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Abstract In the current study, we aimed to review the evidence from twin and family‐based studies that have assessed the familial similarity in intakes of energy and macronutrients among various parent–child pairs. The online literature databases, including Web of Science, PubMed, and Scopus, were searched up to December 2022 to find potentially eligible studies. We converted Pearson's, Spearman's, or intra‐class correlation coefficients to z's using Fisher's z transformation to obtain approximate normality and then calculated a mean and standard error (SE) of transformed correlation weighted by the sample sizes in the studies. We reported pooled r and 95% CI as our final results in five groups, including parent–child, mother–daughter, mother–son, father–daughter, and father–son. Twenty‐one eligible studies were included in this meta‐analysis, in which the sample size ranged from 33 and 4310. Our analysis showed that family resemblance in the intake of energy and macronutrients in various parent–offspring pairs was weak to moderate which could be different based on family pairs, nutrients, and studies. The highest similarity in dietary intakes was observed among the mother–daughter pair, which was for carbohydrate and protein intake, respectively. The lowest correlations in dietary intakes were found between mother–son or father–son pairs. Our meta‐analysis suggested that family similarity for intakes of energy and macronutrients was not strong in parent–child pairs. The highest correlation in dietary intake was mostly found in mother–daughter pairs. The weak similarities in dietary intake among parent–child pairs indicate the noticeable effect of the environment outside the family on individuals' dietary choices.

Abstract Aim To identify the latent profiles and predictors of family management styles for children with asthma. Design This is a secondary data analysis. The demographic data of 506 primary caregivers of children with asthma and their scores of the Family Management Scale in a cross‐sectional study were used. Latent profile analysis and multiple logistic regression analyses were employed. Results Three family management styles were identified: Thriving (Profile 1), Accommodating (Profile 2), and Enduring (Profile 3) Family Management Style. The child's age, gender, mother's education level, family structure, influence of illness on parents' work and family life, whether they had follow‐up plans and whether their parents had read disease and health knowledge pamphlets were found to be the predictors of different styles. Conclusion Three distinct family management styles exist for children with asthma. Future interventions designed to enhance family management for children with asthma should be based on their demographic characteristics and family management styles. Implications for the Profession and Patient Care The precise classification of family management styles in this study can serve as a guide to form multi‐disciplinary teams of physicians and nurses to provide individualized care and conduct in‐depth research to explore the mechanisms of biomedicine and the social psychology of asthma in the future. Impact This paper aims to identify the latent profiles and predictors of family management styles of children with asthma. Thriving, accommodating, and enduring family management styles were identified in this paper. Child's characteristics, family and organizational factors were the predictors of different family management styles. Findings of this paper provide guidance for physicians and nurses to offer individualized care and conduct in‐depth research to explore the mechanisms of biomedicine and the social psychology of asthma in the future. Reporting Method The article was reported according to the STROBE Checklist. Patient or Public Contribution No Patient or Public Contribution.

Abstract Introduction This study, of significant importance to healthcare professionals, policymakers, researchers, and organizations involved in child healthcare and malnutrition in Afghanistan, aimed to estimate the out‐of‐pocket expenditure (OOPE) in patients under 5 years old with severe malnutrition in a children's hospital in Herat Province, Afghanistan. Method This study employed a meticulously designed cross‐sectional descriptive‐analytical approach with practical results. The research population consisted of families with malnourished children under 5 who were referred to Herat Children's Hospital. Data was collected using a comprehensive standard World Health Organization questionnaire to gather demographic information from children in Herat. A carefully selected convenience sampling method was used, with 300 referring patients participating in face‐to‐face interviews with the supervisors of these children. After obtaining personal consent and coordinating with health officials, interviews were conducted with the caregivers of children under 5 who suffered from severe malnutrition. The data was then analyzed using robust descriptive statistics, quantitative variables, mean and standard deviation, frequency, and relative frequency. Multiple regression analysis was used to determine the factors that most influenced direct payments from patients' pockets, ensuring the reliability and validity of the findings. Results The results showed that OOPE in both households with seven and less than seven people and more than seven people was 68%. The findings indicated that among the residents of Herat referred to the studied hospital, these people spent 54% of the treatment costs directly out of pocket. In contrast, people in the rural areas of Herat pay 69% of the treatment costs to receive medical services straight out of pocket. The critical point is that 93% of the families have incurred catastrophic expenses to treat their children suffering from severe malnutrition. The research revealed that the patient's location and the education level of the head of the household were the most significant factors affecting out‐of‐pocket payments by patients. Conclusion Increasing OOPE in rural Afghanistan poses a significant obstacle to equitable healthcare services and access to appropriate medicines. To support the goal of universal healthcare coverage, geographic imbalances, and broad health financing options must be addressed. Strengthening insurance coverage and more government assistance can significantly reduce these patients' out‐of‐pocket payments.

Abstract Survival rates for pediatric acute lymphoblastic leukemia (pALL) have improved dramatically; relapsed/refractory (r/r) acute lymphoblastic leukemia (ALL) remains challenging. Immunotherapies are rapidly evolving treatments for r/r ALL with limited cost‐effectiveness data. This study identifies existing economic evaluations of immunotherapy in pALL and summarizes cost‐effectiveness. Medline, Embase, and other databases were searched from inception to October 2022. Cost‐effectiveness analyses evaluating immunotherapy in pALL were included. Costs reported in 2021 USD. Of 2960 studies, 11 met inclusion criteria. Tisagenlecleucel was compared to standard of care, clofarabine monotherapy, clofarabine combination therapy, or blinatumomab. No studies have evaluated blinatumomab or inotuzumab ozogamicin. Six studies found tisagenlecleucel to be cost‐effective, five of which were supported by Novartis. Four found that it had the potential to be cost‐effective, and one found that it was not cost‐effective. The cost‐effectiveness of tisagenlecleucel was highly dependent on list price and cure rates. This study can inform the use of tisagenlecleucel in pALL.

