High Proportion Of Children Research Articles

Circulating Tumor DNA Combining with Imaging Analysis for Lesion Detection of Langerhans Cell Histiocytosis in Children

Background: The detection of mutations from circulating tumor DNA (ctDNA) represents a promising enrichment technique. In this retrospective study, the significance of ctDNA and imaging in Langerhans cell histiocytosis (LCH) monitoring was first examined, and the broader role of ctDNA in monitoring LCH was additionally explored. Methods: First, data visualization and survival analysis models were used to generalize the concordance between cfBRAFV600E molecular response and radiographic response on clinical outcomes. Next, the molecular response of cfBRAFV600E was observed from a dynamic perspective. A comparative analysis was then conducted between cfBRAFV600E and ltBRAFV600E status, examining their relationship to clinical manifestations and prognosis of LCH. Results: Eventually, 119 participants were enrolled in this trial between 2019 and 2023. Progression-free survival (PFS) was significantly shorter in patients with both radiologic and cfDNA molecular progression (17.67 versus 24.67 months, p < 0.05) compared to those without. A critical cfBRAFV600E value of 0.03% has been determined for the first time. Both cfBRAFV600E and ltBRAFV600E mutations were associated with a higher proportion of children under 3 years of age, skin and spleen involvement, and a lower 3-year PFS rate. In contrast to ltBRAFV600E, cfBRAFV600E was linked to a higher proportion of risk organ invasion LCH (52% vs. 27.9%, p < 0.05) and a better therapeutic response at the sixth week (24% vs. 4.7%, p < 0.05). Furthermore, in patients with risk organ invasion-LCH and multisystem-LCH subtypes, cfBRAFV600E was associated with a significantly lower 3-year PFS. Conclusions: In summary, these findings enhanced and supplemented the implications of ctDNA and imaging analysis application in children with LCH.

Influenza Vaccination, Household Composition, and Race-Based Differences in Influenza Incidence: An Agent-Based Modeling Study.

Objectives. To estimate the effect of influenza vaccination disparities. Methods. We compared symptomatic influenza cases between Black and White races in 2 scenarios: (1) race- and age-specific vaccination coverage and (2) equal vaccination coverage. We also compared differences in household composition between races. We used the Framework for Reconstructing Epidemiological Dynamics, an agent-based model that assigns US Census‒based age, race, households, and geographic location to agents (individual people), in US counties of varying racial and age composition. Results. Influenza cases were highest in counties with higher proportions of children. Cases were up to 30% higher in Black agents with both race-based and race-equal vaccination coverage. Compared with corresponding categories of White households, cases in Black households without children were lower and with children were higher. Conclusions. Racial disparities in influenza cases persisted after equalizing vaccination coverage. The proportion of children in the population contributed to the number of influenza cases regardless of race. Differences in household composition may provide insight into racial differences and offer an opportunity to improve vaccination coverage to reduce influenza burden for both races. (Am J Public Health. Published online ahead of print November 14, 2024:e1-e8. https://doi.org/10.2105/AJPH.2024.307878).

Characteristics and outcomes of children 2-23 months of age with prolonged diarrhoea: A secondary analysis of data from the 'Antibiotics for Children with Diarrhea' trial.

