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The current study examined whether social competence and autistic traits are related to anxiety and depression in autistic and non-autistic children. Parents of 340 children aged 6 to 12 years old, including 186 autistic and 154 non-autistic children completed the Autism Spectrum Quotient (AQ) to assess their child's autistic traits, the Multidimensional Social Competence Scale (MSCS) to assess their child's social competence, and the Behaviour Assessment Scale for Children 2 (BASC-2) to assess their child's internalizing symptoms of depression and anxiety, and children were administered the Wechsler Abbreviated Scale of Intelligence, Second Edition (WASI-II) to assess their intellectual abilities. Hierarchical multiple regression analyses were conducted to investigate the relations between social competence, autistic traits, anxiety, and depression. Social competence was related to anxiety and depression symptoms in autistic children, but only depression symptoms in non-autistic children, above and beyond the effects of autistic traits, IQ and age. Autistic children were also reported to experience more severe anxiety and depression symptoms, and more autistic traits were related to higher levels of anxiety and depression in both groups. These findings suggest that social competence and internalizing symptoms are intricately connected in autistic children and need to be jointly considered in both assessment and intervention. The social implications are discussed with an emphasis on acceptance of diverse social styles as a viable avenue to reduce children's internalizing symptoms. [ABSTRACT FROM AUTHOR]

Sensory Over-Responsivity (SOR) is an increasingly recognized challenge among children with neurodevelopmental concerns (NDC). To investigate, we characterized the incidence of auditory and tactile over-responsivity (AOR, TOR) among 82 children with NDC. We found that 70% of caregivers reported concern for their child's sensory reactions. Direct assessment further revealed that 54% of the NDC population expressed AOR, TOR, or both – which persisted regardless of autism spectrum disorder (ASD) diagnosis. These findings support the high prevalence of SOR as well as its lack of specificity to ASD. Additionally, AOR is revealed to be over twice as prevalent as TOR. These conclusions present several avenues for further exploration, including deeper analysis of the neural mechanisms and genetic contributors to sensory processing challenges. [ABSTRACT FROM AUTHOR]

This study investigated the prevalence, and the developmental, behavior and emotional outcomes of 675 preschoolers with ASD with or without a history of regression, who participated in the Study to Explore Early Development (SEED). The SEED project is a cross-sectional case-control study that collected data between 2007 and 2011. Children's history of regression, adaptive skills, and behavior problems were assessed using the Autism Diagnostic Interview-Revised (ADI-R), the Vineland Adaptive Behavior Scales-Second Edition (Vineland-2), and the Child Behavior Checklist (CBCL), respectively; and children's developmental levels were assessed using the Mullen Scales of Learning (MSEL). Findings from this study indicated that 26% of children experienced social and language regression, and of those with regression, 76% had regained lost skills upon completion of the study. Compared to children without a history of regression, children with social regression demonstrated increased internalizing problems and decreased fine motor skills, and children with language regression demonstrated poorer language skills. Also, children with language and social regression displayed poorer adaptive communication skills than children without regression. Children who experienced regression in one area of development demonstrated better outcomes than those who experience regression in multiple areas. To conclude, children with regression are at risk for poorer outcomes during their preschool years. [ABSTRACT FROM AUTHOR]

Shortened telomere length (TL) has been associated with lower cognitive performance, different neurological diseases in adults, and certain neurodevelopmental disorders in children. However, the evidence about the association between TL and neuropsychological developmental outcomes in children from the general population is scarce. Therefore, this study aimed to explore the association between TL and neuropsychological function in children 4–5 years of age. We included 686 children from the INMA Project, a population-based birth cohort in Spain. Leucocyte TL was determined by quantitative PCR method, and neuropsychological outcomes were measured using the McCarthy Scales of Children's Abilities (MCSA). Multiple linear regression models were used to estimate associations adjusted for potential confounding variables. Main findings showed that a longer TL was associated with a higher mean working memory score (β = 4.55; 95% CI = 0.39, 8.71). In addition, longer TL was associated with a higher mean global quantitative score (β = 3.85; 95% CI = −0.19, 7.89), although the association was marginally significant. To our knowledge, this is the first study that shows a positive association between TL and better neuropsychological outcomes in children. Although further research is required to confirm these results, this study supports the hypothesis that TL is essential in protecting and maintaining a child's health, including cognitive functions such as working memory. [ABSTRACT FROM AUTHOR]

Oppositional defiant disorder (ODD) and attention-deficit/hyperactivity disorder (ADHD) are two of the most common childhood mental disorders, and they have substantial comorbidity. The developmental precursor model has long been widely used to explain the mechanisms of comorbidity between ODD and ADHD, however whether it is equally effective at the symptomatic level is unclear. Therefore, this study aimed to (a) examine the stability of the ODD and ADHD comorbidity network in a longitudinal sample of high-risk children in China; and (b) examine the longitudinal relationship between the ODD and ADHD symptom networks based on a developmental precursor model. Two hundred sixty-three Chinese children aged 6 to 13 years with ODD and/or ADHD were assessed for symptoms of ODD and ADHD in two surveys conducted 1 year apart. We used data from these two time points to construct two cross-sectional networks and a cross-lagged panel network (CLPN) to explore the symptom network for comorbidity of ODD and ADHD. The analysis shows that: (1) the two cross-sectional networks are highly similar in terms of structure, existence of edges, centrality estimates, and the invariance test shows that there is no significant difference between them. The symptoms "follow through", "interrupts/intrudes", "difficulty playing quietly" and "concentration" had the highest expected influence centrality at both time points. (2) Combined with the results of the cross-sectional and cross-lagged networks, we found that "annoy" and "blame" are potential bridge symptoms between the ODD and ADHD symptom networks. The symptom "annoy" forms a reciprocal predictive relationship with "interrupts/intrudes", while "blame" unidirectionally predicts "close attention". In addition, we found that "vindictive" predicted numerous ADHD symptoms, whereas "angry" was predicted by numerous ADHD symptoms. The findings emphasize the broad predictive relationship between ODD and ADHD symptoms with each other, and that ODD symptoms may lead to activation of the ADHD symptom network and vice versa. These findings suggest that the developmental precursor model at the symptom level may partially explain the comorbidity mechanisms of ODD and ADHD, and future studies should further investigate the underlying multiple mechanisms. [ABSTRACT FROM AUTHOR]

Background: Levamisole is a commonly used steroid-sparing agent (SSA), but the reported incidence of antineutrophil cytoplasmic antibody (ANCA) positivity has been concerning. Methods: Observational cross-sectional study wherein children aged 2 to 18 years with frequently relapsing/steroid dependent nephrotic syndrome (FRNS/SDNS) on levamisole for ≥ 12 months were tested for ANCA. Results: A total of 210 children (33% female), median age of 7.3 (IQR: 5.6–9.6) years, and a median duration of levamisole exposure of 21 (IQR: 15–30) months were tested. ANCA was positive in 18% (n = 37): 89% (n = 33) perinuclear ANCA (pANCA), 3% (n = 1) cytoplasmic ANCA (cANCA), and 8% (n = 3) both. Of ANCA-positive children, none had reduced eGFR or abnormal urinalysis. The majority of these children were asymptomatic (81%, n = 30). Rash was more common among ANCA-positive children [6/37 (16%) vs. 3/173 (2%), p = 0.0001]. On multivariate analysis, higher age (OR = 1.02, [95th CI: 1.01 to 1.03], p = 0.007) and longer duration of levamisole exposure (OR = 1.05, [95th CI: 1.02 to 1.08], p = 0.0007) were associated with ANCA positivity. Levamisole was stopped in ANCA-positive children with the resolution of any clinical manifestations if present. Repeat ANCA testing was performed in 54% (20/37), and all were ANCA negative by 18 months. Conclusions: Children with FRNS/SDNS on longer duration of levamisole were associated with increasing prevalence of ANCA positivity, but most of these children were clinically asymptomatic. Prospective studies are required to determine the chronology of ANCA positivity and its clinical implication. [ABSTRACT FROM AUTHOR]

Phonology is a widely discussed topic that is studied in detail by linguists, psycholinguists, philologists, pedagogues, and last, but not least, by speech and language pathologists. The assessment methods do inform us about the phonological processes and phonological delays in details by comparing the results with those of a normative sample and offer an opportunity to gradate the severity of the disorder, which is individual and can vary significantly in individual children. The aim of the study is to present evidence of the validity and reliability of a phonological assessment tool developed to assess the phonological inventory of Bulgarian preschool children. For this purpose, an author's test was developed and conducted among 382 Bulgarian children. Results The present study provided evidence of validity and reliability (internal consistency) for this phonological assessment tool, confirming the reliability of its three subtests. Conclusions The present findings provide strong evidence of the validity and reliability of this phonological assessment tool. [ABSTRACT FROM AUTHOR]

