Brazilian Children Research Articles

Food Neophobia in Children: A Case Study in Federal District/Brazil.

A reluctance to eat and/or avoidance of novel foods is characterized as food neophobia (FN). FN restricts the diet to familiar foods when, in fact, it should be much more varied. FN can be a barrier to healthy foods, affecting the quality of diet, and impairing children's growth and development. Therefore, according to their caregivers' perceptions, this study aimed to evaluate FN in children from Federal District/Brazil. The Brazilian Children's Food Neophobia Questionnaire (BCFNeo), a specific instrument developed and validated in Brazil, was answered by caregivers of children aged 4 to 11 y/o. Sampling occurred through snowball recruitment, being convenient and non-probabilistic. The Health Sciences Ethics Committee approved the study. The analysis evaluated FN in total (BCFNeoTot) and in the following domains: general (FNgen), for fruits (FNfru), and for vegetables (FNveg). FN scores were compared between sex and child's age and categorized according to three ordinal levels. FN levels were compared using the Mann-Whitney U test. The Friedman test, followed by the Wilcoxon test with Bonferroni correction, was performed to analyze differences in FN according to the environment. Of the caregivers' answers for their children, 595 answers were included, because 19 were out of age. The prevalence of high FN was 42.9%. The domain with the highest prevalence of high FN was vegetables (48.6%). Children aged 8 to 11 y/o had a higher mean FN in two domains (FNgen p = 0.047 and FNveg p = 0.038) when compared to children aged 4 to 7 y/o. Boys were more neophobic in all domains (FNgen p = 0.017; FNfru p = 0.010; FNveg p = 0.013; BCFNeoTot p = 0.008), and FN tends not to decrease with age. The results showed that the children of the FD are more neophobic than Brazilian children in general, highlighting the importance of additional studies in FN determinants in this population and nutritional education interventions to reduce FN among FD children.

A Population-Based Epidemiologic Study of Symptomatic SARS-CoV-2 Infections and Fatalities in Brazilian Children over 3 Years

To provide a comprehensive overview of the epidemiologic characteristics, outcomes, and risk factors of COVID-19-related deaths in children and adolescents in Brazil. We conducted a population-based, retrospective cohort study that included all patients aged <18years with laboratory-confirmed, symptomatic SARS-CoV-2 infection as registered in official Brazilian national surveillance systems for COVID-19 between February 2020 and February 2023. The primary outcome was COVID-19-related deaths. Odds ratios (ORs) of risk factors associated with death were estimated using multivariable logistic regression. Over a 3-year period, 2855704 pediatric patients with symptomatic SARS-CoV-2 infection were registered in Brazil. Of these, 59179 (2.1%) were hospitalized, 13844 (0.48%) were admitted to the intensive care unit, and 4943 (0.17%) received mechanical ventilation. A total of 4740 (0.17%) patients had fatal outcomes. The case fatality rate increased to 7.9% among patients who required hospitalization; 2102 (44.3%) patients who died did not receive advanced critical support. Notably, 2 (65%, 95% CI 58-71) or 3 doses (86%, 95% CI 81-89) of the vaccine provided strong protection against death. The following adjusted covariates were significantly associated with increased odds of death: age (0-4 and 11-17years), ethnicity (Brown and Indigenous), region (Northeast or North), dyspnea, nosocomial infection, and comorbidities. Conversely, living in the South or Central-West regions, admission in the later period of the pandemic, and receiving a vaccine were all associated with protection against death. Our findings suggest that a complex interplay between individual factors and social inequities has shaped the impact of COVID-19 on Brazilian children and adolescents.

Association between vitamin A supplementation and stunting and anemia in socially vulnerable Brazilian children.

