Diverse Population Of Children Research Articles

Abstract P411: Child Opportunity and Behavioral Cardiovascular Health in Youth: The Young Hearts Study

Background: Low cardiovascular health (CVH) in childhood is linked to risk of cardiovascular events in adulthood in the US. Relationships between neighborhood characteristics could be important for CVH in children, as appears to be the case in adults. We sought to assess such associations, representing neighborhood characteristics by the Child Opportunity Index (COI) and using a composite behavioral CVH score in youth. Methods: We used baseline data from the Young Hearts study, which is studying CVH trajectories of children ages 0-20. We linked children’s addresses to the COI, with domains encompassing: (1) social and economic, (2) health and environmental, and (3) educational opportunity. CVH behaviors were defined using the Life’s Essential 8 framework and included: self-reported diet, physical activity, nicotine exposure, and sleep. Linear regression models assessed the association between COI and overall and component behavioral CVH scores after adjustment for child demographics, family SES, and moves in the last year. Overall CVH scores comprised of the mean value of 4 behavior-specific scores (each 0-100 points). Results: Participants (N=2202) were 9.5±5.4 years old; 46.3% were female, and 47.05% identified as non-Hispanic White, 25.3% as Hispanic, and 17.9% as non-Hispanic Black. Compared with high (favorable) COI, individuals with low COI had a 2.15-point lower (worse) mean behavioral CVH score (p=0.003); however, those with moderate COI did not have significantly lower mean scores. The pattern for the education domain was similar but weaker. In the social and economic domain, those with low and moderate COI both had lower behavioral CVH scores than those with high COI. The health and environment domain was not independently associated with CVH. Of individual metrics, only sleep scores (beta=68.32, p=0.005) were independently associated with COI after adjustment. Conclusion: COI, especially social and economic factors, were associated with overall behavioral CVH among a diverse population of children.

Outcomes of Gene Panel Testing for Sensorineural Hearing Loss in a Diverse Patient Cohort

A genetic diagnosis can help elucidate the prognosis of hearing loss, thus significantly affecting management. Previous studies on diagnostic yield of hearing loss genetic tests have been based on largely homogenous study populations. To examine the diagnostic yield of genetic testing in a diverse population of children, accounting for sociodemographic and patient characteristics, and assess whether these diagnoses are associated with subsequent changes in clinical management. This retrospective cohort study included 2075 patients seen at the Children's Communications Clinic, of whom 517 completed hearing loss gene panel testing between January 1, 2015, and November 1, 2021, at the University of California, San Francisco Benioff Children's Hospital system. From those 517 patients, 426 children with at least 2 audiograms were identified and analyzed. Data were gathered from November 2021 to January 2022 and analyzed from January to February 2022. The measures of interest were sociodemographic characteristics (age at testing, gender, race and ethnicity, primary language, and insurance type), hearing loss characteristics, and medical variables. The outcome was genetic testing results. Variables were compared with univariate and multivariable logistic regression. Of the 2075 patients seen at the Children's Communications Clinic, 517 (median [range] age, 8 [0-31] years; 264 [51.1%] male; 351 [67.9%] from an underrepresented minority [URM] group) underwent a hearing loss panel genetic test between January 1, 2015, and November 1, 2021. Among those 517 patients, 426 children (median [range] age, 8 [0-18] years; 221 [51.9%] male; 304 [71.4%] from an URM group) with 2 or more audiograms were included in a subsequent analysis. On multivariable logistic regression, age at testing (odds ratio [OR], 0.87; 95% CI, 0.78-0.97), URM group status (OR, 0.29; 95% CI, 0.13-0.66), comorbidities (OR, 0.27; 95% CI, 0.14-0.53), late-identified hearing loss (passed newborn hearing screen; OR, 0.27; 95% CI, 0.08-0.86), and unilateral hearing loss (OR, 0.04; 95% CI, 0.005-0.33) were the only factors associated with genetic diagnosis. No association was found between genetic diagnosis yield and other sociodemographic variables or hearing loss characteristics. Patients in URM and non-URM groups had statistically similar clinical features. A total of 32 of 109 children (29.4%) who received a genetic diagnosis received diagnoses that significantly affected prognosis because of identification of syndromic or progressive sensorineural hearing loss or auditory neuropathy spectrum disorder relating to otoferlin. This cohort study's findings suggest that genetic testing may be broadly useful in improving clinical management of children with hearing loss. More research is warranted to discover and characterize diagnostic genes for those who have been historically underrepresented in research and medicine.

