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Pediatric rehabilitation is fundamentally different from that of adults. Child physiology differs significantly from that of adults, necessitating specialized rehabilitation approaches. Unique injuries and varying metabolic rates underscore the need for tailored care, which changes over the years as the child grows and develops. Waiserberg's paper, "When Everyone is Responsible, No One Takes Responsibility": Exploring Pediatric Physiotherapy Services in Israel," sheds light on a critical issue. While senior practitioners oversee policy implementation and service delivery, practical physiotherapy treatment lacks continuous monitoring. This is a critical issue. Ideally, every child who requires long-term clinical therapeutic interventions to keep up with peers in mobility, communication and cognitive skills should be assessed by specialists several times throughout the school years, and their personalized rehabilitation plan discussed, reviewed, and adjusted according to their progress. The absence of a standardized protocol for overseeing and directing comprehensive rehabilitation plans leaves therapists feeling alone and adrift, whether working in schools or medical settings. Such an assessment would be an opportunity to create a registry, which is currently nonexistent. The collected data would be a priceless resource in policy decision-making and service planning. [ABSTRACT FROM AUTHOR]

Background: Mask induction of anesthesia for pediatric patients has included the use of nitrous oxide since the inception of pediatric anesthesia. However, the use of nitrous oxide precludes adequate preoxygenation. Additionally, pediatric physiology (less Functional Residual Capacity, higher oxygen consumption), increased risk of laryngospasm and lack of intravenous access increase the risk of a severe airway complication in the event of airway occlusion. Nitrous oxide does not facilitate tranquil mask placement on an unwilling child and does not meaningfully speed mask induction. Exposure to nitrous oxide has potential occupational health concerns and nitrous oxide has significant environmental detriment. Conclusion: Utilizing other, evidence‐based, techniques to facilitate tranquil mask placement will assure that patients have a pleasant induction experience and avoiding nitrous oxide will reduce the environmental impact, as well as improve the safety of, pediatric mask induction. [ABSTRACT FROM AUTHOR]

[Display omitted] The goal of the present work was to develop an in vitro toolbox to evaluate the oral administration of dosage forms to children of different age groups and under different administration conditions (fasted/fed). Based on current data on the gastrointestinal physiology of children, a set of new biorelevant media was designed to mimic the composition and physicochemical properties of resting gastric and resting small intestinal fluid in children of different age groups. In addition, guidelines were developed on how to generate fasted and fed state gastric and small intestinal fluids by combining these media with age-specific drinking volumes or portions of already established simulated paediatric breakfast meals, respectively. These fluids can simulate the conditions in the paediatric stomach and small intestine after administration of a dosage form in the fasting state or after a breakfast. The in vitro toolbox was evaluated using the example of pre-school children with a total of five paediatric medicines. Results from the corresponding set of in vitro studies highlight the importance of addressing patient-specific characteristics rather than downscaling existing adult in vitro models. [ABSTRACT FROM AUTHOR]

Background: Children's gait is traditionally understood to mature as young as three years old through pre-adolescence. Studies looking at gait biomechanics suggest that gait matures around three years old, while studies investigating gait variability propose a much later maturation. The studies that have examined children's gait variability did so while the children walked around a track or down hallways that created a discontinuous gait, potentially affecting the measures of variability and the efficacy of the results. Purpose: Therefore, the purpose of our study was to investigate the development of gait dynamics and gait variability in children in a more continuous fashion, in this case, by walking on a treadmill. Methods: To accomplish this, we included four age groups of children, ranging 2–10 years old, walking on a treadmill for at least three minutes while stride time and stride length were collected. Stride time and stride length's variability was then analyzed using linear (mean, standard deviation, coefficient of variation) and nonlinear (sample entropy, detrended fluctuation analysis) measures across the varying ages of our participants. Results: Interestingly, both the linear and nonlinear variabilities of the stride time and stride length measures decreased as the groups of children got older. Specifically, CV ST (2–3 (9.3 ± 4%), 8–10 (3.6 ± 0.7%), p < 0.05) and CV SL (2–3 (11.4 ± 3%), 8–10 (4.6 ± 1%), p < 0.05) were our strongest linear measures, and DFA α ST (2–3 (0.97 ± 0.12), 8–10 (0.82 ± 0.10), p < 0.05) and DFA α SL (2–3 (0.91 ± 0.04), 8–10 (0.81 ± 0.03), p < 0.05) were our strongest nonlinear measures, particularly between the youngest and oldest groups. This trend of variability decreasing with age suggests that as children's gait matures, their gait becomes more stable and reliable. Significance: Our study rejects the notion that children's gait is mature by the age of three, as some would suggest. By analyzing the variability of stride time and stride length, we can see that even later into childhood, children's gait continues to change and evolve. [ABSTRACT FROM AUTHOR]

This article, published in the journal Neuropediatrics, discusses a study on the use of pulsatile corticoid therapy (PCT) in children with genetic drug-resistant epilepsy. The study aimed to compare the epileptic burden in children before and after PCT treatment using objective and subjective approaches. The results showed that PCT led to a significant reduction in spike burden in the electroencephalogram (EEG) and improved sleep physiology, specifically an increase in fast spindle rates. Additionally, seizure frequency improved in the majority of patients, and no severe adverse effects were reported. The study suggests that PCT may be an effective treatment option for children with genetic drug-resistant epilepsy, leading to a reduction in epileptic burden and improvement in cognitive functioning. [Extracted from the article]

Shyness can manifest on behavioral, affective, and physiological levels, but little is known about how these components cluster. We coded behavioral expressions of avoidance/inhibition, collected self‐reported nervousness, and measured cardiac vagal withdrawal in 152 children (Mage = 7.82 years, 73 girls, 82% White) to a speech task in 2018–2021. A latent profile analysis using these behavioral, affective, and physiological indicators revealed four profiles: average reactive (43%), lower affective reactive (20%), higher affective reactive (26%), and consistently higher reactive (11%). Membership in the higher reactive profile predicted higher parent‐reported temperamental shyness across 2 years. Findings provide empirical support for the long‐theorized idea that shyness might exist as an emotional state but also represents a distinct temperamental quality for some children. [ABSTRACT FROM AUTHOR]

