Children's Quality Research Articles

Cerebellar Mutism Syndrome in Children After Surgery for a Posterior Fossa Tumor: Patient Characteristics and Recovery.

Background: Cerebellar mutism syndrome (CMS) is a potential complication that may be experienced by children undergoing a resection of a posterior fossa tumor. Symptoms include mutism and emotional lability; additional symptoms may include hypotonia, difficulty swallowing, ataxia, and changes in cognition. The recovery of children experiencing CMS symptoms can be variable. In this retrospective chart review study, we identified the presenting characteristics of CMS in a cohort of children and compared them to matched-controls who did not develop CMS and examined recovery patterns during the year after diagnosis. Methods: Patients were identified through the program database. Children between ages 3 and 18 years who had a craniotomy for a posterior fossa tumor at our institution were included. For each CMS case, two control cases were selected to match the type of central nervous system tumor, sex, age group, and surgery date. Patient characteristics were abstracted from the patient's electronic medical record and the CMS survey was used to score CMS cases. Results: Seventeen children with CMS and 34 children without CMS were included in the review. Among children with CMS, 53% experienced mutism for less than 4 weeks; ataxia persisted beyond 4 weeks for more than 88% of the children and was still present in 71% 1 year after diagnosis. Clinical characteristics did not differ between the case and control groups. Discussion: CMS symptoms interfere with the child's quality of life and ongoing development. Study findings inform nurses providing anticipatory guidance and support to patients experiencing CMS and their families.

Bringing PROMIS to Early Childhood: Introduction and Qualitative Methods for the Development of Early Childhood Parent Report Instruments.

Provide an overview of the Patient-Reported Outcomes Measurement Information System (PROMIS®) Early Childhood Parent Report measurement development project and describe its qualitative methods. The PROMIS Early Childhood (PROMIS EC) initiative used the PROMIS mixed-methods approach to patient-reported outcome development, with insight from the developmental specification framework to create parent report measures appropriate for assessing young children's health-related quality of life. Qualitative methods to develop these instruments included expert input, literature and measure review, and parent concept elicitation and cognitive interviews to confirm the measure frameworks, item understandability, and developmental appropriateness. Twelve measures resulted from the PROMIS EC initiative. These parent report instruments cover young children's physical, mental, and social health. The new PROMIS EC Parent Report instruments offer clinicians and researchers brief and psychometrically robust tools to evaluate young children's physical, mental, and social health outcomes. Aligned with the PROMIS Pediatric instruments, the early childhood versions enable coherent lifespan measurement starting at age 1 while maintaining developmental sensitivity.

PQMP Phase 2: Implementation and Dissemination.

In 2009, the Children's Health Insurance Program Reauthorization Act provided an opportunity to consider and enhance the measurement of children's health care quality as a means to improve child health.1 The legislation required the identification of an initial Child Core Set of pediatric quality measures for voluntary use by Medicaid/Child Health Insurance Programs. The initial child core set was published in 2009 and is updated annually with 2024 being the first year of mandatory reporting.2

Parental Emotional Support, Family Functioning and Children's Quality of Life

Parental Emotional Support, Family Functioning and Children's Quality of Life

The Role of Paternal Parenting and Co-parenting Quality in Children's Academic Self-Efficacy.