Disparities in Speech and Language Delay Among Children With Aural Atresia.

To describe risk factors for speech and language delay in a diverse population of children with aural atresia. Retrospective chart review was performed from 2012 to 2020 at UCSF Benioff Children's Hospital to identify children with aural atresia evaluated for speech, language, or auditory skills delays. Ninety-five children with aural atresia, conductive hearing loss, and assessment of speech, language, or auditory skills delay were included. Demographic and clinical data were analyzed to identify predictors of speech and language delay. Cohort and case-control analyses were performed to determine risk factors for delayed intervention, and for ultimate delays in speech, language, or auditory skills. Children exhibited a wide diversity of race/ethnicity, primary home language, geography, and insurance status. Eighty-nine percent had unilateral aural atresia. Forty-eight percent had delays in speech, language, or auditory skills. Most children used hearing aids (84%), had educational accommodations (84%), and received speech therapy (63%). In a univariate retrospective cohort analysis, public-insured ( p = 0.004), non-English speaking ( p = 0.002) and non-white/non-Hispanic children ( p = 0.007) were found to be significantly less likely to be fit with hearing aids in infancy. Children with delays were fit with hearing aids at later ages. In a multivariate case-control analysis, primary home language was a significant predictor for presence of delays [OR, 3.9 (95% CI: 1.2-13.2), p = 0.03]. Disparities due to insurance type, primary language, and race/ethnicity are associated with delays in hearing aid fitting for children with aural atresia. Earlier, hearing amplification is correlated with reduced risk for speech, language, and auditory skills delay. These findings can help identify at-risk children for targeted support.

Factors Associated With Penicillin Allergy Labels in Electronic Health Records of Children in 2 Large US Pediatric Primary Care Networks

Penicillin allergy labels influence clinical decision-making, yet most children who are labeled do not have type 1 hypersensitivity allergic reactions and instead have a history of predictable adverse reactions or unspecified illness symptoms while receiving penicillin for viral infections. Studies describing penicillin allergy labeling in the pediatric outpatient setting are lacking. To describe the epidemiology and factors associated with penicillin allergy labels across 2 large US pediatric primary care networks. This retrospective, longitudinal birth cohort study was conducted in 90 primary care pediatric practices serving a diverse population of children across Houston, Texas, Austin, Texas, Philadelphia, Pennsylvania, and parts of New Jersey. Participants were children born between January 2010 and June 2020 who had a health care visit in the first 14 days of life and at least 2 additional visits in the first year of life at one of 90 primary care pediatric practices. Censoring criteria were additionally applied to exclude data from children no longer seeking health care in the 90 clinics over time. Statistical analysis was performed from February to May 2021. Basic patient demographics, health care utilization, penicillin exposure, and primary clinic location. Addition of penicillin allergy label in the electronic medical record. Among 334 465 children in the birth cohort, 164 173 (49.1%) were female; 72 831 (21.8%) were Hispanic, 59 598 (17.8%) were non-Hispanic Black, and 148 534 (44.4%) were non-Hispanic White; the median (IQR) age at censoring was 3.8 (1.7-6.6) years; 18 015 (5.4%) were labeled as penicillin allergic, but the prevalence of penicillin allergy labeling ranged from 0.9% to 10.2% across practices. Children were labeled at a median (IQR) age of 1.3 (0.9-2.3) years. Non-Hispanic White children were more likely to be labeled compared with non-Hispanic Black children after controlling for potential confounders (adjusted odds ratio, 1.7 [95% CI, 1.6-1.8]). There were 6797 allergic children (37.7%) labeled after receiving 1 penicillin prescription and 1423 (7.9%) labeled after receiving 0 penicillin prescriptions. In this cohort study of more than 330 000 children, penicillin allergy labeling was common and varied widely across practices. Children were labeled early in life, and almost half were labeled after receiving 1 or 0 penicillin prescriptions. These findings raise questions regarding the validity of penicillin allergy labels. Future work exploring the fidelity of and outcomes associated with penicillin allergy-labeling in children is warranted.

