Pediatric Practice Research Articles

Clinical Manifestations of Acute COVID-19 in Previously Healthy Pediatric Patients Diagnosed by Rapid Antigen Screening in a Community-Based, Outpatient Primary Care Pediatrics Practice

Background: The PediCenter and Niles Children’s Clinic provide pediatric primary and urgent care services in central California. We remained open throughout the COVID-19 pandemic, providing scheduled well child-care and sick visits. Methods: Beginning in September 2020, we implemented a COVID-19 screening program. Screening was performed on all patients presenting for care and was made available to patients requiring testing for any purpose. Herein, we provide results from that program, including a description of clinical characteristics of COVID-19 in our patients. Results: Key findings: A total of 11,649 COVID-19 antigen screening tests were performed (age range 0.1 to 17.0, mean 8.7, SD 4.5). In total, 1560 pts. (13.4%) tested positive. Among these, 665 (43%) were asymptomatic, 560 (36%) had mild disease, 318 (20%) had moderate disease, and 17 (1%) had severe disease. No critical cases or transfers to the emergency room were reported. Younger patient age was associated with an increased severity of illness, as was time from the onset of the pandemic. A total of 4446 patients reported no symptoms at the time of screening, 15% of whom tested positive. In total, 7203 patients reported symptoms at the time of testing. Among these, 87.6% tested negative and 12.4% tested positive. Disease severity was similar between these two groups. COVID-19 is generally a mild respiratory tract infection in healthy children. Conclusions: Screening is effective in identifying cases, including asymptomatic cases. Statistical models further revealed associations between patient age, time from the onset of the pandemic, and disease severity.

Development of a Virtual Pediatric Holistic Comfort Care Clinic.

Guided by the tenets of Kolcaba's holistic comfort theory, we developed, implemented, and evaluated a simulated online pediatric advanced practice health center. The Pediatric Comfy Care Clinic (PCCC) was created to enhance person-centered diagnostic reasoning and holistic advanced management skills for family nurse practitioner students. Our interprofessional team used a standardized approach to online design and development while integrating essential holistic comfort theory concepts for student engagement and assessment of learning. We explored outcomes of pre- and postclinic quizzes and student reflection data using mixed methods. Significant differences (P<.001) were noted in all postpractice quizzes in each affiliated PCCC module with variable student outcomes on graded clinic encounters. Important student perspectives on teaching and learning in the virtual clinic were noted. A comfort theory-driven, simulated, and digitally enhanced virtual clinic is feasible and valuable with important implications for holistic advanced practice.

Within-couple comparison of maternal and paternal distress in an Italian birth cohort

ObjectiveThis study compared parental distress in 166 couples, using the Parenting Stress Index–Short Form (PSI-SF), in the Italian NASCITA cohort at the two-year well-child visits. The study explored the concordance of distress levels within couples (aim 1) and their correlation with child-related stressors (aim 2).BackgroundPrevious studies focused on maternal distress or considered maternal and paternal experiences separately, without addressing differences within couples.MethodData on parental distress were collected from the PSI-SF completed separately by parents. The total score was derived from three subscales, with high distress defined by a score above 85. The Wilcoxon signed-rank test compared the total PSI-SF scores of mothers and fathers. The prevalence of high distress was assessed using chi-square tests, and concordance between parents within the same couple was estimated using Cohen’s K statistic. Chi-square tests were also used to compare distress levels in parents exposed to potential child-related stressors versus those not exposed.ResultsA slightly higher total score (z = -2.45; p = 0.01) was observed in mothers versus fathers, although the prevalence of distress was similar (15.1% vs. 13.9%, respectively; p = 0.76). Nine children (5.4%) had both parents distressed. Agreement in the high level of distress was observed for 81.9% of the couples, with a fair agreement on the total score (Cohen’s K = 0.27).The percentage of children with both distressed parents was slightly higher in the group exposed to potential stressors (6.6% vs. 4%, p = 0.49).ConclusionsIt is essential to evaluate distress in parents exposed to potential stressors related to child characteristics early. This assessment should be part of the pediatric family practice to prevent adverse outcomes in both child and parental wellbeing.

