Limitations Of Children Research Articles

"I think her life got so much better": parents' perceptions of children's quality of life following treatment of tracheomalacia with aortopexy.

Aortopexy is a procedure to reduce pressure on the trachea in children with severe tracheomalacia. Health-related quality of life (HRQoL) has not been studied in children who have undergone aortopexy; we aimed to explore parents' perceptions of their child's HRQoL before and after aortopexy. Parents of children < 18years who underwent aortopexy at a quaternary specialist centre were purposively sampled and invited to participate in a semi-structured interview. Data were analysed using reflective thematic and content analysis. Eight interviews (23-56min) were completed with parents whose children were aged 1.9-12.1years. HRQoL is explored through themes: a challenging diagnosis, lifechanging, and an understanding of limitations. Parents struggled to obtain a diagnosis of tracheomalacia while their child experienced serious symptoms. Aortopexy was seen as life-saving and allowed a return to family life. Airway safety, having their health and achieving a better quality of life were important outcomes of the procedure. Quality of life following aortopexy was perceived to be greatly improved. Children still struggled in aspects of their life, however families worked within their child's limitations, appreciating the life-saving nature of the intervention, and accepting the complexities of their child's comorbidities. Holistic interventions are important for those at risk of poor HRQoL outcomes.

Comparing Real-Time Continuous Glucose Monitoring to Self-Monitoring of Blood Glucose: Advantages and Limitations for Children and Adolescents With Type 1 Diabetes.

Objectives We aimed to determine the benefits and drawbacks of real-time continuous glucose monitoring (rtCGM) compared with those of self-monitoring of blood glucose (SMBG) in children and adolescents with type 1 diabetes (T1D) and their impact on glycemic control, hypo- and hyperglycemic episodes, exercise, quality of life, and psychosocial factors. Methodology This quantitative, comparative, cross-sectional study was conducted between July 2022 and March 2023 at the Pediatric Endocrine Outpatient Clinic, King Abdulaziz University Hospital, Saudi Arabia. Data were obtained via a clinical interview with children and adolescents with T1Daged 2-18 years. Results The study involved 121 participants, with 71 (58.7%)male patients and 50 (41.3%) female patients. The participants' mean age was 11.9 ± 4.4 years. Compared with patients using SMBG, patients using rtCGM demonstrated a more significant decrease in the mean glycated hemoglobin (HbA1c) level from baseline (7.79 ± 1.17 vs. 8.92 ± 1.63, P = 0.001), a reduction in the number of hypoglycemic episodes (85.7% vs. 70.6%, P = 0.028), and stable blood glucose level during exercise (97.2% vs. 76.4%, P = 0.001). Additionally, 65 (92.9%) rtCGM users had undisturbed sleep compared with 22 (43.1%) SMBG users. Approximately 64 (91.4%) rtCGM users reported that the sensor helped decrease their anxiety levels and pain sensations. Conclusions In this novel study in Saudi Arabia, rtCGM demonstrated a significantly better impact than SMBG on glycemic control, hypo- and hyperglycemic episodes, and psychosocial factors in children and adolescents with T1D.

Exercise Limitation in Children after Tetralogy of Fallot Repair Is Not related to Right Ventricular Dysfunction: Single Egyptian Center Experience

Exercise Limitation in Children after Tetralogy of Fallot Repair Is Not related to Right Ventricular Dysfunction: Single Egyptian Center Experience

Physical Activity Limitations In Children With Severe Haemophilia A. Does Emicizumab Make A Difference?

To assess the effect of emicizumab on physical activity in children with severe haemophilia A. The prospective cohortstudy was conducted from October 2021 to April 2022 at the Paediatric Department of Kafrelsheikh University Hospital, Egypt, in collaboration with the Haematology out-patient clinic of the Paediatric Department, Zagazig University, Egypt, and the Paediatric Department of Cairo University Hospital, Egypt, and comprised children aged 4-18 years with severe haemophilia A who received emicizumab prophylaxis. Paediatric Haemophilia Activities List was used to assess physical activity at baseline and aftersix months of regular emicizumab prophylaxis. Data was analysed using SPSS 26. There were 29 children, all (100%) boys, with mean age 8.7±3.51 years(range 4-15 years. Of them, 17(58.62%) patients were negative for inhibitors. Median Paediatric Haemophilia Activities Listsum score was 59.54 (interquartile range: 50.15-62.05) at baseline which moved up to 84 (interquartile range: 79.05-86.35) post-intervention (p<0.001). Emicizumab prophylaxis improved the level of physical activity in children with severe haemophilia A.