Vitamin A is related to concentrations of insulin-like growth factor type 1, a protein produced in response to growth hormone, and to increased mobilization of body iron stores. Thus, vitamin A aids in increased hematopoiesis and may be useful in preventing stunting and anemia. This study aimed to identify the association between vitamin A supplementation from the National Vitamin A Supplementation Program instituted in Brazil and stunting and anemia in socially vulnerable Brazilian children. This is a Cross-sectional population-based study. Children aged 6-59months old, living in favelas of a capital city in the Northeast of Brazil, were included. Sociodemographic variables were collected. Vitamin A supplementation was also evaluated using the child's vaccination card information. Anthropometric and capillary hemoglobin evaluations were performed to identify the presence of stunting and anemia, respectively. The association analysis was performed using Poisson regression with robust variance estimation. 598 children participated in this study; 11.3% and 55.6% had stunting and anemia, respectively. As for vitamin A supplementation, 59.5% had taken at least one dose of the supplement,and 3.5% were on the complete supplementation scheme. In the adjusted association analysis, vitamin A supplementation decreased the likelihood of children having stunting and anemia by 8% (RP:0.86; 95% IC 0.86-0.98; p = 0.014) and 31% (RP:0.69; 95% IC 0.53-0.89; p = 0.004), respectively. Children who were fully supplemented were 58% (RP:0.42; 95% IC 0.24-0.77; p = 0.008) less likely to have anemia. Thus, vitamin A supplementation is a protective tool against stunting and anemia in children living in a situation of social vulnerability.

The Brazilian (FRANCO) method for dental age estimation: Willems' model revisited.

This study aimed (I) to test the Willems' dental age estimation method in different geographic samples of the Brazilian population, and (II) to propose a new model combining the geographic samples in a single reference table of Brazilian maturity scores. The sample consisted of 5017 panoramic radiographs of Brazilian males (n = 2443) and females (n = 2574) between 6 and 15.99 years (mean age = 10.99 ± 2.76 years). The radiographs were collected from the Southeastern (SE) (n = 2920), Central-Western (CW) (n = 1176), and Southern (SO) (n = 921) geographic regions. Demirjian's technique was applied followed by Willems' method and the proposed Brazilian model. Willems' method led to mean absolute errors (MAE) of 0.79 and 0.81 years for males and females, respectively. Root mean squared errors (RMSE) were 1.01 and 1.03 years, respectively. The Brazilian model led to MAE of 0.72 and 0.74 years for males and females, respectively, and RMSE of 0.93 years for both sexes. The MAE was reduced in 70% of the age categories. Differences between regions were statistically (p < 0.05) but not clinically significant. The new model based on a combined population had an enhanced performance compared to Willems' model and led to reference outcomes for Brazilians. Assessing patients' biological development by means of dental analysis is relevant to plan orthopedic treatments and follow up. Having a combined-region statistic model for dental age estimation of Brazilian children contributes to optimal age estimation practices.

Reference growth curves of anthropometric markers in Brazilian children and adolescents aged 7-14 years from southern Brazil.

Reference growth curves are viable tools for monitoring somatic growth. Therefore, the objective of this study was to develop reference growth curves for body mass, height, body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR) in Brazilian children and adolescents aged 7-14 years. The reference growth curves were constructed from a cross-sectional panel study using data from four surveys conducted in 2002, 2007, 2012/2013 and 2018/2019, with 9675 children and adolescents aged 7-14 years, of both sexes from Florianopolis, Southern Brazil. Growth curves were constructed using the LMS method, based on anthropometric indicators and indices (body mass, height, BMI, WC and WHtR), measured according to standardised norms. There was an increase in body mass, height, BMI and WC values with increasing age in both sexes and percentiles (P5, P10, P25, P50, P75, P85 and P95). The girls presented higher values of body mass, BMI and WC in the analysed percentiles, compared to the boys. Regarding height, there was a higher value from 10 to 11 years old in girls and from 12 to 14 years old in boys. WHtR decreased with increasing age in both sexes and analysed percentiles. Region-specific reference growth curves can enable the monitoring of somatic growth of particular paediatric populations, expanding discussions in different regions of the world.

