Management Of Children Research Articles

A Pilot Controlled Trial of Relaxation Training Combined with a Video Game Reinforcing Emotional Regulation to Improve Anger Management in Children and Adolescents.

Untreated anger and aggression in youth confer heightened risk for subsequent psychosocial problems. However, engaging youth in treatment for anger can be difficult given barriers to accessing care and high rates of attrition. This study examined whether learning relaxation skills and practicing them using a videogame, whose operation was contingent upon keeping heart rate close to baseline levels, could help children learn to manage anger and aggression. Youth ages 7-17 with elevated levels of anger (N = 39) were randomized to receive the active video game condition or a control game that displayed heart rate but did not stop the game if heart rate became elevated. Youth underwent baseline screening, 6 treatment sessions, and follow-up assessments at 2-weeks and 3-months. Compared to the control condition, children in the active condition demonstrated significantly greater improvements in clinician-rated aggression severity (d = 1.48) and youth-rated emotion dysregulation (d = 3.46) at 2-weeks post-treatment. The active group maintained these improvements at 3-month follow-up, but no longer significantly differed from the control group. Intervention effects were nonsignificant for parent-reported emotion dysregulation and aggression. In addition, the intervention group youth, but not control group, experienced increased time with heart rate below baseline over the course of the 6 sessions. Findings suggest a promising brief intervention for reducing aggression and emotion dysregulation in children while they are waiting for longer-term outpatient therapy. Clinical Trial Registration Number: NCT03270813.

Improving Hospital-to-Home for Medically Complex Children: Views From Spanish-Speaking Caregivers.

Children with medical complexity (CMC) experience increased risk of adverse events during and after hospitalization, and these risks are even greater for CMC whose caregiver has a preferred language other than English. Because many adverse events for CMC may be attributable to communication challenges, understanding caregiver and physician perspectives may help prevent adverse events. We conducted semistructured interviews with Spanish-speaking caregivers of hospitalized CMC and their inpatient attending physicians. Each interview was conducted 24 to 72 hours after hospital discharge. Interviews continued until thematic sufficiency was reached. Interviews were audio recorded, transcribed, and translated verbatim. Investigators independently coded and reconciled codes using constant comparison to develop themes via inductive thematic analysis. We conducted 28 interviews (14 caregivers, 14 physicians). Three themes were identified: (1) barriers exist in providing language-concordant care in planning for transitions from hospital-to-home; (2) both physicians and caregivers perceived logistical challenges in using interpreters at the point of care; and (3) many caregivers felt uncomfortable asking physicians questions related to their child's medical management because of their language barrier. Participants also offered strategies to improve the transition from hospital to home: (1) empower families to ask questions and take notes, (2) consider the use of medical educators, and (3) improve the ability of hospital-based physicians to follow up with patients after discharge. Physicians strive for language-concordant care at each stage of discharge planning. However, unresolved gaps such as the lack of interpreter availability during medical-device education, require attention to promote safe transitions from hospital to home.

"Rocking" Continuous Renal Replacement Therapy Management in Children and Young Adults With Sepsis: Impact of Hemodynamic Support on Outcomes.

"Rocking" Continuous Renal Replacement Therapy Management in Children and Young Adults With Sepsis: Impact of Hemodynamic Support on Outcomes.

The Management of Children and Adolescents with Overactive Bladder Refractory to Treatment with Parasacral Transcutaneous Electrical Nerve Stimulation.

Although parasacral TENS (pTENS) has been employed in various centers, there is a lack of studies on how children with overactive bladder (OAB) respond after failing to complete pTENS sessions. This study aimed to describe and assess treatments for OAB in children who did not respond to pTENS. This retrospective case series examined patients aged 4-17 years. Patients were given subsequent treatment options, including: behavioral therapies; oxybutynin; imipramine; a combination of oxybutynin and imipramine; parasacral percutaneous electrical nerve stimulation (PENS); or a repeat course of pTENS. Outcomes were evaluated using the Dysfunctional Voiding Scoring System (DVSS) and the Visual Analogue Scale (VAS). Thirty children were included, with a median age of 7 years. Patients received one or more treatments. Of these, 70% underwent monotherapy. Among them, 57% experienced complete resolution of symptoms, 28% had partial resolution and were satisfied with the results, and 14% discontinued treatment. 30% out of the whole sample continued to experience bothersome symptoms. Complete response, according to initial subsequent, was achieved in: 54% with intensified behavioral therapies, 33% with oxybutynin, and 50% with imipramine alone. The median DVSS score decreased from 7.0 to 2.0 (p=0.025), while the median VAS score increased from 80 to 100 (p<0.001). Children with OAB refractory to pTENS who received structured subsequent treatments showed partial response in all cases, with complete symptom resolution in half of the patients. More intensive urotherapy, medications, or repeat pTENS in combination with oxybutinin can be effective for managing this challenging condition.