Approximately 12% of all diarrhoeal episodes last for 7-13 days. As such, they are termed prolonged diarrhoea, and are associated with over two-thirds of all diarrhoeal deaths. Due to a lack of robust data, we aimed to evaluate a comparative background characteristics of young children with acute and prolonged diarrhoea, and their outcomes at day 90 follow-up. We performed a secondary analysis of data from the Antibiotics for Children with Diarrhea (ABCD) trial. Children aged 2-23 months were enrolled between July 2017 and July 2019 from seven Asian and sub-Saharan African countries. For this analysis, we divide diarrhoea into two categories: acute diarrhoea (duration <7 days) and prolonged diarrhoea (duration ≥7-13 days). We used logistic regression to observe baseline crude and adjusted associations and linear regression to compare post-discharge outcomes. We analysed data on 8266 children, of whom 756 (9%) had prolonged diarrhoea and 7510 (91%) had acute diarrhoea. Pakistan had the highest proportion of children with prolonged diarrhoea (n/N = 178/1132, 16%), while Tanzania had the lowest (n/N = 12/1200, 1%). From an analysis that adjusted for sex, breastfeeding, nutritional status, clinical presentation, housing, water supply, sanitation, and country, we observed that presentation at a health facility with prolonged diarrhoea was associated with low age (2-12 months) (adjusted odds ratio (aOR) = 1.25; 95% confidence interval (CI) = 1.02, 1.53; P = 0.028), presence of three or more under-five children in the family (aOR = 1.54; 95% CI = 1.26, 1.87; P < 0.001), maternal illiteracy (aOR = 1.45; 95% CI = 1.21, 1.74, P < 0.001), moderate underweight (aOR = 1.25; 95% CI = 1.01, 1.55; P = 0.042) and pathogen (Campylobacter) (aOR = 1.27; 95% CI = 1.12, 1.44; P < 0.001). At day 90 follow-up, children with prolonged diarrhoea had significantly lower weight-for-age z-score compared to children with acute diarrhoea (-1.62, standard deviation (SD) = 1.11 vs -1.52, SD = 1.20; P = 0.032), as well as significantly higher frequency of hospital admission (6.1% vs 4.5%; P = 0.042). Prolonged diarrhoea was more common in children of younger age, those who were moderately underweight, those with Campylobacter in stool, those with three or more under-five children in a family, and those with illiterate mothers compared to those who had acute diarrhoea. Children with prolonged diarrhoea more often required hospitalisation during the three-month follow-up period compared to their counterparts.

Follow-Up Outcomes of Children, Adolescents, and Young People on Darunavir-Based Third-Line Antiretroviral Therapy: Observational Cohort From 9 African Countries.

We assessed clinical outcomes among children, adolescents, and people younger than 25 years on darunavir-based antiretroviral therapy (ART) in 9 sub-Saharan African countries. Third-line ART centers in Cameroon, Eswatini, Kenya, Lesotho, Nigeria, Rwanda, Uganda, Zambia, and Zimbabwe. From January 2019 to December 2022, we collected data from a cohort of children, adolescents, and young people receiving third-line ART from 9 sub-Saharan African countries. Data on treatment continuity, viral suppression, death, and clinic transfers were extracted from medical records and summarized. Cox proportional hazards models were used to identify factors independently associated with retention in care. Of 871 participants enrolled, the median age was 14.8 (range: 0.2-24.7) years and 488 (56.0%) were male; 809 (92.9%) [median duration of follow-up of 28.3 months (interquartile range: 17.5-45.2)] had final outcomes after initiating third-line ART. Of these, 711 (87.9%) were alive and in care at the end of study follow-up, 29 (3.6%) died, 30 (3.7%) were transferred to other facilities, and 39 (4.8%) were lost to follow-up. Retention in care was less likely among male patients compared with female patients [aHR: 0.85, 95% confidence interval: 0.72 to 1.0] and in 10-14-year-old children compared with younger children. Adolescents (15-19 years old) had higher mortality compared with children younger than 10 years (aSHR: 4.20, 95% confidence interval: 1.37 to 12.87). Viral suppression was seen in 345/433 (79.7%), 249/320 (77.8%), and 546/674 (81.0%) patients with results at 6 months, 12 months, and study end, respectively. A high proportion of children and young people receiving third-line ART in sub-Saharan Africa remain in care and attain viral suppression during follow-up.

Paroxysmal Sympathetic Hyperactivity in Childhood Tuberculous Meningitis: A New Association.

