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Children, Volume 5, Issue 8 (August 2018)

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Cover Story (view full-size image) Physical inactivity is a global problem, and many young Australians are insufficiently active. [...] Read more.
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Open AccessBrief Report Pediatric Integrative Medicine: Vision for the Future
Children 2018, 5(8), 111; https://doi.org/10.3390/children5080111
Received: 26 July 2018 / Revised: 16 August 2018 / Accepted: 16 August 2018 / Published: 20 August 2018
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Abstract
Pediatric integrative medicine (PIM) is of significant interest to patients, with 12% of the general pediatric population and up to 80% of children with chronic conditions using PIM approaches. The field of PIM has evolved over the past 25 years, approaching child health
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Pediatric integrative medicine (PIM) is of significant interest to patients, with 12% of the general pediatric population and up to 80% of children with chronic conditions using PIM approaches. The field of PIM has evolved over the past 25 years, approaching child health with a number of guiding principles: preventive, context-centered, relationship-based, personalized, participatory, and ecologically sustainable. This manuscript reviews important time points for the field of PIM and reports on a series of meetings of PIM leaders, aimed at assessing the state of the field and planning for its future. Efforts in the first decade of the 2000s led to increased visibility in academic and professional pediatric organizations and through international listservs, designed to link those interested in and practicing PIM, all of which continue to flourish. The PIM leadership summits in recent years resulted in specific goals to advance PIM further in the following key areas: research, clinical practice, professional education, patient and family education, and advocacy and partnerships. Additionally, goals were developed for greater expansion of PIM professional education, broader support for pediatric PIM research, and an expanded role for PIM approaches in the provision of pediatric care. Full article
(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)
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Open AccessArticle Fundamental Motor Skills of Children in Deprived Areas of England: A Focus on Age, Gender and Ethnicity
Children 2018, 5(8), 110; https://doi.org/10.3390/children5080110
Received: 15 June 2018 / Revised: 25 July 2018 / Accepted: 7 August 2018 / Published: 13 August 2018
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Abstract
This study compared the mastery of fundamental motor skills (FMS) of males and females in early-childhood (four to five years, n = 170) and in middle-childhood (nine to ten years, n = 109) who attend schools in deprived and ethnically diverse areas of
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This study compared the mastery of fundamental motor skills (FMS) of males and females in early-childhood (four to five years, n = 170) and in middle-childhood (nine to ten years, n = 109) who attend schools in deprived and ethnically diverse areas of England. Process FMS (object control and locomotor skills) were observed using the Test of Gross Motor Development-2. Sprint speed over 10 meters and jump distance assessments were conducted using light gates and tape measures. A gender (male vs. female) by year-group (early-childhood vs. middle-childhood) interaction was shown for the process and product-oriented FMS measurements. Middle-childhood males and females demonstrated significantly greater FMS mastery, as compared to early-childhood (p < 0.05). Furthermore, middle-childhood males demonstrated significantly greater mastery of total FMS, object control skills, and product-oriented assessments, in comparison to females (p < 0.05). Children of Black and White ethnic groups achieved significantly greater mastery of locomotor skills, compared to Asian children, though this did not differ by year-group (p < 0.05). The results suggest that FMS development in deprived and ethnically diverse areas in England varies between genders during middle-childhood and ethnicity. Thus, interventions addressing the lack of FMS mastery achievement, shown in middle-childhood girls and children from Asian ethnic backgrounds, may be pivotal. Further exploration of the role of ethnicity would provide greater clarity in approaching interventions to improve FMS. Full article
(This article belongs to the Special Issue 5th Anniversary Issue)
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Open AccessArticle Preliminary Efficacy and Feasibility of “Thinking While Moving in English”: A Program with Physical Activity Integrated into Primary School English Lessons
Children 2018, 5(8), 109; https://doi.org/10.3390/children5080109
Received: 25 July 2018 / Revised: 3 August 2018 / Accepted: 8 August 2018 / Published: 10 August 2018
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Abstract
Background: The physical, cognitive, and learning benefits of physical activity for children have already been established. However, many schools are failing to provide children with sufficient activity at school due to a crowded school curriculum. Physical activity interventions that integrate physical activity
