps in TSI-EF dynamics, and supporting theories, such as attachment theory, social learning theory, and socio-cultural theory within educational settings. Crucially, it provides cross-cultural perspectives showing how cultural and contextual factors may intertwine with TSI-EF interactions.

Autism Spectrum Disorder (ASD) is a lifelong condition characterized by restrictive, repetitive patterns of behaviour, and impairments in social communication. Various forms of physical activity, including dance, have shown to improve ASD symptoms among children. The study's purpose was twofold: to examine the lived experiences of a family with a child with ASD, in order to examine family functioning and the effects of the child's participation in a dance programme. The family unit and dance instructor participated in one-on-one semi-structured interviews, which included a myriad of questions about the family, and the child's participation in a recreational dance programme. One salient main theme that emerged was Dance, Dance, Dance, with three subthemes: (1) 'Home Away from Home' (studio as a representation of home), (2) Growing as a Person (physically, emotionally, socially), and (3) Lessons Learned (bidirectional learning between student and teacher). Dance provided many benefits to the child, including improvements in social and listening skills, as well as confidence. Further, dance allowed the child to grow socially and personally. This study may act as a support for other families faced with an ASD diagnosis, as well as highlight the benefits of recreational dance programmes for children with ASD.

This study aimed to obtain consensus on physical activity (PA) and sedentary behaviour (SB) policy items for use in Canadian childcare settings. Purposeful sampling of Canadian experts in PA/SB (n = 19) and Early Childhood Education (ECE; n = 20) was used to form two distinct (i.e., PA/SB and ECE) panels for a 3-round Delphi study. In round 1, the PA/SB experts suggested their top 10 items for a Canadian childcare PA/SB policy. Policy items were then pooled to generate a list of 24 unique items. In round 2, experts in both panels rated the importance of the 24 policy items using a 7-point Likert scale (i.e., 1 = "Not at all important" to 7 = "Extremely important"). The ECE panel was also asked to report on the feasibility of the policy items using a 4-point Likert scale (i.e., 1 = "Not at all feasible" to 4 = "Very feasible"). Policy items that received an interquartile deviation (IQD) score of [less than or equal to] 1 (indicating consensus) and a median score of [greater than or equal to] 6 (indicating importance) in both panels were considered shared priorities. In round 3, members of both panels re-rated the importance of the policy items that did not achieve consensus among their respective panel in round 2 and were asked to order items based on importance. Descriptive statistics were used to assess feasibility of policy items, and differences in panel ratings were quantified using Mann Whitney U tests. Consensus was achieved for 23 policy items in the PA/SB panel and 17 items in the ECE panel. Overall, 15 shared priorities were identified (e.g., provide 120 min of outdoor time per day, sedentary behaviour should not be used as a punishment), and six policy items exhibited a statistical difference in ratings across panels. Members of the ECE panel indicated that the policy item, "children should be permitted to go outside whenever they want, for as long as they want" (M = 1.78; SD = 0.65) was lowest in terms of feasibility, and the policy item, "children should receive opportunities to engage in both unstructured and structured physical activity opportunities daily" (M = 3.89; SD = 0.32) was the most feasible for daily implementation. Findings from this study can inform the development of an expert-generated and feasibility-informed institutional PA/SB policy for use in Canadian childcare settings.

Bilingual children often lag behind monolinguals on standardized measures of language acquisition, such as vocabulary tests. This bilingual lag could be related bilinguals' lesser experience with the target language relative to monolinguals. In this study, we predicted that sequential Mandarin-English bilinguals would perform worse than same-aged English monolinguals on a standardized measure of complex sentence production. As predicted, the bilingual preschoolers performed worse than age-matched English monolinguals. However, once English experience was covaried, there was no significant difference between the two groups. After controlling for age, we tested three predictors of complex sentence production: (1) English vocabulary, (2) verbal memory, and (for the bilinguals) (3) Mandarin vocabulary. For both bilinguals and monolinguals, English vocabulary and verbal memory were significant predictors. These results support the argument that experience with a particular language is highly predictive of children's ability to produce complex sentences in that language. Verbal memory is also an important predictor of individual differences in the ability to produce complex sentences.

Significant barriers to training have been introduced by the COVID-19 pandemic, limiting in-person professional activities resulting in the development of the novel remote training. We developed and evaluated a remote training approach for master trainers of the Caregiver Skills Training Program. Master trainers support community practitioners, who in turn deliver the Caregiver Skills Training program to caregivers of children with developmental delays or disabilities. The aim of this study was to evaluate the remote training of master trainers on Caregiver Skills Training Program. Twelve out of the 19 practitioners who enrolled in the training completed the study. The training consisted of a 5-day in-person session completed prior to the pandemic, followed by supporting participants' ability to identify Caregiver Skills Training Program strategies through supported coding of seven video recordings over 7 weekly meetings and group discussions and ended with participants independently coding a set of 10 videos for Caregiver Skills Training Program strategies. We found that master trainers' scoring reliability varied over 7 weeks of supported coding. All but one participant reached moderate or good independent scoring reliability despite a lack of ability to practice the Caregiver Skills Training Program strategies with children due to the pandemic. Taken together, our findings illustrate the feasibility and value of remote training approaches in implementing interventions.