Abstract Introduction Neurosurgery is considered the mainstay of treatment for pediatric low‐grade glioma (LGG); the extent of resection determines subsequent stratification in current treatment protocols. Yet, surgical radicality must be balanced against the risks of complications that may affect long‐term quality of life. We investigated whether this consideration impacted surgical resection patterns over time for patients of the German LGG studies. Patients and Methods Four thousand two hundred and seventy pediatric patients from three successive LGG studies (median age at diagnosis 7.6 years, neurofibromatosis (NF1) 14.7%) were grouped into 5 consecutive time intervals (TI1‐5) for date of diagnosis and analyzed for timing and extent of first surgery with respect to tumor site, histology, NF1‐status, sex, and age. Results The fraction of radiological LGG diagnoses increased over time (TI1 12.6%; TI5 21.7%), while the extent of the first neurosurgical intervention (3440/4270) showed a reduced fraction of complete/subtotal and an increase of partial resections from TI1 to TI5. Binary logistic regression analysis for the first intervention within the first year following diagnosis confirmed the temporal trends (p

Abstract Background and Aim People with inflammatory bowel disease (IBD) have an increased risk of cardiovascular disease, including in younger adulthood. This may arise in part from chronic, systemic low‐grade inflammation. The process of atherosclerosis may begin in childhood. We sought to determine whether pediatric IBD is associated with adverse changes in arterial structure and function as a marker of early increased cardiovascular risk. Methods We performed a case–control study comparing children with IBD for a median disease duration of 2.49 (interquartile range 1.23, 4.38) years with healthy children. In a single visit, we collected baseline clinical and anthropometric data, and measured blood pressure, pulse wave velocity, carotid artery distensibility, and aortic and carotid intima‐media thickness. High‐sensitivity C‐reactive protein and fasting lipids were measured. Results We enrolled 81 children with IBD (40 with Crohn's disease, 40 with ulcerative colitis, and 1 with unspecified IBD) and 82 control participants. After adjusting for age, sex, body mass index z‐score, blood pressure, and low‐density lipoprotein cholesterol, there was no difference in measures of arterial structure and function in children with IBD compared with controls, nor between those with Crohn's disease or ulcerative colitis. Conclusion We did not show any differences in arterial structure and function in children with a history of IBD for less than 5 years compared with healthy controls. IBD diagnosed in childhood may provide a window of opportunity to actively reduce standard cardiovascular risk factors and improve future cardiovascular outcomes.

Abstract There are few short, validated tools to assess young children's obesity‐related dietary behaviours, limiting the rapid screening of dietary behaviours in research and practice‐based early obesity prevention. This study aimed to develop and assess the reliability and validity of a caregiver‐reported short dietary questionnaire to rapidly assess obesity‐related dietary behaviours in children aged 6 months to 5 years. The Early Prevention of Obesity in Childhood Dietary Questionnaire (EPOCH‐DQ) was developed using a rigorous process to determine content and structural validity. Three age‐appropriate versions were developed for (1) infants, aged 6–12 months, (2) toddlers, aged 1–2.9 years and (3) pre‐schoolers, aged 3–5 years. The questionnaire (7–15 items) measures dietary behaviours, including diet risk from non‐core food and beverage intake, diet quality from vegetable frequency, bread type and infant feeding practices. Test–retest reliability was assessed from repeated administrations 1 week apart (n = 126). Internal consistency, concurrent validity (against a comparison questionnaire, the InFANT Food Frequency Questionnaire), construct validity and interpretability were assessed (n = 209). Most scores were highly correlated and significantly associated (p

Abstract Acute gastroenteritis is one of the most common diseases in children and an important cause of morbidity and mortality worldwide. No specific treatment is available; therefore, management is exclusively symptomatic. Xyloglucan has been approved in Europe as a class IIa medical device for restoration of the physiological functions of the intestinal wall. Our objective was to assess efficacy and safety of xyloglucan for the treatment of acute gastroenteritis in children. We performed a triple‐blind, randomized placebo‐controlled clinical trial in four primary care centers and one continued care hospital center. The study population comprised children with acute gastroenteritis aged >3 months and

Abstract Immune thrombocytopenia (ITP) is a common childhood acute autoimmune bleeding disorder caused by numerous viruses and characterized by isolated thrombocytopenia. Although cases of ITP caused by coronavirus disease 2019 (COVID‐19) infection have been reported in adults, pediatric reports are limited. We present the case of a 1‐year‐old girl who developed COVID‐19‐infection‐related ITP with a very low platelet count (0.0 × 104/μL). We searched for COVID‐19‐related pediatric ITP cases and found 10 other cases, with the majority having platelet counts of

Abstract Aim To investigate reflections of public health nurses (PHNs) on implementing the New Families programme, a supplement to the usual Norwegian child health centre programme. It involves user‐led decisions on the content and number of home visits offered by the family's PHN from pregnancy week 28 until the child is 2 years. Design An interpretive description approach. Methods Altogether 206 anonymized, undated reflection notes by PHNs becoming familiar with the programme were collected in 2017–2020. NVivo 12 and inductive content analysis were used to convert the data into manageable segments. Results Focusing on childhood experiences and parental role expectations among prospective parents during home visits was seen as a major shift in the nurses' counselling strategy. Providing relevant information to the parents‐to‐be ahead of a meeting was important. Given sufficient staff and guidance, the programme was considered a good basis for building a relationship with the family.

Abstract Objectives The severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) virus causes coronavirus disease 2019 (COVID‐19), a respiratory infection that has spread worldwide and is responsible for a high death toll. Although respiratory symptoms are the most common, there is growing evidence that oral signs of COVID‐19 can also be seen in children. The purpose of this systematic review is to provide a comprehensive analysis of the available data on the oral manifestations of COVID‐19 in children and to recommend appropriate methods of diagnosis and treatment. Methods A systematic search of the MEDLINE, EMBASE, Scopus, and Web of Science databases was done to discover relevant papers published between their establishment and January 2023. Articles detailing oral symptoms in pediatric patients with confirmed COVID‐19 infection were included, and data on clinical characteristics, diagnosis, treatment, and outcomes were extracted and evaluated. Results A total of 24 studies involving 2112 pediatric patients with COVID‐19 were included in the review. The most common presentations are oral lesions, taste and smell disorders, oral candidiasis, hemorrhagic crust, tongue discoloration, lip and tongue fissuring, gingivitis, and salivary gland inflammation. These manifestations were sometimes associated with multi‐system inflammatory syndrome in children (MIS‐C) or Kawasaki disease (KD). Management strategies varied depending on the severity of the oral manifestation and ranged from symptomatic relief with topical analgesics to systemic medications. Conclusion Oral symptoms of COVID‐19 are relatively prevalent in juvenile patients and can be accompanied by severe systemic diseases, such as MIS‐C or Kawasaki illness. Early detection and adequate care of these oral symptoms are critical for the best patient results. Understanding the underlying pathophysiology and developing targeted treatments requires more investigation.

Abstract Four decades of research on the health effects of ‘connection to nature’ identifies many wellbeing advantages for young people. Yet this literature has developed largely without reference to biophysical evidence about mass biodiversity loss, the degradation of marine environments and climate change. As these interlocking planetary crises progress, children will be more likely to witness the marine environments they learn about degrade or disappear as they grow up. Improving ocean literacy is important to protect marine environments into the future. However little is known about how learning about ocean degradation affects young people's emotional wellbeing. We undertook qualitative research to investigate how ocean literacy educators in Aotearoa New Zealand view the content they deliver in relation to the emotional wellbeing of young people. Semi‐structured interviews were conducted with 21 key informants from non‐government organisations (NGOs), Ministry of Education funded programmes, university‐community partnerships, youth‐led initiatives and local and national museums and aquariums. Transcripts were analysed using the six steps of Braun and Clarke's (2022) reflexive thematic analysis. Ocean literacy education was described as positively affecting young people's emotional wellbeing through interactive experiences in coastal environments. These provided opportunities for experiencing wonder, curiosity and a shared sense of connection and belonging. Educators reported witnessing distress and overwhelm in young people when some information was delivered. This resulted in educators ‘not focusing on the negative’ and moving straight to solutions young people could take part in. Our findings provide opportunities for re‐imagining ocean literacy education as a space for promoting mental wellbeing, especially when young people have the opportunity to be part of collective experiences that promote joy and wonder. Intergenerational solutions where young people can be supported to take action with adults who work in solidarity with them are also recommended. Further research into how educators can be resourced to acknowledge and facilitate support around young people's negative emotional responses (such as grief, overwhelm and anxiety) is required. Read the free Plain Language Summary for this article on the Journal blog.

