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Aim: To explore how overcrowding affects children's health, environment and schooling., Methods: A qualitative study was conducted with individual interviews among 20 participants with occupational experience from overcrowded Stockholm areas but diverse in professions, locations and employers. The interviews were recorded, transcribed and analysed with Systematic Text Condensation., Results: Almost all participants expressed that overcrowding has a negative impact on children's health, environment and schooling - based on perceptions of precarious and different living conditions for children in overcrowded areas, for example, substandard homes, vulnerability, stress, exclusion, limited resources, lack of learning opportunities, gender differences, confinement, shame, insecurity, conflicts, risk of criminality, and bodily impact, both physical and psychological., Conclusions: Our qualitative evidence suggest that overcrowding has a negative impact on children's health, environment and schooling ., Competing Interests: Declaration of conflicting interestsThe authors have no conflicts of interest to declare.

Social determinants of health (SDoH), including factors such as education level, housing, poverty, racism, and food insecurity and their impact on health outcomes have been well documented. The "Wayne Pediatrics Health and Nutrition Expo" held at Detroit's Eastern Market was an activity-based health and nutrition event addressing pediatric SDoH. Partnering with community organizations, the event had 10 stations addressing SDoH: access to a primary-care pediatrician; HIV-care and prevention; childhood literacy; clothing & winter coats; mental health and childhood development; nutrition; staying active; vaccination; and food insecurity. The free, public event featured a child-themed treasure hunt and map, music, giveaways, and live demonstrations, all in a family-friendly park atmosphere. While SDoH are considered "non-medical" factors that contribute to health and may be difficult to completely address for any individual child, our practice addressed several key SDoH at a single-day, hands-on, child-friendly community event based on the local needs of children., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: EM serves as an Associate Editor (voluntary) for both Clinical Pediatrics and Global Pediatric Health.

Background: It is unclear how family factors affect health care utilization among youth with persistent or recurrent pain, despite potential relevance to interventions targeting treatment barriers., Objective: We aimed to examine health care utilization among young adolescents with persistent or recurrent pain and family factor influences toward higher health care utilization., Methods: We analyzed longitudinal data from the Adolescent Brain Cognitive Development Study and coded pain as none, infrequent (present 1-2 years), or persistent/recurrent pain (present 3-4 years). Higher health care utilization was coded as nonroutine or emergency department visit at ≥2 years. Parent-reported education, pain status, family income, and insurance status were recorded. Logistic regression examined the contributions of the child's pain and family factors toward higher health care utilization., Results: Among 5960 youth, 1908 (32%) had persistent/recurrent pain and 2199 (37%) had infrequent pain. Youth with persistent/recurrent pain were more likely to have higher health care utilization compared to those without pain (adjusted odds ratio [OR]: 2.39) or those with infrequent pain (OR: 1.79). Higher health care utilization was associated with parents' pain (adjusted OR: 1.22) and higher education (adjusted OR: 1.44), and family income below the poverty line (adjusted OR: 1.26), controlling for child characteristics and pain status., Conclusion: Findings show how youths' persistent/recurrent pain, parental, and family socioeconomic factors affect health care utilization among young adolescents, emphasizing a need for family-centered care and economic policies., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Insufficient sleep can lead to problems. We examined the sociodemographic characteristics, sleep habits, and association between sleep problems. Parents were requested to fill out a survey and Children's Sleep Habits Questionnaire (CSHQ). The mean age of 1226 students was 8.42 (5.0-10.0) years. A total of 50.7% were male students. In addition, 69.1% showed signs of sleep problems in the CSHQ. In multivariate logistic regression analysis, bed-sharing, owning cell phone, attending early education group, not using toilet before bedtime, television watching duration, being an only child, not doing physical activity, watching TV before bed on weekends, caffeinated beverage consumption, not reading a book before sleep, waking up at night, sleeping in lighted rooms, maternal education level, having 1 sibling, and not having tablet variables were statistically significant in causing sleep problems. Poor sleep habits and sleep hygiene problems are common in school-age children. Healthy sleep habits are essential to get adequate and quality sleep., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: To assess the prevalence and pattern of ear disease among students attending primary school in urban, rural, and remote