This study explored the unique effect of fathers’ parenting behaviors and the quality of co-parenting described as the degree of consistency between paternal and maternal parenting behaviors on children’s academic self-efficacy. The power of both pancultural parenting behaviors (i.e., emotional warmth and rejection) and specific parenting controlling behaviors that are relatively common in Turkish culture (i.e., intrusion and guilt induction) in predicting academic self-efficacy was tested. A total of 1,931 children completed measures of parenting behaviors and academic self-efficacy in math and literature courses in their school. Overall, girls reported higher levels of literature self-efficacy, whereas boys reported higher levels of math self-efficacy. Compared to boys, girls perceived higher levels of positive parenting behaviors from both their fathers and mothers. The results of the regression analyses showed that, whereas father warmth had stronger effects on boys’ math self-efficacy, mother warmth had stronger effects on girls’ literature self-efficacy. Examination of the effects of co-parenting quality demonstrated that children with positively consistent parents (i.e., both parents having high positive and low negative parenting behaviors) reported the highest level of academic self-efficacy, whereas those having negatively consistent parents had the lowest level of academic self-efficacy. Analyses on inconsistent co-parenting, however, yielded compensatory effects, which were similar to positively consistent parents, and deterioration effects, which were similar to negatively consistent parents depending on the gender of parent and child, domain of parenting behavior, and academic efficacy. This study contributed to the current literature by showing the unique role of fathers over and beyond mothers, and confirmed the importance of positive parenting and parenting consistency in promoting children’s academic efficacy. Cultural and practical implications of the findings were discussed.

Associations of parent dietary role modeling with children's diet quality in a rural setting: Baseline data from the NU-HOME study

These analyses examined associations of parent dietary role modeling with diet quality among school-age children in a rural community. Past research has found protective associations between parent role modeling and children's dietary intake; however, there is a gap in understanding these associations for families in rural communities. Baseline data (2017 -2018) were drawn from the New Ulm at Home (NU-HOME) randomized controlled trial, conducted in the United States. The trial recruited 114 children (7–10 years old) and parents. Parents self-reported dietary intake [fruit and vegetable (FV), sugar-sweetened beverage (SSB), fast food (FF)] and frequency of sitting and eating with their child. Children reported parent role modeling of healthful eating (FV and salad at the evening meal; FV as snacks). Two 24-h dietary recalls assessed child diet quality indicators [Healthy Eating Index-2015 (HEI-2015) total scores, FV intake, SSB intake]. General linear models (GLM) and logistic regression analyzed associations of child diet quality (HEI score, FV intake, SSB intake) with parent dietary intake, parent sitting and eating the evening meal with their child, and child perceptions of parent role modeling healthful eating, adjusted for highest level of education in the home. Higher child HEI-2015 scores were positively associated with more frequent parent role modeling of fruit intake at meals, and inversely associated with more frequent parent role modeling of fruit as a snack; no significant associations of child FV intake with parent role modeling were observed. Higher child SSB intake was positively associated with parent FF intake. In this rural community, parents play significant roles in shaping children's dietary quality and intake, though more work needs to be done to address optimal intervention strategies to promote parent role modeling of healthful eating.

VALIDATION AND ANALYSIS OF THE KID-KINDL QUESTIONNAIRE IN MALAYSIAN PRIMARY SCHOOL CHILDREN FROM THE CHILDREN’S PERSPECTIVE

Health-related quality of life (HRQoL), conceptualized as the patient’s evaluations of their health status, is an essential indicator in evaluating health and health care and treating individual patients. The KID-KINDL questionnaire includes four main components: psychological well-being, social relationships, physical functions, and daily activities. This study aims to validate the KID-KINDL questionnaire in the Malay language and measure the HRQOL of Year One students from the children’s perspective. Forward and the Language Centre Universiti Sains Malaysia supervised the backward translation of the KID-KINDL questionnaire. The questionnaire's validation and reliability were assessed with Winstep™ software, using Rasch model statistics. KID-KINDL was applied to 90 Year One students in SK Zainab 2, Kota Bharu, Kelantan. Minor changes were made to the questionnaire after being translated. From the misfit item of those questions, the range to infit and outfit is beyond the acceptable scope for the Likert scale (0.6-1.4), and four questions were deleted in the validated version. Following validation, analysis with Rasch model statistics was carried out. This questionnaire will be used for further in-depth studies on children's health-related quality of life

The Effect of Chest Physiotherapy on Children's Quality of Life with Acute Lymphoblastic Leukemia and Pneumonia at Dr. Moewardi Hospital, Surakarta