Abstract This review discussed analyzing information dissemination and activities related to mental health conducted by the Centers of Disease Control and Prevention (CDC), considering their application in Japan, and disseminating them to the public is necessary for the Japanese New Center for Health Control. The Japanese government also explores the Japanese New Center For Health Control in addressing children's mental health issues potentially under the Japan health crisis. The findings underscore the urgency of prioritizing children's mental health and implementing effective strategies to mitigate the long‐term effects of the COVID‐19 pandemic.

Abstract Objective To collate and critically review international evidence on the direct health system costs of children and adolescents and young adults (AYA) with cancer. Methods We conducted searches in PubMed, MEDLINE, CINAHL, and Scopus. Articles were limited to studies involving people aged 0–39 years at cancer diagnosis and published from 2012 to 2022. Two reviewers screened the articles and evaluated the studies using the Consolidated Health Economic Evaluation Reporting Standards checklist. The reviewers synthesized the findings using a narrative approach and presented the costs in 2022 US dollars for comparability. Results Overall, the mean healthcare costs for all cancers in the 5 years post diagnosis ranged from US$36,670 among children in Korea to US$127,946 among AYA in the USA. During the first year, the mean costs among children 0–14 years ranged from US$34,953 in Chile to over US$130,000 in Canada. These were higher than the costs for AYA, estimated at US$61,855 in Canada. At the end of life, the mean costs were estimated at over US$300,000 among children and US$235,265 among adolescents in Canada. Leukemia was the most expensive cancer type, estimated at US$50,133 in Chile, to US$152,533 among children in Canada. Overall, more than a third of the total cost is related to hospitalizations. All the included studies were of good quality. Conclusions Healthcare costs associated with cancer are substantial among children, and AYA. More research is needed on the cost of cancer in low‐ and middle‐income countries and harmonization of costs across countries.

Abstract Background Allergic reactions to milk appear sooner than those to hen's eggs, irrespective of the total dose of the oral food challenges (OFCs) and type of matrices. The reported median times for the first symptom occurrence are 20–30 min with milk and 50–60 min with eggs. However, allergic reactions due to wheat have not yet been fully investigated. Methods This study retrospectively collected data from OFC for milk and wheat conducted at Sagamihara National Hospital and Sendai Medical Center from 2009 to 2023. The time from the start of the OFC to the onset of symptoms was compared between children with cow's milk and wheat allergy. Results Twenty‐five and 13 children reacted to single‐dose OFCs with milk products equivalent to 25 mL of raw cow's milk or 15 g of udon noodles, respectively. The median ages of patients with positive challenges were 1.4 and 2.8 years for milk and wheat, respectively, and the median times for the first symptom occurrence were 20 min and 53 min, respectively (p = .006). Conclusion This multicenter study was the first to examine the time of symptom appearance during single‐medium‐dose milk and wheat challenges. Allergic reactions to wheat appear later than those for milk during OFC. For multiadministration OFC for wheat, the dosing interval should be longer than 60 min. Our findings can help improve the safety of OFCs.

Abstract Objective The aim of this study was to develop the Iranian version of the Children's Experiences of Dental Anxiety Measure (CEDAM) and evaluate its validity and reliability in assessing dental anxiety in children aged 9‒16. Methods The CEDAM was translated into Persian following the guidelines of the IQOLA project. A ‎sample of children completed the measure in a clinical setting, with a subgroup completing it ‎again to assess test–retest reliability. Concurrent criterion validity was evaluated by having all ‎participants complete the Modified Child Dental Anxiety Scale (MCDAS) alongside the ‎CEDAM. Construct validity was examined using exploratory and confirmatory factor ‎analyses.‎ Results The study included 275 children between the ages of 9 and 16. The Iranian version of CEDAM ‎exhibited excellent internal consistency with a Cronbach's ⍺ coefficient of 0.83. Test–retest ‎reliability was also high, with an intraclass correlation coefficient value of 0.96. Furthermore, there was a significant and ‎positive correlation between CEDAM and MCDAS scores (ρ = 0.72, p

Abstract Background Childhood cancer survivors face various adverse consequences. This Nordic register‐based cohort study aimed to assess whether survivors of childhood cancer are more likely to have low income than their peers. Methods We identified 17,392 childhood cancer survivors diagnosed at ages 0 to 19 between 1971 and 2009 with 83,221 age‐, sex‐, and country‐matched population comparisons. Annual disposable income at ages 20 to 50 years was retrieved from statistical offices (for 1990–2017) and categorized into low income and middle/high income. The number of transitions between income categories were assessed using binomial regression analyses. Results The prevalence of annual low income among childhood cancer survivors was 18.1% and 15.6% among population comparisons (risk ratio [RR] 1.17; 95% confidence interval [CI] 1.16–1.18). Compared to population comparisons, childhood cancer survivors were 10% (95% CI 8%–11%) less likely to transition from low to middle/high income and 12% (10%–15%) more likely to transition from middle/high to low income during follow‐up. Among those initially in the low income category, survivors were 7% (95% CI 3%–11%) more likely to remain in the low income category. If the initial category was middle/high income, childhood cancer survivors were 10% (95% CI 8%–11%) less likely to remain in the middle/high income and 45% (37%–53%) more likely to transition to the low income category permanently. Conclusions Childhood cancer survivors are at higher risk for low income in adulthood than their peers. These disparities might be reduced by continued career counseling along with support in managing within the social security system.