The association between composite dietary antioxidant index (CDAI) and asthma remains unclear. Our study aimed to investigate the association of CDAI with asthma in children aged 3–18 years in the United States. Cross-sectional analyses were carried out on 18,118 children aged 3–18 years old. Data was obtained from the National Health and Nutrition Examination Survey (NHANES) conducted between 2003 and 2020. The Composite Dietary Antioxidant Index (CDAI) was measured by assessing the consumption of six dietary antioxidants (vitamin A, vitamin C, vitamin E, zinc, selenium and carotenoids). The association between CDAI and asthma was explored using multivariate weighted logistic regression, subgroup analyses, and sensitivity analyses. Among the 18,118 participants, 2045 (11.3%) reported a diagnosis of asthma by a healthcare provider. In both the crude and adjusted models, the odds ratios (ORs) for asthma with CDAI were not significant. Specifically, in the fully adjusted model, the OR for T2 was 0.98 (95% CI 0.83, 1.17) and the OR for T3 was 1.00 (95% CI 0.76, 1.31). Subgroup analyses by sex, age and BMI category also showed no significant associations. Sensitivity analyses, including weighted logistic multivariate analyses adjusting for family history of asthma, confirmed the absence of a significant association between CDAI and asthma. Our study showed no significant association between CDAI and asthma in children and adolescents. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to compare the functional and radiological outcomes following both guided growth surgery (GGS) and acute corrective osteotomy (ACO) correction of angular deformities in children with rickets. Methods: A total of 8 and 7 children who had gradual GGS and ACO correction, respectively, for angular deformities due to rickets from 2002 to 2022 were recalled for follow-up. Demographic data, types of rickets, data on pharmacological treatment, biochemical parameters, recurrence of angular deformity and postoperative complications were obtained from the medical records. A radiographic evaluation of the leg was performed to determine the tibiofemoral angle. For functional evaluation, the Active Scale for Kids (ASK) and Lower Extremity Functional Scale (LEFS) instruments were used for children below and above 15 years old, respectively. Results: In terms of the tibiofemoral angle, the GGS group documented greater angle changes compared to the ACO group, but the difference was not significant. In terms of functional outcomes, the overall score percentage of both groups was comparable with the GGS group showing a trend of higher score percentage compared to the ACO group. The GGS group presented no complication while 2 neurovascular injuries and 1 implant failure were recorded in the ACO group. Conclusion: Both GGS and ACO procedures resulted in similar radiographic and functional outcomes for the treatment of rickets in children. GGS may be advantageous in terms of reducing complications of surgery. Nevertheless, the choice of surgical intervention should be made based on the patient's circumstances and the surgeon's preference. [ABSTRACT FROM AUTHOR]

Background: Three indicators of early childhood undernutrition and associated factors are evaluated among under-5 children in five National Family Health Surveys in India spanning 1992 to 2021. Methods: Data for 533,495 children under 5 years of age (U–5) were analysed in the context of three commonly used indicators of early childhood undernutrition – wasting, stunting and underweight. In addition to descriptive and inferential statistics, binary logistic regression was used to estimate the effects of specific explanatory factors on the three indicators using adjusted odds ratios. Results: Over the three-decade interval, stunting was reduced by 22.1% in boys and 20.9% in girls, followed by underweight, 19.3% in boys and 17.4% in girls; wasting, in contrast, was reduced to a considerably lesser extent, 2.8% in boys and 0.9% in girls. Demographic, maternal and socioeconomic factors were associated with the incidence of early childhood undernutrition, specifically among young mothers and those with less education in low-income families, and among children from Scheduled Tribes or Scheduled Castes. Stunting and underweight declined significantly over the past three decades while wasting changed negligibly. The disparity in the occurrence of early childhood undernutrition was apparent throughout socioeconomic categories and regions of India. Conclusions: The results highlight the need for special programs aimed at reducing waste among children and also the need for customized initiatives focused on the improvement of maternal education and wealth in addition to other ancillary factors related to regional variation. [ABSTRACT FROM AUTHOR]

Background: The word-in-noise discrimination test evaluates the phonological aspect of speech based on the detection of the vowels. While word-in-noise perception (WINP) test is one of the speech perception exams and evaluates the ability to understand the meaning of words by discovering the consonants. Until now, all word-in-noise tests have assessed speech discrimination performance, and for the first time, the normal values of the WINP test for adults have been determined. Since the normal values of WINP scores in children have not been reported, our research aimed to determine the normal values of the WINP test in children aged 5 to 13 years. In this cross-sectional study, 120 Persian speaking Iranain children with normal hearing thresholds were evaluated from the beginning to the end of spring 2023. We divided them into 4 age groups (A = 5–7 < years, B = 7–9 < years, C = 9–11 < years, D = 11–13 < years). The evaluations included general audiology tests and WINP tests using homtonic-monosyllabic words (HMWs) at a signal-to-noise ratio of 5 dB. Results: Significant difference was observed between the mean scores of the WINP test in age group A (54%) compared to age group B (66%), (Pv = 0.04). Also, the differences between the mean scores of age group A compared to age groups C (70%) and D (69%) were significant (Pv = 0.01, Pv = 0.03). Conclusions: This article presented the norm values of WINP test scores for Persian speaking Iranian children aged 5 to 13 years. The norm values of WINP test scores in the age group of 5–7 years were lower than in the age groups of 7–13 years. The biggest change in the performance of speech perception in noise was observed in the age range of 7–9 years. [ABSTRACT FROM AUTHOR]

Background: Individual and social characteristics are attributed to violent behavior in schools, yet environmental hazards may play an understudied role. Ambient air pollution has been linked to neurological dysfunction that inhibits decision-making and may result in violent behavior in adult populations. However, little is known on how air pollution may be associated with violent behaviors in children. Methods: A cross-sectional ecologic study was designed to estimate the associations between air pollution (fine particulate matter, carbon monoxide, and nitrogen dioxide) with the occurrence of violent incidents and incidents involving a weapon among a cohort of children in Minnesota schools (2008–2012). Differences by urban and rural status of schools were also explored. Negative binomial regression models were developed to estimate incidence rate ratios (IRR) and incidence rate differences (IRD) to describe associations between air pollution and violent incidents in school settings. Results: Our results indicate that the highest levels of carbon monoxide, nitrogen dioxide and fine particulate matter concentrations were associated with increased violent disciplinary incidents. Among the total student population, the 4th quartile of carbon monoxide exposure was associated with an IRD of 775.62 (95% CI 543.2, 1008.05) violent incidents per 100,000 students per school year compared to schools in the lowest quartile of exposure. Comparing the 4th to the 1st quartiles of exposure, nitrogen dioxide and fine particulate matter had an IRD of 629.16 (95% CI 384.87, 873.46), and 510.49 (95% CI 274.92, 746.05) violent incidents per 100,000 students per school year respectively. Schools in urban settings shared a larger burden of violent incidents associated with air pollution compared to rural schools. Conclusions: Modifying environmental pollutants surrounding school environments, particularly for high exposure communities, may be a novel tool for reducing violence and subsequent injuries in schools. [ABSTRACT FROM AUTHOR]

Previous research has consistently shown that parental psychological control is associated with negative psychosocial outcomes, including rule-breaking behavior, aggression, and delinquency. Given the potential long-term consequences of early involvement in externalizing problems, it is important to understand pathways of risk for a child engaging in these behaviors. Therefore, the aim of the current cross-sectional study was to investigate whether peer victimization underlies the associations between parental psychological control and externalizing problems. Participants included 275 children (51.6% girls) in the third through fifth grade (M = 9.33 years, SD = 0.99 years) and their homeroom teachers. Children provided self-reports of psychological control, peer victimization, and delinquency, and teachers provided ratings of peer victimization and forms of aggression. Rule-breaking behavior was assessed using school records. As predicted, a higher order latent externalizing problems factor was identified from indices of rule-breaking behavior, relational aggression, physical aggression, and delinquency. Further, results indicated that peer victimization served as a mechanism linking parental psychological control to a higher-order latent externalizing problems factor as well as individual indices (i.e., rule-breaking behavior, relational aggression, physical aggression, and delinquency). Findings from this study suggest that parents can have an impact on child outcomes through their impact on peer relations. Additionally, these findings may have important implications for early identification and prevention efforts addressing externalizing problems during middle childhood. Highlights: There was a significant indirect effect from parental psychological control to childhood externalizing problems through peer victimization. Findings remained consistent when using child- and teacher-reported peer victimization. Rule-breaking behavior, aggression, and delinquency significantly loaded on to a latent externalizing problems factor. Links between parenting behavior and externalizing problems are evident among children in elementary school. There might be multiple points of intervention when trying to reduce youth externalizing problems. [ABSTRACT FROM AUTHOR]