We sought to estimate the prevalence and clinical characteristics of paroxysmal sympathetic hyperactivity (PSH) in childhood tuberculous meningitis. Hospital records of children (6 months to 14 years) with tuberculous meningitis were retrospectively analyzed from September 2019 through January 2022. In September 2019, the first case of paroxysmal sympathetic hyperactivity in tuberculous meningitis was identified in our division. Since then, all admitted children with tuberculous meningitis have been screened for paroxysmal sympathetic hyperactivity using the Paroxysmal Sympathetic Hyperactivity Assessment Measure (PSH-AM). Paroxysmal sympathetic hyperactivity is suspected when any of the following are present: recurrence of fever after initial defervescence, episodic posturing, dystonia, or unexplained tachycardia. Outcome at 3 months was prospectively scored according to the Pediatric Cerebral Performance Category score. Forty-one hospital records of children with tuberculous meningitis were analyzed, and 6 of them had paroxysmal sympathetic hyperactivity (probable paroxysmal sympathetic hyperactivity, 5/6; possible paroxysmal sympathetic hyperactivity, 1/6). Paroxysmal sympathetic hyperactivity appeared after a mean duration of 17 weeks (range: 12-25 weeks) from the diagnosis of tuberculous meningitis in 4 of 6 children and at 4 weeks in 2 of 6 children. Children with tuberculous meningitis who developed paroxysmal sympathetic hyperactivity were younger (median age: 5 years) compared with the nonparoxysmal sympathetic hyperactivity tuberculous meningitis cohort (median age: 10 years). A high proportion of children who developed paroxysmal sympathetic hyperactivity had hydrocephalus at presentation (5 of 6 [83.3%] vs 12 of 35 [34.3%], P = .035). Hospital stay was significantly prolonged in children with probable paroxysmal sympathetic hyperactivity (mean: 71.2 ± 26.8 days) compared with tuberculous meningitis without paroxysmal sympathetic hyperactivity (mean: 20.8 ± 11.6 days; P < .0001). Paroxysmal sympathetic hyperactivity is a late complication of tuberculous meningitis observed in 14.6% cases and should be anticipated in children with reappearance of fever or neurologic worsening without any apparent cause.

Trade and socioeconomic importance of an invasive giant snail in the endemic-rich island of São Tomé, Central Africa.

Managing invasive species is crucial to mitigate their negative impacts on ecosystems, yet conflicts may arise when their social benefits are disregarded. Human pressure on the endemic-rich forests of São Tomé has been high since the island was discovered by the Portuguese in the 15th century, and numerous species have been introduced. These include the invasive West African giant land snail (Archachatina marginata), which was introduced in the mid-20th century, is now widespread on the island, and is a potential threat to native flora and fauna. We assessed the frequency of consumption of this species and its socioeconomic importance to people across the island with household questionnaires, focus group discussions, and semistructured interviews. We explored the prevalence and potential drivers of use (e.g., wealth, household composition, and diversity of occupations) and characterized the commodity chain to identify demographic groups linked to the snail trade. We interviewed 672 people (1 person per household), conducted 6 focus groups, and interviewed 80 key actors belonging to 5 subcategories. The snail was the most widely consumed bushmeat and an important source of income, particularly for women and unemployed youth. Insecure and scarce livelihood alternatives, mostly in rural areas, were reported as drivers for trade involvement. Snail harvesting was more frequent in poorer households with low occupational diversity. Selling tended to occur in households that were well-established in the community and had a higher proportion of children. Both were stimulated by the proximity of communities to the native forest. Buying snails was common in all demographic groups, but it was linked to wealth and occupational diversity. Interventions to manage the impact of this introduced species on the valuable ecosystems of the island should involve multiple sectors of society to ensure societal support. This requires robust consideration of the welfare of vulnerable demographic groups that benefit from the species.

The UK: international child poverty outlier

ABSTRACT The UK has not only one of the highest rates of child poverty in the rich world, but also the most rapidly rising rate in this grouping. Within the UK, a higher proportion of children are poor in the South East of England than in Scotland. The huge rise in economic inequality in the 1980s caused the UK to become an international outlier in terms of child poverty. All subsequent UK governments have maintained inequality at high levels – by choice. The results are telling: children in England are, on average, becoming shorter in height and child death rates in England are rising, almost certainly due to rising poverty and destitution. As inequality rises poverty rises, but so too does ignorance of each other. Those who study human geography in the UK, if they went to university in recent years, are the least likely graduates to have ever been poor. Child poverty remains off our mental maps and largely outside of our geographical imaginations. That has to change.

Impact of early childhood infection on child development and school performance: a population-based study

BackgroundChildhood infection might be associated with adverse child development and neurocognitive outcomes, but the results have been inconsistent.MethodsTwo population-based record-linkage cohorts of all singleton children born at term in New...

Respiratory Status in Children and Exposure to Animal Allergens-The Problem of Reverse Causality in Cross-Sectional Studies.