A 12-Month Randomized Clinical Trial of 38% SDF vs. Restorative Treatment.

The aim of this 2-arm, parallel-group, 12-mo randomized clinical trial was to compare the effectiveness of semiannual application of 38% silver diamine fluoride (SDF) versus restorative treatment (RT) to manage cavitated caries lesions in primary teeth in a diverse population of children in Michigan. Children aged 2 to 10 y with at least 1 soft cavitated lesion (International Caries Detection and Assessment System 5 or 6) with no pain or signs/symptoms of irreversible pulpitis were recruited and randomly assigned to 2 intervention groups. One random lesion per child received 38% SDF (twice, at a 6-mo interval) or RT. All interventions and assessments were done by calibrated dentists. Primary outcome measures were clinical failure rates: minor (e.g., reversible pulpitis, active/soft lesion or progression, restoration loss or need for replacement/repair, secondary caries) and major (e.g., irreversible pulpitis, abscess, extraction). Parent, child, and provider acceptability was also assessed. Ninety-eight children were enrolled and randomized, with a mean (SD) age of 4.8 y (1.8); 46% were female and their mean dmft + DMFT was 6.3 (3.9). Sixty-nine children were assessed at 12 mo (sample was within the planned 30% attrition rate). There were significantly more teeth with minor failures (SDF = 65%, RT = 23%, P ≤ 0.001) and major failures (SDF = 13%, RT = 3%, P ≤ 0.001) in the SDF group than the RT group; 74% of SDF-treated lesions were hard at 12 mo vs. 57% at 6 mo. Providers stated that SDF was easier, faster, and more preferable than RT (P ≤ 0.001). No significant differences were found in parental satisfaction and acceptability. At 12 mo, children in the RT arm felt significantly (P < 0.05) happier with their tooth appearance and stated that their visit to the dentist hurt less. At 12 mo, SDF-treated lesions had significantly more minor and major failures than RT, suggesting that SDF-treated teeth need to be closely monitored in a population at high caries risk (ClinicalTrials.gov NCT02601833). The results of this study can be used by clinicians when deciding whether to restore or apply silver diamine fluoride to cavitated lesions in primary teeth. Information on treatment outcomes and parent, child, and provider acceptability can help guide appropriate treatment decisions and need for monitoring.

SIMON WILE SYMPOSIUM: FOCUS ON DIVERSITY AND EQUITY THROUGH A PEDIATRIC COLLABORATIVE AND INTEGRATED CARE LENS

The goal of this year’s Simon Wile Symposium will be to focus on diversity, equity, and inclusion through the lens of pediatric collaborative and integrated care. National experts will share their experiences and perspectives in building systems to collaborate with pediatric primary care providers (PCPs), working within and improving regional child health and mental health systems to improve health equity. Given national trends of focus on systemic racism and on racial and ethnic disparities, our Center for Inclusive Child Care (CICC) committee discussed possible invitees who had developed innovative programs to target improved access to care for children in Black, Indigenous, and People of Color (BIPOC) and Latinx populations. The literature on child psychiatry access programs was also reviewed, resulting in the current Symposium submission. Presentations this year will focus on programs that are as follows: 1) evaluating the impact of social determinants on ADHD symptoms among a racially and ethnically diverse population of preschoolers in primary care settings; 2) implementing collaborative and integrated care through a Federally Qualified Health Center for a racially and ethnically diverse population of children; and 3) targeting improving health equity among racially and ethnically diverse populations including BIPOC and Latinx populations. As child and adolescent psychiatrists continue to work to address the significant child mental health needs in communities across the country, we have increasingly found child psychiatry collaborative and integrated care to be a valuable tool in helping pediatric PCPs care for children and families struggling with mental health issues. We believe that this can also be a valuable tool in improving health equity. Our speakers will share innovations in their access programs that have allowed them to reach new and underserved populations, better engage PCPs, and carefully build systems of collaborative care.