Developmental theories suggest that exposure to early life adversity (ELA) alters developing emotional response systems, predicting risk for psychopathology across the life span. The present study examines whether negative emotionality (NE), a trait-like measure of emotionality that develops during early childhood, mediates the association between ELA and psychopathology in a representative sample of 917 preschoolers (Mage = 3.84). Additionally, we explored whether cognitive control, which supports attentional focusing and inhibition and has been identified as a transdiagnostic protective factor, moderates the impact of heightened emotionality following adversity on psychopathology risk. We utilized parent report of adversity, psychopathology, and NE and parent report and task-based measures of cognitive control. Structural equation modeling of cross-sectional data revealed that NE partially mediated the link between ELA and psychopathology symptoms. Moreover, parent-reported cognitive control buffered this link such that the effect of ELA on psychopathology through NE was stronger in children with low versus high cognitive control. These results identify elevated NE as one mechanism linking ELA and psychopathology, specifically among children with poorer top-down control, informing our understanding of key risk and protective factors among adversity-exposed children. [ABSTRACT FROM AUTHOR]

Maternal autoimmune diseases (AID) are risk factors for Attention Deficit Hyperactivity Disorder (ADHD). Animal studies suggest that maternal immune activation (MIA) is a disease primer for ADHD, with second environmental factor precipitating the onset of the disease. Prematurity is also a major risk factor for ADHD. In this study, we sought to explore the interaction between parental AID and prematurity on ADHD risk in a community sample. Children of AID parents born prematurely appeared at increased odds of ADHD but these two risk factors do not appear to be additive (OR 1.39 [95 CI 0.75; 2.46]). Longitudinal studies with larger numbers of participants are needed. [ABSTRACT FROM AUTHOR]

Methylphenidate (MPH), a first-line treatment for attention-deficit hyperactivity disorder (ADHD) management, has been the focus of debate for decades regarding its effect on growth. The aim of this PRISMA meta-analysis was to determine the effect of MPH on height in children/adolescents with ADHD and its predictive factors based on literature reports. Available full-text articles were systematically reviewed to identify clinical studies of pediatric ADHD patients with height Z-score (HZS) data for monotherapy MPH-treated and non-treated groups. We estimated standardized mean differences (SMDs) of HZS or its changes from baseline (ΔHZS) between groups, then identified associated factors through subgroup analyses and meta-regression. For before–after treatment studies, the paired standard errors of ΔHZS were re-estimated to demonstrate in the forest plot. Risk of bias was analyzed using the Newcastle–Ottawa Scale. Among the 29 eligible studies, 26 reported ΔHZS with self-control groups, and ΔHZS or absolute HZS were compared to other external controls in 11 studies. A significant reduction was observed between post-MHP and pre-MPH use, with high heterogeneity (SMD = – 0.40; 95% confidence interval = [ – 0.54, – 0.27]; I2 = 91%). The study region, ADHD subtype, and stimulant-naïve status of patients at baseline may modify the effect on HZS. Because of the high clinical heterogeneity in observational studies, clinicians should consider the negative effect of MPH on height in ADHD patients by determining whether patients fulfill appropriate high-risk criteria. Further well-designed longitudinal studies are required to better quantify this effect, especially with prolonged treatment. [ABSTRACT FROM AUTHOR]

The experience of childhood cancer (CC) could be a traumatic event that produces long-term emotional responses such as posttraumatic stress symptoms (PTSS) and posttraumatic growth (PTG) in survivors. The relationship between both PTSS and PTG is not clear in CC survivors. Assessing challenges to core beliefs and rumination could give information regarding the different paths that lead to traumatic responses. Thus, this study aims to identify childhood cancer survivors' profiles from PTSS and PTG measures and to examine the pathways of relationships between PTSS and PTG, rumination, and challenge to core belief. Sixty-two CC survivors completed surveys on their childhood cancer experience, PTSS, PTG, challenge to core beliefs, and rumination. High PTG scores among childhood cancer survivors (Cluster 1), High PTSS scores among childhood cancer survivors (Cluster 2), and Childhood cancer survivors without changes (Cluster 3). Network analysis found that the challenge to core beliefs is the central point in the relationship between the variables, in a direct and positive relationship with PTG. We found an indirect path from challenge to core beliefs to PTSS, mediated by intrusive and deliberative ruminations. The combined findings suggested that there are different profiles related to trauma in CC survivors and the relationship between PTSS and PTG is mediated by the challenge to core beliefs and deliberative and intrusive rumination. [ABSTRACT FROM AUTHOR]

Aim: To assess the attitudes, needs, and burden of parents of children with cerebral palsy (CP) in southeast Nigeria. Subjects and methods: This ethics-approved cross-sectional survey involved 90 consenting parents of children with CP who were consecutively recruited from physiotherapy outpatient clinics of purposively selected tertiary hospitals in southeast Nigeria. Participants' attitudes, burden, and needs were respectively assessed using the Parents' Attitude Scale, the Modified Caregivers Strain Index (MCSI), and the Family Needs Assessment Questionnaire. Descriptive statistics, Spearman correlation, and Mann–Whitney U, and Kruskal–Wallis tests were used to analyse the data at an alpha level of 0.05. Results: Participants were significantly burdened (mean MCSI score = 15.76±5.21) with at least 64.4% of them having significant strain in each assessed life situation. At least 50.0% of participants indicated needing helps in each assessed area while 26.7% had negative attitudes. There were significant correlations between participants' attitudes and burden (rho = −0.48), attitudes and needs (rho = 0.57), and needs and burden (rho = −0.23). Burden (k = 13.31), needs (k = 44.96) and attitude (k = 35.95) varied with occupation. Age had significant correlation with burden (rho = 0.26) and attitudes (rho = −0.31). Gender did not have a significant influence on burden (U = 731.00), needs (U = 864.00), and attitudes (U = 832.50). Educational attainment did not have a significant correlation with burden (rho = 0.02), needs (rho = 0.21), and attitudes (rho = 0.10). Conclusion: Parents of children with CP had unmet needs and were substantially burdened, with a significant proportion exhibiting a negative attitude. Higher burden connoted higher needs and negative attitudes in this group. There is a need to improve caregivers' well-being, as this will understandably improve rehabilitation outcomes. [ABSTRACT FROM AUTHOR]

Background: Ambulatory Blood Pressure Monitoring (ABPM) is recommended for diagnosis and management of hypertension. We aimed to identify characteristics associated with physician action after receipt of abnormal findings. Methods: This was a retrospective cross-sectional analysis of patients 5–22 years old who underwent 24-h ABPM between 2003–2022, met criteria for masked or ambulatory hypertension, and had a pediatric nephrology clinic visit within 2 weeks of ABPM. "Action" was defined as medication change/initiation, lifestyle or adherence counseling, evaluation ordered, or interpretation with no change. Characteristics of children with/without 1 or more actions were compared using Student t-tests and Chi-square. Regression analyses explored the independent association of patient characteristics with physician action. Results: 115 patients with masked (n = 53) and ambulatory (n = 62) hypertension were included: mean age 13.0 years, 48% female, 38% Black race, 21% with chronic kidney disease, and 25% overweight/obesity. 97 (84%) encounters had a documented physician action. Medication change (52%), evaluation ordered (40%), and prescribed lifestyle change (35%) were the most common actions. Adherence counseling for medication and lifestyle recommendations were documented in 3% of encounters. 24-h, wake SBP load, and sleep DBP load were significantly higher among those with physician action. Patients with > 1 action had greater adiposity, SBP, and dipping. Neither age, obesity, nor kidney disease were independently associated with physician action. Conclusions: While most abnormal ABPMs were acted upon, 16% did not have a documented action. Greater BP load was one of the few characteristics associated with physician action. Of potential actions, adherence counseling was underutilized. [ABSTRACT FROM AUTHOR]

Background: Activin A has been shown to enhance osteoclast activity and its inhibition results in bone growth. The potential role of activin A as a marker of chronic kidney disease-mineral bone disease (CKD-MBD) and its relationship with other markers has not been studied in children with CKD. Methods: A cross sectional study was conducted among 40 children aged 2 to 18 years with CKD (Stage 2 to 5; 10 in each stage) and 40 matched controls. Activin A, cathepsin K, FGF-23, PTH, serum calcium, phosphorous and alkaline phosphatase in both groups were measured and compared. The correlation of activin A and markers of CKD-MBD was studied. A p value of < 0.05 was considered significant. Results: The mean age of children with CKD was 9.30 ± 3.64 years. Mean levels of activin A in cases were 485.55 pg/ml compared to 76.19 pg/ml in controls (p < 0.001). FGF-23 levels in cases were 133.18 pg/ml while in controls it was 6.93 pg/ml (p < 0.001). Mean levels of cathepsin K were also significantly higher in cases as compared to controls. There was a progressive increase in activin A and cathepsin K levels with increasing stage of CKD. Activin A had a significant positive correlation with serum creatinine (r = 0.51; p < 0.001). Conclusions: Activin A levels progressively rise with advancing CKD stage. These findings suggest that activin A can be a potential early marker of CKD-MBD in children. [ABSTRACT FROM AUTHOR]

