Measurements In Children Research Articles

Unusually High Calcaneal Speed of Sound Measurements in Children with Small Foot Size

The purpose of this clinical note is to describe the performance of the Lunar Achilles Insight device in assessing bone quality at the calcaneus in 142 children between the ages of 5 and 11 y accessing healthcare in Johannesburg, South Africa. We observed an asymmetric bimodal distribution in speed of sound (SOS). The minor mode consisted of unusually high SOS values (≥1625 m/s), which were primarily observed among children with foot size <19 cm and height <119 cm. Cortical regions of the bone may have been inadvertently included in the region of interest for smaller feet, causing unusually high SOS values. The unusually high SOS values indicate that the validity of SOS in this device, as it is currently used for measuring bone quality in young children, is questionable. Future studies using this device in young children should develop new methodology to account for smaller foot size.

Anthropometric and Dental Measurements in Children with Obstructive Sleep Apnea.

A number of authors have shown that children with OSA are more likely to have certain physical characteristics than healthy controls. With this in mind, our objectives were to collect normative baseline data and determine if there was a significant difference in anthropometric and dental measurements between children with OSA and age-matched nonsnoring controls. Children 2 to 12 y of age, in whom OSA was diagnosed by overnight polysomnography, were recruited to our experimental group. Age-matched nonsnoring controls were screened for signs of sleep-disordered breathing. Anthropometric measurements, including waist, neck, and hip circumferences, and waist-hip and neck-waist ratios, were obtained on all study participants preoperatively. Dental casts were acquired to determine intertooth distances and palatal height. Sixty-one children (42 with OSA [69%] and 19 controls [31%]) with a mean age of 4.7 y participated in the study. Waist and hip circumferences were significantly larger in children with OSA (p = 0.001 and 0.001, respectively). However, there was no difference in neck circumference and waist-hip ratios between the two groups. Neck-waist ratio in children with OSA was significantly smaller than in controls (p = 0.001). Intertooth distance for the first (p < 0.0001) and second deciduous (p = 0.0002) and first permanent molars (p = 0.022) were significantly narrowed in children with OSA; however, no difference was seen in palatal height between groups. Body mass index was similar between groups (p = 0.76). Anthropometric and dental measurements were significantly different in children with OSA compared to nonsnorers. Future studies with a large sample size may allow us to determine if these measurements can be used by clinicians to identify children at risk for OSA. A commentary on this article appears in this issue on page 1213.

In Vivo T1 of Blood Measurements in Children with Sickle Cell Disease Improve Cerebral Blood Flow Quantification from Arterial Spin-Labeling MRI.

Children with sickle cell disease have low hematocrit and elevated CBF, the latter of which can be assessed with arterial spin-labeling MR imaging. Quantitative CBF values are obtained by using an estimation of the longitudinal relaxation time of blood (T1blood). Because T1blood depends on hematocrit in healthy individuals, we investigated the importance of measuring T1blood in vivo with MR imaging versus calculating it from hematocrit or assuming an adult fixed value recommended by the literature, hypothesizing that measured T1blood would be the most suited for CBF quantification in children with sickle cell disease. Four approaches for T1blood estimation were investigated in 39 patients with sickle cell disease and subsequently used in the CBF quantification from arterial spin-labeling MR imaging. First, we used 1650 ms as recommended by the literature (T1blood-fixed); second, T1blood calculated from hematocrit measured in patients (T1blood-hematocrit); third, T1blood measured in vivo with a Look-Locker MR imaging sequence (T1blood-measured); and finally, a mean value from T1blood measured in this study in children with sickle cell disease (T1blood-sickle cell disease). Quantitative flow measurements acquired with phase-contrast MR imaging served as reference values for CBF. T1blood-measured (1818 ± 107 ms) was higher than the literature recommended value of 1650 ms, was significantly lower than T1blood-hematocrit (2058 ± 123 ms, P < .001), and, most interesting, did not correlate with hematocrit measurements. Use of either T1blood-measured or T1blood-sickle cell disease provided the best agreement on CBF between arterial-spin labeling and phase-contrast MR imaging reference values. This work advocates the use of patient-specific measured T1blood or a standardized value (1818 ms) in the quantification of CBF from arterial spin-labeling in children with SCD.

