Children — Open Access Journal

Background: Minorities’ Diminished Returns (MDRs) refer to systemically weaker effects of socioeconomic status (SES) indicators on various developmental, behavioral, and health outcomes of ethnic minorities compared to non-Hispanic (non-Latino) Whites. Similar MDRs also exist for the effects of parental education on the school performance of ethnic minority youth. Aim: To assess whether regression toward the mean (RTM) has any role in explaining the diminished effects of parental education on the school performance of Black and Hispanic youth relative to non-Hispanic White youth. Materials and methods: Data for this cross-sectional study came from the Monitoring the Future survey (MTF, 2017), a nationally representative survey of American youth in 12th grade. The sample included 10,262 youth who were 12th graders (typically 17–18 years old). The independent variable was parental education with five categories: Some high school, High school graduate, Some college, College graduate, and Graduate school. The outcome was self-reported school performance measured as grade point average (GPA). Ethnicity was the effect modifier. Analysis of variance (ANOVA) and the Tukey Post Hoc test was used to analyze the data. Data visualization (line graphs) was used to visualize the shape of youth GPA as a function of parental education levels across ethnic groups. Results: While a perfect stepwise increase was seen in youth school performance as a result of parental education improvement, this pattern differed considerably across ethnic groups. Such a perfect stepwise increase in youth school performance as a result of the incremental increase in parental education was missing for Black and Hispanic youth. The shape of the association between parental education and youth school performance ruled out regression toward the mean (RTM) as an explanation for the observed diminished effects of parental education on the school performance of Black and Hispanic youth. Conclusion: Diminished returns of parental education on the school performance of Black and Hispanic youth cannot be explained by regression toward the mean. Other factors and contextual processes, such as segregation, discrimination, racism, and poor quality of schools in urban areas, should be investigated in future research. Full article

Purpose: The overall aim of the study was to gain a deeper understanding of 3 to 10 year-old children’s experiences, main concerns, and how they manage attending hospital for dental treatment under general anesthesia (DTGA). Methods: Twelve children aged 3–10 who were scheduled for DTGA were interviewed. In addition to tape-recorded interviews, data were collected using video diaries, participant observations, and pre-, peri-, and postoperative drawings. The children’s drawings (n = 43) were analyzed using the Child Drawing: Hospital Manual (CD:H) and Vygotsky postulations for context readings, with the aim to explore what it means for children to undergo DTGA. Results: The analysis found that the main concern for children during the pre-operative period was that they were forced to prepare for an unknown experience, which elicited stress. This situation was handled during the peri-operative period by trying to recover control and to cooperate despite fear, stress, and anxiety. Drawings completed post-operatively showed the surgical mask, “stinky” smell of the anesthetic gas, and multiple extraction of teeth were the main troubling experiences for children. Several weeks after DTGA, children tried to regain normalcy in their lives again. Conclusion: This study contributed to a deeper understanding of how children as young as 3 years undergoing DTGA experience and express their lived experiences: emotional, psychological, physiological, or physical stress in the context of DTGA. Full article

Background: The objective and accurate assessment of children’s sedentary and physical behavior is important for investigating their relation to health. The purpose of this study is to validate a simple and robust method for the identification of sitting, standing, walking, running and biking performed by preschool children, children and adolescents in the age from 3 to 16 years from a single thigh-worn accelerometer. Method: A total of 96 children were included in the study and all subjects followed a structured activity protocol performed in the subject’s normal kindergarten or school environment. Thigh acceleration was measured using the Axivity AX3 (Axivity, Newcastle, UK) device. Method development and accuracy was evaluated by equally dividing the subjects into a development and test group. Results: The sensitivity and specificity for identifying sitting and standing was above 99.3% and for walking and running above 82.6% for all age groups. The sensitivity and specificity for identifying biking was above 85.8% for children and adolescents and above 64.8% for the preschool group using running bikes. Conclusion: The accurate assessment of sitting, standing, walking, running and biking from thigh acceleration and with children in the age range of 3 to 16 is valid, although not with preschool children using running bikes. Full article

