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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.

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.

Curiosity and creativity are crucial for children's learning and engagement within their worlds. However, research on creative teaching that also addresses children's curiosity is quite limited. In this case study, we adopted visual methods in combination with video-stimulated recall dialogue (VSRD) to explore children's experiences in a Forest School (FS) program in Southern Ontario. As researchers, we were particularly interested in the nexus of children's curiosity and creativity in the process of learning. Participating children, aged 6-12 years, wore GoPro cameras to document their lived experiences in the FS. Informed by constructivism, we examined data vignettes, querying the role of curiosity and creativity within children's entanglements in the natural environment. The results indicate that open-ended materials within nature invited and sustained curiosity and creativity. Children tended to gravitate to the complexity and ambiguity offered within the natural environment. The research findings have implications for educators, namely the importance of the choice of materials and approaches to support and prioritize children's curiosity and creativity in learning processes. Implications for inviting educators to capitalize upon inquiry moments and the unknown were also evident.

The authors investigate the personality traits of parents and children and their significant influence on the behavior of the other. Using the HEXACO model of personality, the authors examine the behavior of one hundred parent-child dyads on a playground to understand broader parent-child relationships. Their analyses reveal two opposed types of parental behavior (engaged parents versus unengaged parents) and child behavior (introverted cautious play versus autonomous energetic play) on the playground. The authors assert their study demonstrates that the personality traits of both parents and children as measured by the HEXACO model play a significant role in parental and child behaviors during play and in broader interactions.

In this article, I provide a critical reading of the now-removed statue of Sir John A. Macdonald in Charlottetown, Prince Edward Island, Canada. I bring together my own experience visiting the statue with understandings from Indigenous scholarship and public pedagogy theorizing to think about commemorations as public pedagogies that are foremost relational. I consider how the Macdonald statue works narratively, discursively, and as a site of embodied encounter to create a harmful relationality. Thinking relationally, and pedagogically, about colonial statues suggests possibilities not only for understanding how these commemorative practices produce bad relations but also for envisioning and enacting good relations.

Studies show that executive functions and motor development are associated with each other and with learning ability. A more technological lifestyle combined with digital culture should be considered a viable alternative to stimulate children's development. Therefore, this study aimed to present a systematic mapping of the literature involving executive functions, motor development, and the use of digital games in intervention programs for elementary school children from 6 to 11 years old. Four databases were researched: PubMed, Scielo, Science Direct, and SCOPUS, including publications between 2012 and March 2021. The initial results indicated 4881 records. After the selection process, 15 manuscripts that presented the central theme of the study were selected. The main results indicated that intervention strategies are rather heterogeneous. Most of the studies demonstrated efficient results after intervention protocols, many of them were conducted in Europe, and 46% occurred in a school environment. No research was identified involving technological solutions using executive functions, motor development, and digital games in an integrated manner. Hence, this constitutes a field of future scientific research.

Many adolescents with attention-deficit/hyperactivity disorder (ADHD) experience challenges in social competence. Evidence suggests that specialized summer camps with social skills training may have positive outcomes on social competence development in adolescents with ADHD. This article reports on a pilot study of a therapeutic summer camp program for children and adolescents with ADHD. The study examines the degree to which program objectives were achieved through a pre-camp, post-camp design using a series of standardized instruments, camp evaluations, and surveys with parents. The results indicated that the campers initially reported significantly lower social competence when compared to a normative sample of adolescents before the camp but improved their social competence by the end of camp. This research has implications for researchers, caregivers, and outdoor education advocates to take an assertive lead in promoting evidence-based psychosocial programs for youth with and without ADHD into more generalizable community settings.

This bibliometric study analyzed characteristics of publications related to art therapy for children from 1990 to 2020, based on the datasets taken from Web of Science (WoS) core collections. The results indicate that the USA, Israel, Germany, UK, Australia, and Canada were six leading countries in this field of research interest. The Top 5 most influential journals were identified by the number of publications, TLCS, TGCS and by their impact factor. Five leading journals in the art therapy studies include "Arts in Psychotherapy," "American Journal of Art Therapy," "Child & Family Social Work," "Frontiers in Psychology," and "Monatsschrift Kinderheilkunde." Core themes from the 87 articles focus on surrounding socialization and attachment relationship, art therapy for the well-being of children with learning disabilities, alternative intervention for art therapy, and parent-child art therapy. This bibliometric study portrayed the development of art therapy for children by means of visualization techniques. The potential issues emerging from the data will contribute to future studies in this field. Multiple methods of art therapy are applied for all children's well-being; as such, children's art therapy in schools can be seen as the potential trend for researchers and teachers.

Contemporary children are growing up in a post-typographic era, where mobile electronic devices and digital texts are increasingly present. For parents and educators, shifts into new digital practices and new text forms can create a sense of uncertainty. In response to parent and teacher interest, popular media have frequently focused on topics relating to young children and shifting digital practices. This study addresses popular media accounts of children and digital technologies over five years (2013-2018), looking in particular at the emergence of mobile devices and their impact on children's changing literacy practices. The authors collected popular media articles over this time period and analysed them for the ways in which children and digital technologies were represented and these media called on teachers and parents to respond. The authors provide an overview of their findings and address key themes from the articles, sharing influential examples and addressing the implications and influences of media perspectives. Finally, the authors examine the implications of popular media accounts in relation to informing parent beliefs and approaches, and curriculum responses.

Background: Youth mental health is a growing concern in research, practice, and policy. Practice standards, guidelines, or strategies provide an invisible infrastructure that fosters equity, quality, and safety, potentially addressing inconsistencies and more effectively attending to the mental wellness of Black youth as a particular population of concern. This scoping review aimed to address the following question: What standards exist for the delivery of mental health services to Black youth in community, primary care, and educational settings? Due to a limited initial search yield on publications about standards for the delivery of mental health services for Black youth population, our goal was then to identify and map mental health standards, recommendations, or guidelines for the delivery of mental health services using the same settings to all youth. Methods: Searches were conducted in various databases, including PubMed/MEDLINE, PsycINFO, Embase, SocINDEX, CINAHL, Gender Studies Database, Social Services Abstracts, Sociological Abstracts, Scopus, Web of Science, and Google Scholar. Screening was independently conducted by two reviewers, with disagreements resolved by a third. Information extraction was performed by two independent reviewers. Results: Out of the 2,701 screened publications, 54 were included in this scoping review. Among them, 38.9% were published between 2020 and 2023, with 40.7% originating from the United States of America, 20.4% from the United Kingdom, and 13% from Canada. Concerning the settings, 25.9% of the publications focused on primary care, 24.1% on health care services, 20.4% on educational settings, and 3.7% on the community. Additionally, 25.9% were classified as general because recommendations were applicable to various settings. Attention-deficit/hyperactivity disorder (11.1%) was the most frequently considered specific condition, followed by autism spectrum disorder (9.3%) and depression (9.3%). However, 31.5% of the included references addressed mental health in general. Only three references provided specific recommendations for the Black population. Conclusions: Recommendations, guidelines, or standards for Black youth mental health services in community, primary care, or educational settings are scarce and limited to North American countries. This scoping review emphasizes the need to consider ethnicity when developing guidelines or standards to improve racial equity and reduce disparities in access to mental health services. [ABSTRACT FROM AUTHOR]