Background: Dyslipidemia is an important and modifiable risk factor for CVD in children with CKD. Methods: In a cross-sectional study of baseline serum lipid levels in a large prospective cohort study of children with stage 3–5 (predialysis) CKD, frequencies of abnormal lipid levels and types of dyslipidemia were analyzed in the entire cohort and in subpopulations defined by fasting status or by the presence of nephrotic range proteinuria. Associated clinical and laboratory characteristics were determined by multivariable linear regression analysis. Results: A total of 681 patients aged 12.2 ± 3.3 years with a mean eGFR of 26.9 ± 11.6 ml/min/1.73 m2 were included. Kidney diagnosis was classified as CAKUT in 69%, glomerulopathy in 8.4%, and other disorders in 22.6% of patients. Nephrotic range proteinuria (defined by a urinary albumin/creatinine ratio > 1.1 g/g) was present in 26.9%. Dyslipidemia was found in 71.8%, and high triglyceride (TG) levels were the most common abnormality (54.7%). Fasting status (38.9%) had no effect on dyslipidemia status. Except for a significant increase in TG in more advanced CKD, lipid levels and frequencies of dyslipidemia were not significantly different between CKD stages. Hypertriglyceridemia was associated with younger age, lower eGFR, shorter duration of CKD, higher body mass index (BMI-SDS), lower serum albumin, and higher diastolic blood pressure. Conclusions: Dyslipidemia involving all lipid fractions, but mainly TG, is present in the majority of patients with CKD irrespective of CKD stage or fasting status and is significantly associated with other cardiovascular risk factors. [ABSTRACT FROM AUTHOR]

Background: This study evaluated parenting stress, anxiety, and depression symptoms and their associated factors in parents of children with chronic kidney disease (CKD). Methods: This cross-sectional study compared parents of patients with CKD (0–18 years) with a matched control group of parents of healthy children. Both groups completed the Parenting Stress Index – Short Form, the Hospital Anxiety and Depression Scale, and a sociodemographic questionnaire. Results: The study group consisted of 45 parents (median age 39; 32 mothers) of CKD patients (median age 8; 36% female). Nearly 75% of children had CKD stages 2, 3, or 4, and 44.5% had congenital anomaly of the kidney and urinary tract. Five children (11%) were on dialysis, and 4 (9%) had a functioning kidney graft. Compared with parents of healthy children, more stress and anxiety symptoms were reported. Since the CKD diagnosis, 47% of parents perceived a deterioration of their own health, and 40% reduced work on a structural basis. Higher levels of stress, anxiety, and depression symptoms were associated with a more negative perception of own health, and more child medical comorbidities and school absence. Conclusions: This study showed higher levels of parenting stress and anxiety symptoms in parents of children with CKD compared with parents of healthy children. This was associated with a less positive perception of their own health, especially if the child had more medical comorbidities or more absence from school. Psychosocial interventions to reduce the parental burden should be integrated in the standard care of pediatric nephrology departments. [ABSTRACT FROM AUTHOR]

Background: We recently found headache disorders to be highly prevalent among children (aged 6–11 years) and adolescents (aged 12–17) in Iran (gender- and age-adjusted 1-year prevalences: migraine 25.2%, tension-type headache 12.7%, undifferentiated headache [UdH] 22.1%, probable medication-overuse headache [pMOH] 1.1%, other headache on ≥ 15 days/month [H15+] 3.0%). Here we report on the headache-attributed burden, taking evidence from the same study. Methods: In a cross-sectional survey, following the generic protocol for the global schools-based study led by the Global Campaign against Headache, we administered the child and adolescent versions of the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) structured questionnaire in 121 schools, purposively selected to reflect the country's diversities. Pupils self-completed these in class, under supervision. Headache diagnostic questions were based on ICHD-3 criteria but for the inclusion of UdH (defined as mild headache with usual duration < 1 h). Burden enquiry was across multiple domains. Results: The analysed sample (N = 3,244) included 1,308 (40.3%) children and 1,936 (59.7%) adolescents (1,531 [47.2%] male, 1,713 [52.8%] female). The non-participating proportion was 3.4%. Mean headache frequency was 3.9 days/4 weeks, and mean duration 1.8 h. Estimated mean proportion of time in ictal state was 1.1% (1.4% for migraine, 16.5% for pMOH). Symptomatic medication was consumed on a mean of 1.6 days/4 weeks. Lost school time averaged 0.4 days/4 weeks overall (2%, assuming a 5-day week), but was eleven-fold higher (4.3 days; 22%) for pMOH. For most headache types, days of reported limited activity were several-fold more than days lost from school (45% for pMOH, 25% for other H15+). Almost one in 12 parents (7.9%) missed work at least once in 4 weeks because of their son's or daughter's headache. Emotional impact and quality-of-life scores reflected these measures of burden. Conclusions: Headache, common in children and adolescents in Iran, is associated with symptom burdens that may be onerous for some but not for most. However, there are substantial consequential burdens, particularly for the 1.1% with pMOH and the 3.0% with other H15+, who suffer educational disturbances and potentially major life impairments. These findings are of importance to educational and health policies in Iran. [ABSTRACT FROM AUTHOR]

This cross-sectional observational study sought to examine the environmental correlates of physical activity and screen-time among youth with autism spectrum disorder (ASD). Parents of youth with ASD (n = 1,165) from seven countries/regions provided responses to an online survey form measuring environmental correlates (i.e., physical activity neighborhood environment, social network, social trust and cohesion, bedroom media, social home environment) and outcomes (i.e., physical activity, screen-time). Multiple linear regression analyses were conducted to determine environmental predictors of the outcomes. Physical activity neighborhood environment (B = 0.15, p = 0.047), social network (B = 0.16, p = 0.02), and social home environment (B = 1.07, p < 0.001) were significantly associated with physical activity, whereas social trust and cohesion and bedroom media were not. Further, social trust and cohesion (B = -0.14, p = 0.001), bedroom media (B = 0.10, p = 0.001), and social home environment (B = -0.16, p < 0.001) were significantly associated with screen-time while neighborhood environment and social network were not. The identified environmental attributes of physical activity and screen-time behaviors should be targeted for health promotion among youth with ASD. [ABSTRACT FROM AUTHOR]

Background: Systemic inflammation (SI) is linked to chronic kidney disease (CKD) progression and multiple complications. Data regarding SI biomarkers in pediatric patients are scarce. This case–control and cross-sectional study investigates the correlation of neutrophil–lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), total iron binding capacity (TIBC) and serum albumin to serum interleukin-6 (IL-6). Methods: NLR and PLR were measured in 53 patients (median age: 12.9 years), including 17 on dialysis and 36 with a median glomerular filtration rate of 39 ml/min/1.73m2, and in 25 age and sex-matched healthy controls. Iron profile, serum albumin and IL-6 were measured in the patient group. IL-6 levels > 3rd quartile were classified as high. Results: Patients presented higher NLR and PLR and particularly those on dialysis (p < 0.001 and p = 0.001). We observed a significant correlation between natural logarithm (ln) of IL-6 (lnIL-6) and NLR (rs = 0.344, p = 0.014), serum albumin (rs = -0.350, p = 0.011) and TIBC (rs = -0.345, p = 0.012) after adjustment for CKD stage, while the correlation between lnIL-6 and PLR was not significant (rs = 0.206, p = 0.151). Combination of NLR, serum albumin and TIBC predicted high IL-6 (13 patients) with an AUC of 0.771 (95% CI 0.608–0.943). Pairing of NLR ≥ 1.7 and TIBC ≤ 300 μg/dL exhibited the highest sensitivity (76.9%), while incorporating serum albumin ≤ 3.8 g/dL along with them achieved the highest specificity (95%) for detecting high IL-6 levels. Conclusion: Both NLR and PLR levels increase in CKD, especially in patients on chronic dialysis. NLR, rather than PLR, along with TIBC and serum albumin, are associated with IL-6 in pediatric CKD. [ABSTRACT FROM AUTHOR]