Intensive treatment of acute obstructive laryngitis in children

This paper addresses the specific challenges involved in the intensive treatment of acute obstructive laryngitis (OL) in young children by reviewing current literature, including both domestic and international publications. The analysis reveals that healthcare systems worldwide have significant experience in employing diverse pharmacological and non-pharmacological treatment approaches for this condition. According to the literature, the most effective treatments for OL in children are glucocorticoids and inhaled adrenaline, while there is no evidence supporting the use of oxygen therapy. The paper outlines the main routes of administration, considerations for dose selection, and potential side effects of the medications most frequently used in pediatric practice for OL. A comprehensive understanding of the specific aspects of intensive therapy in this medical emergency can significantly enhance the quality of care provided to pediatric patients.

Egyptian pediatric kidney transplantation: highlights on post-transplant follow-up and management of complications by the Egyptian Pediatric Clinical Practice Guidelines Committee (EPG) Nephrology Group

BackgroundPediatric kidney transplantation is unique when compared to adults. They need optimum post-transplant care to achieve longer graft and patient survival. Infections, rejection, recurrence, malignancy, bone problems, hypertension, and surgical complications are the most important challenges that require prevention, early detection, and management. Chronic allograft nephropathy needs different approaches based on its related causes, allograft pathology, graft function, and availability of re-transplantation.Aim/objectivesThis national adapted guideline aims to frame evidence-based post-transplant recommendations adopted or adapted from EB source guidelines to optimize post-transplant patient care.MethodsOur guideline is evidence based adapted from four national and international source guidelines with permissions [KDIGO 2020, RA/BTS 2022–2018, EAU 2018] that were appraised with AGREE II instrument tool. We followed the “adapted ADAPTE” CPG formal adaptation methodology that consists of 3 phases and 24 steps and tools. Virtual monthly meetings all through the year 2023 were activated for reviewing and validation of final adaptation of evidence-based guideline draft, considering all comments of external reviewers. This guideline was registered in the practice guideline registration for transparency (PREPARE), number: PREPARE-2023CN364.ResultsRecommendation statements in guidelines stand for results in articles. Discussion of important recommendations and the rationale behind selection of adopted statements and tailoring of others to suit our local facilities, expertise, and renal native disease profile was presented in the text with reasons and references.ConclusionThe provided guidelines aim to improve graft and patient outcome through prevention and early management of complications and suggest research areas lacking validated research recommendations.

Changes in Pediatric End-of-Life Process After the Enforcement of the Act on Life-Sustaining Treatment Decisions-The Experience of a Single Children's Hospital.

Background: The Act on Life-Sustaining Treatment (LST) for patients at the end of life (the Korean LST Decision Act), implemented in the Republic of Korea in February 2018, has led to changes in the end-of-life decision-making (EOLDM) process in children. This study aimed to investigate changes in pediatric EOLDM process and LST practices since the Korean LST Decision Act. Methods: This retrospective cohort study included 107 patients who died at Kyungpook National University Children's Hospital from January 2015 to December 2020. Patients were divided into two groups: pre-law (January 2015-January 2018, n = 55) and post-law (February 2018-December 2020, n = 52). We analyzed medical records for EOLDM process, patient characteristics, intensive care unit (ICU) admission, documentation types, and LST withholding or withdrawal decisions. Results: After the Korean LST Decision Act, the median total hospitalization duration decreased significantly (14 days [IQR, 3-80] vs. 6 days [IQR, 2-18], p = 0.020), as did the median ICU length of stay (3 days [IQR 1-33] vs. 2.5 days [IQR 1-10.3], p = 0.002). The time from admission to end-of-life decision documentation was significantly shorter in group 2 (6 days [IQR 1-31] vs. 4 days [IQR 1-9], p = 0.027). The use of physician orders for life-sustaining treatment (POLST) documents increased (0% to 33.3%), while do-not-resuscitate (DNR) orders decreased (85.3% to 16.7%). Notably, LST withdrawal decisions increased from 0% to 27.8% (p = 0.001) in the post-legislation period. Conclusions: The Korean LST Decisions Act has led to significant changes in the EOLDM process for terminally ill children, including earlier decision-making, increased use of POLST documents, more frequent LST withdrawal decisions, and shorter hospital and ICU stays. These findings suggest a shift towards more structured and timely end-of-life care discussions in pediatric settings.