Background: This study aims to assess the relationships between alcohol and tobacco consumption, physical activity (PA) and demographic characteristics in Romanian students. Methods: There were 253 participants in this study (112 male and 141 female, age 19.2 ± 0.70 yrs; BMI 22.4 ± 2.2 kg/m²), students of Transilvania University of Brasov. The International Physical Activity Questionnaire Short Form (IPAQ-SF), Alcohol Use Disorders Identification Test (AUDIT) and Fagerström Test for Nicotine Dependence (FTND) were employed for the data collection. Results: Results showed that moderate consumption of tobacco and harmful consumption of alcohol had high prevalence among age, gender, year of study and PA level categories. Although the correlation coefficient showed no significant relationship between tobacco and alcohol use, it was shown that a negative correlation between tobacco and PA level existed. Further, age, year of study and PA level had a negative significant relationship with alcohol use among students. In the end, the tobacco and alcohol consumption prediction model showed heterogeneous coefficients. Conclusion: Full models of tobacco and alcohol use were differently predicted by variables, so PAL (Physical Activity Level) could predict tobacco consumption but not alcohol. Full article

Background: Drowning is the second leading cause of unnatural death in childhood worldwide. More than half of the drowned children, who were in need of cardiopulmonary resuscitation (CPR) at the scene suffered from lifelong neurological sequelae. There are few data about prognostic predictors in the pediatric population of drowning victims. The objective of the study was to assess incident characteristics, prognostic parameters, and long-term outcome of children recovering from a drowning incident. Methods: We carried out a retrospective analysis of data of the cohort of pediatric cases (age 0–18) of drowning victims admitted in the years 2000–2015 to the emergency room/intensive care unit/pediatric ward at the University Children’s Hospital of Zurich, Switzerland. Outcome was classified by the Pediatric Cerebral Performance Category Scale (PCPCS). New subcategories of severity for known prognostic parameters have been defined. A correlation analysis was performed between the subcategories of the prognostic parameters and the PCPCS. Results: A total of 80 patients were included in the analysis. Of these, 64% were male, most of the patients were at the age of 0–5 years. More than 80% of the patients were unattended at a public or private pool when the drowning incident happened. In all, 61% (n = 49) needed cardiopulmonary resuscitation (CPR). Of the resuscitated children, 63% showed good to mildly impaired long-term outcome (PCPCS 1–3). Furthermore, 15% (n = 12) were transferred to rehabilitation. Seven children died during the hospital stay and another four died due to complications in the ten years following the incident. The newly defined subcategories of the parameter submersion time, Glasgow Coma Scale (GCS) at time of admission, body temperature at time of admission, blood pH, blood glucose, and blood lactate level correlated significantly with the PCPCS. Conclusions: Supervision of children, especially boys of the age 0–5 years, next to public or private pools is most important for prevention of drowning incidents in Switzerland. Cardiopulmonary resuscitation done by trained staff leads to a better long-term outcome. Medical decision making in severe cases of drowning should consider submersion time, GCS at time of admission, body temperature at time of admission, blood pH, blood glucose, and blood lactate levels, as these parameters correlate with long-term outcome. Full article

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may result in the multisystem inflammatory syndrome in children (MIS-C). The clinical presentation of MIS-C includes fever, severe illness, and the involvement of two or more organ systems, in combination with laboratory evidence of inflammation and laboratory or epidemiologic evidence of SARS-CoV-2 infection. Some features of MIS-C resemble Kawasaki Disease, toxic shock syndrome, and secondary hemophagocytic lymphohistiocytosis/macrophage activation syndrome. The relationship of MIS-C to SARS-CoV-2 infection suggests that the pathogenesis involves post-infectious immune dysregulation. Patients with MIS-C should ideally be managed in a pediatric intensive care environment since rapid clinical deterioration may occur. Specific immunomodulatory therapy depends on the clinical presentation. The relationship between the immune response to SARS-CoV-2 vaccines in development and MIS-C requires further study. Full article

Pediatric craniofacial reconstruction surgery is associated with significant perioperative analgesic requirements. As dexmedetomidine mediates central nervous system sympathetic activity and pain modulation, its intraoperative use could be beneficial in craniofacial surgery. We hypothesized that intraoperative administration of dexmedetomidine in children undergoing craniofacial reconstructive surgery would result in reduced opioid requirements, pain, sedation scores, and opioid-induced side effects compared to patients who did not receive dexmedetomidine. All patients who underwent craniofacial reconstructive surgery at our institution from July 2013 to June 2017 were retrospectively evaluated. The primary outcome measure was mean postoperative morphine equivalent requirements. Secondary outcome measures included incidence of opioid-related side effects, pain scores, and hospital length of stay. Thirty-nine patients received dexmedetomidine intraoperatively while 41 patients did not. There was no difference in postoperative opioid requirements or pain scores between the two cohorts. However, patients who received higher doses of dexmedetomidine (4.7 mcg/kg) intraoperatively exhibited significantly lower rescue medication requirements for nausea and vomiting postoperatively. Contrary to the hypothesis, dexmedetomidine was not associated with reduced postoperative opioid requirements or pain scores in children undergoing craniofacial reconstructive surgery. However, our findings do suggest that dexmedetomidine may be beneficial in reducing side effects such as postoperative nausea and vomiting. A randomized controlled trial would be necessary to verify these findings. Full article