Background: Acute lymphoblastic leukemia (ALL), a malignancy that is the most common form of leukemia found in children, accounting for about 30 percent of all pediatric cancer. The incidence of pneumonia is often found in children undergoing treatment for ALL. Complications of ALL and the side effects of its treatment can affect children’s quality of life. This study aimed to the effect of chest physiotherapy on children's quality of life with acute lymphoblastic leukemia and pneumonia. Subjects and Method: This was a quasi-experiment study conducted at the pediatric ward of Dr. Moewardi Hospital Surakarta, from February to August 2021. A number of 60 children aged 2-18 years with lymphoblastic leukemia and pneumonia was selected for this study. These children were divided into two groups, (1) 30 children with chest physiotherapy (intervetion group) and (2) 30 children received standard care (control group). Patients and parents were asked to fill out a quality of life assessment using the PedsQLTM 4.0 generic module. Mean difference of quality of life before and after chest physiotherapy between intervention and control group was examined using independent t test. Results: After intervention of chest physio­therapy, quality of life score in the intervention group (Mean= 68.91; SD= 12.30) was higher than control group (Mean= 60.12; SD= 7.72), with p= 0.002. Conclusion: Chest physiotherapy improves the quality of life in children with acute lymphoblastic leukemia and pneumonia.

Personality, Coping and Developmental Conditions in Female Adolescents and Young Adults with Type 1 Diabetes: Influence on Metabolic Control and Quality of Life.

ObjectiveTo assess personality factors, coping, developmental conditions and quality of life in female adolescents and young adults with type 1 diabetes (T1D) and high vs.low HbA1c.MethodsPatients were approached at the Department for Pediatrics, Medical University of Vienna; n = 129 female adolescents (10 to 23 years, mean age 15.21 ± 2.91) with type 1 diabetes were included. HIGH-A1c was defined as HbA1c > 7.5%, LOW-A1c as HbA1c ≤ 7.5% and compared to a sample of 56 age-matched female healthy controls. Self-rating questionnaires were used to assess psychosocial factors: Children's Depression Inventory (CDI); Junior Temperament and Character Inventory (J-TCI); Eating Disorders Inventory-2 (EDI-2); KIDCOPE; Subjective Family Image Test (SFIT) and Inventory of Life Quality in Children and Adolescents(ILC).ResultsT1D patients with HIGH-A1c were younger at the age of diabetes onset, had a longer diabetes duration, a higher maximum BMI, higher depression score, and higher frequency of diabetic ketoacidosis in the last year. They showed significantly higher levels of fatigue, lower levels of taking responsibility, lower ability to set goals and lower self-acceptance, as well as higher levels of ineffectiveness, lower levels of emotional attachment within the family, in particular with the fathers, and used negative coping strategies more often compared to patients with LOW-A1c. Furthermore, they reported significantly higher burden of illness and lower quality of life.ConclusionsDisadvantageous personality and coping styles as well as developmental conditions should be addressed in the treatment of female adolescents with T1D with management problems.

Alobar holoprosencephaly: Exploring mothers' perspectives on prenatal decision-making and prognostication.

Parents receiving a prenatal diagnosis of alobar holoprosencephaly (HPE) often experience uncertainty regarding the pregnancy prognosis. There is little known about how best to counsel and support families receiving the diagnosis. This study explored parental experiences and wishes after receiving a prenatal diagnosis of alobar HPE. This was a retrospective qualitative study. Semi-structured interviews were conducted to determine factors impacting parents' decision-making process, experiences with healthcare providers, and expectations for their child's length and quality of life. Interviews were analyzed using qualitative content analysis. Eight mothers who received a prenatal diagnosis of alobar HPE between 2013 and 2019 participated in the study. Parental expectations were based on information conveyed during prenatal counseling. Religious and personal beliefs, perceived suffering, and provider prognostication contributed to parent decisions and goals of care. Participants reported pressure to terminate the pregnancy. Parents were not prepared for the possibility of survival beyond the perinatal period. Most parents reported no regret in their choices. Patients receiving a prenatal diagnosis of alobar HPE desire access to balanced prenatal counseling about prognosis, morbidity, and mortality. Providers should explore values and beliefs that contribute to parents' goals of care and offer appropriate information and referrals.

