Childhood Illness Research Articles

Maternal health and child socio-emotional development: findings from the growing up in New Zealand study

AbstractWe study the influence of maternal chronic illness and disability on the socio-emotional development of children across early to mid-childhood using the Growing Up in New Zealand study. Controlling for a host of relevant maternal, household and child characteristics, our results show a negative link between maternal chronic illness and disability and child socio-emotional outcomes at eight years of age. At earlier ages, the evidence of a relationship between maternal health and child socio-emotional outcomes is weaker. We also find that maternal parenting style and depression mediate the relationship between maternal chronic illness and disability and child socio-emotional outcomes. Specifically, parenting style mediates the relationship between maternal chronic illness and disability and child socio-emotional outcomes in early childhood, at age 2, but not at age 5, and for boys after commencement of formal education, at age 8. In contrast, maternal depression consistently mediates the relationship between maternal chronic illness and disability and child socio-emotional outcomes from early to mid-childhood, and for both boys and girls. Our findings stress the need to better understand both direct and indirect effects of maternal health on the formation of skills in childhood that influence future life chances.

Understanding Integrated Community Case Management Institutionalization Processes Within National Health Systems in Malawi, Mali, and Rwanda: A Qualitative Study.

Since 2012, the World Health Organization (WHO) and UNICEF have recommended integrated Community Case Management (iCCM) of childhood illnesses as an intervention delivered by community health workers (CHWs) in areas with limited access to health facilities to increase access to lifesaving interventions for children younger than 5 years with malaria, pneumonia, or diarrhea. In recent years, the importance of institutionalizing iCCM and community health more broadly within national health systems has become increasingly recognized. This qualitative study sought to identify and describe processes of iCCM institutionalization from the perspectives of health system actors. A total of 51 semistructured interviews were conducted with purposefully selected key informants in 3 countries: Malawi, Mali, and Rwanda. Thematic analysis of coded interview data was conducted, and country documentation was reviewed to provide contextual background for qualitative interpretation. The study was informed by a newly developed iCCM Institutionalization Framework, which conceptualizes the process of institutionalization through a maturity model of phases (i.e., awareness, experimentation, expansion, consolidation, and maturity) with 4 drivers: core values, leadership, resources, and policy. According to key informant narrative descriptions, processes of iCCM institutionalization reflected a progression of maturity phases, which were iterative rather than linear in progression. All 4 drivers of institutionalization as conceptualized within the iCCM Institutionalization Framework were described by key informants as contributing to the advancement of iCCM institutionalization within their countries. Key informants emphasized the need to continually strengthen or reinforce iCCM institutionalization for it to be sustained within the context of wider health system dynamics. Overall, key informants viewed government ownership and integration within national systems to define the status of iCCM institutionalization. Further development of the iCCM Institutionalization Framework and other practical sensemaking models could assist health system actors in advancing institutionalization of iCCM and other health interventions.

Early predictors of unfavorable outcomes in pediatric acute respiratory failure

ObjectiveAcute respiratory failure is a leading cause of critical illness in children. However, patient outcomes and early predictors of unfavorable outcomes are not well understood. This study aimed to describe composite unfavorable outcomes, defined as in-hospital death or discharge with new comorbidities, and to identify early predictors in children with acute respiratory failure in acute care hospitals.DesignRetrospective cohort study using a national inpatient database in Japan.SettingAll acute care hospitals registered in the database.PatientsThis study included children under 20 years of age who were admitted with acute respiratory diseases between July 2010 and March 2022 and received ventilatory support within the first three days of hospitalization.InterventionNone.Measurements and main resultsAmong 29,362 eligible children, the median age was 1.2 (interquartile range, 0.3–3.7) years and 28.8% had underlying conditions. The highest level of ventilatory support within the first three days was invasive ventilation (69.4%), noninvasive ventilation (1.0%), and high-flow nasal cannula (29.7%). Respiratory diagnoses included pneumonia (58.6%), bronchiolitis (29.0%), and asthma (11.1%). Among these children, 669 (2.3%) died and 1994 (6.8%) were discharged with new comorbidities, resulting in 2663 (9.1%) children experiencing unfavorable outcomes. In the logistic regression model, older age, underlying conditions, pneumonia, and low hospital volume were associated with unfavorable outcomes after adjusting for covariates.ConclusionsA significant proportion of pediatric patients with acute respiratory failure experienced unfavorable outcomes, warranting future efforts to improve acute care services for at-risk children. Early predictors identified from national database analyses could inform risk stratification and optimize the provision of acute care services for vulnerable pediatric patients.