Adults are skilled at using language to construct/negotiate identity and to signal affiliation with others, but little is known about how these abilities develop in children. Clearly, children mirror statistical patterns in their local environment (e.g., Canadian children using "zed" instead of "zee"), but do they flexibly adapt their linguistic choices on the fly in response to the choices of different peers? To address this question, we examined the effect of group membership on 7- to 9-year-olds' labeling of objects in a trivia game, exploring whether they were more likely to use a particular label (e.g., "sofa" vs. "couch") if members of their "team" also used that label. In a preregistered study, children (N = 72) were assigned to a team (red or green) and were asked during experimental trials to answer questions--which had multiple possible answers (e.g., "blackboard" or "chalkboard")--after hearing two teammates and two opponents respond to the same question. Results showed that children were significantly more likely to produce labels less commonly used by the community (i.e., dispreferred labels) when their teammates had produced those labels. Crucially, this effect was tied to group membership, and could not be explained by children simply repeating the most recently used label. These findings demonstrate how social processes (i.e., group membership) can guide linguistic variation in children.

Background: Active school transportation (AST) is an important source of physical activity for children and a potentially important climate change mitigation strategy. However, few studies have examined factors associated with AST in the context of the COVID-19 pandemic. Methods: We used baseline data from a longitudinal survey to investigate correlates of AST during the second wave of COVID-19 (December 2020). We collected survey data from 2291 parents of 7- to 12-year-olds across Canada and linked this information with data on neighborhood walkability and weather from national databases. We assessed potential correlates representing multiple levels of influence of the social–ecological model. We used gender-stratified binary logistic regression models to determine the correlates of children's travel mode to/from school (dichotomized as active vs motorized), while controlling for household income. We examined the correlates of travel mode for both the morning and afternoon trips. Results: Consistent correlates of AST among Canadian children during the COVID-19 pandemic included greater independent mobility, warmer outdoor temperature, having a parent who actively commuted to work or school, living in a household owning fewer vehicles, and living in a more walkable neighborhood. These findings were largely consistent between boys and girls and between morning and afternoon school trips. Conclusions: Policymakers, urban planners, and public health workers aiming to promote AST should focus on these correlates while ensuring that neighborhoods are safe for children. Future research should monitor the prevalence and correlates of AST as COVID-19 restrictions are removed. [ABSTRACT FROM AUTHOR]

To explore the benefits of a brief autism education intervention on peer engagement and inclusion of autistic children at day camps. A convergent, parallel, two-arm (intervention/no intervention), non-randomized, mixed-methods design was used. The individualized, peer-directed, 5–10 min intervention included four components: (1) diagnostic label, (2) description and purpose of unique behaviors, (3) favorite activities and interests, and (4) strategies to engage. A timed-interval behavior-coding system was used to evaluate engagement between each autistic camper and their peers based on videos taken at camp (days 1, 2, 5). Interviews with campers and camp staff explored why changes in targeted outcomes may have occurred. Percent intervals in which the autistic campers were jointly engaged with peers improved in the intervention group (n = 10) and did not change in the control group (n = 5). A large between group intervention effect occurred by day 5 (Z = − 1.942, η2 = 0.29). Interviews (5 autistic campers, 34 peers, 18 staff) done on the last day of camp in the intervention group garnered three themes: (1) Changed behavioral attribution, (2) Knowledge facilitates understanding and engagement, and (3) (Mis)perceptions of increased inclusion. A brief educational intervention that includes individualized explanatory information and strengths-based strategies might improve peers' understanding of and social engagement with autistic children in community programs such as camps. [ABSTRACT FROM AUTHOR]

Domestic violence (DV) impacts the safety and well-being of adult victims and their children who are exposed to the violence. Police play a critical role in providing intervention strategies to protect the welfare of victims of DV. Police training, policy and procedures on intervention strategies are often adult-centric leaving little direct police interaction with children. Objective: The objective of the current study is to identify the challenges police officers perceive in providing effective safety planning and risk management strategies for domestic violence victims and their children. Participants, Setting & Methods: Interviews with domestic violence police specialists (n = 12) in Ontario, Canada were used to gather information on police officers' perspective on the challenges they face in executing safety planning and risk management strategies. A dual deductive/inductive approach to a thematic analysis at the sematic level was used (Braun and Clarke, Qualitative Research in Psychology 3:77–101, 2006) to explore themes. Results: The major themes that emerged from the interviews were: (a) challenges with the broader economic/social and judicial system; (b) challenges created by organizational factors; and (c) individual challenges affiliated with police officers' perception of barriers they encountered. These challenges all impact the police response to providing intervention strategies to DV victims and their child(ren). Conclusions: This study highlights the need for police organizations to formalize training, policies, and directives specific to safety planning and risk management for adult victims of DV and their children. [ABSTRACT FROM AUTHOR]