Prevalence of obesity in Uruguayan and Brazilian children according to exclusive breastfeeding duration and ultra-processed food intake

Prevalence of obesity in Uruguayan and Brazilian children according to exclusive breastfeeding duration and ultra-processed food intake

Zika virus vertical transmission induces neuroinflammation and synapse impairment in brain cells derived from children born with Congenital Zika Syndrome

Zika virus (ZIKV) infection was first reported in 2015 in Brazil as causing microcephaly and other developmental abnormalities in newborns, leading to the identification of Congenital Zika Syndrome (CZS). Viral infections have been considered an environmental risk factor for neurodevelopmental disorders outcome, such as Autism Spectrum Disorder (ASD). Moreover, not only the infection per se, but maternal immune system activation during pregnancy, has been linked to fetal neurodevelopmental disorders. To understand the impact of ZIKV vertical infection on brain development, we derived induced pluripotent stem cells (iPSC) from Brazilian children born with CZS, some of the patients also being diagnosed with ASD. Comparing iPSC-derived neurons from CZS with a control group, we found lower levels of pre- and postsynaptic proteins and reduced functional synapses by puncta co-localization. Furthermore, neurons and astrocytes derived from the CZS group showed decreased glutamate levels. Additionally, the CZS group exhibited elevated levels of cytokine production, one of which being IL-6, already associated with the ASD phenotype. These preliminary findings suggest that ZIKV vertical infection may cause long-lasting disruptions in brain development during fetal stages, even in the absence of the virus after birth. These disruptions could contribute to neurodevelopmental disorders manifestations such as ASD. Our study contributes with novel knowledge of the CZS outcomes and paves the way for clinical validation and the development of potential interventions to mitigate the impact of ZIKV vertical infection on neurodevelopment.

Spatial clusters and social inequities in COVID-19 vaccine coverage among children in Brazil.

This study examined the spatial distribution and social inequalities in COVID-19 vaccine coverage among children aged 5-11 in Brazil. First and second dose vaccine coverage was calculated for all Brazilian municipalities and analyzed by geographic region and deciles based on human development index (HDI-M) and expected years of schooling at 18 years of age. Multilevel models were used to determine the variance partition coefficient, and bivariate local Moran's I statistic was used to assess spatial association. Results showed significant differences in vaccine coverage rates among Brazilian municipalities, with lower coverage in the North and Midwest regions. Municipalities with lower HDI and expected years of schooling had consistently lower vaccine coverage rates. Bivariate clustering analysis identified extensive concentrations of municipalities in the Northern and Northeastern regions with low vaccine coverage and low human development, while some clusters of municipalities in the Southeast and South regions with low coverage were located in areas with high HDI-M. These findings highlight the persistent municipal-level inequalities in vaccine coverage among children in Brazil and the need for targeted interventions to improve vaccine access and coverage in underserved areas.

Targeted Therapy With Vemurafenib in Brazilian Children With Refractory Langerhans Cell Histiocytosis: Two Case Reports and Review of Literature.

Langerhans cell histiocytosis (LCH) is a clonal myeloid neoplasm with inflammatory component. Refractory disease is a challenge, but vemurafenib has emerged as a therapeutic option. We will delineate the cases of two Brazilian children suffering from refractory LCH with a positive response to vemurafenib. Both cases had a diagnosis of multisystem disease with involvement of organs at risk and had not responded to standard and second-line treatment. After refractoriness to classic treatment regimens, the BRAF mutation was investigated and found to be positive in both patients, and target therapy with vemurafenib was sought. The first case has been using vemurafenib for about 2 years and the second case has been using it for about 3 years, having had an attempt to suspend the medication after concomitant use with maintenance therapy. However, the disease returned 4 months after stopping the medication. Fortunately, the disease returned to remission status after the medication was reintroduced. These cases represent the first reported instances of off-label vemurafenib use in Brazil for the treatment of LCH and both patients have demonstrated excellent responses to the medication. However, the long-term side effects are unknown in children, and prospective studies are needed. In addition, there is a lack of epidemiological data on histiocytosis in Brazil and studies evaluating the budgetary impact of incorporating BRAF mutation research and the use of vemurafenib into the public health system. These reports could be a starting point.

Assessment of Biochemical, Inflammatory Biomarkers and Ultra-Processed Food Consumption in Children with Small Intestinal Bacterial Overgrowth: A Cross-Sectional Study.