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Background: The physical, cognitive, and learning benefits of physical activity for children have already been established. However, many schools are failing to provide children with sufficient activity at school due to a crowded school curriculum. Physical activity interventions that integrate physical activity with learning is a way to enhance physical and cognitive benefits without loss of academic time. This study evaluated the preliminary efficacy and feasibility of “Thinking While Moving in English”, a primary school program that integrates physical activity into English lessons. Method: Two classes of Grade 4 students (n = 55, 10–11 years old) were randomly assigned to the intervention (n = 29) or control (n = 26) conditions. The program components consisted of 3 × 40 min physically active academic lessons per week, delivered over a 4-week period. The following measures were taken at baseline and immediate post-intervention: on-task behavior, cognition (inhibition and working memory), and learning outcomes (spelling and grammar). Results: Results revealed significant improvements in on-task behavior and spelling in the intervention group, compared to the control group. There were no observed improvements in cognitive outcomes or grammar. Conclusions: This study provides preliminary evidence for the efficacy of physically active English lessons to enhance children’s educational outcomes. Full article
(This article belongs to the Special Issue Physical Activity and Sedentary Behaviour in Children and Adolescents)
Open AccessReview Integrating Pediatric Hypnosis with Complementary Modalities: Clinical Perspectives on Personalized Treatment
Children 2018, 5(8), 108; https://doi.org/10.3390/children5080108
Received: 15 June 2018 / Revised: 30 July 2018 / Accepted: 31 July 2018 / Published: 7 August 2018
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Abstract
While pediatric integrative medicine (PIM) emphasizes an “evidence-based practice using multiple therapeutic modalities”; paradoxically, literature reviews examining the prevalence and/or efficacy of such mind–body approaches often address PIM modalities separately. Such contributions are relevant, yet documentation of how to deliver combined complementary approaches
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While pediatric integrative medicine (PIM) emphasizes an “evidence-based practice using multiple therapeutic modalities”; paradoxically, literature reviews examining the prevalence and/or efficacy of such mind–body approaches often address PIM modalities separately. Such contributions are relevant, yet documentation of how to deliver combined complementary approaches in children and youth are scarce. Nevertheless, integrative practitioners in clinical practice routinely mix approaches to meet the individual needs of each patient. Best practices are flexible, and include blending and augmenting services within the same session, and/or connecting modalities sequentially for an incremental effect, and/or referring to outside resources for additional interventions. Resonating with integrative medicine’s definition, this article’s goal is to demonstrate paradigms that “bring together complementary approaches in a coordinated way within clinical practice” by linking clinical hypnosis, the trail-blazer modality in PIM’s history, with mindfulness, biofeedback, acupuncture, and yoga. Following the consideration of the overlap of guided imagery with hypnosis and an abridged literature report, this clinical perspective considers the selection of modalities within a collaborative relationship with the child/teen and parents, emphasizing goodness-of-fit with patients’ contexts, e.g., symptoms, resources, interests, goals, and developmental stage. Case vignettes illustrate practical strategies for mixing approaches. Full article
(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)
Open AccessReview Late Effects and Survivorship Issues in Patients with Neuroblastoma
Children 2018, 5(8), 107; https://doi.org/10.3390/children5080107
Received: 29 June 2018 / Revised: 27 July 2018 / Accepted: 1 August 2018 / Published: 6 August 2018
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Abstract
Over the past two decades, marked progress has been made in understanding the biology of neuroblastoma; this has led to refined risk stratification and treatment modifications with resultant increasing 5-year survival rates for children with neuroblastoma. Survivors, however, remain at risk for a
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Over the past two decades, marked progress has been made in understanding the biology of neuroblastoma; this has led to refined risk stratification and treatment modifications with resultant increasing 5-year survival rates for children with neuroblastoma. Survivors, however, remain at risk for a wide variety of potential treatment-related complications, or “late effects”, which may lead to excess morbidity and premature mortality in this cohort. This review summarizes the existing survivorship literature on long-term health outcomes for survivors of neuroblastoma, focusing specifically on potential injury to the endocrine, sensory, cardiovascular, pulmonary, and renal systems, as well as survivors’ treatment-related risk for subsequent neoplasms and impaired quality of life. Additional work is needed to assess the potential late effects of newer multimodality therapies with the aim of optimizing long-term medical and psychosocial outcomes for all survivors of neuroblastoma. Full article
(This article belongs to the Special Issue Recent Advances in Diagnosis and Treatment of Neuroblastoma)
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Open AccessArticle Correlates of the Timely Initiation of Complementary Feeding among Children Aged 6–23 Months in Rupandehi District, Nepal
Children 2018, 5(8), 106; https://doi.org/10.3390/children5080106
Received: 11 June 2018 / Revised: 1 August 2018 / Accepted: 2 August 2018 / Published: 6 August 2018
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Abstract
Although the predictors of the timely initiation of complementary feeding are well-known elsewhere, there is less awareness of the topic in Nepal. The current study was undertaken to identify the correlates of timely initiation of complementary feeding among children aged 6–23 months. A