regions of Samoa in order to develop an evidence-based national school ear and hearing health program. Methods: Retrospective clinical data review of all primary school students seen by the Ear, Nose & Throat Clinic of Samoa during school-based outreach visits from March 2022 to April 2024. A purposefully designed spreadsheet was created to extract the following information from the clinical records: school location (urban, rural, remote), gender (male, female), age (years), age category (0-4, 5-9, 10-14, 15+ years), right ear diagnosis, left ear diagnosis. Data were entered into the SPSS statistical software package for descriptive statistical analysis and association tests of significance. Results: A total of 1491 primary school students were seen for ear health examinations (51.1% male, 48.9% female), with a mean age of 9.1 years (SD = 2.3). Five primary schools were included, representing urban (n = 865), rural (n = 258), and remote (n = 368) settings. Overall, 682 (45.7%) students had normal ear examination results for both ears, 237 (15.9%) had an ear pathology in 1 ear only, and 568 (38.1%) had ear pathology in both ears. Bilateral ear pathology was significantly higher among students who were in the 5 to 9 age group ( P < .00001), female ( P = .035), and from rural settings ( P = .0001). The most common pathology was impacted cerumen (36.8%), followed by otitis media with effusion (7.5%). Overall prevalence of chronic suppurative otitis media (CSOM) was 2.6% (n = 39 students). Following the school visits, no further intervention was required for 1180 students (79%), mostly due to successful cerumen and foreign body removals for 468 students (31.4%). Conclusion: Impacted cerumen is a significant issue among Samoan school-aged students, and future school-based ear health programs should include staff members trained in cerumen removal. CSOM prevalence suggests an avoidable burden of disease that must be addressed., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This grounded theory study aimed to explore the subjective experiences of children living with Human Immunodeficiency Virus (HIV) from the perspective of children and their families in Indonesia. Twenty participants were interviewed, consisting of 12 children aged 9-18 years and eight family members. Using grounded theory analysis, this study identified three categories: 'coping with diagnosis', 'disclosing their status' and 'living with the stigma of HIV'. Participants responded with shock, denial, sadness, secrecy and often had misconceptions about the virus to the diagnosis of themselves or their children. After diagnosis, children with HIV and their families continuously lived with stigma stemming from individual and societal beliefs about the virus. This stigma manifested in actions such as isolation, disclosure avoidance, secrecy, deception and social rejection. Because of these stigmatisations, many of the participants decided not to disclose the child's HIV status and used status strategies such as telling lies, keeping secrets and keeping their distance. The participants offered insight into the need for comprehensive programs to address care gaps. This study highlights that health professionals need to develop practical guidelines to support families during the disclosure process, provide psychosocial care for children, and create stigma reduction interventions for children with HIV., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Informed by the social ecological model, which asserts that health behaviors and beliefs are the result of multiple levels of influence, we examined factors related to parents' support for in-school COVID-19 mitigation strategies. Using data from a survey of 567 parents/caregivers of public elementary and middle school students in eight Maryland counties, we employed regression models to examine relationships between parent-, child-, family-, school-, and community-level factors and acceptability of mitigation strategies. Acceptance of COVID-19 mitigation strategies was positively correlated with child- and family-level factors, including child racial identity (parents of Black children were more accepting than those of White children, odds ratio [ OR ]: 2.5, 95% confidence interval [CI] = [1.5, 4.1]), parent receipt of the COVID-19 vaccine ( OR : 2.4, 95% CI = [1.5, 3.7]), and parent Democrat or Independent political affiliation (compared with Republican affiliation, OR : 4.2, 95% CI = [2.6, 6.7]; OR : 2.2, 95%CI = [1.3, 3.8], respectively). Acceptance was also positively associated with parents' perceptions of their school's mitigation approach, including higher school mitigation score, indicating more intensive mitigation policies ( OR : 1.1, 95% CI = [1.0, 1.1]), better school communication about COVID-19 ( OR : 1.7, 95% CI = [1.4, 1.9]) and better school capacity to address COVID-19 ( OR : 1.9, 95% CI = [1.5, 2.4]). Community-level factors were not associated with acceptance. Child- and parent-level factors identified suggest potential groups for messaging regarding mitigation strategies. School-level factors may play an important role in parents' acceptance of in-school mitigation strategies. Schools' capacity to address public health threats may offer an underappreciated and modifiable setting for disseminating and reinforcing public health guidance.