Background: Childhood obesity is associated with dyslipidemia, fatty liver disease, and type 2 diabetes. Expert guidelines recommend screening for these conditions in children with obesity. Aims and objectives: The objective of the study was to compare rates of laboratory screening for dyslipidemia, fatty liver disease, and type 2 diabetes in children with obesity prior to and following implementation of a point-of-care decision support tool. Methods: We performed a retrospective record review of children with body mass index (BMI) ≥95th percentile for age and gender (age 7–18 years) undergoing well-child/sports examination visits. Multivariable logistic regression models were used to adjust for patient and provider confounders. Results: There was no increase in the rates of screening following implementation of the point-of-care decision support tool. Tests were more likely to be recommended in children with severe obesity and in females. Conclusions: The implementation of a point-of-care decision support tool was not associated with improvement in screening rates for dyslipidemia, fatty liver disease, and type 2 diabetes for children with obesity. Further strategies are needed to improve rates of screening for obesity-related comorbid conditions in children with obesity. Full article

Arterial stiffness is an important marker of vascular damage and a strong predictor of cardiovascular diseases (CVD). Given that pathophysiological processes leading to an increased arterial stiffness begin during childhood, the aim of this clustered observational study was to determine the relationship between modifiable factors including dietary patterns and indices of aortic arterial stiffness and wave reflection in 9–11-year-old children. Data collection was conducted between April and December 2015 in 17 primary schools in Dunedin, New Zealand. Dietary data were collected using a previously validated food frequency questionnaire and identified using principal component analysis method. Arterial stiffness (carotid-femoral pulse wave velocity, PWV) and central arterial wave reflection (augmentation index, AIx) were measured using the SphygmoCor XCEL system (Atcor Medical, Sydney, Australia). Complete data for PWV and AIx analyses were available for 389 and 337 children, respectively. The mean age of children was 9.7 ± 0.7 years, 49.0% were girls and 76.0% were classified as “normal weight”. The two identified dietary patterns were “Snacks” and “Fruit and Vegetables”. Mean PWV and AIx were 5.8 ± 0.8 m/s and −2.1 ± 14.1%, respectively. There were no clinically meaningful relationships between the identified dietary pattern scores and either PWV or AIx in 9–11-year-old children. Full article

This paper discusses school safety mainly in relation to safety education and examines measures for the comprehensive development of systems to ensure the safety of children at school, including those requiring medical care. The number of children requiring medical care is increasing in general schools following the promotion of inclusive education. The government of Japan has established the School Health and Safety Act and Guidelines on School Curricula. Municipalities have developed education systems that cover the safety education specified in disaster preparedness plans for schools. Safety education has been promoted through problem-oriented and experience-based methods as well as other methods of learning to date. Considering the outcomes of these systems and approaches, it is expected that safety management systems in schools, especially general schools that include children requiring medical care, will also develop in combination with safety education. Full article

This study evaluated the effect of action observation training on spasticity, gross motor function, and balance in children with spastic diplegia cerebral palsy. Eighteen children with cerebral palsy participated in this study. The participants were randomized into the action observation training group (n = 9) and a control group (n = 9). The action observation training group repeatedly practiced the action with their motor skills, while the control group practiced conventional physical therapy. Both groups received 30 min sessions, 3 days a week, for 6 weeks. To confirm the effects of intervention, the spasticity, gross motor function measurement (GMFM), and pediatric reaching test (PRT) were evaluated. The results showed that in the plantar flexor contracture test of both sides, the Modified Tardieu Scale (MTS) of the right side of knee joints, GMFM-B, C, and D were significantly increased between pre- and post-intervention within both groups (p < 0.05). PRT was significantly increased between pre- and post-intervention within the both groups (p < 0.05), and there was a significant difference between the two groups (p < 0.05). These results suggest that action observation training is both feasible and beneficial for improving spasticity, gross motor function, and balance in children with spastic diplegia cerebral palsy. Full article

