Children Aged 3-6years Research Articles

Distraction using virtual reality for children during intravenous injections in an emergency department: A randomised trial.

To determine whether the virtual reality as a distracting intervention could reduce pain and fear in school-age children receiving intravenous injections at an emergency department. An intravenous injection is the most common invasive procedure that paediatric patients encounter in emergency department. School-age children seldom show their fear or discomfort during the procedure which may be ignored. A randomised controlled trial was conducted from December 2017-May 2018 and performed according to the CONSORT guidelines. One hundred and thirty-six children aged 7-12years were randomly allocated to receive either a routine intravenous injection procedure or one with an immersive virtual reality experience. Children were asked to rate their pain and fear along with their caregivers and nurses on the Wong-Baker FACES Pain Rating Scale and Children's Fear Scale, respectively. The time required for successful intravenous insertion was also assessed in the emergency department. Clinical trial registration was done (ClinicalTrials.gov.: NCT04081935). Pain and fear scores were significantly lower in the virtual reality group, as were the children's ratings as perceived by their caregivers and nurses. The children's ratings of pain and fear were positively correlated with the caregivers' ratings and the nurses' ratings as well. The time required for successful intravenous insertion was significantly lower in the virtual reality group. Visual reality intervention can effectively reduce the pain and fear during intravenous procedure in school-age children in emergency department. The results of this study indicate the feasible clinical value of virtual reality interventions during the administration of intravenous injections in school-age children in emergency departments.

The mediation effect of anthropometry and physical fitness on the relationship between birthweight and basal metabolic rate in children.

Birthweight (BW) has been associated with anthropometry, body composition and physical fitness during growth and development of children. However, less is known about the mediation effect of those variables on the relationship between BW and basal metabolic rate (BMR) in children. To analyse the mediation effect of anthropometry, body composition and physical fitness on the association between BW and BMR in children. In total, 499 children (254 boys, 245 girls) aged 7-10years were included. Anthropometry (weight, height, head, waist and hip circumferences), body composition (skinfolds thickness, body fat percentage), physical fitness (handgrip strength, flexibility, muscular endurance, muscular explosive power, agility, running speed) and BMR were evaluated. The analyses were conducted by: single-mediator analysis (SMA) and multi-mediator analysis (MMA). The SMA indicates height, head, waist and hip circumferences and handgrip strength as significant mediators of BW on BMR for boys and height, hip circumference and handgrip strength as significant mediators of BW on BMR for girls. In MMA for girls, there were significant indirect effects for height, hip circumference and handgrip strength, with 79.08% of percent mediation. For boys, the head and waist circumferences mediation had a significant indirect effect, with 83.37% of percent mediation. The anthropometric variables associated with BW were body height, head, hip and waist circumferences for boys and body height and hip circumference for girls. The current study provides new evidence that height and handgrip strength during childhood mediated the relationship between BW and BMR.

Using Animation to Self-Report Health: A Randomized Experiment with Children.

The Child Health Utility-9D (CHU-9D) is the only generic preference-based measure specifically developed to elicit health-related quality of life directly from children aged 7-11years. The aim of this study was to investigate whether the use of animation on a touch screen device (tablet) is a better way of collecting health status information from children aged 4-14years compared to a traditional paper questionnaire. The specific research questions were firstly, do young children (4-7years) find an animated questionnaire easier to understand; secondly, independent of age, is completion of an animated questionnaire easier for sick children in hospital settings; and thirdly, do children's preferences for the different formats of the questionnaire vary by the age of the child. Using a balanced cross-over trial, we administered different formats of the CHU-9D to 221 healthy children in a school setting and 217 children with health problems in a hospital setting. The study tested five versions of the CHU-9D questionnaire: paper text, tablet text, tablet still image, paper image and tablet animation. Our results indicated that the majority of the children aged 4-7years found the CHU-9D questions easy to answer independent of the format of the questionnaire administered. Amongst children aged 7-14 with health problems, the format of questionnaire influenced understanding. Children aged 7-11years found the tablet image and animation formats easier compared to text questionnaires, while the oldest children in hospital found text-based questionnaires easier compared to image and animation. Children in all three age groups preferred animation on a tablet to other methods of assessment. Our results highlight the potential for using an animated preference-based measure to assess the health of children as young as 4years.