Background: The health and well-being of children in the first 2000 days has a lasting effect on educational achievement and long-term chronic disease in later life. However, the lack of integration between high-quality data, analytic capacity and timely health improvement initiatives means practitioners, service leaders and policymakers cannot use data effectively to plan and evaluate early intervention services and monitor high-level health outcomes., Objective: Our exploratory study aimed to develop an in-depth understanding of the system and clinical requirements of a state-wide paediatric learning health system (LHS) that uses routinely collected data to not only identify where the inequities and variation in care are, but also to also inform service development and delivery where it is needed most., Method: Our approach included reviewing exemplars of how administrative data are used in Australia; consulting with clinical, policy and data stakeholders to determine their needs for a child health LHS; mapping the existing data points collected across the first 2000 days of a child's life and geospatially locating patterns of key indicators for child health needs., Results: Our study identified the indicators that are available and accessible to inform service delivery and demonstrated the potential of using routinely collected administrative data to identify the gap between health needs and service availability., Conclusion: We recommend improving data collection, accessibility and integration to establish a state-wide LHS, whereby there is a streamlined process for data cleaning, analysis and visualisation to help identify populations in need in a timely manner., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The Internet is increasingly being used as a health information resource. This meta-ethnography aimed to synthesize the literature on how parents of children aged below 5 years' experienced using the Internet for health information purposes. We employed an interpretive meta-synthesis approach-meta-ethnography-according to Noblit & Hare's seven phases. A total of 22 articles met the inclusion criteria, representing four continents and with 650 participants, mainly mothers. We analysed and synthesized the primary studies into the following lines-of-argument synthesis representing a novel conceptual understanding of the phenomenon: Parents experience the Internet as "A cyber partner for child caring" being a 24/7 available "go-to" among other confined sources. Parents find ways of "patching together" trustworthy information in solicitude for their child's health while navigating between trust and anxiety. They relate online and share their experiences and secrets without being rejected. Clinicians and parents may benefit from "partnering" with this resource., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

School nurses and pediatric nurses play vital roles in providing healthcare for children and adolescents in educational and healthcare settings. School nurses operate within educational institutions, serving as caregivers and facilitating communication between the school, families, and the healthcare system. These professionals closely collaborate with pediatric nurses. The primary objective of this study was to examine the state of school nursing in Spain. The research comprised 27 nurses, including 18 school nurses and 9 pediatric nurses, chosen through theoretical sampling. These nurses participated in in-depth interviews as part of the data collection process. Grounded theory, following Charmaz's process, was employed for data analysis. The findings underscore the nurses' call for their mandated presence and regulation in all Spanish educational institutions to address contemporary health challenges and ensure inclusive education., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Tree of Life Groups (a narrative therapy technique) have been used successfully in a number of paediatric populations. The group intervention aims to give children a space to express their difficulties whilst also holding in mind their strengths and hopes, thereby creating a preferred identity incorporating their physical health condition. No studies were identified which described this approach in a paediatric epilepsy population or involving siblings, families and the multidisciplinary team., Methods: The current paper describes a pilot intervention to facilitate a one-day psychoeducational Tree of Life group for children with epilepsy, their siblings and parents. Separate parent and sibling groups were facilitated concurrently. The groups were co-facilitated by Paediatric Psychology and Paediatric Epilepsy team members. Quantitative feedback was completed by the patient group. Patients, siblings, and parents provided qualitative feedback., Results: A total of 6 patients, 14 siblings and 15 parents attended the group. Quantitative feedback indicated some improvement in patients' confidence and knowledge of managing epilepsy, as well as some improvements in psychological adjustment and thoughts about epilepsy. 87.5% of patients and siblings detailed that they would recommend the group to others. Qualitative feedback from patients, siblings and parents indicated the helpfulness of relating to others and safely expressing difficulties., Conclusions: The results indicated that this pilot group intervention was well received by children with epilepsy and their families. Future studies incorporating a larger sample are warranted to explore this further., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Silver diamine fluoride (SDF) and atraumatic restorative treatment (ART) are treatment modalities that are minimally invasive and used for the prevention and control of dental caries. The amalgamation of these two techniques has led to the development of silver modified atraumatic restorative treatment (SMART). In this approach the carious lesion is restored with glass-ionomer cement (GIC) after SDF application. SMART effectively arrests caries without removing additional tooth structure, making it a promising option for caries management in children who lack cooperative ability.This article reviews the literature on SMART, the evidence regarding its applications in dental practice, its advantages, drawbacks, the scope for research, and clinical use., Competing Interests: Declaration of Conflicting InterestsThe Authors declare that there is no conflict of interest.