Some epidemiological studies suggest that early exposure to animal allergens during infancy reduces the risk of bronchial asthma in school-age children. However, the observed associations in some cases may be an effect of the study used (epidemiological observational studies, especially a cross-sectional study) and indicate reverse causality. This study aimed to determine the association between exposure to animal allergens and the prevalence of respiratory diseases, including bronchial asthma, considering the potential impact of reverse causality on the observed relationships. An analysis of data from a cross-sectional epidemiological study conducted in 2020 involving 3237 primary school students aged 7-15 years in the Silesian Province (Southern Poland) was carried out. The parents of students completed a questionnaire based on The International Study on Asthma and Allergies in Childhood (ISAAC). The relationship between the occurrence of chronic cough, wheezing, and dyspnea in the last 12 months, night waking due to dyspnea, and asthma in the presence of pets was assessed. Exposure to animal allergens was determined by answering the question, "Are there any furry or feathered animals in the home?" with three response options: "yes; they have been in the past; no" (Scenario 1). For the analyses and to reveal a potential reverse causality effect, the last two response categories regarding pet ownership were combined to form a "no" category in Scenario 2, and the first two answers were combined into a "yes" category in Scenario 3. A chi-square test was used to assess the relationship between variables, and a statistical significance level of p < 0.05 was adopted. Chronic cough affected 9.5% of children, wheezing in the last 12 months-9.2%, night waking due to dyspnea-5.8%, dyspnea in the last 12 months-4.8%, bronchial asthma-9.2%. Analysis considering the category of having or not having pets (yes vs. no) showed that bronchial asthma was statistically significantly more common in children who did not have pets at home (10.9% vs. 7.9%, p = 0.002). A similar situation was observed for wheezing in the past 12 months (10.7% vs. 8.1%; p = 0.01) and nocturnal awakening due to dyspnea (6.8% vs. 5.1%, p = 0.03). No statistically significant differences were observed for the other symptoms. Analysis by time of pet ownership (a. present; b. present but in the past; c. not present) highlighted similar relationships. Asthma (a. 7.7% vs. b. 13.4% vs. c. 7.7%; p = 0.004), wheezing in the past 12 months (a. 8.1% vs. b. 8.9% vs. c. 10.9%, p = 0.03) and night waking (a. 5.0% vs. b. 4.5% vs. c. 7.1%; p = 0.04) were more common in children without pets and those who had owned pets in the past. The highest proportion of children with asthma was in homes where pets were present in the past. Analyses indicating a relationship between a higher prevalence of asthma and some respiratory symptoms, and the absence of pets cannot be considered as a casual association. The analysis conducted did not reveal a reverse causality effect. The results of observational epidemiological studies, especially a cross-sectional study, should always be interpreted with caution, considering possible distortions and conclusions drawn.

Home-video EEG monitoring in a pediatric setting

IntroductionPediatric video-EEG monitoring is a standard procedure in epilepsy clinics, typically conducted in in-hospital settings.However, hospitalizationis sometimesunnecessary and imposes a burden on children and their families. In response to the rise of telehealth, home video-EEG monitoring has emerged, utilizing portable EEG equipment and video-cameras. ObjectiveThe aim of this study was to assess the feasibility of home video-EEGin a pediatric population. MethodsWe conducteda prospective pilot study of twentyhome video-EEG tests in children. We evaluated the quality of EEG and video recordings using a 5-point scale.Demographic, clinical and quality data were comparedto a similar group undergoing in-hospital video-EEG monitoring. ResultsTwenty children aged 2.1–17.2 years (mean 9.57 ± 1.01), 12 females (60 %), underwent home video-EEG. A higher proportion of children with intellectual disability/autism were observed in the home-EEG group compared to the in-hospital group: 12 patients (60 %) vs. 5 (25 %) (p < 0.05*, Fisher exact test). In the ambulatory group patients with developmental and epileptic encephalopathy were overrepresented (7 i.e., 35 % vs. 0), while those withself-limited childhood epilepsy were more prevalent in the in-hospital group (5 i.e., 25 % vs 0) (p < 0.05*, Chi square). In the ambulatory group the reasons for referral were seizure localization/classification in 11 patients (55 %), paroxysmal event classification in 5 (25 %) and quantification of sleep epileptic activity in 4(20 %),similar to the in-hospital group (40 %, 40 % and 20 % respectively, p > 0.05, Chi square). The quality of the EEG recording was higher compared to in-hospital tests: median 5 [IQR 3.25–5] vs 4[IQR 3–4] (p < 0.05*, Mann-Whitney U test), while the quality of video recording was lower compared to in-hospital recordings: median 3[IQR 2.25–4] vs 5[IQR4-5] (p < 0.01**, Mann-Whitney U test). ConclusionsHome video-EEG monitoring is apromising option forlong-termpediatric EEG monitoring, particularlyfor children with special needs.