Environmental Heat Illness in Children

Environmental Heat Illness in Children

Prevalence and Genetic Diversity of Respiratory Syncytial Virus Reinfections in Young Thai Children, 2016-2023.

Although a vaccine for respiratory syncytial virus (RSV) is now available for pregnant women and the elderly, RSV remains a significant cause of respiratory illness in children globally. Reinfections by the same or different RSV subgroups in children residing in the tropics are currently under-studied. Therefore, we examined the patterns of RSV infection and reinfection in Thai children aged ≤ 5 years with respiratory symptoms from 2016 to 2023. Screening of 7710 pediatric respiratory specimens identified 1245 RSV-positive samples (16.1%), mostly from the rainy months (July-November). Interestingly, 74 children experienced two infections, and 6 had three infections. Reinfection by different RSV subgroups occurred in 30 children: 21 were initially infected with RSV-B and later with RSV-A, while 9 had the reverse pattern. Reinfections only by either RSV-A or RSV-B were observed in 22 and 2 children, respectively, with one child infected with RSV-A three times. All RSV-A reinfections belonged to the ON1 genotype, while RSV-B reinfections were BA9. Notably, reinfections across different seasons were observed within homologous pairs. These findings suggest a transitory immunity to natural RSV infection and provide the knowledge that may help optimize pediatric vaccination schedule. Ongoing epidemiological data on RSV are essential in monitoring genotype circulation and vaccine effectiveness.

School-Based Health Care: An Overview.

The school building provides a unique opportunity to prevent, identify, and treat illness in children. School staff must be prepared to care for children with acute and chronic health care needs and pediatricians should be aware of the health resources available in local schools for their patients. This article provides an overview of multiple school-based health topics including the roles of various school health professionals, medication administration in the school setting, the legal protections around health information, school-based health centers, and the rise of telehealth. Most importantly, this article reminds providers that school-based health resources are all unique to each school and school district; all parents of children with health needs should meet with their school's administration to understand what resources are available. [Pediatr Ann. 2024;53(12):e435-e437.].

Haematopoietic gene therapy of non-conditioned patients with Fanconi anaemia-A: results from open-label phase 1/2 (FANCOLEN-1) and long-term clinical trials

Allogeneic haematopoietic stem-cell transplantation is the standard treatment for bone marrow failure (BMF) in patients with Fanconi anaemia, but transplantation-associated complications such as an increased incidence of subsequent cancer are frequent. The aim of this study was to evaluate the safety and efficacy of the infusion of autologous gene-corrected haematopoietic stem cells as an alternative therapy for these patients. This was an open-label, investigator-initiated phase 1/2 clinical trial (FANCOLEN-1) and long-term follow-up trial (up to 7 years post-treatment) in Spain. Mobilised peripheral blood (PB) CD34+ cells from nine patients with Fanconi anaemia-A in the early stages of BMF were transduced with a therapeutic FANCA-encoding lentiviral vector and re-infused without any cytotoxic conditioning treatment. The primary efficacy endpoint of FANCOLEN-1 was the engraftment of transduced cells, as defined by the detection of at least 0·1 therapeutic vector copies per nucleated cell of patient bone marrow (BM) or PB at the second year post-infusion, without this percentage having declined substantially over the previous year. The safety coprimary endpoint was adverse events during the 3 years after infusion. The completed open-label phase 1/2 and the ongoing long-term clinical trials are registered with ClinicalTrials.gov, NCT03157804; EudraCT, 2011-006100-12; and NCT04437771, respectively. There were eight evaluable treated patients with Fanconi anaemia-A. Patients were recruited between Jan 7, 2016 and April 3, 2019. The primary endpoint was met in five of the eight evaluable patients (62·50%). The median number of therapeutic vector copies per nucleated cell of patient BM and PB at the second year post-infusion was 0·18 (IQR 0·01-0·20) and 0·06 (0·01-0·19), respectively. No genotoxic events related to the gene therapy were observed. Most treatment-emergent adverse events (TEAEs) were non-serious and assessed as not related to therapeutic FANCA-encoding lentiviral vector. Nine serious adverse events (grade 3-4) were reported in six patients, one was considered related to medicinal product infusion, and all resolved without sequelae. Cytopenias and viral infections (common childhood illnesses) were the most frequently reported TEAEs. These results show for the first time that haematopoietic gene therapy without genotoxic conditioning enables sustained engraftment and reversal of BMF progression in patients with Fanconi anaemia. European Commission, Instituto de Salud Carlos III, and Rocket Pharmaceuticals.

