Features In Young Children Research Articles

579. DUPILUMAB IMPROVES ENDOSCOPIC FEATURES OF EOSINOPHILIC OESOPHAGITIS IN CHILDREN WITH EOSINOPHILIC OESOPHAGITIS: 52-WEEK ANALYSIS OF THE EOE KIDS STUDY

Abstract Introduction Eosinophilic oesophagitis (EoE) is a chronic type 2 inflammatory disease. Dupilumab, a fully human monoclonal antibody that blocks drivers of type 2 inflammation, is approved in the USA for EoE patients aged ≥1 year, weighing ≥15 kg, and in the EU for adult and adolescent EoE patients aged ≥12 years, weighing ≥40 kg. The EoE-Endoscopic Reference Score (EREFS) is a validated tool for assessing oesophageal features of EoE, with subscores for inflammation and remodelling. This study assessed the impact of dupilumab on EREFS in children aged 1–<12 years with active EoE in the phase 3 EoE KIDS trial. Methods In Part A, 102 patients (mean [SD] age: 7.1 [3.05] years) were randomised 2:2:1:1 to receive weight-tiered dupilumab higher-exposure (HE) or lower-exposure, or placebo (two groups) for 16 weeks. In Part B, all patients received dupilumab at their preassigned dupilumab regimen for a further 36 weeks. This analysis focused on the dupilumab HE and placebo groups. EREFS were scored centrally by reviewers blinded to both treatment allocation and time point. Absolute change from baseline in EREFS total score (0−18), and EREFS inflammation (0−10) and remodelling (0−8) subscores were assessed at Weeks 16 and 52. Results A total of 37 and 34 patients received dupilumab HE and placebo, respectively; baseline mean EREFS scores were similar across treatment groups (6.8 vs 7.3) with EREFS inflammation subscores higher than remodelling subscores (6.0 vs 0.9 in the total population). EREFS total score was significantly reduced at Week 16 with dupilumab HE versus placebo (LS mean difference -3.8 [95% CI: -4.9, -2.6], P<0.0001), with improvement sustained through Week 52 in the dupilumab HE group (figure). Similar improvements were observed for EREFS inflammation subscore. Assessment of changes in remodelling was limited by low prevalence of fibrostenotic features in young children. Conclusion Dupilumab HE led to significant improvement in EREFS total score at Week 16 versus placebo, which was sustained through Week 52. Dupilumab HE also improved EREFS inflammation subscore.

Risk Factors for Urinary Tract Infection in Children

Background & objective: Urinary tract infections (UTIs) are a common cause of febrile illness in young children. Due to the absence of overt clinical features in young children, appropriate collection of urine samples, and basic diagnostic tests at first-level health facilities in our country, UTIs are not generally reported as a cause of childhood morbidity. Due to a lack of studies on the epidemiology, risk factors, diagnosis, treatment, prognosis, and prevention of UTI in children in our country, the exact picture of this disease is yet unknown. This study is intended to identify the risk factors of UTI in children in our country. Methods: The present cross-sectional study was carried out in the Department of Pediatrics (both indoor and outdoor) of Bangabandhu Sheikh Mujib Medical University, BIRDEM, and Dhaka Medical College Hospital over a period of 1½ years from January 2015 to June 2016. A total of 201 children with signs and symptoms suspected of having urinary tract infections were subjected to urine culture; of them, 98 had definitive UTI and the rest 103 had no UTI or possible UTI. Several factors such as circumcisional status, constipation, encopresis, previous hospital admission, and premature birth were investigated whether they had any role in contributing to the development of UTI. Result: The children with UTIs were relatively young compared to those without UTIs. However, the age incidence of UTI was found to differ by sex. About one-third of UTI cases in boys were found in the first year of life, one-third between 2nd to 3rd year of life, and the rest one-third in 3rd year onwards. However, the peak age incidence in girls was observed to be 3rd year and onwards. In terms of clinical presentation, fever, and anorexia were more or less common (52% and 43.7% respectively), abdominal pain was less common (18%), and irritability and vomiting were seldom observed. The presence of constipation was significantly associated with UTI in children (p = 0.001). Encopresis was considerably higher in the UTI group than in the non-UTI group (p = 0.169). Conclusion: Children with UTI usually present with fever with or without dysuria, frequency, anorexia, and abdominal or loin pain. While boys more often acquire the disease in their infancy, girls usually present with the problem from 3 years during their toilet training. Thus, the children presented with unexplained febrile illness or any other signs and symptoms should be suggested for a urine culture to find the clue of febrile illness. Identification of risk factors of UTI will go a long way in preventing the same illness in the future. Ibrahim Card Med J 2023; 13 (1&2): 60-65