Statutory Limitations in Children’s Rights Protection under Cameroonian Legal Systems

In terms of Article 1(1) of the African Charter on the Rights and Welfare of the Child (African Children’s Charter), state parties are encouraged to recognise the rights, freedoms and duties enshrined in this Charter and to undertake the necessary steps, in accordance with their Constitutional processes and with the provisions of the present Charter, to adopt such legislative or other measures as may be necessary to give effect to the provisions of the African Children’s Charter. Legislation is one of the most powerful instruments a government has to regulate society and protect its citizens within its national territory. It also outlines the rights and responsibilities of individuals and authorities for whom legislation is intended to protect and govern. However, no amount of legislation will have value if there are neither discipline nor enforcement mechanisms, for example, through the establishment of key institutions. This article sets out to evaluate the sufficiency of the laws and institutions with a mandate to protect children’s rights in Cameroon.

Nutri-Score: Its Benefits and Limitations in Children's Feeding.

Reducing the burden of noncommunicable diseases (NCDs) is one of the top priorities of public health policies worldwide. One of the recognized means of achieving this objective is to improve the diet quality. The Nutri-Score (N-S) is a [five-color-A, B, C, D, E letters] front-of-pack labeling logo intended to help consumers quickly identify the healthier prepackaged foods within a food category. Available studies have shown that the N-S is an efficient tool to achieve this aim in terms of consumers' awareness, perception, understanding, and purchasing and that its use may help to reduce the prevalence of NCDs. The N-S is currently implemented on a voluntary basis in 7 European countries and a discussion is underway within the European Commission to achieve a harmonized mandatory label. However, no study on the putative impact of the N-S on children's dietary patterns and health is available. The N-S is not applicable to infants' and young children's formulas and to specific baby foods, the compositions of which are already laid down in European Union regulations. The N-S does not replace age-appropriate dietary guidelines. As children consume an increasing number of adult type and processed foods, the relevance of the N-S for children should be evaluated considering the children's high specific requirements, especially in younger children. This is especially necessary for fitting fat and iron requirements, whereas protein-rich foods should be better framed. Moreover, efforts should be made to inform on how to use the N-S and in education on healthy diets.

Exercise Limitation in Children after Tetralogy of Fallot Repair Is Not related to Right Ventricular Dysfunction: Single Egyptian Center Experience

Exercise Limitation in Children after Tetralogy of Fallot Repair Is Not related to Right Ventricular Dysfunction: Single Egyptian Center Experience

Assessment of Social Limitations in Children with Peanut Allergy Undergoing Peanut Oral Immunotherapy

We sought to describe responses to the Social Activities Limitations Inventory (SALI), a 20-item checklist to assess activity limitation due to food allergy, which has not previously been evaluated in children with food allergy pursuing oral immunotherapy (OIT).

Evidence to Underpin Vitamin A Requirements and Upper Limits in Children Aged 0 to 48 Months: A Scoping Review.

Vitamin A deficiency is a major health risk for infants and children in low- and middle-income countries. This scoping review identified, quantified, and mapped research for use in updating nutrient requirements and upper limits for vitamin A in children aged 0 to 48 months, using health-based or modelling-based approaches. Structured searches were run on Medline, EMBASE, and Cochrane Central, from inception to 19 March 2021. Titles and abstracts were assessed independently in duplicate, as were 20% of full texts. Included studies were tabulated by question, methodology and date, with the most relevant data extracted and assessed for risk of bias. We found that the most recent health-based systematic reviews and trials assessed the effects of supplementation, though some addressed the effects of staple food fortification, complementary foods, biofortified maize or cassava, and fortified drinks, on health outcomes. Recent isotopic tracer studies and modelling approaches may help quantify the effects of bio-fortification, fortification, and food-based approaches for increasing vitamin A depots. A systematic review and several trials identified adverse events associated with higher vitamin A intakes, which should be useful for setting upper limits. We have generated and provide a database of relevant research. Full systematic reviews, based on this scoping review, are needed to answer specific questions to set vitamin A requirements and upper limits.