African immigrants comprise an increasing proportion of Canada's immigrant population and face myriad challenges upon arrival. There are few studies that examine the experiences of African single-parents and their struggles as they try to integrate into Canadian society with their children. This qualitative study sought to highlight the experiences of single mothers and their children. Semi-structured interviews were conducted with a total of 15 participants comprising eight children and seven mothers. Demographic questionnaires were used to gather background information about each participant. Some of the challenges the mothers experienced included lack of recognition of their foreign educational credentials and work experience, under-employment, financial insecurity, and lack of mental health support networks in Canada. The participants' sources of support included immigrant settlement agencies, schools, government subsidies, faith communities, and their extended family members outside of Canada. The data demonstrate a need to ensure expeditious assessment, and where warranted, recognition of immigrants' foreign educational and work experience to facilitate access to their professional careers. There is also a need to establish culturally responsive supports to foster the wellbeing of immigrants. [ABSTRACT FROM AUTHOR]

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]

1) To explore how children with spina bifida (SB) and their parents understand bodyweight, health and weight management; and 2) To identify what services and supports children with SB and their families feel are most appropriate to help them manage their health and weight. The study used interpretive description within a qualitative design. Participants were children with SB (aged 10-18) attending two Canadian SB clinics and their parents. Data were collected through individual interviews and analyzed using inductive thematic analysis. Five children and five parents participated in the study. Children and parents had a weight-centric approach to health, which was related to the child's mobility. Weight was considered to be under individual control and mostly through diet. Trusting relationships between healthcare providers, children and families were important to discuss weight in a non-judgemental manner. Children should be involved in setting meaningful and achievable weight management goals. Greater knowledge of how children with SB and their families understand weight and health offers opportunities for non-judgemental discussions about their needs and wishes. Helping families to place more value on health over weight may reduce feelings of stigma, while allowing children to develop some autonomy over health-related decisions. Children with spina bifida and their parents do not recognise the complexity of factors contributing to weight regulation. Weight regulation was often seen as the child's responsibility, which could lead to feelings of guilt and shame through internalised weight stigma Healthcare professionals working with children with spina bifida should explore their perceptions, beliefs, and behaviours related to weight, health and mobility to ensure they are not causing themselves physical and/or psychological harm [ABSTRACT FROM AUTHOR]

Background: Detergent packets are common household products; however, they pose a risk of injuries and poisonings, especially among children. This study examined the epidemiological characteristics of pediatric injuries and poisonings related to all types of detergent packets in Canada using emergency department (ED) data from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) database. Methods: The CHIRPP database was searched for ED visit records for injuries and poisonings related to all types of detergent packets between April 1, 2011 and October 12, 2023 (N = 2,021,814) using variable codes and narratives. Data for individuals aged 17 years and younger were analyzed descriptively. Temporal trends in the number of detergent packet-related injuries and poisonings per 100,000 CHIRPP cases were assessed using Joinpoint regression and annual percent change (APC). A proportion ratio and 95% confidence intervals (CI) were calculated to compare the proportion of detergent packet-related cases in CHIRPP during two 34-months periods, pre-COVID-19 pandemic and after the beginning of the pandemic. Results: There were 904 detergent packet-related cases among children and youth aged 17 years and younger identified in CHIRPP between April 1, 2011 and October 12, 2023, representing 59.9 cases per 100,000 CHIRPP cases. The majority (86.5%) of cases were among children aged 4 years and younger. Poisonings (58.8%) and eye injuries (30.6%) were the most frequent primary diagnoses. Unintentional ingestion (56.9%) and squeezing/breaking a detergent packet (32.3%) were the most frequent exposure mechanisms. Sixty-five patients (7.2%) were admitted to hospital. The number of detergent packet-related cases per 100,000 CHIRPP cases increased by 5.0% (95% CI 0.8, 10.2) annually between 2012 and 2022. The number of detergent packet-related poisonings per 100,000 CHIRPP cases decreased by 15.3% (95% CI − 22.3, − 10.6) annually between 2015 and 2022, whereas eye injuries showed an average annual percent increase of 16.6% (95% CI 11.2, 23.0) between 2012 and 2022. The proportion of detergent packet-related cases in CHIRPP after the beginning of the pandemic (79.9/100,000 CHIRPP cases) was 1.43 (95% CI 1.20, 1.71) times greater than pre-pandemic (55.7/100,000 CHIRPP cases). Conclusions: Detergent packet-related injuries and poisonings are a persisting issue. Continued surveillance and prevention efforts are needed to reduce detergent packet-related injuries and poisonings in Canada, particularly among children and youth. [ABSTRACT FROM AUTHOR]