Background: This study aimed to determine the prevalence and etiology of kidney failure (KF) among children below 15 years of age receiving chronic dialysis in Saudi Arabia and describe their dialysis modalities. Methods: This cross-sectional descriptive study was conducted on 8 August 2022, encompassing all 23 pediatric dialysis centers in Saudi Arabia. Data gathered comprised patient demographics, causes of KF, and the dialysis methods employed. Collected data underwent analysis to determine prevalence of children undergoing chronic dialysis, discern underlying causes of KF, and evaluate distribution of patients across different dialysis modalities. Results: The prevalence of children on chronic dialysis is 77.6 per million children living in Saudi Arabia, equating to 419 children. The predominant underlying cause of KF was congenital anomalies of the kidneys and urinary tract (CAKUT), representing a substantial 41% of cases. Following this, others or unknown etiologies accounted for a noteworthy 25% of cases, with focal segmental glomerulosclerosis (FSGS) comprising 13%, glomerulonephritis at 11%, and congenital nephrotic syndrome contributing 10% to etiological distribution. Regarding dialysis modalities employed, 67% of patients were on peritoneal dialysis (PD), while the remaining 33% were on hemodialysis (HD). Conclusions: This first nationwide study of pediatric chronic dialysis in Saudi Arabia sheds light on the prevalence of children undergoing chronic dialysis and underlying causes of their KF, thereby contributing to our understanding of clinical management considerations. This research serves as a stepping stone for the development of national registries. [ABSTRACT FROM AUTHOR]

Background: Previous adult studies have yielded conflicting results regarding whether the presence (D +) or absence (D-) of peritoneal dialysate affects the accuracy of bioelectrical impedance analysis (BIA) measurements. The aim of this study was to investigate whether the accuracy of BIA data varies between D + and D- measurements in children. Methods: This cross-sectional study recruited chronic kidney disease stage 5 patients aged 3 to 18 years who received peritoneal dialysis. Body composition was assessed by multifrequency BIA, and values were compared between D + and D- measurements using the intraclass correlation coefficient (ICC). Results: Fifty paired BIA measurements were collected from 18 patients with a mean age of 13.6 ± 4.1 years and a mean dialysate fill volume of 1,006 ± 239.7 ml/m2. Sixteen out of 17 BIA parameters (94.1%) exhibited excellent correlations between D + and D- measurements (ICC values = 0.954, 0.998). There was a trend of increased fluid status, including extracellular water, edema index, and overhydration, in D + measurements, with mean differences (95% CIs) of 0.5 (0.4, 0.6) L, 0.002 (0.001, 0.002), and 0.1 (0.1, 0.2) L, respectively. Soft lean mass and fat-free mass were higher in D + measurements, with mean differences (95% CIs) of 1.4 (1.2, 1.6), and 1.6 (1.4, 1.8) kg, respectively. In addition, patients older than 10 years had a stronger correlation between D + and D- measurements than younger patients. Conclusions: A total of 94.1% of BIA parameters exhibited excellent correlations between D + and D- measurements, especially patients older than 10 years. We recommend that BIA measurements be collected from children regardless of the presence of peritoneal dialysate. [ABSTRACT FROM AUTHOR]

Background: The current diagnosis of protein energy wasting (PEW) is based on scoring systems that lack precision in measuring muscle deficits. We undertook this cross-sectional study to determine the prevalence of PEW in children with chronic kidney disease (CKD) using a scoring system that included dual energy x-ray absorptiometry (DEXA) for measuring lean body mass (LBM) and to determine the prevalence of selected markers in PEW. Methods: Thirty CKD and 20 healthy children (1–18 years) were evaluated for (1) reduced dietary protein intake (DPI); (2) BMI < fifth centile for height age (BMI/HA); (3) serum albumin < 3.8 g/dl, cholesterol < 100 mg/dl, or CRP > 3 mg/L; (4) LBM < fifth centile for height age [LBMr] on DEXA. PEW was scored as minimal—one parameter positive in 2/4 categories; standard—one parameter positive in 3/4 categories; or modified—standard plus height < 2 SD. Results: Twenty children with CKD (66.7%) had PEW, (5/9) 55% in CKD 3, and (15/21) 71% in advanced CKD; minimal 12, standard 1, and modified 7. LBMr was seen in 20 (100%), reduced DPI in 16 (80%), and BMI/HA in 6 (30%) children with PEW. LBMr had 100% sensitivity and BMI/HA 100% specificity. LBMr was seen in 8 who had no other criteria for PEW. None of the parameters were positive in controls (p < 0.01). Conclusions: PEW prevalence in CKD was high. Both prevalence and severity were higher in advanced CKD. LBMr was a highly sensitive marker to detect PEW. LBMr seen in some children with CKD who were negative for other markers could represent subclinical PEW. [ABSTRACT FROM AUTHOR]

Maternal practices and their exposure to traumatic events might impede children's psychological adjustment; however, family relations, play, and leisure engagement may mitigate it. Previous research that has focused on the mechanisms influencing children's psychological adjustment has not included contextual factors such as family relations and children's engagement in play. In a sample of mothers with and without a history of trauma, this study aimed to examine the impact of maternal practices on children's psychological adjustment and to test their indirect effect through family relations and child engagement in play and leisure activities. A cross-sectional study comprised a sample of 99 mother-child dyads with children aged 6 to 12 years old, predominantly Caucasian, and mothers with college-level education. Self-report measures assessed parental acceptance-rejection, the impact of maternal exposure to traumatic events, family relations, child psychological adjustment, and play. Children of mothers who reported exposure to traumatic events had significantly more psychosocial difficulties. A moderated mediated model tested whether family relations and child play engagement effects varied based on maternal exposure to traumatic events. The model was significant and both direct and indirect effects were supported. Maternal rejection predicted children's psychological maladjustment and this relation was mediated by children's engagement in play for mothers with a trauma history. These findings point to the importance of play and leisure activities within and outside the family context during the middle childhood period. Highlights: Engagement in play was related to greater psychosocial functioning for children whose mothers reported traumatic events exposure impacted their lives. Family relations did not mitigate the relationship between maternal practices and children's psychosocial adjustment. Children's engagement in play and leisure activities may act as a protective factor. [ABSTRACT FROM AUTHOR]

Research suggests that parental reflective functioning (PRF)—that is, the parent's capacity to envision the mind of the child—is a key factor in understanding the child's reflective capacities. Yet, most existing measures of PRF assume that it is a broad trait-like feature. This study investigated cross-sectional relationships between domain-specific PRF, operationalized as mothers' estimates of the Theory of Mind (ToM) capacities of their children (mother's ToM estimates; MTE), and ToM acquisition in 83 preschool children, using a multidimensional approach. Results showed that the accuracy of MTE was positively related to the children's capacity for ToM, while the degree of certainty of inaccurate MTE was negatively related to ToM acquisition. The implications of these findings for the conceptualization of PRF and its relationship to ToM and other features of social cognition in children are discussed. Highlights: Theory of Mind (ToM) and parental reflective functioning (PRF) are multidimensional constructs. Associations among PRF and ToM acquisition are domain-specific. Inaccuracy of mother's ToM estimates (MTE) hampers ToM development in their children. Higher certainty with regard to inaccurate MTE is associated with lower child ToM performance. [ABSTRACT FROM AUTHOR]

Aim: Optimizing bone strength and bone density in childhood can greatly reduce the occurrence of osteoporosis in adulthood. We aimed to investigate the influence and interaction of sleep duration and physical activity (PA) with respect to bone strength among 1221 Chinese preschoolers. Subject and methods: Information on sleep and PA was obtained from the guardians of preschoolers during the annual physical examinations at seven kindergartens in 2019. Bone strength was defined using the percentage of the ultrasonic speed for Asian children of the same age and sex. Generalized linear regression models were used to compare bone strength in participants with different sleep durations and types and different levels of PA. Results: The results showed a significant correlation between sleep duration and bone strength, especially average nocturnal sleep duration (β = 2.37; 95% CI: 0.59, 4.15). A stable link between PA and bone strength was also observed, mainly reflected in the average PA time (β = 1.29; 95% CI: 0.35, 2.22) and walking time (β = 0.20; 95% CI: 0.00, 0.39), but no association was found in moderate to vigorous PA (P > 0.05). In addition, we found a very strong interaction between average nocturnal sleep duration and PA for bone strength (β = 0.14; 95% CI: 0.05, 0.23). Conclusion: Adequate sleep duration combined with moderate PA is associated with greater bone strength. This association needs to be confirmed in further prospective studies. [ABSTRACT FROM AUTHOR]