Myositis autoantibodies in a racially diverse population of children with idiopathic inflammatory myopathies

BackgroundJuvenile idiopathic inflammatory myopathies (JIIMs) is a group of autoimmune disorders, including juvenile dermatomyositis (JDM), juvenile polymyositis (JPM) and overlap myositis, that are characterized by proximal muscle weakness, elevated levels of serum muscle enzymes, and pathognomonic skin findings. While the exact etiology of JIIMs is unclear, the presence of myositis specific autoantibodies (MSAs) have been associated with certain clinical phenotypes, organ involvement and disease prognosis. To date, there have been few studies of the associations between MSA presence and patient ethnicity. It is important to understand the extent to which ethnicity impacts disease manifestations, organ involvement and clinical outcomes. The goal of our study is to determine MSA and myositis associated autoantibody (MAA) presence, clinical phenotype, and disease course in a racially diverse population of pediatric patients with JIIMs.MethodsPatients age 2–21 years with a prior diagnosis of JDM, JPM or overlap myositis, who had been tested for MSA/MAA, were eligible for study inclusion. Clinical and laboratory data were collected retrospectively via manual chart review in this single-center study. Descriptive statistics were performed to summarize each variable. Given the small sample size, non-parametric testing was performed using Fischer’s exact test, Wilcoxon rank sum test and Kruskal-Wallis test.ResultsThirty one patients were included in the analysis. Race and ethnicity were self-reported as Hispanic (48.4%), white (25.8%), and Black (25.8%). The most prevalent MSAs were anti-MDA5 (25.8%), anti-p155/140 (22.6%) and anti-MJ (19.4%). Presence of autoantibodies (p = 0.04) and pulmonary disease (p = 0.03) were significantly higher in patients of Black or Hispanic descent compared with white descent. Anti-MDA5 antibodies, cutaneous ulceration, cardiopulmonary involvement, hospitalizations and one death were only reported in patients with Black or Hispanic descent. Patients with anti-MDA5 antibodies were more likely to be male (p = 0.04) and to have cutaneous ulceration (p = 0.02).ConclusionsThis study describes the prevalence of MSA/MAA in a racially diverse group of patients with JIIM and further delineates clinical phenotype and disease complications in these groups. We found a relatively high proportion of children with anti-MDA5 antibodies and described potentially worse clinical courses in children of Black or Hispanic descent. Further investigation is warranted to examine these findings.

Revisiting the Beighton Criteria: Does Ligamentous Laxity Testing Correlate With Shoulder Range of Motion Norms in a North American, Pediatric Population?

Ligamentous laxity testing using the Beighton score is frequently used as part of the pediatric shoulder examination. However, the relationship between generalized ligamentous laxity (GLL) and shoulder range of motion (ROM) remains unexamined in children, and normative data for these clinical tests have not been well established. In this study, we establish normative data for shoulder range of motion and GLL in a healthy, diverse pediatric population and investigate whether Beighton testing correlates with shoulder ROM in children. Healthy subjects age 2 to 18 years with isolated lower extremity complaints were recruited. Passive shoulder ROM measurements for forward flexion (FF), abduction (ABD), internal rotation (IR), external rotation (ER), and extension (EXT) were obtained using a long-armed goniometer. The Beighton score was obtained, with a positive test defined as ≥5. Descriptive statistics were used to stratify data on the basis of age and sex. Interclass correlation coefficients (ICCs) were calculated. Spearman's r was calculated to determine correlations between the Beighton score and shoulder ROM. Predictive indices of a positive Beighton test to identify patients with high shoulder mobility (ROM in the top 15 percentile, or 1 SD above the mean) were calculated. A total of 202 subjects were enrolled and evaluated. Passive ROM norms by age and sex were determined. Intraclass correlation coefficients for all shoulder ROM measurements were substantial to excellent. Female individuals had greater ROM than age-matched male individuals, but this trend was largely statistically insignificant. Pearson's correlation between age and shoulder ROM was significant for FF, ABD, EXT, and ER (r=-0.52 to -0.20, P<0.001). Based on a Beighton score of ≥5, the prevalence of GLL was 10% in male and 15% in female individuals. Spearman's correlation between Beighton score and shoulder ROM was significant for 3 of 5 ROM measurements: FF, ER, and EXT (r=0.30 to 0.39, P<0.001). Normative pediatric shoulder ROM and joint laxity data have been established in a healthy, diverse population of children. Beighton testing exhibits only a weak to moderate correlation, despite statistical significance, with shoulder ROM and is poorly predictive for high ROM in children. Level I- Diagnostic.