The postnatal mammalian heart undergoes remarkable developmental changes, which are stimulated by the transition from the intrauterine to extrauterine environment. With birth, increased oxygen levels promote metabolic, structural and biophysical maturation of cardiomyocytes, resulting in mature muscle with increased efficiency, contractility and electrical conduction. In this Topical Review article, we highlight key studies that inform our current understanding of human cardiomyocyte maturation. Collectively, these studies suggest that human atrial and ventricular myocytes evolve quickly within the first year but might not reach a fully mature adult phenotype until nearly the first decade of life. However, it is important to note that fetal, neonatal and paediatric cardiac physiology studies are hindered by a number of limitations, including the scarcity of human tissue, small sample size and a heavy reliance on diseased tissue samples, often without age‐matched healthy controls. Future developmental studies are warranted to expand our understanding of normal cardiac physiology/pathophysiology and inform age‐appropriate treatment strategies for cardiac disease. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Hyponatremia is common among children undergoing treatment for hematologic malignancies and may be attributed to multiple underlying causes. In cases of hyponatremia due to mixed physiology, the osmolal gap, can identify pseudohyponatremia that may be masked by other causes. [ABSTRACT FROM AUTHOR]

Chronic liver disease incidence is increasing among children worldwide due to a multitude of epidemiological changes. Most of these chronic insults to the pediatric liver progress to fibrosis and cirrhosis to different degrees. Liver and immune physiology differs significantly in children from adults. Because most of pediatric liver diseases have no definitive therapy, a better understanding of population and disease-specific fibrogenesis is mandatory. Furthermore, fibrosis development has prognostic significance and often guide treatment. Evaluation of liver fibrosis continues to rely on the gold-standard liver biopsy. However, many high-quality studies put forward the high diagnostic accuracy of numerous diagnostic modalities in this setting. Herein, we summarize and discuss the recent literature on fibrogenesis with an emphasis on pediatric physiology along with a detailed outline of disease-specific signatures, noninvasive diagnostic modalities, and the potential for antifibrotic therapies. [ABSTRACT FROM AUTHOR]

An undescended testis is the most common genitourinary disease in boys. The German guidelines, first published in 2009, proposed the timing of orchidopexy to be before 12 months of age. The aim of the study was to analyze the implementation of these guidelines 10 years after publication. The national cumulative statistics of hospital admissions, provided by the Institute for the Remuneration System in Hospitals (InEK), and the statistics concerning procedures performed in private pediatric surgical practices of the professional association of pediatric surgeons (BNKD) regarding the time of surgeries for the year 2019 were analyzed. Data from InEK included all German hospital admissions. Data from BNKD included data from 48 private pediatric surgical practices. The hospitals treated 6476 inpatients with undescended testis, and 3255 patients were operated in private practices. Regarding the age at treatment, 15% of the hospital patients and 5% of the private practice patients were younger than 1 year and fulfilled the guideline recommendations. Forty percent of the hospital patients and 29% of the private practice patients were 1 or 2 years of age. All other patients were 3 years of age or older at the time of orchidopexy. Conclusions: The rate of orchidopexy within the first 12 months of life is remarkably low even 10 years after the publication of the guidelines. Awareness of the existing guideline must be increased for both referring pediatric and general practitioners. What is Known: • In Germany, orchidopexy is performed by pediatric surgeons and urologists either in hospital settings or in private practices. • Most international guidelines set the age for surgical treatment of undescended testis between 12 and 18 months of age. The German guidelines, published in 2009, sets the time-limit at one year of age. Until five years after publication of the German guidelines, the number of patients treated before the first year of life was low; studies show an orchidopexy ratebetween 8% and 19% during this time. What is New: • This study the first to cover all administered hospital patients in Germany and a large group of patients treated in private practices. It contains the largest group of German patients with undescended testis. • Although almost all children participate in the routine check-up at the age of seven months, which includes investigation for undescended testis, adherence to the orchidopexy guidelines is still low. Only 15% of the hospital patients and 5% of the patients in private practice were treated before their first birthdays. [ABSTRACT FROM AUTHOR]

Over the past 2 decades, fundamentals of exercise medicine, including clinical exercise testing, assessment and promotion of physical activity, exercise prescription, and supervised exercise training/rehabilitation programming have demonstrated considerable clinical value in the management of children and adolescents with congenital and acquired heart disease. Although the principles of exercise medicine have become an integral component in pediatric cardiology, there are no standardized training recommendations for exercise physiology during pediatric cardiology fellowship at this time. Thus, the Pediatric Cardiology Exercise Medicine Curriculum Committee (PCEMCC) was formed to establish core and advanced exercise physiology training recommendations for pediatric cardiology trainees. The PCEMCC includes a diverse group of pediatric cardiologists, exercise physiologists, and fellowship program directors. The expert consensus training recommendations are by no means a mandate and are summarized herein, including suggestions for achieving the minimum knowledge and training needed for general pediatric cardiology practice. [ABSTRACT FROM AUTHOR]

Physiologically based pharmacokinetic (PBPK) modeling can be an attractive tool to increase the evidence base of pediatric drug dosing recommendations by making optimal use of existing pharmacokinetic (PK) data. A pragmatic approach of combining available compound models with a virtual pediatric physiology model can be a rational solution to predict PK and hence support dosing guidelines for children in real-life clinical care, when it can also be employed by individuals with little experience in PBPK modeling. This comes within reach as user-friendly PBPK modeling platforms exist and, for many drugs and populations, models are ready for use. We have identified a list of drugs that can serve as a starting point for pragmatic PBPK modeling to address current clinical dosing needs. [ABSTRACT FROM AUTHOR]

Aim: Triage is key to effective management of major incidents, yet there is scarce evidence surrounding the optimal method of paediatric major incident triage (MIT). This study aimed to derive consensus on key components of paediatric MIT among healthcare professionals responsible for triage during paediatric major incidents. Methods: Two‐round online Delphi consensus study delivered July 2021–October 2021, including participants from pre‐hospital and hospital specialities responsible for triage during paediatric major incidents. A 5‐point Likert scale was used to determine consensus, set a priori at 70%. Results: 111 clinicians completed both rounds; 13 of 17 statements reached consensus. Positive consensus was reached on rescue breaths in mechanisms associated with hypoxia or asphyxiation, mobility assessment as a crude discriminator and use of adult physiology for older children. Whilst positive consensus was reached on the benefits of a single MIT tool across all adult and paediatric age ranges, there was negative consensus in relation to clinical implementation. Conclusions: This Delphi study has established consensus among a large group of clinicians involved in the management of major incidents on several key elements of paediatric major incident triage. Further work is required to develop a triage tool that can be implemented based on emerging and ongoing research and which is acceptable to clinicians. [ABSTRACT FROM AUTHOR]