Exercise Limitation in Children and Adolescents with Mild-to-Moderate Asthma.

BackgroundChildren with uncontrolled asthma are less tolerant to exercise due to ventilatory limitation, exercise-induced bronchoconstriction (EIB), or physical deconditioning. The contribution of these factors in children with controlled mild-to-moderate asthma is unknown.ObjectiveTo explore the underlying mechanisms of reduced exercise capacity in children with controlled mild-to-moderate asthma.MethodsThis was a cross-sectional study of 45 children and adolescents (age 8–18 years) with controlled mild-to-moderate asthma (asthma control test score 21–25) and 61 age-matched healthy controls. All participants completed a physical activity questionnaire and performed spirometry and cardiopulmonary exercise testing (CPET; maximal incremental protocol). Spirometric indices and CPET parameters were compared between the two groups. The effect of EIB (FEV1 decrease >10% post CPET), ventilatory limitation and physical deconditioning on maximum oxygen uptake (n{mathop {rm{V}}limits^.}nO2peak), was assessed by multivariable linear regression.Results62.2% of children with asthma and 29.5% of controls (P = 0.002) were categorized as inactive. Reduced exercise capacity (n{mathop {rm{V}}limits^.}nO2peak <80%) was noted in 53.3% of asthmatics and 16.4% of controls (P < 0.001). EIB was documented in 11.1% of participants with asthma. Physical deconditioning was noted in 37.8% of children with asthma and in 14.8% of controls (P = 0.013). Physical deconditioning emerged as the only significant determinant of n{mathop {rm{V}}limits^.}nO2peak, irrespective of asthma diagnosis, body mass index, ventilatory limitation and EIB.ConclusionChildren with controlled mild-to-moderate asthma are less tolerant to strenuous exercise than their healthy peers. The decreased exercise capacity in this population should mainly be attributed to physical deconditioning, while the contribution of ventilatory limitation and EIB is rather small.

Preventive Treatment on Sexual Abuse Survivor with Mental Retardation

The existence of limitations for children with mental retardation causes aninability to protect themselves so that they often become victims of sexualharassment. Preventive efforts are something that needs to be improved forprevention, considering the worse risks to children. The importance of an effortto prevent sexual abuse of children with mental retardation in connection withthe lack of knowledge about sexual abuse and the inability of children to facethe dangers that threaten themselves. From the results of research conductedin the United States in 1994, nearly 90% of children with mental retardationdisorders had experienced sexual abuse, as many as 49% had experiencedsexual abuse more than ten times. The high incidence of sexual abuseexperienced by children with mental retardation is due to various factors,namely the condition of children's limitations, lack of supervision andprotection of children by parents and the environment. Efforts that can be madeare increasing knowledge about sexual abuse and self-protection skills throughthe Behavioral Skills Training Group Program, where children are trained torecognize threatening objects and situations (sexual abuse). Increasingknowledge about sexual abuse and providing training (self-protection skills) isa significant primary preventive measure to reduce the risk of sexual abuse inchildren with mental retardation.

Developing a Self-Report Tool to Measure Functional Limitation in Children Aged 7-12 Years with Physical Dysfunction