This study evaluated anthropometric, biochemical, and inflammatory biomarkers, as well as dietary intake in Brazilian children diagnosed with small intestinal bacterial overgrowth (SIBO) and compared them with their counterparts without SIBO. This was a cross-sectional study with 106 children aged 7 to 10 years. A glucose-hydrogen breath test was performed to diagnose small intestinal bacterial overgrowth (SIBO). Anthropometric and dietary characteristics were assessed. Blood samples were collected and serum biochemical parameters and cytokines were measured. The occurrence of SIBO was 13.2%. Age, BMI, BMI/age WC, BFP, sex and biochemical markers were similar between SIBO-positive and SIBO-negative children (p > 0.05). High consumption of ultra-processed foods tended to be higher in SIBO-positive compared to SIBO-negative children (47.8 ± 8.2 vs. 42.6 ± 9.5, p = 0.06). Serum levels of IL-17 were higher in SIBO-positive than in SIBO-negative children [69.5 (5.4-125.7) vs. 53.4 (2.3-157.7), p = 0.03], while serum levels of IL-10 were lower in SIBO-positive than in SIBO-negative children [2.3 (0.6-7.2) vs. 5.7 (0.5-30.8), p = 0.04]. Finally, in a logistic regression adjusted for sex, BMI and age, consumption of ultra-processed foods (p = 0.03) and IL-6 levels (p = 0.003) were found to contribute to the occurrence of SIBO. this study identified for the first time an occurrence of 13% of SIBO in children living in the northeastern region of Brazil and showed that consumption of ultra-processed foods and serum levels of IL-6 may influence the occurrence of the SIBO in the pediatrics population.

Exploring Maternal Socio-Demographic Factors Shaping Children's Dietary Patterns in Brazil: Results from the 2019 National Health Survey.

This study aimed to identify the dietary patterns of Brazilian children aged 6-23 months and to investigate their association with maternal socio-demographic factors. Data from the 2019 Brazilian National Health Survey were used in this cross-sectional study. Mothers of 1616 children aged 6-23 months reported on their children's dietary intake. Dietary patterns were identified using principal component analysis, and their associations with maternal socio-demographic characteristics were assessed using linear regression models. The first consisted of healthy patterns and the second, unhealthy ones. Linear regression showed that adherence to a healthy dietary pattern was higher among children of mothers who were older (β = 0.02, p = 0.01), had more years of education (β = 0.49, p = 0.04), reported living with a partner (β = 0.29, p = 0.01), and resided in an urban area (β = 0.35, p = 0.01). Conversely, adherence to the unhealthy pattern was positively associated with mothers who declared themselves as black or brown (β = 0.25, p = 0.03). Our results show that older mothers with higher levels of education and paid work and who live with a partner are more likely to contribute to their children's healthy eating patterns. We conclude that socio-demographic factors may influence the quality of the food offered to children. Nevertheless, advocating for public policies promoting nutritious complementary diets emphasising fresh and minimally processed foods remains crucial for children whose mothers do not possess these favourable socio-demographic characteristics.

Accuracy of arm circumference in the diagnosis of overweight in six-year-old children

The aim was to estimate the accuracy of arm circumference in diagnosing overweight among a sample of Brazilian children. A cross-sectional study involving 1,026 six-year-old children from Palhoça, Santa Catarina, was conducted. The correlation between arm circumference and body mass index was assessed using Pearson's correlation coefficient. Accuracy was evaluated using the Receiver Operator Curve and its corresponding confidence interval. A correlation of 0.634 and a coefficient of determination of 0.402 were observed. The overall accuracy was 85.4%. Sensitivity values for the most prevalent measures were 17.0% in males and 20.7% in females. The overall accuracy of 85.4% and the low sensitivity values of the most prevalent measures highlight the need for further studies on this diagnostic method in Brazilian populations.