Inflated Responsibility Beliefs in Paediatric OCD: Exploring the Role of Parental Rearing and Child Age.

Cognitive-behavioural models of obsessive-compulsive disorder (OCD) propose that inflated responsibility beliefs are central to the maintenance of the disorder and are proposed to originate during early childhood via experiences of harsh and/or controlling parenting. The current study aimed to examine the associations between perceived parental rearing behaviours, inflated responsibility/threat beliefs, and OCD severity and impairment in children (aged 7-12years) and adolescents (aged 13-17years) with OCD (n = 136). Results indicated that for younger children, greater child perceptions of overprotection and anxious rearing were each associated with increased inflated responsibility beliefs. For older children, these positive associations remained, and furthermore, inflated responsibility beliefs mediated the association between perceived maternal anxious rearing and OCD impairment. Results highlight the role of the family in the development of inflated responsibility bias and OCD-related impairment.

Vascular Health of Children Conceived via In Vitro Fertilization

To evaluate whether invitro fertilization (IVF) has an effect on the cardiovascular health of offspring. This was a cross-sectional pilot study. We performed vascular health assessment for 17 children aged 10-14years who were conceived via IVF with autologous oocytes at Stanford University. Carotid artery ultrasound evaluated intima-media thickness and stiffness, carotid-femoral pulse wave velocity determined segmental arterial stiffness, and endothelial pulse amplitude testing assessed endothelial function. We compared IVF offspring with control adolescents assessed in the same laboratory, with all comparisons adjusted for age, sex, and race/ethnicity. All participants had normal body mass index and blood pressure. Compared with controls, IVF children had thicker common carotid artery intima-media thickness (0.44±0.03mm vs 0.38±0.03mm; P<.01), higher elastic modulus (395.29±185.33mm Hg vs 242.79±37.69mm Hg; P=.01), higher βstiffness (2.65±0.38 vs 2.28±0.23; P<.01), and higher peak velocity (142.29±31.62cm/s vs 117.71±32.69cm/s; P=.04). The mean endothelial pulse amplitude testing reactive hyperemia index was not significantly different between IVF and controls. The mean pulse wave velocity was 4.69±0.51m/s compared with the controls 4.60±0.57m/s (P=.11), with 8 (47%) having abnormal values. In an assessment of endothelial function and arterial properties of children conceived via IVF, we found that children conceived via IVF seem to have evidence of abnormal vascular health. Further studies with larger sample size and long-term follow-up are warranted.

Motor Competence Levels and Developmental Delay in Early Childhood: A Multicenter Cross-Sectional Study Conducted in the USA.

Developmental delay in motor competence may limit a child's ability to successfully participate in structured and informal learning/social opportunities that are critical to holistic development. Current motor competence levels in the USA are relatively unknown. The purposes of this study were to explore motor competence levels of US children aged 3-6years, report percentages of children demonstrating developmental delay, and investigate both within and across childcare site predictors of motor competence, including sex, race, geographic region, socioeconomic status, and body mass index percentile classification. Potential implications from results could lead to a greater awareness of the number of children with developmental delay, the impetus for evidence-based interventions, and the creation of consistent qualification standards for all children so that those who need services are not missed. Participants included children (N = 580, 296 girls) aged 3-6years (Mage = 4.97, standard deviation = 0.75) from a multi-state sample. Motor competence was assessed using the Test of Gross Motor Development, Second Edition and the 25th and 5th percentiles were identified as developmental delay-related cutoffs. For both Test of Gross Motor Development, Second Edition subscales, approximately 77% of the entire sample qualified as at risk for developmental delay (≤ 25th percentile), while 30% of the entire sample were at or below 5th percentile. All groups (e.g., sex, race, socioeconomic status) were prone to developmental delay. Raw object control scores differed by sex. Developmental delay in motor competence is an emerging epidemic that needs to be systematically acknowledged and addressed in the USA. By shifting norms based upon current data, there may be a lower standard of "typical development" that may have profound effects on factors that support long-term health.