Mental health in secondary school-aged children with epilepsy and their primary caregivers: A case control study

PurposeTo describe the prevalence and associated factors of mental health problems in secondary school-aged (11–16 years) children with epilepsy and their primary caregivers compared to a control group without epilepsy. MethodsChildren with epilepsy (n = 60), controls (n = 49), and caregivers (n = 60 epilepsy and n = 49 control group) completed a measure of the child's mental health (Strengths and Difficulties Questionnaire; SDQ). Primary caregivers in both groups completed a measure of their own mental health (Depression, Anxiety, and Stress Scale-21; DASS-21). Factors associated with child and caregiver mental health in the epilepsy group were explored using linear regression. ResultsThere were no significant differences between the epilepsy and control group regarding age, gender, ethnicity and socioeconomic status. A higher proportion of children with epilepsy scored in the at-risk range on the SDQ indicating more mental health problems than the control group, as reported by the children (45% vs. 24 %) (p = 0.026) and caregivers (52% vs. 14 %) (p < 0.001). Primary caregivers of children with epilepsy had more symptoms of depression (p = 0.001), anxiety (p = 0.028) and stress (p = 0.019) than caregivers in the control group. Children with epilepsy with greater motor coordination problems had greater mental health difficulties. Children with epilepsy with more mental health difficulties had caregivers with more difficulties and caregivers of children with earlier onset of seizures had more mental health difficulties. ConclusionsEpilepsy confers a high risk for mental health problems in adolescents and their primary caregivers. There is a need to better understand the relationship between caregiver and child mental health difficulties in epilepsy.

Оценка диспансерного наблюдения за детьми первого года жизни.

Children’s health is a powerful resource that can become the key to the future health of the nation. Considering the significant increase in morbidity among children in recent years, the assessment of dispensary observation of children in the first year of life is a relevant topic for research. Purpose: to assess the level and dynamics of dispensary observation indicators for children in the first year of life living in St. Petersburg. Materials and methods. Based on copying information from statistical reporting forms No. 12, a retrospective one-time study of indicators of the frequency of taking children of the first year of life into dispensary registration, the frequency of continuing dispensary observation after the first year of life, as well as the proportion of children of the first year of life remaining under dispensary observation from those registered during the year. The significance of differences in indicators was assessed using Student’s t-test. Differences were considered significant at p&lt;0.05. Statistical data processing was carried out using the MS Office‑2016 and StatSoft-Statistica 10.0 software packages. Results. Most often, children in the first year of life needed examination and treatment on an outpatient basis for diseases of the nervous system, certain conditions that arise in the perinatal period, as well as diseases of the respiratory and digestive organs. Most often, in children’s clinics of the metropolis, after the first year of life, dispensary observation of children with diseases of the nervous system, eyes and its appendages, digestive organs and congenital malformations continued. With a high frequency of children with respiratory diseases and certain conditions arising in the perinatal period being taken under dispensary observation, in most cases, by the end of the first year of life, children with these diseases are removed from the dispensary register. At the same time, with a low frequency of children being admitted to convalescent care, on average 71.3% of such patients remain under further dispensary registration. A high proportion of children who remain under clinical observation are patients with diseases of the genitourinary system, the eye and its adnexa, skin and subcutaneous tissue, the musculoskeletal system and connective tissue and the nervous system. Conclusion. In St. Petersburg, the increase in morbidity among children in the first year of life was due to the growing need for dispensary monitoring of children for almost all classes of diseases, except for respiratory diseases and certain conditions that arise in the perinatal period.