Duration of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Participation is Associated With Children's Diet Quality at Age 3 Years

Adequate childhood nutrition contributes to prevention of chronic diseases. The supplemental foods and nutrition education provided by the Special Supplemental Nutrition Program for Women, Infants, and Children, a federal program serving women, infants, and children up to age 5 years in low-income families and at nutritional risk, intend to optimize dietary intakes. This study assesses associations between duration of the Special Supplemental Nutrition Program for Women, Infants, and Children participation, early feeding practices, and children's diet quality at age 3 years. Using data collected between 2013 and 2017 from the Special Supplemental Nutrition Program for Women, Infants, and Children Infant and Toddler Feeding Practices Study-2, investigators derived 4 mutually exclusive patterns of the Special Supplemental Nutrition Program for Women, Infants, and Children participation: participation in the child's first year only, participation into the second year, participation into the third year, and intermittent participation across 3 years. In 2021, multivariable regression assessed associations between these patterns, early feeding practices, and 2015 Health Eating Index total score at age 3 years. When compared with children who participated in the Special Supplemental Nutrition Program for Women, Infants, and Children into their third year, children who participated in their first year only (p<0.01) had 2015 Healthy Eating Index total scores that were 3.6 points lower on a given day. Children introduced to sugar-sweetened beverages in their first year had scores that were 2.4 points lower than children not introduced to them in their first 2 years (p=0.03), whereas those breastfed longer exhibited a small increase in scores (p<0.01). Longer participation in the Special Supplemental Nutrition Program for Women, Infants, and Children improves children's diets, potentially mitigating chronic disease risk. Clinician efforts to refer at-risk families to the Special Supplemental Nutrition Program for Women, Infants, and Children during the early childhood years are supported.

Evaluation of Depression, Anxiety, and Sleep Quality in Children Diagnosed With COVID-19.

COVID-19 has affected individuals of all age groups, both physically and mentally. We aimed to determine anxiety and depression in children diagnosed with COVID-19. Fifty children aged 8 to 18 years diagnosed with COVID-19 were included in the study. The children were evaluated the revised Child Anxiety and Depression Scale, STAI form TX-I (state anxiety inventory), and STAI form TX-II (trait anxiety inventory). Child Sleep Habits Questionnaire was applied for one of the parents according to three different periods. The periods were established as before the pandemic, during the illness-quarantine process, and after the quarantine. We observed the highest scores for depression-anxiety and the poorest sleep quality during the quarantine period. The scores for depression-anxiety were lower, and sleep quality scores were higher in the prepandemic period compared with after the quarantine period. Measures should be taken to protect mental health for children with COVID-19.

Translation of quality of life scale for pediatric patients with Fabry disease in Japan

IntroductionFabry disease is a rare, X-linked lysosomal storage disorder that begins in childhood with a wide variety of symptoms, including neuropathic pain, gastrointestinal abnormalities, and skin abnormalities. Despite the substantial impact of these symptoms on children's quality of life (QOL), systematic QOL analysis of Japanese pediatric Fabry disease patients has been limited. Therefore, to evaluate the QOL of Japanese pediatric Fabry disease patients using standardized and disease-specific scales, we used the Fabry-specific Pediatric Health and Pain Questionnaire (FPHPQ), which was developed by the Fabry Outcome Survey. MethodsThe FPHPQ was translated in accordance with the Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes. A back-translated version was reviewed twice by the original lead author of FPHPQ to confirm the conceptual equivalence. The questionnaire was then validated by cognitive debriefing, and distributed to pediatric Fabry disease patients in Japan. ResultsQuestionnaire responses were obtained from eight patients. The mean scores on the FPHPQ were 11.0 (± 11.43) for heat-associated pain, 5.5 (± 4.60) for cold-associated pain, and 14.8 (± 5.97) for abdominal pain and fatigue. In addition, heat-associated pain negatively correlated with physical well-being, whereas cold-associated pain positively correlated with good friendships. ConclusionWe established the Japanese version of the FPHPQ to assess the QOL of pediatric Fabry disease patients. The internal consistency and partial criterion-related validity of the Japanese version were confirmed. Analysis of a larger number of patients should be performed in the future to further validate the outcomes of this study.