Abstract Introduction Malignant germ cell tumors (MGCTs) can develop either extracranially or intracranially. Growing teratoma syndrome (GTS) may develop in these patients following chemotherapy. Reports on the clinical characteristics and outcomes of GTS in children with MGCTs are limited. Methods We retrospectively collected the data, including the clinical characteristics and outcomes of five patients in our series and 93 pediatric patients selected through a literature review of MGCTs. This study aimed to analyze survival outcomes and risk factors for subsequent events in pediatric patients with MGCTs developing GTS. Results The sex ratio was 1.09 (male/female). In total, 52 patients (53.1%) had intracranial MGCTs. Compared with patients with extracranial GCTs, those with intracranial GCTs were younger, predominantly boys, had shorter intervals between MGCT and GTS, and had GTS mostly occurring over the initial site (all p

Abstract Inflammation may develop due to internal dysfunction of the cystic fibrosis transmembrane conductance regulator (CFTR) protein or external factors in patients with cystic fibrosis (CF). This prospective randomized clinical trial aimed to ascertain the effects of nano‐curcumin as an anti‐inflammatory agent and a CFTR modulator on clinical and inflammatory markers in children with CF. Children with CF were randomly assigned to receive daily curcumin or a placebo for 3 months. The primary outcome measure was to evaluate inflammatory indices, nasopharyngeal swab analysis, and clinical assessments via spirometry, anthropometric measurements, and quality of life (QOL) analysis. Sixty children were included. Intra‐group changes comparison showed that curcumin decreased the level of high‐sensitivity C‐reactive protein (hs‐CRP) (median: −0.31 mg/L, IQR: −1.53 to 0.81; p = .01) and fecal calprotectin level (−29 μg/g, −57.5 to 11.5; p = .03), also increased the level of interleukin (IL)‐10 (6.1 pg/mL, 4.5–9; p = .01). Moreover, curcumin improved the overall QOL and the subscales of the questionnaire. Inter‐group changes comparison depicted the number of Pseudomonas colonies reduced by about 52% in the curcumin group and gained weight by about 16% (p > .05). Nano‐curcumin seems to be considered as an effective nutritional supplement on hs‐CRP, IL‐10, fecal calprotectin levels, and improving QOL in patients with CF.

Abstract Background Despite advancements in the use of body mass index (BMI) to categorize obesity severity in pediatrics, its utility in guiding individual clinical decision making remains limited. The Edmonton Obesity Staging System for Pediatrics (EOSS‐P) provides a way to categorize the medical and functional impacts of obesity according to the severity of impairment. The aim of this study was to describe the severity of obesity among a sample of multicultural Australian children using both BMI and EOSS‐P tools. Methods This cross‐sectional study included children aged 2–17 years receiving obesity treatment through the Growing Health Kids (GHK) multi‐disciplinary weight management service in Australia between January to December 2021. BMI severity was determined using the 95th percentile for BMI on age and gender standardized Centre for Disease Control and Prevention (CDC) growth charts. The EOSS‐P staging system was applied across the four health domains (metabolic, mechanical, mental health and social milieu) using clinical information. Results Complete data was obtained for 338 children (age 10.0 ± 3.66 years), of whom 69.5% were affected by severe obesity. An EOSS‐P stage 3 (most severe) was assigned to 49.7% of children, the remaining 48.5% were assigned stage 2 and 1.5% were assigned stage 1 (least severe). BMI predicted health risk as defined by EOSS‐P overall score. BMI class did not predict poor mental health. Conclusion Used in combination, BMI and EOSS‐P provide improved risk stratification of pediatric obesity. This additional tool can help focus resources and develop comprehensive multidisciplinary treatment plans.

Abstract This study aims to compare three techniques (soap bubbles, distraction cards, coughing) to reduce pain and anxiety in children during phlebotomy and collection with the use of a control group. Pain levels of children were assessed with the Wong‐Baker FACES Pain Rating Scale and anxiety levels of children were assessed with the Children's Fear Scale. This randomized controlled study involved intervention groups and a control group. The population of this study consisted of 120 Turkish children (30 subjects in each of the four groups soap bubbles technique, distraction cards, coughing, and control groups) between the ages of 6 and 12. The study found that pain and anxiety levels of the children in intervention groups were lower than those of the children in the control group during phlebotomy procedure and this difference was statistically significant (P .05). Soap bubbles, distraction cards and coughing techniques were found to reduce pain and anxiety in children during phlebotomy. Nurses can play an effective role in reducing pain and anxiety by using these techniques.

Abstract In children's chronic pain services, healthcare decisions involve a three‐way interaction between the child, their parent or guardian, and the health professional. Parents have unique needs, and it is unknown how they visualize their child's recovery and which outcomes they perceive to be an indication of their child's progress. This qualitative study explored the outcomes parents considered important, when their child was undergoing treatment for chronic pain. A purposive sample of twenty‐one parents of children receiving treatment for chronic musculoskeletal pain, completed a one‐off semi‐structured interview that involved drawing a timeline of their child's treatment. The interview and timeline content were analyzed using thematic analysis. Four themes are evident at different points of the child's treatment course. The “perfect storm” that described their child's pain starting, “fighting in the dark” was a stage when parents focused on finding a service or health professional that could solve their child's pain. The third stage, “drawing a line under it,” changed the outcomes parents considered important, parents changed how they approached their child's pain and worked alongside professionals, focusing on their child's happiness and engagement with life. They watched their child make positive change and moved toward the final theme “free.” The outcomes parents considered important changed over their child's treatment course. The shift described by parents during treatment appeared pivotal to the recovery of young people, demonstrating the importance of the role of parents within chronic pain treatment.

Abstract Background Avascular necrosis (AVN) of bone is a debilitating complication of pediatric patients with acute lymphoblastic leukemia (ALL). While it is extensively studied and reported in Western population, studies focused on Orientals are limited. This study aims to evaluate the incidence, risk factors, and clinical outcomes of AVN among Chinese children with ALL. Methods This study is a retrospective, territory‐wide population‐based cohort study of pediatric patients with ALL enrolled on one of the three consecutive ALL study protocols (ALL‐IC‐BFM 2002, CCLG‐ALL 2008, and CCCG‐ALL 2015). Results A total of 24 out of 533 pediatric subjects with ALL (4.5%) had symptomatic AVN. Age was the single most important risk factor associated with the development of AVN. Only three patients were below age of 10 at the time of diagnosis of ALL. The incidences of AVN in patients aged above and below 10 years were 18.2% ± 3.6% and 0.8% ± 0.5%, respectively, and were significantly different (p

Abstract Aim The aim of the study was to explore and describe the mothers' perspectives on issues associated with caring for Ghanaian children aged 0–14 years living with tuberculosis. Design Exploratory descriptive qualitative design. Methods Semi‐structured individual interviews were conducted face to face with 15 purposively sampled mothers from two health facilities in the Greater Accra area. Transcribed data were analysed using computer‐enhanced thematic analysis. Results Findings were grouped into (1) physical burden on the mothers and (2) psychological burden on mothers. The eight subthemes indicate that mothers of children living with tuberculosis experienced tiredness, sleeplessness, body pains, weight loss and sicknesses as they cared for their children. In addition to worrying, mothers experienced stigma and negative emotions such as sadness, guilt, fear and loneliness. Conclusion Mothers of children diagnosed with tuberculosis in Ghana experience physical and psychological health problems related to their caregiving roles. Nurses and other healthcare providers should identify specific problems and offer broad‐based emotional and other support for these women.