Retinal Nerve Fiber Layer and Macular Thickness Measurements in Children After Cataract Surgery Compared With Age-Matched Controls

To compare the retinal nerve fiber layer (RNFL) and macular thickness in pediatric patients with congenital or developmental cataract after cataract surgery with age-matched controls using optical coherence tomography (OCT). Case-control study. setting: Institutional. Forty-five children (90 eyes) in the age group 4-16 years: subjects with unilateral congenital or developmental cataract (n= 15) and bilateral cataract (n= 15), and age-matched controls with no ocular abnormality (n= 15). Phacoaspiration and intraocular lens implantation was done in children with cataract. Retinal nerve fiber layer thickness (RNFLT) and central macular thickness (CMT) were measured using OCT in normal controls and 3months postoperatively in children with unilateral and bilateral cataract. Children with unilateral cataract had significantly thinner RNFL in affected eyes (85.46 ± 8.16μm) compared with the fellow eye (93.93 ± 13.12μm; P= .036). Average RNFLT in the operated eyes of unilateral cataract was significantly less (85.46 ± 8.16μm) compared to the control group (94.6 ± 12.51μm; P= .004). Average CMT in unilateral cataract (221 ± 42.05μm) was significantly less compared to normal control (245 ± 15.87μm; P= .004). Average RNFLT in bilateral cataract was similar in both eyes but significantly less compared to control group. Children with unilateral cataract showed significant thinning of superior, nasal, and temporal RNFL compared to the fellow eyes as well as age-matched normal eyes on OCT. The central macular thickness was less in deprivational amblyopic eyes than in age-matched normal eyes, but there was no significant difference compared to the fellow nonamblyopic eyes. In bilateral cataract, there was significant thinning of RNFL in superior and nasal quadrants as compared to age-matched normal eyes.

Pain Measurement in Children with Functional Abdominal Pain.

Functional abdominal pain (FAP) occurs frequently in pediatric patients. Lacking clear biomarkers, clinicians and researchers must rely on patient reports of pain intensity. Presently, there are challenges affecting our ability to use existing measures of self-reported pediatric pain intensity. This report discusses those challenges, finding that: (a) inter-rater agreement of children's pain intensity is generally low; (b) typically used approaches to measuring outcomes may yield high levels of unreliable reports of improvement;

Test-Retest Reliability of Isokinetic Knee Strength Measurements in Children Aged 8 to 10 Years.

Background:Isokinetic dynamometry is a useful tool to objectively assess muscle strength of children and adults in athletic and rehabilitative settings. This study examined test-retest reliability of isokinetic knee strength measurements in children aged 8 to 10 years and defined limits for the minimum difference (MD) in strength that indicates a clinically important change.Hypothesis:Isokinetic knee strength measurements (using the Biodex System 4) in children will provide reliable results.Study Design:Descriptive laboratory study.Methods:In 22 healthy children, 5 maximal concentric (CON) knee extensor (KE) and knee flexor (KF) contractions at 2 angular velocities (60 deg/s and 180 deg/s) and 5 maximal eccentric (ECC) KE/KF contractions at 60 deg/s were assessed 7 days apart. The intraclass correlation coefficient (ICC2.1) was used to examine relative reliability, and the MD was calculated on the basis of standard error of measurement.Results:ICCs for CON KE/KF peak torque measurements were fair to excellent (range, 0.49-0.81). The MD% values for CON KE and KF ranged from 31% to 37% at 60 deg/s and from 34% to 39% at 180 deg/s. ICCs in the ECC mode were good (range, 0.60-0.70), but associated MD% values were high (>50%). There was no systematic error for CON KE/KF and ECC KE strength measurements at 60 deg/s, but systematic error was found for all other measurements.Conclusion:The dynamometer provides a reliable analysis of isokinetic CON knee strength measurements at 60 deg/s in children aged 8 to 10 years. Measurements at 180 deg/s and in the ECC mode were not reliable, indicating a need for more familiarization prior to testing.Clinical Relevance:The MD values may help clinicians to determine whether a change in knee strength is due to error or intervention.