The best possible start: A qualitative study on the experiences of parents of young children with or at risk for fetal alcohol spectrum disorders

BackgroundThe developmental outcomes and life course trajectories of young children with or at-risk for fetal alcohol spectrum disorders (FASD) can be optimized when individual and family needs are identified early and met with family-centered early intervention (EI) services. However, little is known about access to and quality of EI services with this high-needs population. MethodTwenty-five biological or adoptive parents of children with or at high risk for FASD, living in the greater area of Seattle, Washington participated in this qualitative study. Three focus groups were conducted using a semi-structured interview guide. Participants described their experience with EI, as well as other supports and challenges faced in their child's first three years of life. Interviews were audio recorded, transcribed verbatim and coded using phenomenological methods. Themes that were consistent across participant groups emerged from the data, as well as themes that showed differences among participant experiences. ResultsCommon EI supports and needs between biological and adoptive parent groups were identified. In addition, perspectives and needs unique to each parent group were revealed. Themes were identified and organized into three categories: (1) child needs; (2) parent needs and priorities; and (3) EI capacity. When parents talked about their child's cognitive, physical, communication or adaptive development, they all discussed how EI was meeting those needs. In contrast, when parents expressed concern for their child's social-emotional development, a description of how EI was supporting these needs was missing from the conversation. Parents appreciated when EI providers were truthful, provided anticipatory guidance, and connected them with supports for their own social-emotional well-being. Yet there were unmet needs for respite care, and parents expressed that support for basic needs related to child or family survival was not consistently recognized as a top priority for families. This high-risk group of young children and their parents also encountered a multitude of transitions in their child's early years and later. Parents wanted more support navigating these transitions as they entered or moved through different systems of care. ConclusionsParents appreciated and endorsed the importance of EI with its provision of individualized, family-centered supports and resources. Examination of the gaps and unmet needs that are common and distinct underscore the importance of an FASD-informed approach to EI. Study findings provide insight into areas for which EI enhancements could be developed in order to tailor supports for the complex needs of this diverse population of children and parents.

Dietary Habits of 2- to 9-Year-Old American Children Are Associated with Gut Microbiome Composition

BackgroundThe human gut microbiome is recognized as an important determinant of human health, yet little is known about how dietary habits are related to the microbiome in post-weaned, pre-pubescent children. ObjectiveThe goal of this work was to link quantitative dietary intake with microbiome features in a diverse population of children consuming a predominantly Western diet. DesignThis was a cross-sectional study. Participants/settingsEnglish- or Spanish-speaking families with healthy children between the ages of 2 and 9 years were recruited from a community-based, early childhood learning center in suburban Los Angeles, California between June and September 2014. Main outcome measuresChildren included in the analyses (n=75) contributed three fecal samples and three quantitative 24-hour dietary recalls using the multiple-pass method with an average of 5.7 days between samples. Microbial communities of each fecal sample were characterized using Illumina sequencing of the 16S ribosomal RNA gene. Dietary recalls were analyzed using the Automated Self-Administered 24-Hour Recall Dietary Assessment Tool. Statistical analysis performedAssociations between dietary factors and microbiome features were assessed using the Kruskal-Wallis test, Spearman rank correlations, or permutational multivariate analysis of variance. For demographic and health-related variables, χ2 analyses were used to test for differences between age groups for categorical variables. ResultsOur results show that age is correlated with three metrics of microbiome diversity (P<0.05) and is associated with both community structure (P=0.0488) and membership (P=0.0002). Several dietary food groups and nutrients were likewise associated with microbiome features. For example, consumption of non–whole-grain foods was associated with community structure (P=0.0089) and membership (P=0.0057), but not diversity (P>0.05). Likewise, the relative abundance of several bacterial taxa were linked to consumption of particular food groups and/or nutrients, as illustrated by the positive associations between total fruit (Pfalsediscovery rate<0.05) and fiber (Pfalsediscovery rate<0.05) consumption with the relative abundance of the Lachnospira genera. ConclusionsThis hypothesis-generating study demonstrates that the composition of the child gut microbiome remains dynamic beyond the age of 3 years and responds to dietary differences across individuals. In particular, non–whole-grain foods fortified with vitamins and minerals appear to be associated with the composition of the microbiome. Future interventional or model organism-based studies will be needed to test these associations between diet and microbiome composition.