Epidemiological characteristics and meteorological factors of acute respiratory infections (ARIs) in hospitalized children in eastern Guangdong, China

Acute respiratory infections (ARIs) are the most common issue in pediatric clinical practice. They pose a significant public threat, with high morbidity and mortality rates worldwide. Aiming at understanding the epidemiological characteristics of respiratory pathogens and their risk factors among children in eastern Guangdong, China. Samples obtained from 15,993 children hospitalized with ARIs in eastern Guangdong Province were tested for 14 pathogens via multiplex polymerase chain reaction (PCR) from May 2019 to July 2023. The number of hospitalizations for ARIs was correlated with pathogens, age, meteorological parameters, and the pandemic of COVID-19. The data were analyzed by different statistical methods. Among all the samples, the positive rate with ARIs accounted for 68.94% (11,026/15,993) in hospitalized patients. Cytomegalovirus (CMV) (24.49%), Streptococcus pneumoniae (SP) (20.54%), and Respiratory Syncytial Virus (RSV) (14.16%) were the top three pathogens with the greatest infection rates. Among hospitalized patients, there were more single infections in pediatric patients (40.91%, P < 0.001). Compared with bacterial infection and mixed infection, the detection rate of virus infection was higher in pediatric (36.04%, P < 0.001). Age-related increases in Mycoplasma pneumoniae (MP) infection (r = 0.729, P < 0.001) and decreases in RSV infection were observed (r = 0.88, P < 0.001). The virus infection peaked at six months, and the bacterial infection and mixed infection peaked at 1–3 years. Viral pathogens are on the rise in the post-pandemic era. The prevalence of SP infection was more influenced by the Air Quality Index (AQI), RSV infections were more clearly influenced by temperature, and Influenza A virus (IAV) infections were more strongly correlated with both the AQI and relative humidity (P < 0.001). This study highlights the need of keeping an eye on monitoring meteorological factors in assessing hospitalizations for pediatric ARIs in eastern Guangdong, China, especially RSV- and SP-associated hospitalizations.

The diagnostic value of cytokines in chronic glomerulonephritis in children

In modern clinical practice of pediatricians, the problem of timely adequate treatment of chronic glomerulonephritis (CGN) in children is of particular relevance, due to both the high prevalence of the disease and the severity of its course, the complexity of therapy and the ambiguity of the prognosis. Lesions of the urinary system in children are not only common, but also tend to grow, and often at an early age. Deterioration of the environmental background, toxic and allergic effects of drugs lead to damage primarily to the kidneys, which are the eliminating organ. The aim of the study was to study urocytokines to assess the immune response in children with HCG, depending on the association with cytomegalovirus infection. The study included 100 children aged 4-7 years, permanently residing in the Bukhara region of the Republic of Uzbekistan. At the time of the study, the patients were undergoing routine treatment in the Department of Pediatric Nephrology of the Bukhara Regional Children’s Multidisciplinary Medical Center. All children underwent general clinical (general blood test with leukoformula, general urine analysis, biochemical blood test with determination of urea, creatinine and cystatin C, immunological (TNFα, IL-18, MCP-1, IgM and IgG antibodies to cytomegalovirus infection (CMVI) in blood serum, IL-1β and IL-17A in urine) examination methods. Thus, it was found that the concentration of cystatin C in the blood serum was inversely proportional to the glomerular filtration rate in the kidneys – with a decrease in kidney function in sick children, a twofold increase was noted, that is, the accumulation of cystatin C in the blood. An increase in the concentration of IL-18 in serum and IL-1β in urine relative to the control group in CGN was an indicator of the severity of an autoimmune reaction, and a relatively low concentration of cytokines in both blood and urine in CGN with CMVI indicated suppression of the specific antiviral immunity of CMVI. It was found that an increase in serum MCP-1 by 1.4 times in group 1 and 2.9 times in group 2 of CGN with CMVI is an indicator of viral kidney damage. A significantly high concentration of IL-17A in urine in CGN with CMVI indicated local cytokine production in the kidneys and acted as an indicator of the prognosis of the outcome of CGN.