Background: Given the significance of motor competence (MC) for healthy development and as a cornerstone for lifelong physical activity (PA), it is crucial to understand the manifold factors that are associated with MC. Thus, the aim of the present study was to investigate correlates of children's MC and their fundamental movement skills (FMS) within their daily life from a comprehensive biopsychosocial-ecological perspective. Methods: This is a cross-sectional sub-study of the 'Physical Literacy for Communities (PL4C)' WAVES cohort study conducted in the West Vancouver School District, Canada. Motor competence was assessed using the PLAYfun tool including overall MC score and five FMS category scores, namely, running, locomotor skills, upper and lower body control and balance skills. By means of structural equation modeling (SEM), direct associationswith MC and with the specific FMS categories addressing physical activity behavior, self-perceived physical literacy, parenting, and school ground design were investigated. Results: A total of 355 children with a mean age of 7.5 years and 111.1 min of MVPA per day participated. The group comprised 51% boys and 47% girls from 14 elementary schools. Most children were at an emerging MC-level (71%), while those at a competent MC-level exhibited significantly more daily minutes of MVPA (123 versus 109, p = 0.001). Additionally, they played outdoors more frequently and engaged in more instructor-led PA. The results revealed that logistical support from parents had not only a direct positive association with overall MC, both for girls and boys, but also with most of the FMS categories. However, the correlates of MC varied between genders and showed different patterns across the five FMS categories. While time spent in sports or coach-/instructor-led physical activities had a significant SEM generated direct effect only for boys' MC and for locomotor, upper body object control and balance, the aesthetic design of the school grounds was only associated with girls' MC and those same three FMS categories. Multivariate SEM could explain 26% of variance for girls' MC and 30% for boys'. Conclusions: This exploratory baseline assessment revealed parental logistical support as an important correlate of MC, irrespective of gender. There were distinct gender patterns across biopsychosocial-ecological correlates influencing MC and FMS. Despite the heterogeneity of the results, our findings indicate a potential role of school ground design in supporting the development of children's MC, especially for girls. Key Points: • The influence of biopsychosocial-ecological correlates on motor competence (MC) varied based on gender and the specific fundamental movement skill (FMS) categories. • While parental logistical support demonstrated a positive direct association with both genders' MC and most of the FMS categories, coach-led physical activities appeared to enhance only boys'. • The positive direct association of outdoor play on boys' MC and of school ground aesthetics on girls' MC might suggest the role of the physical environment in MC development. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: Exposure to adverse social determinants of health (SDoH) in childhood is associated with poorer long-term health outcomes. Within structurally marginalized populations, there are disproportionately high rates of developmentally vulnerable children. The RICHER (Responsive, Intersectoral, Child and Community Health, Education and Research) social pediatric model was designed to increase access to care in marginalized neighborhoods. The purpose of this study was to describe the children and youth engaged with the RICHER model of service and characterize the needs of the population. Methods: A retrospective chart review was conducted on children and youth who accessed primary care services through the program between January 1, 2018 and April 30, 2021. Basic descriptive data analysis was done using Stata v15.1. Results: A total of 210 charts were reviewed. The mean age in years at initial assessment was 6.32. Patients most commonly identified their race/ethnicity as Indigenous (33%) and 15% were recent newcomers to Canada. Evidence of at least 1 adverse SDoH was noted in 41% of charts; the most common included material poverty (34%), food insecurity (11%), and child welfare involvement (20%). The median number of diagnoses per patient was 4. The most frequently documented diagnoses were neurodevelopmental disorders (50%) including developmental delay (39%), ADHD (32%), and learning disability (26%). The program referred 72% of patients to general pediatricians and/or other subspecialists; 34% were referred for tertiary neuropsychological assessments and 35% for mental health services. Conclusions: Our data suggests that this low-barrier, place-based primary care RICHER model was able to reach a medically, developmentally, and socially complex population living in disenfranchised urban neighborhoods. Half of the patients identified in our review had neurodevelopmental concerns and a third had mental health concerns, in contrast to an estimated 17% prevalence for mental health, behavioral, or developmental disorders in North American general pediatric aged populations. This highlights the impact adverse SDoH can have on child health and the importance of working with community partners to identify developmentally vulnerable children and support place-based programs in connecting with children who may be missed, overlooked, or disadvantaged through traditional models of care. [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]

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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]

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]

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]

Background: Marketing of unhealthy foods to children on digital media significantly impacts their dietary preferences and contributes to diet-related noncommunicable diseases. Canadian children spend a significant amount of time on digital devices and are frequently exposed to unhealthy food marketing on social media, including by influencers with celebrity status who endorse products. This study aimed to examine the frequency, healthfulness, and power of unhealthy food marketing in posts by influencers popular with Canadian children on YouTube, Instagram and TikTok. Methods: The top 9 influencers popular amongst Canadian children aged 10–12 years were identified from the 2021 International Food Policy Study Youth Survey. A total of 2,232 Instagram, YouTube and TikTok posts made by these influencers between June 1st 2021 and May 31st 2022 were examined for instances of food marketing. Food products/brands were identified and frequencies were calculated for the number of posts promoting food products/brands, posts promoting products/brands classified as less healthy according to Health Canada's Nutrient Profile Model (2018) and marketing techniques utilized. Results: YouTube had the highest average rate of food marketing instances per post, at a rate of 1 food marketing instance every 0.7 posts, while TikTok and Instagram had instances every 10.2 posts and 19.3 posts, respectively. Overall, fast food restaurants was the most promoted food category (21%), followed by regular soft drinks (13%), snacks (11%), candy and chocolate (11%) and water (8%). The most frequently used marketing techniques were appeals to fun/cool (37%), the use of songs or music (28%) and the product being consumed (25%). In terms of healthfulness, 83% of the products/brands (87% of brands and 82% of products) promoted were classified as less healthy. Conclusions: Social media influencers play a substantial role in promoting unhealthy food products to children, primarily fast food items. Given the significant impact of such marketing on children, there is a need for ongoing government-led monitoring, and it is crucial to include social media and influencer marketing in marketing restrictions targeting children in Canada to safeguard this vulnerable demographic. [ABSTRACT FROM AUTHOR]