Characteristics and Management of Children with Appendiceal Neuroendocrine Neoplasms: A Single-Center Study.

Appendiceal neuroendocrine neoplasms (ANENs) are usually found incidentally during histology examination after appendectomy for appendicitis. Due to their rarity in pediatric populations, there is no consensus on treatment or follow-up. The analysis of patients with ANENs of our and other studies will increase the understanding of this tumor. Pediatric patients with ANENs were uniformly managed at our center between 1998 and 2023. Patients' presenting symptoms, surgery, tumor histology, post-surgical work-up, follow-up and outcome were analyzed. Our report describes 17 patients with a diagnosis of ANEN after appendectomy. The median age was 14 years (range of 4-17 years). Tumors were located at the tip of the appendix in 58.8% of cases and only one had a diameter >1 cm. All were well-differentiated tumors with free resection margins. The submucosa was invaded in five cases, muscularis propria in eight and subserosa in four. Post-appendectomy work-up included tumor marker measurement, abdominal ultrasound and computed tomography or magnetic resonance imaging, chest X-ray and octreotide scintigraphy. No residual tumors or metastases were detected. Additional surgery was not necessary. Follow-up was carried out for a median duration of 6 years (range of 1-10 years). Only one patient was lost to follow-up and all other patients are alive without tumor recurrence. The tumor characteristics of our patients confirmed data from the literature. With the lack of a sufficient number of large prospective trials, it is important to add more information to confirm the benign nature and excellent outcome of this tumor, even without additional surgery. Consensus guidelines are needed for ANENs in pediatric populations.

Interventions for Weight Management in Children and Adolescents

Interventions for Weight Management in Children and Adolescents

The parental perspective of residential environments associated with children's self-regulation

BackgroundThe lack of early development of self-regulation (SR) skills in children can significantly impact their future success. Multiple theories emphasize the role of the environment on child development including SR skills, with income level influencing this relationship. The research used a framework that ties together theories on environmental design and establishes a relationship between the physical environment and a child's ability to self-regulate and manage stress. Limited research exists on addressing physical environmental factors in low-income households and how these factors affect children's self-regulation. PurposeThe purpose of this study is to identify physical environmental factors that can help children deal with stress. The study uses Shanker's self-regulation model and the ecological model to guide the study's data collection and analysis concerning the home environment in relation to child self-regulation from the perspective of caregivers. MethodThis research qualitatively explores affordances factors in the home physical environment in relation to child self-regulation. Data were collected through in-depth interviews and included participants from different income levels and diverse ethnicities. FindingsFifteen affordances factors in the home environment were derived from caregivers' perspectives. The key findings of the study include: (1) The more affordance aspects applied to the home physical design, the better the design is for the child's stress management; (2) Supportive environmental factors can be used to solve hindering effects generated by the environment.

Evidence for the Use of Opioid Medication for Pediatric Acute Pain in the Outpatient Setting: Technical Report.

This technical report summarizes the results of a systematic review designed to support the American Academy of Pediatrics' "Clinical Practice Guideline: Opioid Prescribing for Acute Pain Management in Children and Adolescents in Outpatient Settings." PubMed and Excerpta Medica Database were searched from 2010 to 2023 to identify randomized clinical trials and systematic reviews related to outpatient opioid prescribing to children. Overall, 11 randomized controlled trials were included. Although data were limited, no evidence was found that pain control by opioids is superior to nonopioid alternatives. Further, opioids are often associated with adverse events. The review also suggests that family and patient education and providing disposal methods may decrease risks associated with opioid prescription. Future studies can build on this foundation of evidence to support the appropriate use of opioids for acute pain in children treated in the outpatient setting.