To Screen or Not to Screen? The Value of Routine Blood Pressure Measurement in Children and Adolescents

Most pediatric primary care providers will take care of patients with elevated blood pressure; however, identification of these patients can be problematic. Contradictory recommendations from consensus organizations regarding the utility of pediatric blood pressure screening make this task more difficult. Choosing which recommendation to follow requires a careful analysis of each recommendation’s background and the evidence supporting it. In this review, we examine the association between elevated blood pressure in childhood and adverse cardiovascular outcomes in adults, as well as the evidence linking blood pressure treatment to the regression of target-organ damage. Although there is clearly a need for ongoing research to address gaps in the evidence, we believe that the current body of literature argues for universal blood pressure screening in children and adolescents.

Comparison of Axillary and Tympanic Temperature Measurements in Children Diagnosed with Acute Otitis Media.

Background. Acute otitis media [AOM] may affect the accuracy of tympanic temperature measurements. We aimed to compare tympanic temperature measurements in patients with AOM against control groups, as well as compare the tympanic temperatures with axillary thermometry. Methods. This is a prospective, observational study. Patients from pediatric outpatient and emergency clinics who were diagnosed as single-sided AOM were included consecutively in the study. Normal ears of patients and children having the same age and gender who were not diagnosed as AOM were also studied as controls. Results. In patients with AOM, infected ears had higher temperatures than normal ears with a mean of 0.48 ± 0.01°C. There was no significant difference between the right and left tympanic temperatures in control group. Compared with axillary temperature, the sensitivity of tympanic temperature in the infected ear was 91.7% and the specificity was 74.8%. Conclusion. Comparisons of axillary and tympanic temperatures in children with AOM during the active infection concluded higher tympanic temperatures in infected ears. We suggest that the higher tympanic temperatures, approximately 0.5°C in our study, in infected ears may aid in diagnosis of patients with fever without a source in pediatric clinics.

Parental perception and child's nutritional status.

Childhood obesity is a health hazard increasing worldwide. Preschool period which is under supervision of parents is a critical period to detect overweight and take precautions. We studied the factors affecting parental estimation of their preschool child's weight. Three hundred sixty seven mothers completed questionnaires consisting of child's and parents' anthropometric measurements, parents' assessment of their child's and their own weight status, and general information about their lifestyle. Mothers also chose their wish for current and future body image of their child from child drawings representing percentiles. Child body mass index-for-age z score (BAZ) was related to birth weight and child's appetite. BAZ was not related to child's gender, presence of chronic disease, family pattern, parental age, education or income. 43.1 % of mothers correctly assessed child's BAZ verbally. Maternal verbal estimation was correlated with maternal visual estimation, paternal verbal estimation and child's BAZ. Mothers' wish for future figure of the child was not related to child's BAZ, but showed correlation with mothers' wish for current figure of the child. Mother's correct perception of her child's weight was found to be high, consistent with her spouse and related to child's BAZ.

Reliability and Structural and Construct Validity of the Functional Strength Measurement in Children Aged 4 to 10 Years

Adequate muscle strength, power, and endurance are important in children's daily activities and sports. Various instruments have been developed for the assessment of muscle function; each measures different aspects. The Functional Strength Measurement (FSM) was developed to measure performance in activities in which strength is required. The study objective was to establish the test-retest reliability and structural and construct validity of the FSM. A cross-sectional descriptive study was conducted. The performance of 474 children with typical development on the FSM was examined. Test-retest reliability (n=47) was calculated with the intraclass correlation coefficient (2.1A) for agreement. Structural validity was examined with exploratory factor analysis, and internal consistency was established with the Cronbach alpha. Construct validity was determined by calculating correlations between FSM scores and scores obtained with a handheld dynamometer (HHD) (n=252) (convergent validity) and between FSM scores and scores on the Movement Assessment Battery for Children-2 (MABC-2) (n=77) (discriminant validity). The test-retest reliability of the FSM total score ranged from .91 to .94. The structural validity revealed one dimension, containing all 8 FSM items. The Cronbach alpha was .74. The convergent validity with the HHD ranged from .42 to .74. The discriminant validity with MABC-2 items revealed correlations that were generally lower than .39, and most of the correlations were not significant. Exploratory factor analysis of a combined data set (FSM, HHD, and MABC-2; n=77) revealed 2 factors: muscle strength/power and muscle endurance with an agility component. Discriminant validity was measured only in children aged 4 to 6 years. The FSM, a norm-referenced test for measuring functional strength in children aged 4 to 10 years, has good test-retest reliability and good construct validity.