Background: The significance of narrative skills is evident due to their role in the development of language and their connection to significant social and academic skills. This study aimed to translate, adapt, and validate the Test of Narrative Language-Second Edition (TNL-2) for its use as a tool for the assessment of narrative language in Arabic-speaking Egyptian children. In a cross-sectional study design, the Arabic-translated version of the TNL-2 was administered to 200 typically developing Arabic-speaking Egyptian children ranging in age from 4 years to 15 years and 11 months for validation. The participants were categorized according to their age into ten groups and their scores were analyzed. Face validity was assessed by asking five expert phoniatricians to review the Arabic version of the TNL-2 and complete a questionnaire that assessed the test's effectiveness in measuring different narrative skills. Results: A statistically significant difference was found when comparing the TNL-2 scores among the age groups under study. In addition, there was a significant correlation between standardized Arabic language test scores and the total comprehension and total production subtests' raw scores of the TNL-2. The test-retest reliability and inter-rater agreement demonstrated a high level of reliability and inter-rater agreement. Experts have reached a consensus that the Arabic version of the TNL-2 is capable of evaluating the primary microstructural and macrostructural components of Arabic narratives. Furthermore, it can provide insights into the overall narrative skills of Egyptian Arabic-speaking children. Conclusion: The Arabic-translated version of the TNL-2 demonstrated validity and reliability as an instrument for assessing narrative language comprehension and production skills in Arabic-speaking Egyptian children. [ABSTRACT FROM AUTHOR]

This study examined predictors of access to early support amongst families of 0-6-year-old children with suspected or diagnosed developmental disabilities in the United Kingdom. Using survey data from 673 families, multiple regression models were fitted for three outcomes: intervention access, access to early support sources, and unmet need for early support sources. Developmental disability diagnosis and caregiver educational level were associated with intervention access and early support access. Early support access was also associated with child physical health, adaptive skills, caregiver ethnicity, informal support, and statutory statement of special educational needs. Unmet need for early support was associated with economic deprivation, the number of household caregivers, and informal support. Multiple factors influence access to early support. Key implications include enhancing processes for formal identification of need, addressing socioeconomic disparities (e.g., reducing inequalities, increasing funding for services), and providing more accessible services (e.g., coordinating support across services, flexible service provision). [ABSTRACT FROM AUTHOR]

Background: School attendance and life participation, particularly sport, is a high priority for children with chronic kidney disease (CKD). This study is aimed at assessing the association between CKD stage, sports participation, and school absences in children with CKD. Methods: Using data from the binational Kids with CKD study (ages 6–18 years, n = 377), we performed multivariable regression to evaluate the association between CKD stage, school absences, and sports participation. Results: Overall, 62% of participants played sport with the most frequent sport activities engaged in being swimming (17%) and soccer (17%). Compared to children with CKD 1–2, the incidence rate ratios (IRR) (95% CI) for sports participation amongst children with CKD 3–5, dialysis, or transplant were 0.84 (0.64–1.09), 0.59 (0.39–0.90), and 0.75 (0.58–0.96), respectively. The median (IQR) days of school absences within a four-week period were 1 day (0–1), with children on dialysis reporting the highest number of school absences (9 days (5–15)), followed by transplant recipients (2 days (1–7)), children with CKD 3–5 (1 day (0–3)), and with CKD 1–2 (1 day (0–3)). Duration of CKD modified the association between CKD stage and school absences, with children with a transplant experiencing a higher number of missed school days with increasing duration of CKD, but not in children with CKD 1–5 or on dialysis (p-interaction < 0.01). Conclusions: Children receiving dialysis and with a kidney transplant had greater school absences and played fewer sports compared to children with CKD stages 1–2. Innovative strategies to improve school attendance and sport participation are needed to improve life participation of children with CKD. [ABSTRACT FROM AUTHOR]

Background: Atherosclerotic changes can be attributed to early endothelial damage in individuals with hypertension. We aimed to explore the relationship between endothelial dysfunction and hypertension in newly diagnosed children without end-organ damage, considering carotid intima-media thickness (CIMT), flow-mediated dilatation (FMD), and functional capillaroscopy parameters. We also analyzed the differences between dipper and non-dipper patients. Methods: In this cross-sectional study, 20 patients diagnosed with essential hypertension with no target organ damage, and 20 age and sex-matched healthy volunteers were enrolled. The patient group comprised newly diagnosed individuals not receiving antihypertensive treatment. Hypertensive patients were divided into two groups (dipper and non-dipper patients). The measurements of CIMT, brachial FMD, and functional capillaroscopy were performed before starting treatment. Results: Among the patients, 11 were boys, and 9 were girls, with a median age of 16.0 (2.13) years. Of 20 hypertensive patients, 10 were dipper and 10 were non-dipper. Significant differences were observed between the hypertensive patients and controls in terms of CIMT (p = 0.04), brachial artery FMD (p = 0.02), and functional capillary density (p < 0.001). Hypertensive patients exhibited increased CIMT, reduced brachial artery FMD, and lower capillary density. However, there were no differences between dippers and non-dippers regarding age, sex, height SDS, weight SDS, CIMT SDS, brachial artery FMD, and capillary density. Conclusions: Understanding the vascular consequences associated with essential hypertension emphasizes the importance of early detection and management of hypertension. Herein, we have effectively highlighted significant endothelial changes through the analysis of three parameters in newly diagnosed children without apparent target organ damage. [ABSTRACT FROM AUTHOR]

Praise may have different effects on child self-esteem, depending on its informational and evaluative value. In this multiphase, multimethod investigation, we assessed the interplaying role of two outcome-oriented praises that differed in their informational and evaluative value (i.e., descriptive and non-specific praise) on indicators of child self-esteem. In phase 177 mothers reported on their usage of descriptive and non-specific praise, while their child (M = 10.09 years old) reported on their level of self-esteem. In phase 2, a subsample of 43 children completed an experimental art task during which an experimenter offered either descriptive or non-specific praise. Children then rated their competence at that task. Results from phase 1 showed that mother usage of descriptive and non-specific praise interacted to predict child self-esteem. Specifically, the relation between descriptive praise and child self-esteem was positive (vs. non-significant) when mothers used moderate to high (vs. low) amounts of non-specific praise. Furthermore, the relation between non-specific praise and child self-esteem was negative (vs. non-significant) when mothers used low (vs. moderate to high) levels of descriptive praise. Results from phase 2 showed that differences between descriptive and non-specific praise conditions emerged on child perceived competence for children reporting lower (but not higher) global self-esteem. Specifically, children with lower global self-esteem rated themselves as more competent when given descriptive (rather than non-specific) praise. Results underlie the relevance of including descriptive elements when offering outcome-oriented praise to children. They also advance the field by identifying different ways to offer outcome-oriented praise. Highlights: Compared to non-specific praise, descriptive praise is believed to be more informational. Descriptive praise is positively linked to child self-esteem when mothers combine it with non-specific praise. Non-specific praise is negatively linked to child self-esteem when mothers don't combine it with descriptive praise. Children with lower (vs. higher) global self-esteem respond better (vs. similarly) to descriptive praise, compared to non-specific praise. [ABSTRACT FROM AUTHOR]