Mothers' experiences of caring for children with Prader-Willi Syndrome (PWS) is largely unknown. With no treatment for PWS, parents undertake (extra)ordinary care practices to keep children safe from overeating and self harm. Knowledge of these care practices could lead to effective interventions. Narrative inquiry was used to study everyday experience with Canadian mothers. Participants cared for a child 3 to 17 years old who had hyperphagia. Participants were interviewed 8 to 12 times each over the course of a year. Narrative accounts were co-composed through a collaborative process of analysis. Engaging with participants' everyday experiences amplified complex care needs for families and gaps in health and social care systems. Narrative threads focused on engaging in (extra)ordinary care practices, rigid care work to keep children healthy and safe, tension from others while enacting these care practices, and difficulty conforming to social expectations with childrearing and care work. Recommendations for practice and policy include (a) shifting from untenable care practices, (b) reconceptualizing care work, and (c) alternative care models. [ABSTRACT FROM AUTHOR]

Background: Pediatric intensive care units (PICUs) may not have timely access to therapeutic plasma exchange (TPE) for critically ill patients. The purpose of this study was to evaluate the common indications for TPE in a smaller tertiary PICU-developed TPE program and to evaluate the associated predictors of mortality. We hypothesized that a PICU-developed TPE program could provide timely access for a wide breadth of pathologies and can be delivered safely. Subjects and Methods: This was a retrospective case-comparison within-cohort study in a PICU from Canada. Data from pediatric patients between October 2015 and January 2022 was examined. The study included all patients < 18 years admitted to the PICU and requiring TPE. Multiorgan dysfunction syndrome (MODS) was defined to agree with the International Pediatric Sepsis Consensus Conference. Proportions, medians, and interquartile ranges (IQR) were calculated where appropriate. Results: Twenty-five patients with a median age of 14 years underwent 118 acute TPE runs. The most common diagnosis (24%) was MODS. The median time from PICU admission to initiation of TPE was 38 h (IQR: 5--113.5) hours. The median PICU length of stay was 10 (IQR: 5.5--26) days. Twenty percent (n = 5) of patients who received TPE acutely in the PICU required chronic TPE. There were no adverse events. Conclusions: TPE may be delivered quickly and safely from a small PICU for many indications, with MODS being the most common. [ABSTRACT FROM AUTHOR]

Introduction: Substance-related acute toxicity deaths (ATDs) are a public health crisis in Canada. Youth are often at higher risk for substance use due to social, environmental and structural factors. The objectives of this study were to understand the characteristics of youth (aged 12-24 years) dying of accidental acute toxicity in Canada and examine the substances contributing to and circumstances surrounding youth ATDs. Methods: Data from a national chart review study of coroner and medical examiner data on ATDs that occurred in Canada between 2016 and 2017 were used to conduct descriptive analyses with proportions, mortality rates and proportionate mortality rates. Where possible, youth in the chart review study were compared with youth in the general population and youth who died of all causes, using census data. Results: Of the 732 youth who died of accidental acute toxicity in 2016-2017, most (94%) were aged 18 to 24 years. Youth aged 20 to 24 who were unemployed, unhoused or living in collective housing were overrepresented among accidental ATDs. Many of the youth aged 12 to 24 who died of accidental acute toxicity had a documented history of substance use. Fentanyl, cocaine and methamphetamine were the most common substances contributing to death, and 38% of the deaths were witnessed or potentially witnessed. Conclusion: The findings of this study point to the need for early prevention and harm reduction strategies and programs that address mental health, exposure to trauma, unemployment and housing instability to reduce the harms of substance use on Canadian youth. [ABSTRACT FROM AUTHOR]

Although sucrose is widely administered to hospitalized infants for single painful procedures, total sucrose volume during the entire neonatal intensive care unit (NICU) stay and associated adverse events are unknown. In a longitudinal observation study, we aimed to quantify and contextualize sucrose administration during the NICU stay. Specifically, we investigated the frequency, nature, and severity of painful procedures; proportion of procedures where neonates received sucrose; total volume of sucrose administered for painful procedures; and incidence and type of adverse events. Neonates <32 weeks gestational age at birth and <10 days of life were recruited from four Canadian tertiary NICUs. Daily chart reviews of documented painful procedures, sucrose administration, and any associated adverse events were undertaken. One hundred sixty‐eight neonates underwent a total of 9093 skin‐breaking procedures (mean 54.1 [±65.2] procedures/neonate or 1.1 [±0.9] procedures/day/neonate) during an average NICU stay of 45.9 (±31.4) days. Pain severity was recorded for 5399/9093 (59.4%) of the painful procedures; the majority (5051 [93.5%]) were heel lances of moderate pain intensity. Sucrose was administered for 7839/9093 (86.2%) of painful procedures. The total average sucrose volume was 5.5 (±5.4) mL/neonate or 0.11 (±0.08) mL/neonate/day. Infants experienced an average of 7.9 (±12.7) minor adverse events associated with pain and/or sucrose administration that resolved without intervention. The total number of painful procedures, sucrose volume, and incidence of adverse events throughout the NICU stay were described addressing an important knowledge gap in neonatal pain. These data provide a baseline for examining the association between total sucrose volume during NICU stay and research on longer‐term behavioral and neurodevelopmental outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Caring for children and youth with special health care needs (CYSHCN) is a significant undertaking for families. While respite care is intended to address this burden, demand continues to exceed supply. Exploring the perspectives of respite service providers (SPs) and stakeholders (SKs) provides unique insight into families' needs and respite care systems. Methods: We conducted semistructured interviews with 41 respite care SPs and SKs across four Canadian provinces to ascertain perspectives on current and ideal respite care for families of CYSHCN. The analysis included delineating units of meaning from the data, clustering units of meaning to form thematic statements and extracting themes. The second‐level analysis involved applying themes and subthemes to cross‐functional process maps. Findings: Participants noted the critical, but sometimes absent role of Community Service Workers, who have the ability to support families accessing and navigating respite care systems. SPs and SKs identified current respite systems as operating in crisis mode. New findings suggest an ideal respite care system would incorporate advocacy for families, empower families and value CYSHCN, their families and respite workers. Conclusion: The evidence of unmet respite care needs of families of CYSHCN across Canada has long been available. Our findings identifying respite system challenges and solutions can be used by funders and policymakers for planning and enhancing resources, and by healthcare professionals, respite care providers and SKs to understand barriers and take action to improve respite outcomes to meet the respite needs of all families and CYSHCN. Patient or Public Contribution: The research team is composed of patients, researchers, clinicians and decision‐makers along with our Family Advisory Committee (FAC) composed of members of families of CYSHNC. The FAC was formed and met regularly with research team members, knowledge users and collaborators throughout the study to provide input on design, review themes and ensure findings are translated and disseminated in a meaningful way. [ABSTRACT FROM AUTHOR]