Immunogenicity and Efficacy of Combined mRNA Vaccine Against Influenza and SARS-CoV-2 in Mice Animal Models

Background. The combined or multivalent vaccines are actively used in pediatric practice and offer a series of advantages, including a reduced number of injections and visits to the doctor, simplicity of the vaccination schedule and minimization of side effects, easier vaccine monitoring and storage, and lower vaccination costs. The practice of widespread use of the combined vaccines has shown the potential to increase vaccination coverage against single infections. The mRNA platform has been shown to be effective against the COVID-19 pandemic and enables the development of combined vaccines. There are currently no mRNA-based combined vaccines approved for use in humans. Some studies have shown that different mRNA components in a vaccine can interact to increase or decrease the immunogenicity and efficacy of the combined vaccine. Objectives. In the present study, we investigated the possibility of combining the mRNA vaccines, encoding seasonal influenza and SARS-CoV-2 antigens. In our previous works, both vaccine candidates have shown excellent immunogenicity and efficacy profiles in mice. Methods. The mRNA-LNPs were prepared by microfluidic mixing, immunogenicity in mice was assessed by hemagglutination inhibition assay, enzyme-linked immunoassay and virus neutralization assay. Immunological efficacy was assessed in a mouse viral challenge model. Results. In this work, we demonstrated that the individual mRNA components of the combined vaccine did not affect the immunogenicity level of each other. The combined vaccine demonstrated excellent protective efficacy, providing a 100% survival rate when mice were infected with the H1N1 influenza virus and reducing the viral load in the lungs. Four days after the challenge with SARS-CoV-2 EG.5.1.1., no viable virus and low levels of detectable viral RNA were observed in the lungs of vaccinated mice. Conclusions. The combination does not lead to mutual interference between the individual vaccines. We believe that such a combined mRNA-based vaccine could be a good alternative to separated human vaccinations for the prevention of COVID-19 and influenza.

Evaluation of empathy levels of dentistry students in pediatric dentistry clinical practice education process.

The objective of this study was to assess the empathy levels of dental students during their clinical practice training in pediatric dentistry and to evaluate various factors that influence changes in these empathy levels. The study evaluated the empathy levels of a total of 350 students (70 third-year, 140 fourth-year, and 140 fifth-year dental students) who received pediatric dentistry clinical practice training and/or observation between October 2022 and December 2023. The Jefferson Scale of Physician Empathy-Student Version was used to assess empathy levels before and after the training. The data were subjected to statistical analysis using the Mann-Whitney U test, Kruskal-Wallis test, Wilcoxon test, and Dunn Test (p<0.05). The response rate of the participants was 92.10%. The highest empathy level was observed in third-year students, while the lowest empathy level was observed in fifth-year students. A statistically significant relationship was found between these two variables (p<0.001). Additionally, the empathy level of female students was statistically significantly higher than that of male students (p<0.001). Following the completion of the pediatric dentistry training, a statistically significant increase was observed in the empathy levels of the students in comparison to the baseline (p<0.001). Empathy levels in students are found to be correlated with academic year, sibling count, and gender. It is of paramount importance to enhance empathy skills through training in order to foster the development of human-oriented physicians capable of effective patient communication.

Development and Validation of a "Stress and Coping Assessment Tool Associated with Maintaining Oral Health among Children with Special Health-care Needs".

In our routine pediatric dental practice, many of us encounter parents and caretakers of Children with Special Health Care Needs (CSHCN) who complain about the difficulties they face in daily tooth brushing of their children. Some parents may have to accept defeat as their children face overwhelming medical conditions to cater to; ultimately leading to paradigm shift of oral hygiene leading to increase of dental caries and gingival problems. To develop and validate a comprehensive tool that can help us in assessing parent related stressors and coping factors with regard to maintenance of oral hygiene of their children. Data related to stress and coping factors encountered during maintenance of oral hygiene of their children and their experiences during the child's dental treatment (if any) were collected from parents of CSHCN. Validation and feedback from content evaluation panel experts were done. A comprehensive assessment tool with 45 items (29 stresses related items and 16 coping related items) was developed after validation. We could develop and validate a 'Stress and Coping Assessment Tool associated with maintaining Oral health among Children with Special health care needs' - abbreviated as "SCATOCS" with a hope to benefit and manage oral health care to the referred population.