Spindle chirp and other sleep oscillatory features in young children with autism

ObjectivesTo determine whether spindle chirp and other sleep oscillatory features differ in young children with and without autism. MethodsAutomated processing software was used to re-assess an extant set of polysomnograms representing 121 children (91 with autism [ASD], 30 typically-developing [TD]), with an age range of 1.35–8.23 years. Spindle metrics, including chirp, and slow oscillation (SO) characteristics were compared between groups. SO and fast and slow spindle (FS, SS) interactions were also investigated. Secondary analyses were performed assessing behavioural data associations, as well as exploratory cohort comparisons to children with non-autism developmental delay (DD). ResultsPosterior FS and SS chirp was significantly more negative in ASD than TD. Both groups had comparable intra-spindle frequency range and variance. Frontal and central SO amplitude were decreased in ASD. In contrast to previous manual findings, no differences were detected in other spindle or SO metrics. The ASD group displayed a higher parietal coupling angle. No differences were observed in phase-frequency coupling. The DD group demonstrated lower FS chirp and higher coupling angle than TD. Parietal SS chirp was positively associated with full developmental quotient. ConclusionsFor the first time spindle chirp was investigated in autism and was found to be significantly more negative than in TD in this large cohort of young children. This finding strengthens previous reports of spindle and SO abnormalities in ASD. Further investigation of spindle chirp in healthy and clinical populations across development will help elucidate the significance of this difference and better understand this novel metric.

Assessment of Clinical and Virological Characteristics of SARS-CoV-2 Infection Among Children Aged 0 to 4 Years and Their Household Members