Respiratory Vaccination And Their Correlation On Incidence, And Severity Of Illness In Children Admitted To Hospital For Pneumonia

Pneumonia accounts for 14% of all deaths of children under 5 years old, killing 740 180 children in 2019. India has the second highest burden of childhood pneumonia deaths worldwide. With a child infected with Pneumonia every second, India contributes 26% of the total pneumonia cases worldwide for the period of 2019-21. In the years 2019-21, the average occurrence rate of Pneumonia in India was 2.8% according to the NHFS – 5-6. Based on the data from the Sample Registration System, the under-five mortality rate was seen to be 32 per 1000 live births. Pneumonia was identified as the second most common cause of mortality, with 19.4 percent of deaths in the age group of 1-4 years and 16.8 percent in the age group under 1yearold in India from 2016 to 2018. Prevention efforts, such as vaccination and promoting good hygiene practices, are crucial in reducing the impact of pneumonia on children's health.

Clinical Success of Pulpotomies Using Intermediate Restorations and Preformed Metal Crowns in the Context of a Developing Country: A Retrospective Questionnaire-Based Investigation

Background: Dental caries is one of the most prevalent dental illnesses in children. Untreated severe caries can damage teeth, requiring pulpotomy to save them. Objective: To evaluate the clinical success rate of treatments involving pulpotomies + IRM (Intermediate Restorative Material, composed of reinforced zinc oxide–eugenol polymers) + preformed metal crowns (PMCs) in primary teeth of children treated at a public university in Mexico. Materials and Methods: A cross-sectional ambispective study was conducted on children aged 10 years or younger, treated at a public university in Mexico. A total of 1281 medical records from February 2018 to June 2023 were reviewed, yielding a sample of 199 children treated with pulpotomy + IRM + PMC. Information was collected via telephone interviews with parents/caregivers to inquire about any symptoms following the pulpotomy and metal crown treatments. Success was defined as the absence of pain, inflammation, or infection. Results: During the study period, the number of teeth treated with pulpotomy + IRM + PMC was 414, with follow-ups ranging from 6 to 69 months. Most participants were girls (54.3%), while 45.7% were boys. Out of the 167 pulpotomy + IRM + PMC treatments included in the study, the clinical success rate was 98.2%. Conclusions: The clinical success rate of primary teeth treated with pulpotomy + IRM + PMCs was high, close to 100%, based on evidence and symptom reports from parents/caregivers. It would be beneficial to implement its use in public health institutions in countries such as Mexico.

Kidney and blood pressure outcomes 11years after pediatric critical illness and longitudinal impact of AKI: a prospective cohort study.