Evaluation of Pediatric Dentistry Postgraduate Education in Turkey by Specialty and PhD Students

Aim: Aim of our study is to evaluate pediatric dentistry education in Turkey by directing survey questions prepared considering the educational curriculum to specialization and doctoral students receiving education in different faculties. Material and Metod: Questions prepared in accordance with the core curriculum of pediatric dentistry education published in 2021 were sent to specialization and doctoral students studying at different universities in Turkey via Google Forms. A total of 100 surveys were collected and the responses were statistically analyzed. Result: Mostly "sufficient" responses were obtained to the questions related to the content of pediatric dentistry education. It was determined that the vast majority of the participants did not participate in scientific research. When asked about their proficiency in theoretical topics within the pediatric dentistry curriculum, they received the least responses for sedation in dental treatments, odontogenic infections and surgical treatment approaches, and minor orthodontic treatment applications, respectively. When asked about the clinical treatment practices they perform, they received the least responses for sedation in dental treatments, zirconium crown applications, and permanent tooth extractions, respectively. Conclusion: Overall, when the responses are evaluated, it can be concluded that the pediatric dentistry education process and content in Turkey are conducted in accordance with the curriculum, but it is necessary to encourage the participation of specialization and doctoral students in academic studies. The content of pediatric dentistry education and clinical practices in Turkey should be evaluated in detail with new studies, and efforts should be made to improve the pediatric dentistry education content focusing on areas perceived as lacking. Keyword: Survey, Pedodontics, Curriculum for Pedodontic Education.

26 Culturally informed developmental paediatric care: A qualitative study

Abstract Background Paediatricians provide developmental care through developmental surveillance, identification and management of specific developmental disorders, and health advocacy. Despite being one of the most common reasons to visit a paediatrician, the provision of care in this field is challenging as it intersects with medical, mental health, and educational systems. Additionally, the rise of international migration, inequities in health systems, and unique culturally based concepts of child development require paediatricians to have unique skills for culturally informed care provision in this area. Objectives A qualitative study was conducted to describe the perceptions of paediatricians on providing culturally informed developmental paediatric care to diverse populations. Design/Methods Semi-structured interviews were completed with paediatricians who primarily provide developmental care to understand the challenges, opportunities, and potential educational enhancements to improve culturally informed care for developmental paediatrics. Thematic analysis was used to analyze the transcribed interviews using inductive and deductive approaches. Results Three major themes emerged from 18 individual semi-structured interviews. The first theme, “cultural translation,” described language differences, interpretation, and trust-building between discordant physician/family dyads. The second theme, “inequity,” described systemic barriers that diverse populations experience, power distance in healthcare relationships, and pandemic-related amplifications of inequity. The third theme, “educational opportunities,” highlighted reflective practice opportunities, immersive experiences in diverse settings, and building a community of practice for paediatricians to build their knowledge base. Paediatricians practicing developmental paediatric care highlighted unique elements to the practice which may benefit from practice changes and curricular reform. Integration of meaningful training in the use of interpretation services, multicultural health brokers, and care coordination teams is a recommended intervention which is transferable to many disciplines. Peer-mentorship from colleagues of differing cultural backgrounds may help reduce race-based stereotypes and enhance perspective taking. Conclusion Paediatricians had a variety of perspectives on the provision of developmental paediatric care to diverse populations within Canada. There were a range of perceived opportunities for improvements in care noted on individual and systems levels. The development of infrastructure to build capacity in culturally informed developmental paediatric care to reduce culturally based health gaps is a needed future direction for developmental paediatrics.

Screen Time, Nature, and Development: Baseline of the Randomized Controlled Study "Screen-free till 3".