Evaluation of Effects of the COVID-19 Crisis on Disease Management in Children with Type 1 Diabete

Background: With the spread of the coronavirus disease 2019 (COVID-19), strict laws such as quarantine were implemented in many countries, including Iran. The spread of this disease and the general quarantine overshadowed the treatment and management of some chronic diseases, including type 1 diabetes, and many families faced a serious challenge in providing medicines and periodic tests for their children. This study was conducted with the aim of investigating the effects of the COVID-19 crisis on disease management in children with type 1 diabetes. Method: Based on a researcher-made questionnaire, this cross-sectional study was conducted on 85 children with type 1 diabetes between the ages of 2 and 18 years in 6 months at the Children's Medical Center Hospital. This questionnaire is either collected from the parents during the face-to-face visit of the child with type 1 diabetes, or the virtual visit (telemedicine), and they were asked to complete the relevant questionnaire. This questionnaire included demographic information, laboratory tests, and the challenges of patients' families during the pandemic. In order to properly understand the management of this disease, parents were asked to enter the results of tests related to fasting blood sugar and HbA1c 3 times at the beginning of the pandemic, during quarantine, and during the implementation of the study. Results: Based on the results, the level of HbA1c, the problem of insurance coverage, the problem of attendance, ketoacidosis, and infection before the pandemic, during the pandemic, and at the time of the study among children with type 1 diabetes were unchanged (P&gt;0.05). There was a significant difference between fasting blood sugar levels, insulin levels, blood sugar control levels, and hospitalizations in type 1 diabetes patients before the pandemic, during the pandemic, and the study period (P&lt;0.05). Conclusion: Increasing the use of continuous glucose monitors and the widespread use of telemedicine visits may improve the impact of the pandemic on disease management. It is suggested that more multicenter studies with a higher sample size should be conducted in order to investigate the impact of the COVID-19 crisis on children with diabetes.

Pre-emptive Nebulized Ketamine Versus Lidocaine for Post-tonsillectomy Pain Management in Children: A Comparative Study.

Background Tonsillectomy is associated with significant pain, and postoperative pain control is often unsatisfactory. There have been several methods adopted to treat postoperative pain, but none of the methods were effective, with patients continuing to undergo severe postoperative pain. Hence, our study aimed to compare the efficacy of pre-emptive nebulized ketamine versus pre-emptive nebulized lidocaine with a control group receiving nebulized saline for pain control in children undergoing tonsillectomy. Methods In this prospective randomized clinical trial, 105 patients with American Society of Anesthesiologists(ASA) Ⅰ and Ⅱ undergoing tonsillectomy were enrolled and randomized into three groups, group K, group L, and group C, with 35 patients in each group, wherein pre-emptive nebulized ketamine, lidocaine, and saline were given to each group of patients, respectively. Faces Pain Scale-Revised (FPS-R), sedation scale scores, and the usage of rescue analgesia were noted postoperatively for the first six hours. Hemodynamic parameters were noted before and after nebulization.The primary objective was to determine the number of patients requiring rescue analgesia as an indicator of postoperative pain control. Results In this randomized clinical trial, pre-emptive nebulized ketamine significantly reduced the need for rescue analgesia compared to lidocaine and saline (p<0.05). Only 14.3% (n=5) of patients in the ketamine group required rescue analgesiacompared to 85.7% (n=30) in the lidocaine group and 91.4% (n=32) in the control group. Nebulized ketamine given pre-emptively is an effective strategy for reducing postoperative pain in pediatric tonsillectomy. Conclusion Pre-emptive nebulized ketamine was found to be effectivewhen compared with lidocaine nebulization in reducing postoperative pain in children undergoing tonsillectomy.

Predicting Children’s Sadness Management Based on Paternal Involvement in Parenting and Maternal Emotion Regulation in Students with Specific Learning Disabilities

Background: Current strategies used to control and manage children's emotions often overlook the crucial role of sadness management in their overall well-being. Objectives: This study investigated the relationships between paternal involvement in parenting and maternal emotion regulation with sadness management in students with specific learning disabilities (SpLDs). Methods: This cross-sectional study was conducted among fourth- and fifth-grade boys and girls with SpLDs and their mothers in Karaj, Alborz Province, Iran, during the 2021–22 academic year. A multistage cluster sampling method was employed to select 252 participants. Data were collected using the Children's Sadness Management Scale (CSMS), the Alabama Parenting Questionnaire (APQ), and the Cognitive Emotion Regulation Questionnaire (CERQ). Data analysis was performed using Pearson correlation and simultaneous regression in SPSS-27 software. Results:: Paternal involvement was positively correlated with children's sadness management (r = 0.47). Conversely, maternal maladaptive cognitive emotion regulation was negatively correlated with children's sadness management (r = -0.35). Additionally, a positive correlation was found between maternal adaptive cognitive emotion regulation and children's sadness management (r = 0.40). Paternal involvement and maternal cognitive emotion regulation together explained 52% of the variance in children's sadness management. Conclusions: Paternal involvement in parenting and maternal cognitive emotion regulation play a key role in improving sadness management in children with SpLDs. These findings underscore the importance of promoting healthy parenting practices that involve both paternal participation and effective maternal emotion regulation strategies to support children's ability to manage sadness.