Patient- and Examination-Related Predictors of 3D MRCP Image Quality in Children.

BACKGROUND. MRCP provides noninvasive imaging of the biliary tree and pancreatic duct. In our experience, MRCP image quality is commonly suboptimal in children. OBJECTIVE. The purpose of this study was to characterize the frequency of nondi-agnostic 3D fast spin-echo (FSE) MRCP acquisitions and determine predictors of nondi-agnostic MRCP image quality in children. METHODS. This retrospective study included 200 randomly selected pediatric patients (101 female and 99 male patients; mean age, 11.7 years) who underwent MRCP between January 1, 2019, and December 31, 2020. Patient- and examination-related variables were recorded. Three fellowship-trained pediatric radiologists independently reviewed 3D FSE MRCP acquisitions for diagnostic quality (diagnostic vs nondiagnostic) and overall image quality score on a scale from 1 to 5 (1 = worst image quality imaginable, 5 = best image quality imaginable). After computing interreader agreement, analyses used readers' most common diagnostic quality assessment and mean image quality score. Multivariable logistic regression and linear regression analyses were used to identify predictor variables of a diagnostic examination and higher image quality score. RESULTS. Interreader agreement for an MRCP acquisition being diagnostic quality, expressed as a kappa coefficient, was 0.53-0.71; interreader agreement for image quality score, expressed as an intraclass correlation coefficient, was 0.68-0.74. A total of 36 of 200 (18%) MRCP acquisitions were nondiagnostic; the mean image quality score was 3.5 ± 1.1 (SD). Multivariable predictors of a diagnostic MRCP acquisition included greater body mass index (OR = 1.11 [95% CI, 1.02-1.21]; p = .02), scanner field strength of 1.5 T (odds ratio [OR] = 2.87 [95% CI, 1.23-6.68]; p = .01), and presence of acute pancreatitis (OR = 4.91 [95% CI, 1.53-15.77]; p = .008). Multivariable predictors of a higher image quality score (β = 0.05-0.94) included older age (p = .01), imaging performed with patient under sedation or general anesthesia (p < .001), presence of biliary dilatation (p = .004), and inpatient status (p = .02). A lower image quality score was predicted by a scanner field strength of 3 T (β = -0.61; p < .001). A greater amount of time between the start of the MRI examination and the MRCP acquisition exhibited a nonsignificant association with a decrease in the image quality score (p = .06). CONCLUSION. Pediatric MRCP acquisitions are commonly nondiagnostic. Patient-specific and technical factors systematically impact MRCP image quality in children. CLINICAL IMPACT. Recognition of image quality predictors that are potentially modifiable and amendable to proactive intervention can guide efforts to optimize MRCP image quality in children.

Evaluation of Functional Vision and Eye-Related Quality of Life in Children with Strabismus.