Effect of Core Stability Exercises and Treadmill Training on Balance in Children with Down Syndrome: Randomized Controlled Trial.

Core stability exercises and treadmill training play a crucial role in physical therapy interventions and have an effect on balance in children with Down Syndrome (DS); however, whether core stability exercises or treadmill training has more effect on improving balance has not been investigated yet. The aim of the study was to investigate the effect of core stability training versus treadmill exercises on balance in children with Down Syndrome. Forty-five children aged 4-6years with Down Syndrome were included in the study. The children were equally divided randomly into three groups. Group A received traditional physical therapy intervention strategies to facilitate the balance of participating children. Group B received the same as group A and additional core stability exercise training. Group C received the same intervention strategies as group A in conjunction with a treadmill exercise program. The children's balance was evaluated using the Berg balance scale and the Biodex Balance System. Treatment sessions were for 60min, thrice a week, for 8 consecutive weeks. There were significance improvements in the three groups in functional balance and over all stability indices in favor of groups B and C. Core stability and treadmill training improved balance in children with Down Syndrome and should be applied in conjunction with physical therapy programs.

Associations of gestational and the first year of life exposure to ambient air pollution with childhood eczema in Hubei, China.

Whether exposure to air pollution is associated with the increased incidence of childhood eczema is controversial. Only a few previous researches about the relationship between gestational and early-life exposures to ambient air pollutants and childhood eczema were conducted in China, and there is a lack of studies in Hubei province. This study aimed to explore the associations between air pollution exposure in gestation and the first year of life and childhood eczema. From November to December 2017, a total of 3383 children aged 3-6years were recruited from 12 kindergartens in Hubei, China; 3167 were included in the final analysis. Parent-reported data involved with childhood eczema was inquired by questionnaire, and the concentrations of NO2, PM2.5, and PM10 were acquired from air quality monitoring stations which were the nearest to the twelve kindergartens. A binary logistic regression model was used to evaluate the associations of period-mean concentrations of individual pollutant exposure with childhood eczema. Of the 3167 children, 848 (26.8%) had a history of doctor-diagnosed eczema. After adjusting for the covariates, high levels of NO2, PM2.5, and PM10 exposures were significantly associated with a positive increase in risk of childhood eczema during the gestational period and the first year of life. In the gestational period, the estimate OR in the 3rd and 4th quartiles of NO2 was 1.256 and 1.496, respectively. During the first year of life, the estimate OR in the 3rd and 4th quartiles of NO2 was 1.371 and 1.335, respectively. Our study indicated that the gestational period and the first year of life exposures to high levels of ambient NO2, PM2.5, and PM10 were significantly associated with increased eczema among preschool children. Some effective measures of prevention and intervention could be developed for preschool children.

"Just keep pushing": Parents' experiences of accessing child and adolescent mental health services for child anxiety problems.

Anxiety disorders are among the most common psychopathologies in childhood; however, a high proportion of children with anxiety disorders do not access effective treatments. The aim of the present qualitative study was to understand families' experiences of seeking help and accessing specialist treatment for difficulties with childhood anxiety. Parents of 16 children (aged 7-12years) referred to a child mental health service for difficulties with anxiety were interviewed about their experiences of seeking and accessing treatment within Child and Adolescent Mental Health Service (CAMHS). All interviews were transcribed verbatim and thematically analysed for similarities and differences in families' experiences. Factors that helped and/or hindered families accessing treatment related to (a) parental recognition, (b) contact with professionals, (c) reaching CAMHS, (d) parental effort, and (e) parental knowledge and concerns. High demands on services and parents' uncertainty surrounding the help-seeking process presented key hurdles for families. The critical role of parental persistence and support from general practitioners and school staff was evident across interviews. Findings highlighted the need for information and guidance on identifying child anxiety difficulties and professional, peer, and self-help support, and ensuring sufficient provision is available to allow families prompt access to support.

The effect of aloe vera and tea tree oil mouthwashes on the oral health of school children.