Few studies have prospectively assessed SARS-CoV-2 community infection in children aged 0 to 4 years. Information about SARS-CoV-2 incidence and clinical and virological features in young children could help guide prevention and mitigation strategies. To assess SARS-CoV-2 incidence, clinical and virological features, and symptoms in a prospective household cohort and to compare viral load by age group, symptoms, and SARS-CoV-2 lineage in young children, older children, and adults. This prospective cohort study enrolled 690 participants from 175 Maryland households with 1 or more children aged 0 to 4 years between November 24, 2020, and October 15, 2021. For 8 months after enrollment, participants completed weekly symptom questionnaires and submitted self-collected nasal swabs for SARS-CoV-2 qualitative real-time reverse transcriptase polymerase chain reaction (RT-PCR) testing, quantitative RT-PCR testing, and viral lineage determination. For the analyses, SARS-CoV-2 Alpha and Delta lineages were considered variants of interest or concern. Sera collected at enrollment and at approximately 4 months and 8 months after enrollment were assayed for SARS-CoV-2 spike and nucleocapsid protein antibodies. Incidence, clinical and virological characteristics, and symptoms of SARS-CoV-2 infection by age group and correlations between (1) highest detected viral load and symptom frequency and (2) highest detected viral load and SARS-CoV-2 lineage. Among 690 participants (355 [51.4%] female and 335 [48.6%] male), 256 individuals (37.1%) were children aged 0 to 4 years, 100 (14.5%) were children aged 5 to 17 years, and 334 (48.4%) were adults aged 18 to 74 years. A total of 15 participants (2.2%) were Asian, 24 (3.5%) were Black, 603 (87.4%) were White, 43 (6.2%) were multiracial, and 5 (0.7%) were of other races; 33 participants (4.8%) were Hispanic, and 657 (95.2%) were non-Hispanic. Overall, 54 participants (7.8%) had SARS-CoV-2 infection during the surveillance period, including 22 of 256 children (8.6%) aged 0 to 4 years, 11 of 100 children (11.0%) aged 5 to 17 years, and 21 of 334 adults (6.3%). Incidence rates per 1000 person-weeks were 2.25 (95% CI, 1.28-3.65) infections among children aged 0 to 4 years, 3.48 (95% CI, 1.59-6.61) infections among children aged 5 to 17 years, and 1.08 (95% CI, 0.52-1.98) infections among adults. Children aged 0 to 17 years with SARS-CoV-2 infection were more frequently asymptomatic (11 of 30 individuals [36.7%]) compared with adults (3 of 21 individuals [14.3%]), with children aged 0 to 4 years most frequently asymptomatic (7 of 19 individuals [36.8%]). The highest detected viral load did not differ between asymptomatic vs symptomatic individuals overall (median [IQR], 2.8 [1.5-3.3] log10 copies/mL vs 2.8 [1.8-4.4] log10 copies/mL) or by age group (median [IQR] for ages 0-4 years, 2.7 [2.4-4.4] log10 copies/mL; ages 5-17 years: 2.4 [1.1-4.0] log10 copies/mL; ages 18-74 years: 2.9 [1.9-4.6] log10 copies/mL). The number of symptoms was significantly correlated with viral load among adults (R = 0.69; P < .001) but not children (ages 0-4 years: R = 0.02; P = .91; ages 5-17 years: R = 0.18; P = .58). The highest detected viral load was greater among those with Delta variant infections (median [IQR], 4.4 [3.9-5.1] log10 copies/mL) than those with infections from variants not of interest or concern (median [IQR], 1.9 [1.1-3.6] log10 copies/mL; P = .009) or those with Alpha variant infections (median [IQR], 2.6 [2.3-3.4] log10 copies/mL; P = .006). In this study, SARS-CoV-2 infections were frequently asymptomatic among children aged 0 to 4 years; the presence and number of symptoms did not correlate with viral load. These findings suggest that symptom screening may be insufficient to prevent outbreaks involving young children.

Parents, health professionals and footwear stakeholders’ beliefs on the importance of different features of young children’s footwear: a qualitative study

BackgroundA small but building pool of evidence of the impact of footwear on children’s function means understanding the different beliefs of stakeholders about footwear key features and flexibility is critical for translation into recommendations and to support parents and caregivers in purchasing footwear for their children. Therefore, this research aimed to describe how different stakeholders (health professionals, parents, and footwear industry representatives) described the importance of flexibility and other footwear features for young children.MethodsThis qualitative study was nested within an international modified Delphi online survey. Participants responded to open-ended questions about footwear component flexibility and asked if and why flexibility in these areas were important. Participants also described any other important footwear features. Inductive thematic analysis was used to generate themes.ResultsThere were 121 responses from three stakeholder groups including health professionals (n = 90), parents of young children (n = 26) and footwear industry representatives (n = 5). Overarching themes described by participants included developmental impacts of footwear, therapeutic impact and how footwear may play a role in function.ConclusionThere were key differences in how stakeholders viewed footwear and any perceived benefits of footwear components, much of which was not backed with empirical evidence. It was also identified that health professionals are using footwear within treatment recommendations. This work highlights the importance of understanding circumstances in which footwear may have a therapeutic impact or be the first line of treatment for children with complex foot needs. This is the first step in developing contemporary footwear recommendations for parents and caregivers.

Profile of Autism Spectrum Disorder in Tuberous Sclerosis Complex: Results from a Longitudinal, Prospective, Multisite Study.