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Although the predictors of the timely initiation of complementary feeding are well-known elsewhere, there is less awareness of the topic in Nepal. The current study was undertaken to identify the correlates of timely initiation of complementary feeding among children aged 6–23 months. A community-based cross-sectional study was conducted in the Rupandehi district, Nepal. A total of 155 mother-child pairs were selected using a simple random sampling technique. Logistic regression with adjustment for potential confounders was employed to examine the independent association between risk factors and the timely initiation of complementary feeding. Fewer than 3 in 5 children aged 6–23 months received complementary feeding at the recommended time. Literate mothers and a maternal occupation in the service or business sectors were found to be associated with complementary feeding at 6 months. In addition, child characteristics such as birth order, male children, and those fed micronutrients were also more likely to have been received complementary feeding at 6 months than their counterparts. Maternal education and occupation, and child characteristics such as, birth order, male gender, and micronutrient consumption, which are correlates of the timely initiation of complementary feeding, suggest that the Nepalese Infant and Young Child Feeding (IYCF) programme should target these predictors while designing preventive strategies. Full article
Open AccessArticle Comparison of Accelerometer-Based Cut-Points for Children’s Physical Activity: Counts vs. Steps
Children 2018, 5(8), 105; https://doi.org/10.3390/children5080105
Received: 28 June 2018 / Revised: 29 July 2018 / Accepted: 1 August 2018 / Published: 3 August 2018
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Abstract
Background: Accelerometers measure complex movements of children’s free play moderate-vigorous physical activity (MVPA), including step and non-step movements. Current accelerometer technology has introduced algorithms to measure steps, along with counts. Precise interpretation of accelerometer-based cadence (steps/min) cut-points is necessary for accurately measuring and
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Background: Accelerometers measure complex movements of children’s free play moderate-vigorous physical activity (MVPA), including step and non-step movements. Current accelerometer technology has introduced algorithms to measure steps, along with counts. Precise interpretation of accelerometer-based cadence (steps/min) cut-points is necessary for accurately measuring and tracking children’s MVPA. The purpose of this study was to assess the relationships and agreement between accelerometer-based cut-points (cadence and counts/min) to estimate children’s MVPA compared to measured values. Methods: Forty children (8–12 years; 25 boys) played 6–10 games while wearing a portable metabolic analyzer and GT3X+ to measure and estimate MVPA, respectively. Correlation, kappa, sensitivity, and specificity assessed the relationships and agreement between measured and estimated MVPA. Results: Games elicited, on average, 6.3 ± 1.6 METs, 64.5 ± 24.7 steps/min, and 3318 ± 1262 vertical (V) and 5350 ± 1547 vector-magnitude (VM) counts/min. The relationship between measured and estimated MVPA intensity was higher for cadence (r = 0.50) than V and VM counts/min (r = 0.38 for both). Agreement using V and VM counts/min for measuring PA intensity varied by cut-points (range: 6.8% (κ = −0.02) to 97.6% (κ = 0.49)), while agreement was low using cadence cut-points (range: 4.0% (κ = 0.0009) to 11.3% (κ = 0.001)). Conclusion: While measured and estimated values were well correlated, using cadence tended to misclassify children’s free-play MVPA. Full article
(This article belongs to the Special Issue Physical Activity and Sedentary Behaviour in Children and Adolescents)
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Open AccessArticle Regional Variations in Physical Fitness and Activity in Healthy and Overweight Ecuadorian Adolescents
Children 2018, 5(8), 104; https://doi.org/10.3390/children5080104
Received: 28 June 2018 / Revised: 31 July 2018 / Accepted: 31 July 2018 / Published: 2 August 2018
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Abstract
Background: Insufficient physical activity (PA) and excessive sedentary behavior (SB) are the main contributors to adolescent obesity. However, it is uncertain whether recent economic growth and urbanization in Ecuador are contributing to an obesogenic environment. This study assessed the relationships among fitness, PA,
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Background: Insufficient physical activity (PA) and excessive sedentary behavior (SB) are the main contributors to adolescent obesity. However, it is uncertain whether recent economic growth and urbanization in Ecuador are contributing to an obesogenic environment. This study assessed the relationships among fitness, PA, SB, and perceived social support for PA in adolescents from urban (Quito) and rural (Loja) Ecuador. Methods: Fitness was estimated using 3-min step test and PA and SB participation and social support for PA were self-reported in 407 adolescents. T-tests and analysis of variance assessed differences by sex, obesity status, and region of Ecuador. Pearson correlations assessed relationships among PA, SB, fitness, and social support. Results: Males and rural adolescents (48.3 ± 9.4 and 47.1 ± 9.6 mL/kg/min) were more fit than females and urban adolescents (41.1 ± 7.5 and 39.7 ± 6.1 mL/kg/min). Fitness was negatively correlated with obesity only in rural Ecuador. Few adolescents reported ≥60 min/day of PA (8.4%) or ≤2 h/day of SB (30.2%), with greater SB participation in rural Ecuador. Weak correlations were observed among fitness, PA, SB, and parental/peer support for PA (r = −0.18 to 0.19; p < 0.05). Conclusion: While fitness varied by sex, weight status, and region, SB participation and parent/peer support for PA, not PA participation itself, predicted fitness in rural Ecuadorean adolescents. Full article