The impact of health service access disparities has significant implications for society. The importance of addressing health and social inequities is never more critical than in the early years of a child's life. Despite advances in healthcare implementation, there is a lack of an evidence-based framework to specifically guide the adaptation of child and family health (CFH) service models for different community contexts. This paper describes the development of a framework for the adaptation of community-based CFH service models. Drawing on the findings of an integrative review and Delphi study, Participatory Action Research was used to test the framework, resulting in the Framework for Collaborative Adaptation of Service Models for Child and Family Health in Diverse Settings (CASCADES). The Framework uses the analogy of a waterfall to represent the iterative process of collecting information to inform each step. The framework supports a collaborative co-design approach to build a comprehensive understanding of the target community to inform the adaptation and evaluation of evidence-based interventions appropriate to the local context. The ultimate aim is to enable the delivery of services that are contextually relevant for local communities and provide greater access to effective, accessible services to support children and their families., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

This study aimed to systematically review evidence of the association between learning disorders, motor function, and primitive reflexes in preschool children. Seven databases were systematically searched (EMBASE, CINAHL, Academic Search Complete, Medline, PsycINFO, ScienceDirect, and Cochrane) with no restrictions. Inclusion criteria were full text peer-reviewed articles reporting new empirical data, assessing any two of three phenomena in preschool children: learning disorders, motor function, or primitive reflexes. Intervention studies or studies examining congenital, chromosomal or acquired neurological, or pathological conditions and prematurity were excluded. Included papers ( n = 27) were assessed for methodological quality by the Hoy et al. Risk of bias tool. Learning and motor function were assessed in all except two articles and motor deficits found to be associated with speech/language and executive function as well as several areas of academic performance. Three studies included primitive reflexes, with high levels of the asymmetrical tonic neck reflex positively correlated with fine motor skills, "school readiness" and "impulsivity, hyperactivity and inattention." Caution must be used when interpreting the review results due to significant study heterogeneity. Further research is needed to further understand common underlying mechanisms that may inform earlier diagnostic methods for these three phenomena. PROSPERO: CRD42021265793., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Play has positive effects on children's well-being and development. Play heroes, in Danish, called "Legeheltene", have worked, for the last 7 years, to improve play and movement for hospitalized children in Danish hospitals. However, the significance of this novel Danish intervention is insufficiently researched. This phenomenological-hermeneutic study explored how children experience interacting with a play hero when hospitalized at a Danish paediatric unit. Combined observations and interviews were performed with children from two paediatric departments. Data were analyzed with inspiration from the French philosopher Paul Ricoeur. Three themes were identified: "A sense of familiarity," "From loneliness to connectedness," and "Becoming more powerful." Children experience that interaction with play heroes is existentially meaningful. Through playful activities, children experience that they are connected to their daily lives outside the hospital and their true selves. Bridges to children's everyday lives are built, leading to an improved sense of freedom, security, and the ability to manage difficult aspects of their hospital stay. Engagement with play heroes provides children with an experience of well-being and can be a positive direction in care provided to hospitalized children., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: The relationship between caregivers and children has importance for the development of children's mental health and wellbeing. This study examines the association between orphaned children's mental health and their relationship with their current caregivers., Method: It used a correlational research design, appropriate to answer the research questions. The participants were 172 Ethiopian orphans aged 12-18 years, living in institutional care settings, who were selected by stratified sampling techniques, based on a proportionate number of orphans of both sexes., Results: The findings of multivariate analysis revealed that the level of trusting relationships between children and caregivers was strongly associated, and significantly contributed to mental health measures, such as depression, social anxiety, and self-esteem., Conclusions: Trusting relationships with caregivers showed a significant contribution to mental health measures (depression, social anxiety, and self-esteem)., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Parents of a child with a chronic illness can experience greater distress than the average population, yet little is understood about differences between illness groups. This cross-sectional survey study aimed to compare parents' psychological distress and perceived wellbeing across five chronic illnesses. Parents from one Australian pediatric hospital completed the Kessler Psychological Distress Scale and seven purpose-designed items about their wellbeing. Data from 106 parents (cancer = 48, cystic fibrosis [CF] = 27, kidney disease = 12, gastrointestinal condition/disorder = 9, developmental and epileptic encephalopathy [DEE] = 10) was analysed using bivariate Pearson's Correlation and linear mixed-effects models. Parents' distress scores differed between groups ( F (4,80) = 2.50, p = .049), with the DEE group reporting higher distress than the CF group ( mean difference = 6.76, 95% CI [0.11, 13.42]). Distress scores were moderately correlated to parents' perceptions of their child's health and their own wellbeing. Parents' self-reported coping with their child's condition/treatments differed ( F (4,81) = 3.24, p = .016), with the DEE group rating their coping as poorer than the CF group ( mean difference = -25.32, 95% CI [-46.52, 4.11]). Across all groups, parents reported unmet needs, particularly for psychosocial support and practical/financial assistance. Support interventions may be most effective if tailored to the child's illness, with greater support potentially needed for parents who have a child with DEE and/or severe comorbidities., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