Abstract Objectives This study aims to evaluate the effectiveness of two different distraction techniques (Audio Video Distraction/Video Game Distraction) in the management of anxious pediatric patients during dental treatment. Materials and Methods One hundred and five children were randomly divided into three groups; Group A: active distraction using video games on a tablet device and wireless joystick (VG). Group B: passive distraction using video on tablet, and wireless headphones (AV). Group C (Control group): basic behavior guidance technique Tell Show Do was used (C). The children were selected from the department of pediatric dentistry at the Faculty of Dentistry, Damascus University, who required pulpotomy in primary mandibular molars. All children were assessed by: Simplified Wong‐Baker FACES for pain scale (self‐report), and “HOUPT” Behavior Rating Scale for Overall Behavior (non‐self‐report), at the end of treatment. Results One hundred and five children completed the study (57 boys and 48 girls) aged between 6 and 10 years (mean age of 7.4 years). The active distraction (VG) group was superior to the passive distraction (AV) group and the control group (C) on the pain scale with statistically significant differences as appeared in Simplified Wong‐Baker Scale (p = .000), The active distraction (VG) group was superior to the control group (C) in overall behavior as appeared in HOUPT scale (p = .041), but it was no statistically significant differences between (VG) group and (AV) group in overall behavior (p = .605). With the use of Bluetooth technology and wireless devices, the workspace was comfortable for the dentist and did not interfere with the movement of his hands. Conclusion Positive distraction with video games by wireless joystick displayed on the portable tablet on the dental chair was the best technique for reducing dental anxiety and reported pain in school children (6‐10 years) and was better than negative distraction by video cartoons on the tablet device.

Abstract Introduction Sleep problems in children with epilepsy (CWE) are common. However, little is known about parental experiences and feelings about managing sleep in their CWE. To provide the most appropriate services' provision, it is essential that the lived experience of parents of this patient group and the issues and problems that they face in managing their child's sleep is understood. Method In 2018, nine mothers of CWE (aged 5–15 years) were interviewed about their perceptions and experiences around their child's sleep, sleep problems and their management, the impact of sleep difficulties on the child and their family and available support. Results Four themes were identified that represented the nature of the child's sleep problems, including settling and night‐waking issues, parasomnias and child anxiety around sleep. Seven themes represented mothers' experiences of managing their child's sleep and any associated problems, including the longstanding challenging nature of child sleep issues, management strategies adopted, challenges related to managing sleep over time, the link between sleep and seizures, the negative impact of poor sleep on daytime functioning, role of antiseizure medication and maternal concerns about child sleep. One theme represented the perceived lack of information, help and support available. Conclusions Findings suggest there are unmet needs in supporting parents to deal with sleep, sleep problems and their management in CWE. Patient or Public Contribution This individual study was conducted under the umbrella of the CASTLE research programme (see https://castlestudy.org.uk/). Parents who have lived experience of parenting a child with epilepsy were co‐applicants for the programme and were involved in the original conception, aims, design and funding application for the research programme (including the project reported in this paper) and advised on project design. Mothers of CWE who have lived experience of managing sleep and sleep problems in their child were participants who shared their experiences through the interviews, which formed the data of the current study.

Abstract Objectives The current study aimed to assess the measurement invariance of the 9‐item self‐report Psychotic‐Like Experiences Questionnaire for Children (PLEQ‐C) across various demographic (age, gender, ethnicity) and psychopathology profiles in a community sample of children. Methods Children aged 9–11 years (n = 613; M age = 10.4 years [SD = 0.8]; 50.9% female) completed questionnaire screening at school, with primary caregivers returning questionnaires by mail from home. Configural, metric, scalar, and residual invariance of the PLEQ‐C scores were investigated across groups differentiated by age (9; 10; 11 years), gender (female; male), ethnicity (white; black; other), and by child‐reported and caregiver‐reported psychopathology (abnormal rating; not abnormal). Results The PLEQ‐C scores demonstrated good unidimensional model fit. Full configural, metric, scalar, and residual invariance were demonstrated across gender, ethnicity, and psychopathology (both child‐ and caregiver‐reported). Across age groups, the PLEQ‐C scores showed full configural and metric invariance, but only partial scalar and residual invariance (with a single item measuring differently among 11‐year‐olds). Conclusions In this community sample, the PLEQ‐C was robust to age, gender, ethnicity, and psychopathology profiles, providing evidence of its capacity to identify children in the general population who might benefit from further assessment to determine the clinical significance of their psychotic experiences.

Abstract Objectives To observe variation in imaging requests after publication of the Royal College of Radiologists UK Paediatric Trauma Protocols in 2014, recommending limited use of thoracic computed tomography (CT) to appropriately clinically risk stratified children. Method A retrospective observational study using data from the Trauma Audit & Research Network in the United Kingdom, for children (0–16 years of age) for the years 2012–2021. Percentages were calculated to facilitate comparison between year groups (under 1 year of age, 1–10 years of age, 11–15 years of age), and CT imaging categories reviewed: (1) whole‐body CT (WBCT); (2) abdominopelvic CT (CTAP) with chest radiograph (CXR); (3) chest, abdomen, and pelvic CT (CTCAP) with CXR; (4) CTCAP without CXR; and (5) other imaging. Results Increased use of the recommended protocol (CXR with CTAP) was observed after guidance publication but was not sustained: infants under 1 year old, 0.0% in 2012, 7% in 2017, 0.0% in 2021; 1–10‐year‐olds, 4% in 2012, 13.9% in 2017, 5.5% in 2021; 11–15‐year‐olds, 7.1% in 2012, 10.2% in 2017, 6.6% in 2021. Requests for WBCT increased from 2012–2021 (all age groups, 2.4%, 2012, to 5.3%, 2021) and requests for CTCAP were consistently at a higher level than that of the recommended protocol. Conclusion The increased use of CXR with CTAP after publication of the guidelines, was not sustained with a decreasing trend observed from ∼2017, raising concern for the ionizing radiation burden in this population.

Abstract Breastfeeding has been consistently associated with higher intelligence since childhood. However, this relation could be confounded due to maternal selection bias. We estimated the association between predominant breastfeeding and intelligence in school‐age children considering potential selection bias and we simulated the intelligence gap reduction between low versus higher socioeconomic status children by increasing breastfeeding. We analysed predominant breastfeeding practices (breastmilk and water‐based liquids) of children 0–3 years included in the Mexican Family Life Survey (MxFLS‐1). Intelligence was estimated as the z‐score of the abbreviated Raven score, measured at 6–12 years in the MxFLS‐2 or MxFLS‐3. We predicted breastfeeding duration among children with censored data with a Poisson model. We used the Heckman selection model to assess the association between breastfeeding and intelligence, correcting for selection bias and stratified by socioeconomic status. Results show after controlling for selection bias, a 1‐month increase in predominant breastfeeding duration was associated with a 0.02 SD increase in the Raven z‐score (p