To evaluate the effect of two herbal mouthwashes containing aloe vera and tea tree oil, on the oral health of school children. A double-blinded, placebo-controlled prospective interventional study was conducted in school children aged 8-14years. The study participants were divided into four groups depending upon the mouthwash used: Group 1 (aloe vera), Group 2 (chlorhexidine), Group 3 (tea tree oil) and Group 4 (placebo). The variables studied included plaque index, gingival index and salivary Streptococcus mutans counts, which were recorded at baseline, 4weeks after supervised mouth rinse and after 2weeks of stopping the mouth rinse. A total of 89 boys and 63 girls were included. A statistically significant decrease in all variables was noted after the use of both the herbal preparations at the end of 4weeks which was maintained after the 2-week washout period (p < 0.001). The difference in variables between groups using aloe vera, Tea tree oil and chlorhexidine, was not statistically significant. The use of aloe vera and tea tree oil mouthwashes can decrease plaque, gingivitis and S. mutans in the oral cavity in children. The activity of these two agents is comparable to that of chlorhexidine.

The influence of clinical and psychosocial characteristics on children behaviour during sequential dental visits: a longitudinal prospective assessment.

This is the first study to adopt a multilevel approach to assess the impact of the order of dental visits on child's behaviour. The aim was to investigate which factors directly interfere with child's behaviour regardless of the order of sequential dental visits. In this prospective longitudinal study, children aged 7-12years were invited to participate. Child behaviour was assessed using the Frankl Scale during four sequential dental visits. Chi-square test was used to analyse the effect of dental fear on children's non-cooperative behaviour according to the presence of dental fear. Multilevel mixed logistic regression model was used to assess the association between predictor variables and the outcome (child behaviour) during the sequential dental visits. Overall, 111 children participated in this study. Maternal dental anxiety, dental pain and complexity of the treatment were associated with the non-cooperative behaviour in children aged 7-12years. When stratified by dental fear, the complexity of the treatment remained associated with non-cooperative behaviour. The results provide evidence that, even with the familiarization of child with the dental environment, maternal dental anxiety, dental pain in the last month, and the complexity of dental treatment negatively affect the children's behaviour aged 7-12years.

Effect of a relaxation training exercise on behaviour, anxiety, and pain during buccal infiltration anaesthesia in children: Randomized clinical trial.

Cognitive behavioural techniques can decrease procedural pain and anxiety in children. Bubble breath exercise, a play therapy technique, may be used as a relaxation strategy to manage anxiety and pain. The objective of the study was to evaluate the effect of bubble breath exercise on dental anxiety, dental behaviour, and pain intensity during buccal infiltration of local anaesthetic in children. This randomized controlled trial involved 66 children aged 7-11years, randomly allocated to two groups: Group 1 (control) and Group 2 (intervention group). Group 2 was trained in bubble breath exercise. The reaction during buccal infiltration anaesthesia was recorded in terms of behaviour (Frankl's behaviour rating scale), anxiety (Facial Image Scale and pulse rate), and pain perception (Wong-Baker FACES pain rating scale and the Faces, Leg, Activity, Cry, and Consolability scale). The bubble breath exercise significantly reduced the pain perceived, as measured by both the Wong-Baker FACES pain rating scale (P<0.001) and the FLACC scale (P<0.001). There was no statistically significant difference in dental anxiety and behaviour among the groups. Use of bubble breath exercise may be beneficial in decreasing the pain perceived during maxillary buccal infiltration anaesthesia in 7- to 11-year-old children.

Spanish Validation of the Child Anxiety Life Interference Scale (CALIS-C): Psychometric Properties, Factorial Structure and Factorial Invariance Across Gender.

The Child Anxiety Life Interference Scale (CALIS-C) is a measure created to specifically identify life interference and impairment related to children's anxiety disorders in areas of daily functioning. Despite being a widely used scale, a Spanish version of the CALIS-C is not available. The purpose of this study was to adapt and validate the CALIS-C for Spanish-speaking children. We examined the CALIS-C factorial structure, factorial invariance across gender, and psychometric properties in a community sample of 336 (46.7% girls) Spanish-speaking children aged 8-12years. Confirmatory factor analysis provided support for the original two-factor model. Excellent internal consistency coefficients were found for the total scale (0.88) and the subscales (0.85 and 0.82). 8-week test-retest reliability was moderate (IC = 0.51). Evidence of convergent and divergent validity was found, and factorial invariance across gender was reached. The current study provides initial support for the use of the CALIS-C with Spanish-speaking children by clinicians and researchers.