BackgroundUnderstanding how strabismus impacts a child’s quality of life, as well as their families, should be an important key to guide treatment, not only from the ophthalmological point of view but also regarding psychological and social aspects, which are fundamental for a healthy and harmonious development.MethodsA cross-sectional study was performed to evaluate the functional vision and eye-related quality of life (ER-QOL) in a population of children with strabismus submitted or not to corrective surgery, using the recently developed Pediatric Eye Questionnaire (PedEyeQ) and to compare with age and gender-matched visually normal children. The PedEyeQ was applied to non-operated children with strabismus (n = 18), operated children with strabismus (n = 24), and visually normal children (n = 21). This instrument is composed of 3 components (Child, Proxy, and Parent) and has different versions according to the child’s age (0–4, 5–11, or 12–17 years-old versions). Clinical data such as age, type of strabismus, angle of deviation, amblyopia, occlusion treatment, and surgical outcome were also recorded.ResultsAll PedEyeQ domain scores were significantly lower in children with strabismus compared with visually normal children, except the Child “functional vision” domain. Children with strabismus with successful corrective surgery had significantly lower scores in many domains of the Child, Proxy, and Parent components, compared with visually normal children.ConclusionThis study showed that strabismus has an important impact on affected children and their families, as assessed by PedEyeQ. Interestingly, children with prior successful corrective strabismus surgery had worse PedEyeQ scores compared to visually normal children. Educational programs and psychosocial rehabilitation interventions should be implemented in children with strabismus and their families.

Health-related quality of life after pediatric cochlear implantation

ObjectivesTo examine the results of health-related quality of life (HRQoL) questionnaire scores from deaf children fitted with at least one cochlear implant (CI) and compare responses to normal-hearing age-peers (NHP) and to their parents. MethodsThis cross-sectional study included 33 pediatric patients with a hearing experience of at least 1 year with CI and a control group of 21 NHP. The KINDLR questionnaire for measuring HRQoL (generic) in children (7–12years) and adolescents (13–17years) and a CI questionnaire (specific) were completed by CI users and their parents. Scores were transformed to a 100-point scale with 100 representing the most positive response. ResultsThe group of children and adolescents with CI reached a similar score in the generic HRQoL (Children:78,6; Adolescents:80,4; p = 0,35) and in the overall CI questionnaire (Children:77,6; Adolescents:75,6; p = 0,53). CI users in both age groups scored generic HRQoL similarly to their NHP (NH children:82,2, p = 0,18; NH adolescents:77,5; p = 0,07) and higher than CI users from other centers (OC) (OC children:75,4; OC adolescents:70,3). CI users scored their school domain lower than their NHP (p = 0,04). Generic and CI questionnaire scores of parents and their children correlated positively (r = 0,66, p = 0,00 and r = 0,73, p = 0,00). The total scores of HRQoL in the self-rating and parent rating correlate with none of the variables at study (gender, cause of deafness, age at implantation, years with a CI, chronological age) except with speech progression (p = 0,007). ConclusionsChildren with CI experience similar quality of life as NHP. Parents are reliable reporters on the status of their child's overall quality of life.

Direct Cash Transfer Effect on Children Quality in Women’s Household in Indonesia

Many studies confirm the importance of the role of women in theeffectiveness of government programs, especially the programs aimedat improving family welfare. This study aims to examine the effect ofthe government program of direct cash transfers (BLT) on the humancapital of children in households headed by women in Indonesia.Data for the study was obtained from IFLS (wave 5) and analyzedwith multiple linear regression. The analysis results show that thereis a negative effect of BLT on the education of children. Previousstudies state this is due to the changing behavior of the recipienthouseholds or the spillover effects on the non-recipient households.This research proposes a different reason, such as social discriminationagainst households headed by women. The solid patriarchal culturein Indonesia often ignores female-headed households, so the numberof households receiving social protection programs is relatively verylimited.How to Cite:Setyari, N. P. W., &amp; Purwanti, P. A. P (2022). Direct Cash Transfer on Children Quality in Women’s Household in Indonesia. Signifikan: Jurnal Ilmu Ekonomi, 11(1), 83-94. https://doi.org/10.15408/sjie.v11i1.22769.