Anti-Obesity Medication in the Management of Children and Adolescents With Obesity: Recent Developments and Research Gaps.

Paediatric obesity is a global public health concern. While in most countries the incidence keeps rising, the need for effective and long-term management for children and adolescents living with this chronic, relapsing disease is pressing. Health behaviour and lifestyle treatment (HBLT) is recommended as first-line treatment. Narrative review. A new generation of recently approved anti-obesity medications (AOM) now has the potential to fill the gap between limited effects on body mass index (BMI) by HBLT alone and large effects by metabolic and bariatric surgery in adolescents with obesity aged 12 years and older. While, for semaglutide and phentermine/topiramate, effectiveness is substantial with relevant, but mostly mild to moderate adverse events, there is a gap in evidence regarding long-term effects and safety, effects on outcomes beyond BMI reduction and data for certain groups of patients, such as children < 12 years and minority groups. When integrating AOM treatment into national healthcare systems it should be offered as part of a comprehensive patient-centred approach. This article summarizes recent AOM developments, integration into paediatric obesity management, and identifies research gaps.

Clinical Decision-making and Management for Children with Speech-Sound Disorders in Türkiye

Clinical Decision-making and Management for Children with Speech-Sound Disorders in Türkiye

Non-IgE-mediated drug-induced hypersensitivity reactions in pediatrics.

Despite their prevalence and potential severity, non-IgE-mediated drug-induced hypersensitivity reactions (DHRs) are under-researched and poorly defined, particularly in children. Presentations range from mild cutaneous reactions to severe systemic diseases, with pathophysiological mechanisms and reliable diagnostic markers not well established. The lack of validated tests often leads to permanent drug restrictions, reliance on second-line drugs, and increased costs. Focusing on recent advancements and areas needing further research, this review aims to enhance children's recognition, diagnosis, and management of non-IgE-mediated DHRs. Recent studies have enhanced the understanding of immediate and delayed non-IgE-mediated drug reactions. Key findings include the Mas-related G protein-coupled receptor X2 in mast cells and the identification of HLA alleles linked to severe cutaneous adverse reactions, such as Stevens-Johnson syndrome and toxic epidermal necrolysis. Improved diagnostic techniques, including skin testing, show promise in identifying immediate and delayed non-IgE DHRs. Additionally, research highlights the impact of cofactors, drug metabolites, and co-infections on these DHRs and explores potential biomarkers for predicting reaction severity. Non-IgE-mediated DHRs are a significant cause of morbidity and treatment changes in pediatric patients. Recent research underscores their clinical presentations and mechanisms, paving the way for more precise diagnostic and therapeutic strategies to improve patient outcomes.

The Analysis of children's sports behavior analysis and health management system based on deep learning

The Analysis of children's sports behavior analysis and health management system based on deep learning

Three Cases of Type IIIb Isolated Traumatic Pancreatic Injury Treated with Non-Operative Management in Children

Three Cases of Type IIIb Isolated Traumatic Pancreatic Injury Treated with Non-Operative Management in Children

A Narrative Review of Soccer-Related Concussion Management in Children and Adults Over the Past 10 Years.

Soccer-related concussions (SRC) have increased despite an overall reduction of concussions across all sports activities. Few papers have studied the mechanism of injury, and have been mostly done in high-income countries or focused on small populations, preventing generalization.Our goal was to analyze the available data published about SRC over the past 10 years, independent of the country's income level. A narrative review was performed. The definition of sport-related concussion from the American Academy of Neurology and studies published between 2013 and 2023 were used. Of1210 articles, 45 met the inclusion criteria. The results showed that SRC was more frequent in females (57.6%) than males (44.3%). Player-to-player interaction was the most common mechanism of injury, with midfielders being the most affected position. The first providers to diagnose were certified athletic trainers, within the first 24 hours. Neurological evaluations, including SCAT (SportAssessment Concussion Tool) and ImPact (Immediate Post-concussion Assessment and Cognitive Testing), were included in 42.2% of the studies, with SCAT and ImPact specifically used in 15.5% and11% of cases, respectively. Need for hospitalization was found in 8.9% of participants and one player required surgical intervention. At the time of the concussion, confusion, dizziness, and amnesia were reported frequently. However, after the concussion, headaches and dizziness were prevalent. Follow-up data were included in 35.5% of the studies. On average, children missed 15 practice days and returned to school after 8 days. In conclusion, future research should focus on the circumstances around head-to-head injuries by age, sex, and level of professionalism as well as the importance of early diagnosis and careful follow-up, to protect the players and improve their outcomes.