Free play is essential for children's development and for their physical, mental, and social health. Opportunities to engage in outdoor free play—and risky play in particular—have declined significantly in recent years, in part because safety measures have sought to prevent all play-related injuries rather than focusing on serious and fatal injuries. Risky play is defined by thrilling and exciting forms of free play that involve uncertainty of outcome and a possibility of physical injury. Proponents of risky play differentiate "risk" from "hazard" and seek to reframe perceived risk as an opportunity for situational evaluation and personal development. This statement weighs the burden of play-related injuries alongside the evidence in favour of risky play, including its benefits, risks, and nuances, which can vary depending on a child's developmental stage, ability, and social and medical context. Approaches are offered to promote open, constructive discussions with families and organizations. Paediatricians are encouraged to think of outdoor risky play as one way to help prevent and manage common health problems such as obesity, anxiety, and behavioural issues. [ABSTRACT FROM AUTHOR]

Objectives Access to early phase trials for children with relapsed, refractory or progressive (RRPD) cancer is limited in Canada. Patients and families face barriers to access trials, which are poorly understood. The aims of this study were to assess availability of early phase trials and examine the impact of distance from home to study centre on trial enrolment among paediatric oncology patients with RRPD. Methods Oncology patients ≤18 years at diagnosis who later had RRPD were identified retrospectively via registry at the only quaternary paediatric oncology centre in British Columbia (BC). We determined if distance to home, as calculated using geocoding software, was predictive of trial offer or enrolment. Results Between January 2015 and July 2021, 266 patients experienced 396 RRPD events. Seventy-five patients (28.2%) were eligible for an early phase trial at least once. At first eligible event, 61 patients (22.9%) were offered trial (median age 11.8 years; 69.0% male; 46.0% with CNS tumour) and thirty patients (11.3%) enrolled. Distance was not associated with odds of offer (OR 1.01, CI 0.98 to 1.05) or enrolment (OR 0.99, CI 0.95 to 1.03) on univariate or multivariable analysis adjusted for sex and disease (OR 0.93, CI 0.86 to 1.00). For offered patients, 2-year event-free survival (EFS) and overall survival (OS) were 39.1% (CI 28.0% to 54.8%) and 51.8% (CI 39.9% to 67.2%), respectively. EFS/OS did not differ with distance or enrolment, but varied by disease (EFS P = 0.002, OS P < 0.0001). Conclusions Children in BC with cancer and RRPD have limited access to early phase trials. Distance was not predictive of enrolment, suggesting that families travel to access therapy. [ABSTRACT FROM AUTHOR]

Collaboration is an early emerging component of successful cooperative relations that produces a cascade of positive social preferences between collaborators. Concurrently, robust preferences for affiliated others may restrict these benefits to in-group peers. We investigated how in-group affiliation (based on minimal group markers) and interpersonal affiliation (based on shared preferences) influence children's collaborative partner choice. We asked whether children prefer to collaborate with affiliated peers and if highlighting interpersonal affiliation with out-group members reduce in-group bias in partner choice. In Study 1, we assigned children (4–9 years, N = 124, 62 female, two nonbinary) to either a group or interpersonal affiliation condition and gave them a choice of collaborating with either an affiliated (in-group or same preference) or unaffiliated (out-group or different preference) peer. While children preferred affiliated peers in both conditions, interpersonal affiliation had a greater influence than group affiliation on collaborative partner choice among younger participants. With age, the difference between children's preference for affiliated peers in the interpersonal and group affiliation condition declined until they were similar in middle childhood. In Study 2, we assessed whether shared preferences would override in-group bias when these factors were directly contrasted. Children (4–9 years, N = 62, 33 female) chose between an in-group/different preference or out-group/same preferences peer. Younger children preferred the out-group/same preference peer, a preference that diminished with age to chance levels in middle childhood. These findings suggest that affiliation is an important determinant of collaborative partner choice and that shared preferences can override in-group bias in children's collaborative partner choice. Public Significance Statement: In-group prejudice is a barrier to cooperation with significant real-world consequences. It has long been hypothesized that collaboration between groups may be a way of mitigating in-group bias and encouraging cooperation. The current studies reveal that while children prefer to collaborate with in-group peers, highlighting shared preferences may be a way of encouraging collaboration with out-group peers, particularly in young children. [ABSTRACT FROM AUTHOR]

Machiavellianism is an antisocial interpersonal style involving the use of manipulative, deceptive, and coercive behaviors in the pursuit of self-interest. Although widely studied as a "dark" personality trait in adults, relatively little is known about the developmental correlates of Machiavellian tendencies earlier in life. The present study addressed this knowledge gap by examining associations between Machiavellian behavior and three theoretically relevant social–emotional domains—prosocial emotions, emotion recognition skills, and self-control—in a community sample of 7- and 11-year-old Canadian children (N = 300, 50% female). Of particular interest was the extent to which individual differences in social–emotional capacities were uniquely associated with Machiavellian behavior after controlling for aggression, a relatively well-studied antisocial behavior in childhood. Parents reported on children's Machiavellian behavior and aggression. Social–emotional correlates were assessed via parent and child reports, behavioral tasks, and physiological assessments. Machiavellian behavior and aggression were similarly associated with lower parent-reported prosocial emotions and self-control. Machiavellian (but not aggressive) behavior was associated with lower child-reported guilt (a prosocial emotion), higher resting skin conductance levels (reflecting a general tendency for higher arousal), and better anger recognition. Semipartial correlational analyses indicated that these patterns of association with Machiavellian behaviors held independent of aggression. These findings indicate that, by middle childhood, Machiavellian behavior constitutes a distinct form of antisocial conduct that is associated with a unique social–emotional risk profile. Public Significance Statement: By middle childhood, Machiavellian behaviors such as manipulation, deception, and coercion are distinct from aggression in terms of their occurrence and associations with other domains of social–emotional functioning (e.g., prosocial emotions, emotion recognition ability, self-control). This suggests that traditional prevention and intervention programs targeting aggressive and violent tendencies may be less effective at curbing more subtle and self-serving forms of antisocial conduct. [ABSTRACT FROM AUTHOR]