Pediatric Vital Signs Documentation in a Nationally Representative US Emergency Department Sample.

Vital sign measurement and interpretation are essential components of assessment in the emergency department. We sought to assess the completeness of vital signs documentation (defined as a temperature, heart rate, respiratory rate, blood pressure, and oxygen saturation) in a nationally representative sample of children presenting to the emergency department, characterize abnormal vital signs using pediatric advanced life support (PALS) criteria, and evaluate their association with hospitalization or transfer. We conducted a retrospective, cross-sectional study using the 2016-2021 National Hospital Ambulatory Medical Care Survey. We evaluated the proportion of children (aged ≤15 years) with complete vital signs and identified characteristics associated with complete vital signs documentation. We assessed the proportion of children having abnormal vital signs when using PALS criteria. We included 162.7 million survey-weighted pediatric encounters. Complete vital signs documentation was present in 50.8% of encounters. Older age and patient acuity were associated with vital signs documentation. Abnormal vital signs were documented in 73.0% of encounters with complete vital signs and were associated with younger age and hospitalization or transfer. Abnormal vital signs were associated with increased odds of hospitalization or transfer (odds ratio 1.51, 95% confidence interval 1.11-2.04). Elevated heart rate and respiratory rate were associated with hospitalization or transfer. A low proportion of children have documentation of complete vital signs, highlighting areas in need of improvement to better align with pediatric readiness quality initiatives. A high proportion of children had abnormal vital signs using PALS criteria. Few abnormalities were associated with hospitalization or transfer.

Combining developmental and sleep health measures for autism spectrum disorder screening: an ECHO study.

Sleep problems are reported for up to 80% of autistic individuals. We examined whether parsimonious sets of items derived from the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) and the Brief Infant Sleep Questionnaire (BISQ) are superior to the standard M-CHAT-R in predicting subsequent autism spectrum disorder (ASD) diagnoses. Participants from 11 Environmental influences on Child Health Outcomes (ECHO) cohorts were included. We performed logistic LASSO regression models with 10-fold cross-validation to identify whether a combination of items derived from the M-CHAT-R and BISQ are superior to the standard M-CHAT-R in predicting ASD diagnoses. The final sample comprised 1552 children. The standard M-CHAT-R had a sensitivity of 44% (95% CI: 34, 55), specificity of 92% (95% CI: 91, 94), and AUROC of 0.726 (95% CI: 0.663, 0.790). A higher proportion of children with ASD had difficulty falling asleep or resisted bedtime during infancy/toddlerhood. However, LASSO models revealed parental reports of sleep problems did not improve the accuracy of the M-CHAT-R in predicting ASD diagnosis. While children with ASD had higher rates of sleep problems during infancy/toddlerhood, there was no improvement in ASD developmental screening through the incorporation of parent-report sleep metrics. Parental-reported sleep problems are common in autism spectrum disorder (ASD). We investigated whether the inclusion of parental-reports of infant/toddler sleep patterns enhanced the effectiveness of developmental screening for autism. We reported higher rates of difficulty falling asleep and resisting bedtime during infancy and toddlerhood among children later diagnosed with ASD; however, we did not find an improvement in ASD developmental screening through the incorporation of parent-report sleep metrics. In our sample, the standard M-CHAT-R had a sensitivity of 39% among children of mothers with government insurance compared with a sensitivity of 53% among children of mothers with employer-based insurance.