Impact of the radiographic method on treatment decisions related to dental caries in primary molars: a before-after study.

To evaluate the impact of radiographic examination on changes of treatment decision related to dental caries compared to decisions guided by visual inspection alone in primary molars. A total of 126 children aged 3-6years who had sought dental assistance were randomly selected and examined by two calibrated examiners using visual inspection. A treatment plan regarding dental caries was generated based on this assessment. The same examiners then evaluated two bitewing radiographs, creating an additional treatment plan guided by concurrent assessment of both visual and radiographic methods. Occlusal and proximal surfaces of primary molars received a treatment decision as follows: (i) no treatment, (ii) non-operative treatment, and (iii) operative treatment. The frequency of changes in the treatment decision after radiographic examination was calculated, with subsequent Poisson multilevel regression analysis to evaluate variables influencing such changes. Changes from "no treatment" decided with visual inspection to "non-operative treatment" after radiographic evaluation occurred in 52 surfaces (3.2%), and changes to "operative treatment" were observed in 46 dental surfaces (2.8%). Furthermore, 50 surfaces (6.2%) had their treatment decision changed from non-operative to operative treatment after radiographic assessment. In addition, changes were significantly more frequent in children with higher caries experience, on proximal surfaces and in 1st primary molars. The impact of radiographic examination on changes in the treatment decision of primary molars made with visual inspection is modest. Changes are more frequent in children with higher caries experience and in proximal surfaces. The benefits of the radiographic method for detecting caries in children, as a protocol in the diagnostic process, seem to be overestimated; the impact of this method on changes in treatment decision made by visual examination alone is low. Radiographs could be, however, useful in particular conditions, such as in children with high caries experience.

Group-Based Social Skills Training with Play for Children on the Autism Spectrum.

Despite widespread clinical use of group-based social skills training (SST) for children with autism spectrum disorder (ASD), there remains a lack of follow-up data, generalisation effects, common definition of social skills, and teacher report data. This study evaluated the effectiveness of an 8-week SST intervention with a play component (unstructured versus semi-structured) for children with ASD across a range of social, behavioural and emotional measures. Forty-five children aged 8-12years (M = 10.16, SD = 1.26) were assigned to one of three groups: (a) SST with unstructured play; (b) SST with semi-structured play; and (c) waitlist control. Compared to a waitlist control group, children who participated in the SST intervention showed significant gains in social skills and social competence over time.

The pattern of cystic echinococcosis in children in an endemic area in Morocco.

Cystic echinococcosis is a parasitic infection of major public health concern. The infection is generally acquired during childhood and the disease incubation period can last many years. The occurrence and characteristics of the disease in children were not well studied. The present study aimed to explore the pattern and features of cystic echinococcosis in children in rural and urban environments in Morocco. A total of 338 children diagnosed and treated for cystic echinococcosis were investigated. The trend of the infection, risk and exposure factors and the distribution of the anatomic locations of cysts were studied. A non-uniform decrease in proportions of infected children was found. Children from rural environs had significantly higher infection rates than children from urban environs (p < 0.001). Males were significantly more infected than females. Children aged 7-11years were the most affected. For cysts locations, single organ involvement was found in 94.4% of the children versus 5.6% with multi-organ localization. Despite control program, active transmission of echinococcosis still occurred in children and remains a major public health problem. The infection in younger population may have some features that need to be considered in the prevention and control programs in endemic areas.

Dental fear and its determinants in 7-11-year-old children in Tehran, Iran.