Objective: To develop a self-report questionnaire to measure functional limitation in children aged 7- 12 years with physical dysfunction. Study design: Methodological research design Method: The study was conducted in phases: drafting of the questionnaire, content validation, pilot testing, revision of the questionnaire, field testing and test-retest reliability. A total of 66 items were generated through a review of the literature and interviews of twenty five children, their parents and health-care professionals. Qualitative and quantitative content validation through expert review and item reduction resulted in a 59-item questionnaire which was pilot tested on a sample of 10 children with physical dysfunction. With further inputs the questionnaire was revised. Thus, the final questionnaire with 60 items in two versions (a child and a caregiver’s version) in both Hindi and English was developed. Results: Qualitative review and Content validity was established for the Children’s Functional Limitation Scale. The questionnaire demonstrated high internal consistency (Cronbach’s alpha=0.91), moderate agreement between parents and children (weighted kappa= 0.718) and good test-retest reliability (weighted kappa=0.88). Conclusion: “Children’s Functional Limitation Scale” is a valid and reliable tool for documenting difficulties perceived by children with physical dysfunction. Also, the study demonstrates ability of children to reliably report their limitations. Keywords: Functional limitation, Activities of Daily living, Self-Report, Questionnaire, Children with physical dysfunctions

Exercise Limitation in Children and Adolescents With Severe Refractory Asthma: A Lack of Asthma Control?

BackgroundPatients with severe refractory asthma (SRA), even when using high doses of multiple controller medications in a regular and appropriate way, can have persistent complaints of exercise limitation.MethodsThis was a cross-sectional study involving patients with SRA (treated with ≥ 800 μg of budesonide or equivalent, with ≥ 80% adherence, appropriate inhaler technique, and comorbidities treated), who presented no signs of a lack of asthma control other than exercise limitation. We also evaluated healthy controls, matched to the patients for sex, age, and body mass index. All participants underwent cardiopulmonary exercise testing (CPET) on a cycle ergometer, maximum exertion being defined as ≥ 85% of the predicted heart rate, with a respiratory exchange ratio ≥ 1.0 for children and ≥ 1.1 for adolescents. Physical deconditioning was defined as oxygen uptake (VO2) < 80% of predicted at peak exercise, without cardiac impairment or ventilatory limitation. Exercise-induced bronchoconstriction (EIB) was defined as a forced expiratory volume in one second ≥ 10% lower than the baseline value at 5, 10, 20, and 30 minutes after CPET.ResultsWe evaluated 20 patients with SRA and 19 controls. In the sample as a whole, the mean age was 12.9 ± 0.4 years. The CPET was considered maximal in all participants. In terms of the peak VO2 (VO2peak), there was no significant difference between the patients and controls, (P = 0.10). Among the patients, we observed isolated EIB in 30%, isolated physical deconditioning in 25%, physical deconditioning accompanied by EIB in 25%, and exercise-induced symptoms not supported by the CPET data in 15%.Conclusion and Clinical RelevancePhysical deconditioning, alone or accompanied by EIB, was the determining factor in reducing exercise tolerance in patients with SRA and was not therefore found to be associated with a lack of asthma control.

Preventive Treatment on Sexual Abuse Survivor with Mental Retardation

The existence of limitations for children with mental retardation causes an inability to protect themselves so that they often become victims of sexual harassment. Preventive efforts are something that needs to be improved for prevention, considering the worse risks to children. The importance of an effort to prevent sexual abuse of children with mental retardation in connection with the lack of knowledge about sexual abuse and the inability of children to face the dangers that threaten themselves. From the results of research conducted in the United States in 1994, nearly 90% of children with mental retardation disorders had experienced sexual abuse, as many as 49% had experienced sexual abuse more than ten times. The high incidence of sexual abuse experienced by children with mental retardation is due to various factors, namely the condition of children's limitations, lack of supervision and protection of children by parents and the environment. Efforts that can be made are increasing knowledge about sexual abuse and self-protection skills through the Behavioral Skills Training Group Program, where children are trained to recognize threatening objects and situations (sexual abuse). Increasing knowledge about sexual abuse and providing training (self-protection skills) is a significant primary preventive measure to reduce the risk of sexual abuse in children with mental retardation.

Little Voices: The Importance and Limitations of Children’s Histories

Abstract In a complement to the 2020 AHR Roundtable “Chronological Age: A Useful Category of Historical Analysis” (125, no. 2), this AHR Exchange focuses on the history of children and childhood. Sarah Maza presents a critical review essay, highlighting the limiting factors in the expanding field of childhood studies. Children, she observes, produce few sources of their own voices, have limited agency, and as individuals and as a group soon outgrow their subaltern status—they grow up. Robin P. Chapdelaine, Nara Milanich, Steven Mintz, Ishita Pande, and Bengt Sandin—historians representing diverse geographical, theoretical, and methodological perspectives on the history of children and childhood—react to Maza’s observations by bringing up important methodological questions about subjecthood, agency, and modernity. Maza’s rejoinder reflects on these questions and on the possibility of age-based historical agency.