School-aged Children Who Are Not Progressing Academically: Considerations for Pediatricians.

Pediatricians and other pediatric primary care providers may be consulted when families have concerns that their child is not making expected progress in school. Pediatricians care not only for an increasingly diverse population of children who may have behavioral, psychological, and learning difficulties but also for increasing numbers of children with complex and chronic medical problems that can affect the development of the central nervous system and can present with learning and academic concerns. In many instances, pediatric providers require additional information about the nature of cognitive, psychosocial, and educational difficulties that affect their school-aged patients. Our purpose for this report is to describe the current state of the science regarding educational achievement to inform pediatricians' decisions regarding further evaluation of a child's challenges. In this report, we review commonly available options for psychological evaluation and/or treatment, medical referrals, and/or recommendations for referral for eligibility determinations at school and review strategies for collaborating with families, schools, and specialists to best serve children and families.

Systemic antibiotic prophylaxis does not affect infectious complications in pediatric burn injury: A meta-analysis.

In pediatric burns the use of systemic antibiotic prophylaxis is a standard procedure in some burn centers, though its beneficial effect on the infectious complications is debated. The present meta-analysis aimed at determining whether systemic antibiotic prophylaxis prevents infectious complications in pediatric patients with burn injuries. We searched the PubMed, EMBASE, and Cochrane Library databases from inception to August 2019. We included 6 studies, in which event rates of infectious complications were reported in children with burn injuries receiving or not receiving systemic antibiotic prophylaxis. We found that the overall odds ratio (OR) of developing an infection (including local and systemic) was not different between the groups (OR = 1.35; 95% CI, 0.44, 4.18). The chances for systemic infectious complications alone were also not different between antibiotic-treated and non-treated patients (OR = 0.74; 95% CI, 0.38, 1.45). Based on the age, affected total body surface area, and country income level, we did not find any subgroup that benefited from the prophylaxis. Our findings provide quantitative evidence for the inefficacy of systemic antibiotic prophylaxis in preventing infections in pediatric burns. To validate our conclusion, multinational, randomized trials in a diverse population of children with burn injuries are warranted.

If You Make it Free, Will They Come? Using a Physical Activity Accessibility Model to Understand the Use of a Free Children’s Recreation Pass

Children's sedentary lifestyles and low physical activity levels may be countered using population-level interventions. This study examines factors influencing the use of a free community-wide physical activity access pass for grade 5 students (G5AP). A natural experiment with longitudinal data collection. A sample of 881 children completed the 9-month follow-up survey self-reporting where they used the G5AP. Two analyses were conducted: Getis-Ord GI* geographic cluster analysis of the spatial distribution of users, and logistic regression examining the relationship between use and accessibility (informational, economic, and geographic) and mobility options, while accounting for intrapersonal and interpersonal factors. Overall, 44.9% of children used the G5AP with clusters of high use in urban areas and low use in the suburbs. Other factors significantly related to G5AP included gender (girls), informational accessibility (active recruitment), economic accessibility (median household income), geographic accessibility (facilities within 1.6km of home), and mobility options (access to Boys & Girls Club bus). This study found that a diverse population of children used the G5AP. To continue being successful, community-based physical activity interventions need to ensure that the intervention increases geographic, economic, and informational accessibility and provides mobility options that are available to the target population.

Automated Fine Motor Evaluation for Developmental Coordination Disorder.