Background and Objective: More than half of all drugs are still prescribed off-label to children. Pharmacokinetic (PK) data are needed to support off-label dosing, however for many drugs such data are either sparse or not representative. Physiologically-based pharmacokinetic (PBPK) models are increasingly used to study PK and guide dosing decisions. Building compound models to study PK requires expertise and is time-consuming. Therefore, in this paper, we studied the feasibility of predicting pediatric exposure by pragmatically combining existing compound models, developed e.g. for studies in adults, with a pediatric and preterm physiology model. Methods: Seven drugs, with various PK characteristics, were selected (meropenem, ceftazidime, azithromycin, propofol, midazolam, lorazepam, and caffeine) as a proof of concept. Simcyp® v20 was used to predict exposure in adults, children, and (pre)term neonates, by combining an existing compound model with relevant virtual physiology models. Predictive performance was evaluated by calculating the ratios of predicted-to-observed PK parameter values (0.5- to 2-fold acceptance range) and by visual predictive checks with prediction error values. Results: Overall, model predicted PK in infants, children and adolescents capture clinical data. Confidence in PBPK model performance was therefore considered high. Predictive performance tends to decrease when predicting PK in the (pre)term neonatal population. Conclusion: Pragmatic PBPK modeling in pediatrics, based on compound models verified with adult data, is feasible. A thorough understanding of the model assumptions and limitations is required, before model-informed doses can be recommended for clinical use. [ABSTRACT FROM AUTHOR]

From the perspective of the design of parent-child interaction landscapes, this paper took Wuhan Overseas Chinese Town (OCT) Park for example, explored children's physiology, psychology and emotions as well as external factors, translated them into building landscape spaces, children's emotion spaces, children's exploration spaces, children's social spaces, so as to facilitate parent-child interactions in these spaces, thereby to enhance the family-care education and parent-child emotional exchanges, and provide references for the construction of parent-child interaction spaces. [ABSTRACT FROM AUTHOR]

Brain tumours are among the most common neoplasm in children. Therefore, paediatric anaesthesiologists face the challenge of neurosurgical interventions in all age groups. To minimize perioperative mortality and morbidity, a comprehensive understanding of age-dependent differences in anatomy and cerebrovascular physiology is a mandatory prerequisite. Advances in subspeciality training in paediatric neurosurgery and paediatric anaesthesia may improve clinical outcomes and advance communication between the teams. [ABSTRACT FROM AUTHOR]

Furniture is one of the most enduring items that children grow up with. However, there is a big gap between children's rapidly growing physical and mental needs and existing children's furniture. It is necessary to design children's furniture that is both interesting and multifunctional from the perspective of children's physiology and psychology. In the context of artificial intelligence, this paper applies the artificial intelligence design concept to the design of children's furniture and discusses the necessity and design principles of its application in the design of children's furniture from the aspects of society, children, and development trends. [ABSTRACT FROM AUTHOR]

The use of quantitative MRI methods for assessment of the abdomen in children has become commonplace over the past decade. Increasingly employed methods include MR elastography, chemical shift encoded (CSE) MR imaging for determination of proton density fat fraction, diffusion-weighted imaging, and a variety of relaxometry techniques, such as T1 and T2* mapping. These techniques can be used in a variety of settings to distinguish normal from abnormal tissue as well as determine the severity of disease. The performance of quantitative MRI methods in the pediatric population presents unique challenges as compared to adult populations. These challenges relate to multiple factors, including patient size, pediatric physiology, inability to breath hold, and greater physical motion during the examination. The purpose of this review article is to review quantitative MRI methods that may be used in clinical practice to assess the pediatric abdomen and to discuss special considerations when performing these techniques in children. [ABSTRACT FROM AUTHOR]

Early caregiving experiences set the stage for children's developmental trajectories. Children who experience early adversity are more likely to show difficulties regulating their behaviors, emotions, and physiology than children who do not experience adversity. Parenting interventions designed to enhance parental sensitivity and responsiveness can buffer children from the detrimental effects of early adverse experiences and ultimately enhance child outcomes. One such intervention is Attachment and Biobehavioral Catch-up (ABC), an evidence-based home visiting program developed to enhance parental sensitivity and responsive care. In this paper, we review the intervention objectives and effectiveness of ABC. We then describe efforts made to supervise the fidelity and dissemination of ABC, including its implementation in diverse cultural contexts and with Spanish-speaking families in the United States. Lastly, we discuss the potential of ABC as a novel intervention to be implemented within the child welfare system in Spain and Latin America. [ABSTRACT FROM AUTHOR]

Heart-lung transplantation has historically been used as a definitive treatment for children with end-stage cardiopulmonary failure, although the number performed has steadily decreased over time. In this review, we discuss current indications, preoperative risk factors, outcomes, and heart-lung transplantation in unique patient subsets, including infants, children with single-ventricle physiology, tetralogy of Fallot/major aortopulmonary collateral arteries, and prior Potts shunt palliation. We also describe the different surgical techniques utilized in pediatric heart-lung transplantation. [ABSTRACT FROM AUTHOR]

Exercise testing among the pediatric congenital heart disease population continues to transform and expand the way patients are evaluated and managed. We describe a case where a stress echocardiogram was performed while successfully collecting data from a previously implanted CardioMEMS™ HF system which helped guide decision-making. [ABSTRACT FROM AUTHOR]

Climate change‐related disasters have drawn increased attention to the impact of air pollution on health. 122 children ages 9–11 years old, M(SD) = 9.91(.56), participated. Levels of particulate matter (PM2.5) near participants' homes were obtained from the Environmental Protection Agency. Cytokines were assayed from 100 child serum samples: IL‐6, IL‐8, IL‐10, and TNFα. Autonomic physiology was indexed by pre‐ejection period (PEP), respiratory sinus arrhythmia (RSA), cardiac autonomic regulation (CAR), and cardiac autonomic balance (CAB). IL‐6 was positively related to daily PM2.5 (r =.26, p =.009). IL‐8 was negatively associated with monthly PM2.5 (r = −.23, p =.02). PEP was positively related to daily (r =.29, p =.001) and monthly PM2.5 (r =.18, p =.044). CAR was negatively associated with daily PM2.5 (r = −.29, p =.001). IL‐10, TNFα, RSA, and CAB were not associated with PM2.5. Air pollution may increase risk of inflammation in children. [ABSTRACT FROM AUTHOR]