Role and Clinical Significance of Plasma N-Terminal Brain Natriuretic Peptide Measurement in Children with Brain Edema.

Brain natriuretic peptide (BNP) is a potent natriuretic and vasodilator factor. BNP plasma concentrations were found to be elevated in patients with brain edema. The purpose of the present study is to evaluate the relationship between plasma NT-proBNP concentration and the presence of brain edema in patients with intracranial pathology. The plasma NT-proBNP levels of 50 patients and 25 healthy subjects were measured. The NT-proBNP levels of the patient group were measured during admission and after 7 days of treatment. NT-proBNP plasma concentrations were found to be significantly higher in the patient group with brain edema than in the control group (p < 0.005). There were no significant differences in the NT-proBNP plasma concentrations between patients with intracranial pathology without brain edema and the control group (p > 0.005). NT-proBNP plasma concentrations were found to be significantly higher in patients with brain edema as compared with patients without brain edema before treatment (p < 0.005). These results suggest that excessive secretion of plasma NT-proBNP is related to brain edema. Plasma NT-proBNP levels may serve as a marker to guide the early-diagnostic and therapeutic management in children with brain edema. Further studies are required to evaluate the role of BNP in brain edema pathophysiology.

Systematic review of the use of data from national childhood obesity surveillance programmes in primary care: a conceptual synthesis.

This study reviewed the use in primary care of national surveillance data for children to determine the data's potential utility to inform policy and practice decisions on how to prevent and treat childhood obesity. We reviewed the 28 countries identified by the World Obesity Federation as having high-quality comparable body mass index data for children. Literature published from any period up to December 2013 was included. Peer review literature was searched using Web of Science (Core Collection, MEDLINE). Grey literature was searched using the Internet by country name, programme name and national health and government websites. We included studies that (i) use national surveillance obesity data in primary care, or (ii) explore practitioner or parent perspectives about the use of such data. The main uses of national surveillance data in primary care were to identify and recruit obese children and their parents to participate in school and general practice-based research and/or interventions, and to inform families of children's measurements. Findings indicate a need for school staff and practitioners to receive additional training and support to sensitively communicate with families. Translation of these findings into policy and practice could help to improve current uses of national child obesity surveillance data in primary care.

Determination of Grip Contact Areas with Stereologic Measurement in Children with Hemiparetic Cerebral Palsy

Purpose: The aim of the study is to present a method used to estimate hand and finger contact areas on different sized objects and compare results of children with Cerebral Palsy (CP) with healthy peers. Methods: A total of 51 children, 26 with hemiparetic CP classified as I or II according to Manuel Ability Classification System and had 1 or 1+ level spasticity as to Modified Ashworth Scale and 25 healthy peers were included to the study. The contact area was calculated by the Cavalieri principle of stereological estimation after children grasped cylindrical objects having diameters of 2.5, 4 and 5 cm. Results: The contact areas were found to be different at the thenar side for the grasped object with 2.5 cm diameter, and at the hypothenar side for the objects with 4 and 5 cm diameters (p<0.05). Discussion: Clinicians are more interested with thumb since the contribution of adductor spasticity in CP. However, hypothenar contribution should be also considered especially with objects having larger diameters. The data gained from the study can guide rehabilitation efforts towards improving hand function.