Abstract Objectives To examine the volume, topics, and reporting trends in the published literature of randomized clinical trials for pharmacologic pain management of pediatric tonsillectomy and adenotonsillectomy and to identify areas requiring further research. Data Sources PubMed (National Library of Medicine and National Institutes of Health), Scopus (Elsevier), CINAHL (EBSCO), and Cochrane Library (Wiley). Methods A systematic search of four databases was conducted. Only randomized controlled or comparison trials examining pain improvement with a pharmacologic intervention in pediatric tonsillectomy or adenotonsillectomy were included. Data collected included demographics, pain‐related outcomes, sedation scores, nausea/vomiting, postoperative bleeding, types of drug comparisons, modes of administration, timing of administration, and identities of the investigated drugs. Results One hundred and eighty‐nine studies were included for analysis. Most studies included validated pain scales, with the majority using visual‐assisted scales (49.21%). Fewer studies examined pain beyond 24 h postoperation (24.87%), and few studies included a validated sedation scale (12.17%). Studies have compared several different dimensions of pharmacologic treatment, including different drugs, timing of administration, modes of administration, and dosages. Only 23 (12.17%) studies examined medications administered postoperatively, and only 29 (15.34%) studies examined oral medications. Acetaminophen only had four self‐comparisons. Conclusion Our work provides the first scoping review of pain and pediatric tonsillectomy. With drug safety profiles considered, the literature does not have enough data to determine which treatment regimen provides superior pain control in pediatric tonsillectomy. Even common drugs like acetaminophen and ibuprofen require further research for optimizing the treatment of posttonsillectomy pain. The heterogeneity in study design and comparisons weakens the conclusions of potential systematic reviews and meta‐analyses. Future directions include more noninferiority studies of unique comparisons and more studies examining oral medications given postoperatively.

Abstract Purpose To provide ways to improve the clinical practice of fertility preservation (FP) for children, adolescents, and young adults (AYA) with cancer. Design A systematic research of online databases was undertaken in March 2020 following the PRISMA criteria, including Medline and Web of Science. Results Fifty‐nine articles were included. Surveys, interviews, and focus groups were used to collect data from patients, parents, and health care providers (HCPs). Four themes worth exploring emerged: (a) what do patients and professionals think of and know about FP? (b) what makes the fertility discussion happen or not? (c) what, retrospectively, led to FP being pursued or not? and (d) how do patients and HCPs feel about fertility issues? Conclusion A minority of AYAs preserve their fertility (banking assay for 45% of boys and 23% of girls). Yet fertility concerns have a significant impact on the quality of life of young cancer survivors. Although recommendations and guidelines regarding FP are available internationally, there are no specific guidelines as to how to conduct fertility counseling for children and adolescents. Some barriers are not removable, such as a poor prognosis of an obvious severe disease, time constraints for starting treatment, and cultural and religious beliefs. In response to aspects hindering patients and families to be receptive to any discussion at the time of diagnosis, psychological support could reduce the level of emotional distress and help restore a degree of open‐mindedness to open a window for discussion. Moreover, as the lack of knowledge of professionals about fertility is frequently pointed out as a limiting factor for fertility discussion, reinforcing professional training regarding FP could be proposed to promote fertility discussion and eventually referral for FP.

ABSTRACT Importance The safety and efficacy of the bath‐plug technique for the closure of cerebrospinal fluid (CSF) leaks in children remain unknown. Objective We undertook this study to ascertain whether the bath‐plug technique was safe and effective for the repair of CSF leaks. Methods We retrospectively reviewed patients who underwent endoscopic repair of CSF leaks with the fat graft as a plug‐in at Beijing Children's Hospital from March 2016 to May 2020. Demographic data, medical history, defect sites and sizes, interventions, and clinical outcomes were analyzed. One representative clinical case was additionally selected to highlight the procedure and the healing process. Results A total of 18 pediatric patients were included in this study. The group was composed of 11 boys and seven girls, aged from 5 to 123 months. The etiologies included congenital CSF leaks (n = 9) and head trauma (n = 9). Among all patients, 12 fistulas (66.7%) were located at the cribriform plate area, two (11.1%) at the roof of the ethmoid sinuses, two (11.1%) in the sphenoid sinus, and two (11.1%) at the frontal sinus. The maximum diameters of fistulas ranged from 5 to 20 mm, with a median value of 8 mm. Encephaloceles were identified in 14 (77.8%) patients. No hydrocephalus was recognized. All CSF leaks were successfully repaired with a bath‐plug technique. Follow‐up ranged from 50 to 70 months. No surgical complications were encountered in any patient. Interpretation Bath‐plug technique is safe and reliable for the endoscopic management of CSF leaks in children. Meticulous peri‐operative preparations are important for pediatric patients.

Objective Survival and reconstruction in osteosarcoma is quite challenging. The study aimed to investigate the prognosis in patients treated with neoadjuvant chemotherapy and determine the clinical outcomes of expandable endoprosthesis reconstruction in children. Methods From January 2009 to December 2014, we retrospectively analyzed 29 skeletally immature children (mean age, 10.5 years; range, 6–15 years) with osteosarcoma around the knee. Of the 29 patients who underwent neoadjuvant chemotherapy and limb salvage surgery, an expandable prosthesis was implanted for reconstruction. No patients were missed during follow‐up. The evaluation index involved follow‐up time, complication, functional results, and lengthening procedures. The survivorship and recurrence were assessed by GraphPad Software, and the function was evaluated by the Musculoskeletal Tumor Society (MSTS) scoring system. Results A mean follow‐up time was 8.9 years (range, 6–12 years), and the overall 5‐year survival was 89.1% based on Kaplan–Meier analysis. Three patients suffered a relapse and one underwent amputation. Lung metastasis developed in one patient. At 6 months after the operation, patients had a mean MSTS score of 27 points (range, 24–29). Two patients underwent revision surgery, one for implant infection and one for aseptic loosening. Prognosis is correlated with alkaline phosphatase change after treatment. Conclusions Chemotherapy scheme and limb salvage can achieve high survival rates. This expandable prosthesis was associated with good function and low complication rates. The character of expandability could be a method to overcome discrepancies in the growth period.

Abstract Objective Emergency medical services (EMS) transport for mental and behavioral health (MBH) emergencies occurs frequently in children, yet little is understood regarding prehospital physical restraint use despite the potential for serious adverse events. We aim to describe restraint use prevalence and primary impressions among children with MBH emergencies. Methods This is a retrospective cross‐sectional study of children with MBH emergencies evaluated by Alameda County (ALCO), California EMS from January 1, 2012 to December 31, 2018. Patient demographics and clinical variables were collected from the EMS records including sex, age at time of encounter, year of encounter, transport destination, medication use, and primary impression(s). The primary outcome was the use of physical restraints. Descriptive statistics were used to characterize the primary outcome and associated demographic and diagnostic features, as well as temporal use patterns. Sex and age were compared between restrained and non‐restrained youth using chi‐square analysis. Results Over the 7‐year study period, ALCO EMS transported 9775 children with MBH emergencies. Of these transports, 1205 (12.3%) were physically restrained. Most children restrained had the primary impression of “behavioral/psychiatric crisis” (51.1%), “psychiatric crisis” (27.4%), and “behavioral–other” (12.4%) and the remaining children (9.1%) had a non‐psychiatric/behavioral health primary impression. Over time, there was no statistically significant change in either number of children with MBH emergencies transported or physical restraint rate. Conclusions More than 1 in 8 children with MBH emergencies are being physically restrained during EMS transport. Restraint rate did not substantially change over time. Further studies to understand existing restraint rates and EMS resources available to address acute agitation in children are needed to inform quality and care enhancing initiatives.