Background Fluoride may be a developmental neurotoxicant at elevated exposures. We merged new data from a prospective Odense Child Cohort (OCC) with results from two previous birth cohort studies from Mexico and Canada to characterize the dose–effect relationship in greater detail. Methods The OCC contributed 837 mother–child pairs to the total of >1500. We measured creatinine-adjusted urine-fluoride concentrations in maternal urine samples obtained during late pregnancy. Child IQ was determined at age 7 years using an abbreviated version of the Wechsler Intelligence Scales for Children. Findings from the three cohorts were used to calculate the joint benchmark concentration (BMC) and the lower confidence limit (BMCL) after adjustment for covariables. Results In the OCC, urine-fluoride concentrations varied between 0.08 and 3.04 mg/l (median 0.52 mg/l) but were not significantly associated with full-scale IQ at age 7 years (β = 0.08; 95% confidence interval −1.14 to 1.30 for a doubling in exposure). No difference was apparent between boys and girls. In the OCC, the BMC was 0.92 mg/l, with a BMCL of 0.30 mg/l. The joint analysis of all three cohorts showed a statistically significant association between urine-fluoride and IQ, with a BMC of 0.45 mg/l (BMCL, 0.28 mg/l), slightly higher than the BMC previously reported for the two North American cohorts alone. Conclusions As the BMCL reflects an approximate threshold for developmental neurotoxicity, the results suggest that pregnant women and children may need protection against fluoride toxicity. [ABSTRACT FROM AUTHOR]

Although there is significant variability in the manifestations of persisting post-concussive symptoms (PPCS), autonomic dysfunction has been reported to contribute to PPCS and could serve as a biomarker of recovery. The objective of this study was to evaluate cardiac autonomic reflexes and autonomic function after concussion injury comparing those with prolonged concussion symptoms to those without. This is a case-control study where a non-referred population of concussed children or adolescent participants were enrolled from the Emergency Department (ED) of the Stollery Children's Hospital, a tertiary pediatric hospital in Edmonton, Alberta, Canada. Children and adolescents 8 through <18 years of age who presented with mild traumatic brain injury were diagnosed with concussion. Our study reported concussion symptoms and standardized clinical cardiac autonomic reflex testing at 4 and 12 weeks after injury. Our findings showed that 28 participants with concussion completed the 4-week follow-up questionnaires, and that 17 (61%) were diagnosed with PPCS. Difficulty concentrating, fatigue, noise sensitivity, light sensitivity, and headache were most commonly reported at baseline among those who were later diagnosed with PPCS. The mean change in heart rate (HR) with head-up tilt was 44.2 bpm (standard deviation [SD] 9.1) in the non-PPCS group and 46.6 bpm (SD 14.1) in the PPCS group at 4 weeks and was not significant in the unadjusted (p = 0.2) or adjusted analysis for age and female sex (p = 0.2). Overall, 70% (19/27) had significant orthostatic tachycardia >40 bpm, but PPCS and non-PPCS groups were similar. Similar results were observed among 23 participants at 12-week follow-up. The median maximum decrease in systolic blood pressure (SBP) with head-up tilt was -26.9 mm Hg (interquartile range [IQR] -32.6, -22.3) in the non-PPCS group and -25.1 mm Hg (IQR -32.2, -18.2) in the PPCS group, and was not significantly different in the unadjusted (p = 0.8) or adjusted (p = 0.8) analysis. Overall, 19 of 26 participants (73%) demonstrated orthostatic hypotension (SBP change >20 mm Hg) with no significant difference between the PPCS and non-PPCS groups. Similar results were observed at 12-week follow-up. In conclusion, cardiac autonomic reflex responses are abnormal in most children and adolescents with a concussion injury at 4- and 12-week follow-up and may reflect ongoing autonomic dysfunction. However, autonomic function did not differentiate PPCS, indicating that reported symptoms are not sensitive to autonomic abnormalities. [ABSTRACT FROM AUTHOR]

Medication-induced diabetes (MID) is common during induction therapy for pediatric acute lymphoblastic leukemia (ALL) and has potentially significant negative consequences. Reported risk factors for MID are variable with limited data comparing patients treated with standard-risk (SR) vs. high-risk (HR) regimens. This study aims to evaluate the incidence and risk factors for MID during induction in patients with ALL from the Maritimes over a 20-year period. We performed a retrospective single-center study of 262 patients (142 males, 120 females) diagnosed with ALL at IWK Health in Halifax, Nova Scotia, Canada, from 2000 to 2019. Older age, higher body mass index, greater central nervous system status, Trisomy 21, and prednisone steroid type were risk factors associated with MID in our cohort. HR patients developed significantly more complications than SR patients including MID and infection. Screening for MID should be routine during ALL induction treatment, particularly in those with HR disease. [ABSTRACT FROM AUTHOR]

The release of a Canadian Indigenous Early Learning and Child Care Framework highlights the importance of recent, Indigenous-specific information to describe the landscape of child care among Indigenous children in Canada; however, there has been a gap in identity-specific, national data on child care for Indigenous children. The purpose of the current study was to address data gaps on participation in child care for First Nations children living off reserve, Métis, and Inuit children. Furthermore, two years of data are examined which provide information on child care use both prior to and during the first year of the COVID-19 pandemic. In 2019, First Nations children living off reserve (49%) and Inuit children (42E %)1 were significantly less likely to participate in child care compared with non-Indigenous children (60%), although Métis children (60%) were equally likely to participate in child care compared with non-Indigenous children. Only First Nations children living off reserve (40%) were significantly less likely than non-Indigenous children (53%) to participate in child care in 2020. In terms of the type of child care used, Inuit children were more likely to be in a daycare centre (70%) compared with non-Indigenous children (52%) in 2019, although Inuit children's participation in a daycare centre dropped to 46E% in 2020. This is likely due to public health restrictions which closed many child care centres during the pandemic, as over one-third of child care in the territories is centre-based. The findings provide important information about patterns of child care use for Indigenous children both before and during the pandemic. [ABSTRACT FROM AUTHOR]

