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Background: Digital health technologies are increasingly used by healthcare professionals working in pediatric hospital and rehabilitation settings. Multiple factors may affect the implementation and use of digital health technologies in these settings. However, such factors have not been identified in a multidisciplinary, pediatric context. The objective of this study was to describe actual use and to identify the factors that promote or hinder the intention to use digital health technologies (mobile learning applications, virtual/augmented reality, serious games, robotic devices, telehealth applications, computerized assessment tools, and wearables) among pediatric healthcare professionals. Methods: An online survey evaluating opinions, current use, and future intentions to use digital health technologies was completed by 108 professionals at one of Canada's largest pediatric institutes. Mann-Whitney U tests were used to compare the attitudes of healthcare professionals who intend to increase their use of digital health technologies and those who do not. Linear regression analyses were used to determine predictors of usage success. Results: Healthcare professionals reported mostly using mobile and tablet learning applications (n = 43, 38.1%), telehealth applications (n = 49, 43.4%), and computerized assessment tools (n = 33, 29.2%). Attitudes promoting the intention to increase the use of digital health technologies varied according to technology type. Healthcare professionals who wished to increase their use of digital health technologies reported a more positive attitude regarding benefits in clinical practice and patient care, but were also more critical of potential negative impacts on patient-professional relationships. Ease of use (β = 0.374; p = 0.020) was a significant predictor of more favorable usage success. The range of obstacles encountered was also a significant predictor (β = 0.342; p = 0.032) of less favorable evaluation of usage success. Specific factors that hinder successful usage are lack of training (β = 0.303; p = 0.033) and inadequate infrastructure (β = 0.342; p = 0.032). Conclusions: When working with children, incorporating digital health technologies can be effective for motivation and adherence. However, it is crucial to ensure these tools are implemented properly. The findings of this study underscore the importance of addressing training and infrastructure needs when elaborating technology-specific strategies for multidisciplinary adoption of digital health technologies in pediatric settings. [ABSTRACT FROM AUTHOR]

This study aimed to test a four-wave sequential mediation model linking mother-child attachment to children's school readiness through child executive functioning (EF) and prosociality in toddlerhood and the preschool years. Mother-child attachment security was assessed when children (N = 255) were aged 15 months and 2 years, child EF at age 2, prosocial behavior at age 4, and finally cognitive school readiness in kindergarten (age 6). The results revealed three indirect pathways linking attachment to school readiness: one through EF only, one through prosocial behavior only, and a last pathway involving both EF and prosocial behavior serially. These findings suggest that secure attachment may equip children with both cognitive and social skills that are instrumental to their preparedness for school.

Objective To examine preinjury life events as moderators of postconcussive symptoms (PCS) and quality of life (QoL) in children with pediatric mild traumatic brain injury (mTBI) versus orthopedic injury (OI). Methods Participants were 633 children with mTBI and 334 with OI, ages 8–16.99, recruited from 5 pediatric emergency departments and followed for 6 months postinjury as part of a prospective cohort study. Preinjury life events were measured retrospectively using the Child and Adolescent Survey of Experiences, PCS using the Health and Behavior Inventory (HBI) and Post-Concussion Symptom Interview (PCS-I), and QoL using the Pediatric Quality of Life Inventory (PedsQL). Analyses involved longitudinal regression using restricted cubic splines, with group, positive and negative life events, and time as primary predictors. Covariates included age, sex, race, socioeconomic status, preinjury history (i.e. headache, migraine, previous concussion), and parent-rated retrospective PCS-I, HBI, and PedsQL scores. Results PCS and QoL were worse after mTBI than OI, but group differences declined with time (all p <.001). Group differences in PCS were larger at higher levels of positive life events, which predicted lower PCS (p=.03 to p <.001) and higher QoL (p =.048) after OI but not after mTBI. Negative life events predicted worse PCS and QoL in both groups (p =.002 to p <.001). Conclusions Preinjury positive life events moderate outcomes after pediatric injury, with a protective effect seen in OI but not in mTBI. Negative life events are consistently associated with worse outcomes regardless of injury type. [ABSTRACT FROM AUTHOR]