An evaluation of participation restrictions and associated factors via the ICF-CY framework in children with acute lymphoblastic leukemia receiving maintenance chemotherapy.

Our aim was to determine impairments in physical functions, activity limitations, and participation restrictions with the International Classification of Functioning, Disability and Health version for Children and Youth (ICF-CY) framework in children with acute lymphoblastic leukemia (ALL) receiving treatment. Physical functions were assessed in terms of pain level, fatigue level, handgrip strength, and motor proficiency. Fine motor activities and lower extremity performance were assessed to determine activity limitations. Participation was assessed with a patient-reported questionnaire. Thirty children with ALL (mean age: 8.45 ± 3.33 years) were included. Pain and fatigue level were mild. Poor handgrip strength was found; their mean handgrip strength was 60% of the normative. Fifty-six percent of the children had below-average motor performance. Participation scores were considerably high, except for sport and physical functioning sub-score. Participation level was positively associated with bilateral coordination and duration after diagnosis, while negatively correlated with pain and fatigue level (p ˂ 0.05).Conclusion: The ICF-CY-based evaluation was useful to understand children's limitations in everyday life. Children with ALL need supportive interventions during treatments in terms of physical functioning and participation in activities. Children with ALL with higher pain and fatigue, poor bilateral coordination, and who were in earlier period after diagnosis had higher risk for participation restriction. What is Known: • Children with ALL had physical functioning limitations on treatments. • Participation restrictions were described in children with ALL off treatment. What is New: • The ICY-CY-based health and functioning evaluation allows health care professionals to globally determine limitations of everyday life in children with ALL on treatment. • Impairments in physical functions, pain severity, fatigue severity, and duration after diagnosis are associated with participation to everyday life in children with ALL on treatment.

Improving Sandwich Selection Can Favorably Impact Nutrients to Limit in Children: A Modeling Analysis Using What We Eat in America, 2003-2014 and the USDA Typical Food Pattern

Improving Sandwich Selection Can Favorably Impact Nutrients to Limit in Children: A Modeling Analysis Using What We Eat in America, 2003-2014 and the USDA Typical Food Pattern

Relationship of Parental Responses to Pain Catastrophization, Pain Intensity and Functional Limitations in Children with Functional Pain

Introduction: Pain is primarily a psychological experience. Based on social learning theory, studies have examined association between parental behaviours and child’s functioning in various pain situations. Objectives: 1) to examine relationship of parental responses to pain catastrophization, functional disability and pain intensity in children with functional pain complaints. 2) to explore psychosocial problems associated with functional pain. Methodology: Participants were 43 children diagnosed with functional pain, referred from Paediatric units of Kasturba Hospital, Manipal. Measures examining parental responses to pain, pain catastrophization, pain intensity, functional limitations and psychosocial problems were administered. Results: Analyses revealed significant associations between pain catastrophization and some of its types and functional disability. On the whole, statistically significant relationship between parental responses and pain catastrophization was not observed. But, on gender based analysis, solicitous parental response predicted pain rumination aspect of pain catastrophization in females. Among psychosocial problems, school and family problems were predominant. Conclusions: This study highlighted the role of pain catastrophization in predicting functional limitations in children and role of parental attention in increasing pain rumination in females. Hence, intervention should target the exaggerated pain perceptions, parental attention and psychosocial problems to ameliorate the functional limitations.