Acute kidney injury (AKI) is common in critically ill children and associated with adverse short-term outcomes; however, long-term outcomes are not well described. This longitudinal prospective cohort study examined the prevalence of chronic kidney disease (CKD) and hypertension (HTN) 11 vs. 6years after pediatric intensive care unit (PICU) admission and association with AKI. We examined children (age < 19years) without pre-existing kidney disease 11 ± 1.5years after PICU admission at a single center. AKI was defined using serum creatinine criteria. The primary outcome was a composite of CKD or HTN. CKD was defined as estimated glomerular filtration rate (eGFR) < 90mL/min/1.73 m2 or albuminuria. Multivariable analyses compared outcomes at 11- vs. 6-year follow-up and association with AKI during PICU admission. Of 96 children evaluated 11years after PICU admission, 16% had evidence of CKD or HTN (vs. 28% at 6years, p < 0.05). Multivariable analysis did not show improvement in outcomes from 6- to 11-year follow-up. eGFR decreased from 6- to 11-year follow-up (adjusted coefficient - 11.7, 95% CI - 17.6 to - 5.9) and systolic and diastolic blood pressures improved. AKI was associated with composite outcome at 6-year (adjusted odds ratio (aOR) 12.7, 95% CI 3.2-51.2, p < 0.001), but not 11-year follow-up (p = 0.31). AKI was associated with CKD (aOR 10.4, 95% CI 3.1-34.7) at 11years. This study provides novel data showing that adverse kidney and blood pressure outcomes remain highly prevalent 10years after critical illness in childhood. The association with AKI wanes over time.

Factors Influencing Officer Compliance in the Implementation of Integrated Management of Childhood Illness (IMCI) at Community Health Center in Banda Aceh City

Integrated Management of Sick Toddlers (IMCI) is an integrated approach to improving child health and well-being, which aims to reduce morbidity and mortality and promote growth and development of children under five. Despite its importance, challenges in the quality of IMCI implementation in PHC centers still exist. This research aimed to identify factors that influence staff compliance in implementing IMCI at health centers in Banda Aceh city. This research method used an analytic observational research with a cross-sectional design, involving 64 IMCI service providers from November 2023 to June 2024. Data were collected using questionnaires and analyzed using the chi-square test and multivariate logistic regression. The results showed that staff compliance in implementing IMCI was 39%. Internal factors that significantly influenced compliance were motivation (OR=14.3, 95% CI: 3.039-67.505) and knowledge (OR=8.63, 95% CI: 1.694-43.978). External factors included the availability of complete logistics facilities (OR=8.05, 95% CI: 1.706-38.04). This research identified Ulee Kareng Health Center as having the highest number of PIA service providers (17%), while Banda Raya Health Center had the lowest number (7%). Most of the PIA service providers were aged 19-44 years (68.8%), mostly female (96.9%), and had high educational qualifications (93.7%). The implications of this research underscore the important role of motivation, knowledge, and logistical support in improving staff adherence to IOP protocols. The results of this research have implications for strengthening health care systems and improving the quality of IYCF implementation to meet the health needs of children under five in Banda Aceh city.

The roles of self-compassion and social support on the maternal adjustment to a child's hip dysplasia.

Parenthood can be challenging when facing a child's chronic illness such as developmental dysplasia of the hip (DDH). Although social support is known as a protective factor for the caregiver's mental health, the role of self-compassion is less explored. This study, conducted in Portugal, explored whether self-compassion and social support mediate the relationship between mothers' psychological adjustment and perception of their child's illness. Ninety-four mothers of children with DDH completed questionnaires on illness perception, self-compassion, perceived social support, and psychological distress. Results suggested that self-compassion and social support mediated the relationship between mothers' overall negative perception of the children's illness and psychological distress. The final model accounted for 50% of the variance of depressive symptoms, 40% of anxiety, and 63% of perceived stress. This study highlights the potential value of encouraging mothers to seek social support when facing their child's DDH diagnosis. Promoting self-compassion may be important in clinical intervention.

Influence of Political Guidelines and National Health Strategies on Resource Mobilisation for Integrated Community Care in Burkina Faso

Background: High infant mortality and inadequate access to care have led Burkina Faso to offer integrated community care for childhood illnesses (iCCM) for many years. Studies show that uptake is low and infant and child mortality remains high. The aim of the study is to analyse the influence of policies and strategies on the implementation of community-based management of childhood illnesses. Methods: A mixed methods cross sectional study was conducted in Burkina Faso in the health districts of Boussouma and Boussé. Data was collected from February to March 2023 using interviews of 29 people and administered questionnaires to 42 health workers. Descriptive statistics and thematic analysis was used respectively for quantitative and qualitative analysis. Nvivo 14 was used for qualitative analysis.Results: Overall, 29 people from various structures and 42 health workers took part in this study. The iCCM is well described and integrated into strategic documents and several activities are planned by stakeholders. Despite this strategic commitment, geographical coverage is still insufficient, according to our respondents. Financial resources and especially health products are not enough to meet needs. Conclusions: There is effective ownership of policy orientations and guidelines, but only partial. Vigorous action is needed on governance and funding alignment. The study identified the level of institutionalisation of iCCM and the efforts needed to improve coverage, particularly in terms of funding for drugs and equipment by government.