Various developmental aspects of respiratory physiology put infants and young children at an increased risk of respiratory failure, which is associated with a higher rate of critical incidents during anesthesia. The immaturity of control of breathing in infants is reflected by prolonged central apneas and periodic breathing, and an increased risk of apneas after anesthesia. The physiology of the pediatric upper and lower airways is characterized by a higher flow resistance and airway collapsibility. The increased chest wall compliance and reduced gas exchange surface of the lungs reduce the pulmonary oxygen reserve vis‐à‐vis a higher metabolic oxygen demand, which causes more rapid oxygen desaturation when ventilation is compromised. This review describes the various developmental aspects of respiratory physiology and summarizes anesthetic implications. [ABSTRACT FROM AUTHOR]

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Background: To be successful, students must learn to deal with socially and cognitively demanding tasks. Much remains unknown about the effects of previous classroom experiences and of students' emotional appraisal of a task on their physiological adaptive responses to it. Aims: To investigate how children's physiological response to a social and cognitive task would be directly and interactively influenced by the perceived student–teacher relationship and by children's emotional appraisal of what reaction they expect to have while completing the task. Methods: One hundred and sixteen second and third graders took part in the study. Children completed a cognitive and social stress task. Before the task, they were interviewed on their emotional appraisal of the task and on student–teacher relationships. Children's cardiac activity was registered at rest and during the task to measure physiological activation (heart rate) and self‐regulation (heart rate variability). Results: Heart rate variability during the task was positively correlated with the appraised emotional valence of the task and of being observed while doing it. Regression analyses showed that children's physiological self‐regulation during the task was affected by the interaction between student–teacher relationships and appraised emotional valence of being observed. Only among children who had experienced negative student–teacher relationships, an active physiological self‐regulation was observed in response to the task when they expected it to be positive compared to when they perceived it as negative. Conclusions: Children's emotional appraisal of tasks and the quality of student–teacher relationships are important to promote a functional physiological response of self‐regulation that underlies academic functioning and well‐being at school. [ABSTRACT FROM AUTHOR]

Despite the growing importance of oxygen-delivery devices worldwide, there are only a few reports of physiological data on various oxygen masks in children. The possibility of carbon dioxide (CO2) rebreathing has been a prevalent concern with the use of oxygen-delivery devices. OxyMask KidTM (Southmedic Inc. Canada; hereafter OxyMask) is expected to reduce CO2 rebreathing even at low oxygen flow rates because of its structural features. Biological data using OxyMask in children have not been well investigated. Measured respiratory parameters of OxyMask with those of a simple oxygen mask in healthy children were compared. Ten subjects were enrolled, with a median age of 5.4 years. All subjects used both OxyMask and a simple oxygen mask. The fraction of inspiratory oxygen (FIO2), partial pressure of inspiratory CO2 (PICO2), and partial pressure of end-tidal CO2 were measured using a sidestream gas-sampling monitor in all subjects. The oxygen flow rate was set at 1, 3, 5, and 10 L/min. FIO2 levels were higher with OxyMask than those with the simple oxygen mask at 3 L/min of oxygen. PICO2 levels were significantly lower with OxyMask than those with the simple oxygen mask (1.5 mmHg vs. 3.7 mmHg at 1 L/min, P = 0.005; 1.0 mmHg vs. 2.7 mmHg at 3 L/min, P = 0.005, respectively), whereas PICO2 levels were higher at low oxygen flow rates with both masks. Conclusion: Our results showed that higher FIO2 and less CO2 rebreathing were achieved with OxyMask than those with a simple oxygen mask at low flow rates of oxygen in healthy children. What is Known: • OxyMask is expected to reduce carbon dioxide rebreathing even at low oxygen flow rates because of its structural features. • Efficacy has been demonstrated in experimental models and adult data, but clinical data on the use of the OxyMask in children are limited. What is New: • Higher fraction of inspiratory oxygen and lesser carbon dioxide rebreathing were achieved with OxyMask than with a simple oxygen mask at low flow rates of oxygen in healthy children [ABSTRACT FROM AUTHOR]

Background: Interventions to increase children's physical activity (PA) have achieved limited success. This may be attributed to inaccurate parental perceptions of their children's PA and a lack of recognition of a need to change activity levels. Methods: Fifty-three parents participated in semistructured interviews to determine perceptions of child PA. Perceptions were compared with children's measured MVPA (classified as meeting or not meeting UK guidelines) to produce 3 categories: "accurate," "over-estimate," and "under-estimate." Deductive content analysis was performed to understand the accuracy of parental perceptions. Results: All parents of children meeting the PA guidelines accurately perceived their child's PA; while the majority of parents whose child did not meet the guidelines overestimated their PA. Most parents were unconcerned about their child's PA level, viewing them as naturally active and willing to be active. Qualitative explanations for perceptions of insufficient activity included children having health problems and preferences for inactive pursuits, and parents having difficulty facilitating PA in poor weather and not always observing their child's PA level. Social comparisons also influenced parental perceptions. Conclusions: Strategies to improve parental awareness of child PA are needed. Perceptions of child PA may be informed by child "busyness," being unaware of activity levels, and social comparisons. [ABSTRACT FROM AUTHOR]

Hyperthermia in children is a known risk within enclosed vehicles. Exposure to an overheated hot tub poses a real risk in children due to unique pediatric physiology. Medical and aquatic professionals should understand the risk and mitigation strategies. [ABSTRACT FROM AUTHOR]