Developmental coordination disorder (DCD) is a type of motor learning difficulty that affects five to six percent of school-aged children, which may have a negative impact on the life of the sufferers. Timely and objective diagnosis of DCD are important for the success of the intervention. The present evaluation methods of DCD rely heavily on the observational analysis of occupational therapists and physiotherapists, who score the performance when children conduct some designed tasks. However, these methods are expensive, subjective, and are not easy to expand to a larger population. A fine motor evaluation system (FMES) is proposed with two views of cameras to record children's performance, when they carry out three fine motor tasks. Automated algorithms are developed to perform automated scoring of fine motor skill. The automated algorithms include task localization and individual task evaluation. The purpose of task localization is to detect each task and extract segments belonging to each task from the original video that includes multiple segments of different tasks. A convolutional neural network with temporal filtering is used to do frame-wise classification, and a boundary localization algorithm is proposed to localize each task segment. For individual task evaluation, the extracted video segments of task 1 and task 2 are evaluated based on the proposed feature extraction and time positioning algorithm, and the paper drawings of task 3 are evaluated based on image processing. The proposed methods are validated on a diverse population of children with or without DCD by comparing automated scoring with manual scoring from a professional evaluator. The experimental results suggest that the proposed methods can effectively achieve fine motor evaluation for DCD assessment. Besides, our system is a low-cost solution, and the evaluation methods developed are automated, objective, and can be suited for large population evaluation and analysis.

PS-196-Efficacy and safety of sebelipase alfa over 144 weeks in a diverse population of children and adults with lysosomal acid lipase deficiency

PS-196-Efficacy and safety of sebelipase alfa over 144 weeks in a diverse population of children and adults with lysosomal acid lipase deficiency

Decreasing health disparities for children with asthma and their families: Conceptualizing cultural weaving & identifying the cultural characteristics of a head start organization in the United States

ABSTRACTThe overall purpose was to identify cultural competency characteristics of a community organization and its staff in caring for chronically ill children from diverse backgrounds. The study used a qualitative design to explore the elements of cultural values and beliefs within the context of a Head Start organization that cares for chronically ill, low income children. A small convenience sample of organization employees provided demographic data, completed cultural competency assessment instruments and participated in focus groups. Qualitative data were analyzed first coding and identifying themes related to cultural values and belief of the individuals who manage a local Head Start. The results indicated previous experience influences the working with diverse populations. Whereas the socialized culture had a greater effect on working with diverse groups of children and their families. Although there is a need to provide knowledge on communicating with diverse population of children and families, importantly the past beliefs and values have a powerful effect on the ability to working with diverse population. Nurses need to be more involved in the community and provide educational training on cultural diversity to various organizations. The training should include the personal values and beliefs. In addition, there is the need for the nurses to provide health care training to community organizations on management of chronically ill children in their care. The findings support the benefits of cultural competency training for all those who care for children from diverse backgrounds with health problems.

Nutrition Deficiencies in Children With Intestinal Failure Receiving Chronic Parenteral Nutrition.

Home parenteral nutrition (PN) is a lifesaving therapy for children with intestinal failure (IF). Our aims were to describe the prevalence of micronutrient deficiencies (vitamin D, zinc, copper, iron, selenium) in a diverse population of children with IF receiving PN and to identify and characterize risk factors associated with micronutrient deficiencies, including hematologic abnormalities. Data were collected on 60 eligible patients through retrospective chart review between May 2012 and February 2015. Descriptive statistics included frequencies, medians, interquartile ranges (IQRs), and odds ratios (ORs). Statistical analyses included χ2 , Fisher's exact, t tests, and logistic, univariate, and multivariate regressions. Patients were primarily young (median age, 3.3 years; IQR, 0.7-8.4), Latino (62%), and male (56%), with short bowel syndrome (70%). Of 60 study patients, 88% had ≥1 deficiency and 90% were anemic for age. Of 51 patients who had all 5 markers checked, 59% had multiple deficiencies (defined as ≥3). Multivariate analysis shows multiple deficiencies were associated with nonwhite race (OR, 9.4; P = .012) and higher body mass index z score (OR, 2.2; P = .016). Children with severe anemia (hemoglobin <8.5 g/dL) made up 50% of the cohort. Nonwhite race (OR, 6.6; P = .037) and zinc deficiency (OR, 11; P = .003) were multivariate predictors of severe anemia. Micronutrient deficiency and anemia are overwhelmingly prevalent in children with IF using chronic PN. This emphasizes the importance of universal surveillance and supplementation to potentially improve quality of life and developmental outcomes. Future research should investigate how racial disparities might contribute to nutrition outcomes for children using chronic PN.