In 2019, an estimated 5.2 million deaths were reported among children less than 5 years of age. At primary healthcare level, healthcare workers (HCWs) mostly rely on history and clinical findings and less on inadequate diagnostic facilities. To enhance case management skills of HCWs, World Health Organization devised an integrated management of childhood illnesses (IMCI) strategy in 1995, modified to distance learning IMCI in 2014. A qualitative phenomenological study was conducted to explore perceptions of HCWs about standard and distance IMCI. Four focus group discussions were conducted with purposively selected 26 HCWs (IMCI trained) from 26 basic health units of Abbottabad district in Pakistan. Gadamer's philosophical hermeneutics were adopted during the inductive thematic analysis. Five themes that emerged are inexorable health seeking behaviors, IMCI being a comprehensive algorithm for consultation, a tedious protocol, scaling up protocol to specialists and private practitioners, and administrative insufficiency by the department of health. Improvement in case management skills of HCWs was reported as a result of IMCI trainings. It needs administrative support, regulations to control poly-pharmacy and provision of drugs without prescription, and a curb on political and bureaucratic interference., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This project explored the needs of mothers beyond the immediate postnatal period in Queensland, Australia, for the development of improved models of care. Data were collected through group and individual interviews. A qualitative methodology using thematic analysis captured the experience of 58 participants. Four key themes were generated: Caring for self, Being connected, Getting direction and Having options. Being connected with care providers and peers was highly valued by participants as was having a sense of direction. Having a relationship with a carer who knew them personally throughout pregnancy and postnatal care avoided retelling stories and facilitated information sharing. Relationship-based care enabled mothers to better meet their personal needs necessary to fulfil the parenting role. Yet, many points of disconnect were identified including inconsistencies in information and gaps in care. These findings demonstrate a range of unmet needs, situated within a lack of relational continuity. Maternity and child health professionals, service managers and policy makers must reorient systems by listening, acknowledging and keeping the voice of mothers at the centre of care., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: Effective health communication can increase intent to vaccinate. We compared 8 messages that may influence parents' intent to vaccinate their children against COVID-19., Methods: In a cross-sectional survey of adults in the United States administered online in August 2021, 1837 parents and legal guardians were exposed to 8 messages (individual choice, gain/practical benefits, nonexpert, health care provider recommendation, altruism/community good, safety/effectiveness, safety, and effectiveness) to determine message reception and influence on intent to vaccinate their children. Parents responded to 10 questions using a Likert scale. We computed odds ratios (ORs) for each message, with an OR >1.0 indicating greater observed odds of participant agreement with the follow-up statement as compared with a reference message. We compared outcomes individually across messages with ordinal logistic regression fit using generalized estimating equations., Results: The individual choice message had the highest odds of agreement for understanding intent (OR = 2.10; 95% CI, 1.94-2.27), followed by the health care provider recommendation message (OR = 1.58; 95% CI, 1.46-1.71). The individual choice message had the highest odds of memorability, relatability, and trustworthiness. The altruism/community good message was at or near second best. The altruism/community good message had the highest or near-highest odds of increasing parents' intent to vaccinate their children, asking friends and family for their thoughts, and searching for additional information. The message that most motivated parents to vaccinate their children depended on parental intent to vaccinate prior to being exposed to the tested messages., Conclusions: Messages with themes of individual choice, health care provider recommendation, and altruism/community good may be used in future message campaigns. Further research is needed to refine message concepts related to altruism/community good., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Existing research suggests that children who experience poverty and hospitalization in early childhood are at risk of developing behavior problems. We examined whether the association between early childhood hospitalization and children's internalizing and externalizing behaviors were moderated by family poverty status and child sex. Participants included 224 children from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. There was no direct association between hospitalization and problematic behaviors. Poverty status during early childhood, but not child sex, significantly moderated the association between hospitalization and externalizing problems. Findings support the need for community programs that promote an integrative approach to healthcare for families experiencing poverty., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Little is understood about the unintended consequences of cannabis liberalization on children. Subsequently, this scoping review aimed to map and identify evidence related to acute cannabis intoxication in children. We searched three medical literature databases from inception until October 2019. We identified 4644 information sources and included 158 which were mapped by topic area relating to 1) public health implications and considerations; 2) clinical management; and 3) experiences and information needs of HCPs and families. Public health implications were addressed by 129 (82%) and often reported an increased incidence of acute pediatric cannabis intoxications. Clinical information was reported in 116 (73%) and included information on signs and symptoms ( n = 106, 92%), clinical management processes ( n = 60, 52%), and treatment recommendations ( n = 42, 36%). Few sources addressed the experiences or information needs of either HCPs ( n = 5, <1%) treating children for acute cannabis intoxication or families ( n = 1, <1%) seeking care. Increasing incidence of acute cannabis intoxications concurrent with liberalization of cannabis legislation is clear, however, evidence around clinical management is limited. Additionally, further research exploring HCPs and families experiences and information needs around cannabis intoxication is warranted., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Caregiver-reported data on children's health are typically