Skeletal muscle contractile proteins require a constant supply of energy to produce force needed for movement. Energy (ATP) is primarily produced by mitochondrial organelles, located within and around muscle fibers, by oxidative phosphorylation that couples electron flux through the electron transport chain to create a proton gradient across the inner mitochondrial membrane that is in turn used by the ATP synthase. Mitochondrial networks increase in size by biogenesis to increase mitochondrial abundance and activity in response to endurance exercise, while their function and content reduce with constant inactivity, such as during muscle atrophy. During healthy aging, there is an overall decline in mitochondrial activity and abundance, increase in mitochondrial DNA mutations, potential increase in oxidative stress, and reduction in overall muscular capacity. Many of these alterations can be attenuated by consistent endurance exercise. Children with cerebral palsy (CP) have significantly increased energetics of movement, reduced endurance capacity, and increased perceived effort. Recent work in leg muscles in ambulatory children with CP show a marked reduction in mitochondrial function. Arm muscles show that mitochondrial protein content and mitochondria DNA copy number are lower, suggesting a reduction in mitochondrial abundance, along with a reduction in markers for mitochondrial biogenesis. Gene expression networks are reduced for glycolytic and mitochondrial pathways and share similarities with gene networks with aging and chronic inactivity. Given the importance of mitochondria for energy production and changes with aging, future work needs to assess changes in mitochondria across the lifespan in people with CP and the effect of exercise on promoting metabolic health. [ABSTRACT FROM AUTHOR]

Brain tumours are among the most common neoplasm in children. Therefore, paediatric anaesthesiologists face the challenge of neurosurgical interventions in all age groups. To minimize perioperative mortality and morbidity, a comprehensive understanding of age-dependent differences in anatomy and cerebrovascular physiology is a mandatory prerequisite. Advances in subspeciality training in paediatric neurosurgery and paediatric anaesthesia may improve clinical outcomes and advance communication between the teams.

Purpose: To compare young children's different intensity physical activity (PA) levels in physical education, recess and exergaming programs. Methods: Participants were 140 first and second grade children (73 girls; Meanage=7.88 years). Beyond the daily 20-minute recess, participants attended 75-minute weekly physical education classes and another 75-minute weekly exergaming classes. Children's PA levels were assessed by ActiGraph GTX3 accelerometers for 3 sessions in the 3 programs. The outcome variables were percentages of time spent in sedentary, light PA and moderate-to-vigorous PA (MVPA). Results: There were significant main effects for program and grade, and an interaction effect for program by grade. Specifically, children's MVPA in exergaming and recess was higher than in physical education. The 2nd-grade children demonstrated lower sedentary behavior and MVPA than the first-grade children during recess; less light PA in both recess and exergaming than first-grade children; and less sedentary behavior but higher MVPA in exergaming than first-grade children. Conclusions: Young children generated higher PA levels in recess and exergaming as compared with physical education. Hence, other school-based PA programs may serve as essential components of a comprehensive school PA program. Implications are provided for educators and health professionals. [ABSTRACT FROM AUTHOR]

Background: Sleep disturbances in autism spectrum disorder (ASD) represent a common and vexing comorbidity. Clinical heterogeneity amongst these warrants studies of the mechanisms associated with specific genetic etiologies. Duplications of 15q11.2-13.1 (Dup15q syndrome) are highly penetrant for neurodevelopmental disorders (NDDs) such as intellectual disability and ASD, as well as sleep disturbances. Genes in the 15q region, particularly UBE3A and a cluster of GABAA receptor genes, are critical for neural development, synaptic protein synthesis and degradation, and inhibitory neurotransmission. During awake electroencephalography (EEG), children with Dup15q syndrome demonstrate increased beta band oscillations (12–30 Hz) that likely reflect aberrant GABAergic neurotransmission. Healthy sleep rhythms, necessary for robust cognitive development, are also highly dependent on GABAergic neurotransmission. We therefore hypothesized that sleep physiology would be abnormal in children with Dup15q syndrome. Methods: To test the hypothesis that elevated beta oscillations persist in sleep in Dup15q syndrome and that NREM sleep rhythms would be disrupted, we computed: (1) beta power, (2) spindle density, and (3) percentage of slow-wave sleep (SWS) in overnight sleep EEG recordings from a cohort of children with Dup15q syndrome (n = 15) and compared them to age-matched neurotypical children (n = 12). Results: Children with Dup15q syndrome showed abnormal sleep physiology with elevated beta power, reduced spindle density, and reduced or absent SWS compared to age-matched neurotypical controls. Limitations: This study relied on clinical EEG where sleep staging was not available. However, considering that clinical polysomnograms are challenging to collect in this population, the ability to quantify these biomarkers on clinical EEG—routinely ordered for epilepsy monitoring—opens the door for larger-scale studies. While comparable to other human studies in rare genetic disorders, a larger sample would allow for examination of the role of seizure severity, medications, and developmental age that may impact sleep physiology. Conclusions: We have identified three quantitative EEG biomarkers of sleep disruption in Dup15q syndrome, a genetic condition highly penetrant for ASD. Insights from this study not only promote a greater mechanistic understanding of the pathophysiology defining Dup15q syndrome, but also lay the foundation for studies that investigate the association between sleep and cognition. Abnormal sleep physiology may undermine healthy cognitive development and may serve as a quantifiable and modifiable target for behavioral and pharmacological interventions. [ABSTRACT FROM AUTHOR]