Algorithmic Content Recommendations on a Video-Sharing Platform Used by Children

Free video-sharing platforms (VSPs) make up a high proportion of children's daily screen use. Many VSPs make algorithmic recommendations, appearing as thumbnail images from the video, which content creators use to advertise their video content. To explore how VSP thumbnails use attention-capture designs to encourage engagement with content and to test whether VSP algorithmic recommendations offer more problematic thumbnail features over time. In this cross-sectional study conducted in January 2022, researchers mimicked the search behavior of children on a popular VSP by randomly clicking on recommended videos in order to test whether thumbnail designs changed over 20 sequential video engagements. A digital, footprint-free data collection setting was created by using a new computer and wireless internet router. Data were collected from YouTube via an internet browser not logged into a user account. Data analysis occurred from April to December 2022. Manual searches using 12 top-searched terms popular with school-aged children were conducted. Researchers captured the video thumbnails recommended at the end of each video and randomly clicked subsequent videos for 20 sequential engagements. Thumbnail content codes were developed through iterative review of screenshots by a multidisciplinary research team and applied by trained coders (reliability, κ >.70). The prevalence of problematic thumbnail content and change in prevalence over 20 engagements was calculated using the Cochran-Armitage trend test. A total of 2880 video thumbnails were analyzed and 6 features were coded, including visual loudness; drama and intrigue; lavish excess and wish fulfillment; creepy, bizarre, and disturbing; violence, peril, and pranks; and gender stereotypes. A high proportion contained problematic features including the creepy, bizarre, and disturbing feature (1283 thumbnails [44.6%]), violence, peril, and pranks feature (1170 thumbnails [40.6%]), and gender stereotypes feature (525 thumbnails [18.2%]). Other features included attention-capture designs such as the visual loudness feature (2278 thumbnails [79.1%]), drama and intrigue feature (2636 thumbnails [91.5%]) and lavish excess and wish fulfillment feature (1286 thumbnails [44.7%]). Contrary to the hypotheses, problematic feature prevalence did not increase over time, but the gender stereotypes feature increased with more engagement in the recommendations feed (P for trend < .001). In this study of video recommendations for search terms popular with children, thumbnails contained problematic and attention-capturing designs including violent, stereotyped, and frightening themes. Research is needed to understand how children respond to thumbnail designs and whether such designs influence the quality of content children consume.

A real-world cross-sectional study evaluating the role of an oral amino acid-based supplement in nutrient intake by preschoolers on a cow's milk elimination diet.

Food allergy has several negative nutritional consequences and may persist beyond the first year of lives. This study aimed to assess the role of a complete oral amino acid-based supplement in the diet of children on cow's milk protein elimination diet because of food allergy. This study included two groups of children aged 1-5 years paired by age and socioeconomic status: (1) study group, on cow's milk protein elimination diet plus an oral amino acid-based supplement, and (2) control group, on cow's milk protein elimination diet. Sociodemographic, clinical, anthropometric, and dietary data were obtained through online interviews. Two 24-h dietary recalls were collected on nonconsecutive days. Both groups comprised mostly boys. The study group presented lower values of body mass index. The frequency of feeding difficulties was similar between groups. The study group had a higher intake of energy, protein, carbohydrates, calcium, iron, zinc, phosphorus, magnesium, copper, selenium, vitamins D, E, B1, B2, B6, and B12, niacin, and folic acid compared to the control group. A higher proportion of children in the study group had adequate intake according to the recommendations made for energy, carbohydrates, iron, phosphorus, selenium, vitamins A, D, E, B1, B2, and B6, and folic acid. The use of a complete oral amino acid-based supplement has a positive effect on the diet quality of preschoolers on cow's milk elimination diet because of food allergy, promoting higher intake of energy, calcium, vitamin D, and other essential nutrients.

Improving the social communication skills of preschoolers with autism spectrum disorder: robot-based intervention on Picture Exchange Communication System use

Objectives Children diagnosed with autism spectrum disorder (ASD) often exhibit challenges in social communication. Picture Exchange Communication System (PECS) is effective in enhancing the social skills of children with ASD, and interventions using social robots are potentially beneficial training tools. However, it is uncertain whether robots can facilitate more effective training for children with ASD compared to human therapists. Methods In the present study, we compared the effectiveness of robot-based and human-based interventions on enhancing the social communication behaviors in young children diagnosed with ASD. The feasibility and efficacy of integrating the PECS in robotic systems were evaluated using a single-case design. Eight children with ASD were randomly assigned to either a robot-based group (N = 4) or a human-based group (N = 4). Participants in the two groups underwent phases I–III of the PECS protocol facilitated by either a human therapist or a robot therapist. Changes in social communication behaviors were assessed in each child after intervention using a single-case design. Results Half of the participants in the robot-based intervention group showed significant improvement in both verbal and nonverbal communication behaviors after a two-month PECS intervention. A higher proportion of children in the robot-based intervention group showed significantly enhanced social communication skills encompassing both verbal and nonverbal behaviors than in the human-based intervention group. Conclusions This study demonstrates the effectiveness of robot-based PECS intervention in enhancing verbal and nonverbal communication behaviors in young children with ASD. These findings present novel intervention tools for early intervention educators engaged in supporting children with ASD.