A potential platform for future vaccine trials identifies high incidence of symptomatic and asymptomatic influenza infection among children aged 6-23 months in South Africa.

Approaches for determining whether influenza vaccination prevents infection, attenuates illness, or both, are important for developing improved vaccines. We estimated influenza infection incidence, and evaluated symptom ascertainment methodologies in children to inform future vaccine trial design. We conducted a prospective cohort study among children aged 6-23 months from May-October 2022. Study nurses collected symptom and temperature data and mid-turbinate nasal swabs twice-weekly irrespective of symptoms; caregivers entered symptom data daily and collected nasal swabs weekly. Samples were tested for influenza using PCR. Of 230 healthy, screened children, 93 were enrolled of whom 87 (94%) completed 6-months follow-up. 95% (4245/4476) of scheduled nurse, 90% (2045/2276) of caregiver swabs, 99% (92/93) of baseline blood collections and 67% (9245/13768) of scheduled symptom diaries were completed. PCR-confirmed influenza incidence was 65% (60/93) for ≥1 infection; 11 (18%) individuals had 2 and 1 (2%) had 3 episodes. Of 73 episodes, 55 (75%) had ≥1 symptom and 37 (51%) had fever (measured and/or reported). Median infection duration was 7 days (interquartile range 4-9). Human RNase P gene was detected in 99% (2032/2045) of caregiver-collected swabs, through which 5 additional episodes were identified. Per episode, caregiver's diaries of reported and measured fever were 19%(25/73,34%) and 11%(15/73,21%) higher than nurse-reported (11/73,15%) and -measured fevers (7/73,10%), respectively. The incidence of influenza infection was high and mainly symptomatic suggesting that this platform could be suitable for future trials of vaccine efficacy and correlates of protection against infection and illness in children.

Trends in the Prevalence and Factors Associated with Undernutrition in Tunisian Children Aged 0-23 Months.

In recent years, undernutrition has remained a significant public health issue in Tunisia, increasing the risk of illness and mortality in young children. Therefore, this study aims to analyse the prevalence and factors contributing to undernutrition among Tunisian children aged 0-23 months. The study included 3265 children aged 0-23 months from the 2011-2023 Tunisia Multiple Indicator Cluster Surveys (MICS). Trends and logistic regression analyses were used to determine the prevalence and predictors of undernutrition. The prevalence of stunting, wasting, and underweight in infants and children aged 0-23 months has increased by 3.3%, 0.5%, and 2.1%, respectively. Stunting and underweight were more common among infants aged 0-5 months (11.8% for stunting, 8.9% for underweight, p < 0.01), and first-time mothers (8.3% for stunting, 4.1% for underweight, p < 0.01). In 2023, compared to 2011, the odds of stunting, wasting, and being underweight had increased by 22%, 16%, and 70%, respectively. Infants aged 0-5 months had higher odds of undernutrition in all three indices. Children of obese or overweight mothers, and those who started breastfeeding late, were more likely to be stunted. Boys had significantly higher odds of wasting and underweight. Children with low birth weight, and duration of breastfeeding > 12 months, had significantly higher odds of being underweight. This study shows that infants aged 0-5 months, first-time mothers, boys, and children from poor households in Tunisia are at a higher risk of undernutrition. To address the growing issue of undernutrition in Tunisian children, enhancing maternal and child health and nutrition services, improving parental education, and implementing community-based programs that provide breastfeeding and nutritional education to infants born to new mothers and mothers with high/low BMI is recommended.