Digital Inequality and Developmental Trajectories of Low-income, Immigrant, and Minority Children.

Children growing up in the United States today are more ethnically and racially diverse than at any time in the nation's history. Because of rising income inequality, almost half of the 72 million children in the United States are also growing up in low-income families, with immigrant and children of color disproportionately likely to be within their ranks. Children in low-income households are more likely to face a number of social challenges, including constrained access to the Internet and devices that connect to it (ie, digital inequality), which can exacerbate other, more entrenched disparities between them and their more privileged counterparts. Although the American Academy of Pediatrics' new guidelines encourage clinicians to reduce children's overexposure to technology, we argue for a more nuanced approach that also considers how digital inequality can reduce low-income children's access to a range of social opportunities. We review previous research on how digital inequality affects children's learning and development and identify areas where more research is needed on how digital inequality relates to specific aspects of children's developmental trajectories, and to identify what interventions at the family, school, and community levels can mitigate the adverse effects of digital inequality as children move through their formal schooling. On the basis of the evidence to date, we conclude with guidelines for clinicians related to supporting digital connectivity and more equitable access to social opportunity for the increasingly diverse population of children growing up in the United States.

United Kingdom national paediatric bilateral project: Demographics and results of localization and speech perception testing

Objectives: To assess longitudinal outcomes in a large and varied population of children receiving bilateral cochlear implants both simultaneously and sequentially.Methods: This observational non-randomized service evaluation collected localization and speech recognition in noise data from simultaneously and sequentially implanted children at four time points: before bilateral cochlear implants or before the sequential implant, 1 year, 2 years, and 3 years after bilateral implants. No inclusion criteria were applied, so children with additional difficulties, cochleovestibular anomalies, varying educational placements, 23 different home languages, a full range of outcomes and varying device use were included.Results: 1001 children were included: 465 implanted simultaneously and 536 sequentially, representing just over 50% of children receiving bilateral implants in the UK in this period. In simultaneously implanted children the median age at implant was 2.1 years; 7% were implanted at less than 1 year of age. In sequentially implanted children the interval between implants ranged from 0.1 to 14.5 years. Children with simultaneous bilateral implants localized better than those with one implant. On average children receiving a second (sequential) cochlear implant showed improvement in localization and listening in background noise after 1 year of bilateral listening. The interval between sequential implants had no effect on localization improvement although a smaller interval gave more improvement in speech recognition in noise. Children with sequential implants on average were able to use their second device to obtain spatial release from masking after 2 years of bilateral listening. Although ranges were large, bilateral cochlear implants on average offered an improvement in localization and speech perception in noise over unilateral implants.Conclusion: These data represent the diverse population of children with bilateral cochlear implants in the UK from 2010 to 2012. Predictions of outcomes for individual patients are not possible from these data. However, there are no indications to preclude children with long inter-implant interval having the chance of a second cochlear implant.

Developing a mind–body exercise programme for stressed children

Objective: To describe the process of developing a Health Qigong programme for stressed children using a formative evaluation approach. Methods: A multi-step formative evaluation method was utilised. These steps included (1) identifying programme content and drafting the curriculum, (2) synthesising effective and age-appropriate pedagogies, (3) consulting an expert panel, (4) teaching pilot lessons and soliciting feedback from students and (5) revising and finalising the programme. Results: A total of 16 theme-based lessons were generated in order to help children manage stress by imitating interesting plants and animals, such as sunflowers, pine trees, white cranes, tigers, sleeping lions and deer. Five age-appropriate teaching strategies were synthesised to make the programme fun and enjoyable for children. These included (1) using theme-based lesson plans, (2) building mind–body connections, (3) balancing repetition and creativity, (4) interweaving pictures, stories, volunteers and teamwork and (5) involving parents and school teachers. Modifications based on feedback from the expert panel and students were incorporated to make the programme relevant to elementary school settings. Conclusion: This Health Qigong for Stressed Children programme appears effective in reducing stress over a 16-week period. Future studies should explore the efficacy and wider applicability of the programme with a larger and more diverse population of children.