Relationship between Serum IgA concentration and epileptic seizures in children: A prospective study

Purpose. This study investigated the relationship between serum immunoglobulin A (IgA) concentration and epileptic seizures in children. Methods. Pediatric patients with epilepsy were included in this cross-sectional investigation. Serum IgA levels were analyzed using a biochemical analyzer during admission for initial diagnosis before any medical treatment was administered. Results. Among the 94 patients, 19.1% had decreased serum IgA levels, with a median value of 0.57 g/L. No significant relationship existed between serum IgA concentration and gender, age, epilepsy type, seizure duration or epilepsy waves. Children with low IgA levels experienced more spastic episodes and had a higher seizure frequency compared to those without decreased IgA levels. Changes in serum IgA levels were significantly associated with seizure frequency after three months of treatment. Initially, the occurrence of seizures in the low IgA group was 10.5 times lower than in the non-low IgA group, but, after three months, the low IgA group had a significantly higher seizure rate (72.2%) compared to the non-low IgA group (19.7%). After six months, the low IgA group had a higher proportion of children without seizures (100% versus 84.8%), although the difference was not statistically significant. Conclusion. Serum IgA concentration plays a crucial role in diagnosing and predicting outcomes for pediatric epilepsy.

Opioid prescription patterns among commercially insured children with and without cerebral palsy.

This study aimed to describe opioid prescription patterns for children with vs. without cerebral palsy (CP). This cohort study used commercial claims from 01/01/2015-12/31/2016 and included children aged 2-18 years old with and without CP. Opioid prescription patterns (proportion exposed, number of days supplied) were described. A zero-inflated generalized linear model compared the proportion exposed to opioids in the follow-up year (2016) and, among those exposed, the number of days supplied opioids between cohorts before and after adjusting for age, gender, race, U.S. region of residence, and the number of co-occurring neurological/neurodevelopmental disabilities (NDDs). A higher proportion of children with (n = 1,966) vs. without (n = 1,219,399) CP were exposed to opioids (12.1% vs. 5.3%), even among the youngest age group (2-4 years: 9.6% vs. 1.8%), and had a greater number of days supplied (median [interquartile range], 8 [5-13] vs. 6 [4-9] days; P < 0.05). Comparing children with opioid exposure with vs. without CP, a greater number of days supplied was identified for older age, Asian race/ethnicity, and without co-occurring NDDs, and a lower number of days supplied was observed for Black race/ethnicity and with ≥1 co-occurring NDDs. Children with CP are more likely to be exposed to opioids and have a higher number of days supplied.

Where the children play: Gender gaps in recess physical activity by age and playground area

ObjectiveRecess contributes meaningfully to physical activity (PA), but recess time has declined. The study’s purpose was to report PA by age, gender, and playground feature to inform potential playground configurations more conducive to PA during recess. MethodsUsing the System for Observing Play and Leisure Activity in the Youth, kindergarten through 5th grade recesses were observed on at least four days at four schools in Little Rock, Arkansas, United States during May 2023. Target playground features were ball courts, grass, pavement, play structures, and swings. To provide inferential analysis, a comparison of conditional means across playground features, age, and gender was conducted using linear regression with robust standard errors clustered by school. Results3,356 playground scans (intercoder correlation = 0.93) were collected and aggregated by school, day, gender, age (grade), and target feature for a sample size of 292 observations. The gender gap was widest among 4-5th graders, 79 % (95 % CI: 72, 86) for males and 64 % (95 % CI: 58, 70) for females. Among females, PA was highest on swings [82 % (95 % CI: 77, 86)] and lowest on paved areas [56 % (95 % CI: 43, 69)]. Among males, it was highest on both swings [81 % (95 % CI: 75, 86)] and ball courts [83 % (95 % CI: 77, 89)] and lowest on grassy areas [64 % (95 % CI: 60, 67)]. ConclusionSwings, courts, and play structures were associated with a higher proportion of children being engaged in PA. Research is needed to identify whether physical improvements to facilitate access to these features increase PA.