In the first years of life, increased screen media use is presumably associated with health consequences and developmental impairments. "Screen-free till 3" is a prospective Germany-wide randomized intervention study, started in May 2022 with a duration of 3 years. In the intervention group, 2581 pediatric practices received stickers, which were systematically placed in the screening booklet of all children, along with advice to parents to keep children free from screens until the age of 3. A volunteer sample of 17,436 parents received an invitation to take part in the preinterventional questionnaire. The outcomes were parents' internet use (CIUS test), parental screen time in the presence of children, time of screen media in the background, and children's development. Four thousand twenty-one parents answered the questionnaire. 16.7% of mothers and 31.0% of fathers reached the CIUS score of an internet-related disorder. Parents whose children use screen media at an early age had significantly higher CIUS values on average (M = 4.07) than the parents of children who do not yet have any screen time (p < 0.001). Combined developmental characteristics show a negative correlation with parental screen time (p < 0.001). Time spent in nature was positively associated with development (p < 0.001). The evaluation of the survey shows that screen media is to a large extent used on a daily basis. The study confirms the assumption that high screen media use by parents is linked to higher screen media use by children and also has a negative impact on child development. Trial Registration: Number: RKS00032258; https://drks.de/search/en/trial/DRKS00032258.

An expert consensus on managing cough in Indian pediatric practice: airway disease education and expertise 2.0 (2024)

Cough in children is one of the most frequent presenting symptoms in health care settings. Coughing can significantly affect a child's sleep and level of activity, which often causes parents’ distress. Promptly addressing chronic cough may enhance the quality of life in children and reduce the considerable stress on parents. In 2017, airway disease education and expertise (ADEX) NEXT recommendations for diagnosis, management, and follow-up of persistent (chronic) cough were published. For the present work 27 modified Delphi consensus statements were prepared, and a survey was undertaken involving 30 expert pediatricians from across India. The opinions of the expert panel on the updates related to pediatric chronic cough awareness, diagnosis, and management were collected. Consensus was predetermined to be obtained if more than 75% of the participants agreed or remained neutral for the statement. All the statements were supported by the latest data from the literature search. All the statements reached consensus after an agreement of more than 75%. Consequently, all the opinions from experts were consolidated and expert recommendations were framed. Children presenting with cough should be treated in accordance with child-specific guidelines. The present expert recommendations can be utilized by pediatricians to make well-informed decisions when treating pediatric patients with cough. The management of cough in children should be determined by the underlying cause, where a prompt and efficient therapy can result in early resolution.

Comorbid conditions in pediatric practice

The comorbidity is an urgent scientific and practical problem of modern pediatrics. The practical significance of combined pathology in children is determined by its widespread occurrence and universal impact on all aspects of a child’s health and treatment options. In patients with congenital heart defects, outcomes are influenced by numerous non-cardiac and genetic factors. In childhood and adolescent bronchial asthma, concomitant diseases are a common cause of adverse outcomes, such as poor disease control, frequent seizures, decreased quality of life and increased healthcare costs. A stable interdependence between the state of the gastrointestinal tract and the development of allergic or autoimmune diseases has been proven. The article describes a clinical case of late diagnosis of concomitant pathology in a child with chronic gastritis with clinical symptoms, diagnostic criteria and drug treatment options. The understanding the etiology and pathogenesis of concomitant conditions in children will help identify risk groups for the formation of chronic noncommunicable diseases and develop a plan for their prevention.

Relationship of Crohn’s disease and acute pancreatitis in pediatric practice: literature review

Inflammatory bowel diseases (IBD) are a certain group of pathologic conditions of the gastrointestinal tract (GIT), including Crohn’s disease (CD) and ulcerative colitis (UC). In the modern world, vigilance for these diseases is growing, because their characteristic feature is the involvement of other organs in the pathological inflammatory process, as well as the development of local and systemic complications. As a rule, in children CCD occurs mainly at the age of 12-16 years. Recently, the attention of the medical world has been drawn to the issue of extraintestinal manifestations of CD. Pathological manifestations associated with lesions of the skin and mucous membranes, eyes, bone and joint system, pancreas, negatively affect both physical and psychological health of the child. Such pathology associated with pancreatic malfunction, such as acute pancreatitis (AP) often occurs in patients with inflammatory bowel disease and is one of the main causes of hospitalization for diseases of the digestive system. According to statistics, the incidence ranges from 15 to 40 cases per 100,000 per year in European countries. According to the Gastroenterological Society, there are different variations in the course of acute pancreatitis, whether occurring in patients with IBS due to the disease itself or as a side effect of drug therapy. However, IBD patients are at increased risk of developing both acute and chronic pancreatitis. In this review, we consider the relationship and mutual influence of these two pathologies.