Background: Children's time use is a complex developmental phenomenon in need of a more in-depth, detailed understanding. Objective: The present study aimed to provide a comprehensive description of children's everyday lives in middle childhood and examine how different portfolios and patterns of daily activities occurring at home, school, and community are influenced by multilevel ecological factors. Method: Based on cross-sectional, multi-informant data from a sample of Portuguese 3rd and 4th graders (n = 209), this research expands previous literature by providing a mixture of variable- and person-centered analytical approaches to children's time use. Results: Findings indicate that children's everyday lives are characterized by a diversity of participation portfolios which embody multidimensional, heterogeneous, and qualitatively distinct participation patterns. A total of five different time use clusters were found: "less-active studious", "highly-engaged players", "less-involved after-schoolers", "highly-active homebodies", and "sedentary home screeners". Both portfolios and patterns of activities significantly varied as a function of child characteristics, parental education, family functioning and culture, and the environment quality of activity settings. Conclusions: Variations in ecological affordances and constraints may represent different levels of exposure to developmental opportunities. An ecological developmental perspective of children's time use is necessary and useful to enlighten how families, schools, and communities can positively influence children's lives and effectively support their well-being and growth. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial resistance (AMR) is prevalent among south Asian countries including Pakistan mainly due to excessive and inappropriate use of antibiotics including among children. Globally, the majority of the population especially in low- and middle-income countries (LMICs) visit ambulatory care facilities seeking care Objectives: The objectives of the current study were to evaluate the appropriateness of antibiotics prescribed among children below the age of 12 years in six ambulatory care health facilities against the WHO AWaRe book, 2022. The findings providing a basis for future initiatives. Methods: A cross-sectional study was conducted among children below the age of 12 years in six ambulatory care health facilities among two districts of Punjab, over a period of three months (January–March 2023). Results: Out of total of 399 children included in the study, 58.4% were male in the age group > 1 to 5 years (41.6%). The most common illnesses diagnosed were sinusitis (39.8%) followed by bronchitis (20.3%), and community-acquired pneumonia (15.8%). All the study participants were prescribed at least one antibiotic where only 35.8% (n = 143) of the prescribed antibiotics were deemed appropriate according to the indication. Out of 143 designated appropriate, 134 were appropriate according to the duration of prescribed antibiotics, 137 were appropriate according to the frequency of prescribed antibiotics and 139 were appropriate as per the route of administration. Inappropriate antibiotic therapy was more prevalent in basic health units than rural health centers (p = 0.004), and was higher in older children. Overall, 343 (83.3%) of the antibiotics prescribed were from 'Access' category followed by 69 (16.7%) from the 'Watch' category. Conclusion: Our study concluded a high proportion of inappropriate antibiotic use in ambulatory care facilities. Consequently, urgent measures are needed to improve future prescribing and curb AMR. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) against women presents a major public health challenge, especially in low-income and middle-income countries (LMICs), and its relationship with poor offspring growth is emerging but remains understudied. This study aimed to explore the impact of maternal exposure to IPV on offspring growth based on different approaches in LMICs. We conducted a population-based cross-sectional study using the most recent Demographic and Health Surveys from 32 LMICs; 81,652 mother–child dyads comprising women aged from 15 to 49 years with children aged 0 to 59 months were included. We applied logistic regression models to explore the independent and cumulative relationship between IPV, including emotional, physical, and sexual IPV, with poor child growth status, including stunting and wasting; 52.6% of mothers were under the age of 30 years with a 36% prevalence of any lifetime exposure to IPV. Maternal exposure to any IPV increased the odds of stunting, but only physical and sexual IPV were independently associated with an increased risk of stunting. Three different types of IPV exhibited a cumulative effect on stunting. Maternal exposure to physical IPV was significantly associated with an increased risk of wasting. Significant associations between maternal exposure to emotional IPV with offspring stunting and physical IPV with wasting were only observed in children aged 0 to 36 months. IPV against women remains high in LMICs and has adverse effects on offspring growth. Policy and program efforts are needed to prioritize the reduction of widespread physical and sexual IPV and to mitigate the impact of such violence. [ABSTRACT FROM AUTHOR]

Objectives: The current study intends to measure parents' perceptions of newborn and toddler physical activity. Methods: A Cross-sectional study was conducted at the pediatric clinic at a University Hospital in Riyadh. The parents or guardians of children 0 to 3 years of age, healthy infants, and toddlers who visited the vaccination and pediatric clinic at a University Hospital in Riyadh, were recruited. The Parental Perceptions of Physical Activity Scale (PPPAS) was translated into the Arabic language. The Chi-square test was applied to observe the association between categorical variables. P value < 0.05 was considered to be statistically significant. Results: A total of 383 parents were recruited. There was a significant association observed between physical activity and income, employment, and education. A significant association was observed between the following perceptions; the child enjoys physical activity, it increases the child's fitness level, the strength of the muscles, flexibility, and life span, improves happiness, keeps the child active, and provides a sense of achievement, and decrease future weight problems. Conclusion for Practice: The study determined that parental inclination towards engaging in a physical activity intervention for their infants, as well as identifying any concerns that may impact their children's adherence to physical activity was satisfied. Significance: What is already known on this subject? Youth health is crucial since cardiovascular disease and obesity are linked to sedentary behaviors in children and will persist into adulthood. What this study adds? The study addresses the concerns of parents regarding physical activities which is an emerging concern for children's health. It investigates the viewpoint of parents about physical activities and the risk of diseases that may develop due to sedentary behaviors among infants and toddlers. [ABSTRACT FROM AUTHOR]

Background: Children with various metabolic disorders are considered a high-risk group for different developmental delays. Delayed language development (DLD) and autism spectrum disorder (ASD) have a common incidence in children with metabolic disorders which negatively impact their social and academic life. So, early assessment of this high-risk group for the presence of DLD and/or ASD is of great significance and providing better prognosis through starting therapy as early as possible. Aim of the work: It aims to detect the presence of DLD and ASD among children with metabolic disorders. Methods: This is an analytical (observational) cross-sectional study. The subjects of this study comprised a convenient sample of 100 children diagnosed as having different metabolic disorders with age range between 24 and 48 months. The Modified Preschool Language Scale, Fourth Edition–Arabic version and the Childhood Autism Rating Scale were applied for all children, to detect the presence of DLD and ASD. Results: Assessment of 100 children with unequal distribution of 13 types of metabolic disorders found that 86% of cases had DLD and 16% had ASD. Regarding different metabolic disorders, we found both DLD and ASD in nine types and only DLD in four types of metabolic disorders. Conclusion: Children with metabolic disorders are at a high risk for DLD and ASD. Early detection of these cases provides early intervention and better outcome. [ABSTRACT FROM AUTHOR]

ASD is a neurodevelopmental disorder impacting 1 in 44 children and early identification of children with ASD is critical for the intervention. Several screening measures have been developed for early identification, including the Autism Spectrum Rating Scales, 6–18 years Parent Report (ASRS). The ASRS has been understudied, and the current study assessed the validity of the ASRS in a clinical sample of 490 children at a tertiary ASD-specialty clinic. Results indicated that the ASRS demonstrated favorable sensitivity, but poor specificity. True positive screening results were more likely to occur for children with a multiracial background, while they were less likely to occur for children with a high social capital. Overall, though the ASRS has clinical utility as a screening measure, it did not perform effectively to differentiate ASD from Non-ASD clinical disorders. [ABSTRACT FROM AUTHOR]

Environments have a modifying effect on the participation of children and adolescents with autism spectrum disorder (ASD) in all areas of life. This cross-sectional study investigated parental perspectives on supportive or hindering environments and the daily contextual strategies parents used to enhance their children's participation. Qualitative and quantitative data gathered from 115 parents from German-speaking Switzerland using the participation and environment measure-child and youth (PEM-CY) were analyzed. Results revealed 45 environmental supports and barriers at home, at school, and in the community. Contextual strategies were identified in combination with people, activities, time, objects, and places. Parental perspectives on participation and their contextual strategies should be considered in environmental-based interventions to support the participation of children and adolescents with ASD. [ABSTRACT FROM AUTHOR]

Background: There had been a sudden surge of unusually severe and rapidly progressing acute kidney injury (AKI) incidence in Indonesia since August 2022 which did not correspond to the rise of COVID-19 incidence. We suspected this was related to ethylene glycol (EG) and diethylene glycol (DEG) intoxication. This study is aimed at describing the clinical and laboratory characteristics of AKI related to D(EG) intoxication in order to spread awareness of the possibility of intoxication in cases of rapidly progressing AKI with unknown etiology. Methods: We conducted a cross-sectional study by collecting secondary data from the pediatric AKI registry at a national referral hospital in Jakarta, Indonesia. Data on children admitted from January to November 2022 with diagnosis of stage 3 AKI based on KDIGO criteria were included. Data regarding demographics, symptoms prior to anuria, laboratory results, infection panel including COVID-19 status, treatment administered, and mortality were analyzed. Results: Sixteen patients tested positive for EG and DEG, all with history of consuming syrup-based medications. High anion gap metabolic acidosis was observed in majority of patients with mean pH 7.33 ± 0.07 and mean anion gap 15.6 ± 7.8 mEq/L. No patient had high osmolal gap (mean osmolal gap 3.46 ± 4.68). One deceased patient, who had kidney biopsy performed, showed severe damage and calcium oxalate crystals in the kidney tissue. Mortality was recorded in six patients (37.5%). Conclusion: Careful history taking of patient's clinical course, including consumption of syrup-based medications and laboratory findings, might aid clinicians to establish a working diagnosis of D(EG) intoxication without needing to wait for blood toxicology test. Early diagnosis and therapy are crucial to prevent substantial mortality. [ABSTRACT FROM AUTHOR]

Background: Individual variation in kidney function can be affected by both congenital and acquired factors, and kidney function in children is possibly correlated with that in their mothers. However, the mother–child correlation in kidney function remains directly unconfirmed. Methods: We conducted a cross-sectional study of 655 healthy pairs of 7- or 8-year-old children and their mothers as an adjunct study of a nationwide epidemiological study (Japan Environment and Children's Study). Results: Both serum creatinine level (all children, r = 0.324, p < 0.001; girls, r = 0.365, p < 0.001; boys, r = 0.278, p < 0.001) and estimated glomerular filtration rate (eGFR) (r = 0.274, p < 0.001; r = 0.352, p < 0.001; r = 0.195, p < 0.001, respectively) in children were weakly associated with their maternal values. In the single linear regression analyses, maternal values of serum creatinine and eGFR were significantly associated with the children's values. Moreover, several body composition values in children, such as weight-SDS, fat (%), and predicted muscle weight, were also significantly associated with kidney function values in children. In the multiple linear regression analysis for serum creatinine levels in children, in which weight-SDS and predicted muscle weight in children were selected as adjustment factors, maternal serum creatinine level showed a significant positive association (B = 0.214, p < 0.001 in the adjusted model). Moreover, in the multiple linear regression analysis for eGFR value in children, in which fat (%) and predicted muscle weight in children were selected as adjustment factors, maternal eGFR values showed a significant positive association (B = 0.319, p < 0.001). Conclusions: We directly confirmed mother–child correlations in both serum creatinine levels and eGFR values, particularly in girls. [ABSTRACT FROM AUTHOR]