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Background: Early post-discharge assessments for newborns are recommended. Virtual care has become more prevalent during the pandemic, providing an opportunity to better understand its impact on the quality of post-discharge newborn care. The objective of this study was to understand whether primary care visit modality (in-person vs. virtual) is associated with early newborn hospital readmissions and emergency department (ED) visits. Methods: We conducted a population-based, case-control study using linked health administrative databases between September 1, 2020 and March 31, 2022 in Ontario, Canada. We compared the modality of primary care visits among cases (hospital readmission within 14 days of life) and controls (newborns without a readmission), matched on infant sex, gestational age, and maternal parity. We included an alternative definition of cases as a composite of either a newborn hospital readmission or emergency department (ED) visit or in-hospital death within the first 14 days of life. Conditional logistic regression models were used to model odds ratios (ORs), comparing those exposed to a virtual visit versus in-person visit, adjusting for infant birth weight, birth hospitalization length of stay, neighbourhood level material deprivation, rurality and presence of active maternal comorbidities. Results: Among 73,324 eligible newborns, 2,220 experienced a hospital readmission within 14 days of life and were matched to 8,880 controls. Jaundice was the primary reason for readmission (75% of readmissions). Compared to newborns who were seen in-person post-discharge, newborns who were seen virtually had higher odds of hospital readmission (adjusted odds ratio [aOR] 1.41 (95% CI 1.09, 1.83); the magnitude of effect was not different using the composite outcome (aOR 1.35, 95% CI 1.05, 1.75). Conclusions: Newborns who receive a virtual post-discharge visit are more likely than those who receive an in-person visit to require hospital readmission. [ABSTRACT FROM AUTHOR]

This multi-center study examined the safety and effectiveness of cochlear implantation of children between 9 and 11 months of age. The intended impact was to support practice regarding candidacy assessment and prognostic counseling of pediatric cochlear implant candidates. Data in the clinical chart of children implanted at 9–11 months of age with Cochlear Ltd devices at five cochlear implant centers in the United States and Canada were included in analyses. The study included data from two cohorts implanted with one or two Nucleus devices during the periods of January 1, 2012–December 31, 2017 (Cohort 1, n = 83) or between January 1, 2018 and May 15, 2020 (Cohort 2, n = 50). Major adverse events (requiring another procedure/hospitalization) and minor adverse events (managed with medication alone or underwent an expected course of treatment that did not require surgery or hospitalization) out to 2 years post-implant were monitored and outcomes measured by audiometric thresholds and parent-reports on the IT-MAIS and LittlEARS questionnaires were collected. Results revealed 60 adverse events in 41 children and 227 ears implanted (26%) of which 14 major events occurred in 11 children; all were transitory and resolved. Improved hearing with cochlear implant use was shown in all outcome measures. Findings reveal that the procedure is safe for infants and that they show clear benefits of cochlear implantation including increased audibility and hearing development. [ABSTRACT FROM AUTHOR]

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

OBJECTIVE: Pediatric cerebellar mutism syndrome (pCMS) can occur following resection of a posterior fossa tumor and, although some symptoms are transient, many result in long-lasting neurological deficits. A multi-disciplinary rehabilitation approach is often used in cases of pCMS; however, there have been no clinical trials to determine gold standards in rehabilitation practice in this population, which remains a research priority. The purpose of this study was to identify and compare intervention practices used in pCMS throughout the disciplines of occupational and physical therapy, speech-language pathology, and neuropsychology across geographic regions. METHODS: A 55-question e-survey was created by an international multidisciplinary research group made up of members of the Posterior Fossa Society and sent to rehabilitation professionals in pediatric neuro-oncology centers in the US, Canada, and Europe. RESULTS: Although some differences in the type of intervention used in pCMS were identified within each discipline, many of the targeted interventions including dose, frequency, and intensity were similar within disciplines across geographic regions. In addition, there were common themes identified across disciplines regarding challenges in the rehabilitation of this population. CONCLUSION: These results provide a foundation of current practices on which to build future intervention-based clinical trials. [ABSTRACT FROM AUTHOR]