Tuberous sclerosis complex (TSC) is highly associated with autism spectrum disorder (ASD). Objectives of the study were to characterize autistic features in young children with TSC. Participants included 138 children followed from ages 3 to 36 months with TSC from the Tuberous Sclerosis Complex Autism Center of Excellence Research Network (TACERN), a multicenter, prospective observational study aimed at understanding the underlying mechanisms of ASD in TSC. Developmental and autism-specific assessments were administered, and a clinical diagnosis of ASD was determined for all participants at 36 months. Further analyses were performed on 117 participants with valid autism assessments based on nonverbal mental age greater than 15 months. Prevalence of clinical diagnosis of ASD at 36 months was 25%. Nearly all autistic behaviors on the Autism Diagnostic Observation Schedule-2 (ADOS-2) and Autism Diagnostic Interview-Revised (ADI-R) were more prevalent in children diagnosed with ASD; however, autism-specific behaviors were also observed in children without ASD. Overall quality of social overtures, facial expressions, and abnormal repetitive interests and behaviors were characteristics most likely to distinguish children with ASD from those without an ASD diagnosis. Participants meeting ADOS-2 criteria but not a clinical ASD diagnosis exhibited intermediate developmental and ADOS-2 scores compared to individuals with and without ASD. ASD is highly prevalent in TSC, and many additional individuals with TSC exhibit a broad range of subthreshold autistic behaviors. Our findings reveal a broader autism phenotype that can be identified in young children with TSC, which provides opportunity for early targeted treatments. ANN NEUROL 2021;90:874-886.

MƏKTƏBƏQƏDƏR YAŞLI UŞAQLARDA RİYAZİ TƏSƏVVÜRLƏRİN FORMALAŞMASI VƏ İNKİŞAFININ XÜSUSİYYƏTLƏRİ

The article deals with the actual problems of the formation of elementary mathematical representations in children. The paper shows that this approach in mathematics education based on action learning in conjunction with the natural motivation stemming from common sense is effective. Also, stimulating questions and classical famous problems are important motivating tools in mathematics, which are particularly beneficial in the framework of action learning. The analysis of psychological, pedagogical and methodological literature on the topic of research the author provides an experimental methodology for studying elementary mathematical representations, characterizes their features in young children. Key words: preschool children, mathematical representations, intellectual development of preschool children, mental education, features of development, elementary mathematical representations

The impact of positive parenting behaviors and maternal depression on the features of young children's home language environments.

This study investigated the associations between maternal depression when infants were 3 to 11 months old (M = 6 months), and positive parenting behaviors when children were between 12 and 22 months (M = 17 months) and the home language environment assessed when children were 18 to 28 months old (M = 23.5 months) in a sample of 29 low-income mother-child dyads. After controlling for maternal education, only teaching behaviors remained a moderate and significant predictor of adult word counts. Observed teaching behaviors significantly predicted conversational turns and marginally predicted child vocalizations; effects sizes were small. Encouraging behaviors were a small and significant predictor of conversational turns and a marginally significant predictor of adult word counts. Maternal depression was a moderate and significant predictor of children's vocal productivity scores and a small, marginal predictor of conversational turns. These findings have important implications for parenting and children's language outcomes.

FEATURES OF DIAGNOSTICS AND TREATMENT OF IMPACTED TEETH (A LITERATURE REVIEW)

Research rationale. Impacted teeth are those that remain partially or completely in the bony tissue or under the mucous membrane for 2 years after the term of their physiological eruption. The issues of the impacted teeth diagnostics, clinical manifestations and treatment features in young children have been studied according to the literature sources data; the significant rate of impacted mandibular third molars (up to 22%), maxillary third molars (up to 18%) and maxillary canines (4%) has been determined.&#x0D; The presence of impacted teeth requires a thorough diagnostics and a balanced approach to the choice of treatment method; the latter depends on the clinical situation, the patient’s age and general somatic status.&#x0D; With the right choice of treatment method, the success of restoring the integrity of the dental arch, aesthetics and function is significant.&#x0D; Objective: an analysis of literature sources regarding the issues of clinical manifestations, diagnostics and treatment of maxillary and mandibular impacted teeth in young people.&#x0D; Presentation of the main material. A literature review demonstrated the presence of a significant number of impacted teeth classifications based on clinical data; part of the classifications was based on modern x-ray studies (CBCT - Cone beam computed tomography). Many research works on resorption of the teeth roots located next to the impacted ones have been analysed; a variety of methods for treating dental retention has been reviewed.&#x0D; Conclusions and their discussions. Impacted teeth remain rather common pathology in young people, which requires a balanced approach to the diagnostics and to the choice of treatment method, as only correct management of such patients can lead to beneficial result. In the examination algorithm it is mandatory to establish the position of the impacted tooth axis in the jaw and in relation to the adjacent teeth axis; the condition of the alveolar bone, the age of the patients and their general somatic status are also of great importance.&#x0D; The choice of treatment method, such as orthodontic, surgical and combined, with the additional use of periodontal surgery and physiotherapy treatment should be individual, followed by monitoring and regular medical check-up.