The interest for young people's movement ability has increased. Literature shows that many factors, apart from movement ability, influence the development of and sustained interest in or taste for physical activity and the learning thereof. This longitudinal study illustrates, through the lens of Bourdieu, whether and how assessed movement ability at the age of 15, together with cultural capital and sports habitus, is reflected in exercise habits and a taste for participation in sport and physical activity as a young adult. A multidisciplinary project called School-Sport-Health (Skola-idrott-hälsa) was established in 2001 in Sweden to investigate the physical and health status of children and youth, as well as attitudes to and participating in school physical education. Schools were randomly selected by the agency Statistics Sweden. In total, 1,975 pupils aged 9, 12 and 15 answered a life style questionnaire, and took part in at least one sub study of the baseline study in 2001. Movement ability was examined using the NyTid test. 560 pupils (283 girls, 277 boys) aged 15 (born in 1985, ±1) completed the test. In the follow-up study, lifestyle questionnaires, were answered nine years apart by the pupils who had participated in the NyTid test at the age of 15. The response rate was 61 per cent (341 young adults: 186 females, 155 males). Group and gender differences between those who had a high level of assessed movement ability (HLG) and those with a low level (LLG) were analysed. Data were analysed through Bourdieu's analytical concepts habitus and capital. The assumption that an acquired high level of movement ability plays a central role in being physically active later in life is both confirmed and challenged by the results. The HLG view themselves as more physically active and with a higher intensity (71 per cent) than the LLG (44 per cent). A low level of assessed movement ability at the age of 15 did not prevent young adults from acquiring a taste for sport and physical activity later in life. Habitus is a generative principle and can, according to the logic of practice, give action meaning, which may go against earlier habitus and trigger actions. Earlier described gender differences appear to be less evident in young adults. Further research is needed to understand how pupils' movement narratives are constructed to support young people's taste for movement and development of movement competence. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to analyze the physical activity level, using two tools, and the functional capacity of children and adolescents with asthma and with different levels of disease control, and to compare them to those of individuals without asthma. Methods: Cross-sectional study with children and adolescents with (asthma group, AG) and without asthma (WAG), aged from 7 to 17 years. All participants performed the six-minute walk test (6MWT), the Glittre Activities of Daily Living test (Glittre-ADL), the International Physical Activity Questionnaire (IPAQ), and daily record of steps on a pedometer. Results: The study included 145 individuals with asthma and 173 individuals without asthma. The WAG walked a greater distance in the 6MWT and performed the Glittre-ADL in less time than the AG. Individuals with uncontrolled, partially controlled, and controlled asthma presented the same functional capacity. A difference was observed in the IPAQ classification, with 13.9% of participants from the WAG being sedentary, compared with 26.2% in the AG. The mean quantity of steps measured by the pedometer was higher in the WAG. Conclusion: There was a difference in the performance of individuals with and without asthma in the physical activity and functional capacity tests. The AG presented worse performance in the physical activity tests and, regardless of the level of asthma control, presented worse functional capacity. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate the effect of the stage of dental development on the treatment outcome of maxillary protraction in skeletal Class III children. Materials and methods: The Medline, Web of Science, Embase, Cochrane Library, CMB and CNKI database were searched to identify all of the relevant articles published prior to 30 August 2019. The grey literature was also searched. Human controlled clinical trials in which patients with a skeletal Class III malocclusion were treated by maxillary protraction (facemask with or without rapid maxillary expansion) were considered. The quality of the included studies was assessed using ROBINS-I. Metaanalysis was performed using RevMan 5.3. Results: A total of 19 trials were included in the systematic review and 16 trials were included in the meta-analysis, of which three studies were assessed as low risk of bias (high quality), eight were assessed as having a moderate risk of bias, and five were assessed as a high risk of bias. The treatment effect of maxillary protraction in skeletal Class III children was greater in the primary dentition than that in the early mixed dentition with respect to an increase in SNA, ANB and SN/GoGn. The treatment effect was greater in the early mixed dentition than in the late mixed dentition, with an evident decrease in SNB. The treatment effect was greater in the early mixed dentition than that which occurred in the early permanent dentition, with an increase in SNA and ANB. The treatment effect was not significantly different, either between the primary dentition and late mixed dentition, or between the late mixed dentition and early permanent dentition. No study compared the treatment effect between the primary dentition and early permanent dentition. Conclusion: The dental developmental stage affects the treatment effect of maxillary protraction in skeletal Class III children. The treatment effect at an early dentition stage may be more effective than that at a late dentition stage in improving a skeletal Class III relationship. Although the variations in effectiveness between the various dental stage groups were generally statistically significant, most variations were small, with unclear clinical significance. [ABSTRACT FROM AUTHOR]

Background: School-based physical activity programs can reach large populations of at-risk children however evidence for the sustainability of healthy behaviors as a result of these programs is mixed. Healthy Schools Healthy Families (HSHF) is a physical activity and nutrition program for elementary students in a predominantly minority community. The program includes short teacher led classroom-based physical activities, also known as Transition Exercises (TE). Our aim was to assess whether TE was associated with children's reported recreational physical activity outside of school. Methods: We surveyed HSHF students in grade 5 (n = 383) about their recreational physical activity at the start and end of the school year. Multivariable analysis was used to determine what factors including TE contributed to their reported activity. Results: Students were predominantly Hispanic with a mean age of 10 ± .03. There was an increase in reported recreational physical activity from the start to the end of the school year (73.6% to 82.4%, P < .05). Students who participated in more TE had a 2.75 times greater odds of reporting participation in recreational activity than students who participated in less TE. Conclusions: For students in HSHF, TE was significantly associated with an increase in recreational physical activity. [ABSTRACT FROM AUTHOR]

In many dynamic interceptive actions performers need to integrate activity of manual and postural subsystems for successful performance. Groups of different skill level (poor and good catchers), (mean age = 9.1 and 9.4 respectively) were required to perform one-handed catches under different postural constraints: standing; standing in contact with a postural support aid by their side (PSAS) or to the left of their trunk (PSAF); Tandem; and sitting (control). Results revealed that, for poor catchers, the number of successful catches increased and grasp errors decreased significantly when sitting and with both postural aids in comparison with standing alone and Tandem conditions. Kinematic analyses showed that the postural aid devices reduced head sway in the anterior-posterior direction, while the PSAF reduced lateral head sway. The poor catchers' performance benefited from an enlarged support surface, and reduction of lateral sway. Good catchers performed successfully under all task constraints, signifying the existence of a functional relationship between postural and grasping subsystems during performance. The results are discussed in the frame of Bernstein's (1967) and Newell's (1986) theory. [ABSTRACT FROM AUTHOR]

This longitudinal study examined the movement efficiency of typically developing children between 7 and 9 years of age by scrutinizing their movement amplitudes and frequencies as they settled into a loop-writing task in which both parameters were prescribed. It was hypothesized that during the first three grades at primary school children would show increasing efficiency in exploiting the inverse relationship between movement amplitude and frequency when adjusting their movement errors. Whereas a clear developmental trend showed increasing efficiency with respect to the way in which the primary school children met the amplitude constraints, a more variable pattern was found for the age-dependent adjustments to the frequency requirements. At the level of parameter-error corrections from one cycle to the next, a marginal developmental trend was observed. Results are discussed in terms of contrasting effects between educational targets and movement-efficiency principles. [ABSTRACT FROM AUTHOR]