Interpretation of Lumbar Puncture Opening Pressure Measurements in Children

Interpretation of Lumbar Puncture Opening Pressure Measurements in Children

Knowledge, Attitudes and Practices of Poultry Farms' Workers about Occupational Health Hazards at Assiut District

Abstract Chronic kidney disease (CKD) is recognized as a major health problem affecting approximately 13% of the US population. Nutritional status and academic achievement were affected in 1.3% of Egyptian school age children with urinary abnormalities. Aim: to assess nutritional status and academic achievement among school-age children with chronic kidney disease at Assiut University Children Hospital. Subjects and Method: The study sample was composed of 102 school-age children with CKD. The study was conducted in the Pediatric Nephrology Unit and Outpatient Clinics at Assiut University Children Hospital. Data were collected by utilizing the designed questionnaire sheet that consists of sociodemographic data, socioeconomic data, children's anthropometric measurement as well as assessment of their academic achievement. Results: The results of study revealed that the percentage of anthropometric school-age children under study was normal or around average with no statistical significant between CKD and nutritional status. Regarding academic achievement, about one third of the studied children with CKD had pass average academic achievement score. Conclusions: Based on the results of the present study, chronic kidney disease did not affect nutritional status, but it negatively affected academic achievement in school-age children at Assiut Children University Hospital.

Childhood obesity perceptions among African American caregivers in a rural Georgia community: a mixed methods approach.

Given the pivotal role of African American caregiver's perceptions of childhood obesity in rural areas, the inclusion of caregiver's perceptions could potentially reduce childhood obesity rates. The objective of the current study was to explore childhood obesity perceptions among African Americans in a rural Georgia community. This concurrent mixed methods study utilized two theoretical frameworks: Social Cognitive Theory and Social Ecological Model. Using a convenience sample, caregivers ages 22-65 years completed a paper-based survey (n = 135) and a face-to-face interview (n = 12) to explore perceptions of obesity risk factors, health complications, weight status, built environment features, and obesity prevention approaches. Descriptive statistics were generated and a six-step process was used for qualitative analysis. Participants commonly cited behavioral risk factors; yet, social aspects and appearance of the community were not considered contributing factors. Chronic diseases were reported as obesity health complications. Caregivers had a distorted view of their child's weight status. In addition, analysis revealed that caregivers assessed child's weight and height measurements by the child's appearance or a recent doctor visit. Environmental barriers reported by caregivers included safety concerns and insufficient physical activity venues and programs. Also, caregivers conveyed parents are an imperative component of preventing obesity. Although this study found caregivers were aware of obesity risk factors, health complications, built environment features, and prevention approaches their obesity perceptions were not incorporated into school or community prevention efforts. Findings suggest that children residing in rural areas are in need of tailored efforts that address caregiver perceptions of obesity.

Risk factors of malnutrition among preschool children in Terengganu, Malaysia: a case control study.

BackgroundChildhood malnutrition is a multi-dimensional problem. An increase in household income is not sufficient to reduce childhood malnutrition if children are deprived of food security, education, access to water, sanitation and health services. The aim of this study is to identify the characteristics of malnourished children below five years of age and to ascertain the risk factors of childhood malnutrition in a state in Malaysia.MethodsA case control study was conducted in the maternal and child health clinics in five districts of Terengganu, Malaysia from April to August 2012. Case was a child with moderate to severe malnutrition with z-scores < −2SD from the median of WHO reference. Control was a child without malnutrition with z-scores between -2SD and +2SD and the age matched with case’s. Face to face interviews with the respective child’s mother and measurements of the respective child’s weight and height were carried out. Information on socio-economic characteristics, household food security status, child’s dietary intake, caregivers’ practices and resources were enquired. Univariate and multivariate logistic regression analyses were conducted. Crude odds ratio and adjusted odds ratio with 95% confidence interval were calculated.ResultsA total of 274 children with 137 cases and 137 controls were recruited. All respondents were Malays. Among the cases, a larger proportion of them was female and originated from low income families. After adjusting all confounders, childhood malnutrition was significantly associated with number of children (aOR: 5.86, 95% CI: 1.96, 17.55), child hunger (aOR: 16.38, 95% CI: 1.34,199.72), dietary energy intake (aOR: 0.99, 95% CI: 0.98, 0.99), protein intake (aOR: 1.06, 95% CI: 1.01, 1.12), vitamin A intake (aOR: 0.999, 95% CI: 0.997, 1.00), low birth weight (aOR: 6.83, 95% CI: 1.62, 28.89), frequent illness (aOR: 2.79, 95% CI: 1.06, 7.31), and history of worm infection (aOR: 3.48, 95% CI: 1.25, 9.70).ConclusionsLower socio-economic status, household food insecurity, and poor child caring practices were associated with childhood malnutrition. Besides implementation of programmes focusing on poverty reduction, community based nutrition and hygiene education with extensive family planning and de-worming programmes should be intensified to improve both mother and children’s nutritional status.