Key Clinical Message Seborrheic keratosis is a common benign epidermal lesion that typically occurs in the elderly population. Its occurrence in childhood and adolescence is rare and can pose a diagnostic challenge for clinicians and dermatopathologists. We report a case of a 16‐year‐old boy with multiple brown, black oval‐shaped stuck‐on lesions on his face, which were diagnosed as seborrheic keratosis based on histological findings. The patient had no significant medical history or family history of seborrheic keratosis. In this report, we discuss the differential diagnoses of seborrheic keratosis‐like lesions in childhood and adolescence and explain why they were not compatible with our case. We also review the available treatment options. Our case emphasizes the need for dermatologists to consider seborrheic keratosis in the differential diagnosis of cutaneous lesions in young patients.

Abstract Introduction The responsibility for managing a long‐term condition (LTC) such as chronic kidney disease (CKD) typically transfers from parent to child, as children become older. However, children can find it challenging to become independent at managing their LTC, and evidence for how healthcare professionals (HCPs) support transfer of responsibility is limited. This study aimed to explore how young people with CKD assume responsibility for managing their condition and the HCP's role during this process. Methods Sampling, qualitative data collection and analysis were guided by a constructivist grounded theory approach. Individual and dyadic interviews, and focus groups, were conducted with 16 young people aged 13–17 years with CKD, 13 parents and 20 HCPs. Findings A grounded theory, shifting responsibilities, was developed that provides new insights into how young people's, parents' and HCPs' constructions of the transfer of responsibility differed. These diverse constructions contributed to multiple uncertainties around the role of HCPs, when the process started and was completed and whether the endpoint of the process was young people's self‐management or young person–parent shared management. Conclusion Families would benefit from HCP support over a longer timeframe that integrates assuming self‐management responsibility with gaining independence in other areas of their lives and focuses on young people ‘doing’ self‐management. Patient or Public Contribution Patient and public involvement was integrated throughout the study, with young adults with CKD and parents who had a child with CKD actively involved in the study's design and delivery.

Abstract Background The current systematic review and meta‐analysis aimed to explore the evidence base to date for exercise interventions/interventions that aim to increase physical activity using a modality that can be accessed from home (i.e., online or video‐based programs), and its effects on anxiety and depression in children and adolescents. Methods A broad search was conducted using six databases (PubMed, Web of Science, CINAHL, PsychINFO, ERIC and Scopus) on February 23, 2022. Studies with children or adolescents between the ages 5 and 18 years were included. Of the 2527 records that were identified, nine studies met the full‐inclusion criteria. Their quality was assessed by two independent researchers using the Cochrane risk‐of‐bias tool for randomized trials (RoB 2) and Quality Assessment Tool for Before‐After (Pre‐Post) Studies with No Control Group. Meta analyses were conducted for studies that specifically assessed anxiety and depression. Results The overall results indicated that there is some evidence suggesting the positive effects of exercise interventions delivered online in reducing children's and adolescents' anxiety (d = −0.99, 95% confidence interval [CI]: −1.12 to −0.86). Meanwhile, there seems to be insufficient evidence for its efficacy in reducing low mood (d = −0.42; 95% CI: −0.84 to 0.01). Motivational and coaching based interventions to increase levels of physical activity may be limited in their efficacy, whilst having children exercise along with a video or live sessions online appears promising. Conclusion The current preliminary review revealed potential benefits of at‐home interventions that had children and adolescents exercise along with a video in improving anxiety.

Abstract Background and Aims Childhood vaccination remains a cost‐effective strategy that has expedited the control and elimination of numerous diseases. Although coverage of new vaccines in low‐ and middle‐income countries increased exponentially in the last two decades, progress on expanding routine vaccination services to reach all children remains low, and coverage levels in many countries remains inadequate. This study aimed to examine the pattern of wealth and residence‐based related inequality in vaccination coverage through an equity lens. Methods We used data from the 2017−2018 Benin Demographic and Health Survey. Statistical and econometrics modeling were used to investigate factors associated with childhood vaccination. The Wagstaff decomposition analysis was used to disentangle the concentration index. Results A total of 1993 children were included, with 17% in the wealthiest quintile and 63% were living in rural areas. Findings showed that wealth is positively and significantly associated with vaccination coverage, particularly, for middle‐wealth households. A secondary or higher education level of women and partners increased the odds of vaccination compared to no education (p

Abstract Objective To compare Pediatric Advanced Life Support (PALS) diastolic blood pressure (DBP) criteria to empirically derived DBP criteria for the prediction of out‐of‐hospital interventions in children. Methods We performed a retrospective study of pediatric (90th centile). The accuracy of low DBP for out‐of‐hospital interventions between the two criteria was similar. Conclusion PALS criteria for DBP classified a high proportion of children as having abnormal vital signs, particularly with diastolic hypertension. Empirically derived DBP thresholds more accurately predict the delivery of key out‐of‐hospital interventions. If externally validated, correlated to in‐hospital outcomes, and combined with thresholds for other vital signs, these may better predict the need for out‐of‐hospital interventions.

Abstract A defined daily dose for children (cDDD) taking body weight into account, was proposed as a better measure of drug utilization in children than the World Health Organization's DDD. There is no global definition of DDDs for children, and it is unclear which standard doses should be used for children when conducting drug utilization studies. We used doses according to the authorized medical product information and body weight according to national pediatric growth curves to calculate theoretical cDDD for three common medicines in children in a Swedish setting. These examples demonstrate that the concept of cDDD may not be optimal for drug utilization studies in children, especially not for younger children and when dosing is done according to weight is crucial. Validation of cDDD in real‐world data is warranted. When conducting pediatric drug utilization studies, accessibility to individual‐level data on body weight and age combined with dosing information is needed.