There is limited recent research on the association between parenting practices and externalizing behaviors in autistic children. To address this gap, the current systematic review examined the associations between parenting practices and externalizing behaviors in autistic children, along with the mediating and moderating effects of parent and child variables (PROSPERO registration number CRD42022268667). Study inclusion criteria were (1) Peer-reviewed journals, (2) Participants included parents of autistic children and their children, (3) Quantitative measures of both parenting practices or behaviors/style and child externalizing behaviors, (4) Cross-sectional or longitudinal studies only, and (5) Studies published in English. Study exclusion criteria were: (1) Qualitative studies, (2) Published in a language other than English, (3) Participants included non-human participants, (4) Participants that did not include parents and their autistic children as participants or did not report this group separately, (5) Systematic review and meta-analyses, and (6) No quantitative measures of parenting practices and/or child externalizing behaviors. Quality appraisal and risk of bias were conducted using the McMaster Tool and results were synthesized in Covidence and Excel. Thirty studies were included in the review. Results demonstrated that mindful parenting was associated with fewer or lower levels of externalizing behaviors; positive parenting practices had non-significant associations with externalizing behaviors; specific parenting practices had differing associations with externalizing behaviors; and negative parenting practices were associated with higher levels of externalizing behaviors. We are unable to draw causal relationships due to focus on cross-sectional and longitudinal articles only. The potential for future research to target specific parent practices to support children's externalizing behaviors is discussed. [ABSTRACT FROM AUTHOR]

The background of this study is to examine the associations of individual and combined early morning patterns (i.e., active commuting to school, physical activity before school, having breakfast and good sleep) with white matter microstructure (WMM) and, whether the associated white mater microstructure outcomes were related to mental health outcomes in children with overweight or obesity. 103 children with overweight or obesity (10.0 ± 1.1 years old, 42 girls) from the ActiveBrains project participated in this cross-sectional study. Early morning patterns and mental health indicators (i.e., self-esteem, optimism, positive and negative affect, stress, depression and anxiety) were self-reported by the children using validated questionnaires. WMM was assessed by magnetic resonance imaging using diffusion tensor imaging. When examined independently, early morning patterns were not related with WMM (all P > 0.05). However, the combination of early morning patterns was related with WMM (P < 0.05). Specifically, physically active early morning patterns (i.e., active commuting to school and physical activity before school) were associated with global fractional anisotropy (FA) (β = 0.298, P = 0.013) and global radial diffusivity (RD) (β = − 0.272, P = 0.021), as well as with tract-specific FA (β = 0.314, P = 0.004) and RD (β = − 0.234, P = 0.032) in the superior longitudinal fasciculus (SLF). Furthermore, combined physically active early morning pattern-associated global (i.e., FA and RD) and tract-specific (i.e., FA and RD in the SLF) WMM indicators were positively associated with happiness (β absolute value range from 0.252 to 0.298, all P < 0.05). A combination of physically active early morning patterns may positively relate to white matter microstructure in children with overweight or obesity, and, in turn, happiness. [ABSTRACT FROM AUTHOR]

Background: Parental behavior and infant sleep patterns can vary widely both within and between cultures and settings. Breastfeeding during the second half-year of infancy has been associated with frequent night waking, which is perceived as sleep problem among the Western societies. An understanding of sleeping patterns among breastfed infants during the second half-year of infancy is important in supporting continued breastfeeding. Objectives: The study aimed to investigate the sleeping patterns among breastfed infants during second half-year of infancy. Methods: This is a cross-sectional study. Three hundred and forty-two mothers of 6–12 months old breastfed infants completed the questionnaires on socio-demographic factors, breastfeeding practices, and infant sleeping patterns, which were assessed by using the Brief Infant Sleep Questionnaire (BISQ). The Cox regression model was used to assess the factors that were associated with night sleep duration whereas demographic factors and breastfeeding practices that were associated with night waking frequency were investigated using the Poisson regression model. Results: On average, the breastfed infants slept for 11 h during the night and most infants were reported to have night waking (96.8%) and were breastfed at least once at night (93.5%). In the adjusted analyses, infants in the age group 9–12 months were less likely to sleep longer compared to infants in the 6–8 months age group [HR 1.52 95% CI (1.17, 1.98)]. A one-hour increase in daytime sleep and in night wakefulness increased the likelihood of waking up at night by 19% and 24%, respectively. Infants who had been vaccinated within the last 7 days and infants who were breastfed to sleep were more likely to have a shorter nighttime sleep duration. Nighttime breastfeeding frequency was significantly associated with a 17% increase in the likelihood of night waking [IRR 1.17 95% CI (1.13, 1.22)]. Infants who slept on their parents' bed were 1.28 times more likely to wake up at night compared to infants who slept in a separate room [IRR 1.28 95% CI (1.05, 1.59)]. Infants of parents who reported that their infants' sleep was not a problem were 34% less likely to wake up compared to infants of parents who reported that their infants' sleep was a problem [IRR 0.66 95% CI (0.49, 0.87)]. Conclusions for Practice: Frequent night waking, bed sharing and night breastfeeding were common among 6–12 months old breastfed infants. Frequent night breastfeeding may lengthen an infant's nighttime sleep duration. The study findings indicate that adequate information and support should be given to breastfeeding mothers in relation to the sleeping pattern of breastfed infants in order to promote continued breastfeeding practices. Significance: Breastfeeding during the second half-year of infancy has numerous benefits for both mother and infant. Frequent night waking is known as a common phenomenon among 6–12 months old breastfed infants. However, frequent night waking among breastfed infants during this age is commonly perceived as an infant having sleep problems. This study is the first to understand parental behavior and infant sleep patterns in different cultures and settings in Norway. 6–12 months old breastfed infants still frequently waking and being breastfed during the night. Our findings add to the limited body of evidence on breastfeeding and frequent infant night waking. [ABSTRACT FROM AUTHOR]

The family has a key role in the obesity management of children with autism. This study examines the relationship between the nutrition-physical activity behaviors of autistic children with their families and children's obesity levels during covid-19 pandemic. The descriptive and cross-sectional study involved 80 parents of autistic children. A positive correlation was found between children's mean BMI values before and during the pandemic(p = 0.000). Family Nutrition and Physical Activity Scale(FNPAS) and Brief Autism Mealtime Behavior Inventory(BAMBI) score were 55.18 ± 7.86 and 31.76 ± 8.79, respectively. In addition, it was found that 32.5% of the children ate more than before the pandemic, 50.0% engaged in less physical activity, and 16.3% didn't do any physical activity. The study results suggesting the risk of obesity. [ABSTRACT FROM AUTHOR]

Background: We validated the prevalence of albuminuria and its association with kidney function and hemodynamics in pre-school children who underwent surgery for congenital heart disease (CHD). Methods: From 403 patients who had undergone surgery for CHD at least 6 months before pre-school and were admitted to our hospital between 2011 and 2015, 75 who underwent blood and urine tests and cardiac catheterization were included in this study. The urinary albumin-to-creatinine ratio (ACR) was quantified, and the relationship of ACR with physical and laboratory findings and hemodynamics assessed using cardiac catheterization was analyzed. Results: The study cohort was divided into three groups: Fontan group (n = 25), tetralogy of Fallot (TOF) group (n = 18), and control group (other biventricular CHDs; n = 32). The median age of patients was 5.9 years. ACR was higher in the Fontan group than in the TOF and control groups (median: 15.0 vs. 5.0 and 0.0 mg/g, p < 0.001). Moreover, albuminuria (ACR > 30 mg/g) was observed in 20.0% of Fontan patients, while ACR was associated with potential complicating factors of Fontan circulation: high central venous pressure, high mean pulmonary artery pressure, and worse than moderate atrioventricular regurgitation. ACR showed a moderate correlation with the cystatin C-based estimated glomerular filtration rate (r = − 0.725, p < 0.001). Conclusions: Measurement of albuminuria in Fontan patients before they join elementary school is useful because it reflects kidney function and hemodynamic factors that can worsen their condition. Identification and management of patients with albuminuria may facilitate early therapeutic intervention for worsening Fontan factors, eventually delaying the deterioration of kidney function. [ABSTRACT FROM AUTHOR]