Psychometric properties of the knowledge and understanding questionnaire of the canadian assessment of physical literacy-2 in low-income brazilian children

This study aimed to translate and cross-culturally adapt the Physical Literacy Knowledge (PLK) questionnaire from Canadian Assessment of Physical Literacy-2 for Portuguese version, and to evaluate its psychometric properties (construct validation, content, composite reliability, measurement invariance) in low-income Brazilian children. The sample comprised of 562 children (247 girls), aged between 8.00 and 12.99 years-old (10.20±1.20 years), enrolled in the 12 public-school in Lagoa do Carro city, Pernambuco, Brazil. A translation and cross-cultural adaptation of the PLK questionnaire was carried out. Content validity was determined by calculating the content validity coefficient, which assesses the relevance, clarity and pertinence of total (CVCt) and each question individually (CVCi). The dimensional structure of the PLK and alternative models were considered with first and second order models. Internal consistency was assessed using composite reliability. Structural invariance (configural, metric, scalar and strict) between sexes was also assessed using a multigroup factor analysis. Content validity was considered acceptable, varying between 0.88 and 1.00 for CVCi, and 0.91, 0.94 and 0.99 for clarity, pertinence and relevance in the CVCt, respectively. Construct validity was considered adequate, with 3 dimensions and 9 items model being the most appropriate [χ²(df)=34.01(24); CFI=0.92; TLI=0.87; RMSEA=0.03; SRMR=0.04; 90%CIRMSEA=0.00-0.05]. The questionnaire was structurally invariant (all ΔCFI&lt;0.05). Based on the findings, the PLK questionnaire has adequate psychometric properties to assess the cognitive domain of Physical Literacy in low-income Brazilian children. Key-words: Physical Literacy; Cognition; Children; Psychometry; Child Development.

Demirjian's and Cameriere's Methods for the Assessment of Dental Age Estimation in Children from a Southern Brazilian City.

The chronological age estimation of living individuals is a crucial part of forensic practice and clinical practice, such as in orthodontic treatment. It is well-known that methods for age estimation in living children should be tested on different populations. Ethnic affiliations in Brazil are divided into several major groups depending on the region, with the south of Brazil being known for its German immigration. (1) Background: This study aimed to evaluate the correlation between chronological age and dental age using Demirjian's method and Cameriere's method in a group of children from Joinville, South Brazil to investigate if both methods can be used to estimate dental age in this population. (2) Methods: The sample consisted of 229 panoramic radiographs (119 were males and were 110 females) from Brazilian children (ages ranging from 6 to 12 years). The chronological age at the time of the panoramic radiographic exam was calculated for each child. The dental age was estimated according to Demirjian's method and Cameriere's method. All continuous data were tested for normality by using the Shapiro-Wilk test. The Pearson correlation coefficient test was applied. An alpha of 5% (p < 0.05) was used for all analyses. (3) Results: The mean chronological age was 8.75 years. According to Demirjian's method, the mean dental age was 9.3 years, while according to Cameriere's method, the mean dental age was 8.66 years. A strong correlation between chronological age and dental age according to Demirjian (r = 0.776 and p < 0.0001) and Cameriere (r = 0.735 and p < 0.0001) was observed for both genders. (4) Conclusions: Both methods presented a good correlation with chronological age in the studied population and could be used to assess dental age in this population.

Brazilian children’s theories of empathy: Exploring character through art

ABSTRACT Though academic research and public policy have directed much attention to how education can promote empathy in children, fewer studies have examined exactly how children define empathy. During the COVID-19 pandemic, the Brazilian NGO Usina da Imaginação engaged in a long series of arts and storytelling workshops with children across the socioeconomic spectrum and then used research methods from ethnography, literary studies, and documentary film to hear children’s ideas and theories about alterity, solidarity, and empathy. These interviews showed that for this group of children, art is a transpersonal feeling: one girl described music as a synapse capable not only of connecting neurons within a brain, but of connecting one brain with another. A close genealogy of these children’s theories shows how they emerge from both indigenous and afro-Brazilian practices of esthetic sociality, valuing being-together as a principal element of human flourishing and valuing collective art as a privileged part of that process.