To assess dental fear and its determinants in 7-11-year-old children. In this cross-sectional (descriptive-analytical) study, the standard Persian version of the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) questionnaire was completed by 240 parent-child (children aged 7-11years) pairs referred to dental clinics in Tehran city, Iran. Background characteristics were also inquired. An equal number of boys and girls participated in the study. The mean score of fear among the children was 21.66 ± 8.33. The causes of fear among the children were, first, injection, and then, seeing the dentist's drill, choking feeling, and finally, filling the tooth. There was a significant correlation between the scores of children's dental fear and their experience of meeting with the dentist (p = 0.001). The result of the regression test showed that the age of the children (p = 0.022) and high levels of dental fear among their fathers (p < 0.001) was related to high levels of dental fear among the children. The present children revealed a moderate level of dental fear. Taking children's age into account in behavioural management and challenging father's fear seemed to play a key role to reduce the child's fear and prevent its long-term consequences.

A Developmental Study of the Narrative Components and Patterns of Chinese Children Aged 3-6Years.

To investigate the narrative development of Chinese-speaking children aged 3-6years, 80 children were prompted to tell personal stories. High point analysis was used and both narrative components and overall narrative patterns were analyzed. In terms of narrative components, Chinese children were more skillful in using complicating action, orientation and evaluation than they were in resolution, direct and reported speech. With age, their narratives were longer and richer in content. No gender differences were found in any of the seven narrative components. For narrative patterns, the most frequent was the two-event pattern at age 3 and the chronological pattern from age 4 to age 6. However, the chronological pattern at age 5 and 6 differed from the chronological pattern at age 4. The proportion of leap-frog, two-event and one-event patterns decreased with age, but most Chinese children at age 6 have yet to develop the ability to tell a classic narrative that includes resolution. These findings provided evidence for a developmental pattern of the narrative development in preschool Chinese children and suggested more attention should be paid to improve children's ability to resolve a story, telling listeners how everything worked out in the end.

The efficacy of Ritalin in ADHD children under neurofeedback training.

Current research has shown that neurofeedback (NF) is a viable treatment for attention deficit hyperactivity disorder (ADHD), however having pharmacological approach alongside such stimulants is still inevitable. Therefore, the purpose of this study is the comparison of neurofeedback with Ritalin and without Ritalin in treating children with ADHD. This study was causal-comparative in design. Participants were children aged 5-10years with ADHD; seven participants were in neurofeedback group with Ritalin and seven in neurofeedback without Ritalin group according to random split and parent's conformation. Clinical Q, Conner's continuous performance test (CPT), and WISC-R were used before and after treatment. For analyzing data, we used descriptive statistical and Mann Whitney U tests. Results showed that even if the two groups were modified in all components, modifications of commission and reaction time of the CPT and F4 theta/alpha of the clinical Q were more accurate in NF with Ritalin treatment rather than the other group. These findings suggest that neurofeedback is efficient in improving some of the behavioral concomitants of ADHD in children whose parents favored non-pharmacological treatment, but Ritalin and neurofeedback combination is more efficient. So, multimodal approach is strongly recommended for ADHD treatment.

Accuracy of identifying the cricothyroid membrane in children using palpation.

Accurate identification of the cricothyroid membrane (CTM) has paramount importance in the event of a 'cannot intubate, cannot oxygenate' scenario. We sought to determine the ability of anesthesiologists to correctly identify the CTM in obese and non-obese children. Anesthesiologists were asked to mark the entry point of the cricothyroidotomy device with an ultraviolet invisible pen on obese and non-obese (BMI < 95th percentile for age and sex) children aged 7-12years. A correct estimation was defined as a mark made between the upper and lower borders of the CTM and within the 3-mm midline. Twenty anesthesiologists palpated 30 obese and 50 non-obese children. The CTM was accurately identified with digital palpation in a total 55% of children, and there were no differences inaccurate identification rates of the CTM between obese and non-obese children [57 vs. 54%, respectively; median difference 3%; 95% confidence interval (- 20 to 25%); p = 0.82]. Accuracy was not correlated with any demographic or morphometric features of the children. Percutaneous identification of the CTM in children aged 7-12years was poor and not significantly different for obese and non-obese children. Pre-procedural ultrasonography may help to identify the landmarks for cricothyroidotomy.