Abstract Background Commonly applied diagnostic criteria for growing pains (GP) have evolved without determination by an authoritative representative body. GP and restless legs syndrome (RLS) share anatomical, distributional, temporal, and other clinical features and are associated in individuals over time, in families, and in population samples. In this study, we tested the hypothesis that GP, diagnosed by widely used criteria, is confounded by cases of painful restless legs syndrome (RLS‐Painful). Methods A twin family study of genetic influence and associations of GP using questionnaires was administered by Twins Research Australia. Twins (3–18 years; monozygous 503, dizygous 513), their oldest siblings, mothers, and fathers were randomly selected from the twin registry. Family members completed the questionnaires assessing lifetime prevalence of GP by commonly applied criteria and covariates including the history of iron deficiency and pediatric pain disorders. A GP‐Specific phenotype was defined as GP without urge to move the legs. We determined similarities in twin pairs for the GP and GP‐Specific phenotypes, family associations, and estimated familial and individual‐specific associations for each phenotype. Results Lifetime prevalence was one‐third lower for GP‐Specific than for GP among the twin and family members. Monozygous twin pairs were more similar than dizygous twin pairs for GP and for the derived GP‐Specific phenotype by three methods, consistent with genetic influence. There were familial associations, but the essential evidence for genetic influence was the twin‐cotwin data. GP was associated, in multivariable analyses, with migraine, headaches, recurrent abdominal pain, and iron deficiency, while GP‐Specific associations were limited to migraine and headaches. Conclusions GP is hybrid, one‐third of cases having symptoms and associations of RLS, necessarily RLS‐Painful. GP‐Specific (without symptoms and associations of RLS) could have a genetic etiology. We propose new criteria to facilitate etiological and therapeutic research.

Background Lectin‐like oxidized low‐density lipoprotein (ox‐LDL) receptor‐1 is a scavenger receptor for oxidized low‐density lipoprotein. In adults, higher soluble lectin‐like ox‐LDL receptor‐1 (sLOX‐1) levels are associated with cardiovascular disease, type 2 diabetes, and obesity, but a similar link in pediatric overweight/obesity remains uncertain. Methods and Results Analyses were based on the cross‐sectional HOLBAEK Study, including 4‐ to 19‐year‐olds from an obesity clinic group with body mass index >90th percentile (n=1815) and from a population‐based group (n=2039). Fasting plasma levels of sLOX‐1 and inflammatory markers were quantified, cardiometabolic risk profiles were assessed, and linear and logistic regression analyses were performed. Pubertal/postpubertal children and adolescents from the obesity clinic group exhibited higher sLOX‐1 levels compared with the population (P

Abstract Undernutrition during pregnancy in adolescence confers a high risk of maternal morbidity and adverse birth outcomes, particularly in low‐resource settings. In a secondary analysis, we hypothesized that younger undernourished pregnant adolescents (20 years) from the intervention of supplementary food and anti‐infective treatments. The original trial in Sierra Leone enrolled 236 younger adolescents (

Abstract Evidence suggests children HIV‐exposed and uninfected (CHEU) experience poor growth. We analysed child anthropometrics and explored factors associated with stunting among Malawian CHEU. Mothers with HIV and their infants HIV‐exposed were enroled in a nationally representative prospective cohort within the National Evaluation of Malawi's Prevention of Mother‐to‐Child HIV Transmission Programme after Option B+ implementation (2014–2018). Anthropometry was measured at enrolment (age 1–6 months), visit 1 (approximately 12 months), and visit 2 (approximately 24 months). Weight‐for‐age (WAZ) and length‐for‐age (LAZ) z‐scores were calculated using World Health Organization Growth Standards; underweight and stunting were defined as WAZ and LAZ more than 2 standard deviations below the reference median. Multivariable logistic regression restricted to CHEU aged 24 months (±3 months) was used to identify factors associated with stunting. Among 1211 CHEU, 562/1211 attended visit 2, of which 529 were aged 24 months (±3 months) and were included. At age 24 months, 40.4% of CHEU were stunted and/or underweight, respectively. In multi‐variable analysis, adjusting for child age and sex, the odds of stunting were higher among CHEU with infectious disease diagnosis compared to those with no diagnosis (adjusted odds ratio = 3.35 [95% confidence interval: 1.82–6.17]), which was modified by co‐trimoxazole prophylaxis (p = 0.028). Infant low birthweight was associated with an increased odds of stunting; optimal feeding and maternal employment were correlated with reduced odds. This is one of the first studies examining CHEU growth since Option B+. Interventions to improve linear growth among CHEU should address their multi‐faceted health risks, alongside maternal ART prescription, and follow‐up of mother‐child pairs.

Introduction Primary obstructed non‐refluxing megaureter, a type of congenitally dilated ureter, often resolves spontaneously. Surgery may be indicated in symptomatic cases; however, there are no reports of transvesicoscopic ureteral implantation and ureteroscopy for ureteral stones. Therefore, we describe the treatment of primary obstructed non‐refluxing megaureter and ureteral calculi using this technique. Case presentation A 6‐year‐old Japanese girl was referred for abdominal pain and gross hematuria due to right megaureter with multiple stones in the renal lower‐pole calyces and ureter. She was diagnosed with primary obstructed non‐refluxing megaureter and ureterovesical junction obstruction. The stones were removed using mini‐percutaneous nephrolithotomy and transvesicoureteroscopic surgery, respectively. A narrow segment of the right ureter was cut, and transvesicoscopic ureteral plication and reimplantation were performed. The procedures were successful without postoperative complications. Conclusion Transvesicoscopic ureteral reimplantation with ureteroscopy may be a safe, effective and minimally invasive surgical option for ureterovesical junction obstruction with ureteral stones.

Abstract This paper draws together about 20 years of research work and discovery and the development of a resource about pain assessment and management in children with profound cognitive impairment. The animation tells the story of an imagined child called Lily and the skills her mother uses and the challenges that her mother faces in assessing and managing Lily's pain. The animation is built on stories drawn from qualitative research findings, conversations while in clinical practice and with members of the general public, parent advisers and other sources. Most of the “evidence” came from stories shared by parents and healthcare professionals. This paper draws on some elements of socio‐narratology and is predicated on the basis that stories are important and they can act on and with us. By using an animation to tell Lily's story, the intention was to communicate research findings to a wider and more diverse audience than the typical readership of an academic journal. The intention was to act in and on people's consciousness about children's pain and to strengthen relationships and create bonds between clinicians, parents, and children in pain to make their dialog more social, connected, and meaningful. All three of us—the researcher, the writer, and the animator—have been marked and “re‐shaped” by our work related to creating Lily; we have learned more about children like Lily and their mothers, and we have learned more about ourselves and our humanity. This animation is still a story in progress, a story ‘in the wild’, a story (and a resource) we would like you to re‐tell and share. The story of Lily's pain aimed to change the lives of parents and children and professionals. Our hope is that you can be part of that change.

Abstract Aim This study aims to determine the relationship between the burden of care and self‐care abilities of pregnant women with 0–6‐year‐old children and the factors affecting them. Design A cross‐sectional questionnaire survey. Methods This study consisted of 348 pregnant women over the age of 18, with children between the ages of 0–6. Results The study determined that the self‐care ability mean scores of mothers who have two or more children between the ages of 0–6 were low and the caregiver burden mean scores were high. The researcher found a negative correlation between the self‐care ability scale scores and caregiver burden scale scores of pregnant women included in the study. These results are statistically significant and valuable in terms of revealing information about the caregiver burden and self‐care ability of pregnant women with 0–6‐year‐old children.