Medication Adherence and Practices in Pediatric Patients

Background: Improper medication practices and non-adherence are the biggest challenges faced by pediatricians in outpatient practice. Hence this study was aimed at determining the medication practices and factors affecting adherence. Methods: A cross sectional descriptive study was conducted at a tertiary care hospital in Southern India over a period of 3 months (January to March 2023), to study medication adherence and parental medication practices in pediatric patients. A pre structured questionnaire was administered to parents of 320 children. Results: Majority of the parents (55%) had children aged 1-5 years of age. It was noted that most of the families (89%) were above poverty line (APL). About 34% parents were educated till graduate level and 17% were educated beyond post graduate level. Frequency of medication adherence in our study was found to be 78%. It was noted that parents with education of graduate level and above, those belonging to APL families and the ones with no fear of adverse drug reactions showed higher medication adherence as compared to other parents and this association was found to be statistically significant (p &lt;0.001). Majority of the parents (80%) reported that their children preferred liquid formulations, of which 57% preferred fruit flavoured ones. Around 51% parents preferred twice daily dosing of medications. While 47% parents used previous prescriptions, 39% bought over the counter medicines, especially paracetamol. Conclusion: Knowledge about medication practices and factors affecting adherence is important in order to provide quality health care. Actively involving children and parents while prescribing medications with health education goes a long way in improving adherence.

Asthmatic status in pediatric practice in patients with mild bronchial asthma

The main principle of the treatment of bronchial asthma is rational basic therapy, with priority appointment of inhaled glucocorticosteroids. The basis of the effectiveness of treatment is determined by the correct choice of the form of drug delivery, training the patient in inhalation skills and constant monitoring of the correct use of the inhaler. The article demonstrates the clinical observation of the formation of asthmatic status in a child with mild bronchial asthma. The deterioration of the condition and severe exacerbation was caused by insufficient intake of basic therapy funds into the respiratory tract due to improper inhalation techniques due to the patient's lack of skills in using an inhaler. At the same time, the patient was not trained and the necessary control over the correctness of the inhalation technique was not carried out at the outpatient stage.

Episodic syndromes associated with migraine (clinical and epidemiological study in pediatric practice)

Migraine in children can manifest itself in non-pain clinical phenotypes, among which several episodic syndromes associated with migraine (ESAM) are identified. A significant association with the later development of migraine was found for infantile colic syndrome, benign torticollis, abdominal migraine (AM), cyclic vomiting syndrome (CVS) and benign paroxysmal vertigo (BPV).Objective: to identify the clinical and epidemiological characteristics of childhood ESAM and its association with migraine.Material and methods. The study was conducted in Tambov Children's Clinical Hospital. A total of 250 children were included in the study: 120 (48%) girls and 130 (52%) boys aged 5 to 18 years (mean age 13±2.9 years, median age 13 [11; 15] years) with headache complaints. The diagnosis of ESAM was made according to the ICHD-3 criteria.Results. ESAM was observed in 95 (38%) patients aged 5–18 years. An analysis of the prevalence of ESAM in the different age groups showed that in children aged 5–10 years CVS (n=12; 4.8%) was more common than AM (n=6; 2.4%) and BPV (n=5; 2%). In the group of 11–14 year-old children, the frequency of AM clearly predominated (n=11; 4.4%), while in the group of 15–18 year-old adolescents, BPV (n=15; 6%) was observed more frequently compared to CVS (n=9; 3.5%) and AM (n=5; 2%).Conclusion. The results of the study indicate a high incidence of ESAM in child and adolescent patients of somatic and neurological hospitals. The data obtained show the importance of timely diagnosis and correct treatment of ESAM.