Introduction. The landscape of childhood diabetes has evolved and addressing the knowledge gaps in non-Type 1 diabetes mellitus are key to accurate diagnosis. Objectives. A national surveillance study was completed between 2006 and 2008 and then repeated between 2017 and 2019 to describe Canadian incidence trends and clinical characteristics of non-Type 1 diabetes mellitus. Methods. We prospectively tracked new cases of non-Type 1 diabetes mellitus in children <18 years of age between June 1, 2017 and May 31, 2019. For each reported new case, a detailed questionnaire was completed, and cases were classified as Type 2 diabetes mellitus, medication-induced diabetes (MID), monogenic diabetes, or "indeterminate." Minimum incidence rates and 10-year incidence trends of non-Type 1 diabetes mellitus and its subtypes were calculated. Results. 441 cases of non-Type 1 diabetes mellitus were included (Type 2 diabetes mellitus = 332; MID = 52; monogenic diabetes = 30; indeterminate = 27). Compared to 10 years ago, the incidence of MID and monogenic diabetes remained stable, while Type 2 diabetes mellitus increased by 60% (p < 0.001) overall and by 37% (p = 0.005) and 50% (p = 0.001) in females and males, respectively. Type 2 diabetes mellitus incidence increased by 1.5 times in Indigenous (p < 0.001) and doubled in Asian (p = 0.003) children. Conclusions. Canadian incidence rates of childhood-onset Type 2 diabetes mellitus have significantly increased. Further research, policy, and prevention efforts are needed to curb rising rates of youth onset Type 2 diabetes mellitus. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to describe the knowledge, protective behaviours, and psychological impact of COVID-19 on Chinese residents in Canada, as the emotional and behavioural impacts of the pandemic have not been intensively studied amongst these populations. It was important to determine whether having dependent school-age children (DSAC) aged 16 or under was associated with adverse psychological impacts amongst the Chinese residents living in the country. Methods: In April 2020, 757 eligible participants were recruited through a snowball sampling to complete an online survey related to the COVID-19 pandemic. Psychological, behavioural, and sociodemographic variables were collected and first analyzed using descriptive and univariate statistics. Multiple logistic regression analyses were performed to further confirm the observed significant associations in bivariate analyses for selected psychological outcome variables. Results: Seven hundred forty-two participants who responded to the "dependent school-age children" question were included in the analysis. Most of them identified as females (65.8%) and 77.2% included receiving a university degree or higher. There were no significant differences in COVID-19 knowledge between those living with or without DSAC. However, participants with DSAC were more likely to perceive themselves as being at greater risk of contracting COVID-19 (p =.023); therefore, having a higher chance of adopting protective behaviours (e.g., hand washing, sanitizing frequently or disinfecting work and living spaces (p <.05), elevated risks of depression (p =.007), and stress (p =.010), compared to those without DSAC. Conclusions: Predominantly, the Chinese residents in Canada with dependent school-age children were more likely to report the negative psychological impacts of the pandemic. These findings warrant further investigations that may contribute to informing key stakeholders about the identification and implementation of policies and interventions to support the needs of parents with young children, during and after the pandemic. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic had a widespread impact on families with dependent children. To better understand the impact of the pandemic on families' health and relationships, we examined the association between mothers' and children's mental distress and family strain. Methods: Three waves of the COVID-19 Impact Survey were analyzed, collected from a subsample of mother–child pairs (n = 157) from the Alberta Pregnancy Outcomes and Nutrition (APrON) longitudinal cohort in Alberta, Canada. Latent class analyses were performed to determine patterns and group memberships in mothers' and children's mental distress and family strain. Multivariable logistic regression models were conducted to test associations between mothers' and children's mental distress and family strain trajectory classes. Results: Mothers with medium/high levels of mental distress were at increased odds of experiencing high family strain compared to those with low levels of distress (medium aOR = 3.90 [95% CI: 1.08–14.03]; high aOR = 4.57 [95% CI: 1.03–20.25]). The association between children's mental distress and family strain was not significant (aOR = 1.75 [95% CI: 0.56–5.20]). Conclusion: Mothers' mental distress, but not children's, was associated with family strain during the pandemic. More distressed individuals experienced greater family strain over time, suggesting that this association may become a chronic problem. [ABSTRACT FROM AUTHOR]

Background: Little is known about the impact of the COVID-19 pandemic on families of children with chronic life-limiting conditions who died during the COVID-19 pandemic. Methods: In this qualitative study, parents of a child (< 18 years) who died during the COVID-19 pandemic from an underlying chronic medical condition were interviewed to explore how the pandemic impacted end-of-life care and bereavement experiences. Parents of children followed by the pediatric palliative care service were recruited from a large children's hospital in eastern Canada. Results: Twenty bereaved parents, consisting of 12 mothers and 8 fathers, participated in individual interviews between January and December 2021. Findings identified impacts of the COVID-19 pandemic on children's end-of-life care, experiences in hospital and at home, and family bereavement processes and experiences. Most parents experienced substantial worry about their child's physical status and the additional risk of COVID-19 given her/his vulnerability. Parents also struggled to navigate public health protocols as they attended to their child's needs and their family's desire for engagement and support. Key facilitators that helped families cope included a strong network of formal and informal supports. Conclusion: Implications highlight the need to critically reflect on pandemic care in the context of co-occurring end-of-life processes. Findings amplify the need to balance necessary infection control practices with access to essential supports for families. [ABSTRACT FROM AUTHOR]

This paper explores children's engagements with music during the beginning of the COVID-19 pandemic in Canada. We draw on repeated, qualitative, online interviews with children that explored their experiences during the pandemic. During these interviews, the topic of music came up many times and was present in the children's lives in many ways. Inspired by Christopher Small's concept of musicking to understand music as an action, and grounded in new-materialist emphasis on the interweaving of human and nonhuman entities, we examine children's musical assemblages to discuss how they engaged with music to express themselves and connect to others early in the pandemic in ways that helped them through a difficult time. [ABSTRACT FROM AUTHOR]