Refugees often parent under extreme circumstances. Parenting practices have implications for child outcomes, and parenting in the context of refugee resettlement is likely to be dynamic as parents negotiate a new culture. This study examined African origin mothers’ infant care values and practices related to feeding, carrying, and daily activities following resettlement in the Southeastern region of the U.S. Ten African origin mothers were asked about their infant care practices through semi-structured interviews. Results indicated that mothers valued breastfeeding but often chose to use formula as a supplement or instead of breastfeeding. In addition, participants valued carrying their infants close to the body but used equipment such as strollers. Mothers expressed that perceptions of American culture and rules, social support, interactions with community agencies, and the need to engage in formal employment were factors that influenced their infant care practices. Full article

Nephrotic syndrome is the most common glomerular disease among children. Although most cases respond to steroid therapy, approximately 10–20% of patients exhibit resistance to conventional steroid therapy and are labeled as steroid-resistant. Such patients are at risk of complications, including infection, thrombosis, and chronic kidney disease. Nephrotic syndrome is considered a thrombogenic condition. Pulmonary embolism is associated with high mortality, and early treatment is essential for the survival of patients. Here, we report the case of a 12-year-old girl with late steroid resistance who developed bilateral pulmonary embolism. Full article

Background: Breastfeeding rates are low in many communities in the United States and require attention to come up with ideas that will help increase breastfeeding. This study investigated the effects of income, age, race and education on mothers’ perceptions about breastfeeding and whose needs and views should be considered in a women’s breastfeeding journey. Methods: A survey was distributed via email and Facebook to 525 participants; 453 participants (86.3%) responded to the survey. Results: Younger adults were more likely to agree that fathers should have some say about breastfeeding. Those earning USD 0–USD 50,000 were more likely to agree relative to those with higher incomes on children being entitled to mother’s milk, and children’s needs over-riding those of others. There was a statistically significant difference by education about women's wishes about breastfeeding being considered more important than those of their spouses. However, there was no statistically significant difference for any demographic group for breastfeeding decisions coming from women only. On women’s breasts being primarily for infant's nutrition, people who earned USD 0–USD 50,000 were more likely to agree relative to those who earned more than USD 50,000; younger adults were significantly more likely to agree. Those who earned USD 0–USD 50,000 were more likely to agree relative to those in other income brackets that extended family members should have input regarding babies being breastfed; minority participants were significantly more likely to agree relative to white participants; those with less than 4-year college education were more likely to agree relative to those with a minimum of four-year college education. Younger adults were more likely to agree that employers must provide extended maternity leave to make it easier for mothers to breastfeed. On women having the right to breastfeed in public places, younger adults were significantly more likely to agree compared to older adults. Conclusion: Women have favorable views about breastfeeding and prefer being in charge about decisions to breastfeed. Full article

There are guidelines on lactation following maternal analgo-sedative exposure, but these do not consider the effect of maternal fasting or fluid abstention on human milk macronutrient composition. We therefore performed a structured search (PubMed) on ‘human milk composition’ and screened title, abstract and full paper on ‘fasting’ or ‘abstention’ and ‘macronutrient composition’ (lactose, protein, fat, solids, triglycerides, cholesterol). This resulted in six papers and one abstract related to religious fasting (n = 129 women) and observational studies in lactating women (n = 23, healthy volunteers, fasting). These data reflect two different ‘fasting’ patterns: an acute (18–25 h) model in 71 (healthy volunteers, Yom Kippur/Ninth of Av) women and a chronic repetitive fasting (Ramadan) model in 81 women. Changes were most related to electrolytes and were moderate and mainly in the chronic repetitive fasting model, with no clinical significant changes in macronutrients during acute fasting. We therefore conclude that neither short-term fasting nor fluid abstention (18–25 h) affect human milk macronutrient composition, so that women can be reassured when this topic was raised during consulting. Besides the nutritional relevance, this also matters, as clinical research samples—especially estimating analgo-sedative exposure by lactation—are commonly collected after maternal procedural sedation and maternal fasting. Based on these results, it is reasonable to assume stable human milk composition when such data are used in physiology-based pharmacokinetic (PBPK) models. Full article