provided by mothers. We investigated whether measures of children's health would significantly differ between mother and father respondents to a nationally representative survey. This study used de-identified data on children age 0 to 17 years from the 2016-2019 National Survey of Children's Health (NSCH). The primary exposure was whether the survey was completed by the child's father (cases) or mother (controls). Outcome variables included general health, special health care needs (SHCN), and unmet health care needs. We identified 85 191 children meeting inclusion criteria, of whom 35.1% had a father respondent. After propensity score matching, 27 738 children with a father respondent were matched to an equal size group of children with a mother respondent. On conditional logistic regression analysis of the matched sample, we found that poor health, SHCN, and unmet health care needs were less likely to be reported for children in the sample by father respondents., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Research partnerships between researchers and knowledge users (KUs) in child health are understudied. This study examined the scope of KU engagement reported in published child health research, inclusive of health research partnership approaches and KU groups. Search strategies were developed by a health research librarian. Studies had to be in English, published since 2007, and were not excluded based on design. A two-step, multiple-person hybrid screening approach was used for study inclusion. Data on study and engagement characteristics, barriers and facilitators, and effects were extracted by one reviewer, with 10% verified by a second reviewer. Three hundred fifteen articles were included, with 243 (77.1%) published between 2019 and 2021. Community-based participatory research was the most common approach used ( n = 122, 38.3%). Most studies ( n = 235, 74.6%) engaged multiple KU groups (range 1-11), with children/youth, healthcare professionals, and parents/families being most frequently engaged. Reporting of barriers and facilitators and effects were variable, reported in 170 (53.8%) and 197 (62.5%) studies, respectively. Publications have increased exponentially over time. There is ongoing need to optimize evaluation and reporting consistency to facilitate growth in the field. Additional studies are needed to further our understanding of research partnerships in child health., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: Addressing family psychosocial and mental health needs in the perinatal and early childhood period has a significant impact on long-term maternal and child health and is key to achieving health equity. We aimed to (1) describe and evaluate the role of an Early Childhood Community Health Worker (EC-CHW) to address psychosocial needs and improve psychosocial well-being for families in the perinatal period, and (2) examine factors associated with completion of goals., Methods: An EC-CHW program was modeled after an existing hospital CHW program for children with special healthcare needs and chronic disease. An evaluation was conducted using repeated measures to assess improvements in psychosocial outcomes such as family stress and protective factors after participating in the EC-CHW program. Linear regression was also used to assess factors associated with completion of goals., Results: Over a 21-month period (January 2019-September 2020), 161 families were referred to the EC-CHW. The most common reasons for referral included social needs and navigating systems for child developmental and behavioral concerns. There were high rates of family engagement in services (87%). After 6 months, families demonstrated statistically significant improvements in protective factors including positive parenting knowledge and social support. Only 1 key predictor variable, maternal depression, showed significant associations with completion of goals in the multivariable analysis., Conclusions: This study demonstrated the need for, and potential impact of an EC-CHW in addressing psychosocial and mental health needs in the perinatal period, and in a primary care setting. Impacts on protective factors are promising., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: To determine whether the association between ADHD severity and electronic media use was mediated by parental aggravation., Methods: This was a retrospective analysis from the 2016 to 2017 National Survey of Children's Health (NSCH) involving children ages of 3 to 17 years with parent-reported ADHD ( n  = 5,930). Path analyses were used to model the relationships between ADHD severity with parental aggravation (PA) as a mediator, and electronic device (ED) and television (TV) use as outcomes, controlling for covariates., Results: Parental aggravation mediated the relationship between ADHD severity and ED use and TV use (indirect effects: β = .02, p  < .001; β = .01, p  = .004). When stratified by age, the mediation effect between ADHD and ED use remained significant for adolescents and school-age children, and mediation between ADHD and TV use remained significant only for adolescents., Conclusion: These findings suggest a need to develop targeted interventions to address PA and manage excessive electronic media use in children with moderate/severe ADHD., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Our Grassroots Maternal and Child Health (MCH) Initiative works to build the capacity of individuals and organizations in zip codes with persistently high infant mortality rates to bring about systems change that will improve maternal and child health (MCH) outcomes. Foundational to the Initiative is the training and mentoring of local women to become Grassroots MCH Leaders. We greatly honor that these women possess community expertise, essential to the Initiative's success. Our training equips them with strategies they can use to bring about changes in social, economic, political, and/or cultural systems that underlie poor birth outcomes. One impactful strategy they learn is the use of critical narrative intervention (CNI). This approach, grounded in the crafting and sharing of stories, complements statistical, behavioral, and medical approaches to improve MCH outcomes. This article describes the impact of CNI within the Grassroots MCH Initiative. Drawing from 14 Grassroots MCH Leaders' narratives, we present five significant maternal traumas and influential supports in their surrounding contexts. We explore the leaders' reflections on the impact of story development and dissemination. Our findings reveal that situating CNI within the context of a grassroots initiative provides opportunities for leaders to use their stories to advocate for systems change. Personal MCH narratives provide a powerful and respectful approach to public health promotion, as they highlight important systems-level failures that need to be addressed to sustainability improve MCH outcomes.