Background: There has been dramatic reduction in Haemophilus influenzae serotype b (Hib) since introduction of Hib vaccines, but children still experience serious invasive Haemophilus influenzae (Hi) disease caused by various serotype and non-typeable bacteria. The object of this study was to describe the serotype distribution and clinical spectrum of Hi bacteremia in children admitted to Canadian hospitals. Methods: All children with Hi bacteremia admitted 2013 through 2017 to 10 centres across Canada were included. Demographic, clinical, treatment and outcome data were collected. Results: Haemophilus influenzae bacteremia occurred in 118 children of median age 12 months (inter-quartile range: 7–48 months). Forty-three (36%) isolates were non-typeable (NTHi) and 8 were not typed. Of the 67 typeable (THi), Hia (H. influenzae serotype a) (n=36, 54%), Hif (serotype f) (n=19, 26%) and Hib (serotype b) (n=9, 13%) dominated. The THi was more likely than NTHi bacteremia to present as meningitis (p<0.001), particularly serotype a (p=0.04) and less likely to present as pneumonia (p<0.001). Complicated disease (defined as intensive care unit admission, need for surgery, long-term sequelae or death) occurred in 31 (26%) cases and were more likely to have meningitis (p<0.001) than were those with uncomplicated disease. Conclusion: In the era of efficacious conjugate Hib vaccines, NTHi, Hia and Hif have emerged as the leading causes of invasive Hi in Canadian children, with Hia being most likely to result in meningitis and complicated disease. A vaccine for all NTHi and THi would be ideal, but knowledge of the current disease burden from circulating strains will inform prioritization of vaccine targets. [ABSTRACT FROM AUTHOR]

Children commonly experience pain and distress in healthcare settings related to medical procedures such as blood tests and intravenous insertions (IVIs). Inadequately addressed pain and distress can result in both short- and long-term negative consequences. The use of socially assistive robotics (SARs) to reduce procedure-related distress and pain in children's healthcare settings has shown promise; however, the current options lack autonomous adaptability. This study presents a descriptive qualitative needs assessment of healthcare providers (HCPs) in two Canadian pediatric emergency departments (ED) to inform the design an artificial intelligence (AI)-enhanced social robot to be used as a distraction tool in the ED to facilitate IVIs. Semi-structured virtual individual and focus group interviews were conducted with eleven HCPs. Four main themes were identified: (1) common challenges during IVIs (i.e., child distress and resource limitations), (2) available tools for pain and distress management during IVIs (i.e., pharmacological and non-pharmacological), (3) response to SAR appearance and functionality (i.e., personalized emotional support, adaptive distraction based on child's preferences, and positive reinforcement), and (4) anticipated benefits and challenges of SAR in the ED (i.e., ensuring developmentally appropriate interactions and space limitations). HCPs perceive AI-enhanced social robots as a promising tool for distraction during IVIs in the ED. [ABSTRACT FROM AUTHOR]

Simple Summary: The sociodemographic characteristics of a parent and child may predispose young children to excessive dietary sugar intake; however, there is limited research available on this topic. The aim of this cross-sectional analysis was to examine the impact of sociodemographic characteristics such as child age, child sex, child ethnicity, parent number of years living in Canada, annual household income, parent education and parent marital status on total, free and added sugar intake in young children. Dietary and sociodemographic data including 267 children from 210 families participating in the Guelph Family Health Study were examined. The results indicate that child age, child ethnicity and annual household income can play a crucial role in shaping sugar intake in young children. This research may help inform future research and program interventions early in life along with guiding parents to decrease sugar intake in young children. Background: It is crucial to develop strategies targeted to promote healthy eating patterns in vulnerable populations, especially young children from diverse sociodemographic groups. Thus, the study objective was to investigate the associations between child age, child sex, child ethnicity, parent number of years living in Canada, annual household income, parent education and parent marital status with total, free and added sugar intakes in young children. Methods: This cross-sectional study was a secondary analysis of data gathered in the Guelph Family Health Study. The study included 267 children (129M; 138F) from 210 families aged 1.5 to 5 years. Parents completed questionnaires for children on sociodemographic characteristics and an online 24-hour diet recall. The associations between sociodemographic characteristics and sugar intakes were determined using generalized estimating equations applied to linear regression models. Results: The mean age of the children was 3.5 ± 1.2 years (mean ± std dev.). As children's age increased, there was a greater intake of free and added sugar ( β ^ = 8.6, p = 0.01, 95% CI = 2.4 to 14.7 and β ^ = 6.5, p = 0.03, 95% CI = 0.8 to 12.2, respectively). Those children who identified as white had a higher total sugar intake than children of other ethnicities ( β ^ = 31.0, p = 0.01, 95% CI = 7.2 to 54.7). Additionally, higher annual household income was associated with lower was free sugar intake in children ( β ^ = −2.4, p = 0.02, 95% CI = −4.5 to −0.4). Conclusions: This study underscores the significant influence of multiple sociodemographic characteristics on sugar intake in young children, providing valuable insights for public health policy and nutrition interventions. Moreover, this study highlights the need for early behaviour interventions focusing on reducing sugar intake in young children, while considering sociodemographic factors. [ABSTRACT FROM AUTHOR]