Paediatric acquired brain injury is a life-long condition which impacts on all facets of the individual's lived experience. The existing evidence base continues to expand and new fields of enquiry are established as clinicians and researchers uncover the extent of these impacts. To add to recommendations described in the International Paediatric Brain Injury Society's 2016 paper on post-acute care for children with acquired brain injury and highlight new areas of enquiry. Recommendations were made based on the opinions of a group of experienced international clinicians and researchers who are current or past members of the board of directors of the International Paediatric Brain Injury Society. The importance of each recommendation was agreed upon by means of group consensus. This update gives new consideration to areas of study including injuries which occur in pre-school children, young people in the military, medical referral, young offenders and the use of technology in rehabilitation. [ABSTRACT FROM AUTHOR]

Concussion is commonly characterized by a cascade of neurometabolic changes following injury. Magnetic Resonance Spectroscopy (MRS) can be used to quantify neurometabolites non-invasively. Longitudinal changes in neurometabolites have rarely been studied in pediatric concussion, and fewer studies consider symptoms. This study examines longitudinal changes of neurometabolites in pediatric concussion and associations between neurometabolites and symptom burden. Participants who presented with concussion or orthopedic injury (OI, comparison group) were recruited. The first timepoint for MRS data collection was at a mean of 12 days post-injury (n = 545). Participants were then randomized to 3 (n = 243) or 6 (n = 215) months for MRS follow-up. Parents completed symptom questionnaires to quantify somatic and cognitive symptoms at multiple timepoints following injury. There were no significant changes in neurometabolites over time in the concussion group and neurometabolite trajectories did not differ between asymptomatic concussion, symptomatic concussion, and OI groups. Cross-sectionally, Choline was significantly lower in those with persistent somatic symptoms compared to OI controls at 3 months post-injury. Lower Choline was also significantly associated with higher somatic symptoms. Although overall neurometabolites do not change over time, choline differences that appear at 3 months and is related to somatic symptoms. [ABSTRACT FROM AUTHOR]

Objective Little is known about the symptoms, signs, and management guidelines for children under the age of 6 years after they sustain a concussion. Caregivers of such young children may have unique concerns and encounter different challenges from those of school-age children given the distinctive developmental characteristics of the early childhood period. This study aimed to explore the experience of caregivers through semistructured interviews to inform clinical practice. Methods Fifty caregivers of children aged 6 months to 5.99 years were interviewed 3 months postinjury for this qualitative study to document their experience in relation to their child's accident, recovery, and healthcare provisions. Results Four main themes were identified: (1) visible changes associated with caregiver concerns, (2) a roller-coaster of emotions after the injury, (3) healthcare providers' role in addressing the need for reassurance, and (4) the need for better information after the injury. Conclusion The findings provide critical insight into the unique experiences and information needs of caregivers of young children who sustain concussion. The challenges identified can inform healthcare professionals regarding the needs of caregivers after early concussion and contribute to building a knowledge base for the development of age-appropriate anticipatory guidance for caregiver mental health and child recovery. [ABSTRACT FROM AUTHOR]

In light of emerging evidence suggesting that the affective quality of parent-child relationships may relate to individual differences in young children's executive functioning (EF) skills, the aim of this study was to investigate the prospective associations between attachment security in toddlerhood and children's EF skills in kindergarten. Mother-child dyads (N = 105) participated in 2 toddlerhood visits in their homes, when children were 15 months and 2 years of age. Mother-child attachment security was assessed with the Attachment Q-Sort during both these visits. When children were in kindergarten (ages 5-6), they were administered a battery of EF tasks, and their teachers completed the Behavior Rating Inventory of Executive Function to assess children's EF problems. The results indicated that kindergarteners who were more securely attached to their mothers in toddlerhood showed better performance on all EF tasks, and were considered by their teachers to present fewer EF problems in everyday school situations. These results held above family socioeconomic status (SES) and child age, sex, and general cognitive functioning. The fact that early attachment security uniquely predicted both teacher reports and children's objective EF task performance suggests that parent-child attachment may be a promising factor to consider in the continuing search for the social antecedents of young children's EF.