Features of young children’s cognitive activity with different angle levels

Features of young children’s cognitive activity with different angle levels

Diagnosis of sporadic neurofibromatosis type 2 in the paediatric population

ObjectiveOnset of symptoms in severe sporadic neurofibromatosis type 2 (NF2) is typically within childhood; however, there is poor awareness of presenting features in young children, potentially resulting in delayed diagnosis...

The Role of Book Features in Young Children's Transfer of Information from Picture Books to Real-World Contexts.

Picture books are an important source of new language, concepts, and lessons for young children. A large body of research has documented the nature of parent-child interactions during shared book reading. A new body of research has begun to investigate the features of picture books that support children's learning and transfer of that information to the real world. In this paper, we discuss how children's symbolic development, analogical reasoning, and reasoning about fantasy may constrain their ability to take away content information from picture books. We then review the nascent body of findings that has focused on the impact of picture book features on children's learning and transfer of words and letters, science concepts, problem solutions, and morals from picture books. In each domain of learning we discuss how children's development may interact with book features to impact their learning. We conclude that children's ability to learn and transfer content from picture books can be disrupted by some book features and research should directly examine the interaction between children's developing abilities and book characteristics on children's learning.

Early childhood spirituality in education: Towards an understanding of the distinctive features of young children's spirituality

Early years education is a holistic endeavour, with some education policies including spiritual development as part of that approach. However, studies exploring the spirituality of young children are scarce, which limits understanding of the phenomenon and its full application in educational settings. Furthermore, nurturing children's spiritual development is a complex matter, compounded by a variety of factors, not least a lack of clarity over what spirituality is. This article initiates a discussion about the possible distinctive features of young children's spirituality. It does so by addressing inherent difficulties in attempting to define spirituality before subsequently reviewing how it is conceptualised in the broader literature, and then in the literature on young children. Implications for policy and practice are considered, arguing that there is a need for more clarity in framing how young children's spirituality may be understood, which needs to be founded on a wider evidence base than currently exists.

Defining Encephalopathy in Acute Disseminated Encephalomyelitis

The International Pediatric Multiple Sclerosis Study Group requires the presence of encephalopathy to diagnose acute disseminated encephalomyelitis. Clinical characteristics of encephalopathy are inadequately delineated in the pediatric demyelinating literature. The authors' purpose was to better define encephalopathy in pediatric acute disseminated encephalomyelitis by describing the details of the mental status change. A retrospective chart review was conducted for 25 children diagnosed with acute disseminated encephalomyelitis according to the International Pediatric Multiple Sclerosis Study Group guidelines. Frequency of encephalopathy-defining features was determined. Clinical characteristics, cerebrospinal fluid findings, and electroencephalography (EEG) findings were compared between patients with different stages of encephalopathy. The authors found irritability (36%), sleepiness (52%), confusion (8%), obtundation (20%), and coma (16%) as encephalopathy-defining features in acute disseminated encephalomyelitis. Twenty-eight percent had seizures, and 65% demonstrated generalized slowing on EEG. Approximately half of the patients in this study were diagnosed with encephalopathy based on the presence of irritability and/or sleepiness only. Such features in young children are often subtle and transient and thus difficult to objectively determine.