Exposure to pain‐related stress from frequent invasive procedures in the neonatal intensive care unit (NICU) has been associated with altered physiological stress regulation, neurodevelopment, and behavior in children born very preterm (≤32 weeks gestation). Previously, in a cohort born 2003–2006 (Cohort 1), we found that, at 18 months corrected age (CA), children born extremely low gestational age (ELGA; 24–28 weeks) and very low gestational age (VLGA; 29–32 weeks), had higher pre‐test cortisol levels and a different pattern of cortisol output across a developmental assessment involving cognitive challenge compared to children born full‐term (FT; 39–41 weeks). Also, greater neonatal pain‐related stress exposure among the preterm children was related to higher pre‐test cortisol levels. Given the adverse long‐term effects of neonatal pain in preterm infants and the ensuing rise in clinical concerns to appropriately manage pain in the NICU in recent years, we aimed to examine whether our findings from Cohort 1 would still be evident in an independent cohort (Cohort 2) born 2006–2011 and recruited from the same tertiary NICU in Vancouver, Canada. We also compared the cortisol patterns, clinical and socio‐demographic factors, and their interrelationships between the two cohorts. In Cohort 2, our findings using multi‐level modeling support and extend our earlier findings in Cohort 1, demonstrating that children born ELGA display higher pre‐test cortisol levels than FT. As well, greater cortisol output across assessment was related to more anxiety/depressive behaviors in children born VLGA. Importantly, children born ELGA were exposed to less neonatal pain/stress, mechanical ventilation, and morphine in Cohort 2 than Cohort 1. In both cohorts, however, cortisol levels and patterns were related to neonatal pain/stress and clinical factors (days on mechanical ventilation, overall morphine exposure). Despite less exposure to pain/stress and adverse clinical factors in Cohort 2 compared to Cohort 1, cortisol levels and patterns across cognitive challenge in preterm children at 18‐month CA were consistent across the two independent cohorts. These findings highlight that, despite improvements to neonatal care, children born extremely preterm continue to display altered HPA axis activity, which is associated with their poorer neurodevelopmental and behavioral outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Post-thrombotic syndrome (PTS) is the most common complication of deep venous thrombosis (DVT). The index for the Clinical Assessment of Post-Thrombotic Syndrome in children (CAPTSure©) is a clinical tool for the diagnosis and severity rating of PTS in pediatric patients. The purpose of this study was to translate and adapt CAPTSure© for French-speaking patients. Methods: We conducted a cross-sectional study to perform linguistic and cultural adaptation of CAPTSure©, using a rigorous translation process followed by cognitive debriefings in twenty French-speaking pediatric patients aged up to 18 years old with a history of upper or lower extremity DVT at least 6 months prior. Results: Forward and backward translations were used to produce a pre-final French version of CAPTSure©, followed by cognitive debriefings in twenty participants (median age: 11.5 years, 55% male, median CAPTSure© score: 26). The participants felt that the questionnaire was thorough, with an adequate length. Eight out of fourteen (57%) items in the LE questionnaire and 7/12 (58%) of the items in the UE questionnaire were modified following participants' and a multidisciplinary expert committee's input, leading to the final French version of CAPTSure©. Conclusions: CAPTSure© was successfully adapted for French-speaking pediatric patients. This will ease the diagnosis and severity rating of PTS in children in clinical practice and allow international research collaborations for additional non-English-speaking patients. [ABSTRACT FROM AUTHOR]

Cancer is the leading cause of disease-related death in children, adolescents, and young adults beyond the newborn period in North America. Improving survival rates for patients with hard-to-cure cancer remains a challenge. One approach that has gained particular traction is 'precision oncology', whereby next-generation sequencing is used to identify genomic or transcriptomic changes that can help clarify the diagnosis, refine prognosis, define an underlying genetic cause, or identify a unique treatment target for a patient's cancer. In this primer, we provide a brief overview of the evolution of precision paediatric oncology, its current application to clinical oncology practice, and its future potential as a foundational approach to paediatric oncology care in Canada and around the world. We also address the many challenges and limitations inherent to the implementation of precision oncology as the standard of care, including ethical and economic considerations. [ABSTRACT FROM AUTHOR]

Simple Summary: Treatments used to cure childhood cancer can have negative long-term impacts on physical health and well-being. Here, we present the Alberta Childhood Cancer Survivorship Research Program, its foundational cohort, and descriptive statistics of outcomes ascertained through data linkage. To this end, 2580 survivors of childhood cancer were included in the cohort, the majority of which were male, diagnosed between the ages of 0 and 4 years, and had leukemia, central nervous system tumor, or lymphoma. By the study exit date, the median time since diagnosis was 5.5 years overall and 10.4 years for 5-year survivors. During the follow-up time, 82 subsequent cancers were diagnosed, 20,355 inpatient and 555,425 ambulatory/outpatient events occurred, 606,773 claims were reported, and 437 survivors died. The results from this research program seek to inform and improve clinical care and reduce cancer-related sequelae. Adverse outcomes after childhood cancer have been assessed in a range of settings, but most existing studies are historical and ascertain outcomes only after 5-year survival. Here, we describe the Alberta Childhood Cancer Survivorship Research Program and its foundational retrospective, population-based cohort of Albertan residents diagnosed with a first primary neoplasm between the ages of 0 and 17 years from 1 January 2001 to 31 December 2018. The cohort was established in collaboration with the Alberta Cancer Registry and Cancer in Young People in Canada program and has been linked to existing administrative health databases and patient-reported outcome questionnaires. The cohort comprised 2580 survivors of childhood cancer, 1379 (53.4%) of whom were 5-year survivors. Approximately 48% of the cohort was female, 47% of the cohort was diagnosed between 0 and 4 years of age, and the most frequent diagnoses were leukemias (25.4%), central nervous system tumors (24.0%), and lymphomas (14.9%). Detailed treatment information was available for 1741 survivors (67.5%), with manual abstraction ongoing for those with missing data. By the study exit date, the median time since diagnosis was 5.5 years overall and 10.4 years for 5-year survivors. During the follow-up time, 82 subsequent primary cancers were diagnosed, 20,355 inpatient and 555,425 ambulatory/outpatient events occurred, 606,773 claims were reported, and 437 survivors died. The results from this research program seek to inform and improve clinical care and reduce cancer-related sequelae via tertiary prevention strategies. [ABSTRACT FROM AUTHOR]

This study analyzes the previous literature on the online safety of children and youth under "the 4Cs risk framework" concerning contact, content, conduct, and contract risks. It then conducts a comparative study of Australia, Canada, and the UK, comparing their institutions, governance, and government-led programs. Relevant research in Childhood Education Studies is insufficient both in quantity and quality. To minimize the four major online risks for children and youth in cyberspace, it is necessary to maintain a regulatory approach to the online exposure of children under the age of 13. Moreover, the global society should respond together to these online risks with "multi-level" policymaking under a "multi-stakeholder approach". At the international level, multilateral discussion within the OECD and under UN subsidiaries should continue to lead international cooperation. At the domestic level, a special agency in charge of online safety for children and youth should be established in each country, encompassing all relevant stakeholders, including educators and digital firms. At the school and family levels, both parents and teachers need to work together in facilitating digital literacy education, providing proper guidelines for the online activities of children and youth, and helping them to become more satisfied and productive users in the digital era. [ABSTRACT FROM AUTHOR]

Worldwide, acute gastroenteritis (AGE) is a major cause of morbidity and mortality in children under 5 years of age. Viruses, including norovirus, rotavirus, and enteric adenovirus, are the leading causes of pediatric AGE. In this prospective cohort study, we investigated the viral load and duration of shedding of norovirus, rotavirus, and adenovirus in stool samples collected from 173 children (median age: 15 months) with AGE who presented to emergency departments (EDs) across Canada on Day 0 (day of enrollment), and 5 and 28 days after enrollment. Quantitative RT-qPCR was performed to assess the viral load. On Day 0, norovirus viral load was significantly lower compared to that of rotavirus and adenovirus (p < 0.001). However, on Days 5 and 28, the viral load of norovirus was higher than that of adenovirus and rotavirus (p < 0.05). On Day 28, norovirus was detected in 70% (35/50) of children who submitted stool specimens, while rotavirus and adenovirus were detected in 52.4% (11/24) and 13.6% (3/22) of children (p < 0.001), respectively. Overall, in stool samples of children with AGE who presented to EDs, rotavirus and adenovirus had higher viral loads at presentation compared to norovirus; however, norovirus was shed in stool for the longest duration. [ABSTRACT FROM AUTHOR]