Bloodstream Infection in Children Managed at a Tertiary Hospital in Oman

Bloodstream Infection in Children Managed at a Tertiary Hospital in Oman

Conceptualizing the social networks of children of parents with serious mental illness: a thematic analysis.

Social networks, defined as the set of active and significant ties surrounding an individual, influence the wellbeing of vulnerable children. The best evidenced mechanism through which this occurs is where networks act as a vehicle to access social support. Little is known about the content and function of social networks of children of parents with severe and enduring mental illness (COPMI). COPMI are a frequently under-identified vulnerable child population at risk of negative outcomes. This qualitative study investigates the structure, role and function of these children's networks. Researchers conducted 17 semi-structured egocentric social network interviews. Interviews incorporated personal network mapping as a data collection method. COPMI were recruited through third sector organizations and interviewed across three sites in England. Data was analyzed using an inductive thematic analysis. Five network features were identified (i) parents as primary providers of support (i) limited networks and diminished connections over time (iii) substitutable ties (formal and informal) (iv) peer connections as source of both support and strain (v) coping strategies: self-censorship, avoidance and animals. Children of parents with severe and enduring mental illness networks are structurally typical of vulnerable children in that they are limited, rely on parents as primary ties but allow for some substitution of support ties. COPMI-specific features included peer relationships at times as source of strain and network level coping strategies used to manage wellbeing, including pets. This latter reflects previous findings in vulnerable adult populations so far unevidenced in children. Little evidence as to the mechanistic effect at work within networks was collected. However, COPMI were clearly shown to be engaged in active management and strategising in network navigation approaches, indicating the need to engage with children in this capacity, rather than approaching them as passive recipients of support. As such, effective network level interventions for this group are likely to prioritize access to beneficial substitute ties when support is limited. Additionally, interventions that promote network navigation skills and help foster productive coping strategies can capitalize on the child's active management role within their network.

Understanding how children and young people with chronic non-cancer pain and their families experience living with pain, pain management and services: a meta-ethnography.

Childhood chronic pain is a widespread public health issue. We need to understand how children with chronic pain and their families experience chronic pain and its management. To conduct a meta-ethnography on the experiences and perceptions of children with chronic pain and their families of chronic pain, treatments and services. We investigated how children and their families conceptualise and live with chronic pain; what they think of and want from health and social care services; and what they conceptualise as 'good' pain management. Meta-ethnography with stakeholder and patient and public involvement in the design, search and sampling strategies, analysis and dissemination. Review strategy: comprehensive searches of 12 bibliographic databases and supplementary searches in September 2022, to identify qualitative studies with children aged 3 months to 18 years with chronic non-cancer pain and their families. We included studies with rich explanatory data; appraised methodological limitations using the Critical Appraisal Skills Programme tool; and extracted, analysed and synthesised studies' findings. We used Grading of Recommendations Assessment, Development and Evaluation-confidence in the evidence from reviews of qualitative research to assess confidence in review findings. We integrated findings with 14 Cochrane treatment effectiveness reviews on children's chronic non-cancer pain. We synthesised 43 studies sampled from 170 eligible studies reported in 182 publications. Studies had minor (n = 24) or moderate (n = 19) methodological limitations. Grading of Recommendations Assessment, Development and Evaluation-confidence in the evidence from reviews of qualitative research assessments of review findings were high (n = 22), moderate (n = 13) or very low confidence (n = 1). Moderate and severe chronic pain had profound adverse impacts on family members' well-being, autonomy and self-identity; family dynamics; parenting approaches; friendships and socialising; children's education and parental paid employment. Most children and families sought a biomedical cure for pain. They experienced difficulties seeking and receiving support from health services to manage pain and its impacts. Consequently, some families repeatedly visited health services. Cochrane reviews of intervention effects and trials did not measure some outcomes important to children and families, for example effects of pain on the family and resolution of pain. Reviews have mainly neglected a biopsychosocial approach when considering how interventions work. There were limited data on common pain conditions like migraine/headache, abdominal pain; some rarer conditions; children with learning disabilities and under-fives; siblings; fathers and experiences of treatments/services. We excluded studies on cancer, end-of-life pain and experiences of healthcare professionals. We developed the family-centred theory of children's chronic pain management, integrating health and social care with community support. Future research should explore families' experiences of services and treatments, including opioids, and social care services; experiences of children with autism and learning disabilities, under 5 years old and with certain common pain conditions. We need development and testing of family-centred interventions and services. This study is registered as PROSPERO (CRD42019161455) and Cochrane Pain, Palliative and Supportive Care (623). This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128671) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 17. See the NIHR Funding and Awards website for further award information.