Improving the accuracy and efficiency of respiratory rate measurements in children using mobile devices.

The recommended method for measuring respiratory rate (RR) is counting breaths for 60 s using a timer. This method is not efficient in a busy clinical setting. There is an urgent need for a robust, low-cost method that can help front-line health care workers to measure RR quickly and accurately. Our aim was to develop a more efficient RR assessment method. RR was estimated by measuring the median time interval between breaths obtained from tapping on the touch screen of a mobile device. The estimation was continuously validated by measuring consistency (% deviation from the median) of each interval. Data from 30 subjects estimating RR from 10 standard videos with a mobile phone application were collected. A sensitivity analysis and an optimization experiment were performed to verify that a RR could be obtained in less than 60 s; that the accuracy improves when more taps are included into the calculation; and that accuracy improves when inconsistent taps are excluded. The sensitivity analysis showed that excluding inconsistent tapping and increasing the number of tap intervals improved the RR estimation. Efficiency (time to complete measurement) was significantly improved compared to traditional methods that require counting for 60 s. There was a trade-off between accuracy and efficiency. The most balanced optimization result provided a mean efficiency of 9.9 s and a normalized root mean square error of 5.6%, corresponding to 2.2 breaths/min at a respiratory rate of 40 breaths/min. The obtained 6-fold increase in mean efficiency combined with a clinically acceptable error makes this approach a viable solution for further clinical testing. The sensitivity analysis illustrating the trade-off between accuracy and efficiency will be a useful tool to define a target product profile for any novel RR estimation device.

Comparing Construct and Predictive Validities of the Measurement of Children’s Approximate Number Acuity Depending on Numerosity Comparison Task Format

Comparing Construct and Predictive Validities of the Measurement of Children’s Approximate Number Acuity Depending on Numerosity Comparison Task Format

Tympanic, Infrared Skin, and Temporal Artery Scan Thermometers Compared with Rectal Measurement in Children: A Real-Life Assessment

IntroductionBody temperature measurement in children is of clinical relevance. Although rectal measurement is the gold standard, less invasive tools have become available. We aimed to describe the accuracy of tympanic, infrared skin, or temporal artery scan thermometers compared with rectal measurement to reflect core temperature. MethodsRectal (Filac 3000; Covidien, Mechelen, Belgium), tympanic (AccuSystem Genius2 Typmanic Infrared Ear Thermometer, Covidien, Mechelen, Belgium), temporal artery scan (Exergen, Exergen Corp, Watertown, Massachusetts), and infrared (ThermoFlash Contactless Medical Electronic Thermometer, Visiomedlab, Paris, France) body temperature measurements were randomly performed and readings were collected once. Temperature readings were described as median and range, and observations were compared with rectal temperature readings (using Wilcoxon, Bland-Altman, sensitivity, and specificity tests). The child’s comfort was assessed by the child, parent, and nurse (using Likert scales) and ease of use was assessed by nurses (using visual analog scale). ResultsBased on observations in 294 (median age = 3.2 years, range = 0.02–17 years) children, the mean difference was 0.49°C (tympanic scan; P < 0.0001), 0.34°C (infrared skin scan; P < 0.0001), and 0°C (temporal artery scan; P = 0.9288), respectively, when compared with rectal temperature readings. Based on visual inspection of Bland-Altman plots, all tools overestimated the temperature at lower body temperature and underestimated the temperature at higher body temperature, resulting in a sensitivity of 22% to 41% and a specificity of 98% to 100% for rectal temperatures above 38°C. The Likert scale scores and the visual analog scale scores for rectal measurement were only slightly higher when compared with the other methods. ConclusionsAll noninvasive techniques underperformed compared with rectal measurement. The temporal artery scan deviations were smallest, but all noninvasive techniques overestimate lower temperatures and underestimate higher temperatures compared with rectal measurement. In our hands, temporal artery scan measurement seems to be second best, but not yet ideal.