Objective: Parental leave and breastfeeding breaks influence the ability to initiate and continue breastfeeding. We investigated how eligibility criteria in the Family and Medical Leave Act (FMLA) and Affordable Care Act (ACA) affect access to unpaid parental leave and breastfeeding breaks and assessed affordability and alternative policy models., Methods: We used family income data to assess the affordability of unpaid leave by race and ethnicity. We used 2017-2018 US Current Population Survey data to determine the percentage of private sector workers aged 18-44 years who met the minimum hour (1250 hours of work during a 12-month period), tenure (12 months), and firm size (≥50 employees) requirements of FMLA and ACA. We analyzed eligibility by gender, race and ethnicity, and age. We also examined parental leave and breastfeeding break policies in 193 countries., Results: Most Latinx (66.9%), Black (60.2%), and White (55.3%) workers were ineligible and/or unlikely to be able to afford to take unpaid FMLA leave. Of 69 534 workers, more women (16.9%) than men (10.3%) did not meet the minimum hour requirement. Minimum tenure excluded 23.7% of all workers and 42.2% of women aged 18-24 years. Minimum firm size excluded 30.3% of all workers and 37.7% of Latinx workers. Of 27 520 women, 28.8% (including 32.9% of Latina women) were excluded from ACA breastfeeding breaks because of firm size. Nearly all other countries guaranteed mothers paid leave regardless of firm size or minimum hours and guaranteed ≥6 months of paid leave or breastfeeding breaks., Conclusions: Adopting a comprehensive, inclusive paid parental leave policy and closing gaps in breastfeeding break legislation would remove work-related barriers to breastfeeding; reduce racial, ethnic, and gender inequities; and align US national policies with global norms., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This study examined associations between four indicators of social determinants of health (SDOH; parent education, poverty, material hardships, and child health problems), chronic school absence, and teachers' ratings of parents' engagement in their children's education. Surveys were collected from 304 parents and 26 teachers from eight Baltimore City Public Schools. Results revealed that teachers' ratings of parent engagement were consistently lower among families experiencing adverse SDOH and/or whose children were chronically absent; however, there was no significant relationship between teachers' ratings of parent engagement and child health problems. Additionally, chronic absence partially mediated the relationship between three SDOH indicators (total material hardships, parent education level, and child health problems) and teacher-rated parent engagement. Poverty was excluded from mediation analysis due to evidence of multicollinearity suppressive effects. Addressing the SDOH assessed in this study may be an effective strategy to reduce chronic absence, promote parent engagement, and foster equity in education., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Parent experiences of child health services can be used to understand their value and optimise the support provision to families during critical developmental periods. A gap in the literature exists regarding parental perspectives of linked child development supports, particularly in disadvantaged areas. This study examined parent experiences of the impact and value of a community paediatric clinic (Kidscope) with linked, multi-agency supports in a disadvantaged area of Ireland. Using a qualitative analysis design, 10 parents participated in one-to-one interviews. A Community Advisory Group consulted on interview schedules. Data was thematically analysed in line with Braun & Clarke's Framework. Five themes and twenty-two sub-themes emerged. Kidscope's linked, multi-agency approach was valuable for engaging families, addressing developmental delay, supporting readiness for education, and developing parent-child relationships. Relational working and a child and family centred model of care empowered parents to become active agents in children's health. Coronavirus disease 2019, national deficits in healthcare, and staff turnover impeded service delivery. Kidscope and linked supports work in partnership to disrupt the impact exclusion from healthcare has on vulnerable children and families. This study provides evidence of an effective integrated paediatric service delivery model designed around vulnerable children and families and highlights areas for improvement., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Parents and youth across Alberta were engaged to identify specific research questions that are a priority to them. Two lists, containing 27 topics were developed with local parent and youth advisory groups, and sent to participants via online questionnaires. Topics were rated from one (least important) to five (most important) and ranked in order of priority. Initial questionnaires were completed by 263 (46%) parents and 308 (54%) youth. Parents rated five topics (behaviour, learning, and developmental disorders; mental health; food, environment and lifestyle; quality of health care; and vaccines) and youth rated four topics (brain and nerve health; mental health; quality of health care; and vaccines) as a high priority. Research questions stemming from 4 parent (12 [5%]) and 6 youth (21 [7%]) focus group discussions were then ranked in a second questionnaire, completed by 43 (43%) parents and 56 (56%) youth. Parents' highest ranked research question was 'What is the effect of screen time on cognition and neurodevelopment for children and adolescents?', while the highest ranked question from youth was 'What are the early signs of anxiety and depression and when should an individual seek help?'. These topics highlight areas that are important to parents and youth where funding, research, and knowledge mobilization efforts should be directed., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: In Brazil, a relevant portion and children suffer without receiving adequate control of their symptoms. Failures in pediatrician training may contribute to this problem. Objective: The goal was to characterize the educational failures perceived by pediatric residents for pediatric palliative care throughout their training. Methods: A cross-sectional study was carried out, with the application of the Pediatric Palliative Care Questionnaire (QCPP) to residents of three pediatrics and specialties of public limits at the Escola de Saúde Pública do Estado do Ceará (ESP-CE), Brazil. Results: The response rate was 68 out of 123 residents (55%). It was reported that they did not consider the specialty as patient care or death. He also feels comfortable explaining the physiological process of dying to his family. The time devoted to CPP teaching, as well as medical residency, was considered reduced. For those who attended a subspecialty, the number they signaled was "0 hours" at 82.40%. Conclusion: It can be said that the main flaws in the teaching-learning process of pediatric residents were the number of hours of training in teaching, communication skills training (through participation in conferences) and guidance on the practice of teaching suspension of invasive measures. It was observed that less time reserved for this learning is related to lesser knowledge and greater barriers to the use of palliative care. Those who declared themselves able to take care of children with life-organizing conditions received some teaching in CPP.