Solifenacin in Children and Adolescents with Overactive Bladder: Results of a Phase 3 Randomised Clinical Trial

BackgroundSolifenacin, an effective, well-tolerated treatment for adult overactive bladder (OAB) symptoms, has not been evaluated in placebo-controlled paediatric clinical trials. ObjectivesTo evaluate the efficacy and safety of once-daily oral solifenacin suspension in OAB patients aged 5–<12 yr (children) and 12–<18 yr (adolescents). Design, setting, and participantsThe study involved a 4-wk urotherapy run-in followed by 1:1 randomisation to 12-wk double-blind solifenacin or placebo treatment alongside urotherapy. InterventionSolifenacin paediatric equivalent doses (PEDs) of adult doses: 2.5mg, 5mg, 7.5mg, and 10mg. The starting dose was PED 5mg; all patients were titrated to an optimum dose at 3-wk intervals over 9 wk, resulting in ≥3 wk at the optimum dose before end of treatment (EoT). Outcome measurements and statisticsSuperiority of solifenacin versus placebo in change from baseline to EoT for mean volume voided/micturition (MVV, primary endpoint); daytime maximum volume voided/micturition (DMaxVV); incontinence episodes (mean/24h); mean number of incontinence-free days or nights/7 d; micturition frequency; and Micturition frequency adjusted for baseline total voided volume (VTB) as an exploratory parameter). Efficacy parameters were analysed using analysis of covariance. Safety parameters (treatment-emergent adverse events, serious adverse events, laboratory variables, vital signs, electrocardiogram, postvoid residual volume) are summarised using descriptive statistics. Results and limitationsIn children, solifenacin was superior to placebo in terms of the change from baseline to EoT for MVV (solifenacin-placebo difference 12.1ml, 95% confidence interval [CI] 0.2–24.0; p=0.046), DMaxVV (difference in adjusted mean change from baseline for solifenacin–placebo 31.9ml, 95% CI 4.3–59.5; p=0.024), VTB-adjusted micturition frequency (p=0.028). Other endpoints were not significantly different. Solifenacin was well tolerated. For adolescents, it was not possible to draw firm efficacy conclusions because of the low numbers recruited. ConclusionsOnce-daily solifenacin oral suspension in children with OAB was superior to placebo for MVV (primary efficacy endpoint) and was well tolerated. Patient summaryIn this 12-wk study, a once-daily oral suspension of solifenacin in children aged 5–<12 yr with overactive bladder was superior to placebo in increasing mean volume voided/micturition, the primary efficacy variable in the study. Solifenacin was well tolerated, with a low incidence of dry mouth and constipation.This study is registered at ClinicalTrials.gov as NCT01565707.

P-19: Impaired Pulmonary Function and Ventilatory Limitation in Children With Successfully Repaired Oesophageal Atresia

Significant respiratory morbidity, such as aspiration and recurrent pneumonia occur commonly in young children with oesophageal atresia/tracheo-oesophageal fistula (OA/TOF). Despite clinical improvement with age, lung function may be irreversibly impaired. The role of cardiopulmonary exercise testing (CPET) in the assessment of children with OA/TOF is unknown. To assess lung function, exercise capacity and ventilatory reserve in OA/TOF children. Prospective evaluation of children ≥ 7 years attending a multidisciplinary OA/TOF clinic. Clinical assessment, spirometry and CPET (Bruce Treadmill Protocol) was performed when the child was clinically well. Eighteen children, aged 7.3–17.9 years, performed spirometry according to ATS guidelines. Fifteen children also performed a maximal CPET. BMI z-score range was −4.3–1.25. Thirty-nine percent experienced chronic cough/wheeze during the last year; 33% had a respiratory admission in the previous year; 11% asthma, 61% had a “TOF” cough, 50% experienced exercise limitation and 33% had undergone an aortopexy. Abnormal spirometry (FVC or FEV1 < 80%) was noted in 73% and an additional 3 children had distal airway obstruction (FEF25–75% < 80%). Normal exercise capacity was found in 14 children (93%). However ventilation limitation (defined as Ventilator Reserve <20% normal) was observed in 11 (73%). Perceived limitation had a sensitivity of 73%, PPV of 89% and NPV of 57%. Spirometry had a sensitivity of 81%, PPV of 100% and NPV of 67%. Our preliminary results suggest that perceived exercise intolerance and spirometry are insensitive assessments of ventilatory limitation. A negative history or spirometric evaluation does not exclude diminished breathing reserve.