Reactive arthritis in children

One of the common childhood illnesses is reactive arthritis, which develops during or soon after an infection.Purpose. The aim of the study was to study the etiology, clinical and laboratory manifestations of arthritis in children.Material and methods. The study included 37 children with arthritis aged 1 year 10 months to 15 years who were hospitalized at Kazan City Children’s Hospital № 1.Results. Reactive arthritis was diagnosed in 26 children, and juvenile idiopathic arthritis in 11. In 20 patients, reactive arthritis manifested itself as monoarthritis with predominant damage to the hip or knee joints – in 11 and 9 cases, respectively. Two children had ankle arthritis. In 4 cases there was oligoarthritis. Markers of infectious diseases were identified in 10 out of 26 children with reactive arthritis (38%). In 5 children (19%) IgM to Mycoplasma pneumonia was detected, in two (8%) – IgM to capsid antigen of Epstein–Barr virus, in one child (4%) – IgM to Chlamydia pneumonia. Two children had elevated ASLO values (more than 400 IU/ml). Inflammatory in the blood in 33 cases (89%) were characterized by increased erythrocyte sedimentation rate, the median of which was 22 mm/hour. Increased level of C-reactive protein and leukocytes in the blood were observed only in 9 (24%) and 7 (19%) children, respectively.Conclusion. Reactive arthritis in children mainly manifests as monoarthritis, with predominant damage to the hip or knee joints and in most cases was associated with Mycoplasma pneumonia.

Associations of childhood socioeconomic position and health with trajectories of grip strength from middle to older ages in populations from China and England

BackgroundWe investigated associations of childhood socioeconomic position and health with trajectories of grip strength from middle to older ages in two distinct populations. MethodsWe used data from the China Health and Retirement Longitudinal Study (CHARLS, n = 16,701) and English Longitudinal Study of Ageing (ELSA, n = 12,695). Hand grip strength was measured at three timepoints in CHARLS (2011–2015) and four in ELSA (2001−2020). Random-effects growth models were applied to assess associations between each childhood factor and age trajectories of grip strength. FindingsLower parental education was associated with weaker grip strength, by 0·36 kg(95 % CI:0·17,0·56) for participants of illiterate (vs literate) parents in CHARLS and 1·88 kg(0·43,3·33) for participants of parents without education (vs ≥ high school) in ELSA, after adjusting for parental occupation and own adult socioeconomic position. Low parental occupation was associated with weaker grip strength, although the difference diminished after adjustment for adult socioeconomic position. Financial hardship was associated with weaker grip strength only in CHARLS, by 0·19 kg(0·01,0·38) after adjustment. Self-rated poor childhood health and school absenteeism were associated with weaker grip strength (both studies). Being confined to bed and hospitalised for more than a month due to health were associated with weaker grip strength only in CHARLS. Each additional childhood illness (only reported in ELSA) was associated with 0·52 kg(0·28,0·81) lower mean grip strength. Reported poor childhood health (CHARLS), low parental education and school absenteeism (ELSA) were associated with grip strength decline. InterpretationLower socioeconomic position and poor health in childhood were associated with weaker grip strength in later life in both Chinese and English populations. Addressing socioeconomic disparities and promoting health of children may enhance life-course physical capacity, promote healthy ageing and reduce age-related adversities.

Critical risk factors analysis of infection-associated hemophagocytic lymphohistiocytosis in children.

To analyze the critical factors of infection-associated Hemophagocytic lymphohistiocytosis (HLH) in children, so as to provide theoretical basis for clinicians to evaluate the disease condition, formulate treatment plan and improve prognosis.This study is a retrospective analysis. 60 cases of children with infection-associated HLH were divided into critical and non-critical groups based on the presence of multiple organ dysfunction syndrome (MODS), and the clinical characteristics and laboratory data of the two groups of children were analyzed. A multifactor logistic regression analysis model was used to assess the independent risk factors affecting critical illness in children with infection-associated HLH, and the Receiver Operating Characteristic (ROC) curve analysis was used to evaluate the predictive value of risk factors for critical illness in children with infection-associated HLH. Children in the critical group with HLH had a younger age at onset. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), gamma-glutamyl transferase (GGT), D-dimer (DD), and triglycerides (TG) were significantly higher in the critical group, while albumin (ALB) was significantly lower, showing statistical significance (P < 0.05). Multifactorial logistic regression analysis of age, ALB, and TG showed that younger age and lower ALB were associated with a higher risk of MODS in children with infection-associated HLH, with age and ALB being independent risk factors for critical illness. ALB predicted the ROC area under the curve for critical children with infection-associated HLH was 0.765 (95% CI: 0.643-0.888, P = 0.011), with the optimal cut-off value being 32.50g/L (sensitivity = 68.3%, specificity = 84.2%); age predicted the ROC area under the curve for critical children with infection-associated HLH was 0.711 (95% CI: 0.570-0.851, P = 0.009), with the optimal cut-off value being 1.50 years (sensitivity = 70.7%, specificity = 68.4%). This study suggests that younger patients and those with hypoalbuminemia among infection-related HLH patients are more likely to develop MODS. In the future, verification will be required through large-scale, multi-center studies.