To investigate the correlation between chronic kidney disease (CKD) and the development of neurological disease among pediatric patients in Saudi Arabia. The present retrospective study recruited patients admitted to King Abdulaziz University Hospital during 2018. We reviewed electronic records to collect data on essential demographics including age, gender, and nationality; history of prior CNS disease or related symptoms; results of neurological physical examination; and findings of radiological investigations such as abdominal ultrasound, dimercaptosuccinic acid scan, micturating cystourethrogram, diethylene triamine pentaacetic acid scan, brain computed tomography, and magnetic resonance imaging. The most commonly diagnosed renal pathologies were neurogenic bladder and cystic kidney disease. The most common neurological manifestation was seizure disorder. Males were more frequently affected with neurological sequelae than females. The prevalence of neurological disorders was higher in patients over two years old. The most frequently observed stage of chronic kidney disease was stage 5. Most children who were affected with a neurological disorder required hemodialysis as part of their management plan. Patients with chronic kidney disease are at a high risk of neurocognitive defects. The type of management and renal diagnosis are significant factors that should be considered when anticipating central nervous system involvement in the case of chronic kidney disease. Full article

To date, the only disease-modifying treatment strategy for allergic rhinitis and asthma is allergen immunotherapy (AIT). There is evidence that AIT improves allergic rhinitis and asthma, such as reducing symptom severity and medication use and improving of quality of life, with a long-lasting effect after the end of the course. The recent clinical trials evidenced AIT effectiveness and safety in allergic asthma. Consequently, the current version of the GINA (Global Initiative for Asthma) guidelines recommend AIT as an add-on therapy for asthma. There is also evidence that AIT may exert preventive activity on the possible progression from allergic rhinitis to asthma in children and the onset of new sensitizations. The present review provides a pragmatic summary of the clinical indications of AIT in pediatric asthma, including the immunological mechanisms, the predictive biomarkers, and the safety issues in clinical practice. Full article

Background: Minorities’ diminished returns (MDRs) refer to weaker effects of socioeconomic status (SES) indicators such as parental educational attainment and family income in generating tangible childhood outcomes for racial and ethnic minorities compared to the majority group, a pattern prevalent in the US. Our existing knowledge is minimal, however, about diminished returns of family SES on reducing exposure to childhood trauma. Aim: To determine if there was a difference between non-Hispanic whites (NHW) and non-Hispanic blacks (NHB) in the effect of SES on exposure to childhood trauma among children ages 8–11 years old. Materials and methods: In this cross-sectional study, we analyzed data from 4696 NHW or NHB American 8–11-year-old children who were participants in the Adolescent Brain Cognitive Development (ABCD) Study. The independent variables were parental educational attainment and family income. The primary outcome was exposure to 1 or 2+ childhood traumas, measured by the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) semi-structured interview. Polynomial regression was used for data analysis. Results: Parental education and family income had statistically significant protective (negative) effects on childhood trauma, indicating children from high income and highly educated families were exposed to a lower level of childhood trauma. However, race/ethnicity showed statistically significant interactions with parental education and family income on exposure to childhood trauma, indicating weaker protective effects of parental education and family income on reducing exposure to trauma for NHB compared to NHW children. Race-specific models showed protective effects of parental education and family income on exposure to childhood trauma for NHW but not NHB children. Conclusion: The protective effects of parental education and family income against exposure to childhood trauma are systematically diminished for NHBs compared to NHWs. To minimize the racial/ethnic health gaps, diminished returns of parental education and family income should be addressed. There is a need for programs and interventions that equalize not only SES but also the marginal returns of SES for ethnic groups. Such efforts require addressing structural and societal barriers that hinder NHB families from translating their SES resources into tangible outcomes. There is a need for studies that can minimize MDRs for NHB families, such that SES can similarly secure tangible outcomes in the presence of SES resources. Full article

Youth with functional abdominal pain disorders (FAPDs) may report high rates of trauma and/or posttraumatic stress disorder (PTSD), which could impact both physical and psychosocial functioning, in addition to psychosocial treatment response. The current study aimed to examine the rates of PTSD in a sample of 89 youth with FAPDs and examine the association between PTSD with physical and psychosocial functioning. The impact of PTSD on psychosocial treatment response in a subsample of youth with FAPDs was also explored. Participants were youth with FAPDs (ages 9–14) enrolled in a larger study examining the effect of a short-term pain and anxiety focused cognitive behavioral therapy (CBT) treatment (Aim to Decrease Anxiety and Pain Treatment (ADAPT)) for youth with FAPDs. Youth were administered a semi-structured diagnostic interview by a trained clinician to confirm the presence of psychological diagnoses, including PTSD. Measures of physical and psychosocial functioning were also completed. Results revealed a high rate of PTSD in youth with FAPDs with 12.4% meeting diagnostic criteria for the disorder. PTSD was associated with several indicators of increased psychosocial impairment and one indicator of physical impairment. Exploratory analyses revealed comorbid PTSD may impact response to a brief CBT intervention targeting pain and anxiety, but more rigorous controlled studies are needed. Full article