This study examined the association between home tobacco smoke exposure (TSE) status and gastrointestinal problems in the past 12 months among US children. We conducted a secondary analysis of the 2018-2019 National Survey of Children's Health cross-sectional data including 20 149 children aged 4 to 10 years. Weighted logistic regression models unadjusted and adjusted for child and family covariates were fitted. Overall, 12.3% of children had home thirdhand smoke (THS) exposure only and 1.8% had home secondhand smoke (SHS) and THS exposure. Unadjusted (odds ratio [OR] = 1.70, 95% confidence interval [CI] = 1.32-2.20) and adjusted (adjusted odds ratio [AOR] = 1.51, 95% CI = 1.14-1.99) logistic regression results indicated that relative to children with no home TSE, children with home THS exposure only were at increased odds of having frequent or chronic difficulty with gastrointestinal problems over the past 12 months. Interventions are critically needed to promote smoking cessation among household members who live with children in order to reduce levels of SHS and THS in their homes.

This study aimed to explore the associations of screen time (ST) and its' changes with follow-up body mass index (BMI) in preschool children. Parents of 805 preschoolers participated in our study at baseline and were followed up after 1 year in China. Linear regression models were used to analyze the dynamic relationship between ST and BMI in preschool children. A total of 662 preschoolers, including 342 boys (51.7%) and 320 girls (48.3%) were followed up. The changes in ST (from the initial ≤1 h/day to >1 h/day at follow-up vs keep ≤1 h/d, β(SE) = 0.21(0.09), P = .016) and follow-up ST of preschool children (>1 h/d vs ≤1 h/d, β(SE) = 0.17(0.07), P = .013) were significantly associated with an increase in the preschoolers' z-scored BMI at follow-up after adjusting for potential confounding factors. We concluded that the unfavorable change in ST was associated with increased BMI in preschool children.

Objectives: The Inter Tribal Council of Arizona, Inc (ITCA) Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutrition services for families by partnering with local vendors. In 2009, the US Department of Agriculture (USDA) instituted the WIC Vendor Cost Containment Final Rule, which required WIC programs to group vendors with similar characteristics. USDA issued guidance for evaluating and constructing vendor peer grouping systems in 2017. We constructed vendor peer groups using USDA recommended methods., Methods: We used ITCA WIC vendor and redemption data to construct composite variables for mean food basket cost as the outcome in linear models using the following predictors: business model, Supplemental Nutrition Assistance Program (SNAP) store type, WIC total sales, number of Universal Product Codes (UPCs) redeemed, number of cash registers, store square footage, rural-urban commuting area codes, 2010 Frontier and Remote (FAR) area codes, distance to the closest interstate in miles, and urban or nonurban location. We developed an ITCA WIC vendor peer group system., Results: We examined 146 ITCA WIC vendors. Final complete vendor peer groups for ITCA WIC in linear regression models included SNAP store type ( P < .001), number of cash registers ( P < .017), and FAR codes ( P < .001). FAR codes were important, while other geography measures were not., Conclusions: Using vendor peer groups can improve cost containment measures and the integrity of WIC services. Other WIC programs can use FAR codes as a USDA-required geography measure for local vendor peer group evaluations.

This study aimed to identify barriers and facilitators to discussing parent mental health within child health care for parents of children with congenital heart disease (CHD). Seventy-nine parents of young children with CHD who received care across 40 hospitals in the United States responded to questions about barriers and facilitators to discussing their mental health with their child's health care providers. Responses were analyzed using qualitative research methods. Parents described multiple barriers: (1) belief that parent mental health support was outside the care team's scope of practice, (2) perceived expectation to "stay strong," (3) fear of negative judgment or repercussion, (4) individual preferences for communication/support, (5) desire to maintain care resources on their child, (6) perceived need to compartmentalize emotions, and (7) negative reactions to past emotional disclosure. Parents also described several facilitators: (1) confidence in the care team's ability to provide support, (2) intentional efforts by the care team to provide support, (3) naturally extroverted tendencies, and (4) developing personal connections with health care providers. It is important that health care providers normalize the impact of child illness on the family and create an environment in which parents feel comfortable discussing mental health challenges.