Childhood Respiratory Illnesses Before and After COVID-19 Pandemic Restrictions.

Introduction With the COVID-19 pandemic, multiple studies described a significant drop in common respiratory viruses in children with the lockdown and restrictions. With the lifting of pandemic precautions, we had the ability to observe new patterns of respiratory illnesses in children and emergency department visits. Materials and methods We studied all respiratory nucleic acid amplification test results in emergency patients from a large metropolitan children's hospital from the years 2018 to 2023. The test included adenovirus, coronaviruses HKU1, NL63, 229E, OC43, metapneumovirus, rhinovirus or enterovirus, influenza A and B, parainfluenza virus types 1-4, respiratory syncytial virus, Bordetella pertussis, Bordetella parapertussis, Chlamydophila pneumoniae, and Mycoplasma pneumoniae. Coronavirus SARS CoV-2 became part of the respiratory panel in November of 2020. We reviewed pediatric emergency department census data to describe the trends before, during, and after COVID-19 pandemic restrictions. Results and conclusions Prior to 2020, there was a median of 1080 tests performed per week with an average positivity rate of 3.7-4.1%. During 2020, this dropped to 486 tests per week with a positivity rate of 1.74%. In 2021, after schools reopened, the median number of tests was 589 per week, with a positivity rate of 4.07%. After schools reopened without masks, the median tests per week were 817, with a positivity rate of 4.71%. Emergency department census data showed a large rebound in 2021 and 2022, with significantly earlier census peaks in these years. Common pediatric respiratory illnesses had an early seasonal spike in the years after the restrictions were lifted, with the most significant being the year in which local schools stopped wearing masks.

Caring Under Pressure: Investigating Parental Attitudes in Mother-Child Chronic Illness Dynamics.

The presence of chronic illnesses in both a mother and a child poses a significant challenge for mothers in managing these conditions, yet how maternal attitudes adapt to dual illness remains poorly understood. This study aims to explore parenting styles in families dealing with mother-child chronic illnesses. Mothers of children aged 2-6 were recruited from three pediatric clinics and categorized based on the health status of both the mother and the child. Data collection included case files and the Parental Attitude Scale (PAS), which assessed democratic, authoritarian, overprotective, and permissive attitudes. The interaction between mother-child health status and higher levels of parental subscales was analyzed using the chi-square test. Multiple logistic regression analysis was then performed to evaluate this interaction, controlling for confounding baseline characteristics. In total, 878 mother-child pairs were included. Mothers exhibited varying attitudes based on education, employment, and the child's age. Chronic illness in both mother and child and only the child having an illness were significantly associated with higher overprotective scores (p < 0.001). The percentage of mothers with high permissive scores was higher when only the mother had an illness and when both were healthy, compared to the case of both mother and child having an illness (p = 0.018). After adjusting for confounding factors, having a sick child showed a 1.6-fold increase in the likelihood of a high overprotective score, and both the mother and child having an illness showed a 2.94-fold increase. Similarly, after adjusting for the same confounding factors, the likelihood of a high permissive score was 2.56 times lower when both were ill compared to when both were healthy. This study reveals that when a child is affected by a chronic illness-whether or not the mother is also ill-mothers tend to exhibit higher levels of overprotection and lower levels of permissiveness, while their levels of authoritarianism and democratic attitudes in parenting remain relatively stable.