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

Cerebral palsy (CP) is the most common physical disability in Canadian children. The comprehensive care of ambulatory children with CP functioning at Gross Motor Function Classification System (GMFCS) level I and II was covered in a previous practice point. This companion document focuses on the care of children with CP functioning at GMFCS levels III to V. Children functioning at GMFCS level III and IV mobilize using devices such as a walker, canes, or powered mobility, while those functioning at GMFCS level V require assisted mobility, such as a manual wheelchair. An overview of key concepts in early detection, rehabilitation services, and therapeutic options for children with CP at these levels is provided, along with practical resources to assist health surveillance for paediatricians caring for this population. [ABSTRACT FROM AUTHOR]

The article discusses research which examined the prevalence of invasive bacterial infection (IBI) in febrile young infants in an urban tertiary pediatric emergency department to clarify the role of viral testing when procalcitonin is not available. Data shows the demographic characteristics of infants and prevalence of IBI and viral status among febrile infants classified as high or low risk for IBI based on C-reactive protein, absolute neutrophil count and maximum temperature measurements.

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

Learning to descend stairs requires motor and cognitive capacities on the part of infants and opportunities for practice and assurance of safety offered by caregivers. The American Academy of Pediatrics prescribes the age strategy to teach toddlers to safely descend stairs but without much consideration for individual differences in infants' skills or caregivers' techniques. The purpose of this study was to observe the natural ways in which caregivers teach infants to descend stairs at home and the extent to which infants abide. Of particular interest was to examine the dynamic nature of caregivers' teaching and infants' learning over the session with attention to individual differences. Dyads (N = 59) were videorecorded on Zoom for 10 min interacting on stairs at home in the United States, Brazil, Canada, Italy, and Spain. Infants (n = 30 girls, 29 boys; 13-month-olds ± 1 week) were novice walkers (M = 2.04 months walking experience). Caregivers used a variety of teaching strategies and focused on "backing" and "scooting." Infants were more likely to heed caregivers' guidance when caregivers provided hands-on support and verbal encouragement suggesting infants were engaged and responsive to caregivers' overtures. Infants' walking experience predicted change in descent strategy over the session. Although infants did not show evidence of learning over the session, consistent caregiver instruction suggested caregivers were persistent, if not effective, teachers. Teaching and learning motor skills in a potentially risky task creates a unique opportunity for interaction, allowing infants and caregivers to learn from one another. Public Significance Statement: This work contributes to the general body of knowledge regarding infant motor development and problem solving in specific contexts. This study is one of the first to explore the nature of caregiver-infant interaction on stairs and identifies caregiver teaching strategies and infant motor characteristics that are associated with safe infant stair descent. By doing so, we hope to encourage further investigation of infant behavior in this context, upon which recommendations to caregivers for safe infant descent may be based. [ABSTRACT FROM AUTHOR]

Background: Targeted neonatal echocardiography (TNE) and hemodynamic consultation have typically been performed by physicians. The Stollery Children's Hospital neonatal intensive care unit (NICU) expanded their TNE training program to include neonatal nurse practitioners (NNPs), the first in North America. Purpose: This study examines the thoughts and perceptions of clinicians about the incorporation of NNPs providing TNE and hemodynamic consultation and investigates key facilitators and challenges for consideration when planning future training, expansion of service in Edmonton, or beyond. Methods: In this descriptive study using qualitative methodology, purposive sampling was used to invite NICU clinicians to participate. Using a semistructured topic guide, a focus group and 2 individual interviews were conducted. Results: Participants were supportive of NNPs. Advantages included increased access to service, acquisition and retention of skills, provision of patient-centered care, and leveraged interpersonal relationships in the decision-making process. Key aspects of program expansion included climate and culture of the NICU, presence of adequate patient volume, and resources to support training. Implications for Practice and Research: Support across disciplines and the collaborative working nature of the NICU are key factors in the success of the program's development and implementation. Benefits of having NNPs on the TNE team were clearly expressed. Benefits to the health system included rapid access to hemodynamic information allowing for care based on specific pathophysiology and additional local capacity to perform TNE and reducing demand on other trained providers. Additional research could consider parental views of NNPs performing TNE and hemodynamic consultation as well as the accuracy of diagnosis between the NNPs and physician group. [ABSTRACT FROM AUTHOR]

Newcomer women and children are less likely to access and utilize mental health support services as compared to the general Canadian population, despite reporting experiences of mental health issues. This review aimed to map out the social support interventions that are available for promoting the mental well-being of newcomer women and children living in Canada. A search using Medline, Cumulative Index for Nursing and Allied Health Literature, PsycINFO, and the Cochrane library was conducted to identify published studies. Studies were screened, extracted, and synthesized by two independent reviewers in line with the methodological approach for scoping reviews. Fourteen articles published in English between 2012–2023 were reviewed. Results identified five types of interventions: art and sand play interventions, support groups and workshops, assessment of existing support services, social media interventions, and short-term cognitive behavioral therapy. Our results suggest that culturally appropriate social support interventions increase mental well-being outcomes, such as self-esteem and social support, and reduce peri-migratory traumas for newcomer women and children in Canada. However, findings from this review underscore the need for more quantitative and participatory research approaches so that newcomer women's and children's needs are adequately explored and addressed. [ABSTRACT FROM AUTHOR]