Phonological Awareness and Its Role in Literacy Development among Elementary School Children in Brazil

Purpose: The aim of the study was to analyze the phonological awareness and its role in literacy development among elementary school children in Brazil. Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries. Findings: Phonological awareness plays a crucial role in literacy development among elementary school children in Brazil, as evidenced by several key findings. It significantly correlates with early reading skills, including decoding and word recognition, fostering better comprehension abilities as children progress academically. Effective phonological awareness instruction enhances spelling and writing skills, contributing to overall language proficiency in Portuguese. Unique Contribution to Theory, Practice and Policy: Cognitive-developmental theory (Piaget), connectionist theory (Rumelhart and McClelland) &amp; socio-cultural theory (Vygotsky) may be used to anchor future studies on the phonological awareness and its role in literacy development among elementary school children in Brazil. Educators in Brazil should prioritize early and systematic phonological awareness instruction in literacy programs. Education policies in Brazil should advocate for comprehensive literacy frameworks that recognize phonological awareness as a foundational skill.

Perceptions of Non-sugar Sweeteners Among Parents of Children in Brazil

Perceptions of Non-sugar Sweeteners Among Parents of Children in Brazil

Behavioral and Physiological Responses as a Function of Dental Anxiety Among Brazilian Children [Conference Presentation Abstract

Behavioral and Physiological Responses as a Function of Dental Anxiety Among Brazilian Children [Conference Presentation Abstract

Participation and environment measure - children and youth: PEM-CY Brazil measurements properties

BackgroundParticipation of children with disabilities is an indicator of social inclusion, health, and well-being, and its evaluation needs to be included in the clinical practice of rehabilitation professionals. ObjectivesTo investigate the measurement properties of the Participation and Environment Measure - Children and Youth Brazilian version (PEM-CY Brazil). MethodsWe used the PEM-CY to evaluate participation and environment of children with and without disabilities in the home, school, and community settings. Based on COSMIN guidelines, we analyzed two measurement properties: internal consistency for all domains using Cronbach's alpha; and construct (known-groups) validity, i.e., the degree to which instrument scores identify differences between groups. T-tests, Mann-Whitney, or Chi-square tests compared children with and without disabilities. Results101 Brazilian children (mean age=9.31 years) with (n = 62) and without (n = 39) disabilities were included. Internal consistency ranged from appropriate (0.70) to excellent (0.95) for all domains in all settings, except for Resources in the environment of the home setting (0.53). Regarding construct validity, PEM-CY participation scores were significantly different between groups in most domains. Children with disabilities were significantly less involved and participated in a smaller number of activities in all settings, in comparison to those without disabilities. The PEM-CY scores in all settings of the environment were significantly higher in the group of children without disabilities. ConclusionPreliminary support was provided for the internal consistency and construct (known-groups) validity of the PEM-CY Brazil to measure participation and the environment in the Brazilian context. The PEM-CY can therefore be used by rehabilitation professionals in Brazil.

The Similarity Degree of the Anthropometric and Body Composition Variables of Brazilian and Mozambican Schoolchildren: A New Approach Using the Smoothed Jaccard Index Surface.

Brazil and Mozambique face similar socioeconomic challenges, including common indicators of undernutrition and overnutrition among children. This study evaluated the similarity degree of the anthropometric and body composition variables of Brazilian and Mozambican children by using the Jaccard index. A total of 1831 children of both genders aged 7-10 years from three Brazilian cities (Recife, Vitoria de Santo Antao, and Lagoa do Carro) and three Mozambican cities (Maputo, Boane, and Inhambane) participated in this study. Anthropometric (height, body mass, and waist circumference) and body composition (body fat percentage [%BF], lean mass, and fat mass) variables were measured and the Smoothed Jaccard Index Surface (SJIS) was used to evaluate the similarity degree. Brazilian children were taller and heavier and had a higher %BF and fat mass than Mozambican children. Children living in urban areas were taller than those living in rural zones in both countries. Brazilian and Mozambican children showed high similarity only between %BF and lean mass. Children from Recife and Maputo had high similarities among waist circumference, body mass, fat mass, height, and %BF. Finally, a high SJIS degree was observed among height and %BF for schoolchildren from rural and urban zones. Brazilian and Mozambican children exhibit differences in growth characteristics but a high degree of similarity when children from rural and urban zones are compared.