(This article belongs to the Special Issue Physical Activity and Sedentary Behaviour in Children and Adolescents)
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Open AccessBrief Report Implementing Integrative Nursing in a Pediatric Setting
Children 2018, 5(8), 103; https://doi.org/10.3390/children5080103
Received: 29 June 2018 / Revised: 18 July 2018 / Accepted: 20 July 2018 / Published: 31 July 2018
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Abstract
Pediatric blood and marrow transplantation (BMT) is one of the most challenging allopathic treatments a patient and family can be faced with. A large Midwest academic health center, and leader in pediatric BMT, made the decision in 2013 to incorporate integrative nursing as
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Pediatric blood and marrow transplantation (BMT) is one of the most challenging allopathic treatments a patient and family can be faced with. A large Midwest academic health center, and leader in pediatric BMT, made the decision in 2013 to incorporate integrative nursing as the care delivery model. Nurses trained in advanced nursing practice and specialized in integrative health and healing performed a deep-dive needs assessment, national benchmarking, a comprehensive review of the literature, and ultimately designed a comprehensive integrative program for pediatric patients and their families undergoing BMT. Four years after implementation, this paper discusses lessons learned, strengths, challenges and next phases of the program, including a research agenda. The authors conclude that it is feasible, acceptable and sustainable to implement a nurse-led integrative program within an academic health center-based pediatric BMT program. Full article
(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)
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Open AccessArticle Applied Pediatric Integrative Medicine: What We Can Learn from the Ancient Teachings of Sebastian Kneipp in a Kindergarten Setting
Children 2018, 5(8), 102; https://doi.org/10.3390/children5080102
Received: 13 June 2018 / Revised: 13 July 2018 / Accepted: 24 July 2018 / Published: 26 July 2018
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Abstract
Pediatric integrative medicine focuses on the whole child and the environment in which the child grows up during the treatment of a child’s illness. Nowadays, many different treatment modalities are applied even in children, and doctors need to know about them and, ideally,
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Pediatric integrative medicine focuses on the whole child and the environment in which the child grows up during the treatment of a child’s illness. Nowadays, many different treatment modalities are applied even in children, and doctors need to know about them and, ideally, be able to apply different approaches in the process of treating a child themselves. The program Pediatric Integrative Medicine in Residency (PIMR) already provides residents with several tools to provide this kind of service for the child. In our PIMR pilot program in Germany, we chose to diversify our knowledge about treatment and prevention options by visiting a Kneipp-certified kindergarten in Germany. The philosophy of Sebastian Kneipp focuses on five pillars of health, which incorporate aspects of prevention, self-awareness, self-responsibility, and consciousness of health by means of hydrotherapy, herbal medicine, exercise, nutrition, and lifestyle-medicine. These are being taught to the children during the early years they spend in kindergarten, and represent integral parts of integrative medicine. Integration of Kneipp-based health programs within a kindergarten setting can work well and provides an effective means of early prevention education in childhood. Full article
(This article belongs to the Special Issue Implementing Pediatric Integrative Medicine in Practice)
Open AccessBrief Report Piloting a Developmental Screening Tool Adapted for East African Children
Children 2018, 5(8), 101; https://doi.org/10.3390/children5080101
Received: 31 May 2018 / Revised: 13 July 2018 / Accepted: 24 July 2018 / Published: 26 July 2018
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Abstract
There is a need for developmental screening that is easily administered in resource-poor settings. We hypothesized that known risk factors would predict failed developmental screening on an adapted screening tool in East African children living in poverty. The sample included 100 healthy Ugandan
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There is a need for developmental screening that is easily administered in resource-poor settings. We hypothesized that known risk factors would predict failed developmental screening on an adapted screening tool in East African children living in poverty. The sample included 100 healthy Ugandan children aged 6–59 months. We adapted a parent-reported developmental screener based on the Child Development Review chart. The primary outcome was failure to meet age-appropriate milestones for any developmental domain. Venous blood was analyzed for lead, and caregivers completed a demographics questionnaire. We used multivariate logistic regression models to determine if elevated blood lead and stunting predicted failure on the screener, controlling for maternal education level, age in months past the lower bound of the child’s developmental age group, and absence of home electricity. In the sample, 14% (n = 14) of children failed one or more milestones on the screener. Lead levels or stunting did not predict failing the screener after controlling for covariates. Though this tool was feasibly administered, it did not demonstrate preliminary construct validity and is not yet recommended for screening in high-risk populations. Future research should include a larger sample size and cognitive interviews to ensure it is contextually relevant. Full article
(This article belongs to the Section Global and Public Health)
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