(1) Background: Severe primary insulin-like growth factor-I deficiency (SPIGFD) is a rare disorder causing short stature in children due to low insulin-like growth factor 1 (IGF-1) levels. Given the sparsity of reported cases of SPIGFD worldwide, the condition may be underdiagnosed, potentially preventing affected children from receiving therapy with recombinant human IGF-1 (rhIGF-1). Our objective was to determine the prevalence of SPIGFD among children with short stature at a large pediatric tertiary care center through the use of a novel electronic medical record (EMR) algorithm. (2) Methods: We queried our EMR using an algorithm that detected all children seen at our center between 1 November 2013 and 31 August 2021 with short stature and low IGF-1. We then conducted chart reviews, applying established diagnostic criteria for those identified with potential SPIGFD. (3) Results: From a cohort of 4863 children with short stature, our algorithm identified 30 (0.6%) patients with potential SPIGFD. Using chart reviews, we determined that none of these patients had SPIGFD. (4) Conclusions: Our algorithm can be used in other EMRs to identify which patients are likely to have SPIGFD and thus benefit from treatment with rhIGF-1. This model can be replicated for other rare diseases. [ABSTRACT FROM AUTHOR]

Purpose: To determine characteristics associated with inappropriate antibiotic use amongst children hospitalised for influenza. Methods: We performed active surveillance for laboratory-confirmed influenza hospitalizations amongst children ≤ 16 years old at the 12 Canadian Immunization Monitoring Program Active hospitals, from September 2010 to August 2021. Antibiotic use was presumed appropriate if any of the following indications were met: age < 1 month, immunocompromised, hemoglobinopathy, laboratory-confirmed bacterial infection, radiographically confirmed pneumonia, admission to an intensive care unit and mechanical ventilation. Regression analyses were used to identify baseline and clinical characteristics associated with antibiotic use amongst patients without an appropriate indication. Results: Amongst 8971 children, 6424 (71.6%) received any antibiotics during their hospitalisation. Amongst the 4429 children without an appropriate indication, 2366 (53.2%) received antibiotics. Antibiotic use amongst children without appropriate indication differed between study centres, ranging from 33.2% to 66.1% (interquartile range [IQR] 50.6–56.3%); it did not change significantly over time (p-value for trend = 0.28). In multivariable analyses, older age (adjusted odds ratio [aOR] 0.97, 95% confidence interval [CI] 0.96–0.99), presence of any high-risk condition (aOR 0.80, 95% CI 0.70–0.92), influenza virus type B (aOR 0.8, 95% CI 0.70–0.91) and croup (aOR 0.64, 95% CI 0.49–0.83) were associated with less, whilst fever ≥ 38.5 °C (aOR 1.82, 95% CI 1.42–2.35) and hospitalisation duration (aOR 1.12, 95% CI 1.09–1.15) were associated with more inappropriate antibiotic use. Conclusions: Over two-third of children hospitalised for influenza received antibiotics, including over half of those without an appropriate indication for antibiotic treatment. Differences amongst study centres suggest the importance of contextual determinants of antibiotic use. [ABSTRACT FROM AUTHOR]

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

OBJECTIVES: We aimed to examine the impact of a quality improvement (QI) collaborative on adherence to specific recommendations within the American Academy of Pediatrics' Clinical Practice Guideline (CPG) for well-appearing febrile infants aged 8 to 60 days. METHODS: Concurrent with CPG release in August 2021, we initiated a QI collaborative involving 103 general and children's hospitals across the United States and Canada. We developed a multifaceted intervention bundle to improve adherence to CPG recommendations for 4 primary measures and 4 secondary measures, while tracking 5 balancing measures. Primary measures focused on guideline recommendations where deimplementation strategies were indicated. We analyzed data using statistical process control (SPC) with baseline and project enrollment from November 2020 to October 2021 and the intervention from November 2021 to October 2022. RESULTS: Within the final analysis, there were 17 708 infants included. SPC demonstrated improvement across primary and secondary measures. Specifically, the primary measures of appropriately not obtaining cerebrospinal fluid in qualifying infants and appropriately not administering antibiotics had the highest adherence at the end of the collaborative (92.4% and 90.0% respectively). Secondary measures on parent engagement for emergency department discharge of infants 22 to 28 days and oral antibiotics for infants 29 to 60 days with positive urinalyses demonstrated the greatest changes with collaborative-wide improvements of 16.0% and 20.4% respectively. Balancing measures showed no change in missed invasive bacterial infections. CONCLUSIONS: A QI collaborative with a multifaceted intervention bundle was associated with improvements in adherence to several recommendations from the AAP CPG for febrile infants. [ABSTRACT FROM AUTHOR]