Parental Perceptions of Cerebral Palsy and Expectations of the Operation Outcomes in Greece and in Italy

Children with cerebral palsy (CP) are often hospitalized and have long stays, as they need surgeries and operations. The perioperative period can be perplexing for the people involved. This study investigates parents’ perceptions of CP and expectations of operation and surgery outcomes in Greece and in Italy during this crucial perioperative period. A total of 120 married parents participated in the study: 60 mothers and 60 fathers who had a biological child with CP. All children had operable CP and were under continuous medical/surgical treatment. Semi-structured interviews were used for data collection. Parents expressed diverse perceptions of CP whilst they had almost the same perceptions of it in both countries. They mainly represented CP as a medical problem affecting the whole family, including the child. Parent's expectations on orthopaedic surgeries concerned improving the child's quality of life, the level of its functional impairment and the rehabilitation of its movement and gait. There were no statistically significant differences as regards country of origin and parents’ gender on perceptions of CP and expectations of operation and surgery outcomes. This study suggests that parents outline a variety of perceptions of the condition of CP and of expectations concerning operation and surgery outcomes.

Determinants of Healthy Diet Among Children Exposed and Unexposed to Gestational Diabetes

ObjectivesTo evaluate the association between individual and environmental determinants of diet quality with diet quality of children exposed to gestational diabetes mellitus (GDM+) and unexposed (GDM−); to study the association between mother and child vegetables and fruit (VF) intakes. DesignCross-sectional study. ParticipantsOne hundred forty-two children (104 GDM+; 38 GDM−) aged 6.2 ± 2.5 years. VariablesCanadian Healthy Eating Index 2007 (HEI-C) and VF were obtained with 2 24-hour dietary recall questionnaires in children. Maternal VF was obtained by a validated food frequency questionnaire, and weight and height were measured. Sociodemographic determinants were obtained by questionnaires. AnalysisLinear regression models were used to evaluate the association between individual and environmental determinants and the HEI-C score with interaction for GDM status. ResultsFamily meals were associated with HEI-C among GDM− but not GDM+ children (β = 9.97, P = 0.01 and β = −0.41, P = 0.84, respectively; P for interaction = 0.02). Children's age (β = −1.45; 95% confidence interval, −2.19 to −0.72; P < 0.001) was a determinant of HEI-C among all children. Maternal VF intakes were positively associated with children's VF intake (r = 0.30, P < 0.001, r2 = 0.09), with association of larger variance among GDM− children (r = 0.38, r2 = 0.14, P = 0.02) than GDM+ children (r = 0.23, r2 = 0.05, P = 0.02). ConclusionsThe food environment at home was associated differently with the diet quality of GDM+ and GDM− children. Whether targeting family meals and maternal diet quality is a good strategy to improve children's diet quality among GDM+ children needs to be further investigated.

Pneumonia in Toddlers: Association of Characteristics and Nutritional Status

Pneumonia is one of the health problems that contribute to the mortality of toddlers. Pneumonia cases in children are determined by health history. The purpose of this study was to analyze the relationship between age, gender, birth weight, history of breastfeeding, nutritional status, and immunization status with the incidence of pneumonia in toddlers at the Kudus Aisyiyah Hospital. The design of this study was analytic observational with a cross-sectional approach. A total of 102 patients have participated as research respondents, and sampling was done using the accidental technique. The instrument used in this study is an observation sheet prepared for toddler patients with pneumonia. Data analysis was carried out using chi-square and fisher's exact method. The results showed that 48 patients (47.1%) had pneumonia. There was a significant relationship between the age of children under five (p=0.003) and birth weight (p=0.0001) with the incidence of pneumonia. There was no relationship between gender (p=0.399), exclusive breastfeeding (p=0.495), and nutritional status (p=0.141), with the incidence of pneumonia in children under five. The age variable is associated with the pneumonia incidence in toddlers at Kudus 'Aisyiyah Hospital. Mothers are expected to pay more attention to the health of their toddlers due to their vulnerability to a variety of diseases, particularly infectious diseases. Support and counseling programs from health workers were also expected to help mothers' understanding to improve their child's health quality.