Training staff and volunteers is an important aspect of successful program implementation. This paper follows Part A of an evaluation of the Special Olympics Canada (SOC) Coaching Young Athletes Training course. Consistent with Kirkpatrick's four-level model of training evaluation, Part A evaluated program leaders' reactions to (level 1) and immediate learning from (level 2) the training. This Part B paper covers "on the job" behavior (level 3). In-depth semi-structured interviews were conducted with youth program leaders (n = 11) from eight provinces. Overall, participants felt that more training related to working with children with autism and promoting positive athlete behavior was needed. The findings also lead us to suggest that program leaders need to develop a more fulsome understanding of how to foster skill mastery, including how to practice the same skill in many and varied ways. [ABSTRACT FROM AUTHOR]

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

To evaluate immunocompromising conditions and subgroups of immunocompromise as risk factors for severe outcomes among children admitted for influenza. We performed active surveillance for laboratory-confirmed influenza hospitalizations among children ≤16 years old at the 12 Canadian Immunization Monitoring Program Active hospitals, during 2010–2021. Logistic regression analyses were used to compare outcomes between immunocompromised and non-immunocompromised children, and for different subgroups of immunocompromise. The primary outcome was intensive care unit (ICU) admission; the secondary outcomes were mechanical ventilation and death. Among 8982 children, 892 (9.9%) were immunocompromised; these patients were older (median, 5.6 (IQR, 3.1–10.0) vs. 2.4 (1–6) years; p < 0.001) than non-immunocompromised children, had a similar frequency of comorbidities, excluding immunocompromise and/or malignancy (38% (340/892) vs. 40% (3272/8090); p 0.2), but fewer respiratory symptoms, such as respiratory distress (20% (177/892) vs. 42% (3424/8090), p < 0.001). In multivariable analyses, immunocompromise (adjusted odds ratio (aOR), 0.19; 95% CI, 0.14–0.25) and its subcategories immunodeficiency (aOR, 0.16; 95% CI, 0.10–0.23), immunosuppression (aOR, 0.17; 95% CI, 0.12–0.23), chemotherapy (aOR, 0.07; 95% CI, 0.03–0.13), and solid organ transplantation (aOR, 0.17; 95% CI, 0.06–0.37) were associated with decreased probability of ICU admission in children admitted for influenza. Immunocompromise was also associated with a decreased probability of mechanical ventilation (aOR, 0.26; 95% CI, 0.16–0.38) or death (aOR, 0.22; 95% CI, 0.03–0.72). Immunocompromised children are overrepresented among hospitalizations for influenza, but have a decreased probability of ICU admission, mechanical ventilation, and mortality following admission. Admission bias precludes generalizability beyond the hospital setting. [ABSTRACT FROM AUTHOR]

Parental mental health services in neonatal follow-up programs (NFUPs) are lacking though needed. This study aimed to determine (1) the unmet mental health needs of parents and (2) the parent and provider perspectives on barriers and opportunities to increase mental health service access. Study 1: Parents in a central Canadian NFUP (N = 49) completed a mixed-method online survey (analyzed descriptively and by content analysis) to elucidate their mental health, related service use, barriers to service use, and service preferences. Study 2: Virtual focus groups with NFUP service providers (N = 5) were run to inform service improvements (analyzed by reflexive thematic analysis). The results show that parents endorsed a 2–4 times higher prevalence of clinically significant depression (59.2%), anxiety (51.0%), and PTSD (26.5%) than the general postpartum population. Most parents were not using mental health services (55.1%) due to resource insecurity among parents (e.g., time, cost) and the organization (e.g., staffing, training, referrals). Consolidating parents' and service providers' perspectives revealed four opportunities for service improvements: bridging services, mental health screening, online psychoeducation, and peer support. Findings clarify how a central Canadian NFUP can address parental mental health in ways that are desired by parents and feasible for service providers. [ABSTRACT FROM AUTHOR]

Cow's milk allergy (CMA) is one of the most common food allergies in the first years of life, with worldwide prevalence estimated to range from 2% to 5%. While the majority of children with CMA will eventually develop tolerance to cow's milk proteins (it is estimated that >75% of children with CMA develop tolerance to cow's milk proteins by the age of 3 years, and >90% develop tolerance by the age of 6 years), the selection of an appropriate cow's milk (CM) alternative for those with CMA is vital to ensure adequate growth and development during childhood. The increasing number of CM alternative products on the commercial market with markedly different nutritional content and micronutrient fortification adds a layer of complexity that can be challenging for both families and clinicians to navigate. This article aims to provide guidance and clarity to Canadian paediatricians and primary care clinicians on recommending the most appropriate, safe, and nutritionally optimal CM alternatives for individuals with CMA, and beyond. [ABSTRACT FROM AUTHOR]

Background: In spring 2022, a series of reports from the United Kingdom and the United States identified an increase in the incidence of acute severe hepatitis in children. The Public Health Agency of Canada (PHAC) collaborated with provincial/territorial health partners to investigate in Canada. Clinical hepatitis, or inflammation of the liver, is not reportable in Canada, so to determine if an increase was occurring above historical levels, the baseline incidence in Canada was estimated. This article estimates the pre-existing baseline incidence of acute severe hepatitis of unknown origin in children in Canada using administrative databases. It further summarizes the outbreak investigation using information from the national case report forms. Methods: A committee with representatives from PHAC and provincial/territorial health partners was established to investigate current cases in Canada. A national probable case definition and case report form were developed, and intentionally created to be highly sensitive to capture all potential cases for etiological investigations. To estimate a nationally representative baseline incidence, hospitalization data were extracted from the Discharge Abstract Database and was combined with data from Québec from the Ministère de la Santé et des Services sociaux. Results: Twenty-eight probable cases of acute severe hepatitis of unknown origin in children were reported between October 1, 2021, to September 23, 2022, by six provinces: British Columbia=1; Alberta=5; Saskatchewan=1; Manitoba=3; Ontario=14; and Québec=4. The estimated national baseline incidence was an average of 70 cases annually, or 5.8 cases per month. Conclusion: There was no apparent increase above the estimated historical baseline levels. [ABSTRACT FROM AUTHOR]