In pediatric settings, the concept of hope is frequently positioned as a fundamental aspect of care and at odds with the possibility and proximity of death. This arguably fosters silence about death and dying in childhood despite evidence indicating the benefits of open communication at the end of life. In this paper, we describe the unspeakable nature of death and dying in childhood, including its conceptual and clinical causes and dimensions, its persistence, and the associated challenges for children and youth facing critical illnesses, their families, and society. We explore how the tension between hope and death can be reframed and apply our analysis to the context of medical assistance in dying for mature minors in Canada. Considering the lack of related literature, this paper offers initial reflections to form a framework for the unspeakable nature of death and dying in childhood and to advance the crucial need for research. [ABSTRACT FROM AUTHOR]

Background: In 2016–17 an important consensus was established regarding the use of the diagnostic label 'developmental language disorder' (DLD) to describe children with a persistent language problem having a functional impact on communication or learning and in the absence of any other biomedical condition. Despite this consensus, past research has revealed ongoing uncertainty regarding when to use the DLD label among speech–language pathologists (SLPs). Aims: In response to this uncertainty, a survey of SLPs was conducted aimed at investigating which types of clinical language profiles, and specific assessment results, were viewed as warranting the diagnostic label DLD. Methods & Procedures: SLPs were presented with 10 childhood language profiles and assessment results. Participants reviewed each case and described if they felt a diagnosis of DLD was warranted, which presented symptoms were consistent/inconsistent with DLD and if further information/testing was desired. Additionally, participants provided details regarding their personal diagnostic processes. Outcomes & Results: Results indicated a general consensus among SLPs as to when the DLD label should be applied. However, free‐text responses demonstrated considerable variation between clinicians regarding symptoms of importance, points of contention/confusion in language profiles and minimal assessment results viewed as necessary in the diagnostic process. Conclusions & Implications: This detailed look at the assessment/diagnostic process for DLD provides valuable insight into how to build further practice consistency in the provision of the diagnostic label DLD, especially in cases of complex language profiles and assessment results. WHAT THIS PAPER ADDS: What is already known on this subject: The label DLD should be used as a diagnostic label to describe children with persistent language problems having a functional impact on communication or learning and in the absence of any biomedical condition. However, in current clinical practice, actual use of the label is inconsistent and SLPs face a number of challenges in diagnosing DLD. What this paper adds to the existing knowledge: This investigation provides clarity regarding which complexities in paediatric language profiles are most challenging for SLPs when determining if a child does/does not have DLD. Additionally, details regarding current assessment beliefs and practices are explored. What are the practical and clinical implications of this work?: By providing a detailed look at the diagnostic processes of practising SLPs, valuable insight is provided into how to build further practice consistency and confidence in the provision of the diagnostic label DLD, especially in cases of complex language profiles and assessment results. [ABSTRACT FROM AUTHOR]

Nirsevimab, a monoclonal antibody with an extended half‐life, is approved for the prevention of respiratory syncytial virus (RSV) disease in all infants in Canada, the EU, Great Britain, and the USA. A population pharmacokinetics (PK) model was built to describe the PK of nirsevimab in preterm and term infants, and to evaluate the influence of covariates, including body weight and age, in infants. Nirsevimab PK was characterized by a 2‐compartment model with first‐order clearance (CL) and first‐order absorption following intramuscular (IM) administration. The typical CL in a 5 kg infant was 3.4 mL/day. Body weight and postmenstrual age were the primary covariates on CL, with minor effects for race, second RSV season, and antidrug antibody status (deemed not clinically relevant). Congenital heart disease (CHD) and chronic lung disease (CLD) did not significantly impact nirsevimab PK. The final population PK model, based on 8987 PK observations from 2683 participants across 5 clinical trials, successfully predicted PK in an additional cohort of 967 healthy infants. Weight‐banded dosing (50 mg in infants <5 kg; 100 mg in infants ≥5 kg) was predicted to be appropriate for infants ≥1 kg in their first RSV season. Together, these data support weight‐banded dosing of nirsevimab in all infants in their first RSV season, including in healthy infants, infants with CHD or CLD, and in infants born prematurely. [ABSTRACT FROM AUTHOR]

Purpose: Shared reading provides preschool-age children with the opportunity to learn novel, low-frequency words. Abundant empirical evidence demonstrates that children can learn the meanings of such words during shared reading, referred to as “semantic learning.” However, less is known about whether children learn the spellings of words during shared reading, referred to as “orthographic learning,” and whether this learning is related to early word reading. The present study tested relations between individual differences in 4- to 6-year-old children’s semantic and, critically, orthographic learning during shared reading and their early word reading skill. Method: In an adaptation of the self-teaching paradigm, children listened to a storybook about novel inventions referred to with nonword names. Children then completed orthographic and semantic choice tests, as well as standardized measures of early word reading and phonological awareness. Results: Individual differences in orthographic, but not semantic, learning during shared reading were related to early word reading, after controls for age and phonological awareness. Conclusions: This study provides a novel test of learning during shared reading, helping to specify the relation between orthographic and semantic learning and early word reading skill. These findings hold implications for theoretical perspectives on relations between learning during shared reading and early word reading, as well as implications for educational practice [ABSTRACT FROM AUTHOR]