Autoimmune characteristics in Japanese children diagnosed with type 1 diabetes before 5 years of age

Several studies have shown that the autoimmune features in young children with type 1 diabetes differ from those in older pediatric patients as well as adults. The purpose of the present study was to examine the prevalence of beta-cell autoantibodies, glutamic acid decarboxylase antibodies (GADA), and antibodies to the protein tyrosine phosphatase-related molecule IA-2 (IA-2A), at the time of diagnosis in Japanese children with type 1 diabetes who were younger than 5 years at diagnosis. Subjects consisted of 23 Japanese children (nine boys, 14 girls), 3.1 +/- 1.3 years of age at diagnosis (range, 1.1-4.8 years). The majority had severe metabolic decompensation accompanied by complete absence of beta-cell function at diagnosis. We found 41.7% to have suffered viral infections before disease onset. The prevalence of antibodies to GAD and IA-2 at diagnosis in these subjects was significantly lower than those in older patients diagnosed after 5 years of age (31.6 % vs 86.3% and 47.1% vs 82.5%, P < 0.0001 and P = 0.0064, respectively). Among 17 patients in whom both antibodies were measured, only two (11.8%) had both GADA and IA-2A, three (17.6%) had GADA alone, six (35.3%) had IA-2A alone, and six (35.3%) had neither GADA nor IA2-A. Non-autoimmune mechanisms or age-related differences in autoimmunity could be involved in the pathogenesis of diabetes in young patients.

Chorioamnionitis, gestational age, male sex, birth weight, and illness severity predicted positive autism screening scores in very-low-birth-weight preterm infants

C Limperopoulos Dr C Limperopoulos, Montreal Children’s Hospital, Montreal, Quebec, Canada; catherine.limperopoulos@childrens.harvard.edu What are the prevalence and risk factors of early autistic features in young children who had very low...

乳幼児施設におけるノロウイルス集団感染事例の記述疫学的解析

乳幼児施設におけるノロウイルス集団感染事例の記述疫学的解析

Clinical Features of Young Children with Autistic Spectrum Disorders With and Without a Reported History of Regression

Clinical Features of Young Children with Autistic Spectrum Disorders With and Without a Reported History of Regression

Sensory Experiences Questionnaire: discriminating sensory features in young children with autism, developmental delays, and typical development

This study describes a new caregiver-report assessment, the Sensory Experiences Questionnaire (SEQ), and explicates the nature of sensory patterns of hyper- and hyporesponsiveness, their prevalence, and developmental correlates in autism relative to comparison groups. Caregivers of 258 children in five diagnostic groups (Autism, PDD, DD/MR, Other DD, Typical) ages 5-80 months completed the SEQ. The SEQ's internal consistency was alpha' = .80. Prevalence of overall sensory symptoms for the Autism group was 69%. Sensory symptoms were inversely related to mental age. The Autism group had significantly higher symptoms than either the Typical or DD groups and presented with a unique pattern of response to sensory stimuli -hyporesponsiveness in both social and nonsocial contexts. A pattern of hyperresponsiveness was similar in the Autism and DD groups, but significantly greater in both clinical groups than in the Typical group. The SEQ was able to characterize sensory features in young children with autism, and differentiate their sensory patterns from comparison groups. These unique sensory patterns have etiological implications, as well as relevance for assessment and intervention practices.

Masturbation in Infancy and Early Childhood Presenting as a Movement Disorder: 12 Cases and a Review of the Literature

Infantile masturbation (gratification behavior) is not commonly identified as a cause of recurrent paroxysmal movements. Extensive and fruitless investigations may be pursued before establishing this diagnosis. Sparse literature is available regarding masturbatory behavior as a whole, but literature available as case reports describes common features. The purpose of this case series is to describe consistent features in young children with posturing accompanying masturbation. Twelve patients presenting to a pediatric movement disorders clinic with a suspected movement disorder were determined to have postures and movements associated with masturbation. We reviewed the clinical history, examination, and home videotapes of these patients. Our patients had several features in common: (1) onset after the age of 3 months and before 3 years; (2) stereotyped episodes of variable duration; (3) vocalizations with quiet grunting; (4) facial flushing with diaphoresis; (5) pressure on the perineum with characteristic posturing of the lower extremities; (6) no alteration of consciousness; (7) cessation with distraction; (8) normal examination; and (9) normal laboratory studies. The identification of these common features by primary care providers should assist in making this diagnosis and eliminate the need for extensive, unnecessary testing. Direct observation of the events is crucial, and the video camera is a useful tool that may help in the identification of masturbatory behavior.