Extensive research has established a positive association between caregiver-child behavioral synchrony and child developmental functioning. Burgeoning research examining physiological synchrony has yet to elucidate its impact for children's developing self-regulation. The objectives of this systematic review were to: 1) determine whether there is evidence that caregiver-child physiological synchrony promotes positive child development, 2) examine developmental differences in physiological synchrony and its correlates, and 3) explore whether context, risk, and/or stress influence patterns of synchrony. Sixty-nine studies met the following criteria on PubMed and PsycINFO: 1) peer-reviewed empirical articles in English that 2) examine autonomic, hypothalamic-pituitary-adrenocortical, and/or central nervous system activity 3) for caregivers and children 4) in response to a task and 5) directly examine the association between caregiver and child physiology. Findings varied based on developmental period and current behavioral context. Functional differences may exist across physiological systems and contexts. Synchrony may have different developmental consequences for dyads with and without certain risk factors. Few studies examine physiological synchrony across multiple systems or contexts, nor do they measure child characteristics associated with synchrony. Statistical and methodological challenges impede interpretation. Findings generally support the idea that physiological synchrony may support children's developing self-regulation. Longitudinal research is needed to examine child developmental outcomes over time. [ABSTRACT FROM AUTHOR]

The paradigm that children maintain normal blood pressure during hemorrhagic shock until 30%–45% hemorrhage is widely accepted. There are minimal data supporting when decompensation occurs and how a child's vasculature compensates up to that point. We aimed to observe the arterial response to hemorrhage and when mean arterial pressure (MAP) decreased from baseline in pediatric swine. Piglets were hemorrhaged in 20% increments of their total blood volume to 60%. MAP and angiograms of the thoracic aorta (TA) and abdominal arteries were obtained. Percent change in area of the vessels from baseline was calculated. Piglets (n = 8) had a differential vasoconstriction starting at 20% hemorrhage (celiac artery 36.3% [31.4–44.6] vs TA 16.7% [10.7–19.1] p = 0.0012). At 40% hemorrhage, the differential vasoconstriction favored shunting blood away from the abdominal visceral branches to the TA (celiac artery 54.7% [36.9–60.6] vs TA 29.5% [23.9–36.2] p = 0.0056 superior mesenteric artery 46.7% [43.9–68.6] vs TA 29.5% [23.9–36.2] p = 0.0100). This was exacerbated at 60% hemorrhage. MAP decreased from baseline at 20% hemorrhage (66.4 ± 6.0 mmHg vs 41.4 ± 10.4 mmHg, p < 0.0001), and worsened at 40% and 60% hemorrhage. In piglets, a differential vasocontriction shunting blood proximally occurred in response to hemorrhage. This did not maintain normal MAP at 20%, 40% or 60% hemorrhage. Level II. [ABSTRACT FROM AUTHOR]

Background: Cortisol is the main stress hormone mobilised during surgery to establish homeostasis. Our current understanding of the hypothalamic-pituitary-adrenal axis physiology in children undergoing cardiopulmonary bypass is very limited due to: (1) very few cortisol time point measurements over long periods (2) difficulties of sampling in low weight babies and (3) the concomitant use of glucocorticoids at anaesthesia induction. This lack of understanding is reflected in a lack of consensus on the utility of glucocorticoids perioperatively in cardiac surgery with the use of cardiopulmonary bypass.Methods: The Peacock Study is a prospective, two-centre, observational cohort study of 78 children (undergoing cardiopulmonary bypass procedures and non-surgical procedures - split by age/cyanosis) that aims to characterise in detail the hypothalamic-pituitary-adrenal axis physiology of children using the stress model of paediatric cardiac surgery. Also, we aim to correlate cortisol profiles with clinical outcome data. We herein describe the main study design and report the full cortisol profile of one child undergoing heart surgery, thus proving the feasibility of the method.Results: We used an automated, 24-h tissue microdialysis system to measure cortisol and cortisone, every 20 min. We herein report one cortisol profile of a child undergoing heart surgery. Besides, we measured serum cortisol and adrenocorticotrophic hormone at seven-time points for correlation. Tissue concentrations of cortisol increased markedly several hours after the end of surgery. We also noted an increase in the tissue cortisol/cortisone ratio during this response.Conclusion: We report for the first time, the use of an automated microdialysis sampling system to evaluate the paediatric adrenal response in children. Changes in cortisol and cortisone could be measured, and the concentration of cortisol in the tissues increased after the end of cardiac surgery. The method has wide application to measure other hormones dynamically and frequently without the limitation of the circulating blood volume. The data from the main study will clarify how these cortisol profiles vary with age, pathology, type of procedure and correlation to clinical outcomes.Trial Registration: ISCRTN registry, number: 982586. [ABSTRACT FROM AUTHOR]

Risk aversive perceptions and practices among ECEC practitioners and parents have proven to be an important reason for the decline of young children's opportunities for free outdoor play. Yet, there are also cultural differences in the perception of children's risky play. This study aims at examining the factors that ECEC practitioners and parents experience as barriers for children's outdoor play, especially those associated with risk. ECEC practitioners and parents in five different European countries (Greece, Portugal, Estonia, Croatia and Norway) received questionnaires about their perception of children's outdoor play. The sample consists of 32 ECEC practitioners and 184 parents. Results show that parents and ECEC practitioners from Norway are less risk aversive to children's play than those from the southern European countries. Traffic is a barrier for outdoor play among parents from all countries (above 50%), and stranger danger is particularly noticed in parents from Greece (80.6%) and Portugal (62.9%), whereas in Norway this value is only 13.3%. The mean average age from which parents allow their children to play outside is quite different between the participating countries, ranging from 5.8 years in Norway to 11.8 years in Greece. In total, fear of children getting injured and adults' own concern/anxiety are only mentioned as barriers by 9.4% and 3.1% of ECEC practitioners, respectively. Lack of play spaces (74.3%) and poor play facilities (80%) are also considered obstacles to letting children play outside by Greek parents, whereas Portuguese ones emphasized media alerts (61.3%). Our results suggest a differentiated approach between countries to tackle the reported barriers to children's outdoor risky play. [ABSTRACT FROM AUTHOR]

This study sought to explore if the effect of 20% sucrose rinse (SR) on the salivary electrolytic concentration of calcium (Ca2+), phosphate (Pi) and fluoride (F−) in children with Early Childhood Caries (ECC) is different from healthy children. Here, fifty-eight preschoolers aged 3 to 5 years were divided into 2 groups: caries-free (CF) and with ECC. Changes in saliva flow rate, pH and buffering capacity (BC), as well as in concentrations of Ca2+, Pi, and F−, and the degree of saturation in relation to hydroxyapatite (DSS HAp) and fluorapatite (DSS FAp) were evaluated. The pre-rinse [Ca2+] was higher in the ECC group in the CF group. A significant increase in [Ca2+] was demonstrated after SR in the CF group (p = 0.05). The [Pi] was reduced by 18% after SR in the ECC group (p = 0.007). The [F-] reduced in both groups after SR (p < 0.000). There was a moderate positive correlation between [Ca2+] and the DSS HAp and DSS FAp. Multivariate analysis showed that children with a higher [Ca2+] in pre-rinse saliva are more likely to have ECC. In conclusion, the effect of a 20% sucrose rinse on the electrolytic concentration of Ca2+, Pi and F- was different when children with ECC were compared with CF children. [ABSTRACT FROM AUTHOR]

THE AGE OF INFANTS CAN BE CONSIDERED AS A PSYCHOLOGICAL THRESHOLD FOR THE PEDIATRIC DOCTOR AND FOR THE PARENTS. THE PHYSIOLOGICAL IMMATURITY OF THE DIGESTIVE SYSTEM CREATES A PARTICULAR PHYSIOLOGY OF THE RESPECTIVE PERIOD. THEREFORE, VERY EASY, CERTAIN CHANGES IN THE INTESTINAL TRANSIT COMPARED TO THE VERSION CONSIDERED "NORMAL" BY THE FAMILY. THE STUDY, CONDUCTED OVER A 6-MONTH PERIOD, SHOWS THAT BOTH UNDERESTIMATION AND OVER-APPRECIATION OF THOSE REPORTED BY THE PARENT COULD BE JUST AS HARMFUL, THE ONLY ONE CAPABLE OF PLACING THE CHILD IN A PATHOLOGY OR PHYSIOLOGY CHARACTERISTIC OF THE AGE BEING THE PEDIATRIC DOCTOR. [ABSTRACT FROM AUTHOR]

Children with single ventricle congenital heart defects (SVCHD) experience a significant risk of early mortality throughout their lifespan, particularly during their first year of life. Due to the intense care needed for these children and families, pediatric palliative care (PPC) team consults should be routine; however, medical staff are often reluctant to broach the idea of PPC to families. The involvement of PPC for many carries with it an association to end-of-life (EOL) care. Setting the standard of PPC involvement from the time of admission for the first palliative surgery led to increased family support, decreased days to consult, improved acceptance and communication. The purpose of this article is to describe a quality improvement project of early integration of PPC with families of children with SVCHD. Lessons learned will be presented, including the resources needed and the barriers encountered in assimilating PPC into the standard of care for all patients with SVCHD. The single ventricle (SV) and PPC teams collaborated to enhance the support given to SV families. Education was initiated with cardiology and PPC providers to understand the goal of consistent PPC consults beginning after birth for patients with SVCHD. Parents were educated during fetal consultation regarding the involvement of the PPC team. The SV team ensured compliance with the PPC initiative by identifying eligible patients and requesting consult orders from the primary providers. PPC consultation increased significantly over the 40 month study period to nearly 100% compliance for children with SVCHD who are undergoing pre-Fontan surgery. In addition, mean days to consult decreased dramatically during the study to a current average of 3 days into the patient's hospitalization; the data likely suggest that more PPC consults were routinely ordered versus urgently placed for unexpected complications. Data indicate that patients are being followed by the PPC team at an earlier age and stage in their SV journey which allows for more opportunity to provide meaningful support to these patients and families. The early involvement of the PPC team for children with SV physiology was operationally feasible and was accepted by families, thus allowing PPC providers to establish a therapeutic relationship early in the disease trajectory with the family. It allowed more continuity throughout the SV journey in a proactive fashion rather than a reactive manner. [ABSTRACT FROM AUTHOR]

Background: Objective measures, such as accelerometers, are increasingly being used to measure physical activity (PA) levels in children, and the use of validated and reliable instruments is desirable when measuring the effectiveness of programs. The purpose of this study was to determine the validity and reliability of the New Lifestyles NL-1000 accelerometer among preschoolers using a modified version of the Children's Activity Rating Scale (CARS). Methods: Fourteen preschoolers wore the NL-1000 at their waist while the device measured activity levels (in seconds of moderate-to-vigorous physical activity (MVPA)]. They were also videoed for approximately 12 minutes while participating in normal activities at an early childhood center. At approximately 2-minute intervals, activity level readings derived from the NL-1000 were recorded. The video footage was analyzed using a modified CARS technique and the CARS scores compared with data obtained from the accelerometer. Results: Within subject reliability was measured using intraclass correlation coefficients (0.58 for CARS and 0.59 for NL-1000). Furthermore, 95% of the variation in CARS could be explained by variation in the accelerometer counts, with 2.4% of the variation being participant-specific. Conclusion: The NL-1000 is a sufficiently reliable and valid tool for assessing MVPA in preschoolers. [ABSTRACT FROM AUTHOR]

Background: Levels of physical activity decline throughout childhood. Children's physical self-perceptions have been found to relate to their physical activity. Understanding the relationships among physical self-perceptions, obesity, and physical activity could have important implications for interventions in children. Methods: The current study investigated the moderating effect of cardiovascular fitness (CVF, heart rate recovery from a 3-minute step test) on the relationship between obesity (BMI, waist circumference) and physical self-perceptions (athletic competence, physical appearance) in 104 fourth- and fifth-grade children from a small rural community. Results: Hierarchical regression analyses indicated that CVF moderated the relations between BMI and waist circumference on athletic competence. For children with lower fitness, higher waist circumference was associated with lower athletic competence, while for children with higher fitness levels, higher BMI was associated with higher athletic competence. Results also indicated that both BMI and waist circumference were negatively related to physical appearance. CVF moderated these relations such that only children with lower fitness, greater BMI and waist circumference was associated with poorer physical appearance scores. Conclusions: Implications include the need for support of fitness programs to promote psychological well-being and to investigate the relationship between obesity and physical self-perceptions within the context of fitness. [ABSTRACT FROM AUTHOR]